College: A Generation at Risk

A College diploma is a goal for millions of Americans, yet graduation rates have never been lower and those who do graduate take 6 years on average compared to the 4 years of previous generations.  Recent research has helped us understand that these dismal outcomes are not because students cannot handle the coursework, because the vast majority of students can grasp the academic content; rather mental health issues are now the prominent struggle in College.   

The statistics tell a rather grim story at first glance.  A study by the APA in 2017 found 

86% of students with psychological and learning challenges left school without a diploma. The CDC discovered that suicide is currently the 2nd leading cause of death among college students and this year, WHO found that 1 in 20 full-time college students have seriously considered suicide. 

There is one statistic, however, that gives hope to these startling facts.  94% of high school students with emotional and learning differences receive some form of assistance. In contrast, only 17% of college students with the same challenges do so.  The remaining 74% still need assistance in navigating the new world of College life, but faced with logistical and financial constraints, Colleges will have to adapt quickly when it comes to providing services for the mental health of its students.  Currently, there is a nation-wide average of 2,500 students for every one counselor and this clearly isn’t enough. 

The good news, if you or someone you know needs help while in school, there are a couple of private and non-profit companies filling the gap in the state of Utah so please reach out for hope, healing, and help. 

Originally published on http://utvalleywellness.com

Boundaries With Others – How To Set Them

When you’re trying to create boundaries with people they will be tested. It’s like when cows enter a new pasture, they will knock their shoulder against the perimeter a few times to check out where their boundaries are and how strong they are. Cows are strong enough to take down barbed wire if they really wanted to, but they aren’t really testing if they can get out, they are testing if they are safe from the external world. Once they know that the boundaries are consistent and stable they feel safe and they graze in the middle. If the cows don’t have that consistent boundary they will rely on the cowboy to tell them when they have gone too far. The cowboy, however, doesn’t have consistent boundaries, they will only correct the cow when they notice the cow has gone too far, which doesn’t create a feeling of safety. People are the same when they have never experienced consistent boundaries, or they are experiencing new boundaries. People will test boundaries, not enough to break them but enough to trust that they are there to stay and to trust that they are there to keep them safe.

A lot of young adults who never experienced boundaries, because their parents wanted to be their friend. They have a great relationship with their parents, but they will tell me that they feel like they grew up as an orphan because they don’t have a secure home base. but they will tell me that they are afraid to explore and take risks as an adult because they can’t trust that they have parents who are watching out for them, to make sure they don’t make a mistake big enough to ruin their entire life.

It’s important that people are given the space to grow and find their own solutions within appropriate limits. When your setting limits the goal is not to get a specific outcome, rather the goal is to prevent a specific outcome. It is quite spectacular what people can come up with when their possibilities aren’t limited, but just the same we don’t want anyone hurting themselves or others in the process. Limits are set to prevent irreversible and/or irreplaceable damage, while still allowing people to learn how to cope with and improve from mistakes.

When cattle are being herded they have the instinct to turn around when they feel blocked, which can be disruptive to the flow and requires more work to redirect them back into the flow. To redirect a cow, you want them to feel pressure on their shoulder. If you are in front of them when you apply this pressure they feel blocked, if you are beside them when you apply this pressure they will simply turn a bit from where they shouldn’t be. People are the same, when they are told to stop doing what they are doing (and they don’t continue trampling over you) they will do a complete turnaround, even if this wasn’t your intention. If you’re only wanting a slight redirection from a no-go zone you want to adjust your approach to let them know that you understand that they want to move forward, and you want that too, but you want them going forward in a slightly different direction.

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

 

The Impact of Borderline Personality Disorder on Relationships

All too often, family members, friends, fellow employees, and even therapists become reactive, judgmental, and walk on egg shells when they interact with someone who displays characteristics of borderline personality disorder.  Let me start off by summarizing some of the core characteristics of the disorder, specifically focusing on those traits which play out in the interactions with others.

  1. Affective Instability – This is where those with BPD struggle to regulate their emotions in predictable ways.  Often, their mood does not match with expected life or social situations, thus making it difficult for those around them to understand or relate to the distress they are experiencing.
  2. Fear of real or imagined abandonment – Those struggling with BPD are often afraid of being rejected, abandoned, or left alone emotionally. These feelings are triggered when the potential abandonment is indicated, as well as times where it isn’t.
  3. Identity disturbance – It can be difficult for those with BPD to maintain a consistent sense of self. There is typically a variance of self-doubt, instability in self-image, and self-acceptance.
  4. Impulsivity – Due to the emotional and personal instability, impulsivity is often a regular occurrence for those with BPD. While this may not feel disruptive for the individual, it can be highly disruptive for those around them.
  5. Paranoid ideation and dissociative symptoms – In certain situations, those with BPD may struggle with feeling paranoid, especially in relation to how they perceive other’s intentions or motives. Also, they may experience dissociative symptoms, which is a disconnect from themselves, their reality, or their sense of self.

What we need to understand about personality disorders is that they are just that, disorders which occur within the core personality of the individual.  This is important to consider, because it is extremely threatening to the individual when a personality disorder is suggested, or when a diagnosis is made, especially since it is difficult to be “objective” about your own personality.  Because of this, it can be very threatening for someone experiencing symptoms of BPD to identify and accept that the symptoms are present in their life.

It is my professional belief that the symptoms of BPD are treatable, and that through treatment, people can reduce the identified symptoms to the degree that they no longer qualify for the diagnosis.  This perspective can bring hope to those struggling with BPD, as well as those who are involved in their life.  However, the process of therapy can be challenging, and typically requires long term treatment.

Selecting a therapist who can treat BPD effectively is an important step in the process.  The therapist must be able to accurately diagnose the disorder, as well as position themselves in the therapeutic relationship as to control for and manage the identified symptoms.  A careful balance between soliciting BPD symptoms and maintaining safety and security within the therapeutic relationship is critical.  Failure to challenge the BPD symptoms results in no change, while doing so without carefully creating a safe therapeutic relationship will typically result in early or even immediate rejection on the part of the client.

Once someone with BPD can effectively accept the diagnosis, identify how the symptoms play out in their life, and learn new ways of managing and responding to the symptoms, then they can focus on the primary relationships in their life, and work on how they relate to others in new ways.

Written by Dr. Tony Alonzo, DMFT, LMFT, CFLE therapist at the Holladay Center for Couples and Families

“C”ommunicating with Our Teenagers

We cannot NOT communicate. – Ray Birdwhistell 

Everything we do communicates something. It has been estimated that between 67-94% of our communication is nonverbal. What is non-verbal communication, you ask? It is everything except the words. It could be a grunt, a smile, a sigh, our smell, our jewelry, our clothes, whistling, the way we comb our hair, tattoos, the way we cook our food, piercings or the lack thereof, our posture, the nuances and history of a relationship, a stare at our son, a gaze at a pretty girl, the way we walk, our mode of transportation, hand gestures, or making googly eyes and funny sounds at a baby. We may say something, but our true intentions frequently will leak through our nonverbal behavior.  

The tone, the attitude behind the words when you ask your son to do something, communicates a whole lot more than the words that you verbally say. It is the attitude that he will respond to, not merely the words. Everything communicates. That is why the “C” in the title of this article is so large. Everything communicates something. We cannot NOT communicate. 

Even a dead person communicates. They communicate deadness.  

It is what is not being said that we pay attention to; this is why sarcasm is so dangerous. With sarcasm, there is a contradiction between the verbal and the nonverbal. Sarcasm is typically cutting. In fact, the word means, “to tear flesh.” For children, sarcasm can be very confusing.  

If you were to attend a communication seminar on learning “Effective Communication Skills,” you might come away with skills such as: having good eye contact, sitting on the edge of your chair, nodding and other non-verbal behavior to indicate you are listening. You might also learn about the importance of reflective listening. All these skills are important, however, do you suppose it would be possible to perform all these behaviors and not really listen in a caring way? And, if a person didn’t really care, do you think other people will be able to tell?  

Of course they can. 

“There is something deeper than behavior that others can sense – something that, when wrong, undercuts the effectiveness of even the most outwardly ‘correct’ behavior.” i  This thing that is deeper than behavior is something philosophers have been talking about for centuries. Carl Rogers called it “Way of Being.”ii  

Martin Buber explains that there are two fundamental ways of being, two ways of seeing another person. The first way is as a ”Thou,” a person with hopes and dreams and struggles similar to your own.  The other way of seeing a person is as an “It.” This is where one objectifies a person. “If I see them at all, I see them as less than I am – less relevant, less important, and less real.”iii This is then also about you and your perspective. There is always a good chance that a person does not see things the way they really are; that person may be missing something. We must be willing to honestly look at ourselves and see what part of the problem is our own. “Might I be provoking the other person without even knowing it?” 

When we talk to our teenagers, we sometimes ask them questions.  We must understand that they do not merely answer our questions; they are answering a relationship. Our conversations don’t happen in a vacuum. They happen in the context of a historical relationship.  They are answering a person, and with that person, comes an accumulation and history of their interactions. They answer according to the quality of their recent and remote relationship. 

For example, you might ask your daughter, “Would you take the dog for a walk?” She could respond in a variety of ways. She could ignore you. She could say, “of course.” She could tell you to eat rocks, or yell out while leaving, “maybe later.” On the other hand, if your daughter’s best friend (having a different relationship) said, “Let’s take the dog for a walk?” Your daughter may happily agree to take the dog for a walk. The relationship determines the interaction. 

In his book ”7 Habits of Highly Effective People,”iv Stephen Covey speaks of an emotional bank account we each have with our children. We must have enough positive interactions, thus building the relationship in our “emotional bank account,” before we can safely make a withdrawal (correction/discipline) without damaging the relationship. After all, we do not want to bankrupt the relationship.  When the emotional bank account is healthy, your child can take correction, knowing that it is coming from a place of love. 

The quality of the relationship determines our ability to be effective parents  

and our teenager’s willingness to allow us to influence them. 

 The moment a parent has a nasty verbal exchange with their teenager is not the time to try to immediately solve the problem. There are too many hot emotions for anyone to think clearly. If the relationship is generally good, waiting for a few hours, or perhaps a day to address the problem is wise. Time allows the parents and teenager space to see the situation clearly without the corrupting influence of these distorted and self-justifying thoughts and emotions.  

If the relationship has been rocky, time is needed for the relationship to heal. Part of healing process is deliberately working on developing trust again; another topic for another day. 

Originally published on http://utvalleywellness.com/

 

 

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/

 

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/

 

Pornography Use –

Pornography use in our community is at an all-time high – and there seems to be no slowing down. Unfortunately, those who get caught in its grasp struggle to get free as their lives and the lives around them suffer. Shame accompanies pornography use in a way that is damaging and debilitating. Pornography often acts as a numbing agent for those who use it. Not wanting to feel uncomfortable emotions, several people go to pornography because it takes them from that uncomfortable emotion. It’s important to note that this isn’t always the case. Sometimes people get into pornography out of curiosity and it become habit forming. Now-a-days, young people are getting exposed at younger and younger ages to more and more explicit pornography. The ease of access makes this a serious problem at a young age. I often work with clients who tell me that they started using pornography after stumbling on it when they were anywhere from 5-10 years old (at first use). They report that their parents didn’t know and didn’t ask – they certainly didn’t tell anyone either. They used heavy/severe pornography for years before they were caught or eventually told someone. The secrecy that enables this type of behavior is damaging and serious. Ask your children what their experience is with it – you will be surprised to what they have to say. If we aren’t asking and talking with them about it, they are facing it on their own. A professional counselor can help you talk with your child about pornography.

Written by Dr. Triston Morgan, LMFT of the Holladay Center for Couples and Families

Family Counseling – Tips for a Stronger Family

Here are 5 quick tips on ways to strengthen your family!

 

  1. Appreciation

Showing appreciation to someone increases self-esteem and makes the person feel valued and accepted. Appreciation creates a sense of belongingness which helps to build a strong bond and tells the person that you love them. Short, sincere comments can make a huge difference in improving one another’s moods and creating an atmosphere of love and kindness. Take time to point out the positive attributes that you see in each of your family members. Become comfortable in giving and receiving compliments. Appreciation motivates the person and makes them feel more enthusiastic about contributing to the family.

  1. TIME

Your family needs quality time together in order to know and understand each other. Your family needs time where you can laugh, play and communicate with each other. If you are like most families and have a busy schedule, finding time to get everyone together can be hard, but don’t let that stop you. Get creative, make it a family rule that no matter what Monday night dinner is spent eating together as a family. Do family chores together allowing you to be together while doing family tasks. Play games together, plan birthday parties, go camping, or take a walk to the park together. These are all small things that make big differences in strengthening your family relationships.

  1. Communication

Communication is key to successful relationships. The happiest families that I see, are the families that can openly discuss all issues in their lives. I have watched as family members have openly spoken about their greatest fears and sorrows, and they have been met with listening ears that desired to understand and love. I have also witnessed family members shut down or be told not to feel a certain way when they are trying to openly communicate with their families. The families that are able to communicate their worries, sorrows, and other grievances with each other are often stronger and visibly happier. They are able to work through conflict much more quickly. Be aware of your family’s specific needs during times of change or conflict and encourage your family to express what they are feeling rather than bottling it up. Through honest communication your family will learn to trust one another and will become an excellent support system for one another.

  1. Traditions

Family rituals, such as movie night or the annual Smith family turkey bowl, gives your family something to look forward to and helps bond your family together. Look for ways that your family can create special rituals of your own or take traditions that were special to you or your spouse as a child and implement them into your family. Sometimes these traditions will be created on accident, be flexible and let some traditions develop naturally. Traditions do not need to be serious, formal, or over the top events. Simple, inexpensive, humorous rituals are what children remember as adults. These traditions will be memories that your kids will talk about 20 years from now. Memories associated with joy and time spent with their family.

  1. Expectations

Families that set clear expectations for their children are happier. Make sure your children know and understand your family rules. Hold a family meeting and practice healthy communication by taking the time to explain your family rules and expectations. During the meeting give your children a chance to ask questions and express any concerns that they have. Work together to ensure that your family understands what is expected of each other and what it means to be a part of your family.

 

Written by Brandi Hess, MS, LAMFT at the Holladay Center for Couples and Families

Fighting Fair – Couples Therapy

Couples often fight. Leading researcher, John Gottman, found through decades of successful research, that it’s not the presence of fighting or arguing in a marriage that causes divorce. He found that it was how a couple fights that would cause them to divorce. Learning how to fight fair, in a sense, is important for a healthy relationship.

 

Here are a few principles to consider when learning to fight fair:

  • Soft Start-up – how you start your discussion matters. If you come at your spouse with an accusatory tone, it would be called a harsh start up and usually not end well. Starting your discussion with a softness can really help. For example, you might say, ‘I’m trying to understand how you feel about this, but struggling to do so. Can you tell me more about…’ This sends the message that you are not looking for a fight, but rather to partner up with your spouse in this difficult time.
  • Solve your solvable problems – There are solvable problems and perpetual problems. Knowing the difference and then knowing how to focus on your solvable problems will help you not get stuck. Perpetual problems are ones that seem like they just won’t budge. Most of marriage problems fall into this category. However, you don’t’ have to solve these for your marriage to work well. You just want to know how to deal with them in a manner that allows for them to be present and for your marriage not to fail.
  • Listen to your body – When you argue, your body often reacts in a manner that makes it difficult to use the skills you know. John Gottman calls this flooding. Your body gets overwhelmed. The trick is to let your body calm down when you are in an argument. This often takes some time alone. Let your body’s signals tell you when it’s the right time to take this time-out. Your body might respond to arguing by an increased heart rate, body temperature, sweating, or pressure. As soon as you feel this, know that you are becoming flooded and need to take a break.

Using these three simple principles will help you have a happier marriage and one that can last. If using these principles don’t seem to help, come in to see a therapist. We can help with marital problems such as infidelity, pornography problems, depression, anxiety, arguing, parenting issues,

Taken from John Gottman’s book: the Seven Principles for Making Marriage Work.

 

Written by Dr. Triston Morgan, LMFT