Mental Health Awareness Month

Just a quick post. May is Mental Health Awareness month.  I think Dr. Drew (whether you like him or not) said it best: why is it that we can talk about any illnesses below the neck but anything above the neck, people look away, tell you to "get over it", or don't want to talk about it?
The shame that mental health still causes is a huge problem in this country. We need to get mental health diagnosis out of the dark and into the light. Accepting it is the best way to address it. If you are ashamed, embarrassed, or do not talk to someone about it, it will not get better. Does cancer, heart issues, or any other physical health concern just go away by ignoring it?
Mental health is as important as any physical health issues. Address it, find the proper treatment, feel better. Easy enough?  

The Emotional Brain versus the Intellectual Brain

I have been a cognitive behavioral therapist since I started in this field and I am proud to say that I was trained at Assumption College, which also houses the Aaron T. Beck Institute in the US. I have worked on many aspects of CBT since I started being interested in psychology. I am, however, open to different ways of working with different theories. While I do not necessarily consider myself eccletic, I do embrace several types of counseling theories, including humanistic, behavioral, psychoanalytic, and gestalt. One thing that is not ways considered in counseling is the biological aspect of our bodies. One of the things I usually remind people is that the two spheres of our brain work differently and sometimes does not communicate efficiently.
It is believed that the left side of the brain is the "logical" side, the sides that uses logic, mathematical skills as well as verbal skills. The right side of the brain is considered the "emotional" side, where creativity, emotions, and imagination takes place. A few observations here: our language skills are in the right side of the brain  so it can explain why sometimes, it is hard to put into words how we feel. That is also probably why our language is more simple when emotions are "making" us talk. It also explains why, when we are in our "right" mind, we might actually be more emotional than logical! But I digress.
I have encountered multiple times in my sessions people telling me that they "know" and understand why things need to be a certain way but that they cannot feel it. An example is when we know a person is bad fr us "logically" but we cannot separate ourselves emotionally. It is a difficult process. That is why people develop strange attachment to "bad people" in their lives: they know it is not logical but it feels good. We do not always process logic and emotions at the same time and when you know that they are located in different hemispheres, it kind of makes sense.
Now let's add gender differences into that. At the risk of sounding "sexist", here is another biological fact (although disputed in recent years, including one meta-analysis): The Corpus Collosum, the bundle of nerves that lies between the right side of our brain and the left side has been found in some studies to be thicker or heavier in females than males. This could explain why some women tend to be able to process information both on an emotional level, as well as a logical level more effectively than men. As an observer, I find that men tend to be "over-logical" on certain things and "over-emotional" on others. More often, men will tell you how they feel and will struggle to shift even if you present logical facts. It seems to also hold true, in my opinion, on logic. A man will logically make sense of a problem and will be able to remove themselves emotionally from that decision. Women tend to balance these two things better, however, I also find that the examples I gave about men is not unheard of for women also. I think it also goes back to the fact that an emotionally charged subjects remains emotionally charged and it is sometimes harder to find the logic behind it. As you can see, biologally also plays a big role in our mental health.
I guess that is why I embrace CBT: it tries to make sense of our emotions. A balancing act that is not easy for anyone.

Thank you for a great 2012!

It has been a full year in private practice. I have been fortunate enough to get many great referrals from many different sources (20 to be exact!). I did not think I would be where I am 1 year ago. I have enjoyed my work with everyone of my clients in the past year and every single one of them have made me grow as a therapist and as a person. I am grateful for that.
I think that counseling is a two way street: as a counselor, I am paid to help individuals change some cognitive processes, to embrace change, to learn how to get in touch with their emotions, to look at how engaging in use of substances can be detrimental to them, as well as reach out spiritually. This is a privilege in my opinion and having anyone open up on these difficult subjects will always be treated with the up most respect and decency. That is why I let individuals ask questions about me if they feel like it. I think that we need to show how we value their vulnerability and answering some questions, to me, is not unethical but a great relationship builder. Do I answer all questions? No, but I also look at the situation, person, and value of that information to the therapeutic relationship to make sure not to damage it.
I also sent out a survey to both my clients (current and former clients) and providers in the area. I wanted to get an idea of the source of my referrals, why individuals are coming to counseling,and, very importantly, are they satisfied. From my client list, 23% of the actually completed the survey. The survey indicates that individuals come to counseling for mental health issues (57%) and anger management (28%).  Gender and location are the two main reasons a person came to counseling. (83%) of individuals report that they feel I listen extremely or very well. All are satisfied with their therapist and would recommend his work. 84% are college educated.
As for my colleagues who referred individuals to me, 83% of the providers surveyed (13 total) made referrals to me. 91% made referrals due to my expertise, 41% made referrals related to geographical location, while gender of therapist and insurance were considered 25% of the time. 91% stated that they knew me from previous interactions. 83% stated they would definitely make referrals again.
The conclusion? Clients appeared satisfied with my work, both would recommend my work, and gender and location are very important. Thank you again and all feedback is desired and accepted.

Bonne Annee 2013

Bonjour a tous les cousins Francais qui lisent ma page. J'aimerais savoir pourquoi j'ai un grande nombre de Francais qui lisent mon blogue? S'il vous plait, laisser moi savoir en laissant vos commentaires. Merci et Bonne Annee 2013. _______________________________________________________________________________________ Hello everyone. I have had many hits from people in France. Being French-Canadian, I consider them "cousins" and would love to know about their interest in my blogue. Hopefully, I will get comments from them. Thank you and have a great 2013!

The NFL's Missed Opportunities To Address Important Issues

A week ago, a Kansas City Chief Linebacker was involved in a murder-suicide that both stunned and saddened the sports world and the media in general. It was condemned by many, captured the attention of the population, and upset many. The NFL, using their regular "See no evil, Heard no evil" stance, played the game the next day with a brief mention of victims of domestic violence. By doing so, they missed a huge opportunity to address 3 important issues that this incident raised. While they mentioned domestic violence, they failed to raise awareness on the subject. Not all domestic violence issues end this dramatically, but recognizing that it happens more often than most people think and that it happens in many "happy relationships" should have been done. Domestic violence can be subtle (emotional, financial) and not so subtle. Using this incident to take a stance on this subject and doing public service announcements would have shown more caring by the NFL. I am still appalled by the fact that they actually played the football game the next day. Not only did this incident create instant grief for all the players and the people affected by this act, what is being neglected is that the two people, including the Chiefs' coach, Romeo Crennel, saw a man kill himself. No one will ever know how he feels except for Mr.Crennel, but the general consensus is that, if someone you know commits suicide, and that you were one of the last people to speak to them, you have many severe symptoms that take time to heal. These symptoms include intrusive thoughts, hyper-arousal, and avoidance and/or numbing. This is usually called Post Traumatic Stress Disorder and this MEDICAL condition takes time to heal. Not 24-48 hour. Again, the NFL missed an opportunity to recognize this condition, give time to the team and especially Crennel and Scott Pioli who were, by many accounts, the last two to talk to this player before he committed suicide. Mental health issues are as important as any other medical issues and need to be recognize as such. Again, the NFL could have used this opportunity to recognize these issues, not only for grief, PTSD, but also possible Depression, which may have caused this unthinkable act. What about all this talk about Traumatic Brain Injury (TBI)? How do you know that TBI had nothing to do with this incident? This player did shoot himself in the head but the NFL has long neglected brain injury and their occurrence. What a great opportunity to increase awareness about this issue and state something about increase studies need to be done on this issue. Right now, by saying nothing, some people may say that they know something about the constant contact in this sport causing head injuries but they are trying to hide something. Put it out there, look for a solution. This player may not have had a TBI but use this as an opportunity. I want to also mention a final issue the NFL can address: This may not be the same incident but it's worth mentioning. Friday, a Dallas Cowboys' player was killed by another player driving apparently under the influence of alcohol. This same player was on probation recently for a DUI. When a player has been arrested for substance issues, why are they more supported? Where is the prevention? Substance abuse issues, as well as treatment is left to the legal system and not by a support system. Why not? Again, an opportunity to bring up an issue that is a very big problem in America. The NFL has had many opportunities to address domestic, mental health, substance use issues, as well as traumatic brain injuries, all issues that have plagued the league in several off field issues. It is sad that the NFL continues to ignore these issues...they will just keep on showing up. Acknowledging these things would go a long way for the league, fans, and the public in general.

Medical Treatment: More Legitimate than Mental Health and Substance Use Treatment?

Let me start off by saying that I believe medical, spiritual, and behavioral health are all linked. It is very naive to think that they are not.

One of my first questions when someone comes into my practice relates to medical issues, especially when nothing is indicated about their health. I think that, before you treat someone for mental health and substance abuse, you need to make sure nothing else is going on medically. Think about hypo or hyper thyroidism. That can affect your mood in a huge way. Diabetes, when not treated, can affect your judgement in a huge way. A traumatic brain injury can also appear to be many different mental health conditions. A physical is essential before treatment.

I also want to know about the length of their sobriety if someone has had substance use issues. A person who has been sober for less than 90 days is still dealing with the mental and physical readjustment of their body to this detoxification. You may be going through psychological withdrawal and, in my experience, the mourning phase of their sobriety. Saying goodbye to substances is a huge stress on you, especially emotionally and physically.
During these first sessions, some individuals are looking for "answers" and " a cure" to their emotional ailments. After all, medical doctors usually have a quick answer to what is wrong, usually in the form of medications. Why can't counseling do the same thing? That is usually when we have a discussion about how therapy is indeed not an exact science.

It is also at this time I discuss two points: first of all addiction and mental health has only been around for 150 years. It is, in many ways, in its infancy. It has come a long way during this time and does have lots of research that backs up certain treatments for several ailments, including CBT for mood disorders, EMDR for trauma, motivational interviewing for substance use, among many others. Psychophamacology, or meds, has also been well research and has proven beneficial for many mental health issues.

"But how do they (doctors) know what meds will help me? I've been told many names so which one is for me?" We usually than talk about how different body chemistry react differently to different medications. "So they don't know? That is why this psycho babble stuff doesn't work". I use to react negatively to these type of statements but I got to thinking about medical issues.

Is there only one treatment for diabetes? Is there only one cancer "cure"? What about heart conditions or cholesterol issues? Of course not. Medical professionals also explore different options, which includes behavior modifications for some of these ailments, including diet and exercise.  And we usually discuss at length these points and how behavioral changes may be the only thing needed to a combo of both pharmacological and behavioral change to even just a medication exploration only . I find that many individuals are moved by that argument and seem to understand why different medications and treatments can/should be explored before settling to only a few of them.

Is medical treatment better than mental health and substance use treatment? I believe that, once explained, they are more similar than one might think.

The "Right" Emotion

In counseling, we often here different assessments of emotions. One that I have heard more frequently in the last few weeks is how some emotions are better or "more right" than others.

I hear about it in different contexts. The first one is "What is the right emotion?" Let's look at this in the grieving process. The "correct" emotion according to many is sadness. We have no right to be angry, right? I challenge this by saying "Why not?". Elizabeth Kubler-Ross discussed the 5 stages of grief and included anger. While I don't completely agree with the stages of grief, I do believe there is more than one emotion that is acceptable or "right". Going through this "sequence" of emotions is not only healthy but probably a way to adjust to this loss.

When someone "wrongs" you or when they are "obviously", why would the only "right" emotion be anger? We see this in various situations: when we are driving, when we are disagreeing with "moral" issues, as well as politics, the workplace, and in our close relationships. While anger is probably very normal, Buddhists beliefs state that displaying an emotion of compassion and even sadness is probably ideal. This sounds probably counter-intuitive, but think about it: if we were able to use empathy and caring for what someone else believes/states/does, wouldn't this frustrating situation feel a whole lot easier to accept?

I also think that CBT is again one of the best theory to explain the distortion stated in the title. One of these cognitive distortions is emotional reasoning. This distortion states that if you feel a certain way, it must be true and, therefore, it is the ultimate truth. Any other emotions must be wrong. Looking at this objectively, have you "always" been right in your emotions? Think about it: the anger you have felt has sometimes felt out of place, right? What about your happiness about an event when it affects other people? We may argue that our emotion is right, but thinking it through is important.

You must also look at labeling as the other cognitive distortion involved in this "right emotion" concept. Related to overgeneralization, when we label a situation that can be emotionally charged a certain way, may make it difficult to change our view of our emotion. It makes our view of our situation feel "righteous" and also less flexible to change.

Emotions are tricky, as they emerge from the primitive part of our brain, the amygdala, which in animals, controls the "love-hate" reaction to any particular stimulus. Thankfully, in humans, we have a large cerebral cortex which helps us process emotions and situations in a more analytical way. When it comes to these types of extreme emotions, I try to work on perception and how they can be wrong. When I have individuals who struggle with that, I like to show them a Dali, an Escher, or an optical illusion to demonstrate the importance of seeing things differently.

Is there a right emotion? I still don't know the answer to that question. We can only hope to validate that many emotions are acceptable in any given situation.