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ALCOHOLISM TREATMENT TECHNIQUES AND APPROACHES: RECOVERY AND THE FAMILY

admin — Fri, 13 May 2011 11:05:58 +0000

A common mistake when working with an alcoholic family is to assume that once the drinking stops things will get better. Yet when the alcoholic stops drinking the family again faces a crisis and time of transition. Such crises can lead to growth and positive changes, but not automatically or inevitably. In the alcoholic family there has been a long period of storing up anger, of mistrust and miscommunication. This may have been the children’s only experience of family life. At times children who previously were well behaved may begin acting out when a parent becomes sober. Children may feel that earlier their father loved alcohol more than them, and that now he loves AA more. He may have stopped drinking, but in the children’s eyes they’re still in second place.

Recovering families have a number of tasks to accomplish before they return to healthy functioning. They must strengthen generational boundaries. They must reassume age- and sex-appropriate roles in the family. They must learn to communicate in direct and honest ways with one another. They must learn to trust one another. And finally they must learn to express both anger and love appropriately.

It might be expected, if one considers the family as a unit, that there are stages or patterns of a family’s recovery from alcoholism. This has not yet been adequately studied. No one has developed a “valley chart” that plots family disintegration and recovery. Counselors who have had considerable involvement with families of recovering alcoholics have noticed and are now beginning to discuss some common themes of the family’s recovery.

One observation suggests that the family unit may experience growth pains that parallel those facing the alcoholic. It has long been a part of the folk wisdom that the alcoholic’s psychological and emotional growth ceases when the heavy drinking begins. So when sobriety comes, the alcoholic is going to have to face some growing-up issues that the drinking prevented him from attending to. In the family system, what may be the equivalent of this Rip Van Winkle experience? Consider an example of a family in which the father is an alcoholic, whose heavy drinking occurred during his children’s adolescence, and who begins recovery just as the children are entering adulthood. If he was basically “out of it” during their teenage years, they grew up as best they could, without very much fathering from him. When he “comes to,” they are no longer children but adults. In effect, he was deprived of an important chunk of family life. There may be regrets. There may be unrealistic expectations on the father’s part about his present relationship with his children. There may be inappropriate attempts by him to “make it up,” regain the missing part. Depending on the situation, the counselor may need to help him grieve. There may be the need to help him recognize that his expectations are not in keeping with his children’s adult status. He may be able to find other outlets to experience a parenting role or reestablish and enjoy appropriate contacts with his children.

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HOW TO SUCCESSFULLY TREAT BDD WITH MEDICATION: WHAT GETS BETTER WITH AN SRI? AVOIDANCE AND BDD-RELATED BEHAVIORS

admin — Thu, 17 Mar 2011 09:12:21 +0000

Avoidance

Avoidance usually lessens. It’s easier to do things, go places, and be around others. People become more active—their life becomes more colorful and interesting. Spending less time obsessing or checking the mirror frees you to do other things. It’s also easier to do things and be around others when the thoughts and compulsions are less painful and powerful. In addition, self-consciousness and fear around other people may diminish, making it easier to socialize.

BDD-related behaviors

BDD behaviors usually improve. Less time is spent checking mirrors, skin picking, hair cutting, reassurance seeking, and performing other BDD behaviors. They’re easier to resist and control, and the anxiety caused by doing them, or not doing them, diminishes. “The main thing Prozac did for me was help me stay out of the mirror,” one person told me. “I go into the bathroom, and my heart races, but I have the fortitude not to look. It’s a very important change. The mirror no longer controls me.”

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HOW TO SUCCESSFULLY TREAT BDD WITH MEDICATION: WHAT GETS BETTER WITH AN SRI? AVOIDANCE AND BDD-RELATED BEHAVIORS Avoidance Avoidance usually lessens. It’s easier to do things, go places, and be around others. People become more active—their life becomes more colorful and interesting. Spending less time obsessing or checking the mirror frees you to do other things. It’s also easier to do things and be around others when the thoughts and compulsions are less painful and powerful. In addition, self-consciousness and fear around other people may diminish, making it easier to socialize.BDD-related behaviors BDD behaviors usually improve. Less time is spent checking mirrors, skin picking, hair cutting, reassurance seeking, and performing other BDD behaviors. They’re easier to resist and control, and the anxiety caused by doing them, or not doing them, diminishes. “The main thing Prozac did for me was help me stay out of the mirror,” one person told me. “I go into the bathroom, and my heart races, but I have the fortitude not to look. It’s a very important change. The mirror no longer controls me.”*249\204\8*

THE DIAGNOSIS OF SLEEPWALKING IS NOT TERRIBLY DIFFICULT

admin — Mon, 20 Dec 2010 14:53:07 +0000

Obviously, a diagnosis of sleepwalking is not terribly difficult, although it usually depends on anecdotal evidence from concerned parents or relatives. In assessing your condition, I will try to determine the age at which your problem began and whether there may have been some kind of stressful event at about the same time. Other questions will focus on how often you walk and for how long, and whether any daytime behavior patterns exist that may provide further clues. Basically my goal is simply to eliminate the possible presence of other types of disorders— those caused by fever, for example, or such extreme and rare psychiatric problems as amnesia, multiple personalities, or fugue states in which victims temporarily take up entirely new lives. I may order neurological tests to rule out a diagnosis of epilepsy; psychological evaluation may also help uncover a reason for the behavior.

Often victims of sleepwalking are also prey to episodes of night terrors, a disorder characterized by extreme panic and the physical reactions that accompany it, such as increased heartbeat or sweating. In fact, it is thought that sleepwalking is a milder form of the same pathophysiology that generates night terrors. Night terrors tend to occur during the same stage of sleep as somnambulism, usually during the first hours after retiring.

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THE DIAGNOSIS OF SLEEPWALKING IS NOT TERRIBLY DIFFICULT Obviously, a diagnosis of sleepwalking is not terribly difficult, although it usually depends on anecdotal evidence from concerned parents or relatives. In assessing your condition, I will try to determine the age at which your problem began and whether there may have been some kind of stressful event at about the same time. Other questions will focus on how often you walk and for how long, and whether any daytime behavior patterns exist that may provide further clues. Basically my goal is simply to eliminate the possible presence of other types of disorders— those caused by fever, for example, or such extreme and rare psychiatric problems as amnesia, multiple personalities, or fugue states in which victims temporarily take up entirely new lives. I may order neurological tests to rule out a diagnosis of epilepsy; psychological evaluation may also help uncover a reason for the behavior.Often victims of sleepwalking are also prey to episodes of night terrors, a disorder characterized by extreme panic and the physical reactions that accompany it, such as increased heartbeat or sweating. In fact, it is thought that sleepwalking is a milder form of the same pathophysiology that generates night terrors. Night terrors tend to occur during the same stage of sleep as somnambulism, usually during the first hours after retiring.*178\226\8*

ST JOHN’S WORT IN EVERYDAY LIFE

admin — Sat, 05 Dec 2009 12:30:54 +0000

Experience with St John’s Wort based on people entering research protocols and seeking help from psychiatrists tells us only about the way the herbal remedy is being used and is working for relatively severe clinical problems. But the large majority of people who have turned to the herb would probably not fit into research protocols nor see fit to consult a psychiatrist. How is St John’s Wort being used by the general public, and how is it working for the problems of everyday life? Those are questions that I wanted to answer and realized that in order to do so, I needed to survey the public directly. I did so by means of a questionnaire, distributed in health food shops and pharmacies both in the United States and in Germany, and posted on certain Internet newsgroups. The stories detailed in this chapter are derived largely from responses to this questionnaire, some of which I followed up with telephone interviews.

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ÑHILDREN’S SLEEP PROBLEMS/BUILDING THE BASICS: SLEEP NEEDS AND PATTERNS

admin — Sat, 05 Dec 2009 12:30:45 +0000

The purpose of looking at norms is not to say that all children have the same needs and can be neatly categorized. Because you are reading this book, it is safe to assume that your child does not fit the pattern outlined. It is also safe to say that you are not pleased and you sense something is going wrong. The purpose of this section is not to make you feel worse about yourself or your child.

Norms are very useful to pinpoint problem areas—to help you establish where you are now. Using the norms, you can begin to look at your situation realistically. You will have something to compare your experience to besides, “When you were a child…” and “None of my children….”

Norms are also useful in setting realistic goals. When the problem is solved you will have clear comparisons for determining how far you have come. Read this section with these thoughts in mind.

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SWITCHING FROM A CONVENTIONAL ANTI-DEPRESSANT TO ST JOHN’S WORT

admin — Sat, 05 Dec 2009 12:28:18 +0000

Considering the buzz surrounding the new herbal anti-depressant, it is likely that many people will choose to try and switch from the conventional anti-depressant they are already taking to the herbal remedy. Let me repeat a few suggested guidelines if you should choose to do so. I would recommend first that you involve your doctor in the process (someone must be prescribing the antidepressant, after all); second, that you switch gradually, overlapping the two medications in the transition phase; third, that you monitor your progress carefully to ensure that you do not suffer a relapse; and finally, that you be open-minded about returning to your previous treatment sooner rather than later if the exchange does not appear to be working out. The following story of one of my former patients illustrates a successful transition from a conventional to an herbal anti-depressant.

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ÑHILDREN’S SLEEP PROBLEMS/BUILDING THE BASICS: N PRACTICAL TERMS

admin — Sat, 05 Dec 2009 12:28:13 +0000

As we’ve seen, sleeping through the night is not as simple or common as we might assume.

? Arousals during the night are normal and need not cause problems.

? Sleep problems can arise when a child cannot put himself back to sleep after the arousals.

? It may be harder for children to sleep undisturbed because a child goes more rapidly through the sleep cycles than an adult; there are more periods of arousals and therefore more chances to awaken.

? Deep sleep occurs early in the night and again for a short while near morning. Sleep terrors are likely to happen at this time.

? Light sleep and dreaming occur in the remainder of the night. Nightmares (vs. sleep terrors) happen during that time.

? You can determine your child’s sleep state by her sleep behavior and by what time she went to sleep.

? This information will help you assess the nature of the sleep disturbance and what your response will be.

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POWER OVER PANIC/IN SEARCH OF SELF: JANE’S STORY

admin — Sat, 05 Dec 2009 12:27:45 +0000

It was one of those beautiful autumn evenings. The light from the setting sun filtered through the trees and their leaves blazed with colour. Jane wondered how many other people were looking at this natural masterpiece as they hurried home after the day’s work. Jane knew that she had never taken much notice before. Now was different. Once or twice a day she would be struck by the beauty of her surroundings. A moment here, a moment there. But those moments were precious in their spontaneity. They added to the peace she felt within herself. She was amazed at the last few years of her life. It had not always been like this. The years of panic disorder/agoraphobia had appeared to take everything from her. They were desolate years. The fight back was long and hard but she knew now it had been worth it. Everything that had been taken away from her had been given back a thousand-fold. She was at peace with herself and she was free.

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POWER OVER PANIC/IN SEARCH OF SELF: PETER’S STORY

admin — Sat, 05 Dec 2009 12:27:41 +0000

Peter was exhilarated. It was early morning and he had reached halfway in a 10 km bike ride along the coast road. He wished he had brought his camera. Peter had loved photography ever since he was a child. He had always wanted to be a photographer, and now he was one. He thought of his parents. They had both worked long and hard to pay for his university fees, and they were proud of him when he received his PhD and entered the world of academia. Panic disorder/ agoraphobia had changed all that. As Peter progressed towards recovery he realised that academic life was not for him. He struggled silently with the realisation for three years because he didn’t want to let his parents down. He even studied for another degree, hoping to combat his disquiet. It didn’t work, and he made the break to follow his dream of being a photographer. He knew he was taking a risk, but he also knew it was worth it. He was free.

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ANXIETY DISORDERS/WORKING THROUGH THE RECOVERY: RELEARNING

admin — Sat, 05 Dec 2009 12:27:35 +0000

The working-through process also involves reiearning what it is like to be ‘normal’. We lose sight of what it is like to be ‘normal’, and it is not unusual for people to interpret ‘normalcy’ as a setback! It isn’t, we just have to relearn.

This means reiearning to have a ‘normal’ bad day without reacting with fear that ‘it is all coming back’. Returning to ‘normal’ means we will have bad days, just like everyone else.

We will probably have days when we feel unwell. It doesn’t mean a return of the disorder—it means we are feeling unwell. We need to make sure we are eating properly and getting enough sleep. If not, we will feel tired and irritable just like everyone does when they neglect themselves.

Recovery is worth every step. At times the working-through process is difficult. Don’t lose sight of the overall picture which can be changed from one of fear and anxiety to one of clarity and freedom.

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