Tag Archives: Health

Multiple Sclerosis (MS) CARETAKER groups forming SOON! (Omaha, NE)


Do you suffer from MS?  Do you know someone, a friend or a family member, that has had to endure the MS diagnosis?  Do you know someone who is “just tired” of dealing with the circumstances that accompany this degenerative disorder?


We are here to help. Anticipated group every 1st and 3rd THURSDAY of the Month, 6:00PM-8PM (tentative, will be solidified shortly)
Hosted by : Daryl Kucera of MS Fast Forward.

Phone:  402-330-6292

Location:
8802 S. 135th St.  #300
Omaha, NE  68138
www.MSForward.org

Professional Facilitated by Kent Brooks, MS, PLMHP of Community Chest Counseling, PSC

Anticipated Start Date: Mid October

Maximum number of participants per group = 12

COST: Donations only~

Call for more info:

Daryl Kucera 402-330-6292

Kent Brooks 402-889-6509

Eating Disorders = BIG BUSINESS


“Weight discrimination and the resulting obsession with thinness are rampant and recalcitrant.  I believe that, in order to make any kind of a dent in this field, we all need to combat these pernicious influences.”  (Netherton, Holmes, & Walker, 1999, p. 412)  Amen.  The weight of the media, the “diet food industry,” and the purveyors of a “healthy lifestyle” propagate this issue… without a doubt.  Losing weight is BIG BUISINESS, and there are huge profits to be made for those that offer obese people the glimmer of a stereotypically thin body.

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I also appreciated the acknowledgement on the pressure exerted by managed care.  Eating disorders appear to be particularly “deep seated” and ill suited for half a dozen one hour sessions.  Correcting inaccurate perceptions, relabeling cognitions of visceral and affective states, and redrawing boundaries… this kind of work takes time… more time than managed care often provides.  This is yet another example of the effect managed care will continue to have for as long as it is the primary method of seeking out psychological assistance.

I was suitably surprised at the long-term mortality rate… suggested to be over 10%.  (Netherton et al., 1999, p. 399)  With a roughly 1 in 10 shot of succumbing to starvation, suicide, or electrolyte imbalance; you would think this particular set of disorders would get more research attention.  The fact that there is still limited epidemiological data is frustrating… perhaps the difficulty obtaining the data is related to the relative secrecy and shame associated with the disorders themselves?

Like the BM text, NHW jumps on the multi-determined etiology bandwagon.  It’s hard to disagree with since biological, familial, sociocultural, and personality factors all seem to be plausible.  The differences in family characteristics were particularly interesting.  “Bulimic families tend to be characterized as disengaged, chaotic, and highly conflictual and as having a high degree of life stress.”  Conversely, “anorexic families tend to be characterized as enmeshed, overprotective, and conflict avoidant.”  (Netherton et al., 1999, p. 400)  That’s a strange clinical picture that seems to suggest that there might be a single underlying biological cause for EDs in general, but that familial and personality factors may play a role in its manifestation.

The list of comorbid disorders we need to consider during the assessment process is long and fairly inclusive.  “Depression, anxiety disorders, dissociative disorders, substance abuse, and personality disorders” are on the forefront of the disorders we should be checking for.  (Netherton et al., 1999, p. 401)  Furthermore, NHW suggest we assess treatment history, as well as suicide attempts and self mutilative behaviors (cutters).

Pharmacological interventions employing antidepressants have been particularly successful.  This text only cites 3 studies that have employed SSRI class antidepressants, but they report “significant improvement with 60-80 mg dosages (of Prozac) compared to placebo.”  (Netherton et al., 1999, p. 407)  I think I am going to dig deep into some more recent research to see of this trend holds up, there has to be more than three studies on it by now.

I like the idea of a behavioral contract… not just for eating disorders, but for any disorders which involve “behavior.”  I am inclined to agree with the statement “the contract provides structure and predictability.  Expectations, rewards, and consequences are delineated so that all people involved (patient, treaters, families) know what is expected at all stages of treatment.”  (Netherton et al., 1999, p. 407)  My question is this… realistically, what “consequences” are there if we are dealing with outpatient treatment?

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Reference

Netherton, S. D., Holmes, D., & Walker, C. E. (1999). Child and adolescent psychological disorders: A comprehensive textbook. Oxford, NY: Oxford University Press.

Comparing and Contrasting Dissociative Identity Disorder (DID, Multiple Personality Disorder) with Conversion Disorder (CD)


Dissociative Identity Disorder and Conversion Disorder are similar in that they both stem from stressful events.  In Dissociative Identity Disorder a personality is formed when extreme child abuse or sexual abuse is experienced.  With Conversion Disorder it is a more recent event like a rape or physical or emotional abuse. Other than this similarity the two disorders are quite different.

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Dissociative Identity Disorder is a disorder in which the person affected suffers from as little as 2 distinct personalities and can suffer from as many as 100 or more.  Each personality has a very distinct identity, and will often take control of the person and how they act.  Because of the different identities taking over the people lose time.  They don’t remember the period of time that they were not in control and then have a hard time understanding why everything is different, especially in extreme cases when the other identity takes over for years at a time.  Usually an alternate identity takes over when the primary identity experiences something overly stressful.  It is common for people with this disorder to have other disorders or to have problems with substance abuse.  While DID has been known to last a lifetime, treatment can help.  Treatment usually involves psychotherapy and helps the person to integrate the identities into one.  It can be a painful process as well as time consuming, but according to people who have been able to achieve integration, it is definitely worth it.

Alternatively Conversion Disorder affects people in their sensory areas or physically where voluntary movement is concerned.  It is known to be a somatoform disorder and is said to be a large part of why people visit their primary care physicians.  Basically when people shove their emotions and stress too far inward they turn into physical symptoms.  This is called converting.  The conversion of these symptoms can cause a patient to contact their caregiver nine times as often.  The patient does not control the symptoms and can have a surprisingly painful beginning, and diagnosis can become complicated by a true physical illness.

Conversion Disorder has specific risk factors which include the fact that someone is female, men are less likely to receive this diagnosis.  This diagnosis is more common in the teen years, if there is someone in the family who is already receiving treatment for Conversion Disorder, it is likely to continue in the family line.

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A Personal Narrative on Burnout: PTSD, Balancing Risks and Rewards in the Profession of Counseling


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I have resisted the temptation to share this up until now because it is a very personal article I wrote some time ago… this one goes out to Rey, my only subscriber.

Counseling is a risky and rewarding business.  While counseling invites mental health counselors to participate with their clients in the awesome process of human growth and healing, it also may threaten their well being through exposure to their clients’ trauma and its painful consequences.  (Meyer & Ponton, 2006)  The consequences frequently manifest themselves in adverse and maladaptive reactions to ongoing stress; peaking as a condition we call “burnout.”  The symbolism involved with the word burnout relates to the extinguished flame, which is the motivational force in the caring professions.  Burnout can be defined as a syndrome of emotional exhaustion, depersonalization, and reduced accomplishment which can occur among individuals who do “people work” of some kind.  (Garske, 2007)  Although exact figures are unknown, it is estimated that approximately 10-15% of practicing mental health professionals will succumb to burnout during the course of their careers.  (Clark, 2009)  Due to the emotional stresses involved with caring for others, and my own personal history of dealing with stress and trauma, there is good reason for us to explore strategies to thwart the effects of professional burnout.

I anticipate that I will be particularly prone to what has been described as “vicarious traumatization.”  Vicarious traumatization is conceptually realized through “the development of empathic relationships with traumatized clients,” ultimately leading some therapists to become traumatized themselves.  The impact of this traumatization is not limited to the therapeutic environment and may trickle into other aspects of the therapist’s life.  (Meyer & Ponton, 2006)  Although I have not yet assumed a role as a professional counselor, on occasion I am called upon to be a shoulder to cry on when traumatic events unfold.  On one such occasion, it would suffice to say that my shoulder was soaked.

I wouldn’t describe my relationship with my cousin Josh as “close.”  I saw him a couple times a year, usually around the holidays or for a week or so on summer vacation.  Josh was 6 years younger than me.  I was one of the people he “looked up to” when he was growing up; I guess you could say I was one of his role models.  Josh always wanted to be in law enforcement, mostly because he enjoyed the “action.”  He, too, had an intense desire to help people.  Josh joined the Army Reserves to leverage the GI Bill and pay for college.  Specifically, he joined the 339th Military Police Company based in Davenport, IA.  When he joined, it had been 30 years since that company was activated.  After a short deployment to Cuba, officials activated the 339th once again in December 2003 and the company deployed to Iraq in February 2004.  His mission included guarding people and enemy munitions located at a “forward operating base.”  When he came back, he was a wreck.  Haunted by visions of Iraqi people he had killed, and plagued by Post Traumatic Stress Disorder (PTSD), he took his own life in front of his mother (my aunt) on December 22, 2005.  Because the depth and detail of the situation is beyond the scope of this essay, I would point the interested reader to the award winning essay by Dennis Magee of The Des Moines Register, reproduced on the following site… http://joshua-omvig.memory-of.com/legacy.aspx

Although it is difficult to assess how work as a mental health professional will affect me, I can infer that vicarious traumatization might cause me to react much like I reacted to the second hand accounts of Josh’s suicide.  I did my best to assume as much of the burden as I was able; in hindsight, I probably took too much.  My natural inclination to withdraw took root weeks after the funeral, mostly as a reaction to shouldering the weight of my family and their grieving process.  I couldn’t sleep.  I couldn’t eat.  It’s difficult even writing about this now, nearly 5 years later.  As a counselor, I believe second hand accounts of a traumatic nature have the potential to reproduce that effect in me.  As a result, I have a sense of urgency creating a plan to deal with it.

Inherent in my plan to prevent burnout is continually access my level of competency and adjust the scope of my practice accordingly.  It is imperative for my success as a practitioner that I know my limits.  Due to my traumatic experience with PTSD veterans, I don’t anticipate working with this population in the immediate future.  I bestow all due respect to the women and men who have fought and died for our country, but my personal experience would prevent me from being fully effective as a therapist for our veterans.  Someday I hope to overcome this.

In addition to suffering vicarious symptoms of traumatic stress, therapists have to struggle with the same disruptions in relationships as their patients.  (Canfield, 2005)  I have experienced a wide range of difficult situations in my life, and I have little reason to believe that it will be “clear sailing” from here.  Although I have grieved for the loss of both friends and family, I have yet to endure the loss of any member of my immediate family.  I am the eldest son of a mother thrice divorced, but thus far I have managed to avoid the missteps that could cause the collapse of my own marriage.  Raising my daughter has not been without trials, but in her 8 years she has never been sick or injured without reasonable expectation of full recovery.  In the end, any or all of the above is possible (hopefully not likely).  It would suffice to say that my ability to maintain balance in my personal life will continue to have direct effects on my ability to provide effective counsel.

To that end, I endeavor to continually invest in myself and my personal well being through my family life.  My personal life begins and ends with my family, and to what degree it is possible, I spend as much quality time as I can with them.  It’s as simple as taking the time to read to my daughter every night, or surprising my wife with flowers for no apparent reason.  My father once told me that I should “cherish every day like it was my last.”  That realization, that process, is at the core of my personal burnout plan.

Third and finally, I believe one area of significant vulnerability for me is my excessively preoccupation being successful.  Work tends to play a central role in people’s physical and psychological well-being, I am no exception. “Not only does it provide income and other tangible resources, but also it may be a source of status, social support, life satisfaction, and self-identity.”  (Garske, 2007, expression Nature)  No one likes to fail.  Too often, being anything less than the best is failure in my eyes.  Competitiveness is in my nature; the chase causes me a great deal of stress.

An integral part of my burnout plan involves individual therapy.  My persistent and unrelenting determination occasionally causes me a great deal of stress.  In the end, like our clients, it helps to talk about it.  Therapists cannot take clients any further than they have taken themselves; therefore ongoing self-exploration is important.  (Corey, Schneider-Corey, & Callanan, 2007, p. 73)  I am an advocate of counseling for counselors.  Without, I wouldn’t be writing this paper if not for my successes in individual therapy; I’d probably be burned out.

In closing, I believe we all struggle to balance the risks and rewards of life.  For every day I have spent grieving over a fallen solider, I should spend a reciprocal day defining my limits and reducing potential risks of transference.  For every hour I have spent mulling over the tragedies of yesterday and tomorrow, I should spend a reciprocal hour appreciating today.  For every minute I spend rushing to the destination, I should spend a reciprocal minute examining the road.  In the end, it’s all about achieving balance.  Balancing the risks and rewards could mean the difference between success and failure, not just for me as a clinician, but for the clients I endeavor to help.

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References

Canfield, J. (2005). Secondary traumatization, burnout, and vicarious traumatization: A review of the literature as it relates to therapists who treat trauma. Smith College Studies in Social Work, 75(2), 81-102. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1061959531&sid=3&Fmt=3&clientId=4683&RQT=309&VName=PQD

Clark, P. (2009, Apr). Resiliency in the practicing marriage and family therapist. Journal of Marital and Family Therapy, 35(2), 231-248. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1680596541&sid=3&Fmt=3&clientId=4683&RQT=309&VName=PQD

Corey, G., Schneider-Corey, M., & Callanan, P. (2007). Issues and ethics in the helping professions (8th  ed.). Belmont, CA: Brooks/Cole.

Garske, G. G. (2007, Winter). Managing occupational stress: A challenge for rehabilitation counselors. Journal of Applied Rehabilitation Counseling, 38(4), 34-42. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1418538171&sid=3&Fmt=4&clientId=4683&RQT=309&VName=PQD

Meyer, D., & Ponton, R. (2006, Jul). The healthy tree: A metaphorical perspective of counselor well-being. Journal of Mental Health Counseling, 28(3), 189-202. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1086418421&sid=3&Fmt=4&clientId=4683&RQT=309&VName=PQD

Skovholt, T. M., & Ronnestad, M. H. (2003, Fall). Struggles of the novice counselor and therapist. Journal of Career Development, 30(1), 45. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=420397201&sid=1&Fmt=2&clientId=4683&RQT=309&VName=PQD