Tag Archives: self-esteem

What is a Therapists Scope?

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

Therapist

Therapist.
Photo courtesy of Pixabay.com

Therapists and Counselors need to remember what is in and what is out of their “scope.”

In school, every beginning counselor is taught to pay attention to scope issues. It is not something that we talk to clients about very often. Somehow, a while out of school, a lot of professionals forget about this issue. One reason it is so hard to keep clear is that there are in fact two different “scopes.” Recently a reader commented about their therapist mentioning something as being out of their scope. That comment suggested this post.

Counselors need to remember both their scope of practice and their scope of competency.

1. Scope of practice.

Scope of practice is defined by the law in your jurisdiction. If you get an MFT license you are allowed to do some things, a Licensed Professional Counselor does certain things, an LCSW has their set of allowable things, and so on.

This gets confusing sometimes. We professionals know for example who can do certain kinds of testing and who cannot. The clients do not usually know this and may come to a professional for something that their license does not allow.

In cases like that, we should always refer clients to someone who can help.

A social work license does not allow you to cut hair, or do tax returns, for example. The Therapist or social worker may have been trained as a beautician before becoming a social worker and they may have done tax returns to help pay the cost of going to school, still that Behavioral Science license does not allow them to do those things with their therapy clients.

If a person has two different licenses, say they are lawyers and they are therapists, there are all sorts of rules about what they have to do to keep those two professions separate so as not to confuse clients as to what they are allowed to do and not do.

Every group has a code of ethics and that may influence what a professional does or does not do, but scope of practice is largely a legal issue defined by the law that permitted the licensing of that profession in the first place.

In a future post, I want to tell you about codes of ethics, who have to follow them, and why.

In many places, coaches are not licensed. That means that those who call themselves life coaches do not need to have had any training to do coaching. What the life coach should not do is treat a recognized illness like Major Depressive Disorder. They can help you with say “motivation.” But if you have low motivation because of your depression that is outside their “scope of practice.” They would need to have a license as a counselor, therapist, or social worker to treat a mental illness.

2. Scope of Competency.

To become a licensed counselor, social worker, or therapist there are certain classes everyone needs to take. The typical program at the master’s level would include about 60-semester college units. Some programs might go up to 65 units, some programs include only 45 units. Most classes are 3 units so that means about 20 classes. If they take a few 1 or 2 unit classes they might get up to say, 25 classes.

The beginning mental health professional would get a class in how to diagnose and a couple of classes in how to treat mental and emotional problems but with over 400 recognized mental, emotional, and behavioral issues in the DSM-4 no one ever gets much training in working with specific issues in their program.

For example, a substance abuse counselor in a two-year (A.S,) program would take 36 college units in drug abuse counseling. Most licensed people LMFT’s, LPCC’s and LCSW’s will get one to three units in Substance abuse.

So if you only had a one-unit class in counseling the drug dependent, say that was a one-unit class one weekend, that person would not feel very competent in working with someone with a drug problem.

Many of us had at most a few minute’s discussion of eating disorders. Dissociative Identity Disorder and Body Dysmorphic Disorder probably were not talked about at all in a therapist’s formal training.

So while a person may be licensed as a particular mental health professional they may realize that they just do not know enough about the disorder that the client has to be able to work effectively with that client.

We call this lack of skill in a particular disorder or technique something outside the therapist’s “Scope of competency.”

Most mental health professionals will find they do more studying, read more books, and attend more trainings after graduation than they have done in their master’s level training programs. If you do not continue to study and learn, more and more things will turn up that are outside your scope of competency.

There are ways to expand your scope of competency. Get more education and training in a particular disorder or technique, work with a supervisor or consultant who is knowledgeable in the area, and do more supervised experience in that area. Some professionals do all that and over time grow their scope of competency. Others may decide that they will restrict their practice to the problems they feel competent in working on.

So if you have a relatively common problem, say depression or excess anxiety, most professional counselors can help you. But if you have a more difficult problem, substance use disorder, eating disorders or many of the trauma-related disorders you may need to seek out someone who understands and knows more about your issue.

Hope that explains the very basics of scope of practice and scope of competency.

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

Are internet affairs real affairs?

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

Computer

Internet.
Photo courtesy of Pixabay.com

Are internet affairs real affairs?

The article this post originally sent you to no longer exists. For more information on this and related topics please see:

Affairs

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 your story a Fairytale or Nightmare?

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

Castle in the sky

Fairytale world.
Photo courtesy of Pixabay.com

The stories you tell yourself come true.

We all tell ourselves stories. You may not think of them that way, you may have other names for them. You may think that what you are saying is just self-evident truths.  You are shy, clumsy stupid, and so on. You may say your family is cold or that you are all failures.

The things you tell yourself have a way of coming true. If you tell yourself often enough that you are stupid or that you can’t succeed you create that outcome.

Some people think of these stories as life scripts. If you tell yourself you are a loser, you will continue to lose to meet that requirement.

You tell yourself you are a certain kind of person and that means you will have a specific sort of life. You say you are unlucky and you avoid situations that involve risk. The result is that those great wins in life are always just out of reach.

Which kind of stories do you tell yourself?

If you tell yourself you can’t do something your brain will take that for an order and will prevent you from doing what you have forbidden yourself to do. Like that little engine if you tell yourself you can you will find it easier to get over the hill.

Many of you have pet stories you tell yourself. You tell yourself you are too stupid or too weak to do something and then you find you can’t do it which proves that you were right. The great surprise, for many of you, will come when you stop telling yourself that you are stupid and tell yourself that you can learn what you set out to do, and then that new story becomes true.

If you tell yourself that life is awful and that you can’t, then you won’t. If you can change that story and tell yourself that all things are possible, then more opportunities will open up.

Changing your life script story.

Some people have told themselves that they are addicts and so they need to use drugs. If you tell yourself that you are an alcoholic you will need to drink. But you can change that story. You can be an addict in recovery or an alcoholic in sobriety. You can tell yourself that you no longer need to do those things and if you tell yourself that you can live life without drugs or depression or anxiety, then that can become the new story, the new life script for you.

We all tell ourselves stories, who we are, what we can and can’t do. Make one mistake and you may tell yourself you are a failure. Forget something once and you may start telling yourself you are forgetful. The truth is that you do not forget everything and you can change that story.

The person who told you that story could easily be wrong.

Some of these life tales are stories that we were told as children. We hear that we are stupid and we repeat that story. If you heard these stories often enough you may have stopped recognizing that this is just a story, someone else’s story for your life.

If you have learned to tell those stories to yourself, you will find that you can change the endings. You can be and do so much more than you ever thought you could.

What is the new story, the new life script you are creating for the role you will play in your life?

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

4 reasons your self-improvement program will fail

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

Changing your life

Time for a life change?
Photo courtesy of Pixabay.com

Self-improvement programs fail when you set wrong goals.

Another year, another bunch of resolutions, and by now most are headed for the same old failures. The reason most self-change programs fail – wrong, fuzzy, and poorly defined goals.

Most resolutions are made with little or no thought about where you are going and how you will get there. If this new you is not worth the trouble to plan, then it probably will not be worth the effort to take action, and next year, long about this time, you will be in the same place you are now.

What are the specific things you need to think about if you want your plan to succeed?

1. What is your goal?

Set the wrong goal and you end up at the wrong destination or you don’t get anywhere at all. Fuzzy goals lead you around in circles.

A common form of resolution this time of year goes something like:

I want to lose weight, exercise more, get in shape, and improve my health.

Some of these goals may conflict. One easy way to lose lots of weight is to get sick, physically, or mentally. Worry enough or get really depressed and you may stop eating. Good for weight loss but not for getting healthy.

Exercising more may result in that fat being converted to muscle. You will be healthier but may not lose any weight.

Improving your health may involve seeing a doctor, getting your flu shot, and a lot of preventative screening tests. Hard to do when you are starving yourself and running marathons. Severe calorie restriction and aggressive exercise may result in a hospital say, not really what you had in mind when you set your goals.

Second goal problems example.

You decide you want to be wealthier. For most people, this means wanting to be able to afford to buy the things that you or your family wants. So you work harder, take a second job, save some money and then you buy your kids that new video game console they wanted.

One problem – now you are broke again and you are working more hours than before. When most people say they wish they were wealthier what they really mean is they would like to be able to spend more. The wealthier goal self-destructs the closer you get to it.

To build real wealth you need to scale back your consumption and save. That is exactly the opposite of what most people mean when they say they want to be wealthier.

Getting really clear on your goals can improve your chances that this year’s resolutions have some chance of succeeding.

2. How big a priority is this goal?

Many people set goals that sound all nice but they are not really committed to getting there. If you would like to lose weight or get richer, as long as you do not have to actually work for that goal, there is little chance of you arriving there.

To make achieving a goal a reality it needs to be something that you want more than you want other things. Do you want that goal enough to give up time on the couch? Will you forego spending or eating something to reach that goal?

Just how committed are you to this thing and what difference will it really make in your life if you get there?

3. Is the goal consistent with your values?

You value time with family, especially those family get together dinners. That time with family is pretty inconsistent with working more, spending less, and improving your finances. Those entertaining times are also inconsistent with losing weight.

Despite these inconsistencies, lots of people will say they want things mostly because they would like the praise of others for getting to this goal even when that goal is in direct conflict with their personal values.

4. Can you see clear benefits in reaching this goal?

Some things are kind of nice to have but really getting them will not change much in your life. Unless you can picture yourself reaching this goal and visualize how your life will be better off for having made the sacrifices needed to get there, you are not likely to be motivated to do the work.

So consider now, as the first month of 2014 is well underway, what happened to those New Year’s resolutions? Did you get clear on what you wanted and how that is influenced by your values? Can you see this goal becoming a reality? And most of all is this change thing something you are doing for you or is it something you think you should do because of what others will think about you?

Are you one of the rare ones who decide to make a change and then does the work to get there? Maybe we will check back in about a year and see who has made a success of their change plans.

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

First night of Drug and Alcohol Classes

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By David Joel Miller.

Drugs.

Do drugs cause mania.
Photo courtesy of Pixabay.

Tonight is the first night of classes here at FCC.

One activity in my busy schedule that I thoroughly enjoy is the opportunity to teach Substance Abuse Counseling classes at Fresno City College.

The program here is accredited by the California Association of Drug and Alcohol Educators (CAADE) and leads students towards becoming registered and then certified drug and alcohol counselors.

The program includes 36-semester units of classes in Drug and Alcohol use disorders, recovery, and the work of counselors and social workers. A few students from the 4-year college show up in these classes because this program contains more information about Substance Use Disorders than most Masters or Ph.D. programs.

We see students in this class who want to be drug and alcohol counselors. There are often also social work majors, nursing students, criminal justice majors, and a smattering of people who are in early recovery and know they need more information on Substance Use Disorders to be able to decide what career is right for them.

All these majors are welcome. I try to emphasize that first night that no matter where they work there is a strong possibility that they will encounter people with substance use disorders. They will also if they see substance abusers see mixed in with those clients a lot of people who have emotional or mental health issues.

For those of you, who are not able to take classes of this nature, consider some reading on the topic of substance use disorders, (The A.A. big book is a good place to start.) Also, consider taking a Mental Health First Aid (MHFA) class if one is offered in your area. If there is not one close to you, encourage your local officials to get an MHFA training scheduled for your locale.

Teaching, while enjoyable takes a bit out of my time so the posts may come a little farther apart and the replies to your questions and comments will take a little longer but know that I values all your input and will get back to you all as quickly as I can.

Related articles
  • Are you a Functional Alcoholic? Do you know someone with an Alcohol Use Disorder? (counselorssoapbox.com)
  • How to control your drinking (counselorssoapbox.com)

    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

Pick your grandmas wisely – their life affects your feelings

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

Grandma’s DNA may be affecting you.
Photo courtesy of Pixabay.com

What happened to grandma is affecting your life today.

Not just grandma but great-grandma has an effect on your feelings, even if you never met them, or so we are told. The more we learn about genetics and environment the more complicated it all gets.

We used to think that genes were genes and experiences; well that was what happened to you.  There has been a lot of research on which causes what. Do genes cause addiction and mental illness or do experiences sometimes described as the environment?

We have started to think that genes and experiences are both factors, risk factors for developing an addiction or mental illness. A risk factor does not mean you get the disorder, but it increases your susceptibility. We thought that genes and experiences were separate things.

What if grandma’s experiences became part of her genes?

For a long time, we thought that was not possible, now there is evidence that this may be what has and is happening.

Genes were seen as the blueprint for the way your body and your nervous system would develop. There might be variations, pigmentation for instance; one color was dominant and the other recessive so you get one-half of your genetic material from each parent. Two dominant genes or one dominant and one recessive and you still look like you have the dominant color. Two recessives and you win the different color prize. (In Humans most colors, eyes, hair etc. are the result of multiple genes so it is also more complicated than just dominant and recessive.)

We know environment can affect genes. No matter what your genes say if your grandmother grew up in a time of famine her growth was stunted. We see this in recent immigrants here in the U. S. Grandma is short but her children get more food both before and after birth and they are taller.

So after two or three generations, this family should all be reaching full height. Why then does succeeding generations keep getting taller?

Could grandma’s experience of living through starvation also alter her genes so that for a number of generations her children grow up shorter? Eventually, as time progresses that gene could change back to the full stature that was a potential in the genes but eventually that should stop.

That may not be what is happening genetically.

We were looking at genes as if they were blueprints. Not enough lumber and the house gets built smaller but the blueprints still call for a full-size house. Bringing in more lumber and the next house should match the blueprint. But what if that lack of lumber resulted in a change in the blueprint?

A new field of research, one name for this is Epigenetics, looks at how the way a gene gets expressed, the house is built, in my example, based on the experiences of the parents.

Epigenetics tells us that genes are not constant. They can turn on and off.  So that gene for black hair, that shuts off at some point and the gene begins to produce gray or even white hair. Same person, same genetics, but different hair color.

Research in mice, this is just  beginning to be replicated in human studies, found that in addition to genes and DNA there are other chemicals that can hook onto the gene and then when that gene gets reproduced the add-on gets copied also.

One of these add-ons is a methyl group. So if grandma was traumatized, raped or lived through a violent war. Her DNA could have picked up some extra molecules that shut off those outgoing genes. The result would be that as a result of grandma’s experiences your DNA is changed.

Remember that methyl stuck on is not adding to or changing your DNA, it is preventing some of that DNA from expressing itself. Depending on which part of your DNA it is stuck to, this could be a good thing or a bad thing.

Say your great-grandmother dies when your grandmother was very young. Great-grandfather tried but he was just not able to be affectionate the way great-grandmother would have been. The result is grandma had trouble feeling affection towards your mother.  You mother with a non-affectionate mother would find it hard to show a lot of affection to you.

Some women report that they have difficulty feeling love or nurturing towards their children. Yes they could have learned this but even when they were adopted by a loving adoptive mom these women may as a result of their extra methyl group hooked onto their DNA find it hard to nurture their children.

Now if this concept holds up through more research this may explain how ancestor’s experiences have altered the way our DNA develops and the resulting impact on our mental and emotional health.

My takeaway from this is that while this may explain some things about why we are the way we are this also means that if we learn new things if we have positive experiences our children and grandchildren can be affected by their genes in a very different way. This suggests to me that we need to spend a lot more time on treatment for depressed or anxious children before they have children of their own if we want to have an impact on mental health.

There is a lot of research going on now on mutations in genes. There are a lot more mutations going on than previously thought. But even if a particular mutation increases the risk of a mental illness, what if some early life experiences could counteract that gene and produce a different emotional result?

Let’s hope that it will be possible to help more people as time goes along. For more on this subject check out the article in Discovery Magazine for May 13, 2013, titled “Grandmas Experiences Leave a Mark on Your Genes. 

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

Are the mental health problems in children different?

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

Crying child

Youth mental health.
Photo courtesy of Pixabay.com

Age impacts mental health.

A reader asked “You keep mentioning children in your posts, how are their problems like or different from adult mental illness?

There are some differences between the issues children have and adults, but my experiences tell me that there are a lot of similarities.

We used to have a separate section for “Disorders usually first diagnosed in Infancy, Childhood, and Adolescence, in the DSM-4. In the DSM-5 those disorders get moved around. One problem with the old approach was that many clinicians missed the “Usually” part. We tended to think of these problems as something children get and adult problems as something only adults got.

That just is not so.

Some of these early-onset problems get missed or continue to plague people throughout their lives. Stress-related issues are a good example of this. Reactive Attachment Disorder may be easy to see in a small child but the after-effects can result in a bunch of problems that in adults we usually call by other names.

Just like the child develops, the mental health problems of that child may develop and change with time.

Also, it is very possible for children to develop problems that we used to think were only the providence of adults. Remember that “Happy childhood” myth. There must have been a few people with happy childhoods but there were a lot of people who did not get their ration of that one.

So children can and do suffer from depression, anxiety, stress, trauma, and a host of other adult looking problems.

We currently believe, I think for good reason, that the earlier in life we recognize some of these problems and treat them the better the chance that the person will not grow up to have a severe emotional disorder. That treatment, by the way, need not be medication or prolonged therapy.

Lots of other things can help these children. Anger Management and Parenting classes for unprepared parents also help. So do supportive environments like quality preschool or even grandparents or other supportive adults.

A disclaimer here – my perspective on working with children may be a bit different from other clinicians. My work with children has been largely in crisis settings, these kids were brought in because they said they were suicidal or they were way out of control. The other groups of children I worked with were substance abusing or those brought in for an assessment because someone believed this child has a serious emotional problem or a serious mental illness.

My experiences were with a group of children that may be more seriously affected by society’s problems. As a result, some childhood problems were probably not represented and others were way over-represented.

The problems that bring children to the attention of professionals change as they get older. The 3-year-old who is not talking is a way different problem than a 17-year-old girl who has been abusing drugs and is now suicidal because she found out she is pregnant by her 24-year-old boyfriend.

Both may have been the victims of abuse or neglect, so these very different “symptoms” may stem from the same or similar roots.

As a child gets older the way we should be assessing and the way we treat this “child’s” issues should get more and more like the way we treat adults. Mental health has had problems here for years as I see it. Some clinicians continue to treat adult clients as if they were mentally retarded or little kids.

One day you are 17 and you get the “now little girl” treatment and the next day you are 18 and you get the “grow up” lecture.

One other thing to consider when talking about the difference between adults and youth mental health issues is how to tell the difference between normal adolescent issues and those problems that could be the beginnings of a serious mental health issue. Just being a teen is, in and of itself, not a diagnosis.

Recently I attended a training to get certified as a Youth Mental Health First Aid trainer. I can’t begin to cover all that info here. If the issue of how to recognize mental health problems in young people interests you, you might want to check out that training.

The question about how the treatment approaches may differ between a young person with a disorder and a person who has accumulated more years, presumably an adult, that topic needs a whole other post.

Till next time, David Miller, LMFT, LPCC

Related articles

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 this the year you are going to change?

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

Changing your life

Time for a life change?
Photo courtesy of Pixabay.com

You know you need something to change but what and how?

Lots of New Year’s resolutions. There are every year. But one year from now will be 2015 and just like last time around when we get to New Year’s 2015 some few people will have changed their lives and the majority will be stuck in the same rut they are in now.

Change is hard. Change is easy. You will change whether you want to or not. You will get happier, prouder, and more self-confident or you will get progressively more weighted down by your problems and cares. You will change, eventually. The only questions are the direction in which you will change and when that change will occur.

Intentional change is hard because it takes effort. It can be scary. Change is often uncomfortable if not downright painful. Change means entering the unknown and the things we know are less anxiety-provoking than stepping off in action and making those first tentative moves into the unknown.

Unplanned change is easy. Do nothing and you will change. We get older, no effort required. If we fail to save for retirement we have to cut back on our standard of living. The process of life says that you will change or you begin to decline.

Most of us, when we speak of change are looking for that huge dramatic shift. One day you are poor and then you will win the lottery and be rich. Lasting change does not happen that way.

Yes, some people win the lottery or make a good investment or open a business that succeeds but along the way those things rather than changing that person’s life, are the catalysts that force them to change.

Plenty of people have won the lottery and a few years later they are back to being poor. Anyone can spend like a millionaire but learning to manage money, to hold onto it, and grow it, that is a skill that takes work to develop.

Lots of us have that fairy-tale fantasy, someone will come along, usually a prince or princess, and they will make us happy. That kind of happiness only lasts a moment. Eventually, there are children, bills to pay, and illnesses to suffer through together. The majority of those fairy-tale couples end in divorce when the reality sets in.

Change does not come from the outside it comes from within. As you become emotionally healthier you attract healthier people into your life. If you want a better life, start by working on yourself. Will this make the people in your life suddenly treat you better? No. But as you improve yourself you will find that their opinion of you matters less.

If you want to be wealthier you need to practice the skills wealthier people use to manage their money. Be responsible and pay bills on time. That one late charge, it does not make much difference, but over your bill-paying lifetime, fifty or sixty years of monthly late charges, that amounts to a small fortune.

Increasing your income and reducing your expenses go a long way to changing your financial situation. But this will not happen overnight, not even in a month or a year. Over time the small changes you make add up.

Real lasting change in your life begins on the inside with changing yourself. Change your thoughts and actions and the world around you will begin to change.

Lasting change does not come about as a result of one huge event, it occurs in small incremental steps.

Couples often try to fix what is wrong in their relationship by taking a romantic “honeymoon” type trip, a week at the beach, or in Vegas. Temporarily they see an improvement in their relationship. Most often within a week or two of returning home, they are back to their pre-trip way of interacting and they are just as dissatisfied as before.

Couples who make real improvements in their relationship begin by making changes in the way they interact. Maintaining those changes takes time and practice to have a lasting effect. A good marriage therapist can help you learn and practice those skills.

Many of you have written and told me that you want to change something in your life. You are not happy with the way things are. You have tried to change your life but the change does not seem to take.

I realize that it is easier for professionals to tell someone how to change than it is to actually do the changing. Throughout this year I want to talk with you readers of this blog about how to make those changes you want in your life and how to maintain those changes once you make them.

Stay tuned for some information on the books I am working on. Some things need more words than a blog post can hold.

Much of the information on recovery comes from the extensive literature on drug and alcohol recovery. Alcoholics and Drug Addicts have been recovering for a long time. Some of that information has been applied to people with “co-occurring disorders,” both mental health issues and substance use disorders. What is still in short supply is information that emphasizes the way in which people with emotional and mental health issues recover.

I strongly believe that people with mental health challenges can and do recover. Recovery for them does not necessarily mean that they are cured as if they no longer had ever had that issue, but it does mean that people can have a meaningful life despite their challenges, whatever they chose to call those challenges.

Related articles

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

8 Ways to make the holiday emotionally safe

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

Fall scene

Happy Holidays

Plan now to safeguard yourself in recovery.

The holidays can be stressful times. Recovery, from anxiety, trauma, alcohol or drugs is a precious thing and it takes a lot of work to reach for a recovered life. Keep your recovery and yourself safe this Holiday season by using these tips.

It is easy to get caught up in the “shoulds” and the “musts” and forget to look for the things that will be most helpful to you and your recovery.

Here are some helpful hints for getting through this time of year with your recovery unscathed.

1. Practice saying NO!

There can be a lot of pressure to do and say things that are not good for you. Work on setting healthy boundaries. Tell people no if they try to get you to do things that may be stressful and bad for your recovery.

Learn to tell yourself no also. There is always the temptation to overdo, run about too much, visit too many places, and try to do too much to make this a perfect holiday. Nothing will make the holidays perfect if your recovery unravels.

2. Too much of a good thing is a bad thing.

Even happy times can be stressful. This is especially true if you are recovering from depression, anxiety, or substance abuse. Do not let the good times wear you out and leave you vulnerable to relapse into your particular issue.

Happiness is not a sprint to get to the cookie jar first. A happy life is a long journey of relaxed enjoyment. Trying to put too much pleasure on your plate one day may leave you unable to do the things that might make you happy the next and beyond.

3. Avoid people and places that would undermine your recovery.

Some family is not healthy. Just because they are relatives does not mean you owe it to them to put yourself at risk. Avoid family members who may undermine your mental health. Take a supportive person with you if you will encounter negative people and be prepared to cut your visit short if the stress gets to you or you begin to be overtired.

4. Take exceptional care of yourself.

Get plenty of sleep. Lack of sleep one night can set up the downward spiral that will result in being too emotional wrung out to get up the next day. Overtired can lead to using substances to try to keep going. Cut your sleep short and you are setting yourself up for a relapse.

Drink plenty of water. This reduces the effects of other unhealthy exposures. Being very thirsty sets problem drinkers up to drink alcohol and places people with mental illnesses at risk to drink more than they planned.

Eat healthy food. Avoid excess sugar and take in those calories in moderation. It is a whole lot easier to pass up a few unhealthy treats than it will be to get back in shape in the New Year.

5. Make getting better job one.

Nothing is more important than your recovery. If you have started practices that are furthering your recovery do not put them aside over the holiday season.

Go to the gym, do your journaling, call supportive people. Keep up with your spiritual practice. Prayer and meditation are not tools that should be kept in the drawer this time of year. If you practice mindfulness and meditation make this a do first action.

6. Go for the safe choice first.

Avoid doing things that you “might” be able to handle. Avoid things that are risky and go always for the safe choice first.

Alcoholics should not drop by the bar just to say hi. Do not call people you know will be upsetting.

7. Reach out for help.

Call your support system. If you are a member of a particular fellowship make sure meetings are on your to-do list. Attend religious services if you find this supportive of your recovery.

Every recovering person needs a list of people who are supportive. Make those calls to other recovering people. Sometimes you will find that they needed to hear from you even more than you need to talk with them.

8. Do not push yourself.

Be kind and gentle with yourself. Do not overdo. Do not pile more and more on your plate and expect to get through the holiday season with your recovery intact.

Taking good care of yourself is not being selfish. Be the kind of friend you need. Be your own best friend.

Which of these things do you plan to do? What other techniques have you found that help keeps you safe and in recovery over the holidays?

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

Reactive Attachment Disorder is now a Trauma and Stressor-Related Disorder

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

Words about PTSD

Stress and Trauma. 
Photo courtesy of Pixabay.com

Reactive Attainment is related to Stress and Trauma but how?

We know children can be affected by reactive attachments but now we are wondering if it might underlie some problems of adults. We know what happens to you growing up can shape and affect you for the rest of your life, how much might reactive attachment disorder be contributing to adult mental health issues?

Reactive Attachment Disorder (RAD) used to be a problem relegated to a special section on childhood issues; it has been moved to the Stress and Trauma section of the new DSM-5. Two things to consider – the way in which this childhood problem may be affecting adults and how might this be another case of how much is it affecting adults rather than a simple yes or no question.

Reactive Attachment is a serious problem for very young children as any Child Protective services worker will tell you. We have a fairly good idea of what causes it and some methods of treating it but the long-term consequences seem to get lost when the child reaches the school years and beyond.

Working with adults I see some of these characteristics from time to time. I do not want to minimize the problem in children nor do I think every adult problem should get blamed on childhood experiences. Just the same there are these tendencies we see in adults and I can’t help wondering how many of those adult problems had their roots in childhood experiences.

First the 7 criteria for Reactive Attachment Disorder (very roughly paraphrased from the DSM-5) and along the way some thoughts on how other adult issues may be like this one and may be different from RAD. For the full, precise set of characteristics and diagnostic criteria see the DSM-5.

1. The child is always or almost always is inhibited and withdrawn. They do not go to adults for comfort and when the adult tries they do not appear to be comforted.

2. Low or no social interaction with others, and does not look happy or like they are enjoying themselves. Lots of sadness, irritability, and fear for no good reason.

3. The child has been neglected and did not get their needs met by adults in their life. Parents could not or did not meet the child’s needs or the child moved from caregiver to caregiver so much no pattern of care got off the ground. Group settings with too few adults per child can also cause this.

4. We think the lack of care caused the problem. (This can be the tricky one as we may not know what this person’s care was like way back when.)

5. This is not Autism or something like autism (The DSM lists ways to tell these apart.)

6. This started before age 5.

7. The child is developmentally at least 9 months old.

Now if you got all that you should have a picture of what this neglected (maybe also abused) child might look like. This kid could be a very difficult child to raise. The just sit there and look at you.

Most kids we expect to be cute. Give them a toy to play with and they smile. Hug them and they hug you back. Not the child with RAD. This kid cries for no reason and does not stop when you hold them. They never smile and they are always irritable. They jump at the slightest sound and then refuse your touch when you try to comfort them. Getting the picture?

Now the criteria wants us to see and know all this before 5 years and know that the neglect (or abuse) caused this.

What would this child look like in ten or twenty years as they grow up and for some reason first appear in the mental health system?

What might these symptoms look like if it was not an all or nothing situation? Say the parents worked all the time and the child had to fend for themselves. They moved around a lot and had no friends or close family members?

As this person ages, they might live in various group homes. The caregiver would keep changing. They would develop trust issues. They might believe that you can’t rely on others because they will leave you.

In the teen years, this child might, still angry, irritable, anxious, act out, and get in trouble. These would be the children that blow foster home placements or move from group home to group home. Even if they lived with some family member, grandma or aunt, they would never really get close to that person and eventually, they would “hook up with” a member of the opposite sex and have some more little ones.

Not able to feel cared for they might not be able to care for their own children and they might abuse or neglect the next generation.

While Reactive attachment is an extreme case I think by now you might see how low caregiver contact, abuse, neglect, or frequent changes in living situations could produce some of these characteristics to a greater or lesser degree as the child grows to adulthood.

Not knowing or feeling loved is at the core of these problems.

We may well have been underestimating the effects of lifespan issues in our evaluation of adult mental and emotional issues.

People can and do recover from almost all forms of mental and emotional disorders, but recovery from Reactive Attachment Disorder is a difficult process.

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