When I was a teenager I worked for a small department store a few hours per week.  I made plenty of mistakes.  My supervisor at the time was fairly strict about the procedures and I often felt stressed when I was working with her on my shift since I did often make a lot of mistakes.  I tried humor and a friendly smile, but she did not laugh.  

When it was time to leave for college, I thanked my supervisor for her time with me and gave her a tin of homemade cookies.  My supervisor cried and hugged me.  She told me that no one was ever nice to her.  I later learned just by listening that her husband had died and she had undergone a very difficult year.  After that event my perspective of this woman was changed.  I went back to visit her on school breaks to say hello and made an effort to speak to her before leaving the store.  She met me with a friendly smile, a warm hug, and well-wishes.  

As a counselor, I love teaching others about mindfulness, the benefits of not judging ourselves and others.  I talk about the practice of having compassion for others, even when it’s hard, and to be kinder to themselves during times of challenge or self-doubt.  One of DBT’s distraction strategies is called Contributing.  

By contributing to someone else, we mindfully focus on the need of another person.  By offering help, volunteering, doing a good deed, or providing a service for someone else, it takes our minds off ourselves and contributes to the wellbeing of someone else.  In this way, we learn to be generous, thoughtful, grateful, helpful and develop empathy for others.  Contributing offers a chance to reconnect and provides a sense of achievement. You can find more about this strategy here.

On February 17^th, Random Acts of Kindness Day is celebrated.  This is a great time to think about doing something for someone else.  It doesn’t have to be big.  Perhaps a letter, text, phone call, or card might cheer someone up.  You never know what kind of impact a small gesture of kindness can have on a person’s life.  

For additional words and acts of kindness see Random Acts of Kindness | Kindness Ideas.  

If you are struggling to contribute to someone else and would like to learn more about connecting with others in your life, contact me at SHCS.

Living in the United States during a time of the global pandemic, with political unrest and division, bombarding news images, stories, and social media feeds, is indeed exhausting and stressful.
While most of the world has been focused on the presidential election, others have been concerned about their jobs, health, racism, grades, or the effects of global warming. In my last few blogs, I’ve talked about burnout, compassion fatigue, the importance of boundaries, and today, self-care.

When I ask clients if they have made self-care a priority in their lives, most say “no.” Many say they do not have time, or that self-care takes too much effort. However, when I ask them if they are satisfied with their lives, self-care is typically one of the most important skills they are missing. According to Michelle King, self-care is about “refueling ourselves so we can continue our work, drawing boundaries so we can stay whole, giving ourselves permission to feel and pursue joy, and pausing to take a breath so we do not collapse.”

So how do we practice self-care? She identifies three steps:

1. Know when you need it (awareness)
2. Make a list of your self-care options (toolbox)
3. Commit to practicing self-care (just do it)

Lynn Wonders, play therapy supervisor of Wonders Counseling Services advocates for therapists to create a self-care plan (annually, quarterly, monthly, weekly, and daily).
Imagine if you devoted this same attention to your own care. What would be different in your life?

Lynn describes several considerations for practicing self-care for therapists, however, this list applies to anyone. These include:

• Relaxation Exercises- body scan, breathing exercises, yoga, and tightening/relaxing muscle
• Groups
• Taking time to rest deeply
• Taking a soaking bath with candles, music, essential oils
• Regular daily exercise
• Take time to be out in nature
• Drink a mindful cup of tea or coffee
• Eat nutritiously
• Practice meditation
• Read a book of fiction for fun
• Play
• Spend time with your pet

Self-care is the single most effective thing you can do to feel better, right now. Need more inspiration, contact me at SHCS.

Millions of students are learning remotely during this pandemic, including my own. It is a phenomenon that has required teachers, students, and parents to stretch in new ways and embrace technology like never before. Not only are their challenges in just staying connected, but engaging with students differently, keeping them working and learning, and also meeting their unique learning needs. It’s no simple task.

According to Attitudemag.com, the right technology paired with the right teaching methods can help your child become a better student all around. Software or apps that address your child’s specific learning style can help your child achieve his full potential.
Learning strategies may include:

• Audiobooks or text to speech software
• Adjust the appearance of text to provide guides for visual tracking and to remove distractions(i.e. changing the font, size, spacing, or colors in a text)
• Use highlighters and sticky notes to mark up print
• Use graphic organizers to organize writing tasks
• Use spell-check tools to create positive writing experiences
• Create PDF annotation handouts for students to enter responses
• Reduce the amount of material needed to be copied; Take a screenshot of the assignment on
• the board; record audio of the class and synchronize with hand-written or typed notes
• Reduce distractions or change the environment; Allow for white noise or music if needed;
• incorporate physical movement into daily tasks with fidget toys, wiggle cushions, or sit/stand
• desk
• Create a place for everything to organize daily workflow
• Use visual task timers to assist with time management

For specific apps and software recommendations for your child, see the following link: https://www.additudemag.com/category/parenting-adhd-kids/school-learning/
If you have additional questions on how learning needs and ADHD go hand in hand, give me a call at SHCS.

Drew works 24 hour shifts.  When he does get off work his mind races.  Forget about sleep.  That remains disrupted.  On his mind are the unfinished work tasks that didn’t get done, again.  And the argument with his coworker over something trivial.  He can’t even remember what he was so mad about.  His relationship with his wife is strained and his children feel he does not make time for them.  He can’t remember the last time he had a vacation.  Sound familiar?

In the last blog, I addressed the warning signs and causes of burnout.  Today, let’s review the consequences of burnout and how to best avoid it.  

Consequences of Burnout 

• Loss of productivity
• Reduced creativity
• Excuses for missed days of work
• Poor well-being
• Impacts to relationships with family and friends

Long-Term strategies to Avoid Burnout

• Re-discover your purpose (how does your work impact others?)
• Do a task analysis (what is expected of you and what isn’t?)
• Practice small acts of kindness to others
• Manage your time effectively.  Create a priority list, to do list, action plan, and a goal.
• Exercise regularly
• Get a good night’s sleep
• Manage your stress.  Meditate, breathe deeply, relax, think positively.

For additional resources check outhttps://www.mindtools.com/pages/article/avoiding-burnout.htm

If you are unsure how to repurpose your life, establish boundaries for a better work-life balance, or need support to manage life stress, contact me at SHCS.

Are you feeling tired?  Looking forward to the weekend and it’s only Monday?  Pessimistic about your work or find it to be meaningless?  Have you snapped at others because there never seems to be enough time in the day to get things done?  Are you overly committed to your job?  Is your job mundane or stressful and no matter how hard you try you feel you cannot change the environment?  If so, you have probably experienced burnout.  

According to Ayala Pines and Elliot Aronson burnout is a state of physical, emotional, and mental exhaustion caused by long-term involvement in an emotionally-demanding situation (a cause, way of life, or relationship) https://www.mindtools.com/pages/article/avoiding-burnout.htm

Signs of burnout include:

1. Having a negative and critical attitude at work.
2. Dreading going into work, and wanting to leave once you’re there.
3. Having low energy, and little interest at work.
4. Having trouble sleeping.
5. Being absent from work a lot.
6. Having feelings of emptiness.
7. Experiencing physical complaints such as headaches, illness, or backache.
8. Being irritated easily by team members or clients.
9. Having thoughts that your work doesn’t have meaning or make a difference.
10. Pulling away emotionally from your colleagues or clients.
11. Feeling that your work and contribution goes unrecognized.
12. Blaming others for your mistakes.
13. You’re thinking of quitting work, or changing roles.

Causes of Burnout

• Lack of autonomy
• Feels as if there is never enough time to complete tasks
• Your values don’t align with the organization
• Having unclear goals or job expectations.
• Working in a dysfunctional team or organization.
• Experiencing an excessive workload.
• Having little or no support from your boss or organization.
• Lacking recognition for your work.
• Having monotonous or low-stimulation work.

There are numerous consequences of burnout, however change is possible.  If you recognize that you are experiencing burnout, are unsure of the next steps, and you desire to put your life back on project status.  Give me a call at SHCS.

In my last blog, I mentioned ways to help show compassion and care for our health care providers.  I wanted to elaborate this week on our licensed mental health providers.  Please keep counselors, social workers, and other behavioral health providers in your thoughts and prayers as well.  

The mental health needs of our communities are increasing and changing during this crisis.  The demand for therapy is high and providers are often at full capacity.

Further, while many insurance plans are covering behavioral health services in some manner, others are not.  Many providers are offering reduced rates and sliding scales to accommodate folks during this crisis.

Telemental health platforms are also making it possible to check-in with clients, assess their risk and safety, and continue to work towards stability.  Many providers are offering shorter sessions via telehealth, allowing them to see more people.

To complicate things, some insurance companies are requiring specific platforms to gain services, making it difficult for clients to stay with their current mental health provider.  The disadvantage of these specific platforms is that some are already full and are no longer accepting new providers.  Clients may be forced to change therapists, amidst a national crisis, which can cause harm to them, depending on their situations and unique mental health needs.  

While other insurance plans have expanded their coverage, it is important to stay informed.  Some plans are waiving copays and deductibles while others are collecting copays.  Some companies are reimbursing significantly less for telehealth sessions as well as requiring shorter-length sessions, despite similar quality as face-to-face visits.

Some clients have opted out of services altogether until the crisis is overdue to changing financial circumstances.

Whatever your situation, be an advocate for yourself.  If your insurance plan allows for outpatient visits, but not tele-behavioral health visits, talk to your HR rep, senator or congressman. 

• Senator Pat Tooney (855)552-1831
  https://www.toomey.senate.gov/?p=contact

• Senator Bob Casey (717)-231-7540
  https://www.casey.senate.gov/contact/

• Congressman Scott Perry (202)-225-5836
  https://perry.house.gov/contact/

Continue to seek help if you need it.   Contact me at SHCS with any questions, referral needs, or services.

Never in most of our lifetimes, has there been quite a virus like this one.  Not since the Spanish Influenza of 1918.  Our minds race, trying to make sense of this new normal, however temporary.  Healthcare workers of all disciplines are scrambling to make sure there are enough supplies and testing materials to distribute to people.  It is a true test of our nature as humans to cope effectively and survive.

Our genetics, brain chemistry, and life events are factors we have little control over.  However, the way we perceive and handle those life events we do have a great deal of control over.  How we think about this crisis, literally causes physiological changes in our brain and body.  By dwelling on a stressful thought, anxiety increases.

Peace, on the other hand, is a natural state of being already within each one of us, just masked by all the stress and tension we take in and focus on.  Looking to the past and towards the future actually raises anxiety.  Mindfulness is the act of keeping our focus on the present moment, paying attention to the here and now, with kindness and curiosity (not with judgment or criticism).  By practicing mindfulness, we learn to “let go” of anxiety and bring ourselves back to a peaceful state.

The following are ways to feel more mindful and peaceful:

• Movement:
  • Relaxed stretching.  Stretching slowly and gently dissipates stress chemicals and increases circulation in the body
  • Yoga.  Combines poses, breathing, and meditation to quiet the mind and increase concentration.
  • Tai Chi.  A Chinese martial art performing softly and gracefully movements with smooth even transitions between them to relax, calm the mind, and relieve tension.

• Progressive Muscle Relaxation.  Consciously tensing then releasing muscle tension from various muscle groups relieves anxiety.  
• Deep breathing.  Brings oxygen to all of your muscle groups to relieve anxiety and clear the mind.  Following the breath, focusing on how it flows in and out of your body.
• Centering yourself.  Focusing attention on the physical center of the body for improved balance and stability.
• Mindful attention to daily activities.  Doing one thing at a time. Using one’s senses to experience the activity.  Focusing on what you are seeing, hearing, feeling, smelling, and tasting.   Bringing your mind and thoughts back to the present when your mind wanders.
• Visualization.  Creating a safe place or situation in your mind relaxes the body and releases anxiety.
• Meditation.  Training one’s brain to let go of anxiety and come back to a peaceful state.  Used as prevention, this helps with staying calm in situations that used to make one anxious.
• Prayer.  Belief in a higher power can help with preventing and managing anxiety.

For more on mindfulness, check out https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/mindfulness-exercises/art-20046356.  

If you are struggling to find ways to be mindful or if stress continues to impact your life, contact me at SHCS.

If you’ve ever tried to support a parent, child, friend, or sibling facing depression, then you already know how much of a challenge it can be to offer help.  Many folks often report feeling helpless, not knowing what to do to help their loved one feel better or to get them to the resources that could give them appropriate treatment.  Here are some ways you can offer support and understanding:

Learn the symptoms of depression

This can vary from person to person. Learn more about What Is Depression.

Notice if there are problems in daily activities (i.e. work, school, social activities, or relationships with others).  Some folks may report feeling miserable or unhappy without knowing why.  Children may appear more irritable or cranky rather than sad.

Encourage Treatment

People with depression may not recognize or acknowledge that they’re depressed. They may not be aware of the signs and symptoms of depression, so they may think their feelings are normal.

People often feel ashamed about their depression and mistakenly believe they should be able to overcome it with willpower alone. However, depression seldom gets better without treatment and may get worse. 

Here’s what can be done to help.

• Talk to the person about what you’ve noticed and why you’re concerned.
• Explain that depression is a medical condition, not a personal flaw or weakness — and that it usually gets better with treatment.
• Suggest seeking help from a professional — a medical doctor or a mental health provider, such as a licensed counselor or psychologist.
• Offer to help prepare a list of questions to discuss in an initial appointment with a doctor or mental health provider.
• Express your willingness to help by setting up appointments, going along to them and attending family therapy sessions.
• If your loved one’s illness is severe or potentially life-threatening, contact a doctor, a hospital or emergency medical services.

Identify warning signs of worsening depression.

Everyone experiences depression differently. Observe your loved one. Learn how depression affects your family member or friend — and learn what to do when it gets worse. Observe behavior, triggers or circumstances that make the depression worse.  Also, notice any activities that are helpful in improving the situation.  

Encourage your loved one to work with his or her doctor or mental health provider to come up with a plan for what to do when signs and symptoms reach a certain point. This may include: 

• Contacting the doctor to see about adjusting or changing medications
• Seeing a psychotherapist, such as a licensed counselor or psychologist
• Taking self-care steps, such as being sure to eat healthy meals, get an appropriate amount of sleep and be physically active

Understand Suicide Risk

People with depression are at an increased risk of suicide. If your loved one is severely depressed, prepare yourself for the possibility that at some point he or she may feel suicidal. Take all signs of suicidal behavior seriously and act immediately.

Take action if necessary:

• Talk to the person about your concern. Ask if he or she has been thinking about attempting suicide or has a plan for how to do it. Having an actual plan indicates a higher likelihood of attempting suicide. 
• Seek help. Contact the person’s doctor, mental health provider or other health care professional. Let other family members or close friends know what’s going on.
• Call a suicide hotline number. In the United States, you can reach the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to talk to a trained counselor. Use that same number and press “1” to reach the Veterans Crisis Line.
• Make sure the person is in a safe environment. If possible, eliminate things that could be used to attempt suicide. For example, remove or lock up firearms, other weapons and medications.
• Call 911 or your local emergency number immediately if the person is in danger of self-harm or suicide. Make sure someone stays with that person at all times.

For warning signs of suicide refer to the following link
7 Simple Steps For Suicide Prevention

What you can do for your loved one:

• Encourage sticking with treatment. Help your loved one to remember to take prescribed medications and to keep appointments.
• Be willing to listen. Let your loved one know that you want to understand how he or she feels. When the person wants to talk, listen carefully, but avoid giving advice or opinions or making judgments. 
• Give positive reinforcement. People with depression may judge themselves harshly and find fault with everything they do. Remind your loved one about his or her positive qualities and how much the person means to you and others.
• Offer assistance. Your relative or friend may not be able to take care of certain tasks well. Give suggestions about specific tasks you’d be willing to do or ask if there is a particular task that you could take on. 
• Help create a low-stress environment. Creating a regular routine may help a person with depression feel more in control. Offer to make a schedule for meals, medication, physical activity, and sleep, and help organize household chores.
• Locate helpful organizations. A number of organizations offer support groups, counseling and other resources for depression. For example, the National Alliance on Mental Illness, employee assistance programs and many faith-based organizations offer help for mental health concerns.
• Encourage participation in spiritual practice, if appropriate. For many people, faith is an important element in recovery from depression — whether it’s involvement in an organized religious community or personal spiritual beliefs and practices.
• Make plans together. Ask your loved one to join you on a walk, see a movie with you, or work with you on a hobby or other activity he or she previously enjoyed. But don’t try to force the person into doing something.

What you can do for yourself:

• Learn about depression. The better you understand what causes depression, how it affects people and how it can be treated, the better you’ll be able to talk to and help the person you care about.
• Take care of yourself. Supporting someone with depression isn’t easy. Ask other relatives or friends to help, and take steps to prevent becoming frustrated or burned out. Find your own time for hobbies, physical activity, friends and spiritual renewal.
• Be patient. Depression symptoms do improve with treatment, but it can take time. Finding the best treatment may require trying more than one type of medication or treatment approach. For some people, symptoms quickly improve after starting treatment. For others, it will take longer.

Remember that your loved one’s depression isn’t anyone’s fault. While you can’t fix the person’s depression, your support and understanding can help.  Need additional help with depression?  Contact me at SHCS.

According to the American Psychiatric Association, depression is a common and serious medical illness that negatively affects how one feels, the way one thinks, and how one acts.  Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.

What are the symptoms of depression?

Symptoms vary from mild to severe and must last at least two weeks.  These include:

• Feeling sad or having a depressed mood
• Loss of interest or pleasure in activities once enjoyed
• Changes in appetite — weight loss or gain unrelated to dieting
• Trouble sleeping or sleeping too much
• Loss of energy or increased fatigue
• Increase in purposeless physical activity (e.g., hand-wringing or pacing) or slowed movements and speech (actions observable by others)
• Feeling worthless or guilty
• Difficulty thinking, concentrating or making decisions
• Thoughts of death or suicide

Who Can Have It?

Anyone. Even a person who appears to live in relatively ideal circumstances. Depression affects approximately one in 15 adults (6.7%) in any given year. One in six people (16.6%) will experience depression at some time in their life. Depression can strike at any time, but on average, it first appears during the late teens to mid-20s. Women are more likely than men to experience depression. Some studies show that one-third of women will experience a major depressive episode in their lifetime.

Risk Factors for Depression

• Biochemistry: Differences in certain chemicals in the brain may contribute to symptoms of depression.
• Genetics: Depression can run in families. 
• Personality: People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be more likely to experience depression.
• Environmental factors: Continuous exposure to violence, neglect, abuse or poverty may make some people more vulnerable to depression.

How is it Treated? 

Depression is among the most treatable of mental disorders, with 80-90 percent of people responding well to treatment.

Evaluation

Before starting any treatment have a health professional conduct a thorough diagnostic evaluation, including an interview and possibly a physical examination to make sure the depression is not due to a medical condition. 

Psychotherapy

Psychotherapy, or “talk therapy,” is sometimes used alone for treatment of mild depression, however for moderate to severe depression, psychotherapy is often used along with antidepressant medications. Cognitive-behavioral therapy (CBT) has been found to be effective in treating depression, which helps a person to recognize distorted thinking and then change behaviors and thinking.

Psychotherapy may involve only the individual, or it can include others (i.e. family therapy, or group therapy). Depending on the severity of the depression, treatment can take a few weeks or much longer. In many cases, significant improvement can be made in 10 to 15 sessions.

Medication

Antidepressants might be prescribed to help modify one’s brain chemistry.  Antidepressants may produce some improvement within the first week or two of use, though full benefits may not be seen for two to three months. If a patient feels little or no improvement after several weeks, his or her psychiatrist can alter the dose of the medication or add/change/substitute another antidepressant. It is important to let your doctor know if a medication does not work or if you experience side effects.

Psychiatrists usually recommend that patients continue to take medication for six or more months after symptoms have improved. Longer-term maintenance treatment may be suggested to decrease the risk of future episodes for certain people at high risk.

• Electroconvulsive Therapy (ECT) is a medical treatment used for patients with severe major depression or bipolar disorder who have not responded to other treatments. It involves a brief electrical stimulation of the brain while the patient is under anesthesia. A patient typically receives ECT two to three times a week for a total of six to 12 treatments. It is usually managed by a team of trained medical professionals including a psychiatrist, an anesthesiologist and a nurse or physician assistant.

• Coping Strategies: For many people, regular exercise helps create positive feelings and improves mood. Getting enough quality sleep on a regular basis, eating a healthy diet and avoiding alcohol (a depressant) can also help reduce symptoms of depression.

For more information on depression and psychotherapy used to treat it, contact me at SHCS.

I have been fortunate to have had positive teacher experiences when advocating for my children’s needs at school.  While I have found that most teachers are open and receptive to learning about ADHD and making adjustments to accommodate children with these needs, this remains an area of need.  Here are a list of things that teachers do that an ADHD child appreciates:

• Preferential Seating (away from distractions)
• A consistent place to find daily HW or classroom notes.  Many kids with ADHD miss visual or auditory information due to distractibility or tracking issues.  (Unfortunately, peers are not consistently reliable as a resource.  Many kids with ADHD face more peer rejection than typical kids.)

• Eliminate distractions.  Testing in an environment with fewer people make s huge difference.

• Regular check-ins for organization of materials, reviewing the child’s agenda or schedule.

• Chunking or breaking down of larger assignments.  Kids with ADHD struggle with attention, organization, long-term planning, and time management.  They tend to procrastinate.

• Look, rephrase.  Be clear and specific.  Be patient.  Don’t criticize.  An ADHD child is usually doing the best they can.  Be sure your expectations are reasonable. 

• Be mindful of your own triggers and overreactions.  Yelling, ignoring, sudden or harsh consequences, making comparisons, nagging, negative labeling, and lecturing help the child underachieve.  A defiant child with ADHD may avoid work because it requires sustained mental effort.  This child may also lack emotional intelligence.  The ability to be self-aware, to manage mood, self-motivate, have empathy, and manage relationships is immature. Instead create a calm emotional atmosphere for learning.

• Prepare for changes and transitions.  Kids with ADHD lose track of time and have difficulty understanding directions.  This cannot be fixed with punishment.

• Use of fidgets to improve focus, attention, and to discharge heightened energy.

• Breaks during times of frustration.  Understanding that frustration is very real when work is too hard, too easy, too long, or not stimulating.

• Being understood.    A child with ADHD struggles with daily challenges, bombarding thoughts, and emotions.  A sense of helplessness can occur when overwhelmed.  Negative feedback diminishes self-esteem.  Instead, be calm, firm, and non-controlling.

• Expect setbacks.  Help the child cope with setbacks and making mistakes.  “Let’s figure out to succeed next time.”

• Praise, positive reinforcement, rewards or incentives for their efforts, not outcomes.

• Avoid power struggles.  Free your mind of the need to win.  Pick your battles wisely.  Offer choices.  Use humor. Empower the child.  

Teachers are great role models.  However, they are not immune to feeling drained or overwhelmed by kids having ADHD.  Consult others who are knowledgeable.  Stay proactive and involved.  Contact me at SHCS for more information.