Month: March 2021

Lessons from my kids books Vol 1: Percy Jackson

EllisLeave a comment

Lessons From My Kids’ Books Vol. 1: Percy Jackson

Lessons are EVERYWHERE, if we’re attuned to them. I just finished reading the five books in the Percy Jackson and the Olympians series by Rick Riordan. (I know this is super nerdy, but I’m always reading at least 3 books – a foundational psyc book, a book that might be useful to clients, and an easy-read book for the 2-3 minute breaks in life. Sometimes, I use that time to read the books my kids are reading, so we can engage around them. I like to have at least some of the same stories in our heads, Side note: This is a reason that reading the same books or watching the same movies as your partner can be really cool, even if they’re not what you would choose for yourself!) 

So, I’m assuming this will end up having multiple volumes. 

Ok, so these are books about teenagers who are demigods (in the Greek system) with lots of heroism and action, slight romance, and enough actually accurate mythology to make it totally worth reading. (I felt the need to write a tiny review there. I’m not completely aware of why.) 

So, here’s the lesson. Main character is chatting with Athena, goddess of wisdom, who says, “The most dangerous flaws are those which are good in moderation.” 

In this particular case, she’s speaking about the hero’s personal loyalty to friends. A virtue, of course! Unless it overtakes all other virtues. 

This is a way I often talk to clients, but especially couples. The areas in which couples are different so often become points of contention rather than celebration, and one important part of couples work is helping them to recognize and appreciate their partners’ differences.  

The flipside is that any strength can become a weakness when it gets taken to the extreme. Helping clients realize when they will benefit more from pulling back on an area of strength to keep it from becoming a weakness is just as important. We call it “falling off the cliff.” 

Examples:

  • assertiveness is great, until it alienates everyone
  • quiet acceptance is great, until it leads to resentment
  • putting your partner’s needs ahead of your own is great, until you lose your whole self or collapse from exhaustion
  • prioritizing your own needs is great, until no one can count on you
  • staying home is great, until you don’t have any friends left
  • going out is great, until you have no beer money left

Haha! See where I’m going with this? 

 

Comment below: Virtues in balance. How has that come up with your clients? 

 

 

 

Post Concussion Syndrome

EllisLeave a comment

 

 

Post Concussion Syndrome

Diagnostics is always more complicated then it seems – more like a DND roll than a simple symptom checklist or binary “has it” or “doesn’t have it” question. Here’s a great example:

 

Post concussion syndrome (PCS, or postconcussional syndrome) is a relatively vague set of symptoms that can continue to occur well after someone has had a head injury. The symptoms are wide and many of them are mental health symptoms, which is why it’s especially important for us to know about it. A headache is usually accompanied by symptoms like:

  • sleep problems
  • depressed mood
  • irritability
  • anxiety
  • trouble concentrating
  • difficulty with memory

Sound familiar?! YIKES! 

In fact, it’s so closely associated with other mental health conditions that 10-20% of student athletes meet criteria for it… even if they haven’t had a head injury – just because they’re stressed and somewhat sleep deprived! So, it’s important to consider all facets of this diagnostic mess!

 

 

PCS codes in ICD-10 as F07.81. Now, we probably wouldn’t want to diagnose Postconcussional Syndrome…. but we very well might want to put it in as a Rule Out or make a referral for additional testing/diagnosis with a physician or neuro specialist. 

 

We definitely want to have a question on our intakes that helps us keep this possibility in mind. For example, on my regular intake I have this question:

Have you experienced:
– chronic headache, migraine, vision changes, loss of consciousness, or dizziness?
– changes in your vision, hearing, other senses, or movement? (e.g., blurry vision, ringing in your ears, difficulty swallowing, trouble speaking, weakness or paralysis)
– difficulties with your memory, planning ability, or thinking clearly?

If so, when did you experience these symptoms and for how long?

That allows me to consider PCS, along with some other potential issues such as mild neurocognitive disorder and functional neurological symptom disorder (formerly conversion disorder). These answers can also “flesh out” other conditions, such as chronic headache associated with generalized anxiety disorder or difficulty concentrating as part of a depressive disorder. Loss of consciousness sometimes maps onto a substance use disorder. It’s a big question, but it gives lots of data and paths to follow-up on during the actual intake. 

Comment below: What are some of the diagnostically oriented questions you have on your intake? 

Psychodiversity

EllisLeave a comment

Psychodiversity 

Welcome to the 4th Reversal Theory blog! In this “episode,” I hope to tie all of these concepts together for you in a way that will show how Reversal Theory can be a great addition to your therapeutic repertoire – in terms of conceptualization and even treatment planning!

Popular in both the professional and lay communities is the idea that mental stability equates to mental health. However, Reversal Theory posits precisely the opposite, that people are healthiest when they exhibit the fluidity to be able to experience satisfaction in all eight states at appropriate times. As Apter (2007) says, “The reversal theory view is that a certain kind of instability is essential for a full and happy life: one should be able to pursue the satisfactions of serious achievement, but also at other times the more frivolous joys of play; one should be able to feel the warm agreeableness of bring a ‘good citizen,’ but also from time to time the keen pleasures of defiance and independence; one should be able to experience the pride of personal strength as well as, on other occasions, the comforts of modest humility” (p.187). This ability to experience all of the states and their attendant satisfactions is known as psychodiversity. Combined with an adequate frustration tolerance, a functioning internal measure of satiation, and the ability to respond effectively to situational factors, including other people, psychodiversity defines what it means to be healthy – to be able to work, love, and play effectively.

Let me give a few examples of how the concept of psychodiversity plays out in therapy…

  • Have you ever used Lazarus’ multi-modal therapy model as a way of identifying different areas of life that need to be treated for a holistic approached? What about the pie chart with physicals health, social health, spiritual health, emotional health, etc?
  • How often do clients come in complaining of being “stuck”? They often need help to get the satisfactions from a state they don’t have much practice in, or in learning how to switch states to fit their situations. 
  • All those different presentations of depression that the DSM5 can’t quite seem to cover? When the main characteristic is low self-worth, consider an autic-mastery kind of depression, where the client isn’t able to acheive the satisfaction of that state, but is in it often. When the main characteristic is boredom consider a paratelic-depression. Lack of motivation? Telic depression. Loneliness? Self-sympathy depression. Alienation? Conforming depression. This gives us a way not only to help clients learn how to derive the satisfaction from a state they’re stuck in, but also to focus more on and gain more value from switching to other states, too. 
  • Anxiety is a classic telic-disorder. The focus on danger, on the importance of success (or of not-failing), the future-orientation… And we often try to manage it in a telic way only (reducing anxiety) rather than also using the tool of switching to the paratelic state. 
  • What are the personality disorders but various combination of autic stuckness? 

I’ll do another blog post in the near future about some specific RT-based techniques and tweaks-to-techniques that I have found really helpful. In the meantime…

 

Comment below: Now that you know plenty about RT to start posing really interesting questions to yourself… how could you see this working in therapy? 

 

 

 

 

Preposterous Quote – Rules for life

EllisLeave a comment

These always get me riled up…

  1. Let all of your experiences influence your future… lessons learned are valuable, and ignoring them is just as likely as not to earn you repeated negative experiences. 
  2. Surround yourself with healthy, supportive people and absolutely listen to them. Your relationships are the foundation of a satisfying and productive life. Don’t alienate important others by ignoring their opinions. 
  3. Time can dull some things, but especially painful things – unprocessed – get worse with time rather than better. Regarding things like loss and grief, assume that you need to make a place for that in your life, rather than “getting over it.” 
  4. Social comparison is important – it is one of the main ways that we manage out behavior in order to be acceptable to society and generally keep things running. Competition, when you are able to admire or be inspired by those who are “better” than you, is a valuable experience in teaching you which goals you might want to pursue and how to go about improving. Comparing yourself only to yourself is a dangerous game… closed systems accumulate errors and self-destruct. 
  5. Being calm is generally more effective than being all worked up, except when your accurate anxiety can motivate you to prepare for danger, your accurate fear can motivate you to move away from danger, your accurate anger can motivate you to rectify injustice, your accurate disgust can motivate you to move away from bad influences, etc… Also, the only thing the passing of time advances by itself is your age. It doesn’t inherently help you figure things out, get wise, make better decisions, improve any skills, etc. 
  6. That level of internal locus of control is inappropriate and inaccurate. Though I am the FIRST person to say that other people and/or circumstances don’t MAKE YOU FEEL, and that most people have more control over their internal, emotional experiences than they believe they do, ignoring reality-based external stimuli is not a good recipe for functioning well in the world, building an environment that supports your growth, etc. 
  7. Smile, Frown, Laugh, Cry… Your life is meaningful and valuable even when it’s not happy or traditionally “enjoyable.” Feel free to be present for all of it. 

Comment below and give us a HEALTHY “Life Rule,” if there is such a thing! 

 

 

 

Easier, cheaper, better

EllisLeave a comment

Easier, Cheaper, Better

So, I was listening to news radio a few weeks ago (oh, the joys of adulthood!), to a story about electric cars. Without getting into politics or economics, let’s assume for the moment that people driving electric cars might be a good thing. Because the interesting part of this discussion was a question to the interviewee – How could the transition to most or all people driving electric cars happen? And the answer was so beautifully behavioral. In short, to get most people to drive electric cars (sooner, rather than later, when that might be all that’s available), electric cars need to be easier to buy than gas-powered cars, cheaper than gas-powered cars, and better than gas-powered cars, today. The INDUSTRY and the ENVIRONMENT need to change. Not the buyers. 

And so it is with all of our behavior changes. Shame and willpower get us nowhere. Well, that’s not quite true. Unfortunately, shame and willpower get us a tiny distance in the direction we’re headed, and then they collapse on us, leaving us typically worse off than we were before, with more shame, which leads to more undesirable behavior, and so we look more intensely for “more willpower” to get us to our behavior changes. And that system, while it fits nicely with the sort of hyper-American, Protestant-ethic model that likes to believe we can all be anything we want to be with enough will or inner strength or simple desire, is almost entirely useless. 

If we want to really change behavior in the long term, we need to think about how to make the new, desired behavior easier, cheaper, and better immediately. 

Here’s an example: Does a client want to exercise more? Preferably, we need to find a way to make that easier, cheaper, and better than not exercising, right now. 

  • What does easier mean for them? It’s going to be a challenge to make something like physical work seem like less effort than NOT doing physical effort! DO they want to try a gym? Help them find a close one, that’s on the way to or from work. (The farther away the gym is, the less often people go. ) But walking at the nearby park or exercising at home might be easier still. Is part of “easier” training their middle school age kid to do some of the laundry, so that the increase in workout clothes doesn’t feel like a burden? Does it mean getting a trainer so that they can learn to exercise in a way that’s “easier” on their knee joints? Let’s plan this in the “preparation phase” so that the benefit is immediate!
  • What does cheaper mean for them? This one usually means straight “less expensive,” but it might also mean less expensive in terms of other resources, like time spent. Would they be missing out on time with lover or kids? Could they join the exercise effort so that time isn’t missed? Walking is free, which might make it better than the gym, but it’s not cheaper than doing nothing… unless you can help them schedule their exercise at a time they might otherwise be spending money, like out to lunch or online shopping. If exercising in the morning helps them be more productive or in a better mood during the day, or sleep more restfully at night, maybe we could help them monitor that the very first week, to help “see” that additional value right away. 
  • What does better mean for them? Turns out rich folks will totally go to a far away gym as long as it’s SUPER nice! That after-workout-whirlpool is a Day 1 value and they should use it Day 1. Better health, fitness, weight loss, etc…. nice for long term goals but not helpful for that early part of the change process. Is the time-for-self they could get at the gym something that they need and want but would feel guilty about? Can we help reduce that barrier before they start, so that exercise gives them something nice right at the start? 

For long term, positive change – we don’t want to rely on willpower, and we certainly don’t want to get stuck in the shame cycle (that just leads to more Oreos, or self-criticism, or avoidance, or…). We want to change our environments to maximize the chances of following through – make the change as easy, cheap, and desirable as possible right away. If we can make it easier, cheaper, and better than the alternative, our chances are REALLY good. 

Comment below: How have you successfully used something like this model with yourself or clients in the past? Have you had the experience of thinking that a great change plan was in place, but one of these things got in the way?