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Archive for December, 2007

In this day and age in which the media has exposed the epidemic of childhood obesity and associated diabetes, it is impossible for parents to not be more attuned to this issue with their children.  For better and worse, we have access to data, research and information like never before.  This is clearly the case in the area of food, nutrition and physiology.  No doubt, understanding the implications of how we feed our bodies and how we move our bodies is invaluable information.  What can often be a difficult task is translating this information into utilizable material that our children can understand. 

 As parents, we must be persistently aware of, not just the information we deliver, but HOW we deliver it.  Sometimes being accurate is not enough to help children benefit.  Sometimes accurate information can be useless, if not harmful, when delivered ineffectively.  In trying to educate children about food, weight, nutrition and healthy eating, we must be sensitive to the subtle nuances in our delivery.  We, as parents and caretakers, must be aware of how we deliver potentially embarrassing or shameful material to children. 

 Phillip says to his mother, “Amanda told me that I’m fat.  I want to lose some weight.  How much should I lose?”  “Well,” said her mom, “Dr. Speilman said on your last check up that you could stand to lose five pounds.  Why don’t we start there?”  Phillip agrees and queitly walks away.  Conversation over?  Hardly.  For all practical purposes, Phillip’s mother likely feels like this was a good opportunity for her to address his pediatrician’s concern.  She probably feels relieved that someone else did her the service of alleviating her of hurting her son’s feelings.  What she failed to realize is that she delivered the confirming “blow” to Phillip’s self esteem.  In discussing matters of this nature, it is essential to realize the subtle impacts you may have.  In matters of this nature, it is more fruitful to address the biological and medical aspects of this discussion and to STEER CLEAR OF NUMBER OF POUNDS! For example, you might address blood elevelations such as cholesterol or pulse as the impetus for change, or simply the concept of supporting the development of a healthy heart that will “take care of you,” or “keep your body strong for the rest of your life.”  By externalizing the issue, you reduce the sensitive issue of self-esteem or physical acceptance.  Further, you engage your child in a process about which your child can be more curious and motivated.

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How Does Group Therapy Work? 

Groups may vary widely in purpose and style.  On one end of the continuum, a group can be psychoeducational in nature.  The group leader maintains a “didactic” or educator position, imparting information to the group members.  The information provided generates discussion between the members.  The leader has an important role in structuring the learning experience.  Therapists who work under this model may suggest activities inside or outside the group (homework) in order to help develop these skills, i.e. communication, social, problem resolution skills, etc.  These groups rely heavily upon the use of intellectual, rational understanding, and the conscious wish of the member to make changes based upon ‘decision’ and drawing on the ‘will power’ to fight against old habits in order to practice new behaviors.  The identification that members feel towards one another is a powerful force to sustain motivation and to support each other in times when obstacles to the goal present themselves.  These groups are usually constituted by people who have a common goal or issue, and the work circumscribes to a specific goal.

On the other end of the continuum, the focus is upon ‘group process.’  In these groups, people from potentially different walks of life with unique struggles or issues come together.  These groups parallel natural social environments. Each member comes with a different agenda and the wish to resolve some issue that pains him or her.  What people talk about, and the interactions that occur between the members, happens spontaneously.  How people relate to others, their thoughts, feelings and actions, over time, tell an their “story.”    The member reveals him or herself, letting others “know” them, and they gain a new awareness of self.  It is through the group’s natural interactions, as in life itself, that people attempt to get their emotional needs met.  In the process, they are able to discover the internal obstacles to getting what they say it is they want.  In these process groups, the therapist has a very different role.  His or her role is to facilitate progressive communication between group members; the role is of a more passive nature. 

Below is a description of the groups being offered at Weston PsychCare, P.A.

 Social Skills Groups for Children and Adolescents 

Three groups are designed to strengthen the social skills of children (8-11 years), teens (12-15 years), and young adults (16-19 years) as we discuss issues that are common amongst their age group.  Childhood is a fundamental stage of life and its influence easily extends into adult life.  Providing your child at an early age with skills that will (a) improve communication skills, (b) reduce tantrum behaviors, (c) minimizing impulsive and aggressive behaviors, (d) strengthen self esteem, (e) manage anxiety related to school and (f) encourage appropriate peer interactions is essential for a successful adulthood.  These skills will also be addressed in the adolescent group, along with more verbal processing which will allow the expression and management of emotions regarding issues typical of the teenage years (e.g. family conflicts, peer pressure, at-risk behaviors, and decision-making).  Adolescence is a transitional stage that involves psychological transformations.  The group will provide them with a space to address matters in a setting with their peers.

 Emotional Eating 

This is an ongoing group oriented toward adults who suffer from being overweight due to emotional eating habits.  Boredom, sadness and anger are among the emotions associated with “hungerless” eating.  The group assists members in learning how to eat “mindfully,” using biological hunger and fullness cues.  The group will work on developing alternate coping skills and ways to self-soothe.  Additionally, the group will offer nutrition education on grocery shopping, healthy eating habits, adequate food portions and label reading.  Eating mindfully and incorporating nutritional knowledge into healthy eating patters will help the group member to reach a recommended body weight and live a healthy life.

 Teen Relational Aggression 

This group is oriented towards adolescents who have experienced relational aggression, either in the role of the aggressor or victim.  Members will explore and come to understand the underlying motivations, behaviors and feelings associated with ongoing problems in social situations.  The group will aim to increase insight into the cycle of victimization and to develop efficacy in dealing with difficult peer relationships.  Issues of power, envy, jealousy, exclusion, anger, etc. will be addressed. 

 Parenting Skills 

This six session group is oriented towards parents of children of any age.  The group focuses on exploring and becoming aware of the unconscious motivations that shape the parenting relationship each member develops with his/her child.  Within the context of developmental theories and normal age expectations, the group works together in finding ways to resolve problematic behaviors in the child, parent or the relationship.  This group is conducted in a two-fold manner; reflecting on the deeper individual’s parenting philosophy, and the development of concrete skills and strategies to face the daily challenges of uncovering the true potential of your child and the parenting emotional experience.  Separate English and Spanish speaking groups will be held.

 Relational Issues 

This ongoing group is oriented towards adults motivated to learn about themselves in relationship to others.  Most of us feel most challenged when feelings of intimacy or aggression are aroused.  These feelings most often present themselves in the context of sustained relationships such as ongoing groups.  Group therapy is an ideal method for recognizing individual repetitions that interfere with successful and enjoyable relationships.  Through reenactments that occur in the moment with therapist and other group members, it is possible to identify patterns of behaviors or emotional states that disrupt relationships.  When dark meanings and unconscious motivations rise to awareness, they can be taken into account, and can be influenced or changed.  This revelation can result in a wider range of choices, increased sense of freedom and a richer, more adaptable repertoire of behaviors and feelings.  This group applies to marital, parental, work or social relationships.  It is held separately in both English and Spanish.

 Recovery from Disordered Eating 

This group is organized around assisting and supporting the individual already committed to her treatment and recovery.  This open-ended group is a means of supporting the work being done in individual psychotherapy.  Those who are struggling with symptoms of anorexia nervosa or bulimia nervosa are invited to discuss and examine their struggles and efforts in recovery.  Issues addressed in this group include conflicts with self-esteem, boy image, family dynamics, and interpersonal relationships.  Examining the function and purpose of one’s symptoms is also open for discussion as is methods of symptom management and alleviation.

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Therapists are often asked by their clients what they think about medication either as an alternative to psychological treatment or as an adjunct.  It should be noted that therapists are not licensed physicians and cannot ethically or legally offer medical advice.  Despite this fact, clients and therapists do, in fact, discuss medication as part of a client’s (potential) treatment.  While therapists may have differing philosophical views or beliefs about the benefits of medication, most would agree that such a decision needs to be made on a case-by-case basis.  Among the factors you and your therapist might consider include:

1. Your Medical History:  It is imperative that you thoroughly discuss with your clinician your medical and medication history as certain psychiatric medications can interact with your current medication regimen.

2. Your Drug and/or Alcohol Use: Likewise, a thorough discussion of your usage patters affects the appropriateness for psychopharmacologic treatment.  For example, excessive use of alcohol can easily negate the benefits of an antidepressant, not to mention cause an increase in medical side effects.

 3.  Your Family History of Psychiatric Medication:  It is helpful to know if members of your family have benefitted from certain medications as you might find similar medications and regimens beneficial as well.

4.  Your motivation:  Believe it or not, excessive skepticism or resistance to medication in and of itself can render it useless.  Human will and motivation are biologically strong qualities and can interfere with the potential value of psychiatric medications.

5.  Your Patience:  The decision to begin a medication regimen requires patience and commitment.  In most cases such as a depressive disorder, the benefits of medication may not be realized for upwards of two to three months.  You must decide if you can wait to achieve the full value of the medication.

6-Your Treating Physician:  While psychiatrists are clearly the most well-trained healthcare professionals to evaluate and treat medically based psychiatric symptoms and disorders, other healthcare professionals are becoming better informed and trained in treating certain “uncomplicated” conditions.  Primary care physicians such as internists, family practitioners, pediatricians, gynecologists and neurologists often prescribe psychiatric medications.  The benefits of using these practitioners range from the ease of access, reduced stigma and medical “one stop shopping (my doctor already knows me well).”  These doctors best serve you by consulting with your therapist and acting as a “multidisciplinary team.”

 We all know that in this day and age, being an educated consumer is an essential.  So to, should the “consumer” of mental health services be well-informed.  Do not hesitate to inquire and discuss any and all of your medication concerns with your therapist.

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