College: A Generation at Risk

A College diploma is a goal for millions of Americans, yet graduation rates have never been lower and those who do graduate take 6 years on average compared to the 4 years of previous generations.  Recent research has helped us understand that these dismal outcomes are not because students cannot handle the coursework, because the vast majority of students can grasp the academic content; rather mental health issues are now the prominent struggle in College.   

The statistics tell a rather grim story at first glance.  A study by the APA in 2017 found 

86% of students with psychological and learning challenges left school without a diploma. The CDC discovered that suicide is currently the 2nd leading cause of death among college students and this year, WHO found that 1 in 20 full-time college students have seriously considered suicide. 

There is one statistic, however, that gives hope to these startling facts.  94% of high school students with emotional and learning differences receive some form of assistance. In contrast, only 17% of college students with the same challenges do so.  The remaining 74% still need assistance in navigating the new world of College life, but faced with logistical and financial constraints, Colleges will have to adapt quickly when it comes to providing services for the mental health of its students.  Currently, there is a nation-wide average of 2,500 students for every one counselor and this clearly isn’t enough. 

The good news, if you or someone you know needs help while in school, there are a couple of private and non-profit companies filling the gap in the state of Utah so please reach out for hope, healing, and help. 

Originally published on http://utvalleywellness.com/

The Impact of Borderline Personality Disorder on Relationships

All too often, family members, friends, fellow employees, and even therapists become reactive, judgmental, and walk on eggshells when they interact with someone who displays characteristics of borderline personality disorder.  Let me start off by summarizing some of the core characteristics of the disorder, specifically focusing on those traits which play out in the interactions with others.

  1. Affective Instability – This is where those with BPD struggle to regulate their emotions in predictable ways.  Often, their mood does not match with expected life or social situations, thus making it difficult for those around them to understand or relate to the distress they are experiencing.
  2. Fear of real or imagined abandonment – Those struggling with BPD are often afraid of being rejected, abandoned, or left alone emotionally. These feelings are triggered when the potential abandonment is indicated, as well as times where it isn’t.
  3. Identity disturbance – It can be difficult for those with BPD to maintain a consistent sense of self. There is typically a variance of self-doubt, instability in self-image, and self-acceptance.
  4. Impulsivity – Due to the emotional and personal instability, impulsivity is often a regular occurrence for those with BPD. While this may not feel disruptive for the individual, it can be highly disruptive for those around them.
  5. Paranoid ideation and dissociative symptoms – In certain situations, those with BPD may struggle with feeling paranoid, especially in relation to how they perceive other’s intentions or motives. Also, they may experience dissociative symptoms, which is a disconnect from themselves, their reality, or their sense of self.

What we need to understand about personality disorders is that they are just that, disorders which occur within the core personality of the individual.  This is important to consider, because it is extremely threatening to the individual when a personality disorder is suggested, or when a diagnosis is made, especially since it is difficult to be “objective” about your own personality.  Because of this, it can be very threatening for someone experiencing symptoms of BPD to identify and accept that the symptoms are present in their life.

It is my professional belief that the symptoms of BPD are treatable, and that through treatment, people can reduce the identified symptoms to the degree that they no longer qualify for the diagnosis.  This perspective can bring hope to those struggling with BPD, as well as those who are involved in their life.  However, the process of therapy can be challenging, and typically requires long-term treatment.

Selecting a therapist who can treat BPD effectively is an important step in the process.  The therapist must be able to accurately diagnose the disorder, as well as position themselves in the therapeutic relationship as to control for and manage the identified symptoms.  A careful balance between soliciting BPD symptoms and maintaining safety and security within the therapeutic relationship is critical.  Failure to challenge the BPD symptoms results in no change, while doing so without carefully creating a safe therapeutic relationship will typically result in early or even immediate rejection on the part of the client.

Once someone with BPD can effectively accept the diagnosis, identify how the symptoms play out in their life, and learn new ways of managing and responding to the symptoms, then they can focus on the primary relationships in their life, and work on how they relate to others in new ways.

Written by Dr. Tony Alonzo, DMFT, LMFT, CFLE therapist at the Holladay Center for Couples and Families

Boundaries With Others – How To Set Them

When you’re trying to create boundaries with people they will be tested. It’s like when cows enter a new pasture, they will knock their shoulder against the perimeter a few times to check out where their boundaries are and how strong they are. Cows are strong enough to take down barbed wire if they really wanted to, but they aren’t really testing if they can get out, they are testing if they are safe from the external world. Once they know that the boundaries are consistent and stable they feel safe and they graze in the middle. If the cows don’t have that consistent boundary they will rely on the cowboy to tell them when they have gone too far. The cowboy, however, doesn’t have consistent boundaries, they will only correct the cow when they notice the cow has gone too far, which doesn’t create a feeling of safety. People are the same when they have never experienced consistent boundaries, or they are experiencing new boundaries. People will test boundaries, not enough to break them but enough to trust that they are there to stay and to trust that they are there to keep them safe.

A lot of young adults who never experienced boundaries, because their parents wanted to be their friend. They have a great relationship with their parents, but they will tell me that they feel like they grew up as an orphan because they don’t have a secure home base. but they will tell me that they are afraid to explore and take risks as an adult because they can’t trust that they have parents who are watching out for them, to make sure they don’t make a mistake big enough to ruin their entire life.

It’s important that people are given the space to grow and find their own solutions within appropriate limits. When your setting limits the goal is not to get a specific outcome, rather the goal is to prevent a specific outcome. It is quite spectacular what people can come up with when their possibilities aren’t limited, but just the same we don’t want anyone hurting themselves or others in the process. Limits are set to prevent irreversible and/or irreplaceable damage, while still allowing people to learn how to cope with and improve from mistakes.

When cattle are being herded they have the instinct to turn around when they feel blocked, which can be disruptive to the flow and requires more work to redirect them back into the flow. To redirect a cow, you want them to feel pressure on their shoulder. If you are in front of them when you apply this pressure they feel blocked, if you are beside them when you apply this pressure they will simply turn a bit from where they shouldn’t be. People are the same, when they are told to stop doing what they are doing (and they don’t continue trampling over you) they will do a complete turnaround, even if this wasn’t your intention. If you’re only wanting a slight redirection from a no-go zone you want to adjust your approach to let them know that you understand that they want to move forward, and you want that too, but you want them going forward in a slightly different direction.

Written by Madison Price, MA, LAMFT – therapist at the Holladay Center for Couples and Families

 

“C”ommunicating with Our Teenagers

We cannot NOT communicate. – Ray Birdwhistell 

Everything we do communicates something. It has been estimated that between 67-94% of our communication is nonverbal. What is non-verbal communication, you ask? It is everything except the words. It could be a grunt, a smile, a sigh, our smell, our jewelry, our clothes, whistling, the way we comb our hair, tattoos, the way we cook our food, piercings or the lack thereof, our posture, the nuances and history of a relationship, a stare at our son, a gaze at a pretty girl, the way we walk, our mode of transportation, hand gestures, or making googly eyes and funny sounds at a baby. We may say something, but our true intentions frequently will leak through our nonverbal behavior.  

The tone, the attitude behind the words when you ask your son to do something, communicates a whole lot more than the words that you verbally say. It is the attitude that he will respond to, not merely the words. Everything communicates. That is why the “C” in the title of this article is so large. Everything communicates something. We cannot NOT communicate. 

Even a dead person communicates. They communicate deadness.  

It is what is not being said that we pay attention to; this is why sarcasm is so dangerous. With sarcasm, there is a contradiction between the verbal and the nonverbal. Sarcasm is typically cutting. In fact, the word means, “to tear flesh.” For children, sarcasm can be very confusing.  

If you were to attend a communication seminar on learning “Effective Communication Skills,” you might come away with skills such as: having good eye contact, sitting on the edge of your chair, nodding and other non-verbal behavior to indicate you are listening. You might also learn about the importance of reflective listening. All these skills are important, however, do you suppose it would be possible to perform all these behaviors and not really listen in a caring way? And, if a person didn’t really care, do you think other people will be able to tell?  

Of course they can. 

“There is something deeper than behavior that others can sense – something that, when wrong, undercuts the effectiveness of even the most outwardly ‘correct’ behavior.” i  This thing that is deeper than behavior is something philosophers have been talking about for centuries. Carl Rogers called it “Way of Being.”ii  

Martin Buber explains that there are two fundamental ways of being, two ways of seeing another person. The first way is as a ”Thou,” a person with hopes and dreams and struggles similar to your own.  The other way of seeing a person is as an “It.” This is where one objectifies a person. “If I see them at all, I see them as less than I am – less relevant, less important, and less real.”iii This is then also about you and your perspective. There is always a good chance that a person does not see things the way they really are; that person may be missing something. We must be willing to honestly look at ourselves and see what part of the problem is our own. “Might I be provoking the other person without even knowing it?” 

When we talk to our teenagers, we sometimes ask them questions.  We must understand that they do not merely answer our questions; they are answering a relationship. Our conversations don’t happen in a vacuum. They happen in the context of a historical relationship.  They are answering a person, and with that person, comes an accumulation and history of their interactions. They answer according to the quality of their recent and remote relationship. 

For example, you might ask your daughter, “Would you take the dog for a walk?” She could respond in a variety of ways. She could ignore you. She could say, “of course.” She could tell you to eat rocks, or yell out while leaving, “maybe later.” On the other hand, if your daughter’s best friend (having a different relationship) said, “Let’s take the dog for a walk?” Your daughter may happily agree to take the dog for a walk. The relationship determines the interaction. 

In his book ”7 Habits of Highly Effective People,”iv Stephen Covey speaks of an emotional bank account we each have with our children. We must have enough positive interactions, thus building the relationship in our “emotional bank account,” before we can safely make a withdrawal (correction/discipline) without damaging the relationship. After all, we do not want to bankrupt the relationship.  When the emotional bank account is healthy, your child can take correction, knowing that it is coming from a place of love. 

The quality of the relationship determines our ability to be effective parents  

and our teenager’s willingness to allow us to influence them. 

 The moment a parent has a nasty verbal exchange with their teenager is not the time to try to immediately solve the problem. There are too many hot emotions for anyone to think clearly. If the relationship is generally good, waiting for a few hours, or perhaps a day to address the problem is wise. Time allows the parents and teenager space to see the situation clearly without the corrupting influence of these distorted and self-justifying thoughts and emotions.  

If the relationship has been rocky, time is needed for the relationship to heal. Part of healing process is deliberately working on developing trust again; another topic for another day. 

Originally published on http://utvalleywellness.com/

 

 

Medication Management and Mental Health

In my career in healthcare, I have seen far too many patients who have been prescribed medication and continue to take that medication faithfully; Yet after a time, they are not really sure why they are taking that specific medication or if it is even helping with the diagnosed issue.  

 What is missing for these patients? Medication management 

Medication management is the process of following up with the healthcare provider on a regular basis to assess the effectiveness of the prescribed medication therapy, discuss any side effects that may go along with the medication, and make adjustments in order to achieve proper dosing. In some cases, the follow-up may be to change the prescribed medication therapy, if it is not providing the desired outcomes. Medication management should be an ongoing process. It should include open dialogue between the patient and provider about the effects of the medication combined with any other therapies or treatments that may be in place. This is to ensure useful data is being collected, so decisions can be made based on the whole picture; not just the medication piece. 

When it comes to psychiatric and mental health services, the importance of quality medication management cannot be overemphasized. Not all people who seek psychiatric help will require medication. In some cases, amino acid therapy may be appropriate or continued therapy and counseling with regular psychiatric follow-up is warranted. If medication is prescribed, the patient should plan to see the psychiatric provider within 2 weeks (in most cases) for the first medication management visit.  Continued follow-up visits should be scheduled monthly, or as needed depending on the individual case. 

During these visits, the patient should plan on communicating openly with the psychiatric provider about their use of the medication, any side effects that they may be noticing, and any changes they are feeling in relation to their mental health diagnosis. At times, genetic testing can be used to pinpoint what medications are more likely to work for each individual patient. This testing can be used not only for patients who are just beginning psychiatric treatment but also for patients who have been prescribed medication therapies that aren’t working. The patient should also plan to consult with the psychiatric provider before taking any other medications. They should inform the provider of other mental health therapies being used or medical complications that may arise during treatment. The patient should expect the provider to ask questions that will direct and lead the conversation, so time is well spent and modifications can be made with confidence. 

Ultimately, the key to effective psychiatric medication management is open and continual communication between the patient and provider. At the Center for Couples and Families, our psychiatric providers strive to provide thorough psychiatric assessment, follow-up, and medication management. 

Originally published on http://utvalleywellness.com/

 

Cleaning Out your Marriage Closet: Couples Counseling

People are often worried about drudging up the past with their loved ones. There is controversy as to what is healthy for the relationship. People certainly don’t like to bring up an old fight when everything is going well. The issue is that we all have a closet of sorts where we hide everything that “isn’t worth the fight.” At first this closet is empty and the intention of putting things in there is good, you intend to talk about it later, it’s just not the right time.

The problem is that you enjoy the times you’re not fighting, who wouldn’t! You soon forget about what you’re storing in the closet, and you continue to throw everything “not worth the fight” into the closet. Your closet becomes full, and when you try to fit one more thing in there everything topples over. This is the fight of all fights, this is when you seemingly “loose it” out of nowhere about nothing and everything. This fight happens at a time when something was already “not worth the fight” and you were trying to put it in the closet. Therefore, you are probably not up for resolving everything in that closet either. It’s like if your junk closet toppled over just as company is coming over, you’re going to scoop everything up and stuff it back into the closet because you don’t have time to sort through it. This fight leaves everyone upset and confused and often nothing is resolved in this fight.

So how does one clean out this closet? Well its much like spring cleaning, you are going to take everything out and you begin to sort everything into categories. You evaluate if it is something that only happened once and will never happen again, if this is the case it truly isn’t worth the fight and can be thrown out. If it is something that continues to happen you need to address it, you will be bringing up the past not as a weapon against the other person, but as a justification for bringing it up as an issue. It is absolutely necessary that cleaning this closet is done at a time when your calm and you remain calm to be able to assess what the core of the problem is, what does their behavior tell you about your relationship with them. For instance, If someone is always late, how does their behavior effect you, why does it feel disrespectful to you and how does it create distance in your relationship, what is the message you receive about their feelings toward you. As opposed to judging their behavior as something you wouldn’t do and lecturing them about how it affects them.

When you clean out the closet you are transferring responsibility to the people it will be useful with. You will find that the cleaner your closet becomes the more clarity you will have in your relationships. Your intent in cleaning out the closet is not to change other people’s behavior, it is meant to change your relationships. You will find that some people will choose to become more distant because they are unwilling to make changes, but the relationships that become closer and the internal peace will be worth the distance in others.

Written by Madison Price, MS, LAMFT – therapist at Holladay Center for Couples and Families

Shared originally by the Holladay Center for Couples and Families

Hidden Signs of Depression

Studies show about 1 out of every 6 adults will have depression at some time in their life. This means that you probably know someone who is depressed or may become depressed at some point. We often think of a depressed person as someone who is sad or melancholy. However, there are other signs of depression that can be a little more difficult to detect.  

Trouble Sleeping 

If you notice a change in a loved one’s sleeping habits pay close attention as this could be a sign of depression. Oftentimes depression leads to trouble sleeping and lack of sleep can also lead to depression.

Quick to Anger
When a person is depressed even everyday challenges can seem more difficult or even impossible to manage which often leads to increased anger and irritability. This can be especially true for adolescents and children.  

Losing Interest 
When someone is suffering from depression you may notice a lack of interest in past times he or she typically enjoys. “People suffering from clinical depression lose interest in favorite hobbies, friends, work — even food. It’s as if the brain’s pleasure circuits shut down or short out.” 

Appetite Changes
Gary Kennedy, MD, director of geriatric psychiatry at Montefiore Medical Center in Bronx, New York cautions that a loss of appetite can be a sign of depression or even a sign of relapse back into depression. Dr. Kennedy also points out that others have trouble with overeating when they are depressed. 

Low Self-Esteem 

Depression often leaves people feeling down about themselves. Depression can lead to feelings of self-doubt and a negative attitude.  

What to do
If you suspect you or someone you love may be suffering from depression talk about it, encourage him or her to get professional help and once he or she does be supportive. Remember that at times symptoms of depression need to be treated just like any other medical condition.

Originally published on http://utvalleywellness.com/

 

Couples Counseling with an expert

Couples counseling, if done right, isn’t a refereed fight in a therapist’s office. A trained therapist will help you to identify underlying, unmet emotional needs after helping you to de-escalate from the tension and fighting you have been experiencing with your spouse. The problem is that most couples come into therapy years too late and it is difficult to change course – to learn a new way. It is possible, however! John Gottman, a world-renowned researcher on marital stability and satisfaction, has found that it is not the presence of argument that causes divorce, but rather it’s how a couple argues that causes divorce. Knowing this, couples don’t have to ignore what they are feeling, but rather they can communicate it differently and in a healthier manner.

Marriage and family therapists are trained to do this type of work. This is a specific degree and license type that focuses on relationships between people (husband and wife; father and son; mother and daughter, etc…) as the point of intervention rather than just focusing on fixing symptoms (depression; anxiety, etc…). Its important to alleviating depression and anxiety and its crucial to build relationships that help someone deal better with anxiety and depression in the first place.

Pornography Counseling

Pornography addiction is becoming more prevalent in our society. Organizations like Fight the New Drug do a great job of educating the public on the harmful effects of pornography. What do you do if you struggle and can’t seem to find a way out? For many, the way out seems elusive and unobtainable. It’s difficult to find how when you have tried so many things, only to have this problem keep coming back. Many that come into counseling have already been before and are discouraged that they just can’t ‘get over it’. Knowing how to use the power or education and relationships is part of the answer. A good therapist can help you access both in your efforts to let go of this addiction. At the Center for Couples and Families we specialize in relationship therapy in regard to pornography use. Knowing how to communicate with your loved ones about this difficulty is an important part of the process.

Life Insurance Myths & Misconceptions

Growing up, I would look through the newspaper to find the sports section, the funnies, and any other interesting articles I could find.  However, I always seemed to come across the obituaries.  I would stop and read them.  Most people seemed to live a great life: loving families, great jobs, and lots of extracurricular activities.  But, the thing that affected me the most was when at the end of the obituary, it would state something along the lines of, “in lieu of flowers please send money.”  Today it looks a little different.  There are no more newspaper obituaries, but instead online and social media declarations and announcements.  Yet, one thing looks the same; instead of “in lieu of…” it now states “gofundme” or tells where an account has been set up at a local bank.  The wording is different, but the intent is the same!  That is why I strongly believe we need to address the topic of Life Insurance Myths and Misconception.   

MYTHS

Life insurance is too expensive. 

“86% of Americans say they haven’t bought life insurance because it’s “too expensive,” yet they overestimate its true cost by more than 2X”. *   Believe it or not it’s not as expensive as you think.  It could be half as much as you think. 

Life insurance through my employer is enough. 

“33% of Americans say they don’t have enough life insurance, including one-fourth who already own a policy”.*  Some employers provide some life insurance for their employees; however, they normally offer 1 to 2 times your annual salary.  Most likely that number doesn’t include commissions, bonuses, and other income.   It is recommended that you have 8-12 times the annual income in life insurance coverage.  (You may want to use a calculator to determine specific need.)  Also, if you ever change jobs, get terminated, or retire, in most cases your life insurance coverage will not go with you.  Depending on age and health, it could be less expensive to purchase and own your own policy.  “Those with life insurance carry enough to replace their income for just 3.6 years.  How would their families get by after that?”*  

Stay-at-home parents don’t need it.  

“Imagine if something were to happen to the stay-at-home spouse in your family. The breadwinner may need to hire someone to clean and take care of the kids, and that can cost a lot of money. Unless your family would have that extra income to spare, you may need life insurance on both spouses,” advises Marvin Feldman, President and CEO of life insurance non-profit organization, Life Happens.   This also gives the remaining parent time to grieve, take care of kids, and take time off of work.   

I’m too old or too young for life insurance. 

 Life insurance provides for the needs of those left behind.  There are lots of different options for coverage no matter what stage of life you are in.  And, as long as there is a need there should be coverage in place.  Depending on age and health, different companies will provide different options.  Work with a professional to help you cover that need.   

“85% of Americans say most people need life insurance, yet only 62% have coverage.”* In fact, “3% say their cell phone is the most important, and 20% have cell phone insurance.”* Every person’s situation is unique and different.  Some need a lot of coverage and some may not need any at all.  But what I do know is that families need to be informed and educated on their options.  Each person needs a plan…and “gofundme” isn’t a plan.   

*LIMRA and LIFE Foundation 2013 Insurance Barometer Study (www.lifehappens.org