Thursday, March 29, 2012

What is trauma?

Trauma is something that leaves a seemingly-indelible mark on you. It can affect your feelings, your thoughts, your sleep, and your relationships. It may even affect how you think of yourself.

Typical examples of trauma include rape and war atrocities. These are but the tip of the iceberg. Bad events from childhood, death of a loved one, threats, bullying, witnessing a crime, domestic violence, specific encounters with scary things (perhaps a big dog), being in a dangerous situation, isolation, sudden break-ups, and medical issues like a surgery or amputation can all be traumatic. The abrupt nature of the event is traumatizing because the victim has no warning, no time to prepare defenses or use coping skills. This leaves a mark on the mind that causes a facet of the mind to attempt to prepare defenses after the fact. When those don't work, the mind becomes confused and attempts to replay the event until the defenses work; they cannot work, as the mind cannot create safety where it was not, and the result is flashbacks (when waking) and nightmares (when asleep).

Typically, in adolescents and adults, trauma manifests itself through crying, sadness, withdrawal, re-experiencing the event as if it were happening again, and nightmares. In children, the symptoms are more varied as children are less adept at compartmentalizing memories and coping with things like flashbacks in a situationally-appropriate way. With children, you find behaviors such as crying, aggression, anger, isolation, nightmares, mood swings, confusion, and irritability. These symptoms may persist the life of the victim, from the time of the trauma on. If these things come up at any time, the issue is not yet cleared and needs to be cleared. Even if "it only hurts when I do this, doctor," the answer is not "well, don't do that," but "let's make it not hurt anymore."

With trauma, the mind's gears grind to a halt and attempt to free themselves by repeatedly forcing the same action. Unlike other mental health issues, trauma is specialized in that the therapist must adjust that facet of the mind that is malfunctioning at the precise point of stuck-ness. This is not done by reliving the experience - or the mind would have done this during a flashback or nightmare. The commonly accepted technique is narrative therapy, which is the retelling and reframing of events so that the victim becomes the hero. This is a bending of the truth - or creating a better truth. A more effective method is Rapid Resolution Treatment. With RRT, you will be talking, laughing, losing stock in Kleenex, and staying present, in the moment, while telling - but not living - the experience, with the kinds of emotions you would have in an everyday conversation.

If you are interested in clearing your trauma, or want to refer someone you know, you can call 954-612-9553 and make an appointment in my Weston, Florida office. Trauma is my specialty, and can be easily cleared in 2 sessions, or about 4 hours. (Just as a comparison, narrative therapy takes about an hour a week for about 8 months.) If you do not live locally, I do travel frequently, and may be able to make arrangements to come to you, but the price will be significantly higher. Instead, you may find an RRT therapist in the US and Canada at the Institute for Rapid Trauma Resolution.

Wednesday, March 28, 2012

Have a Great Family Trip

Every family loves the idea of taking a bonding vacation together. But the logistics, a sour experience from the past, or witnessing meltdowns of kids around you may inhibit you from planning that dream vacation. Plan your trip with these simple tips and inspire others with your great fun!

Start small.
Maybe a trip to a theme park would be a lot of fun, but you've never even had your kids out in public for more than a few hours at a time. Start with a trip to the park for a couple of hours. Once they can tolerate that well, plan  a half day at the zoo. Move up to a full day of adventuring at 2 locations, and so forth. This will give you a threshold to know how much your kids can take at once. Maybe they need frequent breaks so they don't become overstimulated. Maybe crowds make them (or you) cranky. Once you have tested the waters a few times, you will know how deep the pool is and can dive in.

Consider the age of your children.
What would they enjoy? What will the whole family enjoy together - even if you have to split the time up between bigger kids and smaller kids. Who is able to ride thrill rides and who needs a lap to sit in? What are your child's fears? Do they run from people in costumes? Do they not like the dark or loud noises? Consider these factors to avoid consoling a crying or screaming child. After all, you want wonderful memories for all of you, including the parents feeling awake, alert, and happy! If you have children with a significant age gap, to where the older ones are more independent, consider allowing a friend to come along.

Plan around their schedule, whenever possible.
Children are frequently creatures of habit. Try to maintain their usual sleep and waking schedules. Plan around naps, even if it means you go back to the hotel for a couple of hours mid-day. Try to keep their foods similar to what they are used to (not too much sugar), and around the same times they normally eat. A hungry child may not tell you they need food, but will show you with tears or agitation. Consider the stamina of your child. Consider also what entertainment is available at your hotel. Is there a pool or a playground? Maybe your kids would like to enjoy the park for the first half of the day, have a nap and lunch at the hotel (kinder on the budget), and run around at the playground or wading pool in the later part of the day, and watch a movie by the pool at dark. Trying to pack everything in will run you all ragged and no one will enjoy that.

Bring help, if you need it.
There is no shame in asking for help. If you think that taking 3 children to Universal Studios will be too much for you and spouse alone, bring an adult friend to act as an extra set of eyes and hands. Do consider this a paid favor, and offer to pay for park entrance, if not the whole trip. (See answers to this kind of question and submit your own at Clear Etiquette.)

Plan ahead.
There are theme park maps available online and you can see what you might find fun or what you might skip. You can ask each child to pick 1 or 2 things they absolutely want to do and make sure to include those so they are part of the planning process and can look forward to their special featured item. Caution: do not use the removal of these items as punishment! This kind of bait-and-switch destroys trust. If you said you would go see a show, go and see it, no matter the child's behavior. After all, they've been planning this trip, too.

Monday, March 19, 2012

Why pay cash?

I don't take any insurance. This benefits my clients in ways they may not know. Today's blog is meant to shed light on this subject.

Insurance companies are often not up-to-date. Most therapists get the majority of their referrals through insurance companies. Certainly, it seems more economical to call up your insurance company, ask for a local practitioner, and go there. Also, the insurance company keeps (you hope) a record of the practitioner's standing - licensure, malpractice, etc. Most will, yes, but some won't require that information to be updated too often, and many will never look into any claims against the license, such as lawsuits.

Insurance companies do not recognize hypnotherapy. As a Certified Clinical Hypnotherapist, and Certified Practitioner of Rapid Resolution Therapy, I can clear up most issues in just a couple of sessions. I charge you one rate for the issue, and we lay out the sessions in advance by a free phone consultation. Traditional therapy drags on and on with a loose treatment plan generally developed in the second session. This means you will be paying for 2 sessions before even having an idea of how long your issue might take to resolve. If insurance companies recognized hypnotherapy as worthy and viable, I might accept insurance for those companies, but at this time, they do not to my knowledge. They would rather pay for months of sessions than a single price for the issue. I would rather return you to your happy life quickly.

Insurance ultimately costs more. If you come in for a standard issue, like trauma, and I charge you $500 for 4 hours of therapy to broken up over 2 sessions, it is less expensive than seeing you for the same issue using traditional therapy each week for $90 . Even if your insurance company pays me $40, you would be responsible for the difference of $50 plus your $20 copayment. That is unreasonable. Even if you took out the difference, and I agreed to lower my rate for your insurance company (which is standard practice, despite how much it costs to get the degree for this level of care), you'd still be paying a $20 copay weekly for 6-9 months. In 6 months, it'd be about the same price as paying it all at once, but you'd have 5 months of living with your problem, plus gas and time. I think your time and happiness are worth far more than that. Also, when I bill insurance, claiming that money take me more time and energy, which I would also have to pass on to you through higher rates.

Insurance companies want your information. I have done medical billing for therapy and know, intimately, the details they insurance companies request. They want your diagnosis (this includes any substance abuse, even if not the treating issue), your risk level (are you at suicide risk because of your depression, for instance), and often want copies of session notes that verify these factors. I feel your information is private and should remain so. If you sue and we go to court, your notes can be turned over, but until then, they are between you and me, and whomever you want them released to, if anyone. I feel you may come in for an issue, like having been the victim of rape, and want to address that without discussing the fact that you may also suffer from some situation depression due to a job loss and be using daily marijuana to cope with that. I will certainly recommend you deal with each issue, but does your insurance company - and thus your employer or the military, or life insurance company - need to know that you are using substances? Certainly not.

My qualifications:
  • I am a Licensed Mental Health Counselor. (LMHC)
  • I am a Certified Clinical Hypnotherapist. (CHt)
  • I am a Certified Practitioner of Rapid Resolution Therapy. 

Unbiased proof:
  • I carry malpractice insurance. 
  • I do continuing education every year - often many times per year - to keep learning new techniques.
  • I also do continuing education to keep up my hypnotherapist status for 2 different boards.
  • I get mentorship and guidance at bimonthly conference calls. This is not required.
  • I subscribe to 3 counseling periodicals, and read them cover to cover. 
  • I am an active member of the American Counseling Association. 
  • I am an active Provider for ChildNet.
  • I am an active member of the Greater Hollywood Chamber of Commerce.

Tuesday, March 13, 2012

International Trauma

Today's blog is short, but features links you might find interesting from all around the world.

For more on any story, click the links included.

  • Irish Health reports that Northern Ireland has the highest level of PTSD of the 30 countries studied.
  • Adelaide Now reports police offers in Australia are getting more help due to the trauma of the situations they 
  • encounter.
  • The Press echoes that sentiment in New Zealand, as well as for civilians after the Canterbury earthquake in February.
  • ABS CBN News reported that trauma counselors were sent to the Phillippines after the flash floods in December.
  • Voice of America has published a new book for Cambodians who survived the Khmer Rouge to assist in dealing with traumatic affects.

Wednesday, March 7, 2012

Breaking Through

There are those moments in one's career that bring things all together.

In December 2010, I was working for an outpatient substance abuse clinic, seeing adults for individual and group therapy who had been using drugs or alcohol, generally for a great many years. Substance abuse is a funny thing in that it's not generally the addiction that you're treating, but all the stuff that was done that fed the addiction - the lying, stealing, prostitution, homelessness, death, and loss of trust. There's a lot of guilt and shame in substance abuse, especially long-term use, that needs treating so those issues don't become reasons for using again.

Specializing in trauma, also prevalent in substance abuse, I attended a training for trauma and hypnotherapy. I was a self-taught hypnotist, but did not practice it. I thought it would be a good fit for me, and boy was I right! Knowing nothing of the training, the methods, or the trainer, I signed up for level 1 at what, to me, was a pretty hefty out-of-pocket price. There was so much information thrown at me that I went home after each of the three long days of training with my head swimming. Rapid Resolution Therapy is a way of conceptualizing a case through the lens of how you see the person as if they were to walk out your door completely free of their burdens. This seems like what every therapist should be doing with every case, right? But we're never taught that in college - at least I wasn't. Once you start seeing clients as whole and fixed, it it's just a matter of getting them there; but that is in Level 2, which I immediately signed up to attend.

I went home from that training, eager to try out the things I'd learned and start seeing my clients as resolved. Into my office that first week came an older-looking gentleman that we'll call Earl. Earl looked about 70, but was only in his mid-50s. He'd been using crack for over 20 years steadily and was referred by the justice system. My job was to get Earl to answer a grueling 2-hour questionnaire on his history of substance abuse and mental health issues. The more of the story he could give me, the faster I could make it go, but Earl was stonewalling me at every turn with yes and no answers, and sometimes just a steady silence. Working in community mental health is always a balance between getting the mountainous job down quickly and really getting the good work done. I needed Earl to go more quickly, but pressing him wasn't going to get me anywhere. I turned aside from the computer and said "Earl, I know the court's making you come here, and you're trying to get yourself out of trouble, but if you could change one thing about your situation, what would you want to do? How can I best help you to get where you want to be?" Earl looked at me for a long while, saying nothing. You could see his gears turning. As a trained therapist with almost a decade under my belt, I was going to ride out his silence - and if the questionnaire didn't get finished in time, we'd reschedule and I'd own that to my supervisor.

Then something happened, as we sat there in silence, sizing each other up. Earl broke down crying. "Miss Autumn," he said, "do you really care?" "Earl," I told him, "you're stonewalling me left and right. I see you have a lot of defenses up and I don't know why, but it's not going to do either of us any good. There's something going on with you that you're here for, not just court. If you're willing to tell me what it is, I'm willing to help see you through it." He looked at me again, a hard clear look and began to tell me about his daughter who was "about your age", though she was about 10 years younger (I get that a lot) who hadn't spoken to him in years due to his drug use, lying, and stealing. "I stole from my family," Earl said simply, and it was clearly the worst thing he could think to ever do. I helped Earl see himself as free from drugs, as clear of mind, as happy and himself again. We finished the questionnaire in record time. "I don't know what you did to me, Miss Autumn, because I don't tell nobody about my daughter, my life." But he left smiling.

Thursday, March 1, 2012

Depression, Common but NOT Normal

Q. What causes clinical depression?
A. Chemical imbalance.

Surprised by the simplicity of the answer? Were you expecting a list of things like: death of a loved one, change of circumstances, lack of resources, inability to participate in previously enjoyable activities, illness, and so forth? Certainly, a feeling of sadness or (more severely) depression could be common after any of those items, but would it be necessary? No. You could be ill but not sad. You could even have terminal illness and not be sad. Perhaps it changes your entire outlook on living and you relish each hour, doing new and profoundly significant things you'd never attempted before. The perception that sadness, and depression, are caused by these events are just plain wrong. Is it common for people to feel sad in the face of that stuff? Yes. But is is normal, no. Depression is not normal, especially clinical depression, or diagnosable depression. However, according to the Mental Health Association, 43% of people think depression is normal. They're wrong. Let's educate those 43% to the truth.

If you get nothing else out of this, understand that: While a clinical-grade depression after a precipitating event can be considered common, it is not ever considered normal.

Okay, so now everyone who's depressed is abnormal? No, of course not. But the depression itself, as a severe reaction (severe enough to be considered diagnosable, to be more than "sad"), is abnormal, yes.

Depression is caused by chemical imbalance. When a person reacts to stressors, there is an increase in cortical fluid. This increase effects the entire body. It can cause an increase in cholesterol, an increase in heart rate and respiration, an increase in blood pressure, a thickening of the blood, and so forth in persons with medical conditions or medical predispositions. This is your perfectly normal person, now with possibly blood pressure and cholesterol issues, and a general crummy feeling from the cortisone, just because of stress. This is why managing daily stress is important. The brain is a part of the body and as such needs to be treated appropriately and medically at times.

What happens in the body of a person with medical conditions?

  • A person who has a heart attack and is given a good prognosis and sent home will be 3-4% more likely to die in 6 months if they also have clinical depression.
  • A person who has a stroke can have personality changes if they also have depression at the time of the stroke.
  • A stroke victim who also has depression generally takes 10 extra months in rehabilitation (closer to a year, than the non-depressed person who takes an average of 2 months to rehabilitate).
  • Some medications, like cancer medications can cause the kind of cortical imbalance that leads to depression. Extra caution must be taken with these patients.
  • Similarly, diabetes causes changes in the body that can cause clinical depression, and vice versa. Depressed people are more likely to develop the lifelong diagnosis of diabetes, and all the lifestyle changes that come with it.
  • Dementia may be over-diagnosed in the elderly because there is a such thing as delusional depression, and it may be under-diagnosed as a result of dementia diagnoses.
  • People with Parkinson's Disorder are more likely to have increased problems with movement and decreased concentration or ability to make decisions if they also have clinical depression.
  • People with clinical depression are more likely to have comorbid back ache and gastrointestinal problems, which may or may not be psychosomatic. 
  • Fibromyalgia shares the same symptoms and treatments as clinical depression. 

Q. Okay, so what can I do with this information?
A. Manage your daily stress in ways that keep your cortical levels...level.

  • Exercise daily; even a 10-minute walk helps. 
  • Do something fun; again, 10 minutes of a puzzle book or reading or talking to a friend on the phone or petting an animal. 
  • Eat well with lots of fresh foods like veggies and fruits and limit the junky stuff. 
  • Sleep properly on a steady routine. 
  • Work toward goals; even little stuff like learning something new or finishing up a project. Looking forward has tremendous effects whereas looking behind you generally is detrimental. 
  • Connect with something beyond yourself, whether that's spirituality, religion, or community involvement through volunteer work.
  • Seek help. If you need help getting/staying on track, I can do that. If you need help reaching out, I'm happy to do that with you, hooking you up with volunteer organizations, and so forth. If you want to correct any sadness that you're having, we can get that done, too; quickly and painlessly!
  • If you see someone who seems to have some sadness or depressive symptoms, refer them for help and a good daily regiment to keep their cortical levels in tact. You may just be saving a life.