Free Association Results

Start Word: DANCE.                        End Word: FINGER.


Analyzing the results, the most interesting association was when Anonymous took us from "STREET" to "FREEDOM." I'm wondering if perhaps the association was for "Dance" instead?

Great job, everyone! Thanks for participating...see you back next Friday!

Friday Free Association Chain

The word is........

DANCE.

First commenter free associates with the above word. Second commenter takes the first commenter's word and free associates, and so on.

Remember -- FIRST thing that comes to mind. GO!!

Oh, and there's still time to enter to win Donna Anastasi's Spin the Plate! Click here!

T3 - Facets of Grief: Emotional Response

A person experiencing loss has major changes in 4 areas: Emotional Response, Physical Perceptions, Cognitions, and Behaviors. This week we'll look at the Emotional Response.

The emotions people experience while bereaved range all over the map. The most overwhelming emotion is depression, since grief shares a lot in common with people experiencing a Major Depressive Episode. Sleep disturbances, appetite changes, and intense episodes of sadness and crying are common in both, but usually these behavioral changes are only present for a short period of time in someone who is grieving.

It's important to note that some people have a reactive response to significant loss, and that is not abnormal. By reactive, I mean that their intense feelings of being alone or isolated might become so overwhelming that they withdraw from even the supportive people who love them most. This emotional response is probably most common with an intimate relationship loss, but could be found in any type of loss and usually wanes over a year or so.

But there are a few emotional responses that, while normal, are difficult for others to deal with or know how to approach a bereaved person experiencing them. I've listed them below.

1) Anger 

One of the first solid emotions a person will feel after shock and denial is anger. The anger is frequently directed at the deceased person, either for leaving the grieving person alone or maybe anger at themselves because they couldn't prevent the death. Anger could be directed outwards, like blaming a cop or doctor who "didn't do their job."

How to approach: Let these angry individuals express themselves in as healthy a manner as possible. Provide outlets - like punching pillows or going to the gym. Don't take it personally if they lash out at you. You adding your hurt on top of what they are already experiencing won't help.

2) Guilt

Guilt could be caused by the angry feelings listed above, but maybe they also said or did something they now regret. People could also think they could have done something to prevent the death. "I should have been there," or "What if I'd recognized the signs of the stroke earlier?" Guilt is often internalized, and might make the bereaved withdraw or feel like they don't deserve the well-wishes of others. Guilt can also occur when the survivor feels relief at the death, perhaps in the case of a chronic long-term illness.

How to approach: Try to help the bereaved focus on the positive aspects of their relationship with the deceased, even if you have to go back to toddlerhood. Reiterating that the person did all they could to save the deceased (if, in fact, they did). Explain that relief in that type circumstance is simply the beginning of recovery, since their grief started much earlier than the actual death.

3) Anxiety

This emotion might be more common among those individuals who don't give themselves time to grieve, like the example I used earlier of a mother who doesn't allow herself to grieve because she's got to take care of her children. But anxiety can come from the confusion or uncertainty that the loss casts the survivor in. "How will I possibly pay all the bills?" "Should we move into a smaller place?" "Who can I count on to pick up Billy from soccer practice now?" Little anxieties can prove to be insurmountable obstacles to dwell on.



How to approach: Let them know that you are available to take care of the "little" things like soccer practices and housecleaning. Knowing they have someone dependable on their support team will go a long way in relieving everyday anxiety focused on maintaining the appearance of normality, especially where children are concerned.


Next week we'll look at possible physical perceptions and changes a grieving person experiences.

Q4U: What have you done in the past to bring comfort to someone who was grieving? What has someone done for you?

Technique Toolbox - ABCs

 ABC Chart Technique

Credited to: Aaron T Beck, founder of Cognitive Therapy

For use with: Individual therapy with adults.

What you will need:

Piece of paper
Pen

What you do:

Explain that every thought has an Activating Event (A). This is what actually happened and the client's immediate interpretations of that event. Then the client forms Beliefs (B) about that event--which can be rational or irrational. Those beliefs lead to Consequences (C), which is what the client feels or does. You can see this in the chart below.

Essentially a therapist can quickly make the above chart by dividing a piece of paper into three columns. Usually this type of assignment is given for homework, but the therapist would likely go over a couple of examples in session to make sure the client understands what they are supposed to do.

Purpose:

Helping the client to recognize their "stinkin' thinkin'" is getting them one step closer to psychological health. In order to do that, people have to recognize the distortions in their thinking, such as:

1. Black-and-White - Thinking or either / or thinking.
2. Making Unfair Comparisons – usually in the negative
3. Filtering – honing in on the negative, forgetting the positive.
4. Personalizing - The Self-Blame Game
5. Mind-Reading – thinking we know what others think (negatively)
6. Catastrophising – imagining the worst case scenario
7. Overgeneralising – “I always mess up…”
8. Confusing Fact with Feeling – “If I think or feel this way then my thoughts/feelings must be correct'.
9. Labelling – I’m a loser vs. I made a mistake.
10. 'Can't Standitis' – being unnecessarily intolerant
(from Basic Counseling Skills.com)

The reason this is called Cognitive Therapy is that it focuses on the second step of (B)elief. If a person's beliefs about something are irrational, then their resulting consequences will be unhealthy, leading to unmanageable behaviors and emotions. Beck believed that if the distorted thought could be intercepted and changed, then psychological illnesses, such as depression, would subside.

Q4U: Any one identify with some of the above examples of "stinkin' thinkin'"?

Treatment Tuesday - Acute Stress Disorder

This week's assessment comes from Sierra. She's writing a psychological thriller short story in the present day about Adriane,* a woman who stabs her husband with a kitchen knife after 6 years of being emotionally abused and constantly compared and found lacking to her husband's first wife. She was steady and reliable, smart and successful prior to this. She is seeing Dr. Black* who is consulting for the defense and conducting their sessions in prison. Adriane still doesn't remember what happened.

Sierra wants to know: Would it be normal for Adriane to remember as she goes through the process of therapy, and if so, what kind of reaction would an inherently good person have after finding out that they did something terrible to someone they loved? What kind of process does someone go through when they make a "mistake" with such horrible consequences?
This sounds like a fascinating plot, Sierra. You are right in assuming that Adriane dissociated to some degree while killing her husband if she does not remember it. We just have to figure out what diagnosis best fits the circumstances.

When a person dissociates, they separate their thoughts, emotions, or experiences from one another. 
This can be on purpose or involuntary. Adriane's was likely involuntary. The presence of amnesia is indicative of many different disorders, such as Dissociative Amnesia or Acute Stress Disorder, the two I want to look at more closely.

With Dissociative Amnesia, the person usually can't recall important personal information, and the information is too extensive to be explained by ordinary forgetfulness. This can happen once or several times. If the amnesia occurs during the course of another disorder, though, that disorder takes precedence. This leads me to Acute Stress Disorder after ruling out the below.

Since you had no indication that Adriane was two or more personalities, she doesn't fit Dissociative identity Disorder. Since you indicated no traveling away from her home or work or assuming a partial or complete different personality, she doesn't fit Dissociative Fugue. There is some indication that she could suffer from Posttraumatic Stress Disorder, but in your sketch, you didn't include any of the traditional symptoms like flashbacks or dreams or avoidance of things that remind her of the trauma.
 
So we are left with the likelihood that Adriane has Acute Stress Disorder. Adriane experienced an event in which she caused the death of her husband, which is definitely traumatic. Shen then would have to exhibit 3 of the 5 characteristics, one of which is the amnesia:

(1) a subjective sense of numbing, detachment, or absence of emotional responsiveness
(2) a reduction in awareness of his or her surroundings (e.g., "being in a daze")
(3) derealization (i.e., feeling a loss of reality or sense of unreality)
(4) depersonalization (i.e., feeling like she's not alive, floating above her body, not a person)
(5) dissociative amnesia (i.e., inability to recall an important aspect of the trauma) 

The last three traits are essentially all aspects of dissociation...a separation from her own body and mind.  Even though she doesn't remember the event at present, she could still experience recurring images or dreams associated with what happened, even if they don't make sense. You'd also want to give her some hyperarousal symptoms, such as inability/difficulty sleeping or concentrating, constantly trying to detect threats to herself (hypervigilance), or exaggerated startle response.

The only thing to consider with this diagnosis is that the symptoms last for a minimum of 2 days and no longer than 4 weeks. If this fits your thrilled time line, then great. If it doesn't, then you can consider a lasting diagnosis of PTSD, more than likely.

Yes, she could eventually remember. But she could also have blocked this memory from resurfacing. Some of my colleagues adhere to hypnosis for this type of memory recovery, but I've never done anything with hypnosis because you have to be trained in the process.

Sierra also wants to know: How would a therapist conduct this sort of thing? What constitutes mental competence to stand trial? How would the therapist go about discussing this with her?

I Googled what constitutes mental competence to stand trial (since I'm not lawyer), and it was pretty much what I thought: the person has to have the capacity to assist their lawyer to defend them and to understand the nature of the proceedings in which they are involved.

You're Dr. Black is going to have a clinical interview with Adriane in which he will assess her with psychological tests or personality tests, like the MMPI-2. He'll take a social and psychiatric history and may use a state competency exam, depending on which state you're in (I found out Georgia has one). Most importantly, Dr. Black will perform a Mental Status Exam and assess current level of functioning of Adriane.


So what's in a Mental Status Exam? I could go into a detailed approach, but why reinvent the wheel? I found a great website with a full explanation of each are of an MSE, so here it it. Essentially, Dr. Black will just ask pertinent questions to cover each of the areas, probably done in a very getting-to-know-you kind of way as part of building rapport with Adriane. However, this would be done at the beginning of the process. You mentioned "sessions" with Dr. Black while Adriane is in prison, which makes me think ongoing counseling. I'm not sure about the legal ins and outs of this type of set-up, and you also want to think about your time line of the diagnosis.

So as it stands, mental competency for Adriane to stand trial would be the results of the following equation:

Functional Assessment

Defendant's Current Mental Status

Specific Demands of Case

I've enjoyed this little foray into legal proceedings and learned quite a bit myself, so thanks for that, Sierra. Hope this helps....thanks for writing in!

Still time to enter to win Donna Anastasi's Spin the Plate! 
Click here!

Spin the Plate Review and Giveaway

Donna Anastasi's debut fiction novel, Spin the Plate, takes the life of one incest survivor and spins the outcome for her in a beautiful, redemptive way.

A description of the book from the author's website: Time has done nothing to heal childhood wounds inflicted more than a dozen years ago, nor fade the memories. Now as an adult, Jo has given up on the human race, men in particular, investing her energies in tattoo artistry and animal rescue. Francis meets Jo during an altercation between Jo and another passenger on the Boston subway. Francis, the brains and speech writer for a Boston philanthropist and billionaire, is painfully lonely as his job requires that he maintain anonymity plus have constant exposure to the shallowness, corruption, and cruelty of humankind. From the moment he lays eyes on Jo, Francis sees beyond her rough exterior to the genuine, passionate, fearless, and beautiful person Jo is and pursues her with unwavering passion.
In a compelling story on living as an incest survivor and the how-to’s of love, faith, and healing, Jo discovers she is not alone in her fight to leave her past behind and move beyond sorrow into joy.

Donna's book is remarkable in that it will reach survivors of incest and other acts of sexual abuse and leave them with something positive to take away from their experiences, as incredulous as that might sound. Jo's experiences are horrid, and she clearly suffers from Post-Traumatic Stress Disorder in that she plays flashbacks in her head as if they are on film, and she numbers them by episode.

And her flashbacks are intense and vivid. Fainthearted readers who take offense to language or mature themes won't appreciate it, but the fact of the matter is that people live with these types of nightmares every day. They are graphic and disturbing and shocking, and Donna portrays them realistically.

Jo's rough and tough. She likes the F-bomb. She's a tatoo-artist who does Sumo moves in her spare time. Francis is the opposite. Soft-spoken. Low-profiler. Yet he sees something in Jo that Jo herself doesn't even see. He sees not only potential, but the perfection we all have in Christ...who Jo doesn't have a relationship with.

Francis in many ways represents Christ in this book. His steadfastness and security, always being there, always being patient, always putting Jo first. Christ is just like that. Jo wrestles with the big question of why a loving God would allow her to go through incest, and Francis helps her realize that perhaps it was to give her a "burning desire to save others in similar circumstances," which is exactly what Jo has a passion to do.

I really like the "spin the plate" idea, and can see myself using this in a therapy session. On Donna's website, you can see the sermon which sparked the idea for the name of this novel. Essentially, just changing one's perspective on their situation can make everything more...okay. Better. More bearable.

There is head-hopping throughout the novel, but when I asked Donna about this, she said she chose to break convention and allow the reader to know what both Francis and Jo were thinking at the same time. The effect is a big jarring, though. Also, I wasn't kidding about the language and vivid flashbacks. But if you know someone who has been sexually abused or experienced incest, enter the giveaway so you can give this book to them. It just might "spin the plate" to their circumstances and touch their heart in a way nothing else has.

To Enter:
Leave a comment with your email address in a format where web trawlers can't pick it up and spam you. If you are already a follower, you get +1. If you are a new follower, you get +2. Tweet about it (using the button by the title) gives you an extra +2. Giveaway goes through Friday!

Free Association Results

Start Word: TABLE.                        End Word: SHORT.


Analyzing the results, the most interesting association by far was Cindy's, who took us from "WAIST" to "TIGHT." I hear ya, girl.

Great job, everyone! Thanks for participating...see you back next Friday!