Tag Archives: Healthy Living

What is a healthy family?


I believe a healthy family is based on a level of mutual respect for other members and themselves.  I believe that a healthy family should provide a level of support for its members, however, each family is a unique system (much like the individuals within it) and each individual will play “roles” within the family system that they are comfortable with.  Individual role-players may exert varying degrees of influence when change occurs (like death, illness, financial issues, or divorce).  Every member of the family should enjoy a sense of security or “belonging” to the family, and all members should share good interpersonal relations with each other.  Healthy families are loyal to each other, and ideally members offer each other unconditional love.  My universal definition of family extends beyond the nuclear family to include multigenerational and extended families… it might also include groups of people with whom you have come to cohabitate (like a college fraternity).

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I am less traditional than most (I suspect) in the respect that I do not narrowly define “marriage” as a relationship that can exist between a man and a woman.  In that respect, my definition of family is predominantly relationship based.  The reader could correctly infer that I am supportive of same sex relationships.  I could potentially see issues in the counseling relationship if I were to counsel someone who was critical of that lifestyle… I might be inclined to suggest that is more “normal” than some people are comfortable with.  All that aside, I would be the first to admit that I have not always taken such a liberal position… perhaps that’s proof that you can teach an old dog new tricks?

 

Anorexia


Like so many other mental disorders, eating disorders project people who are really “out of balance.”  I don’t think anyone would be an obesity advocate… after all; obesity presents as many or more health problems as being overly thin.  In the end, it’s all about balance.

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1 in 5 women have an eating disorder.  Kids start dieting as early as 4th grade.  I can actually see this, I see a bit of it in my daughter… she is age 8 (2nd grade) and has shown concerns about “being too heavy.”  We have turned the focus onto “being healthy” not “being thin.”  80% of 13 year olds have tried to lose weight… this doesn’t surprise me, considering the “ideal image” that western culture projects to children.  1 in 5 anorexics die?  Our text indicates it was closer to 1-10, that’s nearly double NHW’s estimate.  I know it’s a real problem, but having good epidemiological data would be a good start to “justifying” expending resources to extinguish it.

With regard to what a clinican should know or ask about eating disorders, the following questions are at the top of my list.

1)      Clinicians should know your subtypes of Anorexia Nervosa (AN):

  1. Restricting Type describes presentations in which weight loss is accomomplished primarily through dieting, fasting, or excessive exercise.
  2. Binge-Eating/Purging Type describes presentations where the individual engages in binge eating, purging, or both.  They may employ self induced vomiting, misuse of laxative, diuretics, or enemas.  (American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 2000, p. 585)

2)      Probe for comorbid disorders and associated features, especially depression, anxiety disorders, dissociative disorders, substance abuse, and personality disorders (particularly borderline personality disorder).  (Netherton, Holmes, & Walker, 1999, p. 401)

3)      Clinicians should know that, while these disorders predominantly effect females, males can also suffer from either AN or BN.  “There is some evidence that ED prevalences are recently increasing in males.”  (Blaney & Millon, 2009, p. 433)

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References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Blaney, P. H., & Millon, T. (2009). Oxford textbook of psychopathology (2nd ed.). New York, New York: Oxford University Press.

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

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.

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