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/

 

Self Care When Experiencing Parental Alienation

Though almost half of marriages in the US end in divorce, most people who divorce successfully transition to their new life within two years. However, about 15% of divorces experience continued litigation. These cases exhibit a high degree of hostility and distrust between the spouses, making it difficult for them to communicate about the care of their children without involving the court. Often in high conflict divorce, it only takes one high conflict person to keep the dispute from resolving. If one spouse is noncompliant with the parenting plan and unwarrantedly denies the other parent access to the children, it compels the blocked parent to fight to not only see their children, but often to defend themselves against false allegations of abuse. The accused parent has two choices: either engage in conflict, or be separated from their precious children. 

If you are experiencing denied visitations and an unwarranted campaign of denigration, you are most likely going through parental alienation. Those who have experienced it say it is one of the hardest things they have ever gone through. It requires developing advanced skills in order to cope. Parents who have been successful in dealing with parental alienation have developed the following skills: 

  1. They sought knowledge. They read about parental alienation in order to understand why it happens, and what they could do to make it less difficult for their children. “Intellectually understanding parental alienation provides an emotional anchor to help make good decisions for yourself and your children.”1
  2. Reframe the meaning of your child’s behavior. For example, based on your current situation you may constantly tell yourself, “My child doesn’t love me anymore and never wants to see me again.” Try altering that statement to, “My child still loves me and wants to see me, but he is painted into a corner and is doing what he thinks he has to do in order to survive an experience that is as painful for him as it is for me.”2
  3. Stay even-tempered and never retaliate. “A person who reacts in anger is proving the alienator’s point that he or she is unstable.”3 Avoid falling into this trap.
  4. Don’t live a victim’s life. Although you are experiencing victimization, don’t live asif you have no power or worth.Deliberately take care of yourself. Eat healthy foods, stay socially connected, do something spiritual daily, exercise and get out in nature. Do things that you enjoy and that rejuvenate you. 
  5. Be proactive. Always show up to pick up your kids even if you know they won’t be there. Keep a journal, and document what happens.
  6. Take a parenting class. Learn how to understand your children developmentally and respond empathetically.Develop superior parenting skills. 
  7. Reduce your children’s anxiety. Find ways to reduce their anxiety when they are with you by picking your battles and not engaging in conflict. 
  8. Never talk bad about your ex to your children.This forces them to align with the other parent against you, and paints you in a bad light. 
  9. Try to make what little time you have with them positive and fun. It is through having fun that you gain connection and preserve your attachment. 
  10. Find an alienation-aware therapist, and get the appropriate support and treatment you need.

Each time you board a plane you are reminded that if the oxygen masks drop, you need to put the mask on yourself first, before helping others. The same is true of parental alienation. You must deliberately take good care of yourself first if you are going to survive emotionally. 

1,2 Http://www.womansdivorce.com/alienated-parent.html 

3 http://www.majorfamilyservices.com/parents-who-have-successfully-fought-parental-alienation-syndrome-by-jayne-a-major-phd.html 

Shared Parenting Myths: Woozles and Zombies

Custody and parent-time decisions are usually made by using what is called “The Best Interest of the Child” standard. This standard is intended to guard children from conflict and abuse, and to promote stability, but because it is vague, and not based on empirical evidence, it is susceptible to influences of what Edward Kruk, a social work researcher, describes as “judicial biases and preferences, professional self-interest, gender politics, the desire of a parent to remove the other parent from the child’s life, and the wishes of a parent who is found to be a danger to the child.”He argues that “a more child-focused approach to child custody determination is needed to reduce harm to children in the divorce transition and ensure their well-being.”2

What does the research show about the well-being of children of divorce? That shared physical parenting is the best custody determination for children. (This excludes cases of abuse, neglect, and parents with no prior relationship.) So why isn’t this the norm in most cases? It is because of Woozles and ZombiesWoozles are myths and misrepresentations of research that are not supported by evidence, but because they keep being repeated, they are believed to be true.3  Linda Nielsen, psychologist, and expert on shared parenting, explains,

To summarize briefly, the words “woozling” and “woozles” come from the children’s story, “Winnie the Pooh.” In the story the little bear, Winnie, dupes himself and his friends into believing that they are being followed by a scary beast – a beast he calls a woozle. Although they never actually see the woozle, they convince themselves it exists because they see its footprints next to theirs as they walk in circles around a tree. The footprints are, of course, their own. But Pooh and his friends are confident that they are onto something really big. Their foolish behavior is based on faulty “data” – and a woozle is born.4

Nielsen continues, “Nobel Prize-winning economist and New York Times columnist Paul Krugman (2014) wrote about a similar concept that he called a ‘zombie,’—a belief that ‘everyone important knows must be true, because everyone they know says it’s true. It’s a prime example of a zombie idea—an idea that should have been killed by evidence, but refuses to die. And it does a lot of harm.’”5

Some common Woozles and Zombies of shared parenting, followed by what research actually shows, include:

 

  1. Children want to live with only one parent and to have one home. Shared parenting is not worth the hassle.

When adult children of divorce were asked, they said having a relationship with both parents was worth any hassle they experienced in moving between homes.6

  1. Young children have one primary attachment figure, the mother, with whom they bond more strongly. Given this, it is hurtful for infants to spend any overnights with the other parent in the first year of life.7

The truth is that infants form different, but strong attachments to both parents and that “there is no evidence to support postponing the introduction of regular and frequent involvement, including overnights, of both parents with their babies and toddlers.”8  

  1. Where there is high conflict between the parents, children do better with sole custody. Shared parenting only increases the conflict and puts the children in the middle.9

Conflict remains higher in sole- than in shared-custody families. Most children are not exposed to more conflict in shared-parenting families. Maintaining strong relationships with both parents helps diminish the negative impact of the parents’ conflict.10

  1. Shared parenting only works with those who agree to it, and is only successful for a small, cooperative group of parents who have little conflict.

The research shows that even if shared parenting was originally mandated, it leads to better adjustment for the children and less long-term conflict between the parents.11

Sadly, Woozles and Zombies can distort the facts about best practices for custody arrangements,  but the research evidence is clear and irrefutable that a shared parenting model is truly optimal for families and “traditional visiting patterns . . . are . . . outdated, unnecessarily rigid, and restrictive, and fail in both the short and long term to address [the child’s] best interests (Kelly 2007).”12

1,2,12 Kruk, E. (2012). Arguments for an Equal Parental Responsibility Presumption in Contested Child Custody. The American Journal of Family Therapy, 40(1), 33-55.  DOI:10.1080/01926187.2011.575344 

 5 Nielsen, L. (2015). Pop Goes the Woozle: Being Misled by Research on Child Custody and Parenting Plans, Journal of Divorce & Remarriage, 56:8, 595-633, DOI: 10.1080/10502556.2015.1092349    

 3, 4,8,10 Nielsen, L. (2015). Shared Physical Custody: Does It Benefit Most Children? Journal of the American Academy of Matrimonial Lawyers, 28, 79-138. 

 6,7,9,11 Nielsen, L. (2013, Jan. & feb.). Parenting Time & Shared Residential Custody: Ten Common Myths.  https://issuu.com/nebraskabar/docs/janfeb_2013/1 

WRITTEN BY MICHELLE JONES, LCSW

Michelle is the director of Concordia Families – a treatment center offering services for reunification, court involved therapy, parent education classes, treatment needs assessments and professional education seminars and classes.

Originally published in Utah Valley Wellness Magazine

The Multiple Sides of Child Abuse

Each branch of the mental health profession, including psychologists, marriage and family therapists, and social workers, has a code of ethics which outlines the values and standards which should guide the treatment they offer. For example, according to the Social Work Code of Ethics, “social workers pursue social change, particularly with and on behalf of vulnerable and oppressed individuals and groups of people (Code of Ethics, 2017).”1 Further, most exceptions to confidentiality are also based on the values of protecting the vulnerable in the population, meaning children and the elderly.  

Within the arena of high-conflict divorce, there are children who are truly being subject to physical, sexual, and emotional/psychological abuse, and at the same time, there are also parents who make false allegations of child abuse in order to gain an advantage in court. When a professional becomes involved with these families, they need to explore multiple possibilities, and see the bigger picture of protecting the children against all forms of abuse.  Reflexively denying contact between a parent and child in order to err on the “safe” side is not always the “safe” thing to do. Unnecessarily disrupting a healthy parent-child relationship actually enables psychological abuse.  

First of all, therapists should take all claims of abuse seriously. Their obligation is to report it to the Division of Child and Family Services (DCFS). This agency will determine whether an investigation will be made, based on an assessment of risk factors.  DCFS should be able to determine if the claim should be substantiated, whether it is a chronic problem or a one-time incident, or whether there is no evidence for the claim at all.   

But when a parent makes false claims of abuse and unwarrantedly induces symptoms of anxiety or hatred in the child in order to destroy the child’s relationship with the ex-spouse, this is also an abuse known as parental alienation. It has been recognized as a form of psychological abuse, and is severely damaging to the child. A research article published in 2014, called, “Unseen Wounds: The Contribution of Psychological Maltreatment to Child and Adolescent Mental Health and Risk Outcomes,”2 examined the effects of psychological abuse. The lead author, Joseph Spinazzola, Ph.D., of The Trauma Center at Justice Resource Institute, Brookline, Massachusetts stated, 

“Given the prevalence of childhood psychological abuse and the severity of harm to young victims, it should be at the forefront of mental health and social service training,” (APA, 2014).3 

The American Professional Society on the Abuse of Children (APSAC)4 defines psychological abuse as five parental behaviors, as measured by the PMM and CAPM-CV scales: 

  1. Spurning(In parental alienation, a parent withdraws love from the child to punish them when they connect to the other parent.) 
  2. Terrorizing(In parental alienation, one parent induces fear of the other parent in the child.) 
  3. Isolating(In parental alienation the child is cut off from the other parent and most likely the whole side of the family.) 
  4. Corrupting/Exploiting(In parental alienation the child is encouraged to engage in behaviors that are cruel, disrespectful, and immoral in order to benefit the “favored” parent.) 
  5. Denying Emotional Responsiveness(In parental alienation, the child is punished for accepting love from the other parent.) 

In the latest version of the Diagnostic and Statistical manual, psychological abuse is defined as:  

“…non-accidental verbal or symbolic acts by a child’s parent or caregiver that result, or have reasonable potential to result, in significant psychological harm to the child.” (DSM 5, pg 719)5 

If our fundamental value is to truly protect children, who are the most vulnerable in the population, then we need to raise the level of therapeutic competency through education and training, and do assessments which consider all forms of abuse, including parental alienation.  Children should never be weaponized, and intervening systems should never enable it.  

 

  1. 1.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English

2 Spinazzola, J., Hodgdon, H., Liang, L., Ford, J. D., Layne, C. M., Pynoos, R., . . . Kisiel, C. (2014). Unseen wounds: The contribution of psychological maltreatment to child and adolescent mental health and risk outcomes. Psychological Trauma: Theory, Research, Practice, and Policy,6(Suppl 1), S18-S28. doi:10.1037/a0037766 

3 Childhood Psychological Abuse as Harmful as Sexual or Physical Abuse. (n.d.). Retrieved March 25, 2018, from http://www.apa.org/news/press/releases/2014/10/psychological-abuse.aspx 

4American Professional Society Abuse Children | APSAC. (n.d.). Retrieved March 25, 2018, from https://www.apsac.org/ 

5Diagnostic and statistical manual of mental disorders DSM-5. (2013). Washington: American Psychiatric Publ. 

 

Originally published in Utah Valley Wellness Magazine

Forced Apologies by Carol Kim, MS, LAMFT

My four-year-old daughter placed herself in the middle of our living room to play with blocks. She was so engrossed with building a wooden castle that she didn’t notice her two-year-old sister walking towards her with her right arm stretched far back to slap her older sister across the head. When that slap came, my older daughter went from happy to surprise to anger and then lots of tears. She ran towards me seeking justice. “Mommy, she hit me!” My younger daughter remained still, looking innocent. I immediately walked over to her with my older daughter in hand and said, “Hands are not for hitting. Say sorry for hitting please.”  I’m sure many parents can relate to this scenario. Teaching our children the skills for making amends is an important life skill and is not so much about saying the words “I’m sorry”.  

There is a belief amongst some parents that enforcing premature apologies on children is not effective. Their reasoning is that premature apologies teach children to lie and encourage insincerity. It also creates shame and embarrassment. Other studies show that young children have the ability to be empathetic even before they can speak; therefore, parents should encourage apologies (Smith, Chen, Harris; 2010). As I reflected on my research and my knowledge as a Marriage and Family Therapist, I recognized several things we can do as parents to create productive apologies: 

  1. Keep yourself in check: It’s frustrating to see your children fight, especially when it happens at inconvenient times. However, it’s important to remain calm and model for your children how to handle frustration.   
  2. Be immediate when possible: When you see an incident occur between your children, address it. The best time for learning and growth is when the incident is still fresh in their minds. However, when there are time constraints and the issue cannot be addressed right away, it is important to tell your children when and where it will be addressed. Be consistent when using the alternative and follow through.  
  3. Ask instead of tell: Avoid lecturing. Ask questions instead. “Tell me what happened?” “What were you feeling when you hit your sister?” Validate the expressed emotion and help them to understand that it is okay to feel frustration and sadness; however, it is not okay to hit or throw things. Help them to also make the connection between emotion and action. “Look at her face, how do you think she’s feeling right now?” Asking these types of questions enhances empathy. 
  4. Problem Solve: Ask questions about what they think they should do when they feel frustrated or sad. Help them to come up with solutions.  Ask questions about how they can make things better with their sibling/s. 
  5. Have them practice a do-over: When your child identifies the solution, have them practice it with the other sibling/s. Praise them for their efforts at the end.    

What is more important than the phrase “I’m sorry” is what children take away from the experience. We can facilitate and enhance learning opportunities by not focusing on the phrase “I’m sorry” but instead more on what can be learned from this situation and how can we improve.  

About the Author: Carol is a therapist at the American Fork Center for Couples and Families. She is a Licensed Marriage and Family Therapist who has spent the past 6 years practicing in several cities across the United States, including Boston, San Francisco, and now, American Fork. She is passionate about applying the principles of therapy to improve lives and relationships, and is committed to creating a safe, comfortable, and supportive environment. Carol specializes in individual, couples, and family therapy, and has extensive clinical experience treating depression, anxiety, ADHD, addictions, domestic violence, trauma, children/adolescents and relationship issues.

Why Should Couples Consistently Set New Year’s Resolutions Together? By Dr. Matt Eschler, Ph.D, LMFT

I have counseled couples for twenty-five years. Panicking, anxiously pacing, wringing hands, couples have wandered into my office, hoping to find some peace in their relationships. In the counseling arena we explore some very principled foundation ingredients that, when mixed together, produce peaceful, passionate relationships.

There are three fundamental ingredients that all of us need to exercise for a shot at a sound relationship. My challenge to you is to sit with your lover and assess the following three principles, and set specific goals to learn a little more, stand a little more firm, and increase your skills in these three areas:

The first foundation principle is friendship. Friendship is unilateral. Increase your friendship with your lover every couple of hours. You do this by sharing information, being trustworthy, and being transparent—without conditions.

The second principle that relationships will not survive without is influence. You must accept your lover’s influence. Men seem to have a slightly more difficult time with this, but both partners will benefit from allowing influence. Think about a time when there was disagreement in direction of relationship or activity. Did you allow your lover to have influence? Did you argue until one of you gave in? Was their healthy negotiation until a mutually satisfying result occurred? The hope is always influence and no competition. Get a little better at this in 2018!

Finally, the third principle is generating a governing purpose for your marriage. This is the North Star that holds you both accountable to a result that is desirable and cherished. If you are seeking the same purpose, you won’t go after hostile results. For example, my wife and I want to travel the world. If I sneak out and spend our travel money on a new truck and lots of clothes, we won’t have resources available to travel. That causes issues. If I save and we put our travel fund together and watch it grow together, we will eventually accomplish our common goal.

I invite you all to accept this challenge: In 2018 be a little bit better in all three of these areas. Sit with your lover and map out a specific strategy to accomplish these three goals to improve your relationship.

 

About the Author: Matt lives in St. George, Utah where he and his wife Chris are enjoying their life with each other. Since their kids have grown and moved out perusing their dreams Matt and Chris travel the world. They want to visit 200 countries before the are done. Matt and Chris are active in their community and enjoy working out, training for marathons, and spending time participating in numerous activities with their adult children.  Matt has received his PhD in Psychology. He is focused on the arena of resolving personal conflicts and improving interpersonal relationships. In addition to his Doctorate Degree Matt has earned a Masters in Marriage and Family Therapy, studied Criminal Justice and received a category I licensure with Peace Officer Standard of Training along with a degree in the Arts of Business Management. Matt is a professor at Dixie State University and hopes to be part of the positive growth of Southern Utah.

Simple Ways to Improve Mood by Alberto Souza, MSN, APRN, FNP-C

We all have those days when it feels like we woke up on the wrong side of the bed. For whatever reason we are just in a bad mood. Often times these bad mood feelings are associated with difficult or stressful events in our lives such as trouble at work, financial problems or disappointment. Sometimes these bad mood feelings last for only a few hours, but sometimes they might linger for days at a time. There are many simple strategies to improve one’s mood in spite of what it is that might be bringing us down.

Be With People

Often times when we are feeling low just being with a trusted friend or family member and talking about our feelings can make all the difference. Having a sympathetic listener or someone that can get us laughing or looking at the bright side of things can make all the difference. We shouldn’t be embarrassed to talk about our mood or admit that we need help. In fact, many times isolating ourselves can be one of the biggest culprits in a lingering bad mood.

Get Out

Whether its a brisk walk through the neighborhood or a trip to the grocery store, getting out of the house can do wonders for improving our mood. Sometimes we just need a little sunshine or to breathe in some fresh air. The sights and sounds of everyday life can get our mind off of things and be a beautiful distraction.

Enjoy Yourself

When a bad mood strikes we might find ourselves not even wanting to do the things we normally enjoy, but doing them anyways can take our minds off of negative thoughts and often times will help us feel better overall. Think of simple pleasures like reading, exercising, cooking or baking, shopping or just watching a funny movie or show.

Talk to a Professional

Feeling sad or moody are normal human emotions that we all experience from time to time.  Depression is different from these emotions primarily because depression is a pervasive feeling of sadness that impacts our entire life and doesn’t just go away even when things in our lives are good. We should not hesitate to reach out to a professional to help us understand our feelings and deal with them appropriately.

Source: Psychology Today

About the Author:  Alberto has worked in healthcare for over 10 years. He began as a CNA and then worked as a registered nurse until completing his Master’s Degree in Nursing.  Alberto has been been working as a Nurse Practitioner since April of 2013.  In addition to his work as a Nurse Practitioner, he also teaches online classes for the Dixie State University Nursing Program.  He is currently working at the St. George Center For Couples & Families.