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Thursday, October 29, 2009

T3 - Histrionic Personality Disorder

For the third installment in the Personality Disorder Parade, we'll take a look at people colloquially described as divas, egotists, drama queens, spoiled brats, and prima donnas. Why? Because the biggest feature of this disorder is excessive emotionality and attention-seeking behavior.

When a person with Histrionic PD isn't the center of attention, they are uncomfortable and feel unappreciated. They can be initially charming and easily win people over, but these very qualities can wear thin because these individuals don't know when to back off. They may do something overly dramatic just to draw attention back to themselves, like make up a story or create a scene.

Individuals with this disorder often inappropriately dress and behave sexually provocative or seductive. Of course, they are this way with people they are romantically interested in, but they also act this way in a variety of social contexts--at work, church, the grocery store--you name it, it's fair game. They consistently use their physical appearance to draw attention to themselves. They'll spend tons of time getting ready for the day, tons of money on clothes and hair appointments and grooming. They'll fish for compliments and might be overly critical about a less-than-favorable comment of photograph.

Emotional expression may be shallow and rapidly shifting. These people don't exactly express themselves deeply. Rarely do they stick to one emotion, but bounce between several emotions; thus making the expression of the emotions limited (or shallow). What emotion they do express might be exaggerated or overly theatrical. They might effusively embrace a casual acquaintance, sob uncontrollably at something minor, or guffaw at something vaguely funny--and of course the intent is to draw attention to themselves while doing this. But since their emotions turn on and off so quickly, they give the impression to others of being insincere or fake.

People with Histrionic PD have a style of speech that is colorful, flowery and grand (clinical term: impressionistic), but they lack detail when pressed for particulars. They will express their opinion about someone being the world's worst/best doctor, but be unable to give any reasons to support their statement.

Opinions and feelings can easily be influenced by fads or other people because they have a high degree of suggestibility. They may be highly trusting, especially of strong authority top figures they see as magically solving their problems. This is not the type person you'd want to casually recommend something to, because depending on how they view you, they'd take the recommendation to heart. They play hunches and adopt convictions quickly, even in the face of evidence to the contrary.

Lastly, they often consider relationships more intimate than they are. Acquaintances are suddenly "best friends" and when talking about a doctor or politician they might have only met once or twice in professional contexts, they might call them by their first name. For you authors out there--flights into romantic fantasy are common.

These individuals in relationships are trouble. Emotional intimacy is often not achieved because they will act out a role (like "victim" or "princess") in their relationships to others. They can be emotionally manipulative with their seductiveness but show marked dependency on them on another level. Keeping same-sex friends is often difficult, as you might can imagine. Would you want a woman as described above making eyes at your spouse or partner? They are seen as a constant threat.

They don't do well with delayed gratification. They want what they want now. They are all about the excitement and novelty. Long-term relationships may be neglected because of this, as these individuals have a tendency to become bored with routine. Their demands for constant attention are tiresome to others, as is their response when not the center of attention.

It is thought that more females have this disorder than males, but males can definitely have it as well. Sex role stereotypes play a role in how this disorder would be manifested in a male. They may dress and behave in a macho manner and seek attention by bragging on athletic skills or professional prowess. A woman would (likely) choose skimpy, revealing feminine clothes and confidently state how much she impressed a guy at the mall.

Next up is Dependent Personality Disorder. Please feel free to ask questions in the comment section!

Q4U: Known any histrionics from your present or past? Let's see who has the most interesting story to tell...no names, please!

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Tuesday, October 27, 2009

Treatment Tuesday - Enuresis, Phobias, and PTSD

This week’s assessment comes courtesy of Lynn. She’s writing a historical based on the Kindertransport (evacuation of Jewish children prior to WWII; read more about it here). Her MC is 8-year-old Halina* who goes to live with a Quaker family in London. Her 13-year-old brother is left behind due to no room on the train. Halina maintains contact with her parents until they are sent to Auchwitz. Halina eventually moves to the United States. In 1950, when Halina is 20, she marries and two years later gives birth to a daughter.

* Names have been changed to protect the fictional.

Lynn wants to know how someone would help Halina through her multiple issues, which she listed for me:

1) Survivor guilt – she’s not sure what happened to her brother; friends and family were exterminated
2) Insecurity – how could her parents leave her? Did they not love her? Issues with bedwetting
3) Ostracism – hard time fitting in with British children (different language, culture, religion)
4) Phobias – train stations/suitcases
5) Re-evacuation adjustment to the England countryside when war is declared
6) Flashbacks to the burning of the Berlin synagogue during the bombing of London and burning of St. Paul’s Cathedral
7) Repressing memories as a grown woman; not wanting to share it with family
8) PTSD – depending on when this term was named

Can I just say that Lynn has got her ducks in a row? KUDOS! This was such a fantastic rundown of everything you want Halina to experience and work through. You’ve obviously thought this out and it shows. You practically have your own assessment, which is fantastic!

I think I can help by shedding some additional light on some of the “heavy hitters” you put poor Halina through (meanie!). :)

You have her wetting the bed (called enuresis), which is a realistic response for an 8-year-old who has been forced to leave her parents and brother and essentially moved into foster care. Most likely, she’d have secondary enuresis, which is when a child is dry for at least 6 months and then starts to wet the bed, indicating a more emotional reason, but it could be physical or a change in sleep patterns. If Halina never was consistently dry at night, then she has primary enuresis, and her brain just needs to learn to wake her up when her bladder signals it is full.

Enuresis is typically something children grow out of, but there are practical things her British family could do to try to help her.

• Reduce amount of liquid drunk a few hours before bed
• Reward child for dry nights
• Have them change their own sheets when wet
• Bladder training during the day where Halina would be asked to “hold” her urine when she needs to go so that she stretches the bladder to hold more urine (also called retention control, although probably not back then!)

If I did my math right, Halina would be 8 in 1938. This just happens to be the year that bedwetting alarms came out. Now, I have no idea how expensive they were, but the idea is that the alarm goes off as the child is voiding, and this wakes them up and they can either go to the bathroom or hold the urine until later (negative reinforcement). It’s very effective, but the alarms have a high drop-out rate. Back then there was no medicine for this problem as there is now, so these are your options.

Her specific phobia of train stations and suitcases is appropriate and can be easily done in fiction. Obviously, these things remind her of being taken away from her family, and who she left behind. In particular, I’d think the train station would just be an awful place for her to revisit, since your sketch seemed to indicate her brother was at the train station with her, but unable to accompany her because of a lack of room. So that would be extremely traumatic for an 8-year-old to witness and then being left alone on the train. Halina would stop at nothing to avoid train stations and suitcases. Phobias were known to the mental health field in the 30s, but I couldn’t find out much about treatment. You can see my post here regarding phobia treatment (the part you want is about half-way down). Back then, they might have just given in to her anxiety and made it where she never had to visit those places much. There are perfectly “normal” adults who die with phobias still in tact.

Survivor guilt, which first was diagnosed around the 60s, was removed from the Diagnostic and Statistical Manual of Mental Disorders IV in 1994 and redefined as a significant symptom of Post-Traumatic Stress Disorder. So you won’t be able to mention that until quite some time after she’s married, if you decide to. Her flashbacks would be incorporated into this diagnosis, as would the repressing memories (which is an avoidant response common in PTSD…people don’t want to think about things that give them anxiety).

As to how her husband might could help her through these issues, I’d make him an extremely strong male lead. Halina will need some security after such a traumatic past. You mentioned her husband would be a Holocaust survivor. This could be really good, if you write it in such a way that they bond through a sort of mutual experience (even though Halina escaped the Holocaust, she was terribly affected by it). If you make husband’s issues too strong, then it’ll lose feasibility (in my opinion). Halina has so much on her plate to deal with that I’d think it unlikely for her to fall for someone in worse shape than she’s in. Does that make sense? Might just be a personal thought, but it seems she just needs a strong man.

People with survivor syndrome have to learn that they are suffers, too. They take on an unnecessary amount of guilt, almost like the tragedy was their fault. Maybe Halina’s husband could be this huge Jewish nationalist who really sees this fact as it is: the Jews were victims. Halina could learn to accept that she wasn’t in any way responsible and this will enable her to move on with her life and grieve the losses she has suffered. When you’re stuck with survivor guilt, the grieving process gets stuck, too. Her husband would need to be persistent, really drawing out her memories and encouraging her to talk about things rather than stuff them inside, which enabling her to come to terms with what really happened. He’ll have to get past her repression some how. A person can convince herself something didn’t happen if they are good enough as repression and denial. Her husband (maybe when he’s a fiancé?) might have to really put some faces to the horrific event by showing her pictures of the camps or some awful scar he has a result…to really bring home that it did happen. Halina has to face it and grieve it.

Okay. This has been a really meaty assessment, but that’s mainly because you gave me SO much to work with, which is great. I wish I could have done a little more research about treatment for some of these things back in the 30s, but maybe you can do some Googling on your own.

Thanks for writing in…really enjoyed this assessment.

This service is for fictional characters only, so any resemblance to real life examples is entirely coincidental. Any other fictional character assessment questions can be directed to charactertherapist@hotmail.com.

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Monday, October 26, 2009

Behold the Dawn Book Review and Giveaway!

Today I'm doing a review and book giveaway of K.M. Weiland's newest release, Behold the Dawn. For those vampire enthusiasts out there (of which I am one), this has nothing to do with vampires meeting the sun. :) Instead, it's a very well-written medieval historical set during the Crusades.

Here's a blurb about the book from the author's website:

Marcus Annan, a tourneyer famed for his prowess on the battlefield, thought he could keep the secrets of his past buried forever. But when a mysterious crippled monk demands Annan help him find justice for the transgressions of sixteen years ago, Annan is forced to leave the tourneys and join the Third Crusade.

Wounded in battle and hunted by enemies on every side, he rescues an English noblewoman from an infidel prison camp and flees to Constantinople. But, try as he might, he cannot elude the past. Amidst the pain and grief of a war he doesn’t even believe in, he is forced at last to face long-hidden secrets and sins and to bare his soul to the mercy of a God he thought he had abandoned years ago.

Okay, before I put on my therapist cap, I just want to say that as a reader, this book was truly incredible. Katie does such a great job of keeping the reader turning the pages. There's something in this book for everyone: there is enough action to satisfy the adventure lover; enough impossible awakening love to satisfy the romantic; enough research to satisfy the historian, enough intrigue, betrayal and murder to satisfy the mystery lover, and enough mercy and forgiveness to satisfy the Christ-follower.

I was impressed with how Katie portrayed Marcus Annan's hopeless depression. He feels he's being punished by God simply for living such a long life as a tourneyer (an occupation where most people did not live for 16 years). He asks himself when he became "less than meaningless" because of past actions he can't mentally or emotionally release. Since he can't forgive himself, there's no way in his mind Christ could ever forgive him. His past is an insurmountable obstacle to accepting the love and grace God so freely gives.

Katie really gets in deep with Annan's pain and misery. If Annan was in my office with such despair, I'd have to do a suicide assessment on him and would end up checking him in somewhere. (You're such a meanie, Katie!) He's got suicidal ideation (thoughts of wanting to die) and he's got the plan (if he can just get an opponent with a stronger arm than him to smote him). He's got the means (he is a tourneyer) and he's got the motivation ("less than meaningless"). Prime candidate for self-termination.

But the story only begins here, folks. Annan has a wild ride ahead of him as he encounters this monk bent on vengeance. The monk definitely has his own emotional and psychological issues. He went from a devout, God-fearing monk to an altered man willing to stop at nothing for revenge. The desire for revenge can destroy a man, because when the mind dwells for years in hatred and anger and bitterness, the result is a blindness to truth and a victory for Satan.

Katie's book is one of hope. Nothing is too great to separate us from the love of Christ (Rom. 8:38-39). He came to heal not the righteous, but the sick (Matt. 9:12-13). I was reminded of these verses reading this book. Behold the Dawn is a great message of new beginnings.

In a nutshell, Behold the Dawn has beautiful prose, engaging plot, secrets that explode off the page...it's a compelling read.

If you're interested in winning a copy of this book, then please leave a comment in the comment section with your email address. I'll post the winner Saturday!


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Thursday, October 22, 2009

Therapeutic Writing

Every novel is a part of you.

No, I don’t mean in some philosophical sense that they each hold a place in your heart. I mean literally. Pieces of you—quirks, pet peeves, life experiences—are in your novels.

An unforgettable cab driver you had while on vacation pops up in a city scene. A teacher you had in junior high reappears in your YA. Your own affinity for caramel popcorn becomes a charming addiction for a main character. Your character gets worked up over the same injustice that lights your fire.

Some say this is simply writing what you know. And yes, of course they’re right. But it goes deeper than that. Writing is a way to make sense of the world you live in, the world you know.

In this way, writing is therapeutic.

In therapy, counselors often assign writing as homework to underscore an important from the session. Journaling can get a client to think deeper. You’re unlikely to censor what you write in a diary. Unlike a person, a journal won’t make you feel guilty for what you expressed, try to get you to change your mind or talk back to you. (If the latter happens, email me and I’ll see if I can pencil you in.)

Writing is an unadulterated form of communication to self. You write from the heart, for the heart.

And isn’t that what a book should be?

Donald Maass, in his book Writing the Breakout Novel, wrote, "...Novels change us because their authors are willing to draw upon their deepest selves without flinching. They hold nothing back, making their novels the deepest possible expression of their own experience and beliefs" (p. 39).

When you hold nothing back from your novel, there is no barrier between what is you and what is the book. The book is an extension of you—a part¬ of you. And yes, here I do mean philosophically speaking.

I’m convinced the reasons mentioned above are why it’s so hard to take criticism from others about our “babies.” Just as our child carries our eye color or height, our books bear our likeness, our stamp, our genetics. Even the toughest-skinned parent would feel a twinge (and likely much more!) at some well-meaning, but critical, remark about their offspring.

So are you wondering now how can you write for all you’re worth—without flinching, as Maass wrote—during the editing and revision process?

The answer is YOU CAN’T. Just as severing off your baby’s finger would be painful beyond belief, so would cutting that scene or chapter or backstory dump. Switching points of view might be like swapping your toddler for another on the street because you have such an attachment to the one you gave birth to!

Of course, the analogy can only go so far. A book is NOT a flesh-and-blood child. In learning the craft, we realize a “finger,” “hand,” “torso,” or—gasp—the whole of our electronic baby is completely unusable, unpublishable, and in general, plain rubbish.

If this happens to be the case, archive these sections. Not with the hope of resurrection, but for the sake of posterity. Besides being hard to delete, the writing itself—if written from an honest, vulnerable part of your self—is still valuable therapeutically.

So hold a funeral service for those writing endeavors that didn’t make the grade. Bury them inside a graveyard file on your computer.

Then rename the file Therapeutic Writing.

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T3 - Narcissistic Personality Disorder

Narcissistic Personality Disorder gets its name from Greek mythology about Narcissus, a man who was renowned for his beauty. He was very cruel in some of the stories about him, disdaining some people who love him. As divine punishment, he falls in love with a reflection in a pool, not realizing it was his own. He dies there, unable to leave the beautiful image. For more info, read this article.

So, in the spirit of Narcissus, individuals who are in love with themselves get diagnosed with this personality disorder. Typically, they have an inflated view of themselves, deeply crave admiration from others, and show a lack of empathy. But behind the facade is a very vulnerable person, sensitive to the slightest criticism.

There are nine criteria for determining this PD, and five of them are required for diagnosis.

1) grandiose sense of self - often will appear boastful, pretentious, inflate their accomplishments or overestimate their abilities; inherent in this judgment of their own worth is the devaluation of the worth of others

2) preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love - to their way of thinking, their admiration and privilege are long overdue; they may compare themselves with famous, rich, privileged people; sometimes, this is called the "God complex"

3) believe that they are superior, special and unique and expect others to recognize this - they only want to associate with other high-status people or institutions; people of lesser rank can't "understand" them; they may attribute these qualities of perfection to those they do associate with, which in turn enhances their own value; they only want the "best" doctors and restaurants

4) require excessive admiration - due to a fragile self-esteem, constant attention is required, and it had better be of the positive, "you-look-so-good" variety; they fish for compliments and actually expect their arrival at a party to be greeted with fanfare and fawning; they may be genuinely astonished if others don't covet their possessions, looks, charm, etc.

5) has a sense of entitlement - they expect (unreasonably so) to be treated favorably over others; they feel they should be catered to and can be quite furious/confused when this isn't the case

6) is interpersonally exploitative - this could be conscious or unwitting; romantic relationships might only be entered into if the person can see some "gain" from it (like advancing their social status or enhancing their self-esteem); they expect to be given whatever they want or feel they need, no matter the cost to others

7) lacks empathy - has a hard time recognizing or identifying with the desires/feelings of others; they may go into lengthy detail about their own concerns at inappropriate times; they might grow contemptuous and impatient with others talking about their problems (i.e., not the center of attention); they often are oblivious to how hurtful their remarks can be (i.e., telling a coworker who wanted the same job promotion how wonderful the new job is); others who relate to people with Narcissistic PD find "emotional coldness and lack of reciprocal interest"

8) often envious of others or believe that others are envious of them - when others have possessions of successes, people with NPD begrudge them and feel that they are more deserving; they will devalue accomplishments of others, even more so if those accomplishments are praised or acknowledgment

9) display arrogant, haughty behaviors or attitudes - snobbish/patronizing/disdainful ways of thinking, behaving and relating to others

Now that you've gotten an idea for the type person a Narcissist really is, I want you to think about how in the world this person would maintain any type of relationship. No one can say anything remotely negative about them. If their partner/spouse isn't constantly admiring them, there's problems in paradise. They disregard the sensitivities of others, which doesn't bode well for a mutual respectful relationship. So the above characteristics have to be looked at in terms of how this person relates to others. This disorder has to cause some clinical impairment in social, occupational or other important are of functioning. See treatment below.

Of all the people diagnosed with this disorder, 50-75% of them are male. Adolescents seem to go through a stage where many have some of these traits, but that doesn't mean they will go on to have NPD. (Adolescents are generally just more into themselves!) For a diagnosis, the individual has to be 18 years old.

A couple of risk factors have been pieced together from various researchers. Here's a list:
  • An oversensitive temperament as a young child
  • Overindulgence and overvaluation by parents
  • Excessive admiration that is never balanced with realistic feedback
  • Unpredictable or unreliable caregiving from parents
  • Severe emotional abuse in childhood
  • Being praised for perceived exceptional looks or talents by adults
  • Learning manipulative behaviors from parents
I found a cool quiz online here if you're interested. Personality disorders are very hard to treat, but I haven't found them hard to diagnose. A high number of individuals with PDs also have an Axis I diagnosis (like depression, anxiety, or an eating disorder, see my post on Axes here) that usually becomes the focus of treatment. By the very nature of Narcissism, the individual would never want to admit they have a problem. Sometimes hospitalization is required for treatment of this disorder.

People with this disorder might not realize they have a problem until they are educated about the illness. Personally, I focus on behavioral modification and communication and social skills training. These individuals aren't necessarily bad people, but they need someone to help them understand the illness and how they can combat it to make their life better.

Questions about this disorder? Drop them to me in the comment section and I'll do my best to answer.

Q4U: This disorder is commonly found in political leaders and entertainment industry professionals. Who are some people you think might fit the bill (don't let my photo pic bias you)?

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Tuesday, October 20, 2009

Treatment Tuesday - Wishy Washy

This week’s assessment comes from Carolyn.* She’s writing a medieval fantasy with a romantic subplot involving Frank and Sarah*. Frank is an intense, emotionally repressed Ranger (think: mounted police) about 10 years older than Sarah, whose father was Frank’s mentor in the Rangers. After a bit too much holiday wine, Frank kisses Sarah passionately, but regrets his impulsivity and avoids her for months. When they are thrown together in a series of adventures against the Bad Guys, their relationship changes, but Frank has resolved never to marry because if he died in the line of duty, he didn’t want to leave a wife and children to go through what Sarah and her mother went through when her father died.

So in push-pull fashion, Frank draws closer to Sarah in their perilous crises only to pull away deeply conflicted when he allows his internal judgment to rule. During the big battle of Good v. Evil, Sarah is almost killed by Big Bad Guy, but Frank takes the blow for himself. He has a near-death experience, but pulls back due to his love for Sarah.

This experience finally pushes Frank off the fence. Since the thing he most feared—death—has already occurred, he realizes how foolish he has been to throw away their chance at happiness, no matter how temporary it might be. He goes to Sarah, tells her how stupid he has been, and begs her to forgive him. Sarah, who has loved Frank from the get-go, isn’t sure she can trust him. After all, he’s changed his mind before.

What Carolyn wants to know is this: what should happen to Sarah to convince her that Frank is sincere? How can she trust him? And how can Sarah trust herself after all the changes she has gone through?

* Names have been changed to protect the fictional and the not-so-fictional.

This is such a great question. I didn’t include Carolyn’s entire synopsis, just enough to give readers the idea of Frank’s wishy-washiness and strong internal motivations not to marry. As a romantic, I love books where just friends go to something more than friends. Always makes for a good read.

For Carolyn’s novel, she’s got this extremely powerful external motivation for Frank to realize the error if his thinking. Near-death experiences are life altering for those who report them. But Sarah doesn’t have anything near so compelling, does she? So this is a great realization that you’ve had. Sarah needs some sort of assurance that Frank’s finally made up his mind once and for all…and in this circumstance, his verbal pledge isn’t enough (since he’s declared his love for her prior).

The first thing that comes to mind isn’t necessarily purely psychologically related, although that does factor in…but more so on Frank’s side. Let me explain. Recently, I got back from the ACFW conference and I took Camy Tang’s workshop on the hero and heroine’s journey. It was fascinating, of course, but one thing stuck out to me, and that was the idea of a leitmotif.

Here’s a definition of leitmotif in literature from Wikipedia: a recurring event, object or even a character that the story always makes reference to. For example, in Gladiator, Maximus has the two little figurines of his wife and son that eventually get buried in the arena. In Dragnet, it's Friday's badge, which is taken away and then given back when he's reinstated.

How could this be used for Sarah’s sake? I think Frank needs a leitmotif that is a constant reminder of his vow to stay unmarried. Perhaps something from Sarah’s father—a handed-down heirloom or trinket—would make it even more powerful of an image. Maybe Sarah notices whatever it is (say, a pocket watch), but Frank won’t talk about it or brushes her questions off. Perhaps he opens up to her about his resolve not to marry while he’s fingering the watch. Maybe then he tells her it reminds him daily not to get too close, so as not to needlessly cause pain to others.

Whatever object you choose, it’s got to have significance for Frank. And then you need to have it destroyed or damaged in some irreparable way. Or have Frank himself stomp on it or throw it in a river or somehow imbibe it with a different meaning altogether. You could even have it ultimately stop his death somehow, but that might be a bit cliché, as it happens in movies and films all the time. (Like a policeman's badge protects him from a bullet. See here.)

The psychological power comes in how you portray this object in front of Sarah. Her opinion of its importance is paramount. She’s got to see Frank caress this thing, valuing whatever the leitmotif is. He can’t imagine life without it. That way, when she sees Frank without it, she’ll know he’s really serious. Maybe even more powerful would be for her to see him destroy it or for Frank to tell her why he did with it what he did….for her. Because he’s drop-dead serious about being with her. Then she can know she can trust him. Frank’s internal thoughts have changed, and the proof is in the pudding, so to say, by the evidence of the leitmotif no longer being prominent for Frank.

So it’s an outward way for Sarah to have the same kind of epiphany Frank had with the near death experience. Of course, this is just a suggestion.

As to how she can trust herself after so many changes, you indicated that she might take up to six months to “decompress.” I actually like this idea. It will give her time to contemplate the change in Frank, as well as give Frank time to really prove himself (by calling on her, respecting her wishes, etc). The trick will be in how to make that time period fun for the reader or pass quickly to get to the meat of her decision to either accept him or not. So I think you’ve got a built in way for her to reacquaint herself with, well, her self.

The other thing to remember is that the heart knows what it wants. It’s the head that imposes concerns or doubts. Sarah knows her heart is in favor of believing Frank and his declaration. But her head says, “Stop! He’s done this before. You can’t believe him this time.” So the time will give Frank the opportunity to address the doubts of her head while reinforcing the desire of her heart. So I’d keep just the decompression time.

Hopefully this has given you some ideas of what to incorporate into your story to give it the punch you’re looking for.

Feel free to use the anonymous commenter option to tell me what you think or ask any additional questions for clarification. Best of luck!

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Monday, October 19, 2009

Sandra Byrd's Piece de Resistance

Sandra Byrd's third installment in her French Twist series, Piece de Resistance, recently released, and I was given the pleasure of a complimentary copy to review on my blog.

This is a series you don't want to miss. In previous times, I would call this chick lit at its finest, but since that word is so faux pas now, I'll call it women's fiction. It follows a young woman on her journey to self-discovery. Here's a blurb from the back of the book:

Having earned her chef’s hat, Lexi Stuart bids au revoir to her glamorous and deliciously satisfying pastry mentorship outside of Paris and returns to her hometown of Seattle, Washington. There, she finds life unexpectedly complicated.

She’s put in charge of a high-end catering bakery called Bijoux, which should be her dream job, but there’s a catch: She
has to make this lavish bakery into a successful business in just a few, short months, which will require more than her ability to make an amazing wedding cake. Stir in a complicated relationship with her French beau Philippe and his daughter, Celine, then add a dash of romance with down-to-earth lawyer Dan, and life suddenly contains more ooh la la than Lexi can handle.

Since this is the third book, there's a lot from Book One, Let Them Eat Cake, and Book Two, Bon Appetit, about Lexi's journey that I don't want to spoil here. So, typical for my reviews, I like to focus on characterization from a therapist's point of view.

I liked the fact that Sandra doesn't have Lexi coming from some horrible past. She's basically a typical, average twenty-something who speaks French, thanks to her degree in college. She doesn't have a traumatic history. She doesn't come from a divorced family. She's got really good friends. She's got career troubles and romance woes, but nothing out of the ordinary.

That doesn't mean the book is ordinary, though. I think anybody who doesn't know exactly what they want to do with their life will be able to relate to Lexi Stuart. She's on the dawn of true adulthood and everything that means. She's trying to live up to expectations of her parents and herself with regards to her job, her faith, and romance. I find this all too common among this age group (early to mid-twenties).

Lexi suffers from a bit of a self-esteem problem. She's surrounded by those she feels are more successful than her. She's got a retired Marine for a father, a lawyer for a brother and sister-in-law, her best friend's happy as a teacher. Even once she gets her chef hat, she still is under pressure to perform a certain way, to be outwardly successful. And Sandra puts poor Lexi through the ringer as far as career mishaps and misunderstandings.

And for romance, Lexi's got a couple sexy French men and American stud lawyer Dan in her life. I just have to say the way Sandra ends Lexi's romantic story in Piece de Resistance is simply sublime. There couldn't be a more perfect ending, seriously. But before Lexi can get there, she's got to get a little more comfortable in her own skin, to know herself and what she wants/needs better.

As for her faith, I really like how Sandra seamlessly weaves Lexi's Christianity into all the books, but especially Piece de Resistance. In each book, Lexi follows through a book of the Bible. I'm a believer in how God can speak to believers through his Word. Lexi reads just what she needs to read right when she needs to read it. She figures out things about herself, future ministry opportunities, and spiritual truths to live by. There's so much to be gleaned from Scripture for our everyday activities. I think it's a fallacy to think to have a devotional you've got to read three chapters and journal about them. Lexi's devotionals are short and sweet, a verse or two that she ruminates over through the day. If only we could all do that a little more often, a little more consistently.

Great read, folks. Makes you laugh out loud at times, sigh at times, and keep flipping the pages for the next romantic encounter. Lexi is endearing, so I'd suggest you buy all three of these books at once, so that you can go right through them without stopping...took me four days, max (and that's because I've got a toddler).

You can find Sandra on the web at http://sandrabyrd.com and her facebook fan page is at http://www.facebook.com/sandrabyrdbooks.

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Thursday, October 15, 2009

T3 - Antisocial Personality Disorder (AKA Sociopath)

Welcome back to the Personality Disorder Parade. I'm starting with some of the more prominently known personality disorders (or least the ones you might hear thrown around on TV, pop culture, that sort of thing). Antisocial PD will be first.

The main feature of Antisocial PD is a pervasive pattern of disregard for, and violation of, the rights of others than begins in childhood or early adolescence and continues into adulthood. This is also called psychopathy or sociopathy.

For this diagnosis to be given to someone, they have to be over 18 and have a history of some symptoms of Conduct Disorder or a diagnosis of it. Children with Conduct Disorder repeatedly violate the basic rights of others and age-appropriate norms. It's IMPORTANT to remember the following four categories of behavior when giving your villain (or whatever character) a backstory: aggression to people or animals, destruction of property, deceitfulness of theft, or serious violation of rules.

So once they are adults, this pattern continues. They fail to conform to social norms with respect to lawful behavior. So whether of not they get arrested, they do things that would definitely land them in jail if they were caught, and they do these actions with disregard for the wishes, rights, or feelings of others.

They are frequently deceitful and manipulative in order to gain personal profit or pleasure (i.e., wanting money, sex, power, etc) and they may repeatedly lie, use an alias, con others or malinger (feign illness).

These individuals are impulsive, and fail to plan ahead. This means they make decisions without consideration for the consequences to others or to themselves...so they might have sudden job changes, residence changes or relationship changes. They are also extremely irresponsible and may be unable to hold down a job or defaulting on debts/alimony.

People who suffer from APD tend to be irritable and aggressive, repeatedly getting into fights or committing acts of physical assault. These are child beaters, spouse beaters, etc, but the aggressive act isn't in defense of themselves or someone else (so these people don't try to defend someone's honor by getting into a fight...they just pick a fight or punch someone for no reason, that type thing). They have a reckless disregard for the safety of themselves OR others. They may be speed racers on the highway, driving under the influence, engage in sexual behavior of substance abuse with high risks for harmful consequences...and they just don't care. You don't want to have someone with APD solely in charge of taking care of a child, for instance.

Lastly, these individuals show little remorse, if any, for the consequences of their acts. They may be indifferent or give some rationalization for having hurt, mistreated or stolen from someone, like "$#!t happens," or "he had it coming." They may blame the victim for being stupid or in the wrong place at the wrong time.

To give you an idea, here's a quote from Wikipedia about Ted Bundy.

"On death row, Bundy admitted to decapitating at least a dozen of his victims with a hacksaw. He kept the severed heads later found on Taylor Mountain (Rancourt, Parks, Ball, Healy) in his room or apartment for some time before finally disposing of them. He confessed to cremating Donna Manson's head in his girlfriend's fireplace. Some of the skulls of Bundy's victims were found with the front teeth broken out. Bundy also confessed to visiting his victims' bodies over and over again at the Taylor Mountain body dump site. He stated that he would lie with them for hours, applying makeup to their corpses and having sex with their decomposing bodies until putrefaction forced him to abandon the remains. Not long before his death, Bundy admitted to returning to the corpse of Georgeann Hawkins for purposes of necrophilia (sex with corpses)."

Now for some general character traits associated with Antisocial PD, but not necessary for an actual diagnosis of it (take note, you'll want to include these in your characterization):

lack of empathy, callous, cynical, inflated/arrogant self-appraisal (they are better than certain types of work or people), opinionated, self-assured, cocky; glib, superficially charming, exploit sexual relationships, or easily bored.

Those traits in bold are features that have been commonly included in the traditional concepts of psychopathy that may be particularly telling of the disorder and more predictive of convicted criminals who repeatedly offend (Jeffrey Dahmer, Ted Bundy, etc). This disorder is found in about 3% of males and 1% of females in general (higher percentages are found in substance abuse treatment settings, prisons and forensic settings). Antisocial PD is chronic, but tends to become less evident as the person grows older, particularly by the time they reach their 40s. Just FYI.

As you can see, this is the personality disorder of choice (not that they actually have a choice) for serial killers, sociopaths and psychopaths. Hopefully this rundown will give you some ideas for your diabolical stories.

Q4U: What did you learn new about this disorder? Did you know that sociopath wasn't really a "disorder" per se, and that the real associated name was Antisocial Personality Disorder?

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Tuesday, October 13, 2009

Treatment Tuesday - Past Scars

This week’s assessment comes from author Tommie Lyn, who submitted Fallon McKniere, the heroine from her novel, On Berryhill Road. Now, this is not a book review, since I haven’t had the pleasure of reading Tommie Lyn’s work, but it’s an analysis of her character Fallon, whose name has not been changed since she’s taking up a slice of publishing history already. :)

First, a bit about Fallon’s background. When she was six, her Navy father was killed, but it was made to look like a suicide when a note is found confessing his involvement with a recent crime. Her mother, suspected of being an accomplice, was given a dishonorable discharge and eventually retreats into her shell, becoming paranoid and unable to hold down a job until she and Fallon end up on welfare in a rundown trailer. Fallon doesn’t fare well in school where she’s taunted, ostracized and often getting into fights. Finally she drops out at 16 and takes a job in a convenient store to get them off welfare.

Fallon is fearful of people, keeps them at a distance and keeps all interaction on a shallow, surface level, not accepting help from anyone. But she has great sympathy for anyone/anything suffering. One such person she helps is Donavan, the leading man. But Donovan inadvertently makes a comment that hurts her feelings, and in his efforts to apologize, he begins to break through the protective wall Fallon has erected around herself, emerging her from her protective shell.

Tommie wants to know if a person could endure what she put Fallon through and still have her be able to make a connection as Fallon does with Donovan...and through him, eventually to others.

To this, I say never underestimate the relational disposition of mankind.

Fallon had a rough childhood. Children can be very cruel and can cause severe emotional trauma that leaves scars well into adulthood. Most people can tell you off the top of their heads some incident in grade school that stuck with them, perhaps even shaping them into the person they are today.

But God made man to be a relational being. God said it wasn't good for man to be alone, and he made Adam a mate in Eve. So there's an inherent tendency in most men and women to seek companionship. Fallon might be substituting hurt and wounded animals for her relational need, but deep inside, she desires connection. We all do, but some of us just have steeper obstacles to overcome.

Fallon’s experience of being ostracized and taunted is very realistic, and if you brought her into adulthood as a wary, apprehensive, standoffish woman, than I’d say this rings true. It’s only common sense to avoid putting too much of yourself out there for interactions when you have a history of being trampled on. The term for this normal response is “gun-shy.”

The one part of the sketch that gave me pause was this inadvertent comment Donovan made that “hurt Fallon’s feelings.” It would seem that a girl as hardened and tough as Fallon would have to be to endure what she did would just take a lick and keep on ticking. But if you included some other snippets that show her soft heart in the face of the meanness of others, this might be more believable. If this book weren’t already in print, I’d probably suggest the author include some scene where Fallon doesn’t get invited to a big party (and maybe you did this?). She would be all tough on the exterior, telling them she didn’t want to go in the first place, but then have her crying alone in her room. That sort of thing. [I emailed Tommie this assessment prior to posting it and she responded that the comment Donovan makes brought up a slew of unwanted memories from Fallon's past. Donovan immediately realizes he said something to hurt her, but since he doesn't know her background, he doesn't know what. Thus he responds to her with kindness instead of the anger she's used to. So it's a very different sort of experience with hurt, I gathered.]

The reader would have to know that this random comment from this guy didn’t just all of a sudden make an impact like what you described. Since this comment seems to be what the entire story turns on, then it would be good for the reader to know that this random comment from this guy didn’t just all of a sudden make this type of impact.

The key to breaking open Fallon’s protective shell would definitely be Donovan’s persistence. Someone like Fallon would take notice if a person was consistently there for her, showing up when she’s in need (even if she doesn’t want to admit it with a fierce independent streak). He’d have to constantly surpass her rather low expectations.

Since she had an example of a loving relationship at least until she was 6, she probably knows what true love looks like. Children as young as six years old know whether their parent’s relationship is good or bad. I would also hope that her mother, even devastated at the lost of the love of her life and even as she descends deeper and deeper into instability, would still share stories about Fallon’s dad which would further solidify in Fallon’s mind the type relationship she should hold out for. Then, upon meeting Donovan, it’s feasible she might recognize some of the characteristics she wants/desires and bond with him, especially if there is anything in the book that you’ve written about Donovan that might make her remember her father or remind her of her father in some way. [Tommie wrote me that Donovan is in the Navy--like her dad--and that the first time Fallon sees his green eyes, she's reminded of her father's green eyes. So kudos, Tommie!]

So, based on what you’ve given me in the sketch, I don’t see anything unfeasible, Tommie. Human behavior is varied and oftentimes dependent on the situation. Fallon took some hard knocks, but that doesn’t mean she won’t be able to recover from them. The heart can remember, but it doesn't have to be held captive. If you’re ever in doubt about feasibility of a character like a backstory that’s intense, you could always incorporate some therapeutic encounters (either of a professional or lay variety) in your book, and that could suspend reader belief for sure that the character “worked out” her issues. Relatively easy to do. [Tommie's email indicated that this is definitely something she has worked into the book already...so that's great!]

This service is for fictional characters only, so any resemblance to real life examples is entirely coincidental. Any other fictional character assessment questions can be directed to charactertherapist@hotmail.com.

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Thursday, October 8, 2009

T3 - Personality Disorder Overview

Many of you asked for it, so here's the first installment (overview) of the Personality Disorder Parade.

A personality disorder is an "enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early childhood, is stable over time, and leads to distress or impairment" (DSM, p. 685).

There are three clusters of personality disorders that are based on descriptive similarities outlined below:


Cluster A = Odd/Eccentric

Paranoid
Schizoid
Schizotypal

Cluster B = Dramatic/Emotional

Antisocial
Borderline
Histrionic
Narcissistic

Cluster C = Anxious/Fearful

Avoidant
Dependent
Obsessive-Compulsive


All the personality disorders have six diagnostic criteria:

1) an enduring pattern of inner experience and behavior that deviates markedly from cultural expectations and is manifested in at least two of the following areas:
  • cognition (ways of perceiving/interpreting self/others/events)
  • affectivity (range, intensity, ability to change and appropriateness of emotional response)
  • interpersonal functioning
  • impulse control
2) the pattern is inflexible and pervasive across a broad range of personal and social situations

3) the pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning

4) the pattern is stable and of long duration, and its onset can be traced back to at least adolescence of early adulthood

5) the pattern is not better accounted for an a manifestation or consequence of another mental disorder

6) the pattern is not due to the direct physiological effects of a substance or general medical condition


These general diagnostic criteria for a personality disorder will give you a better understanding of how widespread the effect is on a person who suffers from them. Next week, I'll continue the Personality Disorder Parade with a rundown of the more prominent personality disorders (like antisocial, borderline, narcissistic, obsessive-compulsive).

How can this help you as a writer?

Personality disorders are a great vice to give a villain or even the main character. Once the reader understands that the villain has an actual disorder, they are more likely to feel a little sympathy toward them. If the villain is mentally ill and not taking medication or getting help, then there is still hope for the him or her. See how that can be helpful?

Some of these personality disorders are just begging for you to snap them up and use them in a WIP. Just by reading the descriptions of the criteria for diagnosing someone with antisocial personality disorder or borderline personality disorder...your writer brains will be working overtime as the possibilities you'll hopefully come away with!

Stay tuned for next week...Antisocial Personality Disorder is first. It's a terrible thing to actually diagnose a real person with, but a writer's playground to give a fictional character!


Q4U: Is there a particular personality disorder that you've "heard something about" that you might want clarified when I get to that disorder?



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Tuesday, October 6, 2009

Treatment Tuesday - Effects of Trauma

This week’s assessment comes from Jordan. In her WIP, her heroine, Marni*, a former law enforcement officer, is abducted the night before her wedding. After much tribulation, the fiancé gets her back two hours before the wedding.

Jordan wants to know if it would be psychologically feasible for a character who had just been through an abduction to want to continue with the wedding, the idea being that she’s not going to let anything “ruin the day or keep her from getting married.”

She also wants to know what ill psychological side effects Marni might suffer.

* Names have been changed to protect the fictional.

I emailed Jordan to find out if there was any other traumatic history with abduction in Marni’s backstory. Jordan said she’d never been abducted or worked an abduction as a beat cop or FBI counter intelligence. I also wanted to know Marni’s history with the abductors and how long she was abducted (to rule out Stockholm Syndrome). Jordan emailed that Marni knew both of them, as they were all members of the same parish for about 3 years, and that she was only abducted for under 18 hours, and slept during some of that time.

I want to answer the second question first, as perhaps that might be the most helpful for other readers, and then get down to the more specific question regarding the feasibility of Marni’s reaction second.

Being abducted or kidnapped is definitely a traumatic event. Many things factor into the traumatic nature: it was unexpected, the person wasn’t prepared for it, the person felt powerless/helpless, someone else was intentionally cruel…all these things add to trauma. (Even more so if it happens in childhood or if it happens repeatedly, FYI.)

Some people are just more susceptible to psychological and emotional trauma. Who fits this bill?

1) A person already under a heavy stress load (planning a wedding could qualify…)
2) A person who has already suffered a loss or series of losses
3) A person who has already been traumatized before (especially in childhood and especially if it’s a trauma in the same manner, type or event)

So already Marni’s case is looking pretty good. Because Jordan indicated Marni had no prior trauma, then Marni has a better chance of rebounding from the abduction scenario than someone who had some previous red flags.

Now, that said, there are absolutely normal reactions to these abnormal, traumatic events that anyone could have. If I were you, Jordan, I’d pick one or two of the following symptoms to maybe focus on. If your intent is to have her go through with the wedding (which I’ll go ahead and say I see as psychologically feasible…if done right), you don’t want to give her too much baggage up front to process in 2 hours.

Physical symptoms to trauma include: insomnia/nightmares; high startle response, increased heartbeat, fatigue, agitations/edginess, muscle tension/aches/pains, difficulty concentrating, sweating…and several others. I’d pick ONE.

Emotional symptoms run the gamut, but here’s some likely possibilities: denial, guilt, shame, self-blame, shock, disbelief, anger, mood swings, irritability; feeling hopeless, confused, afraid, anxious, disconnected, numb, sad; withdrawing from others. I’d pick ONE or possibly TWO.

Usually these symptoms fade with time, lasting anywhere from a day or two to several months. Of course, with post-traumatic stress disorder, anything that reminds the victim of the trauma can make symptoms reappear.

Now for a little lesson about what trauma actually does to a person. Trauma disrupts the body’s natural equilibrium, freezing you in a state of hyperarousal and fear. In essence, your nervous system gets stuck in overdrive. Successful trauma treatment must address this imbalance and reestablish your physical sense of safety.

One way to address the imbalance is to discharge the pent-up energy in a physical way. If you can find a way to bring about one of the following: trembling, shaking, sweating, crying, laughing, or goose bumps, then it’s more likely Marni’s reaction can be contained. It might be cool (no pun intended) to have her in a meat locker, trembling all over. The physical reaction of her body can process that pent-up energy so when she comes out of the trembling, her nervous system returns to its state of equilibrium. You could have Marni state how “normal” she feels…and even be shocked at this.

Of course, you’ll want Marni to process through her trauma-related thoughts or feelings. This could be done en route to the church or something. And if you’re going to have her get counseling at some point before the end of the story, it could also be done there. But myself, I’d have her process with the groom-to-be at least a little before the wedding.

The key is if Jordan's personality is strong from the beginning of the book. She doesn't have to be an "alpha female" exactly, but if she's a fighter, independent, determined and tenacious, then I think you can definitely pull off this chick wanting to go through with the wedding of her dreams. She can just brush herself off, reapply her lipstick, and walk the aisle if her character personality affirms this. So make sure there's nothing in her backstory that might preclude this type reaction...and go for it. :)

This service is for fictional characters only, so any resemblance to real life examples is entirely coincidental. Any other fictional character assessment questions can be directed to charactertherapist@hotmail.com.

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Saturday, October 3, 2009

The Familiar Stranger Review

Christina Berry's debut novel, The Familiar Stranger, is an amazing read, folks. Amazing.

Here's a little blurb about the book:

Craig Littleton has decided to end his marriage with his wife, Denise, but an accident lands him in the ICU with fuzzy memories. As Denise helps him remember who he is, she uncovers dark secrets. Will this trauma create a fresh start? Or has his deceit destroyed the life they built together?


As a therapist reading this book, I felt like I had been transported back to my office, sitting before a husband and wife as they told me about their version of the same event. Christina's literary device of "His" and "Hers" to indicate the point of view character was creative. Not because other authors don't swap POV of the major characters, but I've never read anyone who did it to give the reader the internal thoughts of each character about the same event. Brilliantly done! Like being in a counseling session, the man inevitably has different thoughts about what they're describing than the woman. And I do mean different. It's riveting in real life...so of course in fiction it's a page turner.

The emotions Denise and Craig both feel are so real, too. Not once did I read through some emotional scene and think, "That wouldn't have happened. No way." This stuff definitely would have been feasible. How each one felt, thought, acted...essentially lifted from the lives of thousands of Americans and people all over the world. Page turner.

Obviously this book strikes a chord at discordant marriages. Craig and Denise have major problems prior to his trauma, as evidenced by the first chapter. We're talking about lack of communication, intimacy, affection...they are essentially roommates instead of husband and wife. Then there is the trauma Craig suffers, and the ensuing secrets uncovered put Denise through a refining fire unlike any other. Page turner.

These secrets, which will have to be skimmed over for the purpose of this review (so that you have to go to amazon.com and buy this book for yourself!), are nothing to shake a stick at. Each one of the revelations uncovered would send a normal couple into therapy for a long time. And there's not just one, either. Oh, and did I mention that they are progressive in nature? Page turner.

Not because of any plot similarity, but I was reminded of the book A Severe Mercy by Sheldon Vanauken. Gripping read, as well, and a true story of Sheldon's relationship with God and his wife. Through Christina's prose and dialogue comes God's "severe mercy" to Denise...and even to Craig and his associations. Page turner.

This book ends with a twist, folks...think Ted Dekker or William Diehl who wrote Primal Fear. But the ending is truly extremely satisfying. All loose ends are tied up and you turn the last page with a sense of hope. Hope for troubled marriages and hope for prosperous futures. Page turner.

Now for a bit about Christina:

Single mother and foster parent, Christina Berry carves time to write from her busy schedule because she must tell the stories that haunt her every waking moment. (Such is the overly dramatic description of an author's life!) She holds a BA in Literature, yet loves a good Calculus problem, as well. Her debut novel, The Familiar Stranger, releases from Moody in September and deals with lies, secrets, and themes of forgiveness in a troubled marriage. A moving speaker and dynamic teacher, Christina strives to Live Transparently--Forgive Extravagantly!


You can read more about Christina at her website, www.christinaberry.net or her blog, www.authorchristinaberry.blogspot.com.

You can BUY THIS BOOK HERE. Don't miss this terrific read.


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Thursday, October 1, 2009

T3 - Therapy Basics: Session Notes

I have a feeling I'm about to surprise some of you about the type notes therapists take in session. Like most things I've already mentioned, notes differ according to the therapist.

There are online notes, handwritten notes, typed notes. Then there are diagrams (which really are sometimes the best way to communicate information succinctly, even in notetaking form), outlines, timelines, genograms (will discuss later) and the occasional doodle when bored. (Just kidding!)

I fall into the category of therapists who use an outline (of sorts) to take my notes. This happened because I started writing notes in a psychiatric hospital, and we had to follow a BIRP guideline for all notes. (And we seriously would ask, "Have you BIRPed yet?" before we could leave for the day. Not kidding on this one.)

B = Behavior
I = Intervention
R = Response
P = Plan

There are different variations of this type of guideline, used for different insurance purposes or personal preferences or company expectations.

Like MIRP:

M = Medical Necessity
I = Intervention
R = Response
P = Plan

And SOAP:

S = Subjective
O = Objective
A = Assessment
P = Plan

You can see some similarities between the three guidelines I've listed. BIRP notes were for in-patient clients whose behavior had to monitored closely. So every person on every shift had to write a BIRP note about that person's behavior, how the therapist/psych technician intervened in the behavior (modeling appropriate behavior, talking to them using a particular method, etc), the client's response and the overall plan for that client's continued therapy (how you're going to implement goals, address the problem behavior, etc).

It's almost the exact same with MIRP. Medical necessity exists because of behaviors or thoughts or emotions that the client wants to change. So that's what the therapist would put under "medical necessity": behaviors, thoughts, emotions. Could be overly tearful, of self-berating thoughts, or lowered self-esteem (but you'd have to indicate how this was the case...see treatment plan post). I used MIRP notes when working for a private, non-profit. MIRP was good for insurance and auditing purposes...b/c it forces the clinician to stick to the treatment plan (which is first and foremost). In an audit, if you weren't sticking to the treatment plan, then they could "disallow" what you billed for that session, which would cost the company moolah (and that might just come out of your check if you're the culprit). Thankfully, I was never disallowed on any of my notes. :)

In private practice, however, I prefer SOAP notes. It keeps everything nice, tidy and clean (no pun intended). I usually start a session with a notepad already doctored with the S, O, A and P strategically lined along the left side of my page. What clients say or do would go under "subjective." It's their actual experience in therapy. A client might say, "I feel worthless." I'd jot this under my "S" on my notepad. What I actually observe goes under "O" for objective. This is my clinical expertise at work...the reading in between the lines of what's being said. I note discrepancies between what a client says and does. I scribble down reactions (like when a client easily breaks down...what prompted it?), pregnant silences (what question did I ask that prompted the client to close off or be reluctant to speak?), how many times I had to keep the client from chasing rabbits. Things like this. Under "Assessment," I might write down any clinical tool I used, or what my overall impression of the session was, including how I think the goals we've set are being met and what might be done additionally to assess where the client currently is. The "P" section is the same as under BIRP and MIRP.

This said, many therapist choose to write stream of consciousness during session...using key words, phrases or the like and then transposing them into a guideline system or just filing them as is in the client's file. Since I'm Type A, I like to type my notes up, and generally I'll include more information in the typed version. As for filing, I typically use a regular manila folder with brads at the top of both sides to secure my notes, intake papers, releases of information, treatment plans, etc. for each client. Some companies use the folders to the left, which hold much more information, include more inserts with brads to section off paperwork better.

So, there you have it. Therapy notes is much more than a nutshell, but hopefully it was informative.

Q4U: Think about doing a BIRP or SOAP note after each scene. Where are you going with your story? Does the character's behaviors/actions line up with this?

Don't forget...there's still time to sign up to win Mary DeMuth's new book, A Slow Burn, and it's prequel, Daisy Chain, if you leave your name in the comments section here.

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