Informational Articles

 

 

Is Caregiver Stress Ruining Your Relationships?

By:  Rachel Thorpe, LCSW, DAPA

 

 

Throughout our lives most of us will be faced with caring for a loved one.  Of course we all want the best for our loved ones and feel compelled to provide the care ourselves to avoid the nightmare of unethical or substandard care. 

 

Unfortunately, if you are caring for a loved one over a long time, relationships can suffer as well as your health and wellbeing.  Once someone becomes a caregiver the relationship between the caregiver and the loved one changes dramatically.  For most people, being a caregiver to someone you love is emotionally painful as it can be seen as an indicator of permanent changes that will prevent that person from being themselves and may also be indicative of the impending end of their life.  The grief that often accompanies being a caregiver often leads to that person emotionally separating from their loved one in order to feel like they can face the necessary caregiving tasks.  This changes the relationship between the caregiver and loved one significantly and often leads to changes in roles.  For example a son or a daughter starts taking on the role of being the caregiver (parent-like), thus ending their relationship as they have known it.   

 

 Some caregivers end up becoming ill themselves, due to stress, making them unable to care for their loved one; or become emotionally burnt out and feel very frustrated, guilty, and angry.   Full time caregiving can also affect the care- giver’s marriage as well as their relationship with their children and siblings.  The bottom line is, although full time caregiving starts out well intentioned, it can spiral into an unhealthy time for the whole family. 

 

How can your loved one receive quality, loving care while maintaining family roles and healthy relationships?

 

 

  • Families can divide caregiving tasks, making sure that everyone has adequate time off and each person’s needs are addressed.

  • A good compromise is to assign personal care tasks to a Certified Nursing Assistant.  This can be very helpful in allowing the family to maintain roles as spouses, children, etc.  Many people feel more comfortable with having a professional provide personal care such as bathing.

  • Many home care agencies also offer respite volunteers, which can provide the family with a well deserved break.

  • Many states have respite programs and financial assistance for in-home care.  Contact your local Department of Elderly Affairs or Department of Human Services.

  • Many states also offer friendly visitor programs, and discounted homemaker programs.

 

Being a caregiver for a loved one can be very difficult despite having a very close and loving relationship with your loved one.  Guilt is an emotion that many people face when undertaking the caregiver role seems to be more than they can handle.  It is important to realize that you must have realistic expectations of yourself.  Caring for a loved one requires more than any one person can do and should be considered a team effort.  It is unrealistic for someone to care for a loved one full time while managing their own household, family obligations, work, school and self-care.  There are also many emotional costs to being a lone, full time caregiver, including loss of relationships, health and emotional well-being.

 

 

 



Is It Alzheimer’s, Dementia, Or Am I Losing My Mind?  

By:  Rachel Thorpe, LCSW, DAPA

   

 

Many people worry about changes in memory and panic about possibly developing dementia or Alzheimer’s type dementia.  Many people find themselves feeling forgetful at different times in their lives but it does not automatically mean that you have dementia.  There are many factors that could account for forgetfulness including medications, sleep issues, anxiety, poor nutrition, poor nutritional absorption, depression, stress, ADHD, urinary tract infections, circulatory diseases and menopause,  just to name a few.  When should you worry about your memory?  You should worry when forgetfulness is interfering in any of the following areas of your life: social, work, self-care, decreased productivity, and feelings of frustration leading to a decrease in the quality of your life. 

 

What should you do if you are struggling with forgetfulness?  The first thing that you should do is to discuss your concerns with your primary care physician.  He or she may ask you a number of questions and may order tests to rule out non-dementia medical causes.  Your physician may also refer you to a specialist who will complete a full assessment and investigate all causes.  Many times forgetfulness is due to non-dementia causes that can be easily treated.

 

You can also see a psychotherapist to obtain an assessment of bio-psycho-social factors.  He or she may give you some psychological tests; obtain a complete psychosocial history and detailed information about you and your family.   Therapists should also work with your primary care physician to coordinate care in order to address all areas of concern.  There are several treatments and skills building that a psychotherapist can provide to address forgetfulness.  Relaxation treatments, cognitive behavioral therapy, solutions focused therapy and Interactive Metronome are often effective in treating forgetfulness due to psycho-social causes.  Interactive Metronome is also quite promising in treating individuals with dementia by improving executive functioning.  This treatment is a powerful and fun therapy and produces measurable results in a short period of time.

 

If you are diagnosed with dementia, there are several medications that help in slowing the progression of the disease.  Depending on the type, some dementias can respond to specific treatments.  Cardio-vascular exercise, remaining socially active and maintaining productivity can also have positive effects on the symptoms of dementia.  The medical community is making progress in developing a cure for dementia everyday.  In the meantime, it is important to stay active, exercise and explore alternative treatments such as Interactive Metronome. 

 

 

 

Why Does My Child Procrastinate?

By Rachel Thorpe, LCSW, DAPA

 

This question has undoubtedly been asked by millions of parents, causing endless conflict.  Sometimes procrastination can be a symptom of an underlying problem.  How can you tell if your child is just a procrastinator or if he or she is struggling with something else?  Before you go into battle consider the following:

 

Is the procrastination specific to one or two tasks?  If so, fully explore what the activities are.  For example, is the procrastination mostly about doing household chores, writing assignments or math assignments?  These details are important clues that can help determine if there is an underlying problem. 

 

If your child is consistently procrastinating in one academic area, you may want to speak to his or her teacher to see if they have any idea why this subject is so problematic for him or her.  Sometimes children can have an underlying issue such as difficulty with sequencing or processing, which could make the task extremely overwhelming.  Another issue that can often go unrecognized is dyslexia or ADD. 

 

If your child is consistently procrastinating in multiple areas it is important to see if there are any connecting variables.  For example, do the tasks require a number of steps or organization?  Does your child become frustrated about his or her own procrastination?  Is the procrastination negatively impacting social or fun activities?  If you answered yes to any of the above, you may want to have your child evaluated as he or she could be struggling with anxiety, a learning disability or ADD.

 

Things to try if your child is just a procrastinator:

 

1)        Do not get into power struggles.  (If you take away privileges, make sure that you are not in a constant battle to reinforce this.  For example if you take away video games, confiscate the controllers and the cords)

2)       Use a large calendar and break down tasks into small manageable parts, such as writing one paragraph of a report per day.

3)       Use a reward system.  If your child cleans their room, they may watch an extra 15 minutes of television.  You can also teach your child to utilize short-term rewards, such as after they have completed a task, they get a 5 minute break.

4)       Tell your child that he or she can be in charge of their own privileges and how much time they get to enjoy their privileges (i.e.:  when they are done with their chores they can do the things that they want to do: video games, friends, television etc.)  Consistency is key as well as being relentless.  Many children will challenge this by saying they don’t care if they can’t do anything.  This usually only lasts so long.  Whatever you do, do not get into a battle.  If they refuse to complete the tasks, simply tell them that this is fine and when they are ready to do so you will resume privileges but in the meantime they have none.

5)       You could also have a set routine.  For example, you could have quiet time for an hour.  This could be a time where everyone does something quiet like pay bills, read, do homework, etc.  You could also have a cleaning time where everyone is involved in household chores.

 

 

 

 

Divorce Mediation and Psychotherapy: Protecting the Children

By:  Rachel Thorpe, LCSW, DAPA

 

Most parents with children who are facing the divorce process struggle with the heart wrenching task of doing what is best for their children while keeping their sanity.  Unfortunately, children tend to be the most vulnerable family members during divorce and often feel powerless regarding any of the changes that affect them.  As a psychotherapist I have worked with many families post divorce to address adjustment issues and creatively develop strategies to decrease anxiety and depression. Divorce mediation allows parents more flexibility in decision making which can reduce the trauma affecting their children during divorce and in the future.

 

Psychotherapists are in a unique position to take on the role of Divorce Mediator due to their experience working with families that are divorcing or have divorced.  Psychotherapists tend to see families and individuals after divorce to address many unforeseen issues that often arise after a divorce agreement is complete.  When individuals are in the midst of divorcing, emotions can impede their ability to anticipate how the divorce agreement will affect all involved once enacted.  Psychotherapists as mediators can assist parents by calling attention to possible unforeseen issues that may evolve as a result of certain decisions made during the divorce process.  Psychotherapists also have an abundance of experience working with many families who have created successful agreements and can offer creative suggestions that can minimize future difficulties, especially for the children.

 

Some common difficulties that kids face post divorce include but are not limited to:

 

  • Feeling conflicted when an extracurricular activity is scheduled during a planned visit with the noncustodial parent.

  • Parents not both being present at the child's activities.

  • Forgetting articles at one parent’s house and how to address these situations.

  • Visitation schedules that encourage the children to "choose", making them feel torn.

  • Inconsistency in visitation and inflexibility in visitation schedules.

  • Holiday schedules that may not be in the children's best interest.

  • Who will pay for extra activities that the children would like to participate in and guilt over the cost.

  • Vacation schedules.

  • How will parents communicate calmly regarding the children?

  • Parental conflicts regarding visits to extended family.

  • Placement of pets.

  • How to address school activities, i.e. parent teacher conference, plays etc.

  • Post divorce housing.

 

Difficulties that the parents face post divorce include:

 

  • Communicating with each other regarding their children's activities, schedules etc.

  • Authorization of medical treatment for children, including counseling.

  • Collaboration of health insurance plan(s) and member ID cards etc.

  • Addressing changes in children's schedules and adapting visitation plans.

  • Future relationships/step-parenting.

  • Transportation to and from visitations.

  • Addressing school expenses and future college expenses.

 

In mediation parents have the power to address the above issues and concerns before they become problems post-divorce.  Mediation allows for greater creativity while addressing matters required by the courts in order to obtain a divorce.  Mediation also allows divorced individuals to re-negotiate a settlement agreement in the future regardless of whether or not their original agreement was mediated or completed through attorneys.

 

What to expect when your mediator is also a psychotherapist:

 

When psychotherapists are acting as a mediator they will maintain very clear boundaries and sound ethical practices. Psychotherapists should never take on the dual roles of being a therapist and a mediator, regardless of which role was established first.  When mediating, a psychotherapist will never act as a therapist to either party or both parties collectively.  Divorcing parties should not expect to utilize mediation by a psychotherapist as a means to decide whether or not to divorce or save their marriage.  Both individuals should have determined that divorce is the necessary step to be taken prior to seeking divorce mediation.  Should two married individuals begin the divorce mediation process then decide to seek out marriage therapy, they cannot utilize the therapist that is mediating.  Should marriage therapy prove unsuccessful, the two parties can return to mediation at any time.  Mediation is appropriate for parties that are married, common law married, or in a committed civil union and are faced with the unfortunate task of separating or divorcing.

 

Once both parties have mediated a fair and equitable agreement, the mediator will guide both individuals through the steps of having their agreement processed in family court.  The mediator can also assist the parties in finding an attorney(s) to process their divorce should they need assistance.

 

What to look for?

 

If you are interested in benefiting from the experience and unique perspective of a psychotherapist as a mediator, you should be certain that the individual is qualified.  He or she should have completed a comprehensive, in-depth training program.  Psychotherapists do not receive mediation training as part of their education, however, psychotherapists with mediation training are well suited to the role of mediator and bring with them experiences that can help identify and prevent possible future concerns.

 

 

 

 

Mental Health Concerns and Psychosocial Stressors in Individuals Who Have Down Syndrome

By:  Rachel Thorpe, LCSW, DAPA

 

Common behavioral and mental health concerns:

 

  • Impulsivity and ADHD type behaviors

  • Self Talk (coping strategy used to process information)

  • Anxiety

  • Depression

  • Obsessive Compulsive Disorder

  • Autistic Spectrum Disorders

 

Many times symptoms are interpreted as behavioral issues but often behaviors can be symptoms of a mental health issue.  Individuals who have Down syndrome are at higher risk of having expressive and or receptive language difficulties, leading to acting out of symptoms thus, making it difficult to diagnose a mental health problem based on self reporting of symptoms .

 

Medical problems can also alter the behavior of an individual with Down syndrome as it does with any individual. The increased risk of expressive and receptive language difficulties can make it very difficult for the individual to express how they are feeling and the symptoms they are experiencing thus, leading to the acting out of symptoms.

 

What to do if a loved one has Down syndrome and is showing signs of decline or is having a change in behaviors:

 

  • Consult with the individual’s primary care physician to rule out a medical cause. Common medical causes can include but are not limited to:  

 

Heart disease

Thyroid disorders

Atlanto-axial instability/ dislocation

Celiac disease

Sensory issues

Vision or hearing changes

Dental issues

Sleep apnea

Gastro-intestinal issues

Seizure disorders

Alzheimer’s disease/dementia

Medication side effects

 

  • Obtain a psycho-social assessment from a professional that has experience working with individuals with Down syndrome.  Many times assessments are strongly reliant upon behavioral symptoms.

  •  

  • A neurological evaluation may also be recommended to rule out a neurological cause.

 

Treatment:

 

Treatment for mental health problems in individuals with Down syndrome is very similar to the treatment provided to the any individual struggling with a mental health issue.

 

  1. Medication:  Medication with anti-depressants or other psychiatric medications can be very effective in decreasing symptoms.

  2. Psychotherapy:  Psychotherapy or counseling is also an effective treatment with or without medication.  Individuals with Down syndrome have an ability to learn skills and process feelings just like any other individual.

  3. Behavioral/Environmental changes:  Caregivers can play an important role in facilitating change by working with their loved one and therapist in order to make changes in the home, work, etc.

 

Caregiver Stress:

 

With caregiving one can experience ongoing joy and celebrations of accomplishments and growth.  However, caregiver stress can become a very real challenge.  It is important for loved ones to develop a very strong network of supports.  There are many groups that offer families opportunities to participate in activities and social events in order to foster a support network.  Sometimes caregivers may also need to participate in therapy to decrease stress and learn behavioral interventions.

 

The bottom line is that individuals whom are diagnosed with Down syndrome should not be treated as a syndrome.  They are individuals that are as diverse as the general population and assumptions should not be made about their health and mental health just because they have been diagnosed with Down syndrome.

 

 

 

 

  

 

ADHD Myth or Fact?

By:  Rachel Thorpe, LCSW, DAPA

 

For years professionals and parents alike have questioned whether or not ADHD is a real disorder or a choice.  I have included information regarding this controvercy in an attempt to untangle fact from fiction.

 

ADHD SUBTYPES as Described in the Diagnostics and Statistical Manual:

 

There are three subtypes in the diagnostic criteria for ADHD.

 

  1. Attention Deficit Disorder:  inattentive type.  This type was once referred to as ADD.  One must have at least 6 of the following to meet criteria for ADHD, the inattentive type:

 

  • Fails to give close attention to details or makes careless mistakes (often it seems like the person just does not care)

  • Difficulty staying focused

  • Does not appear to listen

  • Struggles to follow through on instructions

  • Organizing is a major problem

  • Avoids or dislikes tasks requiring mental effort

  • Often loses things necessary for tasks

  • Is easily distracted

  • Is forgetful

 

2.  ADHD Hyperactive:  impulsive type.  One must display at least 6 of the following to meet criteria for ADHD, hyperactive type:

 

  • Fidgets with hands or feet or squirms in their seat

  • Has difficulty remaining seated

  • Runs around, climbs excessively (in adults they may just feel restless)

  • Difficulty engaging in activities QUIETLY

  • Acts as if driven by a motor

  • Talks excessively

  • Blurts out answers before the questions have been completed

  • Has difficulty waiting for his/her turn

  • Interrupts or intrudes upon others

 

3.  ADHD The Combined Type:  meet criteria for both inattentive and hyperactive ADHD.

 

Is ADHD a real phenomenon or is it an excuse for laziness or behavioral issues?

 

ADHD has been controversial over the past several years as many debates have evolved questioning the authenticity of ADHD.  This has sparked a number of studies, which have revealed the following:

 

Most neurological studies show that those with ADHD Have:

 

  • 20-30% less brain electrical activity

  • 3-4% less brain volume

  • Reduced glucose metabolism - thus making areas of the brain less active

  • Areas of the brain that may be effected impact organization, motivation, motion, impulsivity, memory and the ability to differentiate the level of importance of thoughts, tasks, etc. making everything equally important.

  • Average to above average IQ

  • Some studies found that as many as 10% of individuals diagnosed with ADHD actually have seizure disorders.

  • ADHD appears to have a strong genetic link: one study analyzed twins whose parents had been diagnosed with ADHD and were adopted into two separate households.  Both twins developed similar levels of symptoms of ADHD.

  • In 2002 an international consensus statement regarding the authenticity of ADHD was released.  It stated that ADHD was a valid and scientifically proven phenomenon.

 

What Does this Mean?

 

Symptoms vary greatly from one individual to another.

 

Picture a continuum where ADHD symptoms go from no symptoms to extremely high symptoms.  Somewhere in between there is a point at which symptoms significantly affect functioning.  We all fall on this continuum, which explains why we can all say, “Gee I do that”.

 

ADHD is not an inability to pay attention.  It is an over-ability to pay attention.  Individuals with ADHD pay attention to everything equally; if there are 10 things going on, their attention is broken into 10 equal parts.  They also have many thoughts going on at the same time.

 

Many people question consistency of symptoms, especially in  individuals who play video games for hours on end without having any difficulty paying attention.  Upon closer inspection, you will discover that the games typically chosen by these individuals utilize a great deal of action, multiple characters and multiple tasks all going on at the same time.  Individuals with ADHD are able to master these video games because of their ability to divide their attention on every detail displayed on the screen.  They are not paying attention to one thing, but rather the many stimuli before them.

 

There are many treatment approaches and skills building that can decrease or manage symptoms of ADHD as well as medications.  Each individual is unique and requires a complete assessment to develop the most helpful treatment plan. 

 

Gulf Coast Psychotherapy offers comprehensive assessment and treatment options for all ages.





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