Reader Questions

Counselorssoapbox.com

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

A slight change in format and procedure here. In the past, I was calling this feature “Morning Questions” but there needed to be a change in my writing schedule if that book in my brain was ever going to get down on paper or electrons. So the main blog post will be going up in the early AM.

I thought about calling this feature short questions or brief answers but sometimes they will be brief and other times not so brief. I settled on the title “Reader Questions.” My goal is to provide useful information and commentary while avoiding filling your inbox with excessive posts. These Reader Question posts will probably be infrequent unless there get to be more questions. Henceforth when a question or comment comes in or someone uses a search term that needs an answer you will see a Readers Question post.

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Body remembers what the mind forgets

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

Body remembers what the mind forgets.
Photo courtesy of pixabay.

We don’t have just one memory system.

 

Seems that memory is a lot more complicated than we used to think. Like computers with different operating systems, our brain has a lot of different ways in which memory is saved, processed and recalled. This may explain some of the problems we have with sudden unexplained reactions to things that we didn’t know would affect us that way.

People with a history of trauma may respond in extremely strong ways to seemingly minor things. This is not an “over-reaction” but this unusually strong reaction to a small cue in the environment may be connected to the way they have stored that memory.

Let me try to explain this one and see if I can get this memory stuff right.

One way we remember things is by creating a story about the events. This is called the “verbally accessible memory system (VAM.)” These memories can be saved accurately when we are paying full attention to what is going on. This is the kind of memory that is most useful for the student sitting in class listening to the teacher and taking notes.

The second form of memory is called Situational Accessible Memory and is largely a compilation of the sensory data that is stored in a second redundant memory system. So this memory system will be recording how the person felt during that lecture. Was it boring, did their back hurt? If the lecture was boring they may store the bodily sensations they experienced while in class. If the lecture used humor and stories the student may remember laughing and enjoining the class.

These memories are not stored in one system or the other but in both. Which system holds the most detailed and important memories depends on a whole lot of what was going on at the time things happened.

Many people will tell us that their first memory in life was a picture of something they saw often combined with other sensory data such as smells, tastes or tactile experiences. As we get older we develop more of a vocabulary and are able to record more of the verbal story elements. We come to know that the brown thing was a cookie and those dots were chocolate chips and that smell was mother baking. The sensory data is transformed into the story of mom’s Christmas chocolate chip cookies.

Sometimes, times in later life, when emotional events happen or we experience a trauma, the body shuts off or restricts that verbal channel and as a result that emotional event is stored as a highly emotional sensory memory.

Levels of various chemicals in the bloodstream and in the brain, which is largely filled with blood, determine the way in which these memory systems interact. Hang with me here because some of this may explain why we remember or don’t remember aspects of trauma.

Our human brains also include some primitive structures and processes. One system governs those basic survival skills we share with other animals. So the lizard’s reaction to stress and ours is a lot alike.

The lizard sees you hand coming, he tries to hide by freezing and not moving. Maybe if he does not move you won’t see him. This protective mechanism functions automatically just like your heart that keeps beating all night even though you are asleep. So regardless of what you plan, there is likely to be a hesitation when an emotionally charged event occurs. During that hesitation, we, just like the lizard, tend to freeze. Police officers and combat troops need to be overtrained to respond in order to reduce that hesitation.

Next, as the hand continues the reach for the lizard, he will suddenly spurt as fast as he can go to get away. This behavior we call flee. During that flee process all resources will be focused on escape. So during this process, verbal memory will stop or reduce recording. People who have experienced trauma might describe this as “blind fear.” So while they are running they may not remember where they went, what they leaped over or what sound was coming over the radio, still, some other sensory data may be stored at a magnified volume.

Lastly, the poor lizard in our story, cornered with no way out, will turn and flare out to try to make themselves as large as possible. They prepare to fight, even knowing they may die, but they are going to get their licks in and hope when they bite you, you will drop them in pain. Humans sometimes report that when they got far into fear or anger they began to attack even though there was little hope of winning the fight. This is sometimes described as a “red out” meaning the anger got so strong that most other verbal memory processes and rational thought shut off.

In higher mammals, there is one other stress response here that has a bearing for humans. The puppy when under attack may roll over on its back, exposing its stomach or neck and in effect giving up. They are saying to the attacker go ahead do what you want I give up. We might call this behavior “placating.” In a human that rolling over and playing helpless or dead is often accompanied by some form of dissociation. This could be a momentary blank spot in the memory recording or a longer dissociation.

So during all these automatic behaviors, the verbal memory system will be turned down and the sensory memory system will be turned up.

This result of shifting memory systems may explain why a seemingly unrelated sensory trigger can set of an episode of fear and stress. The victim of a previous assault may see a yellow car and suddenly be overcome by fear. Last time an assailant chased them they ran full speed until they ran into a yellow car, seeing that same color car cause the sensory memory to spring back to work and recall the full trauma, stress hormones and all.

Hope that explains some of the potential relapse triggers for emotional conditions that may be present in the sensory memory even if not available consciously in the verbal memory system. My apologies to any memory researchers out there if I have gotten any of this theory incorrectly.

So have any of you ever experienced a sudden emotional response that came out of nowhere?

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

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

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Where does the Bipolar spectrum begin and end?

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

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

Thoughts on Bipolar spectrum.

My understanding of the Bipolar Disorders, like many other “mental illnesses” has changed over the time I have been involved with this field. Not all professionals agree on some of these things so it is only fair I tell you some of my biases first.

When I first learned the technical part of diagnosis we had to study the diagnostic manual (the DSM.) The assumption here is that a really good clinician can distinguish between those with a mental illness and those without and further that those with a mental illness are in some specific way different from the normal ones.

Neither of those assumptions is necessarily true.

In school, it was really important to learn to distinguish the niceties of the diagnosis. I spent a lot of time on things like the differences between Schizophreniform disorder, Schizophrenia, and Schizoaffective disorder. This is very important in school and in taking your exams for licensure. In the real world, it is not so important. Both the meds and the talk therapy are likely to be the same for all of these.

Some of our view of the “Bipolar disorder spectrum” is distorted by the need to rule people in or out and to state which things are normal and which are diagnosable. The ruler you use can alter the results. Our venerable rule books on diagnosis in the mental health field fluctuate between the categorical approach, putting people into pre-sized boxes, and the continuum approach where we line them up from well to sick. Here are my beliefs on this.

1. There are NOT two groups, the “normal” and the “mentally ill.”

With some medical disorders, you either have it or don’t. Mental illness is not like that.

We are coming to recognize that there are not two distinct groups, the well and the unwell, but in fact, there is a continuum between being well and unwell. Something bad happens to you, then you should be sad or anxious. All of us have some days we feel better and other days that we feel less well.

Most of the things we count as symptoms are in fact normal human behaviors. It is just that the unwell person has more symptoms or more severe symptoms than the less unwell person. When the symptoms add up to enough to make a diagnosis is largely a judgment call.

People do not move directly from a healthy weight directly to obese. The move comes on slowly one ounce at a time. The same thing happens with mood disorders. It is not just the number of symptoms but also the severity of symptoms that cause a professional to assign a diagnosis. Two different professionals and you may get two different diagnoses even in research studies using “strict diagnostic criteria.”

2. Counting symptoms is not an exact science.

Each mental health disorder has a list of symptoms that are believed to make up the disorder. The client needs to have some number of symptoms to get the disorder. Say a disorder requires the majority of the list of symptoms, 7 of 13 possible symptoms, look at all the ways we could add this up. The mathematicians among us will recognize this as a factorial problem, the number of outcomes of 13 things taken 7 at a time. Email me if you do the math and get a number. Take my word for it the number of combinations is huge.

So as the clinician talks to you he considers, do you have enough characteristics of a symptom to count that one? Then he adds them all up and if you get enough you win the diagnosis.

Lots of judgment calls in this process.

So what about the spectrum of Bipolar disorders?

I think this is a long spectrum and a lot of it does not deserve a diagnosis. The most severe cases can and should be diagnosed because if you have that many symptoms you need help.

Are birds Bipolar? Are other animals? I think they are a little. Every spring the days get longer, there is more daylight and they are awake more. They become interested in the opposite sex. Here in the northern hemisphere birds start looking for mates by Valentine’s day in February and by Easter, they have bred, created nests and are hatching out chicks. People do this same thing.

We humans, tend to fall in love in the spring and marry in the summer. It takes a little longer for the children, but not that much longer.

There is also a seasonal decline in activities for all animals in the winter. Bears eat all they can and then go sleep for the winter. In humans, we call this atypical depression. So some change from active, even hypomanic behavior occurs naturally with the seasons. These mood changes are normal human behavior.

We probably should not give every teenager a Bipolar diagnosis, though most of the time their parents are sure that their preoccupation with sex and their moodiness should qualify.

People who have diagnosable Bipolar disorder do not really have different symptoms. What they have is a difference in the severity of symptoms. They also have different outcomes.

With all spectrum disorders, we should not make our decision based on the presence or absence of symptoms, which alone is not enough. The key factor is what effect do those symptoms have on the person.

If the increased interest in sex during the manic or hypomanic phase damages their relationships, gets them fired for sexual harassment of causes other disruptions in their work and relationships then they get the diagnosis. Also if the symptoms of the mood swings become unmanageable and they upset the person with those symptoms, then they should be treated.

So yes there is a spectrum of Bipolar-like symptoms from almost unnoticeable to debilitating severe. The thing we professionals should be looking at is not our judgment of the severity of the symptoms, but how are these symptoms, these problems in living life, affecting the client.

If the problems interfere with having a happy life then it has become severe enough we need to give it a diagnostic label and begin treatment.

Personally, I think there are a lot of people with less severe mood swings than what would be diagnosed as a Bipolar spectrum disorder that would benefit from some counseling. But as long as they can maintain the choice is up to the client.

Thanks to reader Dr. Charan Singh Jilowa for suggesting this topic. For more on this topic check the list of posts to the right or the post list on Bipolar disorder and mania.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

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

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Ca. Professional Counselors – CALPCC and LPCC’s

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

October CALPCC board meeting.

This year California became the 50th state to License Professional Counselors. The official designation in California is “Licensed Professional Clinical Counselor” LPCC for short. Other states had some form of professional counselor’s licensure before California, so we are still finding our way as this profession matures and adapts to California.

CALPCC, a non-profit organization, is the statewide organization for this new profession. Last weekend was the annual “retreat” for CALPCC’s board of directors which I was able to attend.

CALPCC has seen fit to appoint me to that board to fill out an open board member term. I am excited about this opportunity.

Some short recaps of what we talked about are below. Remember that as a new board member these are my impressions and that I can’t speak officially for the board. So any sentiments expressed are purely my own. Here are some of the questions that came up.

1. Why are Marriage and Family Therapists (MFT’s or LMFT’s) becoming LPCC’s also?

At least 4 of the CALPCC board members, myself included, are also licensed as LMFT’s so there was some discussion of why LMFT’s might want to also become LPCC’s.

My belief is that there are things that each profession does that the other does not do and to best serve my clients I needed to be trained in both areas.

Most LMFT’s work with couples, families and sometimes children. Since I see some children, couples, and families I need to stay licensed, active and up to date in the LMFT field.

Much of my private practice is in individual counseling, particularly something I loosely call “men’s issues.”  LPCC’s are specially trained in things like career counseling and mediation. Sometimes this shades over into the area of life coaching. I approach these issues by trying to help clients solve problems that are causing social or occupational problems or interfering with having a happy life.

2. Why should someone join CALPCC?

Lots of counselors are already members of one or more professional therapist or counselor organizations. They asked why they should join another group.

My view is that if I was solely an LMFT I would need to belong to the one or two organizations in that field. Since I am also an LPCC I felt the need to join the organization that is specific to LPCC’s, which would be CALPCC. I chose to be a member of organizations in both fields and would recommend that to other people who are dually licensed.

3. What are the benefits of being a member of CALPCC?

CALPCC maintains a website. There is information on the website for anyone who is interested in the new Professional Clinical Counselor profession. There is also a member’s only area with additional information that is useful to LPCC’s that may not be of interest to non-counselors. Other professional associations also use this member’s only format for some of their website content to encourage those who use the resources to help pay the cost.

I recommend that if you are licensed or seeking licensure as an LPCC, you want to be a member of CALPCC and get access to the members-only content on the website.

4. Can LPCC’s bill Medi-Cal?

Not yet, but we believe this is coming and coming soon. At this point, there are only a few LPCC’s licensed in California. The last license number I heard was about LPC200. Those who are getting licensed now are people with previous other licenses who are getting a second license.

We were told that there is a huge pile of applications for the LPCC license that were mailed on the last day of 2011. BBS will be working on that pile for a while. By the time those licenses are completed and the BBS moves to issuing new licenses to people who did not have a previous license we hope that the Medi-Cal approval will be completed.

There are other federally funded programs in which LPCC’s are already being hired.

5. Can LPCC’s open a private practice and take private insurance?

Yes, they can. Who the insurance company place on their panel is up to each individual insurance company. I am on several panels and each one that I have looked at will take LPCC’s.

That does not mean that if you are newly licensed as an LPCC the insurance company will automatically add you.  Most insurance companies want to know they are sending their customers to someone who is reliable. They require providers to have a certain length of time in the profession before they add you to their panel. They also look to see if they have too many or too few counselors on their list for your area.

This is not insurance companies picking on the new LPCC profession. These rules have also been applied to existing LMFT’s and LCSW’s.

Most insurance companies I have looked at require you to have been licensed for 2 to 5 or even 6 years before they will consider you for their panel unless you have a particular skill they need on their list. So if you speak Russian and Swahili you may get on insurance panels sooner.

6. Should students join CALPCC now or wait till graduation?

I recommend that you join while still in school and read the members only updates while you are preparing for your exams. This keeps you up to date on the latest events and trainings in your field.

Also – the CALPCC student member price is VERY reasonable.

Consider that the really good counselors and therapists do not stop learning when they graduate. If you want to be the best possible therapist or counselor you can be, stay active and up to date in your field.

If you are a client or an out of California professional forgive the very California LPCC specific post. The last two weeks have been extra busy for me. Shortly I will return to my posts on recovery, resiliency and having a happy life.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

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

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Is Dysthymia better in the morning or worse?

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

Depressed person

Depression.
Photo courtesy of Pixabay.com

Which depression is worse in the morning? – Morning Question #14

Having more depressive symptoms in the morning is a characteristic of “Atypical features” of a mood disorder. Atypical does not mean unusual it means “not melancholy.”

Atypical features include the hibernating-like-a-bear symptoms, overeating, sleeping too much and being tired and grouchy in the morning. With atypical features, the person may be able to feel better temporarily if something they really like happens, but the happiness does not last long. They may also feel better in the evening but by morning the depression comes back.

Atypical features can occur during episodes of Dysthymia, Bipolar one or two Disorders and Major Depressive Disorder. In practice, the only time I remember seeing this on a file is as part of the diagnosis of a Major Depressive Disorder but having atypical features increases the risk that this will eventually turn into a Bipolar disorder.

If your mood is customarily worse at a particular time of day, make sure you are eating and sleeping well, that there are not environmental problems like relationship issues that are causing this and then seriously consider consulting with a medical doctor or psychiatrist. If the doctor rules out any medical problems then some counseling should help.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

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

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Morning Question # 2 Does Methcathinone help you get big in the gym?

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

Bath salts.
Photo courtesy of Pixabay.com

NO! No stimulant makes you big and strong, you just think you are.

Not even if you consider someone with anorexia to be overweight. Methcathinone is a stimulant just like Methamphetamine. Different chemical formula but similar results. The people who are telling you this are also pushing the “Jenny Crank” diet. Is losing your teeth your idea of weight loss? The only bulking out you do on powerful stimulants is from the scabs on your face. There is to my knowledge no safe and effective way to get big in the gym other than eating healthy and lots of appropriate exercises. The shortcuts that do work are not safe. The safe shortcuts don’t work.  Want to get big in the gym? Lift more weight, run more miles and eat a lot of health food.

Are people who go for counseling crazy?

New post over at counselorfresno.com “If I go for counseling does that mean I am crazy.” If you check it out feel free to leave a comment and let me know what you think.

By David Joel Miller.