Perspectives Counseling https://www.perspectivesoftroy.com/ We promise you or a family member the highest level of experienced clinical counseling and therapy. Tue, 02 May 2023 19:37:14 +0000 en-US hourly 1 https://www.perspectivesoftroy.com/wp-content/uploads/2020/09/cropped-favicon-32x32.png Perspectives Counseling https://www.perspectivesoftroy.com/ 32 32 Prioritizing Balance https://www.perspectivesoftroy.com/2023/05/02/prioritizing-balance/ Tue, 02 May 2023 19:37:05 +0000 https://www.perspectivesoftroy.com/?p=12079 The post Prioritizing Balance appeared first on Perspectives Counseling.

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By Dequindre Jernigan, MA, LPC

Oftentimes, we can become overwhelmed by the variety of life’s stressors. Trying to find a balance between family, friends, work, and self-care can be difficult, but it’s not impossible. In order to get the most out of your life and decrease stress, consider trying the following:

Balance is defined as an even distribution of weight. You think about things like a balance beam or how waitresses are trained to balance a customer’s order on a food tray. If that tray tips too far to one side, of course, the items will fall off. Concerning mental health, if you put too much importance on one area of your life and neglect the others, you’ll eventually feel as if something is missing or that you’re falling short in some capacity. But sometimes, it’s a struggle to discern what things are priorities and when they should be priorities. One thing to keep in mind is that if everything is a priority, NOTHING is a priority. It literally cancels out the definition of the word, which is something that is more important than another. Instead, being able to prioritize different things at different times is more effective. For example, if someone learns that an individual in their family has fallen deathly ill, more than likely they will prioritize family over hanging out with friends and socializing. Alternatively, if someone has a big deadline at work that they cannot miss, work would be prioritized over other things. Now this doesn’t mean that one completely ignores or disregards the other important things in their life, but that they merely take a backseat for a period of time to focus on what’s more urgent.

How one spends their time speaks to their personal values. Values are things that are important to us at any given time and they are usually influenced by our immediate family while growing up. Values can range from family, friendship, loyalty, trust, independence, achievement, and love, to wealth or popularity. Taking a step back to look at your life and which areas have the most attention can highlight your personal values. People can aspire to improve their values as well. For example, a person valuing honesty, yet knowing that he or she is a habitual liar, may work on being more honest. There is nothing wrong with acknowledging your shortcomings and making a conscious choice to do better. The problem lies in a lack of action despite awareness. Choosing what type of person you want to be can have a positive effect on the future decisions you will make.

There have been times when it’s difficult for one to live up to their personal values and the expectation of others. In these types of situations, setting hard boundaries may be necessary. There are different types of boundaries ranging from physical, and material, to sexual. But when trying to prioritize balance, more than likely, time-related boundaries would be important to consider. Things such as having a hard cut-off time for work can ensure that you have the opportunity to engage in other meaningful aspects of your life. Someone who’s been more passive or permissive in the past can find it hard to follow through with boundary setting, but we all have to start somewhere. And recognizing that consistency is key can help remind you that the uncomfortable feeling is only temporary. Some people don’t like boundary setting because it can potentially affect their relationship with the other person but it’s supposed to! If nothing changes, nothing changes.

For those who lead hectic lives, sometimes becoming more organized can be effective. Taking a look at your daily routine and seeing where there’s a lack of time management can help you plan better and avoid scheduling conflicts. Another thing to consider is how long you’re giving yourself to get certain things done. For example, a person who gives themselves thirty minutes to get ready in the morning, but still finds themselves chronically late to work may consider giving themselves an additional 15-30 minutes. Some people find planners helpful while others solely rely on their phones or other mobile devices. You should decide what’s more convenient for you and what will help you maintain progress.

Self-care can be hard to consistently implement, especially if you have an inaccurate perception of what self-care is. It isn’t solely related to things requiring that you spend money (getting your hair and nails done, going shopping, or getting a facial). Some people put aside funds for self-care activities and even have a consistent day or days they engage in self-care. There is nothing wrong with that. But while money-related self-care activities can certainly bring joy and peace, there are other alternatives that don’t cost money. Things such as taking a nice long bubble bath or reading your favorite book can be just as relaxing. Self-care activities and coping skills fall under the same umbrella of things that help ease your mind in some way. Now again, people with hectic schedules are probably wondering how to make time for self-care. Well, I’d like to introduce something called “little pockets of time”. This can be as short as dedicating five minutes sporadically throughout the day to focus on yourself. That can include five minutes of journaling, meditation, deep breathing exercises, or sending a text to a friend. You have to remember that your mental health is just as important as your physical health and it’s important to prioritize it. Some people spend hours on social media looking at TikTok videos or creating reels on Facebook. So why can’t those same people take at least five minutes throughout the day to do something productive that’s geared toward their mental health?

Lastly, the most important thing to remember is that you cannot control everything. Letting go of that perception will ease a lot of anxiety for a person and allow them to look at things rationally. Sometimes there is power in letting go and delegating. You weren’t meant to be a one-man or one-woman show. It’s okay to ask for help if you’re struggling and it’s unfair to assume that others know that you need help if you never vocalize your needs. Sometimes, things will be out of your control and instead of allowing that fact to derail you, you must make the choice to push forward and consider other alternatives. Look at new ways to solve the same problem. Soliciting help can bring about a new perspective and improve problem solving skills. We are all on a journey of self-improvement in some way; and along that journey, we must learn to find and keep balance in our lives to ensure a sense of fulfillment.

Dequindre Jernigan (Quin), is a graduate of Wayne State University where she obtained her Master’s in Counseling Education. She currently works as a Licensed Professional Counselor treating children, adolescents, adults, and couples. Quin offers Christian counseling and specializes in cognitive behavior therapy (CBT) as well as rational emotive behavior therapy (REBT). She helps treat depression, anxiety, PTSD, mood disorders, self-esteem, and stress.

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The Importance of Recognizing Strengths https://www.perspectivesoftroy.com/2023/01/31/the-importance-of-recognizing-strengths/ Tue, 31 Jan 2023 19:15:58 +0000 https://www.perspectivesoftroy.com/?p=11909 The post The Importance of Recognizing Strengths appeared first on Perspectives Counseling.

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By Dequindre Jernigan, MA, LPC

When you’re struggling with depression or negative thinking patterns, it can be hard focusing on positive things about yourself, such as your strengths. Low self-esteem is another factor that could make it a challenge. Part of implementing any goal or habit is to first recognize the problem and then come up with a detailed plan on how to solve it. Introspection, or the act of examining your own thoughts and feelings, can be enlightening. It allows you to consider things you haven’t thought about before, such as the areas in your life that are going well. For example, maybe your relationship with your family isn’t going so great, but you have strong connections with your friends. Or maybe you haven’t been consistent with eating healthily, but you’re disciplined with working out each day. Being able to apply strengths in one area can allow you to tie those same successes to others with practice. Recognizing strengths is one way to practice positive psychology. Positive psychology recognizes the positive influences in a person’s life and can aid in individual well-being.

There are many strengths that you may not be aware of. To help, below are some examples of common strengths:

Humor
Confidence
Leadership
Spirituality
Self-Control
Independence
Modesty
Social Awareness
Intelligence
Optimism
Patience
Ambition
Creativity
Bravery
Open
Mindedness
Persistence

Strengths can be implemented in three major areas in your life: in your profession, in relationships, as well as your personal life. Your profession includes your job or school, relationships include friendships, family, and romantic relationships and your personal life includes your hobbies or things you find enjoyable. Looking back to the list, were you able to identify any of them? If so, think about a time when you displayed one of these strengths. What happened? How did it make you feel? Were you even aware that you were practicing those strengths? Maybe you felt accomplished being able to manage your anger in a healthier way or maybe your persistence finally paid off to promote some type of necessary change. Even if these things are insignificant to you, you must remember to give yourself credit for these small accomplishments.

Sometimes it can be helpful to think about how your strengths align with the people who are important to you. For example, some people may say a parental figure is someone they admire or look up to because they always maintain a positive attitude in the midst of struggles. Using your strengths to overcome daily stressors can aid in future success. Personal goals are more likely to be accomplished when individuals utilize their strengths. Someone who is optimistic can use that same optimism to encourage themselves when they lack motivation. Saying things such as, “Okay, things didn’t start off great, but I have a chance to turn this around and do better than before,” can renew that initially non-existent motivation. Using that same example, patience could also be useful if the person’s goal is more of a long-term goal, such as losing weight. Understanding that big goals take time will allow an individual to trust the process more.

Recognizing the positive things about yourself is an integral part of self-love. When you feel good about yourself, you in turn have a healthier mindset. This positively affects your mood. You are able to achieve more things because your self-confidence allows you to believe you can. Alternatively, consistently engaging in negative thinking patterns will worsen pre-existing depression and feed into the mindset that you will never be able to accomplish your goals.

To keep things in perspective, remember that whatever you nourish, it will grow. If you feed your mind with positive thoughts along with taking appropriate action, you will begin to see the changes you want to see. But if you feed your mind with negativity, self-doubt, and fear, you will only continue in a self-defeating cycle of depression. We all have moments of doubt and experience insecurities in certain situations, but the important thing is to recognize them and try to fix them.

Sometimes with depression, it is hard to think positively because it is more than just a mindset. In certain cases, a person’s depression may be so severe that an individual may need to see a psychiatrist for medication in addition to talk therapy. And that is okay! Every person is different with varying mental health needs. It is up to you to determine what may be best for you.

The most important thing is to get the help you need if you find yourself struggling. Friends and other people who are part of your social support are great resources to turn to, but sometimes they are not adequately equipped to handle severe depression or anxiety. A mental health professional will be able to help you with your mental health goals and see yourself in a more positive light.

Dequindre Jernigan (Quin), is a graduate of Wayne State University where she obtained her Master’s in Counseling Education. She currently works as a Licensed Professional Counselor treating children, adolescents, adults, and couples. Quin offers Christian counseling and specializes in cognitive behavior therapy (CBT) as well as rational emotive behavior therapy (REBT). She helps treat depression, anxiety, PTSD, mood disorders, self-esteem, and stress.

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5 Common Cognitive Distortions https://www.perspectivesoftroy.com/2022/12/23/5-common-cognitive-distortions/ Fri, 23 Dec 2022 16:31:53 +0000 https://www.perspectivesoftroy.com/?p=11835 The post 5 Common Cognitive Distortions appeared first on Perspectives Counseling.

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By Dequindre Jernigan, MA, LPC

You may already be familiar with cognitive distortions. You know, those little negative thoughts that influence our actions? No? Well, let’s talk about it. We all have thought patterns, whether they’re more negatively inclined or relatively positive. Think about a time when you didn’t do your best at something. It could have been receiving a bad test grade, an attempt to make a friend, or your performance at work. Typically, we all have certain expectations of ourselves or a standard we want to live up to. When we fall short of that, it can be mentally damaging for some people because of their thinking patterns. There are many cognitive distortions to discuss, but we’ll focus on some of the most common ones. Let’s start with polarized thinking.

1. Polarized Thinking
You may have heard someone use the term “polar opposites” before, usually referring to a person’s characteristics or personality. With polarized thinking, a person has an “All or Nothing” attitude. Anything less than perfect doesn’t count. These are the individuals who are labeled as “perfectionists” and you probably know a few friends or family members who fit this category. Things are either black or white for these types of people. There isn’t an in-between. For example, someone who is used to getting A+ on every test is overly critical of themselves when they receive an A.

2. Mental Filtering
There are two types of mental filtering: Negative Mental Filtering and Disqualifying the Positive. Think about it this way: A filter is a lens through which something is altered or changed. There are many types of filter examples, such as water filters, and social media filters; some people even filter their language in certain social settings. So it shouldn’t be surprising that some individuals mentally filter their everyday experiences. Negative Mental Filtering is when an individual only focuses on the negatives of an experience, leaving no room for the positive. When this happens, the negativity becomes magnified making the situation appear worse than it actually is. An example would be receiving constructive criticism at work. There’s a difference between criticism and constructive criticism. Constructive criticism is meant to help a person improve in some way while criticism only points out the negative aspects of something. Someone who struggles with negative mental filtering will do just that: view constructive criticism as criticism even if the person pointed out some type of growth or improvement.

3. Overgeneralization
Some of you may be familiar with this one. In this case, a person focuses on one negative event or instance and attributes it to other things. I like to also refer to this one as the Domino Effect. One bad thing, such as waking up late for work can make a person think, “This is going to be a horrible day.” So what happens? Usually, the day isn’t so great, but that’s because the person has already made that up in their mind. There is power in the way we think and therefore, in the words that we speak. Our thoughts influence our actions and we must be careful with our thinking patterns.

4. Jumping to Conclusions
We’ve all done this at some point in our lives, right? Oftentimes, it is without any real evidence and is solely based on assumptions. These assumptions can be related to “mind reading” or assuming what other people’s thoughts or feelings are towards you or “fortune telling”, which is assuming how something is going to turn out without any concrete evidence. For example, a kid who transfers to a new school in the middle of the year assumes she isn’t going to make any friends and that the school year will be a bad one for her.

5. Catastrophizing
Like Mental Filtering, Catastrophizing has two components: Magnification and Minimization. Magnification occurs when a person exaggerates a situation, in which a person will think worst-case scenario. This can be problematic because there is no proof that the worst-case scenario will play out. This leads to increased anxiety. With Minimization, a person tends to dismiss positive experiences. This can be for a variety of reasons. Sometimes individuals don’t think they deserve recognition or the chance to be happy.

There are many other types of cognitive distortions, such as Personalization, Blaming, Labeling, Always Being Right, Should Statements, Emotional Reasoning, Control Fallacies, Fallacy of Change & Fairness, and Heaven’s Reward. To some degree, all of these cognitive distortions are similar, but at their core, they are all irrational or unhealthy thinking patterns. If you’ve recognized any of these cognitive distortions within yourself, it may be a sign to talk to a mental health professional. If they are causing social, academic, occupational, or affective distress, make the decision today to do something about it to improve your mental health.

Dequindre Jernigan, MA, LPC
Dequindre Jernigan (Quin), is a graduate of Wayne State University where she obtained her Master’s in Counseling Education. She currently works as a Licensed Professional Counselor treating children, adolescents, adults, and couples. Quin offers Christian counseling and specializes in cognitive behavior therapy (CBT) as well as rational emotive behavior therapy (REBT). She helps treat depression, anxiety, PTSD, mood disorders, self-esteem, and stress.

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ADHD – What To Do About It By Dejan Jancevski, MA, LLP https://www.perspectivesoftroy.com/2022/08/02/adhd-what-to-do-about-it-by-dejan-jancevski-ma-llp/ Tue, 02 Aug 2022 14:52:52 +0000 https://www.perspectivesoftroy.com/?p=11521 Introduction ADHD is one of the most common conditions affecting children and adults. ADHD symptoms can be challenging for people with the condition and their families, but there are effective treatments that can help reduce symptoms and improve functioning. ADHD is Treatable ADHD is not a character flaw or a sign of laziness. It’s a […]

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Introduction

ADHD is one of the most common conditions affecting children and adults. ADHD symptoms can be
challenging for people with the condition and their families, but there are effective treatments that can
help reduce symptoms and improve functioning.

ADHD is Treatable

ADHD is not a character flaw or a sign of laziness. It’s a brain disorder that causes the sufferer to be
unable to focus, complete tasks in a timely manner, and pay attention to details. ADHD is not curable,
but it is treatable.

Those with ADHD typically have three main areas of impairment:
• Inattention – being easily distracted, forgetful or disorganized
• Hyperactivity/impulsivity – fidgeting excessively or talking too much; interrupting others; behaving without thinking first

An effective treatment plan addresses more than just ADHD symptoms.

ADHD is a complex condition that affects many areas of life. It can impact your ability to pay attention, follow through with tasks, control your emotions and maintain focus. As a result, ADHD symptoms are often present in social situations, at school, and at work as well as within relationships and family relationships.

This means that an effective treatment plan addresses more than just ADHD symptoms. If you’re going
to have any hope of managing your symptoms effectively—and living a happy life despite them—
you’ll need to address all these different aspects of your life simultaneously. There are many options for treatment.

There are many options for treating ADHD. The first step is to consult a doctor or psychologist who
specializes in ADHD. Medication, behavior therapy, social skills training, parent training, and cognitive
training are common treatments. Brain training can also benefit people with ADHD by helping them
improve their executive functions (the ability to plan and organize tasks). Exercise has been shown to
help some people with ADHD. Diet changes such as eliminating sugar or artificial sweeteners may be
helpful as well. Holistic therapies such as yoga, meditation, and sleep hygiene can help reduce stress
levels which can improve symptoms of ADHD in some people.

There is no one treatment that works best for everyone but there are many choices available depending
on your needs! The best results come from a coordinated effort by the family, educators, doctors, and therapists.
The best results come from a coordinated effort by the family, educators, doctors, and therapists. It’s important to work together to create an individualized plan for managing ADHD symptoms. This is especially true if you have more than one child with ADHD since they may have different needs. Treatment helps to reduce symptoms and improve functioning. Treatment can help reduce symptoms and improve functioning. Treatment can help you manage your ADHD symptoms so that you can live a better life with fewer difficulties and greater success.
No single treatment works for everyone with ADHD.

No single treatment works for everyone with ADHD. Treatment options depend on the person and their
symptoms. The best treatment plan is a combination of different treatments that address all areas of
ADHD, such as medication and behavior therapy. The treatment plan should be individualized to each person’s needs, which means it’s important to work with a team of professionals who can coordinate with each other (for example, a psychiatrist or psychologist who specializes in treating ADHD). A long-term, comprehensive treatment plan can help you manage your ADHD symptoms and live a better life.

ADHD is a lifelong condition. It’s important to understand that it’s not something you outgrow, nor is it a “phase” you’ll eventually grow out of. ADHD is often referred to as a neurobiological disorder because it involves changes in the brain that cause symptoms. These changes may continue throughout your life, but with proper treatment and care, you can manage your symptoms and live a better life.

The primary features of ADHD are:
• Inattention (difficulty paying attention; forgetfulness)
• Hyperactivity/impulsivity (fidgety; restlessness)
• Problems with self-regulation (organization; self-control).

Conclusion

If you think you or your child may have ADHD, it’s important to seek out a qualified health care professional. With the right treatment plan, you can manage your symptoms and live a more fulfilling life.

Mr. Jancevski is a Limited Licensed Psychologist practicing working at Perspectives Counseling Centers in
the State of Michigan. He obtained his Bachelor’s Degree in both Psychology and Microbiology/Virology at
the University of Michigan. He later completed his Master’s Degree in Clinical Psychology (specializing
in Child Development) from the University of DetroitMercy.

Mr. Jancevski provides psycho-therapeutic services to individuals with various mental health concerns, including, but not limited to:
• ADD/ADHD
• Adjustment issues
• Anxiety
• Behavioral issues
• Communication/Relational issues
• Depression
• Parenting issues
• Self-Esteem and Self-Efficacy issues
• Stress Management
• Head injuries / Dementia concerns
• Hallucinations
• Delusional Thinking

Mr. Jancevski specializes in treating: children, adolescents, adults, seniors, anger, anxiety/panic/phobias, chronic pain and Illness, depression, mood disorders, psychological and neuropsychological testing, self-esteem issues, severe and persistent mental illness, and stress management. He is trained in utilizing cognitive behavioral therapy (CBT), psychodynamic psychoanalysis, accelerated resolution therapy (ART), mindfulness / motivational interviewing, and solution-focused brief therapy (SFBT).

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Dealing with past abuse and neglect: Is it still a problem today? https://www.perspectivesoftroy.com/2022/07/01/dealing-with-past-abuse-and-neglect-is-it-still-a-problem-today/ Fri, 01 Jul 2022 16:04:04 +0000 https://www.perspectivesoftroy.com/?p=11463 The post Dealing with past abuse and neglect: Is it still a problem today? appeared first on Perspectives Counseling.

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What is childhood abuse and neglect?
Sometimes people come into the counseling office unsure of whether or not poor treatment received as a child constitutes abuse or neglect. One may have received poor treatment from parents while growing up or sometimes from others outside the family (friends, relatives, etc). Here are the definitions:

Abuse = Treating another human with cruelty or violence.
Neglect = The process of withholding or the state or fact of being uncared for.

While abuse is usually clear (punching, hitting, an adult having sex with a minor, etc), neglect is harder to define especially if it’s emotional in nature. Examples of emotional neglect can be lack of nurturing, consistent lack of affirmation from parents, being treated as a nuisance, constant reminders that the child is too needy or costs too much, consistently speaking to the child with a cold and unfriendly tone, consistently dismissing a child’s opinions, lack of interests in the child’s activities, verbally aggressive tone, persistent fault-finding or criticism, repetitive ignoring the child’s cues for help in tasks. Abuse and neglect both leave scars on children, and if not properly treated will linger well into adulthood. Oftentimes, clients come to the counseling office with scars dating back to their childhoods. Abuse and neglect will not heal itself without spending time and effort to put it behind you.

What are the effects of childhood abuse and neglect?
Depression, anxiety, difficulty trusting others, broken relationships, anger/irritability, divorce, problems connecting with spouse or children, PTSD, difficulty with employment and underachieving at work, lack of ambition, preoccupation with the past abuse or the abuser; shame, humiliation, low compassion towards oneself.

What are some steps to overcoming my past?
1. Consider a letter: Whether or not your abusers ever see the letter is of no consequence. Writing it out and putting it on paper is therapeutic for you, the victim. Getting your feelings out of your mind can help free you from the past and also helps you make sense of your feelings. There’s something different about writing than thinking………………. If the person who abused or neglected you would be open to reading the letter and perhaps a conversation you may want to mail the letter.
2. Find forgiveness. Abuse or neglect will never be okay, it wasn’t then, and it isn’t now. BUT you have to learn to let go. Forgiveness is necessary if you are going to detach yourself from your abuser(s). People often resent having to do the work of forgiving. They feel in essence, “Why do I HAVE to do the work of forgiveness??? I’M THE ONE who was taken advantage of!! Don’t forget………..you forgive for YOURSELF, not for the abuser’s sake. Without forgiveness, you are inextricably forever tied to the person that hurt you. Your abuse could have been decades ago and you can live halfway around the world, but without forgiveness, you will still be connected. Be careful also not to confuse forgiveness with reconciliation. Forgiveness is mandatory, reconciliation is optional. The relationship could be so broken that you may not want restoration. Still…………forgiveness is the key that unlocks the chains of abuse or neglect.
3. Receive Professional help – a professional therapist who understands treating this issue can be invaluable in helping you get past the past.
4. Lean on your religious faith. FAITH CAN HELP……realizing that God loves you and is here to help can give you the power that you cannot muster on your own.
5. Find a good workbook on childhood abuse. One good workbook from a Christian perspective is “Reclaiming your Inner Child” by Ken Parker.

Perspectives has many good therapists trained in dealing with childhood abuse and neglect. One of them would gladly walk the road to recovery with you………..reach out today to get started.

By Eric Nordquist MA, LPC, NCC
Eric has nearly 20 years of full-time experience in outpatient therapy. He obtained his Master of Arts degree from Oakland University in 1995 and is a Nationally Certified Counselor.

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Life in the Therapy Room! https://www.perspectivesoftroy.com/2022/02/28/life-in-the-therapy-room/ Mon, 28 Feb 2022 19:35:57 +0000 https://www.perspectivesoftroy.com/?p=11216 The post Life in the Therapy Room! appeared first on Perspectives Counseling.

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Existentialism. Now what is that, and how does that apply to therapy? Well…let’s start with the therapy part first. One major reason to see a therapist is to learn what may be the reason you or a loved one are struggling with something, be that called depression, anxiety, obsessive-compulsive disorder, oppositional defiance, attention-deficit/hyperactivity disorder, substance use, an eating disorder, or any of the other numerous categories listed in the Diagnostic and Statistical Manual of Mental Disorders. Helping you learn or become more familiar with the so-called triggers to your diagnosis and helping you learn, or hone coping skills tends to be one of the main goals of therapy, and much of the therapeutic encounter involves this psychoeducation. Learning to gain greater insight into yourself and using your learned skills to better manage and even overcome those triggers may be the main goal for you.

Even so, despite whatever we may be dealing with, at our core, we are human beings seeking meaning and purpose in life (and that may even be in the therapy room…): enter Existentialism; the other two schools of thought asserting that we seek sex and power…psychoanalysis and ego psychology…respectively! Obviously, writing this blog, I ascribe to existential thought, as even sex and power would ultimately appear to be where meaning and purpose are found for some! From college students choosing a major; to people picking a career; to adolescents trying to figure out what they want to do with their lives outside (or inside) school; to adults who are wondering what it’s all about; to Why did I end up here?; to Why me?; to Where am I going?; to Who am I?; to What’s this issue of choice and responsibility all about (and how much of it do I have with what I am going through…)? Etcetera, etcetera, etcetera.

Finally, therapy, while leading to a diagnosis, always leads to a life situation that is behind the diagnosis: some deeper issue, an existential fact of life, be it interpersonal and/or personal, perhaps a struggle yet unresolved that is potentially a major reason for the diagnosis itself! So, the therapy room is a place where you can do so much more than just learn about what your “problem” is called identify what triggers you may have, and learn what new coping skills may help you. It is a place where you can also spend 30 minutes to an hour a week with a trained therapist who will provide you with a confidential, safe, and supportive therapeutic environment where you may, not only learn what you can do to live a life of wellness but also explore your reason for being, which may also (though perhaps challenging in itself…) lead to a life of wellness!

Sincerely,
Steven Coddington, MA, LPC
Steven is a Licensed Professional Counselor with a Master’s Degree in Community Counseling from the University of Detroit Mercy, working with adolescents and adults, specializing in anxiety, depression, and adjusting to life transitions.

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I’m a Psychiatrist, and Women Aren’t Being Honest About Their Sex Lives https://www.perspectivesoftroy.com/2022/02/18/im-a-psychiatrist-and-women-arent-being-honest-about-their-sex-lives/ Fri, 18 Feb 2022 16:08:51 +0000 https://www.perspectivesoftroy.com/?p=11190 Mental health struggles can get in the way of your ability to orgasm — and you deserve to get that sorted out. “I have never told anyone that before.” I hear this often in my office as a psychiatrist. Talking to me, my patients are often more vulnerable than they have ever been with someone. […]

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Mental health struggles can get in the way of your ability to orgasm — and you deserve to get that sorted out.

“I have never told anyone that before.”

I hear this often in my office as a psychiatrist. Talking to me, my patients are often more vulnerable than they have ever been with someone. They tell me about why they hate their parents or siblings, their fears of getting close to someone in a relationship because of past traumas, and how much they want to quit their jobs or leave their marriages.

But as it turns out, one topic they really don’t want to talk to me about is their sex life — especially the women.

A female patient of mine, let’s call her Sophia*, had been taking an antidepressant to treat her anxiety for over two years. The medication (first prescribed by a different doctor) helped her interact in social situations and get through high school academically, so she never questioned the sexual side effects that came along with it — at 19, she had to use lubrication every time she had sex. This is common, by the way. Antidepressants, which are the first-line treatment for depression and anxiety, have an increased risk of sexual side effects like difficulty becoming aroused, sustaining arousal, or reaching orgasm.

Our conversation about it went something like this. I ask her pointedly, “Have you noticed any changes to your interest in sex or sexual functioning?” She looks back at me stunned. She shifts in her chair, avoiding eye contact.

She takes a big breath in and replies softly, “Now that you mention it, yes. I thought this was just what sex is like now.”

In my experience, women feel more shame talking about sexual side effects, even to another woman. While my male patients don’t hesitate about opening up to me (a 5’1″ female) about their sexual dysfunction — perhaps in part because it’s more obvious, physically — with women, changes can be more subtle, and they often assume they are at fault in some way.

The fact that a young woman would feel embarrassed or ashamed of having this conversation may seem surprising considering the popularity of shows like The Sex Lives of College Girls and Sex and the City, but television doesn’t always match reality. No matter how many times shows try to normalize the conversation, or how long ago Salt-N-Pepa told us to talk about sex, we still exist in a culture where many women feel they’ll be judged for talking about sex — even by their therapist.

The data agrees. In one study, 80% of women surveyed who were experiencing sexual dysfunction never talked about it with their mental health providers. Some, nearly 15%, stopped taking their medication due to sexual side effects, choosing silence over getting better. But why should anyone feel they have to choose between good sex and their mental health? It is about time that changed.

Change starts with knowledge and awareness. We must acknowledge that mental health and sexual functioning are intricately linked. It isn’t made up or “in your head” — it is normal and physiologic and real. In one large analysis, people with depression had a 50-70% risk of developing sexual dysfunction. In another study, this time in women aged 50-99, sexual health was found to be more associated with mental health than stress, age, or even physical functioning.

Even still, the symptoms of mental health disorders like depression and anxiety feed into our own insecurities in our relationships or about our own sexual desire and performance. Depression is associated with negative thoughts about oneself and the world. If the depressed voice in your head tells you that you are unattractive or unloveable, it’s going to be hard to want to put on lingerie for your partner. Not to mention, an active sex life also requires a desire and interest in having sex, and depression can prevent you from ever being “in the mood.” To put it simply, no matter how many flowers and fancy dinners Valentine’s Day brings, depression can alter your plans.

Anxiety, on the other hand, might cause you to be worried about a sexual experience so much that it distracts you from being in the moment. It can cause premature arousal or no arousal at all. Perhaps unsurprisingly, these symptoms can create distance and conflict in your relationship, making sex even less likely to occur, which often causes anxiety about the relationship to build. It also creates yet another issue in your life, compounding your already worsening mental health.

Take my patient Marie* who has been arguing regularly with her partner about sex. She never had a huge sex drive to begin with, she tells me, but her partner tells her it has absolutely gotten worse recently. He feels disconnected from her, and she feels pressured, making her anxiety worse. He urges her to talk to me about it and so we do, finally opening up a dialogue that she had been avoiding because she was both embarrassed and thought her sex life was not worth prioritizing over everything else she had going on. Because we did, it helped her to actually make things different, and better — in sex, anxiety, and her relationship.

Therapy should be a safe, neutral, and confidential space to talk about anything — including sex (even if it’s something your therapist might have to Google — you should see my search history!). It should ease the pressure you might feel talking to a partner, or even friend, as it centers the conversation on you and your needs. You might even tell your therapist that you are uncomfortable talking about sex and they can help you understand why. (And, if you really don’t feel like you can talk to your therapist about it, it might be time to find a new one.)

“What good is an antidepressant that works if you also have no arousal during sex, or desire for sex, or can never orgasm again? Life is long — the pleasurable things matter too.”

— JESSI GOLD, M.D.

But pretending sex isn’t a part of your overall mental health isn’t the answer. And when it comes to medication, it’s especially important to speak up. Even if I ask my patients about sexual side effects they might be experiencing from meds — which is still surprisingly uncommon for providers to do — I can’t know someone needs help unless they tell me. (Much to people’s dismays, including men on dating apps, I am not actually a psychic.)

This vulnerability is not wasted, as your psychiatrist can often do something to help. There is tremendous variability in sexual side effects of medications, which means just because you get them on one medication, doesn’t mean you will on another. While it is important to weigh the risks and benefits of being on your medication, the role of your sex life should not be brushed off or minimized. Intimate relationships are key to many of our overall well-being. What good is an antidepressant that works if you also have no arousal during sex, or desire for sex, or can never orgasm again? Life is long — the pleasurable things matter, too.

After a few months and multiple medication attempts, Sophia finally found the right combination. We were both excited and relieved to have finally figured it out and I was happy she trusted me enough to do it. It is possible to have it all — no depression and no sexual dysfunction.

Just as we were preparing to leave our visit and we say our goodbyes, she, finally looking more comfortable talking about sex with me, said, “You know, even though you told me differently, I always thought it was always going to be this way. That it was all my fault. That this was just me.”

I replied, “Sometimes it is not you, it is because of me.”

I laughed, and so did she, but really, I meant it — it’s my job to help make things better, including sex, especially if the medications I prescribed are the reason they are bad in the first place.

No one should be struggling in silence — and caring about your own sex life is never selfish.

*Names have been changed to protect patients’ privacy.

Jessi Gold, M.D., M.S., is an assistant professor in the department of psychiatry at Washington University in St. Louis.

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What West Point Graduates Can Teach Us About Stress and Resilience https://www.perspectivesoftroy.com/2022/01/18/what-west-point-graduates-can-teach-us-about-stress-and-resilience/ Tue, 18 Jan 2022 17:01:22 +0000 https://www.perspectivesoftroy.com/?p=11118 The post What West Point Graduates Can Teach Us About Stress and Resilience appeared first on Perspectives Counseling.

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In May 2020, during the first wave of the COVID-19 pandemic, Dr. Melissa Thomas graduated Yale School of Medicine and immediately started work in the Emergency Department of Yale New Haven Hospital. She quickly noticed similarities between her new job and her two deployments to Iraq as a U.S. Army Medical Service Corps officer.

“Relying on teamwork, having strong bonds with people going through these experiences with you at the same time — that’s very similar,” Thomas said. “It’s why I was drawn to emergency medicine.”

But high stress can also have negative consequences for mental health, even among highly trained and experienced health care providers. To explore how to promote psychological resilience and prevent negative health outcomes among such individuals, Dr. Thomas investigated the long-term physical and mental health risks and resilience of her fellow graduates from the U.S. Military Academy at West Point. It was the first study to focus on graduates and consider gender differences in these topic areas since the elite institution’s integration of women in 1980. It earned Dr. Thomas the William U. Gardner Prize for the most outstanding thesis in her graduating class.

By focusing on successful resilience we can learn a lot about how to build prevention strategies.

Now published in the peer-reviewed journal Chronic Stress, the study surveyed 1,342 graduates from the classes of 1980-2011 to collect sociodemographic information and data on self-reported physical and mental health behaviors and conditions as well as details of their military service. Women’s Health Research at Yale Director Carolyn M. Mazure, PhD, and Dr. Robert Pietrzak, director of the Translational Psychiatric Epidemiology Laboratory in the Clinical Neurosciences Division of the U.S. Department of Veterans Affairs National Center for Post-traumatic Stress Disorder, served as Dr. Thomas’ mentors on her medical school thesis and published the Chronic Stress paper with her. Other authors include Dr. Steven Southwick at Yale, Dr. Dana Nguyen of the Uniformed Services University, and Dr. Diane Ryan of Tufts University.

After applying statistical models developed by Dr. Pietrzak, Dr. Thomas found that increased psychological resilience in the graduates was associated with a higher sense of purpose in life, social connectedness, and grit, which is defined as “perseverance and passion for pursuing long-term goals.”

“A lot of research on stress and trauma focuses on negative outcomes,” Thomas said. “But by focusing on successful resilience we can learn a lot about how to build prevention strategies.”

Notably, greater time in military service correlated with higher resilience for women but had little correlation for men. The authors suggest this apparent difference in resilience for women remaining in the service might be due to the relative reduction in resilience for those goal-oriented women trained at West Point who leave the service. This latter group may leave paid work in the process of raising a family or pursue a non-military career, and in so doing feel a reduction in their purpose in life or find difficulty adapting to male-dominated fields without the structure and stability of military formalities.

“There are many ways that people can build their mental health and prevent negative health outcomes,” Thomas said. “With this new research, can see the importance of enhancing purpose in life, social connectedness, and even grit to improve the capacity for resilience in the face of stress or trauma.”

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Long-term outcomes of a course of deep TMS for treatment-resistant OCD https://www.perspectivesoftroy.com/2022/01/07/long-term-outcomes-of-a-course-of-deep-tms-for-treatment-resistant-ocd/ https://www.perspectivesoftroy.com/2022/01/07/long-term-outcomes-of-a-course-of-deep-tms-for-treatment-resistant-ocd/#respond Fri, 07 Jan 2022 16:33:35 +0000 https://www.perspectivesoftroy.com/?p=11091 After a multicenter randomized sham-controlled trial of Deep TMS™ therapy for obsessive-compulsive disorder (OCD) demonstrated a 38% response rate that is sustained for at least four weeks the FDA granted a de novo clearance for the H7 Coil. In real-world clinical practice settings 52.4% of patients achieved at least one month sustained response. There have […]

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After a multicenter randomized sham-controlled trial of Deep TMS™ therapy for obsessive-compulsive disorder (OCD) demonstrated a 38% response rate that is sustained for at least four weeks the FDA granted a de novo clearance for the H7 Coil. In real-world clinical practice settings 52.4% of patients achieved at least one month sustained response.

There have been limited studies on the durability of pharmacotherapy for OCD and the few publications on the subject report no durability, requiring maintenance. With regards to cognitive behavioral therapy (CBT), there are mixed results. A recent large meta-analysis of twenty-four randomized controlled trials demonstrated no durability. Another study found durability after one year. Yet another study demonstrated durability for a year for patients who reached remission (Y-BOCS score≤12), while patients with higher post-treatment Y-BOCS (Yale-Brown Obsessive-Compulsive Scale) scores had a high likelihood of decompensating. In adolescent OCD durability of up to 3 years has been reported for CBT . No durability is reported for DBS since turning off the stimulator results in immediate symptom worsening.

To shed some light on the potential durability of Deep TMS treatment for OCD, clinical sites that participated in the OCD multicenter trial, as well as those that contributed the post-marketing data, were contacted (n = 16). All sites were provided with a list of their patients who met response criteria at their last Y-BOCS evaluation following the Deep TMS treatment course (overall N = 108) and were compensated for contacting these patients and reporting whether each of them had, since the end of their treatment, any medication change/CBT/hospitalization/Deep TMS re-treatment. If so, on what date did the change in treatment occur and was it due to an exacerbation of the patient’s OCD or due to a desire for greater improvement. Sites were also requested to inquire about functional disability, days lost and days unproductive per week. The patient populations were previously described, and the study was approved by Sterling Institutional Review Board.

The potential durability of response to Deep TMS was defined as the elapsed time from the end of the Deep TMS treatment course until a change in treatment occurred. Demographic data on the participating patients had already been recorded prior to their Deep TMS treatment course and included the following information: OCD symptom severity (Y-BOCS), functional impairment (Sheehan Disability Scale, SDS), comorbidities, age, gender, age of OCD onset, family history of OCD, number of life-time failed medications, and concomitant SRI medications. Symptom severity (Y-BOCS) had also been recorded at the end of each patient’s Deep TMS treatment course as well as the number of Deep TMS sessions they received. This data allowed, beyond reporting on the average ‘durability’ of Deep TMS treatment for OCD, an analysis of predictors and moderators of the Deep TMS response ‘durability’.

The analysis set included 60 patients from 7 centers for whom there was ‘durability’ data. Of those, only 8 patients (13.3%) had ‘durability’ of <1 year, while 52 patients (86.7%) had ‘durability’ of ≥1 year. Half of the patients who had at least 1-year ‘durability’ (n = 26), who represent 43.3% of the analysis set, had ‘durability’ of ≥2 years (Fig. 1B). The average ‘durability’ of Deep TMS for OCD was ≥1.98(±0.13) years. Importantly, 37/60 (62%) patients were still considered to have Deep TMS ‘durability’ at the time of the survey (see Fig. 1A for a narrative breakdown of the data). None of the demographic or treatment information was found to be predictive of ‘durability’ length.

Fig. 1‘Durability’ of Response and Functional Disability following Deep TMS™ for Treatment-Resistant OCD. (A) CONSORT flow diagram presenting a narrative breakdown of the available data. (B) Kaplan-Meier survival curve of cumulative ‘durability’ of response to Deep TMS for OCD, where ‘durability’ is defined as time since Deep TMS without change in treatment for patients who met response criteria at their last Y-BOCS evaluation after the Deep TMS course. (C) Functional disability presented as days lost (grey bars) and days unproductive (blue bars) per week pre and post Deep TMS (left and right, respectively). Asterisks denote statistical significance: ∗-p<0.001, ∗∗-p<5−9. (D) Scatter plot presenting correlation across patients between change from baseline in functional disability (weekly unproductive days) and in symptom severity (Y-BOCS score) following Deep TMS. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Almost half of the analysis set (n = 28) had functional disability data (SDS) as well. A significant reduction in disability was reported by patients following Deep TMS treatment. While prior to Deep TMS the self-reported unproductive days per week was on average 5.5(±0.4), post treatment it was only 1.8(±0.4) – an average reduction of 3.8(±0.4; p < 5−9). The decrease in lost days per week was also statistically significant, with reports of an average of 1.9(±0.6) prior to Deep TMS vs. 0.3(±0.2) post treatment – an average reduction of 1.8(±0.5; p < 0.001) (Fig. 1C). A significant correlation was found between the improvement in symptom severity (i.e., reduction in Y-BOCS from baseline) to the functional improvement (i.e., reduction in weekly unproductive days) following Deep TMS treatment (r = 0.45, p = 0.018) (Fig. 1D).
It has been previously demonstrated that Deep TMS therapy is an effective treatment for OCD patients who have failed multiple medications, alluding to a different mechanism of action. The ‘durability’ results demonstrated here reaffirm that the mechanism of Deep TMS treatment in OCD is different from that of medications that necessitate chronic use. The mechanism of Deep TMS is likely based on direct modulation of the cortical-striatal-thalamic-cortical circuitry, specifically through up-regulation of the Anterior Cingulate Cortex (ACC). A recent 1H-MRS study found significant increases in levels of NAA, Choline and Creatine in the ACC following Deep TMS in OCD patients, indicating direct neural stimulation of this region. A recent modelling study found that Deep TMS induces significant electric field in various deep structures including the ACC.

As with any registry-based study, the primary limitations to ours are incomplete data due to a lack of follow up or continued care with the Deep TMS provider after the treatment course. Many patients only went to the Deep TMS center for the treatment and not their ongoing psychiatric care, which limited the analysis set to 60/108 responders and 7/16 centers. Furthermore, as the Y-BOCS is not used in routine clinical practice, this resulted in a ‘durability’ definition as elapsed time from the last Deep TMS session until any change in treatment was necessary. Ideally, this would be corroborated by Y-BOCS scores, a more standardized metric administered every few months. Confirmatory and mechanistic studies investigating the response ‘durability’ of Deep TMS therapy for OCD with standardized measures are warranted.

Funding

BrainsWay Ltd.

Declaration of competing interest

Tal Harmelech is a BrainsWay employee. Aron Tendler is the Chief Medical Officer of BrainsWay and has a financial interest in BrainsWay as well as a commercial clinical and research TMS center. He has received speaking fees from BrainsWay, Neuronetics and the Clinical TMS Society. Yiftach Roth is a key inventor of the Deep TMS technology, Chief Scientist at BrainsWay and has a financial interest in BrainsWay.

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Children and Exposure to Terror: The 3 Cs of Coping https://www.perspectivesoftroy.com/2021/12/06/children-and-exposure-to-terror-the-3-cs-of-coping/ Mon, 06 Dec 2021 16:46:19 +0000 https://www.perspectivesoftroy.com/?p=10500 The post Children and Exposure to Terror: The 3 Cs of Coping appeared first on Perspectives Counseling.

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This blog was jointly written by “The Older Dad,” Dr. Kevin D. Arnold, and by Ms. Theresa Gaser, MSSA, LISW-S of Trinity Family Counseling, Westerville, Ohio

Children and Exposure to Terror: The 3 Cs of CopingAccording to the VA, children who are exposed to higher amounts of TV coverage of a disaster develop more stressful reactions. Terrorism and disasters can easily alter children’s lives like the ripples of waves in a pond impact on the shore.  Given that, what might we expect after children experience traumatic events by watching TV coverage or hearing about them as adults discuss those events?

General Impact of Observing Trauma

Any child old enough to laugh is old enough to experience the effects of trauma.  Children do not need to be a direct witness of the trauma to feel terror.  They can hear about a shooting and worry that it will happen to them or others they care about.  A child can feel excited to see one parent and terrified that they will never see the other parent again once they drive away. Children do not have to understand what is happening in order for trauma to occur.

Developmental Implications

Younger children (about 6 to 12 years) process information using more concrete ways of thinking than do older, teenage children.  For example, before about age 8, children are often mislead by the height of water in a glass as an indication of the amount of water in a glass (higher = more).  Understanding this concrete thinking can help explain some subtle symptoms of distress in children who have watched several hours of TV coverage of the Las Vegas shooting.

Experiencing Fear by Watching

Children easily react to watching violence with the same type of anxiety we might otherwise expect from being the victim of that violence. We all normally react with anxiety watching others be harmed, and children are no different. However, adults can abstractly reason about the probabilities of mass shootings occurring in their hometown; but children will gravitate to the physical features of the situation in which the shooting occurs. They will use the concrete reasoning of the “where” and “what” and build ideas about risk based on those real-life features. In other words, they may easily think that if we go to a concert in an open area we will get shot.

Hypervigilance in Childhood

Children can easily develop increased cautiousness when around large crowds after watching mass shooting TV coverage.  When children see crowds of people screaming, it automatically makes children fearful.  It’s a natural trigger leading children to scan situations to identify threats to their safety.  We can watch children to see  if their “radar” is turned up a bit too much, especially if they scan, and overreact, to situations that remind them of a recent terror event reported in the media.

Phobic Reactions to Similar Situations

Learned fear responses generalize past the specific situations in which they are occur, and often emerge in  similar, but the same settings.  For example, in the case of the Las Vegas mass shooting, children easily may show signs of phobic fear and desperate avoidance when in crowded open spaces or near tall buildings.  We can be mindful of children acting fearful in malls, open-air markets, or  downtown metropolitan areas.

When Should I Be Concerned

When a child has been exposed to a horrific events, whether it be in person, through media outlets, or by hearing others talk about it, they may develop secondary stress.   Children show signs of secondary stress through increased difficulty in completing school work, problems concentration, or unusual forgetfulness. They can appear anxious or agitated, and may appear more “clingy” than normal.  Children will sometimes refuse to go anywhere that reminds them of what they saw or heard about that reminds them of the tragedy.  These can all be signs of their efforts to cope with fear, even if their behaviors don’t seem sensible to us grown-ups.

The 3 Cs: What to Do when Children Show Signs of Secondary Stress

There are several useful strategies to use when we see our children reacting with secondary stress.  We can think of these as the 3 Cs:  Comfort, Conversation, and Commitment.

Comfort

Provide comfort for children through shared meals, planned family time, laughter and engaging in activities that are relaxing and pleasant. We can rely on children’s resilience by remembering that most children will resolve their anxiety within a few months if they do not become re-exposed to the trauma.  We show them the safety of our own self-assurance by not over-reacting to their fears. Instead, we can model how to remain calm by talking about feelings through creating a parent-child dialog. It is important for our children to know we are there for them, and that they are not alone.

Conversation

When we start those dialogs, we create a venue for validation and empathy.  We turn away from avoiding fear by leaning into a conversation, offering realistic reassurance by expressing our understanding of their fears.  Often, asking thoughtful questions and listening carefully to the things children say to us is great medicine all on its own.  We all benefit by having our emotions heard and embraced, even when our ideas (“There might be a bad person up/out there!”) don’t ring true.

When children react with fear can become a great opportunity to teach emotional intelligence skills: a) label their emotions to help them think them through; b) empathize with gentle words about times we’ve been afraid;  and c) model problem solving by focusing on the safety of current circumstances. By using the conversation, we help them manage (rather than avoid) their fears.  We can help children learn that fear is not a scary feeling.

Commitment

Of course we all experience trauma when a man shoots people from hotel window.  But after a week, many of us, including our children, may still experience fear. Ways to help children cope  include showing them the horrific event has ended: creating the framework of “that was then, but this is now.”  When we make a commitment to be a good example of how people cope with fears, our children learn from that example.  Often children confuse what they saw or heard (a past event) with the here-and-now.  We can help them tell a story about what happened (“What scared you the most when it happened?”) and then move the story into the present (“What is scary now?”).  When we tell the present story, we can highlight the concrete features of their world that make it a safe place. In our conversation, we can ask questions to encourage children to tell you what makes them feel safe. Our commitment to coping (rather than avoiding) teaches them to how to change the fear narrative (“I am not safe”) to a coping with fear narrative (“I can do things to help me feel safe” or “I can do these things to help me when I do not feel safe.”).

The End of the Story

Helping children during difficult times can be hard because we must both manage our own feelings and focus on theirs simultaneously. To help us be successful in helping children, we can rely on the capacity of children to “bounce back.” Resilience in childhood exists as an ongoing resource for coping. It is important to keep in mind that “Children have the resilience to outlive their suffering if given a chance.” Ishmael Beah

Resources

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