Monthly Archives: May 2012

Have you lost your child forever? Parenting after being away.

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Children working

Parentified child.
Photo courtesy of pixabay

How do you reconnect with your children if you have been away a long time?

Recovering people have often been away from their children for extended periods of time, in jail and prison, in rehab programs, or just gone doing their drug of choice. When you have been away from your children for a while, parenting can be especially difficult. Over time they change, you change and the situation changes also. Here are some thoughts on making the transition back home.

The reunification challenges are greatly increased if your child has been in foster care or their other parent has started a new relationship. You may be the biological parent but someone else has been there raising this child while you were gone.

You need their permission to reconnect.

Just being the biological parent does not give you the right to force your way back into their life. Time changes people. Painful as it may be for you, the process needs to move at the child’s pace, not the pace you would want.

The longer you have been away the more your children will have changed. You can’t expect to pick up where you left off. We tend to remember things the way they were and forget how much they will have changed.

Short separations don’t pose the problems that longer separations do. Several clients, I have worked with were away from a decade or more. That cute five-year-old who was starting kindergarten when you went away, would be a teenager now. Your “little girl” may have a boyfriend, piercings, and a whole lot of habits you wish she hadn’t picked up. She won’t take kindly to you coming back after all this time wanting to change her life.

You need to figure out how you fit into the child’s life, not the other way around.

What they went through left wounds.

You may have changed but the only memory they have of you is the way things were. Drug addicts with three days clean wonder why the family can’t forgive them, after all, they quit right? One way people protect themselves is to hold on to that anger or resentment. For some kid,s that has turned to indifference. You left them, whether you chose to or not. Seeing you again can be like being grabbed where the broken bone still hasn’t healed.

They have had to adjust.

Adjusting for the child means developing new relationships. Someone has cared for them, seen that they were fed, taken care of them when they were sick. They got close to that person. They have come to love that person and trust them. They owe that person some loyalty. Reconnecting with you can make them feel like they are betraying the one who cared for them while you were away.

Now suddenly you want them to forget the person who raised them and follow you blindly?  Why should they trust you? You weren’t there?

This is a huge problem if their other parent has started a new relationship. Papernow has written about step-families and tells us that with blended families the new spouse is always an outsider. The parent and the children had a relationship first and the new spouse came second.

If you have been away for a long time you may be in the position of the new stepparent with your own biological children. The child has developed a relationship with their other parent’s new partner. The one who was there all those years has been the one that went to their school activities and played with them.

Biological parent or not you are the new person in the child’s life, and to make it more difficult you are not even living in the house now.

To rebuild this relationship will take time, lots of time and that time will have to fit into your child’s life and their family’s life, not yours.

Reconnecting needs to be a priority.  Lots of people in early recovery fantasize about having those great relationships with their children, the reality is that it takes lots of work and it will probably not live up to your expectations. Lots of people give up. I commend those who are so determined that they stick with the process even when it is less fulfilling than they had hoped.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Therapist, Counselor or Social Worker?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Therapist

Therapist.
Photo courtesy of Pixabay.com

LPCC, LMFT, or Social Worker?

Recently a number of people have asked me about the different mental health professions and which they should go to see. Students in my Substance Abuse Counseling classes also ask me about which career they should pursue. It might be helpful to talk about where these professions came from, what they do, and why you would choose to see or become one of these professionals. Many professionals in these fields are in recovery also and they often make excellent helpers.

Here is a brief explanation of my point of view on the subject. Remember that I am licensed as both a Licensed Professional Clinical Counselor (LPCC) and a Licensed Marriage and Family Therapist (LMFT), have taken classes in the Psychology Doctorate program but am a long way from finishing that one and that these are just my opinions.

The titles and what they are allowed to do depend on your jurisdiction.

California was the last of the 50 United States of America (North America) to license Professional Clinical Counselors. Substance abuse counselors in California are registered or certified not licensed and in some states, there are no requirements other than getting hired to do the work. Educational requirements and licensing rules can vary widely and have changed over the years.

These titles and what they may legally do vary from place to place. Check with your appropriate state or national agency to see what the regulations are in your location. Consumer protection agencies can sometimes tell you what the rules are in your locality.

Licenses, Job titles, and Educational degrees are not the same things.

Agencies hire people to work in a particular field. Not everyone who works in a social work agency has either an educational degree or a license in social work. Someone who processes welfare applications or inspects homes for child abuse or neglect may be called a social worker. Sometimes these workers have a degree in the field but not always. This depends on the rules of this agency.

If you are looking for work and have not yet finished your education there are far more entry-level positions for doing social work than any other of the behavioral health professions. There are two-year degrees (AA or AS) in social work and Substance abuse counseling but not much else in the Mental Health field. There are also many social work bachelor degrees that qualify you to work in the field but not to be a clinical social worker.

There is a large difference between a “social worker,” someone with a master’s degree in social work (MSW) and a Licensed Clinical Social Worker (LCSW.) To be an LCSW you would need to complete a master’s degree, complete a number of hours of supervised experience, and pass a test. LCSW’s spend a lot more time working with clients and some specialize in therapy around certain issues, such as foster family and abused or neglected children.

All of the licensed professions also have beginner categories of learners who are being trained and supervised by licensed people.

So what are the primary types of behavior health specialists?

They would be Social Workers, Marriage and Family Therapists, Clinical Counselors, psychologists, and Psychiatrists. Here is my oversimplified description of what each profession does. Let’s take a short look at a scenario that might show us how all these professions may interact with one family.

Police are called to the home where a domestic disturbance is in progress. The adults are both drunk and they are fighting. The kids are scared and under the bed. Parents are out of work and about to be evicted. Mom has a history of depression. Both parents are yelling about wanting a divorce.

So what does each profession do?

Social Workers (LCSW’s or beginners are called ASW)

They might be called to the scene. They will evaluate the home and maybe take the children into custody and place them in foster care. Once the parents are released from jail for the domestic violence charges the social worker might meet with the mother, get her in a battered woman’s shelter, arrange for both adults to attend substance abuse treatment, and enroll them in domestic violence counseling. A Licensed Clinical Social Worker could be assigned to work with the children to see if they have PTSD and need treatment for the effects of living in a violent home.

While an LCSW may do long-term therapy, they are specially trained in policy and referrals. They are likely to be running programs, deciding to leave the kids, or take them and making referrals to long-term treatment.

DV and substance abuse counselors

These professionals often have a short-term, two-year, or less training in their specialty. They are limited to working on one problem only and most often they must work for a licensed agency or under the supervision of a licensed person.

Parents may be required to complete a Substance abuse program and or Domestic Violence or anger management groups before the kids are returned to the home.

Once the parents stop drinking and they have learned how to control their anger, or not get angry in the first place they may decide to try to get back together.

Marriage and Family Therapists

Marriage and Family Therapists (LMFT’s, or MFT’s if they are licensed and beginners are called MFT interns or MFT trainees.)

MFT’s work from a systems approach that says that all humans have relationships and relationships are like dances. If one person changes, the others may change, and then the dance changes. So they would with couples or families on better communication and having a good relationship.  They most often work with the couple or the whole family at once. If they work with one person it is most often about that client’s learning skills to improve their relationship.

They might also have to tackle working with mom on how her depression or dad’s unemployment is affecting the kids and the family.

All the Marriage and Family Therapist programs I know of are 45-60 unit masters degrees. MFT’s often have bachelor’s degrees in all sorts of things unrelated to therapy. They frequently have had some life experiences that pointed them in this direction.

Professional Clinical Counselors (LPC or LPCC in California)

These counselors are specifically trained in mental health and problems solving. They might work with mom on changing her long-standing depression or they might work with dad on how to find a new job.

Should the marriage counseling fail they might also work on meditation and working out custody arraignments.

These three professions, LMFT, LCSW, and LPCC despite having differences in training may do very similar things. Beyond the basic degree or license, they are required to take continuing education classes each year. Some professional counselors or therapists specialize in a particular issue, some are generalists. If clients only had one problem we could all get really specialized but most people have multiple problems and so over time a counselor learns to work with clients on many issues.

Psychiatrists.

Psychiatrists are medical doctors with additional training in psychiatric medicines. Child Psychiatrists are even more specialized and unfortunately, there are never enough of these professionals. Because of the high demand for their services they are very busy. Most psychiatrists see clients for an initial “assessment” which is a medical assessment and very different from the counseling assessments we therapists do. After that first appointment, most psychiatrists will be seeing clients for a ten to fifteen-minute med check appointment every month or even every few months. They are looking for side effects of the medication and to see if they need to change meds or doses.

Psychiatrists generally do not have the time to spend talking with clients that are required for therapy. Most often they oversee the meds and refer the clients to see a counselor or therapist to work on the thought and behavior parts of the problem.

In our example of the couple above, the Social worker, therapist or counselor might refer the mother to a psychiatrist if the depression was severe. Some clients are so affected by their disorder that they can’t benefit from therapy until they are on medication. Some conditions are the result of changes in the brain and that person may need medication for the rest of their life. Meds may stabilize them but they will often need counseling for other problems like relationships and careers.

Psychologists.

This is a doctor’s level degree. I completed 6 units in this program before deciding that I did not have time for another degree and license. What their training appears to be directed towards are long-term problems. They can spend a lot of time studying, testing, and personality structure.

Many psychologists work with clients over the long-term on problems that are slow to change. They are also likely to be called upon to do evaluations for court or disability insurance.

In the example of the couple above the man might be court-ordered to see a psychiatrist who will determine if he should be allowed back around the family. The wife might be evaluated if she puts in for long-term disability saying she is so depressed or traumatized that she is unable to work.

So there you have it, a brief oversimplified outline of what the larger professions in the mental health field do. Whether you are a client or an aspiring professional you need to pick the profession that will be a good fit for you.

Licensed Professional Clinical Counselor (LPCC), Marriage and Family Therapists (LMFT), Social Workers, Psychiatrists, and Psychologists which is the right fit for you?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

He slept in trash cans.

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He slept in trash cans.

“Mental health care advocates hope the video of police beating the homeless man, who later died, will spark systemic reforms in the treatment of the mentally ill, even in this era of funding deficiencies.”

This story about Kelly Thomas and how he died is moving reading. If you haven’t heard about this yet check out the story by Scott Gold, Richard Winton, and Abby Sewell of the Los Angeles Times.

The full text is at:

http://www.latimes.com/health/la-me-kelly-thomas-mental-20120509%2c0%2c4023045.story?utm_source=Join+Together+Daily&utm_campaign=61e7621ec3-JT_Daily_News_Senate_Opens&utm_medium=email

Scared or Excited?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Scary stuff

Scared or Excited.
Photo courtesy of Pixabay.com

What is the difference between scared and excited?

Some people live their whole lives in fear. Everything is scary when you live in fear. Being afraid doesn’t make something dangerous but dangerous things ought to scare us. So how come there are those people who seek out the things other people call scary?

People in recovery often are overwhelmed by fear of the changes that need to be made. Fear can be a trigger to take someone back to the old patterns of behavior. That very same person who is afraid of the challenges of recovery may have been constantly seeking excitement via drugs or mania before they began recovery.

What makes some of us attracted to risk and excitement? One theory is that people range between two extremes, scared-anxious and stimulation seeking. As new-born babies some kids are easily overstimulated and need to take breaks and others are constantly seeking more stimulation.

Anxiety and stimulation are considered basic personality traits by some in the psychological professions. So the anxious person sees a situation as scary and a stimulus-seeking person thinks of the very same event as exciting.

Our appetite for risk and excitement can also be learned. We learn from our own experiences and we also learn from watching those around us. What is learned can be unlearned. If you are afraid of a change could you come to view the possibilities of a new life course with excitement?

Transforming fear into excitement is possible.

Consider the case of two clients.

First client, Betty, is 18 about to leave home and head off for college. She is scared to death. She will be leaving her family and friends. She has never been particularly close to her family and does not have many friends but she is terrified that at the new school she will know no one and thinks that they are likely to not like her. Betty is not sure she can do this and wishes she had not let her school counselor talk her into applying to an out-of-town school. What if she fails? She is sure something will go wrong and there will be no one at the school to help her. She is afraid. To cope with her fear she may drink, use drugs, or withdraw and hide in her room.

Client number two, Maria, attends the same high school as Betty, though the two don’t seem to know each other. Maria is also 18 and graduating. She likewise is about to leave home for a cross-country college. The difference is that Maria is excited to be on the go. She looks forward to the new things she will learn and the people she will meet. Maria has high self-esteem, she feels good about herself. She also has high self-efficacy; she knows she can do something if she sets her mind to it. Maria will be the first in her family to attend college and she is proud of what she will be accomplishing.

The primary difference between these two students is not the situation. Both are academically well-prepared students accepted to an out-of-town college.

The real difference between the two students is the way in which they view change. Yes, there are underlying differences in temperament and in the emotional skills they have learned, but either could be taught to see the situation from the other perspective.

As parents, we sometimes need to teach our children to be fearful to avoid excessive danger. They or we grow up and discover that our fears are keeping us trapped. Changing your perspective from fear to excitement can alter the whole experience. Changing your view can move something new from the scary categories to the exciting group.

Performers, actors, comics, and singers often get “butterflies” before they go on stage. They can interpret those symptoms as stage fright or they can think of this as the energy that sends them, to put out their best performance yet.

Athletes try to psych themselves up before a game or match. They transform that nervous energy which could be fear and keep them on the sidelines into the excitement that carries them to their best possible performance.

Is there something in your life that scares you which you need to start thinking of as an exciting new possibility?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Sniping wires that connect you to problems.

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Cutting the wires that connect you to your problems.
Photo courtesy of Pixabay.com

Ending the connections with your problems.

Wouldn’t it be wonderful if we could solve our life problems by just tossing them out? Just toss that addiction, the depression, and the clutter out in the trash can and now life will be grand. Lose that excess weight – once and for all. Why doesn’t it work that way?

Our problems are not just a single thing ready for disposal. Often they are an integrated part of our life. Life problems are connected by lots of wires to other aspects of our life. We have a host of wires connecting our problems with the rest of our lives. These wires are elastic like bungee cords, toss the problem and it keeps bouncing back.

We see this in relationships that crash and burn. We see it in addiction and we see it in lots of self-help failures.

A couple can’t get along, they divorce, but there are children, the children act like wires pulling the parents back together. Calling the ex to complain about “look what your son did” or to argue about money and the needs of the children keep the dysfunctional relationship alive. I have seen couples ten years post-divorce and already with new partners who still manage to call each other once a week to continue the old marital argument.

“Rightism” that need to prove you are right long after it has stopped mattering is a common defect of character.

Just because you end a relationship does not mean the connections are severed. You divorce your partner but not your kids. I warn teens when I counsel them that you can break up with a boyfriend or girlfriend but babies mommas and babies daddies are forever. The key here is to maintain the relationship with the ex as your child’s parent while cutting all the old relationship wires. The wires of anger, bitterness, and resentment keep us connected to the pain of the past.

Any 12 step meeting is sure to have a couple of people, sometimes more, who are not drinking, but they are not happy about being sober. You can spot these people in a flash. Ten years not drinking and they are still angry and resentful, unwilling to do any work on self-change. They keep the wires that connect them to their addiction connected and eventually most of them are pulled back to the problem.

Three things we all should know can keep us connected to our problems, people, places, and things.

Most of us have people in our lives that help maintain our problems. Plan to lose weight? Do you drop by that friend’s house, you know the one I mean, the one that is a good cook and always has a fresh-baked cake ready to help you eat instead of exercise.

Do all your friends have your same problem and are they stuck in the problem and not the solution?  Addicts in recovery find most of their “friends” are really just using associates. Going to see old friends often means doing old behaviors. Hard to cut wires of bad relationships? They have a strong pull to take you back to old behaviors.

Places are also strong wires that bind us to our past. The old saying goes – “Hang out in a barbershop and you get a haircut. Do you think it is safe to visit a bar?

When a mental illness takes hold, people may find that they can’t return to the place they used to work or even the career they used to hold. Not that the place or job makes them mentally ill but the tendency to slip back into old patterns, to work too much, neglect self-care, all these things set you up for another round of illness.

Do you have some wires connecting you to your problems that need to be sniped?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

What is hitting bottom?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Hands with pills

Addiction.
Photo courtesy of Pixabay

How would you know if you have hit bottom, and does it matter?

The idea that you have to hit bottom before you can start back up comes from the early days of the 12 step movement largely by way of Jellinek’s research on people who recovered in A.A.  It is not often applied to mental health but the two are just too similar in their disease and recovery processes to not take a look at the significance of the idea of hitting bottom and whether it applies to something other than addiction.

The hitting bottom expression referred to the point of accepting that the way you have been doing things was not working and it was time to try something different. You can think of this as “admitting complete defeat” but you can also think of this as “radical acceptance”, take your pick.

Most people will continue to struggle long after they should have changed directions. Who wants to admit they are an alcoholic? Who wants to say they have Bipolar Disorder or any other form of mental illness. I do not remember Alcoholic or Schizophrenic being included in the list of future careers when I was back in high school. It can be reassuring to tell yourself that you are not that bad. But some of us got there anyway.

So if there is some sort of bottom, lower than where you are, it can give you the false sense that you are not as bad as someone else. People fool themselves for a long time because they can believe that alcoholics are homeless bums. The truth is more than 90% of alcoholics have full-time jobs. People with Bipolar Disorder fool themselves into thinking they are more productive, creative, or have more energy than others until they crash.

So hitting bottom is different for different people. For one person the realization they have the disease of alcoholism will come after the first DUI or the first unpleasant incident with the family. Other people will continue to try to control their drinking, complete with recurrent episodes of out of control drinking until they have been sentenced to a fifth or tenth program, or have done more years in prison than on the street.

But it is not just alcoholics that try to deny their disease. People may try suicide multiple times, have repeated psychiatric hospitalization, and still believe that they just need to move somewhere else, that it is someone else’s fault, anything to avoid the fact that they have a mental health problem that needs treatment.

Many of us want to pretend we don’t have a disease. If you just ignore it then this problem will go away. Don’t give in to depression is their mantra. A few relatively minor conditions do go away without treatment. Colds and flu may remit without treatment. But serious conditions, Cancer, tuberculosis, and heart disease get worse if ignored. Alcoholism, addiction, and mental illness also can worsen if not treated. Pretending is not treatment.

The founders of A.A. concluded that sometimes we need to “raise the bottom” till it hits people. Why do people need to totally destroy their life, spend time in prison, or psych hospitals before they can accept that they have a condition that will respond to treatment?

Education can help sometimes. But the people who need education the most avoid it. What person who is manic, drunk, or on drugs wants to sit and listen to others talk about how they were unable to control their disease until they became willing to accept help?

Lots of people with addictions and mental illnesses will isolate, they will avoid others, and shrink from treatment. Their bottoms most often come when the losses and the pain become unbearable.

So you don’t need to wait for you or a loved one to “hit bottom” before you seek help. You do not reach bottom until you put the shovel down and quit digging. There is help available the moment you realize that you can’t dig your way out of a hole. Accepting that you have a problem, condition, illness, or defect of character that requires a new way of thinking and behaving can be your bottom. You don’t have to get any lower before you start your journey back.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Posttraumatic Growth (PTG) vs. Posttraumatic Stress Disorder (PTSD)

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Words about PTSD

PTSD.
Photo courtesy of Pixabay.com

How are PTSD, PTG, and Resilience related?

Is some sort of personal growth possible as a result of living through a traumatic experience? Recently researchers have begun to study the concept of Posttraumatic Growth (PTG.) There has always been a body of literature about how some difficulty might spur changes in a person and lead to a new way of seeing life. But could something that was so severe a stressor as to be traumatic really lead to positive growth? And if that change might happen, why? What characteristics of the person, the treatment they received, or their support system might transform Posttraumatic Stress into Posttraumatic Growth?

Zoellner & Maercker defined PTG as “the subjective experience of positive psychological change reported by an individual as a result of the struggle with trauma.” So far studies of PTG have been lacking and those that have taken place include mostly groups of people who are different from the clients we see in therapy who have PTSD. For example, many patients with PTSD also have co-occurring substance abuse disorders. Most studies of PTG have excluded clients with substance use disorders. We know from many individual reports that overcoming substance abuse especially in clients with PTSD can result in the client developing a new way of seeing the world and many in recovery report that they have grown as a result. Clients with suicidal thoughts have also been excluded from studies of PTG despite the recurrence of clients telling us that being hospitalized for a mental illness, especially with suicidal thoughts, can be a life-altering experience.

Hagenaars & van Minnen (Journal of Traumatic Stress, Vol. 23, No. 4, August 2010, pp. 504–508 (c 2010), conducted a study using Exposure Therapy. The therapy included steps beginning with low-intensity experiences such as “Patients were asked to close their eyes and talk about the traumatic event in the first person and in the present tense, recollecting as many sensory details as vividly as possible, i.e., as if the trauma was happening “here and now.” The intensity progressed to real-life situations. This procedure is similar to systematic desensitization procedures in use for specific phobias.

So what did they find? The more PTG the less PTSD and vice versa. Also, the more someone was “emotionally numb” the less likely they were to benefit from the treatment, and the less likely they were to have PTG. They concluded that an inability to feel emotions is related to an inability to grow. So the ability to face problems leads to growth and the inability to face problems leads to staying stuck in the problem. Unfortunately, this leads us around in a circle to the place we started. Resilient people can grow as a result of trauma but trauma can make you less resilient especially repeated traumas.

Some clients who have been forced to relive traumatic events become re-traumatized. So sometimes the exposure techniques make you better but the same treatment can also make you sicker. How do you choose? Clients who share about trauma in a safe environment seem to get positive benefits; those who are cross-examined for details get worse. So, in the end, the value or damage of the technique depends on the relationship. This is one reason that group counseling is so appealing. People with similar traumas feel safer in talking about them in a group that has had a similar experience. Counselors who are seen as accepting help and rejecting professionals harm. It is in the case of PTSD as in other therapy – all about the relationship.

One further problem with the concept of PTG, how do we know it happens? Mostly we measure it by the client’s subjective report. They say they grew as a result of the trauma so that is evidence. But how did they grow? Did they take new actions or did they have a change of attitude? Maybe both? People who are spurred to action appear to grow more.

We also suspect that PTG is related to resilience. So do resilient people have more growth as a result of a traumatic event or do people who overcome a traumatic event become more resilient?

We know that PTG reduces PTSD symptoms and that the process of growth is related to resilience somehow. It is also clear that there is a lot more PTSD out there than we wanted to recognize. The challenge is making use of the things we learn in research and theory to help the clients who walk in the door in their journey from Posttraumatic Stress Disorder (PTSD) to Posttraumatic Growth (PTG.)

Do any of you have experiences with Posttraumatic Stress Disorder (PTSD) or Posttraumatic Growth (PTG) you would care to share?

This post was featured in “Best of Blog – May 2012”

For more information on Stress and PTSD see:

Posttraumatic Stress Disorder – PTSD and bouncing back from adversity

8 warning signs you have PTSD

Acute Stress Disorder vs. PTSD 

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Licensed Professional Clinical Counselors (LPCC) Update

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

More about LPCC’s and LMFT’s.

Interest in California’s Licensed Professional Clinical Counselor (LPCC) program is noticeable on the Web. I was surprised that a couple of short, mostly personal posts about the LPCC license received as many hits as they did. I realize now that I also forgot to mention CALPCC, the organization for LPCC’s. Briefly, this is a counseling specialty that is now licensed in all 50 states. Surprisingly enough California was the last of the 50 U. S. States to license LPCC’s.

Had this been an option when I enrolled in my degree program, it is the one I would have chosen. I am glad that I took the training as a Marriage and Family Therapist now that I have done it. But now that LPCC’s are licensed I completed my original plan and took that exam and became licensed as an LPCC also.

The posts about LPCC’s can be found at LPCC exam is behind me!

Licensed Professional Clinical Counselors (LPCC) in California

Some of the searches were about study courses for the exam and about pass rates. Since my license issued 4/17/2012 is number 15, it would appear that so far about one person per week is getting through the Gap exam which is being given to LMFT’s and LCSW’s who chose to test for the LPCC license also.

I feel sure that there will be study classes for this exam offered by the same companies that offer study classes for the LMFT and LCSW exams. Only time will tell how useful those classes will be.

For more information on the California, LPCC license check out the information at the Board of Behavioral Sciences website.

LMFT’s who are choosing to take the gap exam and become licensed as both MFT’s and LPCC’s should already know about the California Association of Marriage and Family Therapists – CAMFT

For information on CALPCC – the organization for LPCC’s see:

Questions and comments about Counseling, Therapy, LMFT’s, LPCC’s and recovery and resiliency are always welcome.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

DSM-5 Diagnoses begin to disappear

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Medical record

Diagnosis.
Photo courtesy of Pixabay.com

UPDATE – changes in the DSM.

You can erase most of this post from your memory. During the process of updating the Diagnostic and Statistical Manual of Mental Disorders (DSM) from the DSM-IV to the DSM-5 a lot of things were proposed. Some of those suggested changes were instituted and others were left out. This post includes mostly ideas that did not make it to the final DSM-5. Because these ideas were included in a lot of research articles and other blog posts, I have left the post up but need to tell you that some of this information is now out of date.

Mental illnesses appear and disappear like magic – More DSM-5.

The effort to improve and refine the Diagnostic and Statistical Manual of Mental Disorders continues. This round of revisions has created a lot of concern about the way in which things we thought we knew about the nature and treatment of mental illness can change dramatically in a short time span.

There has been a lot of opposition to some of the proposed changes from both inside the American Psychiatric Association (APA) and those outside the association who have to work with the manual. The effects for consumers and clients may not be obvious for some time.

Recently the APA posted a notice on their website about changes they are making to the proposals for the new edition of the DSM. Not surprisingly, those revisions in proposals have coincided with the APA’s convention. The pressure to get this worked out is on now as the new edition is due out next year at the May 18-22, 2013 APA convention. That means the decisions need to be made and the book sent to the publishers by the end of 2012. The APA is accepting comments on their website from May 2nd to June 15th, 2012.

Most of these ideas are tested in carefully controlled trials with strict adherence to criteria. Unfortunately in daily practice clients don’t come in with only one problem and clinicians don’t have the time or resources to do extensive testing and diagnosing. The question remains, will this new understanding of mental disorders help or hinder the efforts to get clients the best possible care and still stay inside agency’s budgets?

Here are some of the most recent changes

1. Mixed Anxiety and Depression

This is getting moved to the back of the book under diagnosis for further study. We know that clients often have both of these together but then they also may have diabetes and sore throats but so far we are not creating lots of combo diagnosis. Bottom line if you have two mental illnesses you get two diagnoses, not one “combo,” for now.

2. Attenuated Psychosis

This moves to the back of the book also. We have plenty of psychosis class diagnosis, not sure one more will make any difference.

3. Depression gets a footnote about being careful not to make normal things into mental illnesses.

But that always has needed some judgment. If it is causing you too many problems it gets diagnosed if it is within normal it does not. So we still try to keep categories of illnesses while we also allow for variations in degree.

4. The Non-Suicidal Self-Injury Diagnosis (often called cutting)

So far has not worked the way they thought it would. Some have proposed adding Suicidal Behavior Disorder also. Currently, neither of these is considered a mental illness. They are symptoms of something but we are not all agreed on what they are symptoms of. These two are likely to end up in the back of the book along with that complex grief thing.

So the announced changes in the draft move us back closer to where we were before – except that to this point the APA is staying with their proposed changes in Autism and Substance Use Disorders. Only time will tell.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Is Bereavement a mental illness?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Bereavement

Bereavement, grief and loss.
Picture courtesy of pixabay.

Should bereavement, grief, the loss of a loved one be a mental illness?

How we see the death of a loved one is a real problem for our society.  The loss of a loved one is for many people the most traumatic event in their life. Grief and loss is an important topic. There are a gazillion books on the subject and plenty of therapists who say they specialize in “grief work.” We know that the closer the person is to you the worse the loss.

But is bereavement, grief, the loss of a person, loved one, or relationship a mental illness? Should it be?

Death and dying are something we don’t like to look at if we can avoid it. Most people die in hospitals behind closed doors. We consider death like birth a part of a human condition. It doesn’t seem right to make every emotion, happy or sad, suspect as being unacceptable. Should mental health help people avoid feelings or face them?

Professionals are just as confused about this as anyone else.  Up till now we specifically excluded grief as a diagnosable mental illness. This is a controversial issue among psychiatrists and therapists.

When someone dies do you get depressed? Should you? Bereavement is specifically excluded from the criteria of Major Depressive Disorder. So if you get depressed because your favorite T. V. show was canceled you can be treated for Major Depression but is a family member dies it is not by definition a mental illness.

In the revision of the DSM, as we move to the DSM-5 in the middle of 2013, the professional community is trying to find a solution to the whole grief and bereavement problem. So far there is not much agreement.

Sometimes professionals get around this in various ways. They wait a while and then say this is going on too long and then give the diagnosis of Major Depression anyway. There are some professionals that say that we should just delete the exclusion. Depression is depression they say. So let everybody be depressed if they want to.

The contrary to that is that including people who are depressed because of bereavement may be enlarging the category, increasing the number of people who get treated for depression and making a normal human reaction to loss into a mental illness.

Some people want to exclude bereavement for the first year. If you are sad more than a year after the death of a loved one maybe we would want to offer you counseling. Depending on how sad you were, is it really depression?

Currently, Grief is included as a V code. V codes are those things listed in the back of the book like parents and children who can’t get along that are sometimes treated but we don’t specifically count these as a mental illness. (In the DSM-5 the V codes became Z codes.)

I wrote in a previous post about the movement, coming from outside the APA, to add a new disorder called “Complex grief” as if this is somehow different from regular grief.

So how do you deal with grief? Is it normal or a mental illness?

See also: Bereavement, grief, and loss

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel