Author: Jeff Dwarshuis

Five tips for strengthening your marriage WHILE raising teens

By Jeff Dwarshuis LMSW ACSW

1. Align in discipline and decisions – Outside of inappropriate methods of discipline, the choice of discipline is much less important than the spouses’ staying aligned. Even if you disagree, present a united front verbally and physically. Discuss differences in private.

2. Hold off on directives and exercise negotiation – Adolescents need to increasingly make decisions independently. Parents can talk alone to discuss the parameters of teen decisions then assist the teen in making decisions by asking questions. This facilities parental influence and decreases opposition.

3. Tell Your Story – Does your teen “act out” the same way you did? Are you divorced or recovering from substance abuse? Tell your story of change first to your spouse and then to the teen in an appropriate way they can understand. The teen is most likely experiencing the same thing but does not know how to end it.

4. Don’t do for a teen as they can do for themselves – Rescuing a teen from the realities of adulthood is destructive. Assist teens in being independent by increasingly having them take on adult tasks such as earning money, spending money with limitation, cooking and cleaning. Parents can use the extra time to date.

5. Talk together to make plans of success for the teen and then tell them what you did – Following this suggestion will demand from your teen that they visualize their parents as loving, bonded advocates for their well-being. It makes it very difficult for the child to consciously be oppositional.

 

Posttraumatic Stress Disorder (PTSD) – Signs and Symptoms

By Jeff Dwarshuis LMSW, ACSW

PTSD can happen to anyone at anytime at any age. Here is a list of symptoms to watch. Not all symptoms need to exist for diagnosis.

  1. Exposure to or witnessing an event that is horrific beyond what is typically endured by a person. (All PTSD cases have this symptom.)
  2. The person experiences intrusive thoughts or flashbacks of the event(s).
  3. The person has nightmares about the event(s).
  4. The person feels as if the event(s) is continuing to happen.
  5. The person has emotional overwhelm when reminded of the event(s).
  6. The person has physical reactions when reminded of the event(s).
  7. The person avoids thoughts and feelings about the event(s).
  8. The person cannot recall all of the event(s).
  9. The person withdrawals from others.

10. The person does not experience the peaks of good or bad emotions.

11. The person believes they will not live long or have a good and productive life.

12. The person has sleep disturbance, hyper vigilance and extreme anger.

Also, because of the PTSD, the person almost always has Major Depression and Generalized Anxiety.

Substance abuse is very common as a self medicating attempt. This is often the initial reason for seeking treatment.

People are fearful of treatment because they think they will have to talk about the traumas.

High Functioning Families

By Jeff Dwarshuis LMSW, ACSW

The McMaster Model of Family Functioning was developed as a measurement device for family health. This model suggests six important and well researched dimensions needed for family health. Knowing and following these six dimensions will help any family or group to better functioning and health.

Problem Solving

Problem Solving consists of a family’s ability to solve problems in an effort to maintain effective functioning. It is known that most all families, whether healthy or dysfunctional, have the same amount of problems. However, the differences in functioning are related to the family’s ability to resolve problems thoroughly. Thorough problem solving consists of problem identification, recognition of the key players in the problem, developing alternatives to the problem, deciding on an alternative, monitoring the decision’s effectiveness and then evaluating the effectiveness of the process. High functioning families do these steps in a very quick and spontaneous way. Most high functioning families have little or no unresolved issues

Communication

Communication is seen as the exchange of information in a family. For families to be functioning well the members need to be communicating both clearly and directly. Clear communication is determined by whether the message has been clearly stated or if it is unclear, camouflaged or “muddied”. Direct communication occurs when the family members give information to the intended recipient rather than talking through people.

Family Roles

Family Roles are seen as the repetitive patterns of behavior that members use to complete family tasks. Healthy families tend to follow three distinct characteristics regarding family roles. First, the members arrange themselves in a way that allows their collective work to fulfill all family needs and developmental demands. Also, members expect only what are appropriate tasks of its members. Overwhelming members is not an option and no task can be too intellectually, emotionally or developmentally beyond capacity. Also, healthy families have a built-in accountability process by which members are evaluated on their role performance. Family roles are clear so that evaluation is fair and accurate.

Affective Responsiveness

Affective Responsiveness refers to a family’s ability to respond to a given situation with the appropriate amount and type of emotional expression. Healthy families have a wide range of emotions and can apply the correct emotional response to a given family problem or success. Expression is neither overblown nor disengaged but is an appropriate response to the situation. Family members have the expectation that their actions will be followed by appropriate and consistent emotional reactions. Family members are not left in question regarding how members feel about their behavior.

Affective Involvement

Affective Involvement is the extent to which the family shows interest or involvement in activities and interests of individual family members. Healthy families are involved in the process of understanding each other. Family members need to have a reasonable response to members’ interest, neither being too engaged or uninvolved. At all levels of family activity, members need to be open and spontaneous with emotion. Healthy families take a basic tone of being invested and encouraging.

Behavior Control

Behavior Control is the pattern a family develops for managing family activity. Healthy behavioral control is seen as having standards that are reasonable for its members while also allowing for an opportunity to negotiate and change. Behavioral control is neither too ridged nor inflexible nor is it Laissez- faire with few standard requirements. Expectations for behavior are clear, negotiation is an option and accountability is the norm. Individuals in these families maintain a sense of responsibility and insight into the consequences of their behavior.

Optimal family functioning is acquired through knowledge and practice. Long standing research on healthy functioning has allowed people to follow suggested methods of change that lead to family health. Learn these six things, discuss them at home and invest in positive group change.

 

EMDR for a Vietnam Veteran – The Puzzle Method

By Jeff Dwarshuis LMSW ACSW

Background

A Vietnam Veteran with chronic Posttraumatic Stress Disorder (PTSD) and Major Depression was referred to the writer from the treating staff of a local psychiatric hospital. The veteran had a history of numerous inpatient hospitalizations for PTSD and despite decades of individual, group and psychotropic therapy the client could not find relief from his traumatic memories of Vietnam. The referral source thought Eye Movement Desensitization and Reprocessing (EMDR) could be of benefit. (For a description of EMDR see blog article “Eye Movement Desensitization and Reprocessing”.)

EMDR Treatment

Following an assessment the client agreed to EMDR therapy but due to past treatment failures the client felt hopeless of any change.

EMDR treatment began with complications. During the treatment of the first identified disturbing memory the client quickly responded with intense fear that caused frequent occurrences of nausea. With the treatment disrupted the possibilities for success were in question.

The Puzzle Method

Because of the complications the writer developed “The Puzzle Method” which is an extension of the EMDR Safe Place exercise combined with techniques of Ericksonian Hypnotherapy.

Milton Erickson is the father of modern hypnotherapy and developed a unique method of hypnosis that concentrates on multilevel communication and client capacity. Regarding trace states involving memory he explained that deepening a trance state occurs when the therapist deliberately limits their own helping directives and instead teaches the client to themselves move in and then out of a trance state using their own abilities.

Erickson also taught that client safety is increased when the client has more choice regarding both self disclosure and the extent to which they want to think about something that is disturbing. Within this framework Erickson argued that the client should be given choice about treatment pace and the self disclosure of memory. Based on Erickson’s understanding of client resistance to change he also suggested the therapist intensify the client’s sense of safety by instructing the client to “hold back” from focusing on particular memories thus eliciting the client’s natural opposition which indirectly influences the client to focus more on their memory.

The Puzzle Method combines Erickson’s techniques of self initiated focus and increased safety with the EMDR Safe Place exercise in an effort to increase the likelihood of success for clients dealing with intense reactions to traumatic memories. This is done by telling the client to imagine that the traumatic picture is broken into several pieces like a puzzle and to focus only on a few pieces of the puzzle at one time. If the client becomes emotionally overwhelmed by the traumatic memory they should stop their focus on the memory and return their thoughts to the safe place picture until they feel relaxed. Following the relaxation the client should return their focus to the traumatic memory, focus on a little more than before and continue this process until the whole traumatic memory can be imagined. When using this method the client is in charge of their level of traumatic exposure as well as their level of relaxation.

The client returned to EMDR therapy, followed the steps of the Puzzle Method and was able to successfully reprocess the first memory in thirty minutes without any disturbance of nausea. The client returned to treatment for six more sessions to reprocess other traumatic memories of Vietnam using the EMDR Protocol and the Puzzle Method only when needed. The client ended therapy after seven EMDR sessions with no symptoms of PTSD or Major Depression. Follow up sessions showed a continuation of symptom reduction. The client reported that he had not felt so good since before going to Vietnam.

 

Bullying in Children and Youth – Warning Signs

By Jeff Dwarshuis LMSW ACSW 

Here is a description of the behavioral warning signs of both victims and bullies.

Victims

  1. Socially victims may appear to be isolated, unable to defend themselves, cautious, having low self esteem and having poor social skills.
  2. Psychologically victims may appear anxious, depressed and impulsive with a poor ability to regulate their emotions. Depressive thinking and hopelessness in the victim can lead to suicidal thoughts and attempts.
  3. Victims’ behavioral warning signs of abuse are a loss of interest in school, taking a different route to school, having physical injuries, withdrawing from family and school activities, emotional upset after receiving a call or email or using derogatory statements about specific kids.

Bullies

  1. The bully’s primary characteristic is a persistent expression of contempt towards someone he or she sees as being different, inferior or not deserving of respect. The bully’s abusive behavior is not a single act but an on-going pattern of abuse towards another individual.
  2. The most common targets of the bully are people who are physically disabled, obese, who appear to be of a different sexual orientation or in a racial or religious minority.
  3. The bully will show warning signs of his or her behavior through displaying a lack of empathy, having a favorable view of violence, being aggressive towards adults, having a hard time following rules and having a need to dominate others.

Bullying happens most commonly when kids travel to and from school, in unsupervised school areas, in sports team settings that normalize aggression and over the internet.

Factors that contribute to bullying are not having anti-bullying policies, inconsistent school discipline, high teacher turnover and a lack of support for children with special needs.

What is EMDR?

By Jeff Dwarshuis LMSW ACSW

Eye Movement Desensitization and Reprocessing (EMDR) is a treatment that quickly and effectively eliminates the impacts of negative memory. EMDR has its beginnings as a treatment for Posttraumatic Stress Disorder and has been very effective with depression and anxiety as well. Created by psychologist Francine Shapiro PhD, EMDR uses a blend of cognitive, emotive and client centered therapies in combination with neurobiological interventions. Since its beginning in 1995, EMDR has dramatically changed the lives of thousands of people.

EMDR, REM and Memory Reprocessing 

To understand EMDR it is helpful to first know about the impact of Rapid Eye Movement (REM). After 30-60 minutes of sleep an individual begins REM sleep. During REM, one involuntarily moves their eyes back and forth. The eye movements cause a neurobiological reaction which stimulates a reprocessing of the day’s memories and makes recent memories into old memories. If someone has a negative memory in their day, the REM process facilities making this recent bad memory no longer bothersome.

REM and Posttraumatic Stress Disorder

Traumatic memories occur when one is overwhelmed by either witnessing or enduring something that is horrific beyond the typical human experience. This might include combat, child abuse, domestic violence, personal assault, traffic accidents or traumatic medical procedures. Because of the severity of these memories, the REM mechanism described does not work. In these cases, the individual remains aware of the memory and continues to experience its negative impacts. The memory is not reprocessed and the individual could go on for decades terrorized by their own memory. This is called Posttraumatic Stress Disorder.

Negative Memories and the “Three Point Power Supply”

All negative memories create three things which exist interdependently and make a memory seem unpleasant. These three things are a negative emotion, an unpleasant body sensation and a negative self belief. Say for example someone went to a social gathering and said something foolish in front of a group of people. When thinking about this memory, the person would experience embarrassment, flushing and a self belief of “I am so stupid!” During REM, eye movements create an even stimulation of the right and left hemispheres of the brain and cause a tremendous and fixated calm in the body. Since the body is so relaxed, it does not react during the subconscious reprocessing of daily negative memories. The body reaction is separated from the two other interdependent “power supplies’ and the negative impacts of the memory fade. The individual can recall the event but no longer experiences embarrassment, flushing or a negative self belief.

EMDR Procedure as REM Simulation

EMDR is a simulation of REM used in a therapeutic setting and applied to a traumatic memory. During an EMDR session, a client visualizes a trauma while recognizing the negative emotion, body sensation and self belief. The therapist measures the negative response levels and leads the client through sets of eye movements by use of a light bar or “eye scan”. After 45-60 minutes, the negative impacts of the trauma are gone…permanently.

EMDR and Mental Health

In the therapeutic setting, EMDR is a tremendous tool for eliminating mental health symptoms. Most all mental health diagnosis have their origins in life events and the memories of these events cause symptoms. The impacts of negative memories are most obvious in PTSD but also are very much a part of depression, anxiety and behavioral disorders. Using EMDR, the therapist and client are open to eliminating the negative thoughts, feelings and self perceptions created by any memory. The possibilities for healing are enormous. Additionally, EMDR is user friendly since it is quick and highly effective. Clients utilize a well established and highly effective technique that works and the average length of therapy, compared to traditional therapy, can be reduced by 60% to 80%.

EMDR and Performance Enhancement

EMDR also is used effectively with personal performance. All individuals are functioning below their potential because of a history of mistakes, criticisms, self questioning or relational abuse. A therapist can uncover these performance interferences by asking someone a detailed list of questions to help the person visualize an ideal state. The ideal state may have to do with performance in school, the performing arts, sports, relationships or in the workplace. The therapist asks what memories or experiences get in the way of the individual being able to live up to their ideal. Those memories are then treated as EMDR memory targets, the EMDR procedure is done in the office and the client is free to return to their goals without the interference of negative memories.

Building Quality Relationships with Coworkers

By Jeff Dwarshuis LMSW ACSW

The workplace is a central part of adult life and employees invested in their work spend a tremendous amount of time with coworkers. The level of quality relationships in the workplace is extremely important as it impacts employee mood, satisfaction and productivity. Improving quality relationships in the workplace takes effort but can be done. Read further to learn about five key ideas for improvement.

The “Flexibility Rule”

People tend to follow routines. While this can be good for predictability, it is not always good for developing relationships. Sitting at the same lunch or meeting location are part of an employee’s typical work day but exposes them to a limited number of coworkers. Changing routines allows employees to use a different set of relational skills and to meet new people. This is called the “Flexibility Rule”. For example, during all meeting and social times, employees should shift their sitting place. Additionally, meetings, big or small, should be held in a variety of places. Further change can be initiated by shifting who runs the meeting. These changes will cause employees to get to know other workers. Also, the shift in setting creates an unconscious increase in openness to new ideas and suggestion.

Boundary Management

Relational boundaries create safety in relationships and allow coworkers to develop better relationships. Over involvement or relational enmeshment should be avoided. For example, employees should not push or manipulate other employees into giving too much information about their personal lives. Also, employees should not overwhelm other employees by constantly talking about themselves or projecting their moods onto others. Support in the work place can be helpful but discussing personal topics has a place and requires first establishing a trusting relationship. Disengagement, the opposite of over involvement, should also be avoided. Examples of this include isolation, pushing people away through body language, rudeness and name calling. Instead of disengagement, employees should be involved in workplace meetings and social gatherings and be kind.

Clarity in Work Context

Have you ever walked into a meeting that was half over and tried to figure out the reason for the meeting? This is an example of context confusion. Part of the development of healthy workplace relationships is keeping clear contexts. Achieve this by always having clarity regarding the purpose and themes of all social exchanges. Make sure all meetings have a clear communicated purpose or conflict may emerge due to time management disagreements. Make sure that there are no hidden agendas that exclude participants. This will lead to distrust and fear. Additionally, make sure that there is no substance abuse during working hours or excessive use after work hours. Substance abuse has a profound negative impact on communication and one’s ability to appropriately understand context purpose and implementation.

Celebrate though Traditions

Part of a mature community is the holding of traditions. Traditions create a group identity and a sense of unity and belonging. Individuals feel useful and valuable when they participate in or add to the traditions. Do this in the workplace through daily, weekly, monthly, annual and varied traditions. Examples are holidays, birthdays and daily and weekly employee recognitions. Also, celebrate group accomplishments by recognizing their annual occurrence. For example, keep a list of big accomplishments of the company and recognize them each year through celebration.

Create a ‘Best Potential” Environment

People have an innate desire to succeed and do their best. Coworkers can add to this desire to create a “best potential” environment. First, coworkers should be ready to give praise for others’ accomplishments. Additionally, employees should respect others’ viewpoints. Part of a growing environment includes a place where people can speak openly. Also, experienced workers and leaders can use knowledge to create a learning environment. New employees can seek out a mentor while leaders and experienced workers can become a mentor. All workers should remain openly ambitious. Ambition, respect and praise lead to coworkers’ self development and are contagious! 

Recognizing and Managing Stress

By Jeff Dwarshuis LMSW ACSW

The work environment can be very stressful and without proper management of stress the negative impacts on an employee can be surprisingly harmful. Stress, also called anxiety, creates symptoms that are physical, psychological and emotional. Left unmanaged, anxiety can leaving the employee with mild behavioral symptoms to chronic anxiety requiring medical leave and long-term follow-up treatment.

Symptoms and Types of Anxiety

The most common form of anxiety is called Generalized Anxiety Disorder and it has a number of symptoms. First there are physical symptoms of headaches, muscle tension, tightness in the chest, stomach pain, difficulty swallowing, restlessness, being easily tired and tingling in the hands or feet. There are psychological symptoms of excessive worry, feeling on edge, poor concentration and then behavioral symptoms of irritation, having a hard time getting to sleep and pacing. People who are stressed often appear angry, keyed up, directionless, over paced, argumentative, flushed and unhappy.

There are several types of anxiety in addition to Generalized Anxiety Disorder. For example, there are Phobias, Posttraumatic Stress Disorder, Obsessive Compulsive Disorder and Panic Attacks. These have more specific behavioral patterns and are much less common than Generalized Anxiety.

Managing Stress

The most important thing to do is to recognize stress symptoms early and treat them quickly. Anxiety, especially if it has continued for a long time, can be unpredictable with symptoms emerging in a way that seems to be ”for no good reason”.  Unmanaged Generalized Anxiety can lead to Panic Attacks and Major Depression. At this level the person generally requires inpatient psychiatric hospitalization. Early treatment of anxiety ranges from homecare to medication and psychotherapy. Most intensive treatment can be avoided by following the suggestions below. Remember also that managing stress is both a conscious process and a life style.

  1. Recognize the Symptoms – Read and memorize the symptoms listed above. If you have more than a few of these symptoms you should make changes.
  2. Critical Problem Solving – Unsettled problems create stress and completed projects decrease stress. Clearly define unfinished projects, create a list of brainstormed options and come up with the best solution quickly.
  3. Assertiveness – Recognizing and saying or writing one’s feelings will dramatically decrease stress. When self expression is used with people it leads to problem solving and increased quality in the workplace environment.
  4. Time Management – Develop time management skills. Be organized by mapping out tasks and allow a proper amount of time for each task. Stay away from perfectionism while also spending enough time to do a good job. Also, keep clear boundaries between work and home.
  5. Self Care – Maintain a balanced and healthy diet. Avoid excessive caffeine, get proper sleep and keep from substance abuse. Exercise is critical because it has an effect on the body that decreases stress. Also, body relaxation is important and can be done by stretching, breathing exercises, reading, laughing and having fun.
  6. Social Support – A fulfilling family and social life is enjoyable and allows a healthy distraction from routine stress. Social fulfillment helps to keep values in perspective and gives a sense of purpose and belonging. Distraction, perspective and purpose are central to a calm attitude.

Take some time to evaluate if stress is a problem for you. Addressing and decreasing stress will lead to a happy, healthy and more productive life.