Lastly, it's been awhile since PJ has contributed to the blog. He's very high maintenance and has been taking his catnaps during blog posting time. He's a deep sleeper, as you can see.
Kim
Sunday, April 27, 2014
Final thoughts on Technology and Counseling
As this semester has progressed my horizons have expanded in numerous ways. One of those has been the evolution of my views on the relationship between technology and counseling. At the start, I wasn't against the idea of using technology in counseling, but I didn't know a lot about what that included or how to use it effectively. Now, I really see myself integrating the use of e-mail or Skype counseling into the private practice that I hope to open one day. Becoming aware of what technology has been developed specifically for counseling, such as deep breathing apps, but also how to effectively use it in counseling is a skill I've developed that I think is really valuable. I also think that creating and using blogs and websites is an important skill that I have developed and will use to not only share information but also to market myself, now and in the future.I'm excited to expand on those skills and continue to integrate technology into my counseling techniques as my skill set and career advance.
Lastly, it's been awhile since PJ has contributed to the blog. He's very high maintenance and has been taking his catnaps during blog posting time. He's a deep sleeper, as you can see.
As always,
Kim
Lastly, it's been awhile since PJ has contributed to the blog. He's very high maintenance and has been taking his catnaps during blog posting time. He's a deep sleeper, as you can see.
Kim
Interviewing
I was doing some reading on Personality Disorders this week and I came across some interesting things related to interviewing clients with potential PDs that I wanted to share. I do a lot of interviewing during psychosocial assessments at my internship site and knowing what to look for can really help foster insight on the part of the clinician that helps aid in the diagnostic process.
According to Woo and Keating (2008) the presence of a personality disorder can be detected based on not only the content of what the person is saying but also how they react to the clinician on an interpersonal level as well as their nonverbal behavior (Woo & Keating, 2008). How a client is responding to you is often very telling in regard to how they react to other people in their life, which can provide a great perspective into what their interpersonal reactions are like, as well as their insight, judgement and coping strategies (Woo & Keating, 2008). This is helpful to be aware of to not only for diagnostic purposes but also for novice clinicians to be aware of to help reduce negative reactions. Being aware of this fact can help the clinician to not take client's behaviors personally if they are feeling attacked in anyway during the initial interview.
Another interesting point I came across was, "the number of similar conflicts the individual has within a year indicates the severity of these behaviors (Woo & Keating, 2008, p. 842)." How many times a personal struggles with aggressive behaviors, impulsive behaviors, interpersonal problems, etc. is indicative of how severe their pathological personality traits are.
Finally, another really important fact related to interviewing that I thought was worth sharing is the importance of obtaining collateral information to verify what your client is telling you and check for an discrepancies as well as obtaining additional information (Woo & Keating, 2008). In an inpatient setting, this is often not difficult because family contact is typical. However, in an outpatient setting my thought is that it would be harder to obtain collateral information because of confidentiality concerns. In either case, Keating and Woo (2008) stress the importance of obtaining releases of information and consents to share information in addition to accurate documentation throughout the duration of the counseling relationship.
According to Woo and Keating (2008) the presence of a personality disorder can be detected based on not only the content of what the person is saying but also how they react to the clinician on an interpersonal level as well as their nonverbal behavior (Woo & Keating, 2008). How a client is responding to you is often very telling in regard to how they react to other people in their life, which can provide a great perspective into what their interpersonal reactions are like, as well as their insight, judgement and coping strategies (Woo & Keating, 2008). This is helpful to be aware of to not only for diagnostic purposes but also for novice clinicians to be aware of to help reduce negative reactions. Being aware of this fact can help the clinician to not take client's behaviors personally if they are feeling attacked in anyway during the initial interview.
Another interesting point I came across was, "the number of similar conflicts the individual has within a year indicates the severity of these behaviors (Woo & Keating, 2008, p. 842)." How many times a personal struggles with aggressive behaviors, impulsive behaviors, interpersonal problems, etc. is indicative of how severe their pathological personality traits are.
Finally, another really important fact related to interviewing that I thought was worth sharing is the importance of obtaining collateral information to verify what your client is telling you and check for an discrepancies as well as obtaining additional information (Woo & Keating, 2008). In an inpatient setting, this is often not difficult because family contact is typical. However, in an outpatient setting my thought is that it would be harder to obtain collateral information because of confidentiality concerns. In either case, Keating and Woo (2008) stress the importance of obtaining releases of information and consents to share information in addition to accurate documentation throughout the duration of the counseling relationship.
Woo, S., & Keatinge, C. (2008). Diagnosis and treatment of mental disorders across the lifespan. Hoboken, NJ: John Wiley & Sons, Inc.
Wednesday, April 16, 2014
DBT Group Therapy
This week I wanted to share my favorite Dialectical Behavior Group Therapy activity that I use when I run DBT groups with patients at the hospital. As we know, DBT places a strong focus on emotional regulation as well as managing distressing emotions. This activity focuses on both of those aspects and is flexible enough to leave a lot of room for patient's to take the discussion in a direction that is specific to that group of people (99% of groups that I do are with different people every time). I've had the topic end up in a lot of different places but all of them I felt were constructive and I have gotten really positive feedback from group participants. I can't take credit for creating these group therapy activities, I downloaded them from DBT Handouts, Protocols and Client Learning Activities Website, which has lots of really awesome tools to use in DBT individual or group therapy.
These two sheets describe the pictorial handout that is given to the patients that breaks down the Emotion Regulation model into six digest-able steps. I don't usually use this sheet but it was helpful to have the first time I used this activity and sometimes I will glance at it to get some inspiration for things to say if there is a lull in the discussion.
This sheet is the meet and potatoes of the activity that helps people new to DBT get a grasp on the process of emotions so they can gain insight into how activating events and our judgements made about them quickly lead to somatic responses that trigger behavioral reactions which are often negative such as cutting or drinking. I usually starting by facilitating a discussion about different events that occur that start these emotional chain reactions and end in a discussion about how we slow this process down so there is time to avoid a negative behavior reactions.
This brings me to the second part of my activity: "Ways to Manage Distress Now"
This handout has some great tried and true ways that are effective in managing extreme emotions. I like that there are a variety of different strategies, such as distraction techniques, mindfulness techniques and so on. To end the group I usually spend 10 to 15 minutes discussing which of these techniques group members have already tried that work and which techniques are new to them that they think may be helpful in the future for managing distress. I encourage the group members to keep these sheets and practice distress tolerance techniques when they are not feeling extreme emotions so they will be more mindful of ways to reduce their distress the next time they experience an extreme emotion.
As I said, the link to the website that I shared above has tons of great DBT resources to use in counseling. I have also found plenty of other websites that have great free worksheets to down load and use for a variety of different mental illness.
The activity includes handouts of a pictorial depiction of the Emotion Regulation model used in DBT, with an additional narrative for the group leader that helps describe what each picture is representing.
This brings me to the second part of my activity: "Ways to Manage Distress Now"
Wednesday, April 9, 2014
The Oxygen Mask
The stewardesses on airplanes always make sure parents know that if they oxygen masks come down, to put their own on first, and resist their instinct to put their child's oxygen mask on before their own. Because, if the parent passes out from no oxygen they aren't going to be much help to the kid after that anyway. I like that thought as an analogy for self care in mental health professionals. If you don't take care of yourself FIRST, you aren't going to be much good to anyone else.
I wanted to take a minute this week and reflect upon the importance of self care when dealing with clients who are personality disordered. I'm speaking from experience on this one as I've been struggling through treatment for a client with significant Borderline Personality Disorder. I've found myself exhausted, running around in circles talking to every family member under the sun (appropriate in inpatient facilities) and, as hard as I've tried not to, fallen right into the tangled web of manipulation that is BPD. I've also learned about the "Borderline split" which is a concept I was unfamiliar with. I use "split" here, not is as much of the psychodynamic defense mechanism sense, but more of the dividing and conquering of staff (or family members) that are manipulated to the point where they find themselves set against each other. Sound extreme? I agree, but I've been in the trenches over the last few days and have seen this ALMOST play out. Lucky for me I have a phenomenal supervisor who has been instrumental in the maintenance of my sanity. She is no stranger to BPD games and manipulations and is well aware of the dynamics that can occur when treating a patient with BPD.
So, my focus is not on how to provide appropriate treatment to the patient, my focus is how to deal with BPD and not loose your mind. I've already mentioned what I think the most important thing is: having a rock star supervisor. Or if you are the supervisor, seeking supervisor from a colleague. Someone who is well versed in the battle tactics of BPD can look at the sea of manipulation you are swimming in and fish you back out onto try land. My supervisor has been awesome in providing guidance as to what direction to go and helping me to not "work harder than the client," which is actually a lot harder than it sounds. This brings me to my next thought, which is, not to work harder than the client. After all, you as the counselor are not responsible for their wildly traumatic past or desperately hopeless future (in their opinion). The individual is responsible for finding the motivation to pull it together, to the capacity that they are capable, and the counselor is there as a tool to help. Creating and maintaining boundaries so as to not become overly invested is incredibly important because other wise you will always be working harder than the client.
My last thought is make sure you develop and maintain appropriate self care strategies. After you've set your boundaries and done all you can to ensure you are not working harder than your client, the next step is to take care of yourself so that you do not burnout. Over the last two semesters I've come a long way in my self care and have developed self care tools and coping strategies to use to help me unwind after an emotional exhausting day and to help me leave the thoughts of my patients at the hospital until tomorrow. These are vastly different for everyone but for me cooking a nice dinner and taking a scalding hot bath works wonders. My boyfriend is also in the Mental Health field so venting to him my feelings is also helpful for me so that I can let go, relax and enjoy my leisure time.
What's your Oxygen Mask? What self care strategies are you employing that are helping you "leave the drama at the office?"
I wanted to take a minute this week and reflect upon the importance of self care when dealing with clients who are personality disordered. I'm speaking from experience on this one as I've been struggling through treatment for a client with significant Borderline Personality Disorder. I've found myself exhausted, running around in circles talking to every family member under the sun (appropriate in inpatient facilities) and, as hard as I've tried not to, fallen right into the tangled web of manipulation that is BPD. I've also learned about the "Borderline split" which is a concept I was unfamiliar with. I use "split" here, not is as much of the psychodynamic defense mechanism sense, but more of the dividing and conquering of staff (or family members) that are manipulated to the point where they find themselves set against each other. Sound extreme? I agree, but I've been in the trenches over the last few days and have seen this ALMOST play out. Lucky for me I have a phenomenal supervisor who has been instrumental in the maintenance of my sanity. She is no stranger to BPD games and manipulations and is well aware of the dynamics that can occur when treating a patient with BPD.
So, my focus is not on how to provide appropriate treatment to the patient, my focus is how to deal with BPD and not loose your mind. I've already mentioned what I think the most important thing is: having a rock star supervisor. Or if you are the supervisor, seeking supervisor from a colleague. Someone who is well versed in the battle tactics of BPD can look at the sea of manipulation you are swimming in and fish you back out onto try land. My supervisor has been awesome in providing guidance as to what direction to go and helping me to not "work harder than the client," which is actually a lot harder than it sounds. This brings me to my next thought, which is, not to work harder than the client. After all, you as the counselor are not responsible for their wildly traumatic past or desperately hopeless future (in their opinion). The individual is responsible for finding the motivation to pull it together, to the capacity that they are capable, and the counselor is there as a tool to help. Creating and maintaining boundaries so as to not become overly invested is incredibly important because other wise you will always be working harder than the client.
My last thought is make sure you develop and maintain appropriate self care strategies. After you've set your boundaries and done all you can to ensure you are not working harder than your client, the next step is to take care of yourself so that you do not burnout. Over the last two semesters I've come a long way in my self care and have developed self care tools and coping strategies to use to help me unwind after an emotional exhausting day and to help me leave the thoughts of my patients at the hospital until tomorrow. These are vastly different for everyone but for me cooking a nice dinner and taking a scalding hot bath works wonders. My boyfriend is also in the Mental Health field so venting to him my feelings is also helpful for me so that I can let go, relax and enjoy my leisure time.
What's your Oxygen Mask? What self care strategies are you employing that are helping you "leave the drama at the office?"
Wednesday, April 2, 2014
CounsellingResource.com
In this post I wanted to highlight one of the resources I mentioned in my last Top 10 picks post, counsellingresource.com. This website has a lot to offer in a lot of different areas of mental health, including personality disorders. I mentioned previously that I really appreciate the UK flavor of the website, which has contributions from mental health professionals from the US, UK and Europe. The site is highly credible as evidenced by its accreditation through the Health on the Net Foundation and that it is overseen by an international advisory board of distinguished academic faculty and mental health professionals. Also, all of the material provided on the site is peer reviewed. The articles provided on the site, which are numerous in subject matter, all provided identifying information for the authors, their credentials, and bios that detail their professional backgrounds. In perusing through this site I have found everything from an article written about the TV show "Dexter" and psychopathy to multiple articles on guidelines for using different forms of online counseling directed toward mental health professionals.
There is also information directed toward mental health consumers for engaging in online distance counseling. There are articles on the advantages of distance counseling. There are articles on the disadvantages of online counseling. There are also articles on topics such as suitability for online counseling and security. The site also provides "referrals" of a sort to talk to a therapist live online. This feature is described as a secure live chat with the client's choice of a online counselor, therapist, or psychologist specializing in specific areas of mental health. The site is transparent in stating that referral fees are collected through these recommendations and directs clients to "drop off" questions at the free "Ask the psychologist" service that is also offered on the counsellingresources.com site, if they would prefer.
Here's the link for the site: Counsellingresource.com
I truly have nothing but praise for the credibility and transparency of this site. Even the quizzes provided have disclaimers that discuss the validity of the measure. I think it has so much to offer, especially in the realm of providing information and services for online distance counseling. There is a plethora of information for counselors and clients alike and I think anyone interested or involved in mental health should check it out!
Monday, March 31, 2014
Top 10 list: Random
Below I've put together another Top 10 picks list for technology resources that can be used in counseling people with personality disorders. This list is a modge podge of different websites, Facebook pages and Pinterest boards related to Personality Disorders that I think are excellent resources for the client and counselor alike. Enjoy!
1. Borderline Personality Disorder Pinterest Board
http://www.pinterest.com/michele_vincent/borderline-personality-disorder/
This link is to a Pinterest Board that covers all things BPD! I rate this resource a 5 out of 5 stars because of the great variety of articles, websites, and other links provided by this board. I think this source would be helpful for clients because of the diversity of material provided in the interesting format that pinterest provides.
http://www.pinterest.com/michele_vincent/borderline-personality-disorder/
This link is to a Pinterest Board that covers all things BPD! I rate this resource a 5 out of 5 stars because of the great variety of articles, websites, and other links provided by this board. I think this source would be helpful for clients because of the diversity of material provided in the interesting format that pinterest provides.
2. Personality Disorders Pinterest Board
http://www.pinterest.com/healthyplace/personality-disorders
Here we have another Pinterest Board, this one covers a diversity of Personality Disorder related topics. I rate this resource a 5 out of 5 stars because it covers lots of personality disorder topics. I would recommend this board to a client because it encompasses a variety of personality disorders, and has a host of interesting and relatable pins.
http://www.pinterest.com/healthyplace/personality-disorders
Here we have another Pinterest Board, this one covers a diversity of Personality Disorder related topics. I rate this resource a 5 out of 5 stars because it covers lots of personality disorder topics. I would recommend this board to a client because it encompasses a variety of personality disorders, and has a host of interesting and relatable pins.
3. Borderline Personality Today
http://www.borderlinepersonalitytoday.com/main/
This website hosts a number of BPD resources including information on articles, research, and treatment options. It is operated by a Master’s Level Social Worker which increases the site’s credibility, leading to my rating of 5 out of 5 stars. I think this site could be another helpful resource for people with BPD looking for more information from a trusted source.
http://www.borderlinepersonalitytoday.com/main/
This website hosts a number of BPD resources including information on articles, research, and treatment options. It is operated by a Master’s Level Social Worker which increases the site’s credibility, leading to my rating of 5 out of 5 stars. I think this site could be another helpful resource for people with BPD looking for more information from a trusted source.
4. Borderline Personality Disorder Demystified
http://www.bpddemystified.com/
This is a website that truly lives up to its name! Run by Dr. Friedel, it provides information on BPD from a medical standpoint that is directed towards clients, client’s families and mental health practitioners. I rate this site a 5 out of 5 stars because it offers a plethora of credible information on what BPD is, treatment and resources related to adolescents and children and self-injurious behavior, to name a few. I think this is another great site to recommend to clients who are interested in doing some of their own research on BPD outside of session.
http://www.bpddemystified.com/
This is a website that truly lives up to its name! Run by Dr. Friedel, it provides information on BPD from a medical standpoint that is directed towards clients, client’s families and mental health practitioners. I rate this site a 5 out of 5 stars because it offers a plethora of credible information on what BPD is, treatment and resources related to adolescents and children and self-injurious behavior, to name a few. I think this is another great site to recommend to clients who are interested in doing some of their own research on BPD outside of session.
5. Personality Disorders Awareness Network
https://www.facebook.com/PDAN
This is the Facebook account for Personality Disorders Awareness Network, who’s goals are to raise awareness of PD’s! I give this page a 5 out of 5 stars because of the positive impact this site has on the social media community. I think this page would be a great thing to direct clients to because of the positive message they deliver and the impact they strive to achieve on the mental health community.
https://www.facebook.com/PDAN
This is the Facebook account for Personality Disorders Awareness Network, who’s goals are to raise awareness of PD’s! I give this page a 5 out of 5 stars because of the positive impact this site has on the social media community. I think this page would be a great thing to direct clients to because of the positive message they deliver and the impact they strive to achieve on the mental health community.
6. Borderline Personality Disorder Community on Facebook
https://www.facebook.com/borderline.personality.disorder.community
This is a peer run Facebook page that offers information and support for people with BPD. I rate this page a 4 out of 5 stars because of the interactive and supportive environment it provides. I think this page would be great to share with clients with BPD because of the involvement they can have with other people with BPD.
https://www.facebook.com/borderline.personality.disorder.community
This is a peer run Facebook page that offers information and support for people with BPD. I rate this page a 4 out of 5 stars because of the interactive and supportive environment it provides. I think this page would be great to share with clients with BPD because of the involvement they can have with other people with BPD.
7. Band Back Together
http://bandbacktogether.com/
This is an interesting site that is a group blog which allows users to share their stories and get information on a host of mental health issues. I rate this site a 4 out of 5 because it provides an engaging and interactive environment for users to share their stories, hear stories form others and have access to information on a multitude of mental health issues, including personality disorders. I think this resource would be most beneficial to younger clients looking to learn and interact online. As with many similar resources, I would exercise caution in recommending this site to all clients as the interactive nature of the material allows for some degree of misuse by users. However, the site seems to be well monitored and free from any highly questionable content.
http://bandbacktogether.com/
This is an interesting site that is a group blog which allows users to share their stories and get information on a host of mental health issues. I rate this site a 4 out of 5 because it provides an engaging and interactive environment for users to share their stories, hear stories form others and have access to information on a multitude of mental health issues, including personality disorders. I think this resource would be most beneficial to younger clients looking to learn and interact online. As with many similar resources, I would exercise caution in recommending this site to all clients as the interactive nature of the material allows for some degree of misuse by users. However, the site seems to be well monitored and free from any highly questionable content.
8. MDJunction Personality Disorders Support Group
http://www.mdjunction.com/personality-disorders
This website provides an online support group environment which includes forums, articles, diaries and videos for people diagnosed with personality disorders to use in order to build a sense of community based on commonalities. I rate this site a 3 out of 5 stars because I think the discussion boards and forums provided would be a good additional support to certain clients. However, I would caution clients, as does the site, that opinions and thoughts shared should only be of a constructive nature which cannot be guaranteed of other participants. There are site leaders monitoring the content, which gives this online support group some added credibility.
http://www.mdjunction.com/personality-disorders
This website provides an online support group environment which includes forums, articles, diaries and videos for people diagnosed with personality disorders to use in order to build a sense of community based on commonalities. I rate this site a 3 out of 5 stars because I think the discussion boards and forums provided would be a good additional support to certain clients. However, I would caution clients, as does the site, that opinions and thoughts shared should only be of a constructive nature which cannot be guaranteed of other participants. There are site leaders monitoring the content, which gives this online support group some added credibility.
9. MDJunction Mental Health Support Groups
http://www.mdjunction.com/support-groups/mental-health/
http://www.mdjunction.com/support-groups/mental-health/
I’ve included this branch of the MDJunction online support
groups because I thought it important to highlight that there are other, more
specific, support groups available to people who are personality disordered.
This includes specific online support groups for Antisocial Personality
Disorder, Avoidant Personality Disorder, Borderline Personality Disorder and
Paranoid Personality Disorder. I rate this site a 3 out of 5 stars because I
think that the content provided could be especially helpful for people
diagnosed with these specific personality disorders because of the difficulty
with interpersonal relationships that each of these disorders are
characteristic of. I think that this resource could be very helpful for clients
with these personality disorders because they would have an opportunity to
interact with people with similar struggles as them without the added anxieties
of having to meet people face to face.
10. Counselling Resource
http://counsellingresource.com/
This is a site that I think is super cool because it provides professional information on therapy, symptoms quizzes (not for diagnostic purposes of course) and research on a number of mental health issues, including personality disorders, with a UK flavor. I rate this site a 3 out of 5 because of the helpful information it provides for clients as well as mental health providers. I personally like it because of the UK vibe it gives and the exposure to the ICD 10 that it provides. Looking at diagnoses I am familiar with from the view of ICD 10 was novel for me and something that I found to be very engaging.
http://counsellingresource.com/
This is a site that I think is super cool because it provides professional information on therapy, symptoms quizzes (not for diagnostic purposes of course) and research on a number of mental health issues, including personality disorders, with a UK flavor. I rate this site a 3 out of 5 because of the helpful information it provides for clients as well as mental health providers. I personally like it because of the UK vibe it gives and the exposure to the ICD 10 that it provides. Looking at diagnoses I am familiar with from the view of ICD 10 was novel for me and something that I found to be very engaging.
Saturday, March 29, 2014
PowerPoint Presentation
This week I wanted to share with you a PowerPoint presentation that I put together this week for one of my classes. It is short and sweet and goes over the very basics of personality disorders. As counselors or counselors in training, we are or should be familiar with the majority of the points I cover, however, when making it I thought it was a good refresher of the essence of each personality disorder as defined by the DSM 5. It may also be helpful to share with clients for psychoeducational purposes as an introduction to personality disorders. I hope that you find it to be helpful!
https://present.me/view/157814-personality-disorders
https://present.me/view/157814-personality-disorders
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