Substance Use and The Myth of Hitting Bottom

It has been said time and time again by people in the media, the entertainment world that a person who abuses substances "must hit bottom in order to get better". While this could be true for some, I don't believe it is the rule.
I believe that an all or nothing statement like that is dangerous and harmful. First of all, if you wait for this to happen, the person may end up in a body bag. This person, which had potential, now has lost their life just because the people around him waited for them to hit the rick bottom. I remind friends and family members that if this happened because they waited for the "rock bottom" how would they actually feel.
Secondly, I have yet to hear a good definition of what is the rock bottom. Is it listing their family, friends, houses, jobs, freedom, all of this (another all or nothing statement) some of it, or something else. In my experience, I have seen most of these in some way, shape, or form. I have seen people change their use after losing one of these or many of these even all of these. Yet, others have lost all these things and continued their use. Saying something like "hitting rock bottom" is not only dangerous, its a fallacy.
So the obvious question is: how do you treat substance use? Well, just like any medical and mental health,  there are several solutions. Always engaging the individual is probably the only universal answer. Talk to the person each day. If they are annoyed, walk away. Lecturing is useless. I think you just ask how they are. When you speak to them, they feel like you care enough. Not caring is exactly what they think you feel so avoid not caring, it feeds into their thought process. 
And a point on engagement: don't yes them, don't over engage and certainly do not offer money. If they get mad, walk away. You are not there to rescue, just to be there. Reflect what they say, summarize what they said, ask open ended questions, and show empathy. These are all motivational interviewing techniques that family, friends, neighbors can use. It avoids many of the pitfalls described above and makes the person feel engaged by people around them.
Using these techniques avoids the "hitting bottom" paradigm and leaves hope both for the individual and the people around him.

One Mission’s Kid’s Cancer Buzz-Off

One Mission’s Kid’s Cancer Buzz-Off I don't usually make these requests but I am working on this very important cause. Please give anything. As you know, cancer has touched most people in one way or the other. As a counselor, I have seen the toll cancewr has on family, specifically when young kids are involved. The psychological impact is immense. This cause is very important to me.

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.