Blog page for Enthrive North Counseling private psychotherapy practice, providing therapy for adults, adolescents and the elderly in the areas of addiction, adoption, anxiety and substance abuse. The blog entries are designed to cover these topics and start discussions.
Anxiety tries to convince us it doesn't exist by utilizing our brain's tendency to use limited information to predict future risks. By learning what worries are simply anxiety and which are legitimate we can more accurately taste the world and push back against the stress that Anxiety puts on us.
I have a difficult relationship with Methadone. I see what it can do positively for a person: decreasing drug-seeking behavior, reducing or eliminating sharp withdrawal symptoms, providing comfort and reducing the criminal or anti-social behavior that continuous illegal drug use requires. I also see that it provides a very helpful service to the community and society: reducing drug-related crime, providing long-term treatment at a low cost/dose and, possibly most importantly, pacifying a population of time-consuming patients that would otherwise require intense (expensive) treatment to rid themselves of the need for opiates or opiate substitutes.
I dislike methadone for about the same number and quality of reasons: Instead of freeing a person from an opiate addiction, it moves them to a less-problematic opiate addiction; it is too freely given by doctors that are not specialized in opiate use cessation, it is provided without the proper education; it is given by doctors who are not ready to put in the time to properly titrate a patient off of it; I'm going to say this again because it is important, methadone is often given by doctors as if it is a long-term medication for heart disease, leaving the patient with the conclusion that this is as good as their life will get.
But why? Methadone is fully addictive physiologically, is prone to abuse and can lead to withdrawal because it shares much of its qualities with short-acting opioids like heroin and oxycodone. There is something to the common belief that methadone treatment is simply a trade from one addiction to another, even if it is a much less destructive addiction. Along with being abused and overdosed, methadone is given to patients over a duration that prolongs the addiction recovery process.
Counseling interventions, the development of social supports, skill practice and trigger awareness are part of recovery planning for those with acute problems with alcohol and drug use, but with methadone these interventions can be put off, ignored or minimized since the majority of pressing addiction symptoms are reduced or eliminated with the daily dose. Can you seen the problem here? My car has a hole in the gas tank and I figure out that if I only fill it past 1/8 of a tank it doesn't leak (much), so I don't fix the hole. I can't visit anyone that is farther than 30 miles from a gas station, don't really want to drive more than I need to, and am not confident taking my family on trips, but the solution is working: just don't fill the tank.
Many people on methadone maintenance therapy are being told this same thing: just don't fill your life up with things that you like doing or make you feel productive and you will be able to maintain the treatment protocol that is easiest for the doctor.
Oh, I didn't mention the side effects of methadone as yet.
Chronic fatigue, Sweating, Vomiting, Diarrhea, Perspiration, and Blurred Vision are some of the physical ones. Insomnia, Weight gain, Decreased or absent libido, anxiety, Cognitive impairment, Memory loss, Cognitive impairment, and Mood change are some of the psychological ones. This isn't just a list though, it's a picture of what someone's life will be for the years they are on methadone. But unlike the rare occurrences that some other medications have of their associated side effects, every methadone client I have worked with reported having some or all of these to some degree.
So the person, supposedly given a prescription to help them regain control of their life, is given a medication that makes them almost unable to live it to any real degree. The flattened affect and lethargy are some of the most dramatic side effects because they present to a degree usually found in severely depressed clients. The patient has almost no motivation and if they do accomplish something the enjoyment from doing it is reduced or eliminated.
There has to be a better way.
I spent some time trying to figure out the proper phrasing for what it is we are trying to accomplish with the combination of Post-Modern Narrative Therapy, the emerging science of Neural Plasticity development and my own predilection for Motivational Interviewing techniques for engagement. What I came up with was a mishmash of words, all that I felt needed to be crammed into the modality name. It would be something like:
Heroic Targeted Intentional Revisionist Cognitive Neural Preferred Story Reconstruction. I'm open to suggestions.
But here is the problem and the opportunity. I believe that people, when presented with the overwhelming information regarding our own self-creation of the world around us, will choose to work towards a creation of their preferred reality instead of continuing a problem-saturated reality. But introducing this in therapy is a bit clumsy, much like telling a story and getting kids to come along with you in a game of make-believe. Only in this story the hero is you and it's not make believe, it's self-revision.
Self-revision is the key component in real cognitive change. It is the result of retelling the stories of your life in a way that reframes them to come in-line with the person you want to be. Our histories structure our future by forming our beliefs about what we are and what we can accomplish. We see this technique starting to change the paradigm of treatment in domestic violence and child abuse, as people affected by these problems are called survivors instead of victims. What are some of the titles you carry? If these titles are the name tags we wear tightly pinned to our chests, how would you like them to be re-visioned to more accurately reflect who you want to be.
So-here is where it gets important. How do we free up the activity of the limbic system (blog post for clarification) to allow for more pre-frontal activity, which is what we need for self-recreation. We need to practice with our active mind in order to convert the new belief into our durable self-concept. So instead of Cognitive Behavioral Therapy, we are in effect doing Cognitive Identity Therapy.
Ask a question, post a comment or start a conversation if you want to take this farther.
Your first session should take about 90 minutes and will involve only some paperwork, as we work to preserve as much time as possible to start the real work.
The most important task in the first session is for you to get a feeling or a sense of how it will be working with me. A good thing to ask yourself is if you are going to be able to be honest with yourself while talking to me, and if you are going to feel respected and supported properly for what you need to accomplish. I am not offended by clients preferring another person for specific reasons (gender, age, location) or more general reasons (fit, feelings, or just because). If you are serious about making your life better, it is worth it to leave treatment that does not fit with you personally. That being said, I've found that I work well with a broad range of people from many sorts of backgrounds and experiences.
My job during the first session is to help you get a concrete idea about what you want to get out of therapy and how you are going to go about doing that. I also will ask a lot of questions regarding your past medical and mental health history as well as specific questions about substance (drug & alcohol) use and previous psychological treatment. This information is most easily completed through my online intake process, but we can do it in person as well.
I recommend that you spend some time deciding how much you are going to share and when you are going to share it. Counselors like to pretend that clients are always completely honest, but quite often it just isn't realistic to expect real people to share real emotions and experience with someone they met only that day or only a few times. That's understandable and fits right into the method of treatment I follow. My job is to help you start working on your identified problem right away, with the information you are able to share at that time.
Near the end of the session we will check in to see how it is going so far. This is your time to be honest about how you feel it would be working with me. If you decide to make another appointment, we will do so and I will probably ask you to fill out some forms either online or on paper before the next time we meet.
Into the category of "Didn't I already know this?" goes green therapy. But it may actually go well beyond the self-evident benefit that being outdoors gives us.
I first ran into Green Therapy when I was working with adolescents and adults troubled by Attention Deficit and Hyperactivity problems. It was being found that even painting a child's room green (especially multiple shades of leaf green) was helpful in reducing behavioral problems and increasing focus. Another study found that when you actually put children in a forest setting, the results became much more dramatic. I ran into this again recently when a friend posted this summary work on the subject: Your Brain on Nature. It outlines the many ways in which we can find more peace by interacting with green spaces.
Actually, this is part of the reason we moved from Philadelphia back to Northern Michigan. We wanted ourselves and our children to be able to look out the window or take a walk through the neighborhood and see lots of trees, water and other palliative natural surroundings.
At the river's edge
That Green can help anxiety seems to be just one more finding along the same line of thinking: natural environments help our body feel secure and right in the world. In one study, a researcher decided to test outcomes after surgery, but instead of seeing which medication helped, he decided to see if a view of trees outside the recovery room would aid treatment.
"In comparison with the wall-view group, the patients with the tree view had shorter postoperative hospital stays, had fewer negative evaluative comments from nurses, took fewer moderate and strong analgesic doses, and had slightly lower scores for minor postsurgical complications. "
-from "View through a window may influence recovery from surgery." by Ulrich, R. Science v224
Right, wow. That is just looking at trees through a window. Now, with modern technology, we can actually go outside.
So I'll quit typing if you'll quit reading. Let's both go outside.
The process of starting my practice in TC was both a leap of faith and a carefully calculated endeavour. When I moved to Traverse in June 2014 it was both to come back to the place where I was raised and to find a place where I could combine my efforts in several areas of counseling to best fit my own professional goals. I really wanted to find a way to combine my clinical experience, my research experience, and my natural desire to help people.
I have worked in several settings, most recently for the University of Pennsylvania in their Treatment Research Center, which is one of the foremost addiction research programs in the country.
acoustic hvac pipe wrap installed, kinda
