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Posts Tagged ‘
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Introduction
Women who experience significant changes in their normal thinking and mood after pregnancy may be genetically predisposed to such changes. Their condition is related to a type of mood disorder known as bipolar disorder. A bipolar disorder is characterized by moods that swing between elation and depression.Women who have never had symptoms of a diagnosable mood disorder may find that after giving birth their thinking and moods change. These changes are more common with women who have significant mood changes during their pre-menstrual periods.
- Severe sadness or emptiness; emotional numbness or apathy
- Withdrawal from family, friends, or pleasurable activities
- Constant fatigue, trouble sleeping, overeating, or loss of appetite
- A strong sense of failure or inadequacy
- Intense worry about the baby or a lack of interest in the baby
- Thoughts about suicide; fears of harming the baby
Incomplete Diagnoses
A woman may receive the wrong diagnosis of her problem if her physician fails to take a comprehensive history. If a woman's symptoms are treated without properly assessing her vulnerabilities (i.e. familial and personal history), this may lead to an inaccurate diagnosis, and more severe problems later on for her and her family.
If the woman has a family history of alcoholism, bipolar disorder, schizophrenia, even rage and anger management problems or any other mental problems, the physician should proceed with extreme caution and monitor very closely for any of the symptoms of a mood disorder. These include, but are not limited to feeling anxious, depressed, nervous, jittery, high, maniacal, mood swings, unusually high energy to name a few. Women who have a history of significant premenstrual moodiness also have an elevated risk of post-partum depression.
There is also research that says that those that have a rapid response to antidepressants such as feeling better in just a few days, rather than the more usual 2-3 weeks are at greater risk for these problems.
Treatment Options
A woman may receive better care if her obstetrician has a good working relationship with a specialist in treating mood disorders, and that would be a psychiatrist, or other well-qualified specialist. Unfortunately, not even all psychiatrists or other mental health care providers are well versed in the genetics of mood disorders, or fully understand the relationship of hormonal and genetic vulnerabilities. A specialty service that routinely deals with and understands these relationships can offer the type of cutting edge interventions that can prevent and assist women that find themselves in the turmoil of moods and hormones interacting together to cause emotional uproar.
A woman who has recently given birth will probably need more than a 15-minute visit to discuss her ongoing mood and thinking changes that are a normal part of adjustment after giving birth.
Social workers, especially those working as Medical Social Workers often have the ability to work with women who have recently given birth. Screening and history taking is a role in which Social Workers can assist the public in better preventative healthcare.
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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
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Introduction
If the woman has a family history of mood disorders she is at an elevated risk for pregnancy-related mood and thought changes. Post-partum (sometimes referred to as post-birth) mood changes should be treated with great care.
Those who are most vulnerable to mood disorders may experience significant changes, including having thoughts that are unusual and bizarre, and even feeling suicidal. A woman who has never felt this way before or had this type of thinking may feel ashamed and not divulge this to her physician.
Recently women in the news such as actress Brooke Shields and singer Marie Osmond have disclosed the depression, mood swings, delusional and terrifying thinking they had after having given birth. Brooke Shields recalls that this was, "the most devastating challenge I have ever faced." Marie Osmond in her book, "Behind the Smile" describes in detail what it is like to have to, "fake it" for the benefit of others.
By the second trimester of her pregnancy a woman's body is producing 50 times the amount of Progesterone that it did before pregnancy. Progesterone acts on the brain much like an antidepressant does. The big letdown comes after the woman gives birth, because her Progesterone level then drops dramatically. Marie Osmond found out that her own mother also had this "post-partum depression" but never discussed it due to the image she wanted to project.
Symptoms of Post-Partum DepressionAbout 70 percent of new mothers get the “baby blues” — feelings of anxiety and irritability that can hit three or four days after delivery, but disappear quickly. Postpartum depression, which can appear even a year after giving birth, is more severe and can last for months, if not treated. About 1 in 10 new mothers experience the disorder. Symptoms include:
Tags: compulsions, diagnoses, mood disorder, obsessions, options, post-partum, pregnancy, symptoms, treatment, William Shryer
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Rape is forced, unwanted sexual intercourse. Rape is sometimes also called sexual assault. Both men and women of any age can be raped.
Rape is about power, not sex. A rapist uses actual force or violence – or the threat of it – to take control over another human being. Some rapists use drugs to take away a person’s ability to fight back. Rape is a crime, whether the person committing it is a stranger, a date, an acquaintance, or a family member.
No matter how it happened, rape is frightening and traumatizing. People who have been raped need care, comfort, and a way to heal.
What’s the right thing to do if you’ve been raped? Take care of yourself in the best way for you. For some people, that means reporting the crime immediately and fighting to see the rapist brought to justice. For others it means seeking medical or emotional care without reporting the rape as a crime. Every person is different.
There are three things that everyone who has been raped should do, though:
- Know that the rape wasn’t your fault.
- Seek medical care.
- Deal with your feelings.
Whatever happened, it wasn’t your fault. No one has the right to have sex with you against your will. The blame for rape lies solely with the rapist.
Sometimes a rapist will try to exert even more power by making the person who’s been raped feel like it was actually his or her fault. A rapist may say stuff like, “You asked for it,” or “You wanted it.” This is just another way for the rapist to take control. The truth is that what a person wears, what a person says, or how a person acts is never a justification for rape.
Most people who are raped know their rapists. That can sometimes lead the person who’s been raped to try to protect the perpetrator. Make protecting yourself your priority; don’t worry about protecting the person who raped you. If that means reporting the crime, do it. If you don’t feel comfortable reporting it, though, you don’t have to. Do whatever helps you feel safe and heal – without blaming yourself.
The first thing someone who has been raped needs to do is see a medical doctor. Most medical centers and hospital emergency departments have doctors and counselors who have been trained to take care of someone who has been raped. It’s important to get medical care because a doctor will need to check you for infections and internal injuries.
Most areas have local rape hotlines listed in the phone book that can give you advice about where to go for medical help. You may want to have a friend or family member go along for support, especially if you’re feeling upset and unsafe. Some rape crisis centers also provide advocates who can go along with you. You can also call the national sexual assault hotline at (800) 656-HOPE.
If you are under 18 and don’t want your parents to know about the rape, it’s a good idea to ask the rape crisis center about the laws in your area. Many jurisdictions treat rape exams confidentially, but some will require that a parent or guardian be notified.
You should get medical attention right away without changing your clothes, showering, douching, or washing. It can be hard not to clean up, of course – it’s a natural human instinct to wash away all traces of a sexual assault. But getting examined right away is the best way to ensure you get proper medical treatment.
Getting immediate medical attention also helps people who want to report the crime be sure they have all the evidence needed to prosecute the rapist if they decide to do so. Even people who think they don’t want to prosecute the rapist change their minds later. Having the results of a medical exam can help you do this. (There are laws that only give a person a certain amount of time to report a crime, though, so be sure you know how long you have to report the rape. A local rape crisis center can advise you of the laws in your area.)
Even if you don’t get examined right away, it doesn’t mean you can’t get a checkup later. It’s always best to see a doctor immediately after a rape, of course. But a person can still go to a doctor or local clinic to get checked out for sexually transmitted diseases (STDs), pregnancy, or injuries any time after being raped. In some cases, doctors can even gather evidence several days after a rape has occurred.
When you go to the hospital after a rape, a trained counselor or social worker will listen while you talk about what happened. Talking to a trained listener can help you begin to release some of the emotions you are probably feeling so that you can start to feel calm and safe again.
The counselor may also talk with you about the medical exam and what it involves. Each state or jurisdiction has different requirements, of course, but here are some of the things that may happen during the medical exam:
- A medical professional will test you for STDs, including HIV/AIDS. These tests may involve taking blood or saliva samples. Although the thought of getting an STD after a rape is extremely scary, the quicker a person finds out about any infection, the more effectively he or she can be treated. Doctors can start you on immediate treatment courses for STDs, including HIV/AIDS, that will greatly increase your protection against developing these diseases.
- If you’re female, a medical professional may treat you to prevent an unwanted pregnancy, if you wish.
- A medical professional will examine you internally to check for any injury that might have been caused by the rape.
- A medical professional or trained technician may look for and take samples of the rapist’s hair, skin, nails, or bodily fluids from your clothes or body.
- If you think you’ve been given a rape drug, a doctor or technician can test for this, too. Be aware that this toxicology test covers any and all illegal drugs.
At any time during the medical exam, you can say if you don’t want a certain test performed or evidence collected. All procedures are being done to help you, so you have control over which procedures you’d like done, as well as a say in any you don’t want.
Rape isn’t just physically damaging, it can be emotionally traumatic as well. The right emotional attention, care, and support can help a person begin the healing process and prevent lingering problems later on.
Someone who has been raped might feel a lot of things: angry, degraded, frightened, numb, or confused. It’s also normal for someone who has been raped to feel ashamed or embarrassed. Some people withdraw from friends and family. Others don’t want to be alone. Some feel anxious, or nervous.
Sometimes the feelings surrounding rape may show up in physical ways, such as trouble sleeping or eating. It may be hard to concentrate in school or to participate in everyday activities. Sometimes it may feel like you’ll never get over the trauma of the rape. Experts often refer to these emotions – and their physical side effects – as rape trauma syndrome. The best way to work through them is with professional help.
It can be hard to think or talk about a frightening experience, especially something as personal as rape. People who have been raped sometimes avoid seeking help because they’re afraid that talking about it will bring back memories or feelings that are too painful. But this can actually do more harm than good.
Talking about rape in a safe environment with the help and support of a trained professional is the best way to ensure long-term healing. Working through the pain sooner rather than later can help reduce symptoms like nightmares and flashbacks. It can also help people avoid potentially harmful behaviors and emotions, like major depression or self-injury.
Every rape survivor works through his or her feelings differently. Some people feel most comfortable talking one on one with a therapist. Other people find that joining a support group where they can be with other survivors helps them to feel better, get their power back, and move on with their lives. In a support group, you can get help and support as well as give it. Your experiences and ideas may help others heal, too.
If you’ve been raped, there are many places to get help. Below are a list of helpful resources.
The Rape, Abuse & Incest National Network
http://www.rainn.org
Call: (800) 656-HOPE
 National Domestic Violence/Abuse Hotline
Call: (800) 799-SAFE
 American Psychological Association (APA)
http://www.apa.org
The APA provides information and education about a variety of mental health issues for people of all ages.
National Center for Victims of Crime
http://www.ncvc.org
This organization is devoted to helping victims of crime recover and rebuild their lives. Call: (800) FYI-CALL
 National Youth Violence Prevention Resource Center (NYVPRC)
http://www.safeyouth.org
NYVPRC was established as a central source of information on prevention and intervention programs, publications, research, and statistics on violence committed by and against children and teens. Call: (866) SAFEYOUTH
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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
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Stress is one of the more common reasons that people seek help from therapists like social workers. Many social workers work with clients to help them better cope with stress. One method of reducing stress involves the use of Guided Imagery.
Although it has been called “visualization” and “mental imagery”, these terms are misleading. Guided imagery involves far more than just the visual sense – and this is a good thing, given the fact that only about 55% of the population is strongly wired visually. Instead, imagery involves all of the senses, and almost anyone can do this. Neither is it strictly a “mental” activity – it involves the whole body, the emotions and all the senses, and it is precisely this body-based focus that makes for its powerful impact.
When properly constructed, imagery has the built-in capacity to deliver multiple layers of complex, encoded messages by way of simple symbols and metaphors. You could say it acts like a depth charge dropped beneath the surface of the “bodymind”, where it can reverberate again and again.
Over the past 25 years, the effectiveness of guided imagery has been increasingly established by research findings that demonstrate its positive impact on health, creativity and performance. We now know that in many instances even 10 minutes of imagery can reduce blood pressure, lower cholesterol and glucose levels in the blood, and heighten short-term immune cell activity. It can considerably reduce blood loss during surgery and morphine use after it. It lessens headaches and pain. It can increase skill at skiing, skating, tennis, writing, acting and singing; it accelerates weight loss and reduces anxiety; and it has been shown, again and again, to reduce the aversive effects of chemotherapy, especially nausea, depression and fatigue.
Because it is a right-brained activity, engaging in it will often be accompanied by other functions that reside in that vicinity: emotion, laughter, sensitivity to music, openness to spirituality, intuition, abstract thinking and empathy.
And because it mobilizes unconscious and pre-conscious processes to assist with conscious goals, it can bring to bear much more of a person’s strength and motivation to accomplish a desired end. So, subtle and gentle as this technique is, it can be very powerful, and more and more so over time.
One of the most appealing and forgiving features about imagery is that almost anyone can use it. Although children and women probably have a slight, natural advantage, imagery skips across the barriers of education, class, race, gender and age – a truly equal opportunity intervention.
Even though it can be considered a kind of meditation, it is easier for most westerners to use than traditional meditation, as it requires less time and discipline to develop a high level of skill. This is because it seduces the mind with appealing sensory images that have their own natural pull. And because it results in a kind of natural trance state, it can be considered a form of hypnosis as well.
People can invent their own imagery, or they can listen to imagery that’s been created for them. Either way, their own imaginations will sooner or later take over, because, even when listening to imagery that’s been created in advance, the mind will automatically edit, skip, change or substitute what’s being offered for what is needed. So even a tape, CD or written script will become a kind of internal launching pad for the genius of each person’s unique imagination.
Three Principles of Guided Imagery
Guided imagery works because of three very simple, common-sense principles. You already know them.
First of all, to the body, images created in the mind can be almost as real as actual, external events. The mind doesn’t quite get the difference. That’s why, when we read a recipe, we start to salivate. The mind is constructing images of the food — how it looks, tastes and smells; it might even be evoking the sounds of the food cooking or the feel of its texture as it’s being chewed. And all the while, the body is thinking “dinner is served”, and is responding by generating saliva and appetite.
The mind cues the body especially well if the images evoke sensory memory and fantasy – sights, sounds, smells, feel and taste – and when there is a strong emotional element involved. So, for instance, a strongly evocative image might be remembering the sound and timbre of Daddy’s smiling voice, telling you he’s proud of you; or the internal bristling of energy all through your body as you realize that you are about to triumph at something… that you are home free… golden.
These sensory images are the true language of the body, the only language it understands, immediately and without question.
Secondly, in the altered state, we’re capable of more rapid and intense healing, growth, learning and performance. We are even more intuitive and creative. In this ordinary but profound mind-state, our brainwave activity and our biochemistry shift. Our moods and cognition change. We can do things we couldn’t in a normal, waking state – lift a tree that has fallen on a child; write an extraordinarily delicious poem; replace our terror of a surgical procedure with a calming sense of safety and optimism; abate a life-threatening histamine response to a bee sting.
We wander in and out of altered states all through the day, as a matter of course. Sometimes it’s not a conscious choice, and we drive past our exit on the highway. At best, the altered state is a state of relaxed focus, a kind of calm but energized alertness, a highly functional form of focused reverie. Attention is concentrated on one thing or on a very narrow band of things.
As this happens, we find we have a heightened sensitivity to the object of our attention, and a decreased awareness of other things going on around us, things we would ordinarily notice. We are so engrossed, we lose track of time or don’t hear people talking to us. Or we are so focused on our tennis, we don’t realized we were playing on a broken ankle, and the pain isn’t perceived until the game is over.
The altered state is the power cell of guided imagery. When we consciously apply it, we have an awesome ally, a prodigious source of internal strength and skill.
The third principle is often referred to in the medical literature as the “locus of control” factor.
When we have a sense of being in control, that, in and of itself, can help us to feel better and do better.
Feeling in control is associated with higher optimism, self esteem, and ability to tolerate pain, ambiguity and stress. Decades of research in ego psychology informs us that we feel better about ourselves and perform better when we have a sense of mastery over the environment. Conversely, a sense of helplessness lowers self-esteem, our ability to cope and our optimism about the future.
Because guided imagery is an entirely internally driven activity, and the user can decide when, where, how and if it is applied, it has the salutary effect of helping us feel we have some control.
So, when you put all this together, you have a technique that generates an altered state, in which the mind is directed toward multi-sensory images that the body perceives as real. This is done exactly when, where and how the user wishes. And that’s why it’s so effective.
© Naparstek 2000
© Staying Well with Guided Imagery, 1994
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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
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What Is Stress?
Stress is the “wear and tear” our bodies experience as we adjust to our continually changing environment; it has physical and emotional effects on us and can create positive or negative feelings. As a positive influence, stress can help compel us to action; it can result in a new awareness and an exciting new perspective. As a negative influence, it can result in feelings of distrust, rejection, anger, and depression, which in turn can lead to health problems such as headaches, upset stomach, rashes, insomnia, ulcers, high blood pressure, heart disease, and stroke. With the death of a loved one, the birth of a child, a job promotion, or a new relationship, we experience stress as we readjust our lives. In so adjusting to different circumstances, stress will help or hinder us depending on how we react to it.
As we have seen, positive stress adds anticipation and excitement to life, and we all thrive under a certain amount of stress. Deadlines, competitions, confrontations, and even our frustrations and sorrows add depth and enrichment to our lives. Our goal is not to eliminate stress but to learn how to manage it and how to use it to help us. Insufficient stress acts as a depressant and may leave us feeling bored or dejected; on the other hand, excessive stress may leave us feeling “tied up in knots.” What we need to do is find the optimal level of stress which will individually motivate but not overwhelm each of us.
There is no single level of stress that is optimal for all people. We are all individual creatures with unique requirements. As such, what is distressing to one may be a joy to another. And even when we agree that a particular event is distressing, we are likely to differ in our physiological and psychological responses to it.
The person who loves to arbitrate disputes and moves from job site to job site would be stressed in a job which was stable and routine, whereas the person who thrives under stable conditions would very likely be stressed on a job where duties were highly varied. Also, our personal stress requirements and the amount which we can tolerate before we become distressed changes with our ages.
It has been found that most illness is related to unrelieved stress. If you are experiencing stress symptoms, you have gone beyond your optimal stress level; you need to reduce the stress in your life and/or improve your ability to manage it.
Identifying unrelieved stress and being aware of its effect on our lives is not sufficient for reducing its harmful effects. Just as there are many sources of stress, there are many possibilities for its management. However, all require work toward change: changing the source of stress and/or changing your reaction to it. How do you proceed?
1. Become aware of your stressors and your emotional and physical reactions.
- Notice your distress. Don’t ignore it.
- Don’t gloss over your problems.
- Determine what events distress you. What are you telling yourself about meaning of these events?
- Determine how your body responds to the stress. Do you become nervous or physically upset? If so, in what specific ways?
2. Recognize what you can change.
- Can you change your stressors by avoiding or eliminating them completely? Can you reduce their intensity (manage them over a period of time instead of on a daily or weekly basis)?
- Can you shorten your exposure to stress (take a break, leave the physical premises)? Can you devote the time and energy necessary to making a change (goal setting, time management techniques, and delayed gratification strategies may be helpful here)?
3. Reduce the intensity of your emotional reactions to stress.
- The stress reaction is triggered by your perception of danger…physical danger and/or emotional danger. Are you viewing your stressors in exaggerated terms and/or taking a difficult situation and making it a disaster?
- Are you expecting to please everyone?
- Are you overreacting and viewing things as absolutely critical and urgent? Do you feel you must always prevail in every situation?
- Work at adopting more moderate views; try to see the stress as something you can cope with rather than something that overpowers you.
- Try to temper your excess emotions. Put the situation in perspective. Do not labor on the negative aspects and the “what if’s.”
4. Learn to moderate your physical reactions to stress.
- Slow, deep breathing will bring your heart rate and respiration back to normal.
- Relaxation techniques can reduce muscle tension. Electronic biofeedback can help you gain voluntary control over such things as muscle tension, heart rate, and blood pressure.
- Medications, when prescribed by a physician, can help in the short term in moderating your physical reactions. However, they alone are not the answer. Learning to moderate these reactions on your own is a preferable long-term solution.
5. Build your physical reserves.
- Exercise for cardiovascular fitness three to four times a week (moderate, prolonged rhythmic exercise is best, such as walking, swimming, cycling, or jogging).
Eat well-balanced, nutritious meals.
- Maintain your ideal weight.
- Avoid nicotine, excessive caffeine, and other stimulants.
- Mix leisure with work. Take breaks and get away when you can.
- Get enough sleep. Be as consistent with your sleep schedule as possible.
6. Maintain your emotional reserves.
- Develop some mutually supportive friendships/relationships.
- Pursue realistic goals which are meaningful to you, rather than goals others have for you that you do not share.
- Expect some frustrations, failures, and sorrows.
- Always be kind and gentle with yourself — be a friend to yourself.
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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
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About Alcohol and Drug Addictions
Addiction is a misunderstood and common problem. According to the U.S. Substance Abuse and Mental Health Services Administration, approximately 21.6 million individuals in the U.S. fit the diagnosis for substance dependence or abuse, which is over 9 percent of the population age 12 or older. At the same time, many people who wonder if they have a problem with drugs or alcohol feel alone and even ashamed, and this is often an obstacle to getting help.
There are a number of ways to define addiction. One of the simplest is to look at whether use of alcohol or other drugs has continued after it has led to problems. Problems can include difficulties in relationships with family and others. People may also be experiencing financial problems, health, legal, or job problems.
There may be risks that have not yet resulted in consequences, but are dangerous to be taking. There may be losses, such as money spent on drugs instead of home or vacation, or time spent obtaining, using or recovering from use of drugs or alcohol instead of investing in job, education, or relationships.
The next step is to look at how many of these areas of life have been affected, and how seriously. The idea is to look at the relationship the person has with alcohol or other drugs as we assess whether that person has a problem.
A substance abuse or dependency problem is more obvious when a person is using alcohol or drugs in order to feel normal, get through responsibilities or activities that he finds difficult, or if alcohol or drugs are needed in order to avoid withdrawal symptoms.
It is important to know that the symptoms of addiction can arise slowly over time in a person's life. For many, these symptoms increase in amount and severity over time, resulting in losses in several areas of life, and, all too often, in alcohol or drug related death. This is all the more reason to consult a professional if there is concern.
If an individual thinks he may have a problem and consults with an addictions professional, he will first go through an assessment to establish whether there is a problem and, if so, get an objective picture of that problem. Talking with a professional provides a link to the many resources and supports available for those dealing with substance abuse.
A program of treatment, rather than individual counseling only, is the most typical way an active addiction is addressed. Participants receive a number of supports.
- Health education and psychological counseling. The goal here is to increase understanding of the health consequences of continued use. In addition, people learn how the addictions process happens and the biological reasons why getting free of alcohol and drugs is so challenging. In order to treat an addiction, it is vital to understand the physical and psychological reasons why consistent support and hard work is necessary.
- Group support. Due to the psychology of addiction, people are greatly helped by participation in treatment groups which are run by addictions professionals including social workers. There they see that their experiences and struggles are not unique and they can be more honest about the nature of their difficulties.
- Individual counseling and resource referral. People in treatment work with a counselor with whom they set treatment goals, track progress and address obstacles. Counselors also help their clients find resources to address life areas that may have been affected by drug or alcohol use, such as job training and placement, education or family counseling.
- Self-help. People who participate in self-help programs, such as 12-Step programs, have greater success living without drugs or alcohol. Self-help groups are run by people in recovery from addiction who serve as volunteers, and the goal is mutual support rather than treatment. While in treatment, people are educated on the benefits of self-help and are supported as they establish an effective connection to a self-help meeting.
If an individual enters treatment, his success is far more likely if family members are willing to learn about addiction and recovery. Addictions professionals welcome family involvement and will guide family members in the best ways to help their loved one, including attendance at Al Anon or Nar Anon meetings.
If there is addiction or substance abuse in the family and the troubled individual is not ready to get help for himself, it is important for family members to seek their own support. Substance abuse has a tremendous impact on family members and they deserve assistance in dealing with this painful issue. Help can be obtained at a treatment center or with a qualified therapist.
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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
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Introduction
Anorexia Nervosa, a type of eating disorder is defined by eating miniscule amounts that do not maintain body weight, or not eating at all for an extended period of time, or using methods to induce eliminating the consumed food by either excessive exercise, laxatives, and/or self-induced vomiting. Bulimia, another type of eating disorder can involve any or all of the above behaviors plus he or she binges on food and then compulsively eliminates it.
The anorexic patient can have an irregular heartbeat and excessive body hair; major body organs can begin to shut down, and for women menstrual periods can cease. The stomach acid from vomiting can cause hemorrhaging of the esophagus and the eroding of tooth enamel for the bulimic person. This patient can also have electrolyte imbalance (the water in individual cells) from the purging. All these signs of the seriousness of the progression of an eating disorder can happen without the therapist’s awareness or training to detect such occurrences.
Treating eating disorders is complicated because it involves psychological as well as physical factors. If the trained social worker determines his or her client needs hospitalization and the insurance is managed care, the situation can become not only frustrating, but also life-threatening. In order for the client to enter an in-patient treatment facility authorization (approval) must be obtained prior to admittance. This process can take time and certain criteria must be met. Often insurance cards have a number printed on them that one can call to get answers to questions about the conditions are covered and how approval is determined.
If a client is admitted to the hospital, she will learn that there are two components to the insurance coverage. One is the mental health, or behavioral component. The other is the medical component. Different divisions of managed healthcare handle these two components. Often the two do not have communication or coordination with one another.
On the hospital unit the Utilization Review staff person arranges for approval for treatment, including physical examinations, psychological examinations, lab work, nutritional counseling, etc. Often this person gets the one component authorized, but fails to arrange for the other. Unfortunately, the patient or the patient’s family can end up owing the hospital money for services that were not preauthorized.
What Family Members Can Do To Help
There are steps families can take to help insure their loved-one is getting the best care.
- They should ask the therapist (i.e., a social worker) if he or she is trained to detect signs of serious complications. Knowing these signs can help prevent delays in the patient getting needed medical attention.
- They should make sure the therapist works closely with a physician who regularly treats eating disorders.
- They should also find out what their insurance covers and how long the process takes, if hospitalization becomes necessary. If hospitalization happens, ask to speak with the Utilization Review person to make sure they have both identification numbers for the medical and behavioral components.
- They should Insist on signing releases so one component can coordinate treatment with the other. Call and verify that both components will be treated to insure preauthorization has been obtained.
- If the family receives a bill that they do not believe they should be responsible for, they should talk to the billing department of the hospital, and/or appeal to your insurance carrier.
- Finally, families should not delay seeking a second opinion if they believe the therapist, doctor, or other healthcare professional is not treating the eating disorder seriously and as the life-threatening situation it is.
###The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
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Introduction
As a social worker specializing in mental health issues, I spend most of my week working in the public mental health system, where I see firsthand how helpful our newer antidepressants and antipsychotic medications are.
Because of these medications, combined with various rehabilitation, case management, and psychotherapy services, more patients are able to enjoy a far more robust quality of life outside of hospitals than ever before.
Antidepressant medications have been lifesaving to countless patients. However, there are possible side effects and health consequences to taking any medication. Each individual situation should be weighed carefully in consultation with an experienced health care provider. And every person who is considering taking medication to treat depression should be fully informed of those potential side effects and health consequences, as well as of the potential benefits.
Antidepressants have helped millions of people but patients also should consider the option of psychotherapy to treat their depression.
Psychotherapy, often referred to as talk therapy, can work in many cases as well or better than medications, at lower cost, with fewer side effects and more lasting benefits. For many patients, psychotherapy can be a first choice treatment option. For others, a combination of medication and psychotherapy is indicated.
All mental health providers generally are able to provide psychotherapy – social workers, counselors, nurse specialists, psychologists, and psychiatrists. Psychologists generally do more testing and psychiatrists prescribe medications.
Since most mental health services, especially for children and families, in this country are provided by social workers, it is very likely that clients will have an opportunity to work with a highly trained and qualified social worker in some treatment or counseling setting. Social workers can help people change quickly and reliably through psychotherapy or counseling.
Social work psychotherapists, often called clinical social workers, have a full 60 credit Master's degree with extensive coursework in the diagnosis and treatment of psychopathology. Social workers, perhaps more than other disciplines, also consider the person-in-environment most fully and the ways in which social, family, community, and other stressors impact functioning.
Clinical social workers must obtain advanced licensure in most states which requires at least two years, fulltime, supervised work experience and are required to stay current by obtaining continuing professional education each year. Many social work psychotherapists have additional advanced training in psychotherapy techniques.
One type of therapist is not necessarily likely to be better than another because all therapies and therapists work some of the time with some clients. The best predictor of a good result in therapy is the quality of the relationship that the client has with his or her therapist, not what type of therapy they practice, or what type of degree they have.
Research confirms repeatedly that psychotherapy is a safe and effective treatment for many psychiatric disorders and problems of living and is currently being extended with promise into the treatment of major mood disorders and psychosis.
Clients will generally be able to find a therapist with whom they work well, and since social workers are so prevalent in many settings, it will likely be a trained social worker. Unfortunately, many people do not believe that therapy can help them change, or are worried about the stigma of talking to a therapist. But therapy can and does help.
Unless a prospective therapy client has a very specific type of treatment in mind, which most do not, a potential therapy customer would expect to review some of what's bringing them to treatment, what they hope to get from treatment and what better might look like, as well as the types of strategies that have helped them cope before.
Generally speaking, if nothing positive is happening in therapy after three to six sessions, clients should discuss this with their therapist. If no change persists, it may be time to find another therapist.
Therapy is not necessarily long term or short term – it should continue as long as it is being helpful – but we know that if it is not proving to be helpful early, it is not likely to be helpful later with this particular therapist.
Other tips for a good therapy outcome include finding a therapist who you like and feel comfortable with and whom you think understands and appreciates you and your point of view. Clients will also want to work with a therapist with whom they share goals for treatment and whose opinions and feedback they find helpful. If you are asking for something and not getting it, or if your therapist believes your problem inevitably will require years to change, you also may want to look for another one.
There is a time and a place for medications. A careful evaluation is essential, to assess each individual situation and to consider the possible health consequences and outcomes of medication. But it is equally as important to know that therapy works too. And sometimes it can work better and should be considered as a first line treatment option in many instances. And for other persons, a combination of medication and therapy is the best option. There is a good therapist match for every client to ensure a positive outcome. Every social worker should be able to help their clients evaluate what is right with themselves as well as what's not working, and what the best treatment options may be. Therapy works. Change happens.
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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
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Survivors of Suicide Support Groups
Each year, 180,000 people in the United States lose a loved one to suicide. Parents, children, siblings, friends, and spouses are left with complex feelings of grief. They may also be embarrassed by what happened ashamed, guilty, and alone. Historically, many religions viewed suicide as a sin. However, during the late 20th century, thoughts on suicide shifted both religiously and legally. Today, suicide is usually seen as part of an illness related to an individual's internal struggles.
Many communities have begun coordinating survivor groups. According to the Jewish Family and Community Service (JFCS), groups for survivors of suicide help participants in many ways. They provide a community of support to help manage the difficult grieving process felt by survivors. Participants know they can share their stories and details of their loved one's death without pressure or fear of judgment and shame. Survivors realize they are not alone and feel less isolated and ashamed by the loss when they attend these meetings.
Groups offered by JFCS, for example, are usually co-led by a social worker and a lay leader who is a survivor of suicide. The lay leader helps participants share openly by example. Lay leaders also demonstrate that a survivor can go on and heal even though their lives are changed forever. As one survivor said, "The group is a safe place…to share your feelings without the sense that you are being judged or pitied or that people are uncomfortable in your presence."
Participants in varying stages of their grieving process attend the group. Those who have recently suffered a loss come to a group hoping for a little relief from the intense pain they are experiencing. Sometimes participants attend a group long after the death of a loved one. They come to revisit their feelings and understand the impact of the suicide on their current lives.
A 28-year-old man in one group, whose father died when he was 13, attended a JFCS survivor of suicide group. When his father died, the man's mother had told him never to tell anyone outside the immediate family that his father had killed himself. The man respected his mother's wishes but had recently begun to feel dishonest in close relationships. After the survivors' session, the man decided to share details of his father's death with his girlfriend. He was relieved that telling the truth did not change his relationship, as he had feared. He proudly shared the breakthrough with the group the following week.
Professionals who lead these groups say they are touched over and over by stories, such as this one, and admire the strengths of the people who attend their workshops.
The LOSS Team
Most referrals for survivors of suicide groups come from physicians or nurses who share the information when the death is pronounced in a hospital. Unfortunately for many, a hospital is never involved, so that survivors do not receive a referral from a doctor or nurse. Even when resources are available in communities, there is a long time between when the suicide occurs and the survivor gets help. Unfortunately, the survivor may not know about services and those offering the services do not know about the survivors. One study showed that average length of time between the suicide and the survivor seeking an assessment was 4.5 years.
In 1997, a group in Baton Rouge, Louisiana was formed to help survivors of suicide find the resources they need. The group was named the LOSS (Local Outreach to Suicide Survivors) Team. The team is made up of trained suicide survivors and Baton Rouge Crisis Intervention Center (BRCIC) staff. They go to the scenes of suicide to spread information about resources and to be the breath of hope for the grieving survivors. The goal of the LOSS Team is to let suicide survivors know that resources exist as soon as possible following the death.
Survivors have proven to be important resources at the scenes of suicide. Their volunteer involvement contributes greatly to the entire project. They work as peer facilitators in weekly survivors groups, participate in survivor assessments, serve as members of the agency speakers bureau, and mentor new team members.
Since the LOSS Team began responding in 1998, team members have been recognized for their contributions to the newly bereaved in Baton Rouge. The team is working on changing the legacy of suicide for survivors. In September 2004, a documentary was produced by the Discovery Channel to highlight the stories of several survivors and staff of the BRCIC. The program was created to show what it is really like to get help and reduce the chance of another suicide in the future.
To learn more about resources available, please visit the Baton Rouge Crisis Intervention Center Web site at www.brcic.org
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Introduction – The Many Faces of Depression
Depression wears many faces. Some of these faces are masked with smiles, some may be buried under anger, some frozen and emotionally empty, others drowned in tears. All are sad. The faces may be that of a child or that of an octogenarian, that of a Native American, African American, Asian American, Latino/Hispanic or Caucasian. The face is most likely to be female and adult. If you live in the United States, the face has a one in sixteen chance of being your own.
Would you know if it were your own face? You are at special risk if you have experienced a significant loss–of a loved one, a marriage, a reputation, or an income. Unemployed, divorced, young adults who use drugs or alcohol excessively are at significant risk. Your risk also increases if your family has a history of mood disorders. The onset is usually gradual and only occasionally sudden, related to a traumatic event. The symptoms diminish the quality of life and interfere with functioning in most areas of our lives–work, relationships, play, pleasure.
Most people with depression feel miserable or "down." They experience:
- Episodes of crying
- Disrupted sleep (insomnia for portions of the night or excessive sleep)
- Change in appetite
- Impaired concentration
- Low energy and motivation, fatigue
- Feelings of hopelessness, helplessness, worthlessness, excessive guilt
- Loss of interest in formerly pleasurable activities
- Decreased libido
- Irritability
- Problems with decision making
- Feelings that life is not worth living
- If you have five or more of these symptoms and these last at least two weeks, you may be experiencing an episode of Major Depression.
- If you have several of the above symptoms for a two-year period of time, you may have a diagnosis of Dysthymia.
- If you develop several intense symptoms in response to a disruptive life situation, Adjustment Disorder with Depressed Mood may be occurring.
- If you have periods of depression followed by periods of euphoria or normal mood, Bi-Polar Disorder may be a problem.
All of these conditions are treatable. While some situational depressive symptoms resolve when the situation improves, most do not. Remember that the implications of untreated depression can be death by suicide.
Depression is reportedly under diagnosed in this country, especially because it masquerades in a variety of forms. Easily dismissed as just "the blues," depression can hide in chronic pain, physical symptoms that have no medical findings, alcoholism or drug abuse, and dementia. In youth it can hide in the angry acting out of a teen. Other atypical forms include post-partum depression. The media has made us more aware of the risk that illness poses for a mother and her family. Also receiving more publicity is Seasonal Affective Disorder, a depression that occurs in response to changing light conditions in fall and winter. Regardless of the masquerade, depression responds to treatment best when it is identified and treated early.
Treatment for depression involves talk therapy and may also require medication. Treatment outcome studies find that a combination of the two works best for Major Depression. Most often the type of talk therapy or psychotherapy that is most helpful is called Cognitive Behavioral Therapy (CBT), a form of therapy that teaches skills to help the depressed person engage the logical part of the brain in calming the emotional part of the brain. CBT helps to interrupt thinking patterns associated with depression, such as black and white thinking, catastrophic thinking and over-generalization. Another mode of treatment effective with depression is called Interpersonal Therapy, a treatment method that is helpful when significant relationships are missing or in trouble.
Clinical Social Workers who have a master's degree in social work and the prescribed post-masters years of clinical practice (differs from state to state, but two to five years are standard) are the largest group of mental health professionals providing talk therapy for depression. Clinical social workers who diagnose and treat depression practice in family service agencies, community mental health centers, private practice mental health groups and in outpatient clinics attached to general or psychiatric hospitals. You can identify a clinical social worker by the credentialing initials, such as LCSW (Licensed Clinical Social Worker), after a name. Social workers who qualify for advanced credentials from NASW will be certified as follows: ACSW (Academy of Certified Social Workers), QCSW (Qualified Clinical Social Worker), or DCSW (Diplomate in Clinical Social Work).
Medication, which can be prescribed by a primary care physician or by a psychiatrist, is often needed to interrupt the progression of a Major Depression episode. It can be prescribed for Dysthymia, Atypical Depression or an Adjustment Disorder, especially those that do not respond to talk therapy alone. The kind of antidepressant medication that is usually prescribed is an SSRI (serotonin reuptake inhibitor) such as Prozac, Zoloft, or Lexapro, although other medications may be equally appropriate and helpful. Successful treatment depends upon close contact with the prescribing doctor until an effective medication and dose has been achieved. Remaining on the medication until your doctor feels you can stop taking it is also important. Most treatment guidelines specify six months of medication treatment as a minimum.
Source:
"Mood Disorders," Lee W. Badger and Elizabeth H. Rand, Mental Health Research, Implications for Practice, Janet B.W. Williams, DSW, and Kathleen Ell, DSW, editors, NASW Press, Washington, DC, 1998.
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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
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