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/

 

Divorce – Counseling

Once the decision to divorce becomes imminent, components of the family system must prepare for change.  As a marriage and family therapist, its always my initial response to determine if the marriage can be repaired.  However, when people choose to end the relationship, the best course of action is to remain engaged in a therapeutic process throughout the transition.

The couple will need to work with one another to at least determine how to make decisions required for the legal aspects of dissolving the relationship.  If a couple can manage this on their own, and collaboratively and respectfully complete and submit the required documentation directly to the appropriate State department, and implement resulting legal stipulations, then this is typically the least intrusive and cost-effective method for divorce.  However, most couples have a level of financial, family, possession, and interactional patterns and history to require a divorce mediator to become involved. Typically, within a few sessions, the mediator can direct a process which results in immediate and long-term legal conditions to best assist the couple in divorce.  

All too often, individuals facing divorce immediately discontinue therapy because the marriage is over.  This can be biggest mistake they make in the process, especially considering how many different aspects of their life will require adjustment and change.  While I do not request that the couple meet together in session once they decide to divore, I strongly encourage them to remain engaged in individual therapy, and if children are involved, to make arrangements for each parent to attend therapy with their child(ren) in order to work through the questions, fears, concerns, and aspects of change they will all face, and most importantly, how to establish a new relationship with each parent individually.

Finally, without each partner exploring how they contributed to the dissolution of their marriage, they will most likely repeat harmful interactional and communicative patterns in future relationships.  Even if individuals post-divorce do not have the current intention of entering into another relationship, they should engage in the work which would otherwise place them in a position where they can, in the most healthy way, be available to engage in a future relationship.

Written by Anthony T. Alonzo, DMFT, LMFT, CFLE, Director at the Holladay Center for Couples & Families

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

Relationship Land Mines – How to Handle Them

All people have topics or behavior that are emotional landmines. I think of watching M.A.S.H seeing a big sign saying, “DANGER-MINE FIELD.” I love to picture this sign in my relationships. If these emotional landmines are going to be there I think it is essential for survival to create a boundary around the mine fields. I have found it courteous to set boundaries around mine, so that people have more freedom within a relationship with me. If people don’t set boundaries around their own boundaries I have to create boundaries to keep myself safe from their emotional landmines, unfortunately I don’t know exactly where the landmines are, so I have to create a boundary with large radius for extra safety. This is unfortunate because If boundaries are bigger than they need to be for the emotional safety this is limiting the potential for emotional intimacy in the relationship.

This is not only unfortunate for the person who “steps” on the emotional landmines, but also the person with the emotional landmines without appropriate boundaries. People thrive on relationships and connections. People who don’t create boundaries are absolutely terrified of being alone. Without knowing about emotional landmines, if you had the choice between land without blocked off areas and land that had nothing on it, the land without any blocked off areas seems more attractive, at least until you start walking over it! A person without boundaries want to attract people, and boundaries are not attractive. Their need for connection is not inherently bad, they are meeting this need in the only way they know how, because they haven’t experienced a long term intimate relationship as an example. Therefore, they have people around them who are avoiding a close relationship, or freeze to avoid any emotional landmines.

When you are in a relationship with someone who doesn’t create boundaries, you will often find yourself apologizing without knowing how you’re at fault. If apologizing becomes your default to suppress emotional explosions, you will attract people who have a need to blame.  People who blame are only considering their own needs, people who apologize as a default only consider the needs of others. A healthy relationship will balance your emotional needs with the needs of others with consideration of the context. If this isn’t happening your efforts to get closer to people will result in resentments. If you’re thinking “if they only knew what I was really thinking, they wouldn’t love me.” You will feel lonely in a room of people who love you.

When you share your truth, unfortunately you do risk losing people in your life.  However, knowing that even the one person who stays loves every part of you, and respects you enough to respect your boundaries will be worth anyone you lose. This is the most difficult part of setting boundaries, you have to reach a point where you can accept losing a relationship all together in order to do what it takes to be a healthier person. Accepting that you could lose a relationship means that if they are uncomfortable with boundaries they may cutoff communication with you. When you respect yourself and you respect other people enough to show them where your boundaries are to keep you and them emotionally safe, you will begin attracting healthier relationships.

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

 

Why Couples Therapy Often Fails

Couples often start therapy years after they first need it. I work with couples who tell me about their struggles years before they end up in my office. Its sad to hear how they saw the need for help, but didn’t get it for one reason or another. I hear them talk about things they try, reading books, talking with church leaders, trying harder, date nights…to no avail. There is nothing wrong with these types of activities as they do help strengthen a marriage. The problem is that the couple needs more fundamental healing and work. They need a solid relationship foundation (i.e., secure attachment, emotional safety), not a superficial fix (i.e., date night).

Here is what I tell these couples – start focusing on yours and your spouses emotional needs and experiences. Most couples struggle to do this because it is scary and unfamiliar. Understanding what your emotional needs are helps you to know what to communicate with your spouse. The trick is, at that point, communicating those needs in an appropriate manner. Extending an Invitation rather than an Demand regarding these needs is important. Invite your spouse to understand your needs and collaborate with you how to get them met. The more you then do this for your spouse the better your relationship will be. Understanding their needs and trying to meet them will help them feel safe and secure in your relationship and give them the ability to do this for you. This can be a difficult experience for both of you. Its scary to be that vulnerable and exposed with your spouse. No one else can hurt you like they can in this world. Opening up in this manner requires that you trust them to take care of you and be soft and caring. Them opening up in this manner requires the same type of trust in you.

A couples counselor can help you learn to be that vulnerable with each other while maintaining emotional safety.

By Dr. Triston Morgan, LMFT

When Teenagers Refuse to Accept Parental Influence

You have been there, most of us for the 2nd time around.  A parent offers a lifetime of experience, knowledge, and observance of others, and their teenage child refuses the knowledge, insight, suggestion, direction, or invitation.  Let’s explore how this plays out in families, and how we can approach these situations differently.

I know for myself, I was that teenager.  At the time, I felt like I needed to figure it all out on my own. My parents didn’t know my life, my situation, my perspective.  How could they get what I was going through, let alone provide accurate or helpful support?

I now find myself as the parent of three teenagers, and feel as though I see them clearly, and have excellent advice, support, and direction for each of them.  Of course I would, I am a therapist, however, my children refuse my support and suggestions on a frequent basis.

What’s really happening here, and what can we do about it as parents?  Although I cannot provide suggestions for every situation, I will propose an invitation to consider these dynamics from a different perspective.

First of all, we need to consider what relational process encourages the stance of resistance.  As parents, we want to feel valued in our role. We want to improve the next generation, and most likely, prevent our children from some of the difficult, painful, and regretful experience we have had in our life.  However, we typically deliver them in a manner which only reveals the constraints of though, belief, and action, rather than exposing the confusion, pain, and suffering caused by our previous and current actions in life.  

How would your teenager respond to you differently if they were afforded the opportunity to hear what those experiences were truly like for you.  Most teenagers will find it difficult not to get sucked into listening to those kinds of disclosures from their parents. Imbedded in these life accounts are lessons which they can then choose to interpret and implement in their life as they see fit.

Once we get around our teenager’s resistance, we then gain access to mentor, teach, and influence.  Do not take this as control over their decisions, as you are extremely limited in your ability to control your children’s thoughts, believes, and actions.  However, when your teenagers have no reason to resist, what are they left with? Its like engaging in a tug of war, and one side lets go of the rope. If there is no resistance, the attempt to pull on the rope becomes obsolete, and a new perspective of interacting becomes necessary.

I challenge you to attempt to do this in your own way with your teenager. The sooner you attempt to approach them differently, the more likely you will be successful in shifting your teenager’s resistance to your influence and create opportunities of connection which will influence them for the rest of their lives.

by Anthony T. Alonzo, DMFT, LMFT, CFLE

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/

 

How Do I Help My Depressed Teenager?

Teens with depression can be successfully treated if they seek the right help. Teen depression doesn’t have to mean a lifetime of struggle, and it certainly doesn’t have to end in suicide. Wake up parents, be aware, notice the red flags and then seek to find the professional help that your teen needs and deserves. In addition to seeking professional assistance, below are a few key suggestions on how to help your depressed teenager.

Acknowledge their feelings: Acknowledging the pain and sadness they are experiencing can go a long way in making them feel heard, understood and supported. Often times adults try to talk their teens out of depression, by rationalizing or trying to convince them that their problems are really not that bad. Well-meaning attempts to explain why “things aren’t that bad” come across as if you don’t take their emotions seriously.

Focus on listening: Listen to your child without offering advice or lecturing. Once your teen begins to talk resist the urge to pass any judgement or get upset. You’ll do the most good by simply letting your teen know that you’re there for them, listening fully and unconditionally.

Encourage social connection: Depressed teens tend to withdraw from their friends and the activities they used to enjoy. Isolation makes depression worse, do what you can to help your teen reconnect with their peers and loved ones. Suggest activities such as sports, after-school clubs, or an art, dance, or music class suggest things that interest your child or that he or she has a special interest in.

Make Time: Set aside time each day to talk one on one with your teenager. Put your phone and work away and focus completely on your teen without trying to multitask.

Physical Health: Depression is associated with inactivity, inadequate sleep, and poor nutrition. Teens are known for staying up late, eating junk food, and spending hours on their phones and devices. Encourage your teenager to create healthy habits in their lives by exercising daily, getting enough sleep, and eating nutritious foods.

Set limits: Cell phones have become a way for teenagers to escape real life and ignore their problems. As the number of hours, a teen spends on their phone increases the number of hours that that teen spends being physically active or socially connected with their peers decreases. Which in turn, increases depression.

Be understanding.: Living with a depressed teenager can be exhausting.  At times, you may experience unnecessary guilt, rejection, despair, anger, and many other negative emotions. It is easy to blame yourself and to start doubting your own parenting skills. Remember that your child is not being difficult on purpose. Your teen is suffering, so do your best to be patient and understanding.

When Do I Seek Professional Help?

Listen to your gut. You know your child, you know what is and isn’t normal for their personality. As you are actively engaged in their lives you will know if something is up. Have the courage and the strength to seek the professional help that is necessary to help your teen learn how to manage and understand depression in order to live a happy, balanced, and fulfilled life.

 

Written by Brandi Hess, LAMFT

 

Is Your Teen Depressed?

Many of the parents that I see often wonder what is and isn’t normal teenage behavior. They sit in my office and try to make sense of the most recent argument that they have had with their teen. They wonder how on earth their teenager can sleep until noon on a Saturday and cannot for the life of them figure out the patterns or the causes of their teens good and bad moods. Teenagers face a variety of pressures and stresses. As they enter Jr. High they are adapting to an entirely new way of learning and socializing. Often times their group of friends are changing and the teen naturally wonders where they fit in as they are trying to figure out who they really are. Beyond the natural biological changes of puberty, teenagers are also dealing with the pressures of getting good grades, maybe dealing with high stress family issues, or struggling with feeling accepted in their social circles. So, what is normal and what is depression?

 

Teen depression goes beyond moodiness. It’s a serious health problem that is estimated to affect one in five adolescents from all walks of life. Between 10-15% of these teens suffer from symptoms at any one time, and sadly only 30% of depressed teens are being treated for it. A depressed teenager’s entire life is impacted. The depression can affect their self-esteem, their family and social relationships, their overall health and their ability to function in everyday life.

Many times, the teenager has just not learned how to cope or handle the new set of emotions and feelings that they are feel as their bodies are changing and as they are starting to face real daily stresses and pressures. Rather than seeking support and help from their family and friends they become withdrawn, anxious, and sad. They begin to act out in an attempt to cope with their emotional pain. If depression isn’t treated or addressed it can destroy the essence of your teen’s personality causing them to feel an overwhelming sense of sadness, despair, anger and disappointment. Below is a list of signs and symptoms to look for in your teen if you think that they may be struggling with depression:

 

  • Irritability or hostility
  • frequent crying
  • Withdrawal from friends/family
  • Loss of interest in activities
  • Poor school performance
  • Changes in eating and sleeping habits
  • Restlessness
  • Feelings of worthlessness and guilt
  • Lack of enthusiasm and motivation
  • Lack of energy
  • Difficulty concentrating
  • Unexplained aches and pains
  • Thoughts of death or suicide

Teenagers often times suffer silently, feeling alone. They become hopeless and believe that life will never get better. Teenagers rely on their parents and caregivers to recognize their suffering and to get them the help that they need. If you are unsure if our teenager is depressed or just “being a teenager” consider how long the symptoms have been present and how severe they are and then consider how different your teen is acting from his or her usual self. Be proactive and find a professional who can help your teen overcome this difficult part of their life. There is hope, and things can get better.

 

By Brandi Hess, LAMFT

Couples Counseling (near Cottonwood Heights, Sandy, Holladay)

“Couples counseling” isn’t a four letter word. Knowing when to get help is important and something that every couple needs be aware of. Here are a few signs that you might need help.

  • Failed attempts to fix your marriage – many couples have/will have an experience where they need help in their marriage. They try and try and nothing gets better. They talk with friends, family and read books. They listen to online video’s from experts, but just can’t seem to get it right.
  • Significant stress in your relationship during transitional periods – couples often experience stress during transitions. Children being born, children moving out, retirement, loss of a job – or getting new job, a change in health, a move to a new city, etc… These all bring stress (even positive stress is still stressful!).
  • 4 Horsemen of the Apocalypse – Researcher John Gottman found that if you have any of the following in your relationship, that it could be in trouble: Defensiveness, Criticism, Contempt or Stonewalling. See his book, Seven Principles for Making Marriage Work.

A competent couples counselor will help you work through any of these types of issues. Couples come in to therapy years after it would be good to start. Don’t wait until its too late – most couples do.