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

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/

 

Maintaining A Relationship That Is Juicy, Fun, Passionate and Loving by Dr. Matt Eschler, Ph.D

I am pretty certain that we all hope for a juicy, fun, passionate, loving relationship with our lovers! The relationships that maintains a spark over decades of being together are built carefully they most definitely are NOT accidents! You don’t connect with a “soul mate” and settle into mandatory bliss. If you are hoping, longing, reaching for a juicy fun passionate relationship then you will want to read the rest if this article!

Juicy fun passionate relationships are created. If you keep a few rules you can be certain your marriage is all you ever fantasized about! Keep these three incredibly simple rules of engagement and juicy, fun, passion will be yours!

Get to know each other every day.

By constantly developing connection and strengthening your relationship bond you breath new life into your marriage every chance you get. Sometimes you will be giving rescue breathes during crisis and struggle while other times you are giving extra oxygen creating a sense of peace and relaxation. Know your lovers top five or six needs to be happy. Many couples think they know each other and know what drives happiness only to find they have lost touch with change, growth, and each other. To keep on the razor edge front line of juicy passionate fun you have to meet together and talk. I suggest three meeting a week is the minimum. These three meetings each come with there distinct purpose. First have a date night. This is where couples flirt, tease, kiss, and talk about hopes and dreams with each other. Second meeting is couples council. In this meeting you discover the struggles you each face. You empathize with each other, grow through strife and strain while talking about hard topics trusting you will stand by each other for better or worse. Third meeting is family night. This is a time to organize your family share family activities, dreams, and structure the household as a unified front. All three of these meetings are really mandatory and refreshing if you engage weekly on purpose.

Transparency

Second of the three “must” for juicy fun passionate relationships is all about transparency. Share your whole self holding nothing back. If you only share what your lover approves of your holding them hostage. Allow your lover to see all of you and realize your love for each other grows with knowledge of what makes us tic. Sharing a deep sense of fondness and adorationfor each other! (Number one cause of divorce is contempt) is a major part of the intimacy you will Experience. Have you ever caught yourself thinking fond thoughts about your lover and not expressing these thoughts out loud because it feels way vulnerable? My challenge to you is be vulnerable every day! Dare to share all your fondness and admiration out loud and often! Pray with each other express gratitude to the God of your understanding for each other. Imagine the power you will have as Couple joining in prayer to begin each day unified! Celebrate victories, Support each other’s interests, and helping achieve each other’s dreams are all ways of generating juicy fun passionate marriages. I think you get the idea.

Positive Sentiment Override (Gottman Term)

Finally the third principle followed by juicy, passionate, fun couples is a constant positive sentiment override. You always have two choices in how you SEE your lover. You can think negative or you can see the good. You can interpret what is said through a filter of offense. Seeking to be offended will generally lead to you finding a way to actually be offended. The thousands of interactions will be filled with minor slights and errors that can be exploited and used to feel sad, hurt and bugged a each other. On the other hand you have every right to filter all those same interactions through a sieve that separates out all the warm juicy passionate sentiments and feel love and joy. It’s really fun p to you! No, your not burying your head in the sand your simply seeking the good gifts offered.

Think about all of this and have an incredible juicy fun valentines month in February.

About the Author:  Dr. Matt Eschler 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.

Hidden Signs of Depression by Alberto Souza, MSN, APRN, FNP-C

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.

Sources

Healthtalk.org

helpguide.org

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.

A New Start. A New Journey. A New You. How the right therapy, and the right therapist can help get you there by David Nutter, MA, LAMFT

New starts in life often happen when people decide to engage therapy. Whenever I meet new clients as individuals, couples, or even families, I ask them what their goals are in therapy. For some, they have not been asked about what they need, want, or even prefer in their lives for a long time. For others, it often feels that they have never been heard at all, let alone asked. What happens when you go to therapy? What type of model and style of therapy will the person you see provide? What is their level of formal training, how well attuned are they to meet your needs and do they rely on any other resources other than their self-perceived competency? Understanding how much someone knows about your particular issue(s) is a critical step in selecting the type of therapist and style of therapy you will engage.

For example, as I write this article I am thinking of the many different styles of therapy available. I can immediately think of 11 different styles: structural family therapy, strategic therapy, the Milan systemic approach, the Mental Research Institute (MRI) approach, Satir’s communication approach, symbolic-experiential family therapy, intergenerational family therapy, collaborative therapy, narrative therapy, cognitive behavioral therapy and solution-focused therapy. That’s a lot of different styles of therapy, all with empirical research associated with their model and experts in each field.

Added to this list of styles of therapy are the therapists themselves. Who are you going to see and what you are likely to experience is largely dependent on the type of education they have and the experience they have with others. There is a vast difference in the education requirements to become a life coach, mental health counselor or a marriage and family therapist (MFT). There are differences in approaches and emphasis, even within the same style/model of therapy. You and the particular issues you bring to therapy may be weighing on you. The therapist fortunate enough to have you as a client should work as hard on your issues as you do.

There are resources such as books, workbooks, films, music and other sources that might resonate with you that are not particularly useful or preferred by others. You have decided to make a new start and that new start needs the support of the developing relationship of trust you are building with your therapist of choice. That relationship is essential for discussing what you want to achieve and the ways you plan to address the changes or goals you want for yourself and your relationships. Your new journey starts with a decision about what you want to experience in the future. Often this gets accomplished by a review of the past and current life experiences you have survived or thrived from. The therapist caring deeply about your experiences and your strengths will celebrate what you have achieved and where you are going. Aspects that you bring to the therapy effort are elements of the way you might describe yourself—the many facets of who you are. When people describe their experiences in therapy, I hope they include feeling heard, challenged, respected, validated, encouraged and celebrated. Their experience should feel welcomed like a friend, with a serious focus in a nurturing manner. Sometimes people cry, reflect and reconsider critical directions or attitudes they have adopted. Sometimes they laugh and release tension in a light-hearted way. New beginnings are often encouraged by a therapist going the extra mile along side of you, so you can keep going more miles, confidently forward. Welcome to your new start.

 

About the Author:

David Nutter is an Associate Marriage and Family Therapist at the St. George Center For Couples & Families. His career experience includes military service, management and executive positions and international business consulting. He received his undergraduate degree from BYU and his Masters in Marriage and Family Therapy from Northcentral University, a COAMFTE approved program. David was inducted into two honor societies for academic and clinical excellence and is enrolled in NCU’s PhD/ MFT program. During his Master’s program he was mentored by Steve Allred, with a broad range of client ages and issues. He served as the SGPD Chaplain (board certified) to reduce the impact to personnel and citizens from significant trauma experiences. He is adjunct faculty at DSU. He has lived in every U.S. time zone and abroad, and appreciates diversity. David is married to his “girlfriend” Diane. Together, they call their 7 children, their spouses/partners and 5 grandchildren their immediate family.