Medication Management and Mental Health

In my career in healthcare, I have seen far too many patients who have been prescribed medication and continue to take that medication faithfully; Yet after a time, they are not really sure why they are taking that specific medication or if it is even helping with the diagnosed issue.  

 What is missing for these patients? Medication management 

Medication management is the process of following up with the healthcare provider on a regular basis to assess the effectiveness of the prescribed medication therapy, discuss any side effects that may go along with the medication, and make adjustments in order to achieve proper dosing. In some cases, the follow-up may be to change the prescribed medication therapy, if it is not providing the desired outcomes. Medication management should be an ongoing process. It should include open dialogue between the patient and provider about the effects of the medication combined with any other therapies or treatments that may be in place. This is to ensure useful data is being collected, so decisions can be made based on the whole picture; not just the medication piece. 

When it comes to psychiatric and mental health services, the importance of quality medication management cannot be overemphasized. Not all people who seek psychiatric help will require medication. In some cases, amino acid therapy may be appropriate or continued therapy and counseling with regular psychiatric follow-up is warranted. If medication is prescribed, the patient should plan to see the psychiatric provider within 2 weeks (in most cases) for the first medication management visit.  Continued follow-up visits should be scheduled monthly, or as needed depending on the individual case. 

During these visits, the patient should plan on communicating openly with the psychiatric provider about their use of the medication, any side effects that they may be noticing, and any changes they are feeling in relation to their mental health diagnosis. At times, genetic testing can be used to pinpoint what medications are more likely to work for each individual patient. This testing can be used not only for patients who are just beginning psychiatric treatment but also for patients who have been prescribed medication therapies that aren’t working. The patient should also plan to consult with the psychiatric provider before taking any other medications. They should inform the provider of other mental health therapies being used or medical complications that may arise during treatment. The patient should expect the provider to ask questions that will direct and lead the conversation, so time is well spent and modifications can be made with confidence. 

Ultimately, the key to effective psychiatric medication management is open and continual communication between the patient and provider. At the Center for Couples and Families, our psychiatric providers strive to provide thorough psychiatric assessment, follow-up, and medication management. 

Originally published on http://utvalleywellness.com/

 

 

Cleaning Out your Marriage Closet: Couples Counseling

People are often worried about drudging up the past with their loved ones. There is controversy as to what is healthy for the relationship. People certainly don’t like to bring up an old fight when everything is going well. The issue is that we all have a closet of sorts where we hide everything that “isn’t worth the fight.” At first this closet is empty and the intention of putting things in there is good, you intend to talk about it later, it’s just not the right time.

The problem is that you enjoy the times you’re not fighting, who wouldn’t! You soon forget about what you’re storing in the closet, and you continue to throw everything “not worth the fight” into the closet. Your closet becomes full, and when you try to fit one more thing in there everything topples over. This is the fight of all fights, this is when you seemingly “loose it” out of nowhere about nothing and everything. This fight happens at a time when something was already “not worth the fight” and you were trying to put it in the closet. Therefore, you are probably not up for resolving everything in that closet either. It’s like if your junk closet toppled over just as company is coming over, you’re going to scoop everything up and stuff it back into the closet because you don’t have time to sort through it. This fight leaves everyone upset and confused and often nothing is resolved in this fight.

So how does one clean out this closet? Well its much like spring cleaning, you are going to take everything out and you begin to sort everything into categories. You evaluate if it is something that only happened once and will never happen again, if this is the case it truly isn’t worth the fight and can be thrown out. If it is something that continues to happen you need to address it, you will be bringing up the past not as a weapon against the other person, but as a justification for bringing it up as an issue. It is absolutely necessary that cleaning this closet is done at a time when your calm and you remain calm to be able to assess what the core of the problem is, what does their behavior tell you about your relationship with them. For instance, If someone is always late, how does their behavior effect you, why does it feel disrespectful to you and how does it create distance in your relationship, what is the message you receive about their feelings toward you. As opposed to judging their behavior as something you wouldn’t do and lecturing them about how it affects them.

When you clean out the closet you are transferring responsibility to the people it will be useful with. You will find that the cleaner your closet becomes the more clarity you will have in your relationships. Your intent in cleaning out the closet is not to change other people’s behavior, it is meant to change your relationships. You will find that some people will choose to become more distant because they are unwilling to make changes, but the relationships that become closer and the internal peace will be worth the distance in others.

Written by Madison Price, MS, LAMFT – therapist at Holladay Center for Couples and Families

Shared originally by the Holladay Center for Couples and Families

Hidden Signs of Depression

Studies show about 1 out of every 6 adults will have depression at some time in their life. This means that you probably know someone who is depressed or may become depressed at some point. We often think of a depressed person as someone who is sad or melancholy. However, there are other signs of depression that can be a little more difficult to detect.  

Trouble Sleeping 

If you notice a change in a loved one’s sleeping habits pay close attention as this could be a sign of depression. Oftentimes depression leads to trouble sleeping and lack of sleep can also lead to depression.

Quick to Anger
When a person is depressed even everyday challenges can seem more difficult or even impossible to manage which often leads to increased anger and irritability. This can be especially true for adolescents and children.  

Losing Interest 
When someone is suffering from depression you may notice a lack of interest in past times he or she typically enjoys. “People suffering from clinical depression lose interest in favorite hobbies, friends, work — even food. It’s as if the brain’s pleasure circuits shut down or short out.” 

Appetite Changes
Gary Kennedy, MD, director of geriatric psychiatry at Montefiore Medical Center in Bronx, New York cautions that a loss of appetite can be a sign of depression or even a sign of relapse back into depression. Dr. Kennedy also points out that others have trouble with overeating when they are depressed. 

Low Self-Esteem 

Depression often leaves people feeling down about themselves. Depression can lead to feelings of self-doubt and a negative attitude.  

What to do
If you suspect you or someone you love may be suffering from depression talk about it, encourage him or her to get professional help and once he or she does be supportive. Remember that at times symptoms of depression need to be treated just like any other medical condition.

Originally published on http://utvalleywellness.com/

 

Telling Your Kids About Divorce

Making the decision to divorce is hard enough when thinking about only the spouses involved, add kids to the mix and things get ten times more difficult. If you are going through a divorce, most likely you are concerned about how your decision to separate will affect your children, and how are you going to tell them? As parents we are constantly trying to protect our children from any pain and suffering, the reality is that the news of your parents’ divorcing, no matter how carefully delivered, is going to cause some kind of pain, hurt, or confusion in the eyes of your child.  Although you can’t control how you or your child will feel during this stressful time in your lives, you can make the choice to commit to seeking out effective ways to handle and offer a positive healthy source of support for your children. Committing to this will allow them to adjust to the divorce in a positive way, and in their own way as you lovingly guide them through the process.

TIPS  

  • If possible the news of the divorce should come from both Mom and Dad together as a family.  During this conversation stress the fact that even though family life is going to look very different, you will both continue to love them.
  • Tell the children that the divorce has nothing to do with anything that any of the children may have done or not done. Reassure them that they are not the cause of the divorce.
  • Children thrive on structure, especially during transition periods. Keep a daily routine with school, activities, and their regular everyday life. Keeping as much consistency as possible helps the children to feel more secure.
  • Having some kind of a plan of what life might now look like for them can be very beneficial. It is comforting for them to know where they will be going to school, where they will be sleeping, and how often they will see mom or dad. Nothing is permanent in this arrangement but offering them some sort of idea of how their lives will and won’t change will again help them to feel secure.  
  • Address your children’s concerns. Encourage them to talk, scream, cry or celebrate. Help them to feel safe in expressing their feelings.
  • Lastly make sure that they are told how much you both love them and how that will never change.

Studies show that children do best and have fewer long term emotional, social or academic problems, when parents can establish a healthy, respectful, co-parenting relationship. Transitioning into a new type of relationship and putting aside the hurt and anger that are associated with the broken marriage can be extremely difficult for many parents to accomplish. But through patience with each other and hard work it can be done. Divorce changes families but it does not end your commitment to your children. Make sure you take the time to find the solutions that work best for your family to ensure a positive outcome for you and your children.

**If you or your children are struggling to deal with the life transitions involved with divorce, seek out professional assistance for individual or family therapy. The therapist can assist in encouraging better communication, and helping all families member to properly heal and process the trauma of divorce.

 

Brandi Hess, MA, LAMFT

Brandi Hess has a passion for helping people to work through life’s difficulties, assisting them in finding joy, and the strength to reach their full potential. Brandi strives to ensure that she understands each of her clients’ unique needs. She provides therapy and counseling sessions tailored specifically to obtain her clients’ goals, in an individual or family setting. She offers a kind, honest, and straight-forward approach in therapy, allowing for trusting relationships to be built. She specializes in couples and family distress, pre/post-divorce, and adolescent treatment. One of Brandi’s many strengths is being able to connect with adolescents by creating a therapeutic environment where the adolescent feels safe and willing to start the process of change. Brandi works with a variety of concerns such as depression/anxiety, women’s issues, and trauma. Brandi received her Bachelors of Science in Human Development and Family Studies at the University of Utah, and her Master’s degree in Marriage & Family Therapy from Argosy University.

What to do if you are on a path of divorce – Couples Counseling

Marriage is never easy. Have you ever wondered how so many people seem to look so happy in theirs? Well – they might be, but chances are, they struggle too. The difference might be how you handle the struggle as a couple that can bring you happiness or not. It’s important to know that how you argue with your spouse matters more to the life and longevity and healthy of your marriage than the simple fact or presence of arguments in the first place – according to marital researcher John Gottman. Learning how to argue or fight fair is crucial to building a relationship that lasts. John Gottman outlines several important types of fighting that can harm your marriage. The first is criticism. This is where you directly complain and nitpick at your spouse. The second is contempt. This is harsher than criticism because you start to attack the character of your spouse instead of just what they are doing. The third is defensiveness. This is where you react with a defensive posture to things that your spouse does or says. Lastly, stonewalling. This is where you cut your spouse off emotionally and don’t engage in any way. John Gottman found that when these types of interactions are present in your marriage, that it’s in trouble. Come to counseling to find out what to do if you are engaged with your spouse in these ways of fighting. They can help fix and turn things around.

Couples Counseling with an expert

Couples counseling, if done right, isn’t a refereed fight in a therapist’s office. A trained therapist will help you to identify underlying, unmet emotional needs after helping you to deescalate from the tension and fighting you have been experiencing with your spouse. The problem is that most couples come into therapy years too late and it is difficult to change course – to learn a new way. It is possible, however! John Gottman, a world-renowned researcher on marital stability and satisfaction, has found that it is not the presence of argument that causes divorce, but rather it’s how a couple argues that causes divorce. Knowing this, couples don’t have to ignore what they are feeling, but rather they can communicate it differently and in a healthier manner.

Marriage and family therapists are trained to do this type of work. This is a specific degree and license type that focuses on relationships between people (husband and wife; father and son; mother and daughter, etc…) as the point of intervention rather than just focusing on fixing symptoms (depression; anxiety, etc…). Its important to alleviating depression and anxiety and its crucial to build relationships that help someone deal better with anxiety and depression in the first place.

Pornography Counseling

Pornography addiction is becoming more prevalent in our society. Organizations like Fight the New Drug do a great job of educating the public on the harmful effects of pornography. What do you do if you struggle and can’t seem to find a way out? For many, the way out seems elusive and unobtainable. It’s difficult to find how when you have tried so many things, only to have this problem keep coming back. Many that come into counseling have already been before and are discouraged that they just can’t ‘get over it’. Knowing how to use the power or education and relationships is part of the answer. A good therapist can help you access both in your efforts to let go of this addiction. At the Center for Couples and Families we specialize in relationship therapy in regard to pornography use. Knowing how to communicate with your loved ones about this difficulty is an important part of the process.

An Ethic to Live: Building Barriers to Suicide Around Ourselves & Those We Love

In cities throughout the world, notable high buildings and bridges increasingly have additional fencing built atop of them with the specific purpose of preventing suicides. Suicide fences tend to work because research has shown that suicidal actions are frequently impulsive, hence such fences serve to forestall that impulse and buy individuals precious time to further think about their decisions. In studies of suicide fences, it appears that individuals don’t leave such barriers to go look for another bridge or tall building to end their lives from, but instead return to the business of living for yet another day.  

Presently suicide is the leading cause of death among young people ages 10-17 here in Utah, and over the last decade, it’s also doubled amongst adults in our state. As concerned friends, neighbors, and parents, how do we help our community build more barriers to suicide; protecting and empowering those we love? Over the next year, I’ll be writing a series of articles in answer to this question; offering my perspective as both a therapist, who has stood on sacred ground in helping others walk back from suicidal thinking, and as one who’s felt and ultimately rejected the dark pull to end my life amidst heavy times.   

Perhaps you’ve already noted that there’s no way to build suicide fences everywhere or to somehow block all of the endless ways in which someone might consider ending their life. Sound public policies on prevention and physical barriers like suicide fences are only some of the important ways to help. So in addition to these forms of prevention, the focus of my writing will be on how to build barriers to suicide directly into the thinking and values of individuals, and into the culture of our community as a whole. In this first article, I want to introduce how we help foster an ethic to live within ourselves and in others as a key barrier to suicide.  

An ethic to live means valuing our lives and holding a commitment within ourselves to continue living — even when we’re unsure of how we’ll cope or move forward. In my experience, helpful conversations about consciously building an ethic to live, begin by first taking care to turn our attention to the reality that to live is to be vulnerable to an array of difficult life experiences, with the potential to evoke within us the thought to end one’s life to escape them. Throughout human history, individuals and peoples have had to confront extremely painful and unjust challenges which have overwhelmed their sense of being able to continue on, and it’s important to acknowledge that when we confront such considerable pain, it is the most human thing in the world to want relief from it. This is real; excruciating human suffering beyond one’s current sense of how to reduce or stop it is real, and in these concentrations of pain, we may find ourselves having suicidal thoughts.  

When we acknowledge and honor that such excruciating life experiences do show up for many of us, it’s then that we can locate where we need to begin building internal fences to prevent suicide. It’s here that we recognize the need to develop a strong ethic to live even though there are times that we might not yet fully know how we’ll cope or be able to see brighter ways forward. It’s also here that we find the need to define as individuals what makes life worth living with specificity to our own life experiences, as well as the need to find a listener who we can turn to and voice what’s going on inside of us. 

As you navigate life’s difficulties, no matter how hard things may get, make the commitment now to live and identify your personal reasons to do so. Additionally, identify suicidal thoughts as a  sign to find a listener who you feel safe enough to talk to. It’s worth thinking about right now who it is you might feel comfortable turning to during your hardest times. By doing so, you’ll begin to build your own internal fence between you and suicide as well as have greater insight as to how to help others you care about to do the same.  

* If you or someone you care about is currently having thoughts of ending their life, caring help is available 24/7 by texting 741741 from anywhere in the USA or you can call 1-800-273-8255 to speak directly with a Counselor from the National Suicide Prevention Lifeline. 

Bio: Laura Skaggs Dulin holds a master’s degree in Marriage and Family Therapy from San Diego State University. She currently sees clients at the Spanish Fork Center for Couples and Families and at Encircle LGBT Youth and Family Resource Center in Provo.  

Forced Apologies

My four-year-old daughter placed herself in the middle of our living room to play with blocks. She was so engrossed with building a wooden castle that she didn’t notice her two-year-old sister walking towards her with her right arm stretched far back to slap her older sister across the head. When that slap came, my older daughter went from happy to surprise to anger and then lots of tears. She ran towards me seeking justice. “Mommy, she hit me!” My younger daughter remained still, looking innocent. I immediately walked over to her with my older daughter in hand and said, “Hands are not for hitting. Say sorry for hitting please.”  I’m sure many parents can relate to this scenario. Teaching our children the skills for making amends is an important life skill and is not so much about saying the words “I’m sorry”.  

There is a belief amongst some parents that enforcing premature apologies on children is not effective. Their reasoning is that premature apologies teach children to lie and encourage insincerity. It also creates shame and embarrassment. Other studies show that young children have the ability to be empathetic even before they can speak; therefore, parents should encourage apologies (Smith, Chen, Harris; 2010). As I reflected on my research and my knowledge as a Marriage and Family Therapist, I recognized several things we can do as parents to create productive apologies: 

  1. Keep yourself in check: It’s frustrating to see your children fight, especially when it happens at inconvenient times. However, it’s important to remain calm and model for your children how to handle frustration.   
  2. Be immediate when possible: When you see an incident occur between your children, address it. The best time for learning and growth is when the incident is still fresh in their minds. However, when there are time constraints and the issue cannot be addressed right away, it is important to tell your children when and where it will be addressed. Be consistent when using the alternative and follow through.  
  3. Ask instead of tell: Avoid lecturing. Ask questions instead. “Tell me what happened?” “What were you feeling when you hit your sister?” Validate the expressed emotion and help them to understand that it is okay to feel frustration and sadness; however, it is not okay to hit or throw things. Help them to also make the connection between emotion and action. “Look at her face, how do you think she’s feeling right now?” Asking these types of questions enhances empathy. 
  4. Problem Solve: Ask questions about what they think they should do when they feel frustrated or sad. Help them to come up with solutions.  Ask questions about how they can make things better with their sibling/s. 
  5. Have them practice a do-over: When your child identifies the solution, have them practice it with the other sibling/s. Praise them for their efforts at the end.    

What is more important than the phrase “I’m sorry” is what children take away from the experience. We can facilitate and enhance learning opportunities by not focusing on the phrase “I’m sorry” but instead more on what can be learned from this situation and how can we improve.  

Seasonal Affective Disorder – SAD

Every now and then, most of us feel down or blue – this is different than depression. Situational sadness comes and goes with whatever is getting us down. For example, if you don’t get recognized for something you worked hard at, you will probably feel sad. After time, your sadness will start to disappear. It isn’t as sad over time. This is situational. Depression, on the other hand, seems to last beyond these events. Even when something potentially sad has come and gone and if there is seemingly no reason to feel sad, you still might feel sad. This can especially be true in the winter. The days are shorter and colder. This causes most of us to stop moving as much, and to stay inside. We then lack exercise and sunlight. On top of that, with the Halloween, Thanksgiving, Christmas and New Year’s, we tend to eat food that isn’t as healthy. We eat more sugar. This all contributes to feeling sad when we don’t seem to have anything to be sad about. Seasonal Affective Disorder (SAD) is what happens to many people during the winter months. Most people don’t realize they have this type of problem, they just think that they are down or blue. It is more than just having the ‘winter blues’. It impedes you in your daily life and interferes with your functioning. Recognizing that you have SAD will help you know what to do to overcome and let go of it. Some of the symptoms include: feeling sad, losing interest once enjoyed, change in appetite, change in sleep (usually sleeping more), loss of energy, restless activity, feeling worthless or guilty, trouble making decisions, and thoughts of suicide or death. If you think you might have this type of depression talk with a therapist today.