The Shrink Is In

Parent Tips For the New School Year

2007-08-31T09:37:00.001-07:00

With the start of a new year, I wanted to impart some information that can be helpful to all parents. Let me just say that I have been involved in school districts as a school psychologist and in private practice as a clinical psychologist. For many years I have advocated for children in all aspects of education from pre-schoolers to college students. Over the years, I have tried to impress upon all parents that they have to be partners in their children’s education. It is important for parents to be aware of the demands their children face in school and to be involved in their homework and long term projects. Those parents who are lucky enough to have children with average or above average intelligence, internal motivation, and no learning problems will probably have an easier path. Parents of children who have specific learning problems, emotional or behavioral problems, or who are even intellectually advanced, will have to be more diligent. For these parents, it is even more important to understand what the school systems can offer and how to advocate for their children.

Many parents have come to me unsure about how to help their child who has been doing poorly in school or who has been identified as a behavior problem. They have been intimidated by the teachers or the administrators, who were seen as being smarter than the parents, or who were viewed as being all knowing. I can understand parents being unsure of themselves with professional educators. I believe that most teachers and school personnel do not want to be seen as unavailable or difficult. I believe they are well meaning and motivated to help, but they may not have all of the answers. When a child is having a chronic problem in school, some changes have to be made to accommodate that child’s needs. The changes range from easy fixes, to curriculum modifications, to elaborate programming changes. Sometimes alternative educational environments are needed.

There are rules and laws that govern what can and cannot be done for children with special needs. These regulations are a subset of the Americans With Disabilities Act. Many times, I have had parents who were afraid of identifying their children as having a problem. They were afraid of labeling their child for life. It has been my experience that the label has not hurt any children. In fact, I have worked with children whose parents did not get the school district help and their children were failing miserably and did not go on in school. Over the years, I have advocated for many other children who did receive special educational services and who have gone on to college, and even earn graduate degrees.

As a parent, if your child is having long-term academic problems, make an appointment with his/her teachers and brainstorm ideas to help your child learn more efficiently. Have contact with the teachers on a regular basis. If that does not help, meet with guidance personnel and even the school principal. If you see signs of siginficant learning problems or your child’s needs are not being met by the regular educational programming, write a letter to the individual who is in charge of the District’s Committee on Special Education(CSE) asking for an evaluation of your child. The CSE is not forced to formally evaluate your child, but they will have to investigate what is happening with your child.

Remember, parents have all of the power in regard to what happens to their children. School districts cannot institute changes in your child’s educational programming without your consent. If you have questions about special educational services, you can obtain information and support from district parent groups, national support groups, state and federal regulatory agencies, and professional advocates.

My tips on how to pick a life partner

2007-02-18T17:21:00.000-08:00

Today’s article is an outgrowth of a conversation I had with Dr. Barbara Fontana for a podcast for the Suffolk County Psychological Association. You can hear the podcast at http://scpa.podOmatic.com. After doing the interview, I realized that there were aspects about relationships that we had not discussed and I thought it was important to offer the pointers and suggestions I have given my own patients over the years.

In my experience, I have found there are five big issues that cause problems in relationships. These are the major issues that could interfere with the longevity of any relationship. Here are my pick for the five issues that cause the majority of problems in relationships- not in any specific order:
1) Differences in sex drives.
2) Outside family members intruding on the relationship.
3) Religious differences.
4) Economic differences.
5) Different perceptions on how to parent the children.

My list may not be the most exhaustive and there are others out there. For example, The Americans for Divorce Reform’s list of issues that cause problems in marriages is different and larger, but there is some overlap with my own list. Here is their list:

1) Communication problems.
2 Financial problems.
3) A lack of commitment.
4) A change in priorities.
5) Infidelity.
6) Failed expectations or unmet needs.
7) Addictions and substance abuse.
8) Physical, sexual, or emotional abuse.
9) Lack of conflict resolution skills.

In light of these lists, I believe it is important to do your homework. Explore the following areas:

Find out if the person you are interested in has ever had substance problems or any other addictions. If these problems had been in the past, there is a somewhat higher probability they may reappear in the future.

I know that it seems obvious, but consider if someone has had a criminal past. If they did, find out what their crime was. Depending on what they did, it may tell you if they have an inability to follow rules, or they believe the rules don't apply to them. Could their crime tell you that they could have the ability to violate other people's needs without thinking? Could you be next?

Too many job changes in a short period of time could be a sign of a problem. Be suspicious if they blame all of their bosses. I find it highly unlikely that every boss they have ever had was a fiend. If they have been changing jobs constantly, it might indicate that they are not financially stable enough to support a family for the long term, or they have trouble with authority figures, or even just getting along with others.

I would be suspicious if when talking about their past relationships they claim that every other individual they went out was responsible for the breakup, or that they were always monsters and terrible people. It may suggest that they do not take responsibility for their own unfavorable behavior that may have led to, or contributed to, the prior breakups.

See how they were raised his children. If they came from a verbally or physically abusive family, it may reflect on how they choose to parent their own children.

Make sure religious beliefs are similar to yours. If you have significant different religious values it may create problems in the decision on how to raise your own children.

Observe how they handle money. Are they able to part with their money or are they unable to hold onto their money. Different values and finances can create problems. Find someone with similar values of handling money.

Check out their family history, or as many generations about which you can obtain information. Find out if anyone in their immediate family was alcoholic, had major mental illnesses, or had been in jail. The reality is when you marry a person or are in a long-term relationship their family and family problems come with them.

Keep those pointers in mind when looking for a potential lifelong spouse or partner. You need to do your homework and find out about their past, their family, and their needs. Ask questions and observe. Do not think you will change the person into someone else.

Does smoking cigarettes cause a drop in IQ?

2006-09-26T08:19:00.001-07:00

Over the years, we have all read many articles about the dangers of smoking cigarettes to our general health. The ingredients in the cigarettes have been linked to a variety of cancers, lung disease, heart disease and hormonal imbalances. These medical problems are estimated to be the cause of over 400,000 American deaths per year.

Now, we have additional information that suggests smoking cigarettes may also cause brain damage. The recent data suggests that smoking cigarettes actually lowers smoker’s intelligence.

I came across a study in Scotland that was undertaken by Dr. Lawrence Whalley with combined support from University of Aberdeen and the University of Edinburgh. Dr. Whalley retested 465 participants who completed a mental health survey in 1947, when they were eleven years old. The participants were re-evaluated between 2000 and 2002, when they were approximately 64 years old.

The data indicated that smokers performed worse on five tests that measured their thinking abilities when they were compared either to people who stopped smoking or to those who never smoked cigarettes. When other variables were controlled for, such as education levels, occupational levels and alcohol use smoking still appeared to have a negative effect, but on a lower level.

The author of the study suggested smoking might affect the oxidation process of the brain neurons. Oxidation is the process in which cells obtain energy from oxygen. The oxygen is needed by all cells for proper function. The brain requires a considerable amount of oxygen to keep the cells functioning and healthy. The research seems to suggest that the elements in cigarette tobacco clog the lungs and prevent enough oxygen from entering the system. If it is true that cigarettes cause less oxygen to reach the brain, it could cause the premature death of necessary brain cells, lowering the smoker’s ability to think.

Clearly, if the data is accurate, it presents another reason to stop smoking cigarettes- it kills brain cells and makes the smoker less intelligent

Does smoking cigarettes cause a drop in IQ?

2006-09-26T08:19:00.000-07:00

Therapy is more common than you think!

2006-06-16T11:03:00.000-07:00

It is estimated that approximately 75 percent of all patients who visit a primary care physician have a psychological component to their initial complaint. 48 percent of all Americans between the ages of 15 and 54 will experience a psychological disorder during their lifetime. According to recent data, in any one year, one in four Americans will have a mental disorder ( a serious diagnosable disorder) or a mental health problem (a less serious emotional problem ). Of those people, only 28 percent of them will seek treatment. 5-10 percent of Americans will have a depression in a one year period.
According to the Surgeon General’s 2000 year report 15 percent of the population will use some form of mental health services during the year ( 8 percent for a mental disorder and 7 percent for a mental health problem). The Surgeon General’s report also indicated that 21 percent of children aged 9-17 will receive some mental health services in a year.

Short term, cognitively based psychological interventions have been found to reduce depression and anxiety. The Office of Scientific Information found that 70%-90% of panic disorder patients report significant improvement after therapy. In another study, 70% of depressed patients found relief after an average of only 9 sessions. Studies of substance abusers who receive treatment have reported less absenteeism and increased income.
Psychologists help patients cope with medical problems, develop healthy behaviors, cope with stress and improve their quality of life. The data shows:
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Breast cancer patients who participated in group therapy survived longer than those who did not participate in a group.
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Therapy for patients helps in reducing the negative effects of chronic pain.
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Pre-surgical counseling has been found to reduce complications and patients’ medication usage.
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Diabetic adolescents are able to maintain better discipline of their diet and medication when they participate in therapy programs.

Depression- The Two Types

2006-06-06T12:52:00.000-07:00

As I indicated in the previous blog, depression is not being blue for a few days. Depression is a long episode of sadness that impairs the person’s ability to function. We see depression as coming from within the person (endogenous) or coming from a specific life situation (exogenous). This article was written to explain the two major causes of depression.

First, there is the depression that is internally caused, the endogenous depression. We know that our brain controls thinking, feelings, sensations, bodily functions, and our actions. The brain operates on electrical and biochemical processes. It is made up of over 160 neurochemicals (at last that is how many we have identified as of today). We also know that there are at least three neurochemicals that are involved in our moods. These neurochemicals are serotonin, dopamine, and norepinepherine. When one is depressed, there is less of one or more of these neurotransmitters; therefore, the popular antidepressant medications essentially work to artificially increase one or two of these neurochemicals in the brain. At this time, we do not have all of the answers about brain chemistry and depression. We also know that antidepressants do not work on all depressed patients. Clearly, more research is needed in the area of depression and pharmaceuticals.

Now let’s turn to depressions that are created by events outside of the individual, exogenous depressions. Loss of a loved one, marital crisis, health problems, job loss, financial problems all can make someone feel depressed. These events can lead a person who was previously functioning into a state in which they are unable to work, sleep appropriately, eat properly, think clearly, or experience happiness. It is believed that in response to a significant distressing event, the individual’s thinking is altered and they cannot think clearly about solutions or consequences. We do know that many times when these negative life events are cleared, or passed, the individual can return to their previous level of functioning. However, there are cases in which the individual cannot easily recover and they do not return to their previous level of functioning. It is possible that significant stress can upset the fine balance of neurochemicals and cause the person to be depressed.

The data indicates that the treatment for either depressive response should be a combination of medication and therapy. The length of treatment and extent of medication would be dictated by whether there was a long-term change in the individual’s biochemistry and the duration of the external stressors.

what Is Depression?

2006-05-30T10:34:00.000-07:00

We live in a time when our general vocabulary is filled with psychological terms. Unfortunately, many people use psychological labels incorrectly. The most common error I hear is the misuse of the word, depression. Depression is used when people are sad, upset, distressed, and really depressed. If someone is sad or upset for a few days, we do not consider him or her to be depressed.

The symptoms of depression are poor eating or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness. Many people may experience these symptoms from time to time. However, to be diagnosed as depressed, an adult has to have these symptoms consistently for almost two years. For children and adolescents it can be one year. Yes, children can be diagnosed as being depressed.

To make it easier, I like to view depression in a comparison to common illnesses: cold, flu, and pneumonia. What we call a “subclinical depression” is when someone is always negative, irritable, easily angered, and does not seem to enjoy their life. They have been this way for years, maybe their whole lifetime. They work and take care of their needs, but they just do not seem to be happy. The person with a subclinical depression would not see himself or herself as being depressed. Others may just see this person as being difficult, or even abusive. Since they can function every day and they are not bedridden, I compare this to a cold. However, with a cold people tend to self-medicate. The possibility of a subclinically depressed patient finding relief in substances (alcohol or drugs) is very high.

A more severe depression causes the person to have many of the symptoms I stated above. They may still be able to partially function, but they are obviously ill. They feel ill, others can recognize that they are not functioning, and they should see a doctor for medical attention. They have what I would consider the middle level depression- what I would compare to the flu.

The person with a more severe depression would be unable to function. They may have no energy or drive to get out of bed; their will to live may be sapped. Depending on their age, level of general health, and severity of the illness, they need significant medical attention or even hospitalization to keep them alive. This level of depression is what I compare to Pneumonia.

In this brief article, I have simplistically explained depression. I do not want to minimize the disorder or suggest that the proper diagnosis of depression is this simple.

How to Choose a Mental Health Professional

2006-05-13T07:04:00.000-07:00

As a psychologist, I cannot ignore my own bias. I believe that psychologists are best at doing therapy. However, I cannot say that all psychologists are good, and I cannot claim that all social workers, mental health workers, or psychiatrists are bad. There are some very capable social workers who I refer cases to and some psychiatrists who I believe are great pharmacologists and diagnosticians. Having said all of that, here are my suggestions for finding a good clinician.

To start with, you need to answer a few basic questions:

Do you have insurance that covers mental health? What are your benefits per calendar year, and how are they really determined? Contact your insurance carrier and ask what are their usual and customary fees for therapy, what percentage of the fees do they cover, and what is your co-payment. I expect they will say we cannot give you that information because we do not know the CPT codes the therapist will be using. well, I can help you there. The three most common codes are: the initial session code is 90801, individual therapy is 90806, and family therapy is 90847.

In regard to using your insurance be aware that your confidentiality could be affected. So, think, do I have a problem that I do not want ANYONE to find out about? If I want complete privacy, can I afford to go privately?

If you need to use your insurance, and then contact your insurance company and get as many names of clinicians in your area as you can. They usually only give you a few. Many times the person who you speak to is only looking at a computerized list and they may not know the clinician's specialties or the closeness to your location. After obtaining names, you can call local hospitals and professional mental health associations and ask if they know the clinicians. If the patient is an adult, you can contact the primary care physician to ascertain if they know of the mental health professional. If the patient is a child, call your pediatrician, or the school psychologist, to ask for clearance on the names you received from the insurance carrier.

If you are having a specific problem that requires specialized training (e.g. eating disorders, marriage issues, substance abuse, etc.), it may be helpful to contact organizations or self-help groups to get names that they may recommend.

Lastly, and most importantly, call the professionals and ask them all the questions you need to on the phone. In a few short minutes you can get a sense of what they are like, if you are comfortable with them, and if they sound knowledgeable. Trust your own judgment, because no matter what the treatment style or approach of the therapist is, you have to be comfortable and trust them.

To check on whether a psychologist or social worker is licensed, you can verify someone’s license by calling the licensing board in your state.

ADD and Adults

2006-05-05T12:16:00.000-07:00

Over the years here have been many news articles and television news shows that have reported that too many children were being diagnosed as having ADHD and that they were excessively being prescribed medication. The facts are that 3-7% of children have these disorders and they do need the help of medication and therapy to deal with the symptoms. In addition, we know that these disorders are neurobiological in nature and that they tend to run in families. Therefore, either siblings or parents of ADHD children may have the disorder. What is more significant is that we know approximately 60% of these children will continue to have symptoms into adulthood. Therefore, approximately 4% of adults may have these disorders.
ADHD is a more complex disorder than most people think. The individual with ADHD can not be just characterized as one who cannot sit still or who is “climbing the walls”. In fact, we now see ADHD as taking several forms. There are those individuals with the disorder who cannot focus and are disruptive to others. There are some individuals who appear in control, but they are actually internally distracted. Some individuals with ADHD become over focused and get stuck on small details that are not that significant to the task at hand. Then there are individuals who have combinations of ADHD, depression, Oppositional Defiant Disorder, or even Bipolar Disorder. In light of the variability of primary and secondary symptoms, proper diagnosis, specific medications, and therapeutic approaches have to be individualized.
The diagnosis of ADHD in children can be somewhat easier than in adults. Children are required to listen to adults, pay attention in school, and while in school they are actually monitored by many adults. There are frequent measures that can help rule out whether the child’s problems are due to ADHD or another issue. In children, learning disabilities, anxiety, or Oppositional Defiant Disorder can make the child appear to have ADHD. Proper diagnosis is important and a good pediatric neurologist or child psychiatrist who specializes in ADHD would be the best route to perform this assessment.
So what are the symptoms in adults? Constant fidgetiness and restlessness can be a sign of ADHD; however, as we age the hyperactivity component of the disorder tends to fade, generally leaving the disorganization piece. Therefore, if they were not properly identified as children, they may slip through the cracks and their ADHD would not be identified. .Other signs that may lead one to suspect ADHD in adults would be concentration difficulties, persistent procrastination, organizational problems, failure to complete tasks, poor time management, poor impulse control, sleep problems, poor management of money, interpersonal relationship problems, anxiety, and depression. These symptoms can be quite diffuse and may be expressions of other disorders, so they may go unrecognized or denied. In adults, the problems may lead to repeated employment failures, tumultuous relationships and poor parental skills. The individual with ADHD may be perceived as a failure or a difficult person to live with but not be recognized as having a disorder. Due to complications of ADHD, adults also may have significant secondary problems with alcohol, drugs, or legal problems.
If ADHD is suspected, what should you do? Given the possible devastation ADHD can have on an adult’s functioning and well being, it would be wise if it is suspected to be assessed for the disorder. The testing for ADHD is not that intrusive or complicated. The assessment is based upon the data obtained from a good review of information regarding the individual, their family (parents, siblings), and their early academic experiences. Self-rating forms and Objective Personality Tests are used to gauge the impact of present symptoms on the individual’s life. An additional test requiring the individual to work on a computer for approximately 14 minutes provides information on impulse controls, attention, and concentration. Lastly, a conference with a psychiatrist who works with ADHD adults would be necessary to asses the proper medications and dosages.
If an individual has had undiagnosed ADHD for years, they have probably developed low self-esteem and negative coping behaviors. Medication can help with the symptoms of the disorder, but therapy would be needed to improve the self-esteem of the individual, improve their interpersonal skills, and help eliminate nonproductive coping skills. For some executives and professionals who can afford frequent one to one services, there is a specialty line of coaches who work individually on assisting these people with enhancing life skills or teaching new organizational skills.

Although we know that ADHD does not go away, we do know with the proper diagnosis and treatment, the disorder can be controlled and the negative effects can be limited.

It Is Not News But It Is Newsworthy

2006-04-28T17:44:00.000-07:00

What appears in the media as amazing new discoveries in psychology and health sometimes is really just old news being recycled. Take for example, the announcement of a study that was recently found in the United Press International. The article was on a paper which was presented at the Experimental Biology 2006 Conference, which indicated that even anticipating watching a funny movie may be beneficial to our health. Dr. Lee Berk, from Loma Linda University, reported the results of a study on the effects of humor on health using sixteen young males who were divided into two equal groups. Eight of the male subjects were told that in three days they were going to watch a comedy video while a group of eight comparable males was not provided with any information about the video. Just prior to viewing the video, all of the subjects were tested for Endorphins (a natural pain killer) and Human Growth Hormone levels, HGH (HGH is prevalent during growth and healing). The males who were pre-warned had 27percent more Endorphins than the control group, and they had 87 percent more Human Growth Hormone than did the control group.
This article reinforces the belief that humor and laughter can be good for us and that even the anticipation of experiencing a fun time may be beneficial to our overall well being. This is clearly not new knowledge. The concept that humor and laughter are good for our health has been around since the time of the Bible. In Proverbs 17:22 it was stated, “A merry heart doeth good like a medicine.” Immanuel Kant, a philosopher who lived between 1724 and 1804, stated, “Laughter produces a feeling of health through the furtherance of vital bodily processes.” Robert Burton, English Clergyman and writer, who lived between1747-1825, said “Humor purges the blood making the body young, lively and fit for any manner of employment.” Victor Borge (1909-2000), a comedian, stated, “He who laughs last, lasts.” And of course, Alfred E. Newman, Mad Magazine, always said, “What, me worry?”

What does this all mean? Repeatedly, the research findings of many studies seem to identify a constellation of simple concepts. Basically, good common sense in dealing with people and emotions, reasonable living styles, moderation in all things, and finding satisfaction in everyday activities can make one’s life better. Yes, life can be complicated and more difficult at times, but if one has a positive outlook and one seeks out happy situations and happy people, you can weather the storms better and live a longer and healthier life.

Phantom panels

2004-10-24T16:24:00.000-07:00

I have been quite successful in developing thriving practice as I have strong referral sources, including prior patients. As a result, I usually get between 25 and 30 new referrals a month. In light of the number of referrals I receive, I have the ability to limit my practice to provide a high quality level of service. The down side is that most of the individuals who call me have to be referred elsewhere. These individuals have continuously told me that they cannot get a therapist on their insurance company list to take them on as new patients. I feel their discomfort and I also have been very frustrated with this situation. In my conversations with these individuals, I have encouraged them to complain to the source of this problem- their insurance companies.

The insurance companies have created this problem for what I think is their own financial gains. Most insurance companies have locked up their provider panels many years ago. They have not let mental health workers join the panels to keep control over their providers. It is my opinion that they have created roadblocks for subscribers to get access to mental health providers in order to reduce usage and ultimately save money.

Insurance companies have also created adversarial relationships with providers which has also served to reduce their costs, since providers would avoid accepting new managed care patients. It has been reported that non-insurance friendly psychologists (or those that do not go along with insurance company policies) have been blackballed or somehow do not come up on the computer screens when subscribers call 800 numbers for therapists in their area. Recently, Oxford Insurance Company audited 300 mental health worker’s (100 psychiatrists, 100 psychologists, and 100 social workers) notes of patients from a few years ago. Oxford reviewed the session notes and demanded money back from almost all of the mental health workers. Oxford claimed they deserved the money back because they questioned the type, or duration of the session. It was very unlikely that almost all of the providers were unethical. After Oxford was threatened with, lawsuits they did back down and rescinded their auditing procedures and demands for reimbursement.

Insurance companies have put restrictions on therapists, required the release of confidential information in order to reimburse for therapy sessions, or have been failing to pay their bills in a timely manner. In addition, most insurance companies have not raised the fee structure since the 1980's. Some companies have not only kept the fees stagnant since the ‘80's but recently one company (GHI) has even reduced the fees for 2004 to an unacceptable level. Their attitude has been: accept our fees or leave the network. Our expenses have increased in the past 20 years and we cannot meet our bills if we cannot keep up with inflation.

Some psychologists have resigned from insurance panels to avoid ethical issues, procedural conflicts, or the low fees. It has been reported that insurance companies have sometimes not taken their names off the provider list to make the list look bigger. Other psychologists who do not resign will just refuse to take on new patients. If prospective clients call them, they claim they are all booked up or have no available spaces. They are essentially removing themselves from the provider list but not officially resigning. The outcome is that the managed care panels are really, what we call, ”phantom panels”. They look big, but they are filled with psychologists who no longer actively take clients. Phantom lists are good for the insurance companies because they can sell employers what looks like a good package of services and providers but not have to actually pay for the services.

It is my perspective that the insurance carriers are picking on the weak. Mental health services represent the smallest portion of the overall health care costs and users of mental health services represent approximately 5% of the total population of health insurance subscribers. Yet, this is the area where the insurers constantly cut. It would appear that mental health does not have true parity with medical health issues. In addition, those who use mental health services are generally not willing to be vocal to advertise their problems.

This problem will continue until employers, and subsequently insurance companies, get the message that subscribers are fed up with their tactics. Providers have no influence, since we do not pay premiums and we cannot financially affect the insurance companies’ bottom line. Subscribers have all of the influence in this area. Subscribers need to call their human relations department, or those responsible for health insurance in their companies, and complain when they cannot find therapists on their respective insurance companies’ provider list. Insurance companies have to realize that making money for their shareholders and executives will not continue if their business plan is built on denying services, restricting availability, or low balling fees.

If this problem continues, it would seem to me that the outcome will be that the that more seasoned, quality providers will drop out of the panels leaving newer or, possibly less capable providers. There could be a two-tier system, with the wealthy, who can afford to pay out of pocket, getting service from the seasoned providers, and the middle class and lower class will be left with the less experienced providers. So, help keep the “health” in mental health services by speaking to your insurance carriers and registering your dissatisfaction with their procedures and policies.