Posts Tagged ‘Clinicians’

Being a More Mindful Clinician: Getting Back to Basics

Thursday, December 6th, 2012

In case you haven’t noticed, there are an awful lot of psychotherapy modalities out there! And many trainers are adamant that their treatment paradigms are the best, or the only ones that you need to use in your work with clients. As a result, many clinicians are understandably anxious about which ones to learn and incorporate into their practices. Even seasoned practitioners can feel pressured to learn “the latest” way of doing therapy. Although I am firm in my belief that we always need to continue growing professionally, and that our clients will benefit from our willingness to stay open to new and creative ways of helping them in their healing journeys, sometimes a willingness to return to the basics can be the most effective way to work.

As I continue to use the precepts of mindfulness, I realize how elegant it is in its simplicity. The idea of staying in the present moment is almost counter-intuitive to the eager clinician who is constantly looking for an “opening” to weigh in, offer words of wisdom, challenge a cognitive distortion, or move a client past a painful experience. Certainly, our clients don’t like living in the “present moment!” Yet, I recently re-visited a video showing the work of the amazing Carl Rogers, and his paradigm, “client-centered therapy,” and was so struck by how “in the moment” he was with his client. There was nothing fancy about his work, he just stayed steadfastly “present,” and simultaneously non-judgmental and available. The “unconditional positive regard” that he was famous for allowed the client to really be with her thoughts and feelings. And as a result, she began moving to places of insight, self-awareness, self-acceptance and compassion. A process that is synonymous with what is now called “mindful awareness.”

Given what we now know about the brain, the mind-body connection, and the power of expressive therapies, there certainly is a real place for new paradigms in our professional studies. However, let’s not forget the basics, including genuinely and authentically being in the present moment with our clients, wherever they are in their process. Remember the power of attunement, a non-judgmental relationship, and the ability to do reflective listening, as well as the healing benefits of just holding “safe space” with and for a client. The longer I do this work, the more I realize that no one is re-inventing the wheel. The things that work best are probably the things that have always worked best, and the core concepts of mindfulness give us another opportunity to re-visit them and integrate them in our practices.

How do you practice ‘mindfulness’ with your clients?

Tips for Clinicians: Helping your Eating Disordered Client Survive the Holidays

Wednesday, December 5th, 2012

by Sharon R. Peterson, LCSW-C
Founding Director of: Eating Disorder Network of Maryland

The holidays are not relaxing and fun for everyone, especially those with an eating disorder (E/D). They may dread the day when the table is completely filled and over-flowing with deliciously home cooked or catered food along with the sounds of relatives and loved ones laughing and enjoying themselves. They are already obsessing about numbers, calories, fat grams or how they will appear in an outfit. They are already trying to figure out how to cheat and sneak off to the bathroom without being noticed or convince a loved one that they have indeed finished all the food on their plate.

Feeling guilty comes naturally to someone with an E/D. Most of your clients with an E/D also have problems with anxiety, depression, and OCD. They may be struggling or over-worry about seeing a relative that they don’t like or have a conflict with. Where do their thoughts go? They go directly to the one coping skill that they feel has “saved them” or helped them get through a sticky situation in the past. They head straight to “acting on” E/D symptoms. Manipulating food in one way or another has become a security blanket. Eating or restricting caloric intake will temporarily take their brain off whatever they are REALLY worried about or it will give them a false sense of control.

Here are some tips you can use to help your clients:

Bulimia & Binge Eating Disorder:

Use a smaller plate when going to get appetizers.
S-L-O-W down when eating. Put your fork down and chat with the people around you. This will allow your stomach to catch-up to your brain and alert you when you are getting too full.
Remember to be mindful of the holiday. It is NOT a holiday to “just eat.”
Make sure you eat regularly throughout the day so you don’t go to the table famished or too hungry.
Have a “buddy” that you can check in with during the meal.

Anorexia:

Follow the meal plan your treatment team gave you.
Use a “buddy” to talk to if you start struggling or panicking
Downplay the “feast” type image in your head. This is just a regular meal like the rest of them. Don’t make this one any different. You can NOT gain lots of weight in one day. It isn’t possible.
Allow yourself to try some new foods that you haven’t tried before. Make your plate colorful by adding foods with different textures, shapes, and colors. Even if you can only try one new food it is a step in the right direction.

Helpful links:

Eating Disorder Network of Maryland (EDN Maryland)
National Eating Disorders Association (NEDA)
Anorexia Nervosa & Associated Disorders (ANAD)

Do you work with E/D clients? Please share any tips or advice that you have for this group of people as a comment to this article.

The Impact of Sandusky on Clinicians and Clients

Wednesday, December 21st, 2011

I can only imagine how the Sandusky scandal has impacted your practices. For my clients it has been profoundly triggering. The ongoing reality that children continue to be betrayed and violated while adults look away- minimizing, rationalizing, and denying the unimaginable horrors that someone with power can inflict on innocent lives –has opened healed wounds and caused new ones. My clients get angry all over again, and re-connect with the grief, despair, and helplessness they experienced in childhood. For them, the onslaught of new disclosures and the tepid empathy shown towards the victims reinforces the relentlessness of their own experiences, and the lack of protection and compassion they felt from others whenever they did find the courage to come forward with their trauma narratives.

As clinicians we have a difficult task ahead of us. It is unclear how this story will play out in the media and the courtroom. How vocal and articulate will Sandusky’s supporters be? How much “blaming the victim” will be woven into the story? Will his attorneys attempt to distort the truth, downplaying the seriousness of his offenses or the long-term adverse effects on his victims? Will Sandusky take any responsibility for his actions or be held sufficiently accountable in a court of law? And what will be the short and long-term effects on our clients?

As is often the case, I find myself confronted with the reality that there are many things that happen in this world that are not within our control. And there are some things that are- including the meaning we choose to attach to events, the extent to which we learn and grow from them, and what we do with them once they have occurred.

I encourage my colleagues to use this very difficult event as an opportunity to continue educating both clients and the community at large about the dynamics of abuse and victimization. Focus on the innocence of children and the need to proactively protect them from predators. Let it be known that “looking the other way” makes you an accessory, and is an unacceptable and unconscionable response. Challenge the media when they use the word “relationship” to describe “rape.” Empower survivors of sexual abuse to find the courage to share their experiences, ending generational cycles of secrecy and denial. Educate anyone who downplays the severity of what was done to these children. Keep the discussion alive- it not only validates experiences, it gives survivors a voice and communicates to them that we care, deeply, about their pain and believe, deeply, in their capacity to transcend it and heal.

Taking the time for Self-Care

Wednesday, July 13th, 2011

As the summer approaches, it’s a great time to make time for yourself. We are so focused on helping others that we often neglect our own needs. I am thoroughly convinced that our efficacy as professionals is contingent upon the extent to which we take care of ourselves personally. This mindset doesn’t always get the level of support that it should: agencies and mental health organizations seem unduly focused on pushing the limits of workers’ productivity and the equivalent of “billable hours.” Clinicians are obligated to account for every minute of their day, with the expectation that the focus is always on clients. I have heard from more and more colleagues who are feeling overwhelmed and under-appreciated at work, and who are not encouraged to take the time they need to re-group and re-ground after difficult client sessions.

Despite the fact that there may be little external support for increased self-care, I urge my colleagues to find small ways, throughout the workday, to re-energize and attend to legitimate personal needs that often get pushed to the side. Whenever I give workshops on self-care, I ask to see a show of hands for the following questions: “How many of you skip a meal during the day because you are busy tending to your clients?” “How many of you ignore a headache, rather than stopping to take Advil, because you are too busy at work?” “How many of you put off going to the bathroom because you are tied up with client’s issues”? Although the questions get a laugh, every hand is raised!

If we don’t give ourselves permission to take a break, eat lunch, close our office door and just breath for a minute, it won’t happen. A whole third of my upcoming book, “Treating Self-Destructive Behaviors in Traumatized Clients: A Clinician’s Guide,” is dedicated to clinician self-care. Given the complexities of treating addictions, eating disorders and self-mutilation, it is imperative that we focus on ourselves in order to stay effective in our work. Here are some simple things to try throughout the day:

Download a favorite soothing picture onto your computer’s screen saver and your cell phone, or have a postcard-sized copy of it on your desk. In between each client, stop and look at it, allowing yourself to smile and take in all of the sensory memories of the image.
Aromatherapy is a great way to re-ground throughout the day. You can use scented hand lotion or soap,; an unlit votif candle ; the fragrance of a favorite teabag; a scarf or scrap of fabric that has your significant other’s cologne or perfume on it.
Close your office door (or hide out in the bathroom if you have to!) and allow yourself to just breath deeply five times. Put your hand on your belly or chest so you connect with your body- feeling each inhalation and exhalation. Pair the breath with words of comfort.

Here’s a great recommendation for an easy summer reading book, “The Resilient Clinician,” by Robert Wicks. It offers many wonderful ideas for clinician self-care, and emphasizes the absolute importance of making the time to attend to our own needs. Remember: take care of YOU!