PTSD Treatment that Works

PTSD Treatment that Works

No time for games.  Persistent posttraumatic stress disorder needs serious and effective treatment, as soon as you can get it. Lost time off work may be 

Distressed_man_sittng_on_floorthe least of it. The risks of losing relationships, your job, or your longer-term stability can be very real. If PTSD symptoms (like nerve-wracking memories or dreams, ‘zoning out,’ feeling upset at seeing reminders, or your body going into panic mode) have not resolved several weeks or months after the traumatic incident, you will most likely need therapy to recover. The good news is this: Even if you have had PTSD for many years, evidence-based therapy is usually still effective. Even more good news:  Before PTSD (right after the incident) comes Acute Stress Disorder (ASD) which is a version that has not yet gotten entrenched. When you get the right supports during ASD (and therapy can be one of them) often it will not even turn into PTSD, in the first place.  For either disorder, the highest success-rate methods are those which are first heavily researched and then thoughtfully individualized to you, so they fit your needs. First responders, veterans, victims of crime and victims of abuse are all at risk for AppleMarkdeveloping PTSD or ASD. Choose a practitioner registered to practice clinical psychology. This assures that you are getting a big-picture assessment that first makes sure we know what we are treating (sometimes another problem was there, before, and also needs help) and then also looks to see there are other, new problems, existing alongside PTSD, or complicating PTSD. About three to four
months of weekly work is a typical course of treatment. Occasional follow-up can also be necessary. If  you are a veteran and able to get a certificate to be reimbursed for a private registered psychologist of your own choosing, this funding model will be accepted. (Unfortunately, motor vehicle accident victims are not seen at this practice. However, this practice can refer you to a highly competent psychologist for treatment of PTSD or ASD.)  
Ken McCallion, MA, CPsych Assoc

Summer school? or summer assessment? School Psychology works.

Why, oh, why would you haul your child or teen teen to a school psychologist and ruin a glorious summer?  Fun, for one thing.  Done right, school psychology assessments ARE fun. Less stress; there’s another reason. When children and teens are NOT in school is actually the ideal time.  The whole process feels proactive, instead of reacting to a crisis.  Most likely, you will feel SO ready for September, this time.  For adults in post-secondary studies, that can be especially crucial.  No-one can afford to lose a term or a year.  And so: Summer school may be a prime opportunity to catch up, raise a mark or get a jump on a daunting year. But longer term, if you need a whole new approach, it often begins with assessment.  -Ken McCallion MA CPsych Assochttp://www.torontopsychologicalpractitioners.com/

Temperament, Attachment and sibling rivalry: “I saw you get borned–You were disgusting!”

[ Toronto ] How do they come up with this stuff? Whether that’s truth or more likely, fantasy, it hurts, badly.  In Siblings Without Rivalry, Adele Faber & Elain Mazlish,  nicely reined-in Alfred Adler’s  idea that the ‘will to power’ among sibs was always the big deal. – It depends.  Then Melitta Schmideberg  opened our eyes to the parentified child who gets to be boss, but suffers for it in the end.  Most recently, thoughtful minds like Kristin Caspers and her colleagues have been unfolding mysteries of sibling attachment.  One reason it’s still a bit of a schmaz is that we haven’t seriously looked at sibs through the lens of their inborn differences; that first layer of personality which we call inborn temperament.  Wouldn’t you love to know your child’s inborn layer of personality?  Try this:   http://steinhardt.nyu.edu/insights/profile 

To get a quick read on each of your offspring, be they alike in temperament or not at all, you can complete the above, New York University 38-item online questionnaire WITHOUT giving any identifying data.  Click SUBMIT and you’ll see a four-column chart that just may become a go-anywhere mnemonic for you. (There’s also a teachers’ version, on the same site.)

Temperament is a latin word that suggests different ‘colourings.’ To put this another way, as babies, we come in different emotional flavours. And that, fellow parents, plays mightily into how each of us responds to our own “little, live-in Zen Masters” (as Jon Kabat-Zinn once called them).

SUCCESS STORIES

Most of us can remember at least one pair of sibs who shouldn’t be allowed to get along so darn well. It makes rest of us feel bad.  Odds are that both of them felt safely connected to at least one of their parents.  These two sibs are among the fortunate few who enjoy a secure bond(as an attachment psychologist would say). They may have sibling tiffs, but their war games never extend to that classic, calculated, surgical strike against self-esteem, which so shocks parents and dismays peers. A friend who grew up as the eldest once confessed to me that he, along with his second sib, convinced Sib 3 that she was adopted—As if that would be a problem.  But, to an innocent four year old, you bet.  Their parents dealt with that one, mighty quick.  Much healing ensued.  And it seems that some sib pairings in this family got a little stronger, once kids realized how serious their parents were, about treating everyone equally.

I SAWED YOU GET BORNED! YOU WERE DISGUSTING!

Why would an elder sib aim so low?  Because, at least in the formative years, their own self-esteem is the flip side of their security with parents.  The less secure we feel, the less valuable we feel, and so, the more we try to cut that seemingly favoured sibling down to size.  Enter parental problem-solving.  Most of us will be tempted to say to our child, “That was really immature/low/beneath you/small of you.” Here we go, saying this to the very child who almost certainly feels, despite our most loving efforts, less valued right now. They are just choosing an inappropriate way to fend off that feeling.  This situation is so common for elder sibs, in relation to the next child, that most psychologists once thought it was inevitable. (Hence the ‘dethronement’ concept.)  That was before John Bowlby and Mary Ainsworth changed our view of child-parent bonds forever.  As the Gershwin brothers would say, It Ain’t Necessarily So.

“MY KIDS FEEL SECURE WITH ME.”

“So they won’t be doing that.”  You may be bang on. Enjoy this great blessing. Your grandchildren stand a good chance of inheriting this blessing as well. Quit reading now and send this post to three friends who are a bit less lucky. In Canada and the United States at least, most of us are wrong when we assume that our kids feel consistently secure with us.  It’s tricky stuff, for most parents, to build durable security with each child. It’s especially so, if our kids are born different from each other. That usually means one child’s inborn temperament is more likethe parent’s, while another child’s temperament is unlike the parent’s. Psychologists call this ‘temperament goodness-of-fit.’  Having a difficult fit with our child doesn’t prevent us from building attachment security.  It just makes it trickier.  Child and parent don’t really ‘get’ each other, at first. A parent with strong emotions may, for example, have to work harder to tune into Sarah, than to Samir . . .

SARAH & SAMIR – INTO THE BREACH

Samir freaks out at the sight of their common friend’s blood in a serious injury.  Bravely, shakily, tearfully, he helps open the bandages and dials 911. Sarah thinks everyone’s being rather dramatic about it all.  She doesn’t help until she’s directly told to, as clearly and calmly as possibly, being told the exact steps she must take, right now:  “Sarah, you need to get a blanket from the closet and come straight back. Good. Now open the blanket and put it over your friend. Good. Now stand at the door and watch for the ambulance. And Sarah, this is going well, because you’re helping.”  Neither child acted out.  Both deserve equal recognition.  Sure, it was harder for Samir, emotionally.  But Sarah probably learned more, ethically. She’s now a better team member. Let’s not take that away from her, by asking ‘why’ she needed to be ordered (gently) into it.  She just did.

MACKLIN & DION: WHY CAN’T YOU TWO JUST LEARN TO GET ALONG?

Sib to sib, inborn differences can be confusing and frustrating. They have a lot less experience with this stuff than their parents.  Macklin loves sports and contests and kids’ novels and chess.  Dion can’t stand any of those. Dion draws and paints and asks deep questions at dinner—whereupon Macklin rolls his eyes and tries to leave the table. One of the worst parenting responses we can make is to insist that Macklin and Dion spend more time together, find some common interests or ‘just learn to get along.’ (What does that even mean?)  In a way, we are telling both of them both to please, not be themselves.  Polite, considerate and distant may all they ever are, with each other, for decades.  That is not a failure of parenting. It is a success.  If both of them reach some level of security with at least one parent, odds are, they will both grow up to have friends, understand themselves somewhat, and achieve at their potential.  As adults, if they care, and they work at it, they will discover unsuspected, interesting aspects of each other—and therefore, of themselves.  No blame in coming late to that party. As kids, they simply weren’t meant to be so close.

SOMMAYAH & JULIA:  THE PLOT SICKENS

Sommayah (16) and Julia (14) were not on equal footing.  Julia was falling behind in school.  Her parents reduced her screen time on all devices to two hours a day and bought her the cheapest !@#$%^&*! cell phone EVER, with only texting and calling. It would be confiscated if used in class.  Sommayah, doing well in school, had no such restrictions.  She loved her sister but didn’t quite ‘get’ her, emotionally.  At lunch time, Sommayah neglected to introduce her sister to a group of her new friends when the two sisters ran into them.  After a few agonizing minutes, Julia left, hiding her tears.  Getting home first, Julia hid some of her mother’s best jewellery in Sommayah’s room (usually a much younger child’s stunt, but Julia was really losing it here).  She was expressing her view of Sommayah as seemingly the ‘thief’ of parental affection—and of course, trying to get her in trouble. Fortunately, Sommayah had a change of after-school plans and discovered the stunt before her mother did, but felt deeply hurt by her sister. Their parents arrived home to find both girls in tears, and trading loud litanies of past hurts.  They would not speak to each other, for weeks.

Once in a while, sibling rivalry may contribute to truly unhealthy child or teen behaviours.  This family may have a need for evidence-based behavioural consultation. (In more involved cases, one child might also have a diagnosable, treatable disorder.) The rivalry itself can be treated too. But it is neither the symptom nor the cause. It just is. When the treatment team includes a psychologist who understands temperament and attachment, then treating the behaviour (or disorder) will almost always strengthen child-parent attachment, too. Then the rivalry has fewer emotions driving it, and becomes likely to respond to behavioural work (or just fade out).

Sommayah and Julia both went to therapy with separate therapists, but Julia, more-so. Both had the option of inviting a parent to sit in, any time. Both did.  In two months they were ready to take on full-fledged family therapy with an attachment-aware social worker.  Gradually they became peaceful siblings for the first time. One could begin to see that, when they truly need each other, they will always be there.

familiesonline_comBut who felt they learned the most?  The parents, of course.  They learned how very different their two daughters’ needs are, in emotional parenting terms.  Sommayah shrugs off public display of affection and is perfectly happy just knowing that her parents will listen, lovingly, whenever the need arises.  Emotionally, what Julia needs most from her parents is expressed warmth every day, frequent firmness (though soon she needed less-and-less of this) and well-timed, smiling, full-on reminders of parental confidence in her abilities.

Finally, they learned how Julia positively thrives when her different, emotional needs are understood as core aspects of who she is; and who she can become.  Julia became interested in social work because she recognized in the family therapist a person with strong emotions very like her own, and these actually made her pretty effective at her work.  And oh yes:  Julia DID eventually earn an upgrade, from that cell phone.

The above cases are entirely fictional and based on years of clinical experience.  

Ken McCallion, Registered, MA, CPsych Assoc (Ontario)

The ‘Write Like Helen’ Issue

(ONTARIO) “Try writing like Helen over there. She can give you some tips.”  Prof. Claritti’s comment is a bit out there, for the lecture hall, but he means well. He likes Jac’s concepts. –When he can find them.

Jac got into his first-pick university because his high school averages soared. – On wings of math and science.  Now, these strict, First Year expectations for smooth, clear, concise writing are hitting Jac like a line-drive to the gut. Feedback notes on his lab reports and essays seem ‘blind’ to Jac’s best efforts.

Jac never needed special education. High school teachers consistently ‘tolerated’ his writing because he was a strong student overall (if sometimes a big show-off). His teachers had other issues to address . . .

peer editing

Teachers never hadcause enough to get Jac to practice key strategies. For example:

   -Note-taking while Reading then Outlining.

   -Listen to the ‘sound’ of writing you like. 

   -Write the Abstract & Conclusion, then fill in.

   -Have a friend read your draft to you, aloud, and without commenting.

Whether you form a study group with stronger writers, hire a private tutor, or qualify for learning disability Access Centre and BSWD for software like Kurzweil and WordQ, you’re among many first-year students who have a wall to climb, just to raise their writing to expected levels. If a disability is truly unlikely, just max-out your campus network by trading your highest skills for writing guidance and arm’s length editing. -And keep your ethics. Even when a friend is happy to trade in theirs.    KM 

The ‘ Invest in Child-Parent Bonds’ Issue

(ONTARIO) From the heart, of course. But so many parent who have lots of heart still struggle with it.  Take comfort in the fact that you are in the majority.  –Alarge majority actually, at least in Canada and the U.S.  Blame it on technologically focused society, hyper-mobility or the six-day corporate work week, for decades now (at a minimum) most of us have been growing up with overriding, child-parent ‘issues.’  That is: Most of us as parents have our own attachment 

These are typically the big pieces, in how each of us manages the relationship, with each child we have. For most of us, our own uncertainties about ‘how to be’ just plain get in the way.

WHAT? ARE YOU SAYING WE’VE ALL BECOME SELF-ABSORBED PARENTS? No.  It would be amazing if every one of us could always feel good about ourselves and about our child—and at the same time!  But unless you’re among the fortunate few (and it has very little to do with economics) who have grown up feeling over-archingly secure and con-fident your-self, or you have done some very advanced personal growth, that often turns out to be one !@#$%^&*! challenge.

WHAT IS CO-REGULATION? 

Father and son - attachment

How we learn to handle the toughest times and how we figure them out, as a child-parent ‘team’ makes all the difference.  How can two such unequal people truly be a team? That is the emotional genius of parental learning. We don’t have to be born to it, or be experts in anything, just to get there with ourown child. No honest parenting expert out there got to be so, without paying their dues. But for most of us, it takes time. And it’s trickier if child and parent happen to be ‘born different.’  Child and parent can have different, inborn temperaments (from the latin for colouring—as in tempera paint.)  It’s quick, easy and enlightening to get a read on your own child’s temperament just by going to Prof. Sandee McClowry’s website at NYU’s School of Nursing:

http://steinhardt.nyu.edu/insights/

SATI Blank Profile - Cropped

You won’t have to give any identifying information and you’ll immediately get a parent-friendly, memorizable profile that looks like this, with X’s where your child’s four basic temperament factors stand. You’ll also strike a blow against the tyranny of psycho-logical tests that only clinicians can give and interpret.

–In truth, these tests are invaluable, when needed.  But, as parents, many of us feel empowered when we realize psychologists do NOT have a monopoly on guided insight. There’s simply no need to keep all of it behind the jewelry counter. McClowry’s book, Understanding Your Child’s Unique Temperament helps us take next steps.

Bonding is much easier when child and parent both have the same, inborn, foundation layers of their personalities. But how many times have you heard a parent exclaim: “OMG, what is with Kid-2, here?— My first one was so easy!” (Or the exact opposite.)  We simply come in different emotional flavours, right from the start.

OK, SO WHERE’S THE QUICK ‘N’ EASY PARENT TEMPERAMENT PROFILE?  

Great idea!  But our temperament gets overlain with other layers of our person-alities, throughout life:  our own  childhood bonds with either parent; our social learning with peers; and finally, what we each build on top of all that:  our adult self-concept. Still, in our closest relationships, where we truly must be, or can’t avoid being our truest selves, our natural, inborn differences re-emerge. Stuff that our colleagues would never guess would push our hot buttons can be ridiculously easy for a family member to target if they’ve had too much stress (and for some reason, you seem to be part of it).

Bonds - Market Share- best resolution

Now, none of us would like to admit it, but we can find ourselves doing the exact same thing with our own kids whenwe’ve had too much stress. That can confuse both childand parent. But as parents, we can learn to bridge that gap. When we do, we show our child: Not only can I comfort you when you’re scared; not only do I too recall having that kind of disgusted, overexcited or stunned feeling, buteven when I mess it up as your parent, I can still figure it out. (Or if you can’t, at least now you know what kind of help will actually help.)

Mother & Son - Pat-a-Cake

Through co-regulation, we show our child that growing up never ends.Self-regulation is the magic of how kids can then keep building, more independently, on that.

Ken McCallion, Registered, MA, CPsych Assoc

Emotional Intelligence at school and work

[TORONTO] We are right to be leery of each and every new psychological term that tries to invade our lives.  We’re not about to fall for a repackaging of something we already bought.  Nor do we need to live up to some diabolical new yardstick for job performance, school progress or (worst of all) self-worth. And in truth, emotional intelligence (EI) is not new. It is simply a neglected part of ‘intelligence’ itself, even as IQ test-builder David Wechsler defined it, back in 1940.   He meant this concept to include all abilities we need, to develop and to achieve, on our own terms.  But he never presumed to pack all that into one handy test kit. Others began filling gaps. Today, measures of emotional self awareness, other-awareness and problem-solving are much stronger predictors of school success, career success and social satisfaction than any cognitive test you name.

 SO, EXPRESSION IS IMPORTANT. NOT NEW!

True, but reptiles can do that.

panther chameleonWhat our cold-blooded cousins are not so good at is managing the complex interplay of each other’s emotions, in ways that lead to supporting child development and later, to achieving shared goals.  That’s a triumph of the mammalian mind. We can take the most unlikely,unpromising situations and turn them to the benefit of all parties—or not.

ASK ANY  SEASONED PROJECT MANAGER,

much-loved parent or happy classroom teacher.  In fact, ask the U.S. military. Using EQ-i testing to select recruiters saved the Air Force nearly 3 million dollars.  (Maybe you thought an idea that sounds so warm and cozy just had to be a feel-good campaign; a consultant’s boondoggle.)

HAVEN’T WE GOT RELIGION, FOR THIS?

religions_symbolsm

Good point. In fact, Daniel Goleman, a key author in the field, has heard from faith leaders across a broad range of traditions, that EI looks like one way to measure the human qualities

that their faith teachings and community inspire. Sadly, the EI of self-defense is just as important as community. So don’t blink.

WHAT IF MY ADMINISTRATION WON’T BUY THIS, MY CHILD’S TEACHERS CAN’T GET TRAINING AND I’M NOT FEELING SO AMAZINGLY ‘EI’ MYSELF? 

Then you would  be in good company with a lot of folks. But there is much you can do, on your own.  Reading Goleman’s book itself is one place to start.  If you already practice traditional, Indian yoga, traditionalmartial arts (such as Tae Kwon Do) or mindfulness meditation, then you’re probably already good at recognizing and managing many of yourown emotions.  If you’ve gained ground in a psychological therapy that promotes recognizing of others’ emotions, and emotional problem-solving (such as emotion-focused therapy, child-parent attachment work or interpersonal therapy) then you have also increased your skills in perception of others’ emotions; your reach and depth of reflective thought; and your total range of responses from which you can wisely choose before speaking or acting.

talking mouth thCA981SLW

Book-clubbing a major EI author or two (see below) or reading-up with a trusted friend or your partner, then discussing how EI skills play out in your daily lives, can help. Journaling about situations at work or home, predicting outcomes of your response options, is invaluable. And remember:

 

SCHOOLS NEED VOLUNTEERS AS MUCH AS PARENTS NEED KIDS TO HELP AROUND HOME.

kindergarten hard at work - clipboardThoughtful, adult team-work in a ‘safe’ place where you arenot being constantly evaluated, and don’thave to focus on parenting, is a great proving-ground for new EI skills. Most parent volun-

teers feel appreciated—hugely. And you may find an educator on a similar journey of growth.  And by the way:

 

SOCIAL-EMOTIONAL LEARNING (SEL)

is just school talk for teaching EI skills in the classroom. SEL programs improve student behaviour, reduce peer-on-peer aggression and raise academic achievement levels.  And EI level itself better predicts the student’s career trajectory than top marks.

THIS SOUNDS LIKE A LOT OF WORK.

psycho-babble muscle_brain colour adjustedIt can be, especially if one had a parent (or two) who had their own trouble cult-ivating EI skills of any kind. And some of us are just plain born with greater challeng-es around developing EI.  So-called ‘trait’ EI does not come naturally to all.  The great news is that over time, ‘skill EI’ can be learned by pretty much anyone. It can go a long way in compensating for lack of trait EI.  People who make progress in skill EI report stronger self-esteem, trusting bonds and work effectiveness.

 

POSITIVE LEADERSHIP =  LOADS OF EI

School TeamIf you’re struggling in a leadership role, bring forward, in your reporting relationship, the track record of corporate EI training. There’s no down-side; just a startling upside.

 

 

 

Business Case for Emotional Intelligence  http://www.eiconsortium.org/reports

Women in Leadership http://t.co/PgiBRNSPD3

EI predicted success levels in nursing school  http://www.ncbi.nlm.nih.gov/pubmed/23660239

Social-Emotional Learning in Schools  http://www.edutopia.org/social-emotional-learning 

MYTHS ABOUT PROBLEM DRINKING, versus ALCOHOL DEPENDENCE

“Problem drinkers are irresponsible people.”

business_presentation_sat

High-achieving students, dedicated professionals and safety-minded tradespeople can all have alcohol misuse problems. They carry on bravely and responsibly, despite inner struggles. And they worry like hell that it could affect their work. Rightly so.

“Students drink. It’s a phase. Get used to it.”
Long-term drinking problems have post-secondary origins, for most. After graduation, stress levels don’t zoom to zero. Likewise, healthy ways to cope don’t automatically replace drinking. (Even if a good salary does replace that student budget.)

“Drinking problems always worsen in the long run.”
The majority of people with problem drinking never become full-blown alcoholics. The impact on their lives, families and careers can still be major.

“The only way to drink safely is to NOT.”keynote-address-left
That is true for alcoholics (people with a history of alcohol dependence). If you’ve EVER been in that boat, then yes: Stick to shore for life. No experimenting. On the other hand, turning problem drinking into safe drinking is generally more successful than quitting completely. This particular beast is easier to tame, than kill. But first, make VERY sure you have the right beast.

“AA is the only effective approach. But you really have to really want it.”  For the person who truly needs AA, their philosophy can work miracles. NO-ONE should mess with the One True Light where it actually works.  But people who have never had full-blown alcoholism can’t relate to it. For them, it may do more harm than good.

“Problem drinkers are just self-medicating and should see a psychiatrist.”
Too simplistic. A problem drinker may OR MAY NOT have another disorder that would require medication (or psychiatric care). If they do have another disorder, usually they can feel or see the impact of it, separately from their drinking.

“Medical model just makes a weakness into a sickness.”
Must we rewind 45 years to that? Alongside AA, psychological and medical interventions have been saving careers and families at steadily improving rates. If there was such big money in the treating problem drinking, we could afford to be so cynical.

“Problem drinkers are binge drinkers.”
Yes and no. It depends. What day is it? Are there deadlines are coming up? Do I have to drive tomorrow? Are the kids safe? Which day do we fly home again? Honey, do you think you can deal with the realtor just during my fishing trip?

“Docs are just going to give you medication and a lecture.”
That would be unfortunate, but let us not pretend it’s a total myth. Most physicians realize you can be a serious person, yet, have a serious problem.

“Psychology is just talk therapy. That’s not the answer.”
Results speak for themselves. Less talk. More action. THAT’s modern psychology.

“Treatment doesn’t work. It just feels lousy and costs money.”
Motivational interviewing and relapse prevention (MI & RP) work. If you don’t also have another major psychological disorder; and if you do stick with an RP support group; and you deal with your setbacks positively; your risk of relapse keeps dropping. After several years, relapse becomes rare.

So take the first steps: See a psychologist AND your physician. Let them communicate. Listen to both. If they’re worth their salt, they’ll listen to you. Stop either one of them if they say, ‘zero or nothing.’ They may mean well. They may be out of date. Remind them (if it’s true) that you’re not alcohol dependent. You’re an accomplished person with some major skill sets. You’re looking to add one more. For you, safe drinking is safer than no drinking. No joke!

Yours in health and development,

Ken McCallion, Registered, MA, CPsych Assoc