Sunday, April 30, 2017

Comments by Bob Bennett

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  • From my experiences with ‘the mental health system’ I come to the following Recommendations:
    DEVISING EFFECTIVE TREATMENT PROTOCOLS FOR THOSE WITH MENTAL HEALTH ISSUES

    Our current treatment protocols for those exhibiting behaviors associated with having mental health issues are inadequate, and some claim abusive. New protocols are needed where respect for the individual is integrated into the process.
    In order that individuals obtain the best chance of recovery – and leading contented productive life, several changes to the system need to be implemented.
    1. Screen and treat individuals for trauma (numerous non-drug modalities are available, including somatic experiencing, Eye Movement Desensitization & Reprogramming, and others.
    2. Work with client to find out where he/she falls on the personality type grid utilized by the video series How To Deal With Difficult People (by Dr. Rick Brinkman & Dr. Rick Kurshner)
    3. Have client attend workshops on Non-Violent Communications – (the one by Marshall Rosenberg is excellent)
    4. Encourage Meditation
    5. Encourage perception shifting exercises: Cellular Memory Release -see Memory in the Cells by Luis Diaz-
    6. Utilize the Dali Lama’s method of transforming anger. (adapted from The Art of Happiness by the Dali Lama)
    7. Investigate the use of alternative therapies including Craniosacral Therapy and sound Therapy using tuning forks. Those who receive appropriate intervention early have the best chance of optimum recovery, yet nearly all should be able to make at least some recovery.
    8. Integrate the Recovery Oriented Practices by Larry Davidson, Ph.D. as recommend by SAMSHA.
    1. Screen and Treat Individuals for Trauma
    A history of Trauma is common in most, if not all individuals who experience emotional problems. The symptoms of trauma are quite similar to the symptoms lists of the DSM-IV – and soon to be released DSM-V. It is likely that successfully treating trauma would also
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    substantially reduce the symptoms which are the basis for the various designations in these manuals.
    Somatic Experiencing, devised by Peter Levine Ph.D. and explained in his book – Healing Trauma and Eye Movement Desensitization and Reprocessing (EMDR) are two methods which have been established as effective in treating trauma. There may be others as well. EMDR was developed for children, but also highly successful with adults, this method of treating trauma doesn’t require the patient to divulge information about the trauma. While the patient recalls the incident, the eyes are guided in a smooth pattern.
    2. Personality Grid
    The grid used by How to Deal with Difficult People is a simplified system which correlates where a person is on the grid to various types of difficult behavior.
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    Everyone falls someplace along the continuum from passive to aggressive. Likewise, everyone falls someplace along the line of being task oriented or people oriented. Those who have developed the skills to be near the center; as well as having the ability to change according to circumstances, tend to be well adjusted, generally having few problems dealing with people. Those who fall further away from the center tend to have more interpersonal problems.
    Each of these quadrants hat result represents a type of person strategy, or way of coping with conditions. Each has a positive intent as well as a number of difficult behaviors. Depending on where an individual falls on the grid when these two items are considered, various strengths as well as problems tend to occur.
    Ruler Quadrant
    Those in the Ruler quadrant believe the most important thing is to get the task at hand accomplished. They tend to be direct and to the point, decisive, confident, but needs control, and can become dictatorial, and may intimidate and alienate people by yelling, bullying, and arrogantly taking potshots at anyone – particularly when under stress. These people, often in positions of authority, can easily become ‘Tanks’ willing to roll over anyone they see as being in their way. The immediate short term goal is their only concern. Many individuals in this category are very knowledgeable in a certain field, yet they can become so habituated to doing things a certain way, they become closed minded to the benefits of doing things in a new or different way; Know-It-Alls. Another way individuals in this category can become difficult is when they turn into snipers. Snipers cut people down with snide remarks, use sarcasm and are disrespectful – often believing they are giving the person his or her just desserts from a perceived – or actual harm that was inflicted on them.
    Analyzer Quadrant
    Those in the Analyzer quadrant want to get things right. They are attentive to detail, systematic, accurate, factual, precise and organized. They can be indirect and detailed when speaking to others, as well as being stubborn, boring, aloof and unimaginative. They have a need for perfection, and can become silent, negative, fleeing or withdrawing under pressure.
    Analyzers can become chronic complainers, always presenting problems, but never a solution. They can also turn into ‘Nothing People’ where they never speak up, but are resentful of something. It can be a real challenge to figure out what is bothering them. Some can also only be positive about the negative; always saying something isn’t good enough, but never offering suggestions on how to make it better.
    Relater Quadrant
    Those in the Relater quadrant want to get along, and are agreeable, personable, friendly caring, and helpful. They are indirect and considerate, likeable, team players who are loyal, steadfast and patient; but also indecisive, gullible, waste time, passive aggressive, easily submits, accommodates to a fault, and puts things off – sometimes forever. Those in this quadrant are afraid to say either yes or no.
    Maybe is their strong suit. Someone might not be happy if they commit one way or another, so any decision gets put off. They can also become ‘Yes People’; saying yes to everything because that is what they think the person wants to hear. But saying yes doesn’t mean they will follow through. Passive enough to do nothing, nothing is typically accomplished.
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    Entertainer Quadrant
    The Entertainer wants to receive appreciation. They can be creative, warm, charismatic, and energetic. They tend to be direct, but elaborate when talking to others, can be persuasive, optimistic and have good verbal skills. Yet they can be egotistical, lack follow through, and be on the ‘flakey’ side. Under pressure they talk louder and faster, exaggerate, and throw tantrums.
    Some in the entertainer quadrant can become ‘Grenades’ – blowing up at unexpected moments whenever they believe their need for appreciation may be thwarted. Individuals in this category generally don’t have a great deal of in-depth knowledge about certain subjects, but that doesn’t prevent them from becoming ‘Think They-Know-It-Alls, claiming they do. They will parade as experts, but typically make their claims – and give solutions on scant evidence and poor logic
    This video series can be used as an aid during cognitive / cognitive behavior therapies to have clients better understand how these therapies can improve their quality of life.
    3. Non-Violent Communications
    Non-Violent Communication is founded on language and communication skills that strengthen our ability to remain human, even under trying conditions. It contains nothing new, but rather helps us reframe how we express ourselves and hear others. Instead of being habitual, automatic reactions, our words become conscious responses based firmly on an awareness of what we are perceiving, feeling and wanting. We are lead to express ourselves with honesty and clarity, while simultaneously paying others a respectful and empathic attention.
    4. Meditation Meditation has been proven to increase activity in the left pre-frontal cortex of the brain. Individuals with greater activity in the left pre-frontal cortex have been found to be happier and more content than those with a more active right pre-frontal cortex, who have been found to be more likely to display spontaneous anti-social behavior (anger, violence, and withdrawal).i While other benefits also accrue from meditation, this alone should be reason enough to encourage it.
    5. Perception Shifting Exercises Please see the attached information sheet
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    6. Transforming Anger
    Below is part of the coursework I put together while leading an anger group as a volunteer at NNAMHS. It is adapted from the book The Art of Happiness by the Dalia Lama, and I personally found it quite useful.
    Step one
    The first step is to write down what is making you angry. Take your time with this. If you have a lot of things making you angry, pick the one making you the angriest. If you find yourself getting angry as you write, take a break. Go out for a walk or do something you feel calming. Tell yourself, I’m addressing my anger, I’m working to resolve my anger Take the time you need. Then go back and continue writing. Write down all the details about it. When you think you’re done, ask yourself, Anything else? Write it down.
    Step two
    The second step is to ask yourself: Did I contribute anything to this situation? Write down all the contributions you made. It may be eighty percent of the situation, or it may only be one or two percent. Write it down. When you think you are done, ask yourself, “Anything else?” If you think of anything else, write it down.
    Step three
    The third step is to ask yourself, What was the other person’s perspective? Write it down. “What was the other person view of what happened?” Did that other person see some danger to themselves or one of their loved ones? What was the other person’s perspective? Was the other person doing the best he or she could? Write it down. Was the other person in over their head? Was the other person dealing with a new situation? Sometimes it isn’t a person you may be angry with. If you’re angry with God, ask yourself “What was God’s perspective?” Were you being given a challenge to overcome? Are you being requested to improve your life or the lives of others? If the answer feels right to you, it is the right answer.
    Step four
    Anger is a perceived injustice. If you have gotten this far and still feel anger, either you hid something from yourself along the way, or an injustice was done. Anger is also energy stored in the body. It will seek action. It is up to individuals to find ways to release this energy in a way that will benefit themselves and society. MOTHERS AGAINST DRUNK DRIVING (MADD) was formed by parents angry over the death or injury to a child, or other loved one. NAMI was formed by parents and family members who were angry over the lack of knowledge, treatments and care available to those of us with a mental illness. They have changed things. But, more work needs to be done.
    Write down what you can do to make things better for someone else who may be in a similar situation, and then do it.
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    7. Alternative Therapies
    On my recovery journey I utilized numerous alternative therapies. I found a number of these to be quite beneficial. The scientific research, for the most part has not yet been conducted. There are numerous reasons this has not yet happened. The two therapies I believe have the most potential to offer the greatest good in a relatively short time, at minimal cost are Craniosacral Therapy and Sound Therapy using tuning forks. Both of these therapies help to gently increase the flow of cranial-spinal fluid to the brain. I encourage research into these therapies, as well as into the entire range of alternative-complementary therapies.
    8. Integrate the Recovery Oriented Practices by Larry Davidson, Ph.D. as recommend by SAMSHA. Ten Things You Can Do to Be Recovery Oriented, Starting Today by Larry Davidson, Ph.D. For practitioners to fully embrace recovery, many changes are needed that require significant policy, program, and systems reform, which is why SAMHSA and other organizations are calling for a transformation of behavioral health care. However, the need for large-scale reform doesn’t mean behavioral health care providers cannot make important changes in their everyday practice while waiting for broader reform to take place. You’ll be surprised how small changes can make a big difference. Try these 10 steps with the people for whom you provide care. 1. Ask them how they would like to be referred to (first name, last name, nickname, etc.). Refer to them as people, not as diagnoses or disorders. Although doing so may initially seem unnecessary or awkward (e.g., referring to someone as “a woman with schizophrenia” or “a man with an opiate addiction”), talking—and even more important, thinking—about people as “schizophrenics” or “addicts” is disrespectful and not in line with recovery-oriented practice. 2. Ask if there is anything you can do to help them feel more comfortable during your time together. 3. Encourage them to ask questions about the care you or others are providing. To facilitate this question-and-answer exchange, inform them of your treatment plans before taking action (e.g., “Now I’m going to ask you a few questions about …” or “I need to get some information from you so I can …” or “I’d like to set up our next appointment, but first I want to see if you …”). This will allow them to prepare and pose questions at an appropriate time.
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    4. Enhance your service setting so it is dignified and conveys hope and compassion. Decorate the space with art and furniture and play music (if appropriate) that is appealing and culturally meaningful to the people for whom you provide care. Within the limits of your available resources, make the space one you also enjoy coming to every day. Pay particular attention to waiting areas and restrooms. 5. Eliminate artificial and unnecessary rules. These rules have typically been in place for a long time, whether for staff convenience (e.g., “towel hours” in inpatient units) or as a result of stigma. If rules are necessary, involve your patients in their development and communicate the reasons why they are needed to staff and patients. 6. Do not make rules to control patients’ behavior. These restrictions, which are often based on negative stereotypes about people with behavioral health conditions, can result in discriminatory practices that impede recovery. Examples include using “privilege” systems in inpatient units or residential programs, making access to resources contingent on treatment adherence (e.g., “I won’t refer you to supported employment until you take your meds for three months”), and attempting to control what people who are receiving care can and cannot do outside of treatment (e.g., “there can be no contact between group members outside of the group”). 7. Be mindful that the majority of people with behavioral health conditions have a history of trauma. Therefore, when conducting intake interviews, exploring psychosocial histories, and developing care plans, remember to ask people what helps them get through difficult times (e.g., spirituality), what would help them feel safe in your care, and whether or not they feel comfortable discussing their sexuality with you, as all three issues are pervasive human concerns that have been relatively neglected by behavioral health practitioners in the past. 8. Ask them if they know anyone who has recovered from or is in recovery from a behavioral health condition. If they don’t, offer to introduce them to people who have (or provide DVDs with relevant recovery narratives).
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    9. When conducting team rounds, case conferences, or discussions about patient care in which the individual receiving care cannot participate, have at least one person assume the role of the patient/client. Ask that person to try his or her best to represent the patient/client perspective in the discussion. This strategy was first suggested more than a decade ago by Ken Thompson, M.D., when he asked staff to refer to a patient/client they wanted to discuss by using the first name of a staff person in the room. So instead of discussing the case of Mr. or Ms. X, they would discuss Ken’s situation, and the care they were offering him. If this is not feasible, use your imagination to put yourself or a loved one in the person’s place and consider the discussion from his or her point of view. For example, ask yourself: “What would I want from this group if I was in the patient’s/client’s situation?” or “How would I feel about this discussion if we were talking about my son, daughter, spouse, or sibling?” If you already practice these nine things, try this final suggestion: 10. Ask the people for whom you provide care and their loved ones what you can do to better help them, or how you can improve the quality of your care. They will undoubtedly have ideas. After you’ve tried these suggestions, share your positive (or negative) experiences with RTP and its readers by submitting your stories to [email protected]. Dr. Davidson is the RTP Project Director.
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    i Destructive Emotions: How Can We Overcome Them? A Scientific Dialogue with the Dalai Lama Narrated by Daniel Goleman (pgs. 334-346); The Benefits of Meditation, Psychology today, (April 1, 2003) Colin Allen; Growing the Brain through Meditation, On The Brain: The Harvard Mahoney Neuroscience Institute Letter, Fall 2006, Vol. 12 No. 3

  • Thank you for the excellent article, as well as for the insights from those making comments. The study of Buddhism as well as daily meditations helped me in my recovery journey. Allowing yourself to feel emotions without being overcome by them – instead of being frightened,ashamed, or trying to either run away or cling to them – is a much healthier way to experience life. I began meditating about 17 years ago after reading – In The Artist Way by Julia Cameron – that meditation can help one become more creative – At about the same time I read in The Journal – which was published by California NAMI that racing thoughts was a symptom of bipolar, which was one of my diagnosis, the other being PTSD. I had racing thoughts for as long as I could remember, at least since age 5 or 6. I began meditating every time my thoughts began to race, and then daily for at least 10- 15 minutes. Within 6 or 8 months, I realized that I was no longer having racing thoughts. During this time I was also receiving cognitive therapy, which helped me to relearn responses to stress. My journey through madness helped make me a better person, and while it is a journey I do not recommend to anyone – for those who find themselves on the journey, please try to consider it as a valuable learning experience – and work to make the mental health system first rate by sane, compassionate and even joyful.