DI News’ Mental Health Series – list of articles (updated 3/2010)

• July 30, 2009 – What is Counseling, by Lindsey Davis

• Aug. 6, 2009 – Managing Financial Anxiety, by Susan West

• Aug. 13, 2009 – Relationship Between Stress and Personality, by Scott Mohler

• Aug. 20, 2009 – Coping with Change, by Scott Mohler

• Aug. 27, 2009 – Nutrition and Exercise, by Lindsey Davis

• Sept. 17, 2009 – National Recovery Month, by Lindsey Davis

• Sept. 24, 2009 – ADHD and Coexisting Conditions, by Barbara Fowler

• Oct. 1, 2009 – Depression v Sadness, What is the Difference, by Susan West

• Oct. 8, 2009 – How to Make Any Relationship Better, by Scott Mohler

• Oct. 15, 2009 – Why Do Women Think They Way They Do? by Scott Mohler

• Nov. 12, 2009 – Managing Holiday Stress, by Susan West

• Nov. 12, 2009 – Managing Holiday Stress, by Barbara Fowler

• Nov. 19, 2009 – The truth about PPD, by Risa Mason-Cohen

• Nov. 26, 2009 – What’s Wrong With You? By Scott Mohler

• Dec. 3, 2009 – Psychiatrists vs. Psychologists, by John Pybass

• Dec. 10, 2009 – PPD part 2, by Susan West

• Dec. 24, 2009 – Adolescent Suicide, by Cherie Tolley (Palmetto Behaviorial Health)

• Jan. 14, 2010 – Understanding your teenager, by Barbara Fowler

• Feb. 4, 2010 – Cooperative parenting, by Risa Mason-Cohen

• Feb. 11, 2010 – The art of giving feedback, by Scott Mohler

• [no articles in Feb. 18, Feb. 25 issues]

 

July 30, 2009 – What is Counseling, by Lindsey Davis

Introducing, a Mental Health Column

We’ve Got Something to Talk About . . .

With this issue, The Daniel Island News introduces its mental health column, with area professionals addressing reader questions and topics of interest. This week, Professional Counselor Lindsey Davis answers the question: “What is Counseling?”  and next week Dr. Susan West will talk about stress – both its impact and steps we can take to reduce it.

The Daniel Island News mental health column will appear from time to time and will focus on issues of greatest concern to our readers. To date, readers have posed 16 questions for our mental health professionals, and in her column next week, Dr. West will address the first of those, on stress. If you have a specific question that you would like answered, please send it to survey@thedanielislandnews.com, and put the words “Mental health column” in the subject line. Thank you. 

Currently, six area professionals are participating in our mental health consortium: 

• Susan West, Ph.D. is a psychologist who specializes in individual, couples, and family psychotherapy;

• Lindsey Davis is a licensed professional counselor, licensed marriage and family therapist, and certified addictions counselor for the state of South Carolina;

• John Pybass, M.D., is an outpatient adult psychiatrist, who treats affective, personality, psychotic and dementia related disorders through psychopharmacology, psychotherapy, and family/social intervention;  

• Dr. Katherine St. Germain Smith is a child, adolescent and adult psychiatrist;  

• Patrick McArthur, M.D., is a child, adolescent and general psychiatrist in private practice in Mount Pleasant for 15 years;

• Scott Mohler, Ph.D., is a licensed, clinical psychologist with 17 years experience as a psychotherapist; for the past seven years he has worked exclusively in the area of organizational psychology. 

What is Counseling?

By Lindsey Davis

It may be fear of the unknown that prevents someone from talking to a counselor/ therapist.  In this article, I hope to provide you with a realistic perspective about what to expect from counseling.

 

Unfortunately, the media has often portrayed mental health professionals in a negative light. Picture a therapist – sitting in a business suit, reading glasses perched on the tip of her nose, taking notes (or doodling) while seated behind a patient lying on a dark, leather couch spilling their guts. All the while, the therapist nods, watches the clock, and asks repeatedly throughout the session: “How does that make you feel? . . . Doesn’t sound that appealing, does it? Nope, didn’t think so.

 

More accurately, counseling is a relationship between you and a professionally trained person who has the desire and willingness to help you with your concerns. A counselor will listen objectively and nonjudgmentally and help you explore issues of importance to you. Issues may focus on a specific concern or they may be interpersonal in nature and involve your relationship with a loved one. Counseling might also focus on your overall sense of well being, becoming a means by which you can gain greater understanding and acceptance of yourself and enhance your growth as a person.

Millions of Americans have found relief from depression and other emotional difficulties through therapy. There is increasing evidence that most people who have at least several sessions of therapy are far better off than untreated individuals. (APA, 2007)

 

Therapy is not a magical quick fix for your problems, rather it is a process. With some effort on your part and a strong relationship with your therapist, it can be a successful tool toward resolving problems.

 

Being in therapy is NOT about being crazy; in fact, therapy is for those that are VERY sane. It’s for people that value their mental and emotional well-being as much as their physical well-being. It’s for people who want to get the most out of life.

 

About the writer: Lindsey H. Davis  has a master’s degree in Clinical Counseling and is a licensed professional counselor, licensed marriage and family therapist, and certified addictions counselor for the state of SC. She has been in the mental health field for approximately 10 years and is proud to be one of the mental health professionals on Daniel Island.  If you have any questions, you can reach Lindsey H. Davis of Life Matters Counseling, LLC at 843-471-2215.

　

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Aug. 6, 2009 – Managing Financial Anxiety, by Susan West

Mental Health: Five Steps For Dealing With Financial Anxiety

By Dr. Susan West

Today, Dr. Susan West addresses reader questions on stress, financial anxiety in particular.  One reader asked our panel of professionals to deal with the question: “Has the economic downturn created stress in your life?” And another reader requested “stress relief advice.” Dr. West tackles these issues below.

Let’s face it Americans are stressed out.   More than half of Americans report that they are anxious about everyday life events (APA, 2008).   The economic downturn of our nation has really thrown many of us for a loop. Whether it is the increase in unemployment rates, the declining housing market, or difficulty managing our money, most of us are feeling the financial “crunch”. 

It seems every time I turn on the news there is someone discussing our country’s current financial crisis. All that negative news can be quite overwhelming! Financial concerns impact marriages, friendships, the ways we parent, and our overall health. When we fear the worst our anxiety can really ramp up.

Stress can manifest both emotionally and physically.  We usually talk about the emotional symptoms of stress-agitation, depression, and feelings of worry and panic.  However common symptoms of stress include many physical challenges such as, feelings of fatigue, muscle soreness, racing heart rate, and disrupted sleep.

Many individuals cope successfully with stress by setting boundaries, relying on their support systems, establishing priorities, and asking for help. Many individuals who generally cope effectively are being significantly impacted by financial stress. Why? Money can be an emotional issue. Overall, when we feel financial stress, we can feel “spread thin” and our coping skills become compromised.  Stress is linked to many maladaptive ways of coping e.g., unhealthy eating, alcohol and drug abuse, gambling, and not exercising. 

When it comes to coping with financial stress consider the following:

1. Do not panic. Start by turning off the TV or limiting your access to negative press.  This can help you stay calm.

1. Take stock.  Identify what in particular is causing you financial worry e.g., identifying is it making ends meet, or the fear of not having enough to retire, etc.  Once you identify your specific problems, start developing a plan.

1. Own it.  Often we struggle to realize how we are handling stress.  Do you misuse food, alcohol, and drugs?  Or do you have a short temper with co-workers and family?  Maybe both? How often does this happen?

1. Do it.  Start making more self-interested decisions regarding your financial stress. Review your plan on a regular basis.  This can be difficult.  Many of us do not want to have financially based conversations.  However, you need to see if your plan is working.  Denial will not work as an effective long term coping plan.

1. Ask for help. Over time you may realize that despite your plans to “do it”, something still gets in your way. It maybe the way you spend money, the fear of losing your money, or the way you feel about money. The difference between temporary situational stress and a clinical concern is the extent and length your symptoms persist.  If you find that you are anxious for more than two weeks and your mood is significantly impacting your personal or professional life, seek professional help.  Know that a psychologist or other mental health professionals can provide you guidance and structure in these stressful times.

About the writer: Dr. Susan West has been practicing on Daniel Island since 2005. She has a special interest in providing psychological services tailored to meet needs of individual, families, and couples.  Dr. West offers assessment and treatment for a broad range of areas including: depression, anxiety, adjusting to various life changes (marriage, divorce, parenthood, career change, etc.), post-traumatic adjustment concerns, academic difficulties, addictions, coping with chronic pain/health problems, body image concerns, and/or relationship difficulties.  If you have any questions, please call Dr. West of Daniel Island Psychological Associates, LLC at (843) 278-5402.

 

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Aug. 13, 2009 – Relationship Between Stress and Personality, by Scott Mohler

Mental Health Column: Relationship between Stress and Personality

By Scott Mohler, Ph.D.

As part of our continuing mental health series, Daniel Island resident Dr. Scott Mohler addresses the relationship between personality type and stress. Dr. Mohler’s article is in response to a reader who wrote:

“ I'd like to see information about different personality types and how they might deal with stressors differently (but effectively!)”

Not all stress is bad and not all stress is bad for you. Sometimes we look forward to certain notoriously stressful events – like getting married, having children, moving, starting a new job, even divorce! We also know that we tend to perform our best when there is some pressure on us but not too much.

There are many factors that contribute to how people respond to stressful events including what the events are, the amount of stress that happens within a given time period, and specific personality traits.

There are also different ways of measuring the effects of stress such as job performance, social functioning, physical health, and emotional well-being. This article focuses mainly on the latter two. 

Although it is true that there is a correlation between the amount of stress people experience and health problems, that doesn’t necessarily mean that stress causes illness. In fact, many people are remarkably resilient even after experiencing major trauma or loss. For example, studies of bereaved spouses typically find that fewer than half show signs of significant, long-term distress, and most show no signs of clinical depression.

Clearly, some people do not cope as well as others, and personality plays a part. It has been found, for example, that people who are prone to negative moods are more likely to experience life difficulties and health problems. But it has not been established that life difficulties and health problems cause negative moods. In other words, it appears that being negative or pessimistic puts you at risk for health problems—not the other way around.

This is likely due to the subjective nature of stressful events. It is the negative interpretation of the event that compromises the immune system and leads to health problems – not the event itself. Fortunately, most people are optimists, even when faced with potentially life-threatening circumstances. Research shows that optimistic people react better to stress and are generally healthier than pessimists.

Another factor that is important in our culture is perceived control. A high sense of perceived control, where we feel we can influence outcomes in our lives, is associated with good physical and mental health. But when people feel that they have lost control (e.g., being placed in a nursing home against their wishes), they often deteriorate rapidly and sometimes die unless some measure of control is regained.

A related concept is self-efficacy. This is the belief in your ability to carry out specific actions that will produce a desired outcome. High self-efficacy is associated with greater success in lifestyle change efforts such as quitting smoking, lowering cholesterol, and exercising regularly.

Another factor that has been linked to health problems, specifically coronary heart disease, is Type A personality. Type A persons are typically competitive, impatient, aggressive, control-oriented, and hostile. Of these characteristics, hostility—not simply a fast-paced lifestyle—appears to be the culprit.

The good news is that much research has shown that it is possible for people to improve the way they cope with stress without changing their basic personality.  

About the writer:  Dr. Scott Mohler is a licensed, clinical psychologist and Senior Consultant with ORConsulting Inc., an international organization development firm. His current activities include executive coaching, leadership development, team-building, cultural assimilation, change management, and improving employee motivation and performance.  Previously, Dr. Mohler practiced as a psychotherapist for 17 years and was VP of Operations for a regional healthcare company that served the southeastern U.S. and Texas.  He can be contacted at (859) 322-1952 or scott.mohler@orconsulting.us.com. He has been a Daniel Island resident since July 2008.

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Aug. 20, 2009 – Coping with Change, by Scott Mohler

Another in a series from our mental health experts

Coping with Change

By Scott Mohler, Ph.D.

Some people thrive on change; others hate it. A change that may send one person over the edge may have little or no effect on another. Even someone who accepts some changes readily may wrestle with others for a lifetime.

What is it about change that accounts for these different reactions, and what can be done to cope with change better?

First, we need to distinguish between “change” and “transition.” Change, as the word is used here, refers simply to an alteration of circumstances—having a baby, losing your job, returning to school, misplacing the car keys. Change is, by itself, neither good nor bad. It is subject to interpretation. When change results in an emotional adjustment, we are now talking about transition.

Every transition involves loss—even those that are chosen voluntarily and eagerly anticipated (e.g., getting married). Sometimes the loss is obvious and has tangible value: income, property, investments. More often, the loss has psychological value that we may not immediately recognize: control, status, authority, security, self-worth, etc.

Sometimes, people who can’t appreciate the potential benefits brought about by a particular change get stuck in the past. They are unable to “grieve” their loss because they don’t recognize it, and therefore, find it difficult or impossible to move on. Many times, denial takes over. This is the mind protecting itself from a reality that is too grim to face. The person may intellectually understand what has happened (e.g., “I lost my job”) but initially may feel shock or nothing at all.

Transition impacts us in at least three important ways. It affects our self-confidence, perceived effectiveness, and morale. As time goes on, all three of these tend to suffer as we grapple to understand the change and make sense of it for ourselves. The situation is made worse if the change seems senseless or we lack sufficient information to understand the rationale for it (e.g., “Why did I lose my job when others who are less productive got to keep theirs?”).

The key at this point is to be able to focus on the future in a positive way, even when you don’t know for sure what the future looks like. For many people this is extremely hard and the time when resistance to change is greatest. What people need most at this stage is understanding from someone with credibility that they trust.

Facts and logic do not work when powerful emotions are driving behavior. Transition is an emotional process, not a rational one. People at this stage feel misunderstood. That does not mean we should seek out those who will tell us what we want to hear or coddle us. It does mean we need to be willing to listen to others without judgment and ask for the same in return. It is important that both parties come away feeling valued, appreciated, and respected, even if they see things differently. We still may be held accountable for change (e.g., in a work situation), but it de-personalizes the issue, and in doing so, often results in a willingness to explore new ways of doing things. 

About the writer:  Dr. Scott Mohler is a licensed, clinical psychologist and Senior Consultant with ORConsulting Inc., an international organization development firm. His current activities include executive coaching, leadership development, team-building, cultural assimilation, change management, and improving employee motivation and performance.  Previously, Dr. Mohler practiced as a psychotherapist for 17 years and was VP of Operations for a regional healthcare company that served the southeastern U.S. and Texas.  He can be contacted at (859) 322-1952 or scott.mohler@orconsulting.us.com. He has been a Daniel Island resident since July 2008.

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Aug. 27, 2009 – nutrition and exercise, by Lindsey Davis

Exercise/ Nutrition/ Mood: What’s the connection?

Turning on the television to watch the news requires effort. It seems like today’s world is full of tragedy and seeing the positive does not come naturally for many of us. Now, more than ever, folks need to be proactive with self care.

I am no expert on brain chemistry or diet. However, along my personal journey to good health and mental well-being—these are things I’ve learned. It is with this thought in mind that I’ll attempt to answer the reader question submitted:

“What role does nutrition and exercise play in good mental health?”

Good mental health enhances our ability to enjoy life and to effectively deal with challenges. It allows us to handle day-to-day demands such as caring for ourselves and our families, maintaining friendships, working and participating in recreational or spiritual activities. It also helps us to manage the unexpected without “losing it.”

It’s suggested that good mental health is made up of a number of different markers: a person’s self-esteem, physical symptoms of psychological well-being, such as how someone sleeps, and whether a person is depressed or what their immediate mood is like. For whatever reason, physical activity can help improve all of these things, although it works differently in each person.

Improved self esteem is a key psychological benefit from regular physical activity. When we exercise, the body releases chemicals called endorphins. These endorphins interact with brain receptors to reduce the perception of pain. For example, the feeling that follows a run or a workout is often described as “euphoric.” That feeling, known as the “runner’s high” can be accompanied by a positive and energizing outlook on life.

Exercise also increases levels of serotonin, dopamine, and norepinephrine in the brain. These neurotransmitters have been associated with elevated mood, and it is thought that antidepressant medications like Prozac also work by boosting these chemicals.

Proper nutrition and diet also play a role in the mind body connection. Commonly, appetite is affected in depressed individuals, resulting in weight gain or weight loss. This can have a further impact on mood. Skipping meals can make your blood sugar fall too low, while eating starchy, sugary foods, or simple carbohydrates, such as white bread and pastries, can make your blood sugar too high. This can do funny things to a person's mood, making them irritable, forgetful or sad. Translation: sugar crash.

There is no denying that the quality of our emotional health is reflected in the physical state of the body.

Take care of yourself. To have good emotional health, it’s important to take care of your body by having a regular routine for eating healthy meals and exercising to relieve stress.

Believe me, I know firsthand how easy it is to hit a drive through on my way home from the office, rather than prepare a healthy meal after going to the gym. But, this is the phrase I am mindful of everyday: It’s about progress, not perfection.

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Sept. 17, 2009 – National Recovery Month, by Lindsey Davis

Mental Health Column

Understanding Substance Abuse and Addiction

By Lindsey Davis

September is National Alcohol and Drug Addiction Recovery Month (Recovery Month). Recovery Month celebrates the positive impact of treatment for addiction in communities throughout the nation. September is set aside to recognize the strides made in treatment and to educate the public that addiction is a treatable public health problem that affects us all. So, here goes…

Many people do not understand why individuals become addicted to alcohol and other drugs or how these substances change the brain to foster compulsive abuse. Substance abuse and addiction is often mistakenly viewed as strictly a social problem and as a result of this misperception, people who abuse alcohol and drugs are often described as morally weak.

One very common belief is that alcohol and other drug abusers should be able to just stop using if they are only willing to change their behavior. What people often underestimate is the complexity of addiction—that it is a disease that impacts the brain and because of that, stopping substance abuse is not simply a matter of willpower.

Through scientific advances we now know much more about how exactly alcohol and other drugs work in the brain, and we also know that addiction can be successfully treated to help people stop abusing substances and resume their productive lives. However, a cautionary statement should be made here – while addiction can be successfully treated and quality of life restored, addiction cannot be cured so a person struggling with an addiction issue should always pay attention to signs or triggers of a relapse.

What is addiction? It is a chronic, often relapsing brain disease that causes compulsive alcohol and other drug (AOD) seeking behaviors and use despite harmful consequences to the individual who is addicted and to those around them. Addiction is considered a disease of the brain because the substance abuse leads to changes in the structure and function of the brain. Although it is true that for most people the initial decision to use substances is voluntary, over time the changes in the brain caused by repeated substance abuse can affect a person’s self control and ability to make sound decisions, and at the same time send intense impulses to use them again.

It is because of these changes in the brain that it is so challenging for a person who is addicted to just stop abusing substances. Fortunately, there are treatments that help people to counteract addiction’s powerful disruptive effects and regain control. Research shows that combining addiction treatment medications, if available, with behavioral therapy and sober social support is the best way to ensure success for most patients. Treatment approaches that are tailored to each patient’s substance abuse patterns and any additional medical, psychiatric, and social problems can lead to sustained recovery and a life without substance abuse and its associated harmful consequences.

Similar to other chronic, relapsing diseases, such as diabetes, asthma, or heart disease, alcohol and other drug addiction can be managed successfully. And, as with other chronic diseases, it is not uncommon for a person to relapse and begin abusing substances again. Relapse, however, does not signal failure—rather, it indicates that treatment should be reinstated, adjusted, or that alternate treatment is needed to help the individual regain control and recover.

Recovery Month is a vital observance to let people know that addiction can be managed effectively when the entire community supports those who suffer from this treatable disease.

About the writer: Lindsey H. Davis  has a master’s degree in Clinical Counseling and is a licensed professional counselor, licensed marriage and family therapist, and certified addictions counselor for the state of SC. She has been in the mental health field for approximately 10 years and is proud to be one of the mental health professionals on Daniel Island.  If you have any questions, you can reach Lindsey H. Davis of Life Matters Counseling, LLC at 843-471-2215.

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Sept. 24, 2009 – ADHD and Coexisting Conditions, by Barbara Fowler

ADHD and Coexisting Conditions

By Barbara A. Fowler, MA

It is common to hear people talk about ADHD/ADD (Attention Deficit Hyperactive Disorder/ADD is the inattentive type). Is it ADHD, another condition, or both? Does ADHD exist? One reader asked, “Is there a connection between ADHD (ADD) diagnosis and comorbidity with DSM categorized mental illness?”

Children, adolescences, and adults come into my office saying:

I am always late for appointments and deadlines.

I can’t get anything accomplished.

I get so easily distracted at work/school.

I never finish anything.

It takes me so much longer to do anything.

I keep trying and trying but I never get it right.

I am so frustrated with myself.

No one understands.

I can’t seem to do the things others do.

I’m killing myself and I still can’t do it.

The first five statements are some symptoms of ADHD. Yes, ADHD exists. It is a neurobiological condition that affects the frontal lobe of the brain. The next five statements explain how someone interprets and internalizes his/her ADHD symptoms. One client, Kate, said, “If I just worked really hard I can get it right. The more I tried the more anxious I became. I still couldn’t get it right.” One-third of individuals with ADHD will have anxiety. When Claire found out she had ADHD, she said, “I’m defective. There’s nothing I will ever be able to do to be like everyone else.” Others give up before getting treatment. They don’t know what to do, they tried, and failed in their eyes. These individuals move towards depression. Depression is present with 35% of people with ADHD.

Ben, a middle school student, got so frustrated trying and trying it made him very angry. He would tell his Mom, there’s something wrong with me, I can’t control this anger. He was diagnosed with the comorbidity of Oppositional Defiant Disorder (ODD). In a few weeks with treatment Ben was back on track doing schoolwork and feeling good about himself. About 40% with ADHD have ODD. Unfortunately, Ben’s parents chose not to continue with treatment, and with academic failures, school suspensions, problems with friends, and an unstable family life, Ben was diagnosed two years later with Conduct Disorder (CD). Approximately, 35% develop CD.

Approximately 50% of individuals with ADHD have learning disabilities, 20% are Bipolar, and 7% have Tics/Tourettes.

As you hear the difficulties with untreated ADHD you can see how comorbidities develop. Often people develop anxiety, depression, ODD, and/or CD with their ADHD by how they have interpreted their ADHD difficulties. Early diagnosis and treatment can help to prevent clinical DSM diagnoses. Psychiatrists, neurologists, and psychologists diagnose. If the underlying problem is a comorbidity, then psychiatrists and therapists treat. If the underlying problem is ADHD, then coaches and therapists treat ADHD.

ADHD Coaching is about changing lives by doing: make a goal, devise a plan, and find success one step at a time. Coaching works out of strengths to accommodate weaknesses. ADHD individuals are not lazy or stupid nor is it a matter of will, intelligence, or discipline. With ADHD Coaching individuals accomplish their goals and start feeling good about themselves.

All names have been changed to protect confidentiality. All the comorbidity percentages are approximations as the research changes.

Barbara A. Fowler has a MA in Clinical Counseling, a BA in Organizational Management, and completion of an ADHD Coaching Course. She has specialized in ADHD for over 8 years, 7 in private practice in Philadelphia as a Psychotherapist and Coach and now with offices on DI and Mt. Pleasant as an ADHD Specialist and Coach. She works with children, adolescences, and adults. Barbara’s clients learn to focus on their goal whether it is academic, career, organizational, personal, or professional. She is an international speaker, writer, and consultant to schools and professionals. Barbara can be reached at 843-377-8794 or bfowler22@aol.com.

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Oct. 1, 2009 – Depression v. Sadness: What’s the Difference? By Susan West

Mental Health Series

Depression vs. Sadness: What’s the Difference?

By Dr. Susan West

According to the World Health Organization, it is estimated that 121 million people worldwide (2 percent) are currently clinically depressed. And experts estimate that, worldwide, just over five percent of men and nine percent of women worldwide will struggle with depressive symptoms sometime during their lifetime. Now clinical depression is not occasional sadness. Everyone struggles with sadness (a.k.a. the blues) from time to time. So when do the blues turn into the depression?

A reader asked, “How does one distinguish between feeling ‘down’ due to the real estate market, state of the economy and one’s overall financial well being with real, i.e., clinical depression?

This is a great question. When your sadness regarding finances last more than two weeks and significantly impacts your social, work, or academic performance; then we (mental health professionals) consider your mood clinically depressed. It is important to note that regardless of the trigger (financial, personal, vocational), the same criterion is used to differentiate between the feeling down and clinical depression.

Another reader asked, “How do you spot depression?”

This is another fantastic question! “Spotting” depression can be tricky because many of us display our sadness differently. Some people get mad and agitated others get weepy and glum. In general when trying to determine if you (or someone you know) is depressed, look for the following:

• Persistent sadness or agitation

• Change in sleep patterns-some individuals may struggle to fall and stay asleep (insomnia) others may sleep excessively (hyper-somnia).

• Significant changes in weight (usually mild depression is correlated with weight gain and weight loss to moderate/severe depression)

• Difficulty concentrating

• Increased social isolation

• Feelings of hopelessness

• Feelings of worthlessness

• Thoughts of suicide

Sometimes a person may not have many “sad” feelings however does display a host of physical symptoms such as chronic stomach aches, muscle pain, or headaches. No matter if the symptoms present in your body or in your mood, it is important to get help.

 

“…and what do you do about it?”

It is important to say – depression is very treatable. The two mental health venues for treatment are psychotherapy and medication. Many individuals may have a preference for therapy versus medication (or vice versa). Both are effective tools. Recent research has shown that the most effective way to treat depression is a combination of psychotherapy and medication.

Psychotherapy provides a platform for individual(s) to learn more effective ways to cope as well as process the events linked to his/her depression. Medication can address the biological components of the depression.

If at anytime you feel that you or a loved one is actively suicidal, please seek immediate help by going to the nearest emergency room or calling 911.

[Editor’s note: in an upcoming issue, Dr. West will continue to discuss depression, answering a reader question about Postpartum Depression (PPD).]

About the writer: Dr. Susan West has been practicing on Daniel Island since 2005. She has a special interest in providing psychological services tailored to meet needs of individual, families, and couples. Dr. West offers assessment and treatment for a broad range of areas including: depression, anxiety, adjusting to various life changes (marriage, divorce, parenthood, career change, etc.), post-traumatic adjustment concerns, academic difficulties, addictions, coping with chronic pain/health problems, body image concerns, and/or relationship difficulties. If you have any questions, please call Dr. West of Daniel Island Psychological Associates, LLC at (843) 278-5402.

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Oct. 8, 2009 – How to Make Any Relationship Better, by Scott Mohler

How to Make Any Relationship Better

By Scott Mohler

From the publisher: Today clinical psychologist and DI resident Scott Mohler continues our mental health series. Mohler is one of 11 professionals now contributing to this column.

Sometimes we take relationships for granted. Or, perhaps we rationalize that while certain relationships might be important to us, there are times when other things must matter more.

This happens in business and school, with our family and friends, as well as with everyone from mere acquaintances to total strangers whose paths we cross as we go about our daily lives. Yet, relationships are often key to getting what we want (and getting rid of what we don’t).

While there are many ways to improve relationships, there is one basic skill that is essential. Although practically anyone can use it, many people find it incredibly hard to do so when it’s needed most—and that’s listening.

Listening is a remarkably powerful skill that when done well is actually an art form. Listening not only builds and maintains effective relationships, it’s instrumental in negotiating, motivating, coaching, influencing, and developing others.

Unfortunately, many people think they are good listeners when they are not. These are the people who equate listening with keeping quiet until it’s their turn to talk. That may be acceptable etiquette, but it’s not adept listening.

Listening is actively engaging another person for the purpose of understanding their point of view and being able to convey back that understanding accurately. Effective listening requires suspending judgment about the other person and their message. This isn’t to say that you must agree with them. Instead, listening means showing genuine interest in what the other person is saying, asking clarifying questions, and summarizing what you have heard in your own words.

Too often we want to challenge or give advice or get our point across. Even though we may mean well, all these things can get in the way of building or maintaining the relationship. It can be a big mistake to assume that the other person wants your opinion let alone will be swayed by it.

If you want to influence someone’s thinking, sometimes the best way to do that is with non-confrontational, thought-provoking questions. These are open-ended questions that invite a bit of reflection and elaboration but aren’t threatening or leading. Tip: Questions that start with “how” or “what” (or even the statement, “Tell me more about that.”) are often useful. Be careful when using questions that begin with “why,” as that may put people on the defensive.

Using listening in this way, not only will you gain clarity and a better understanding of another person’s perspective but so might they! People often don’t know what they really want or believe until they talk through their surface thoughts and feelings. Some of the most potent and lasting learning comes from self-discovery—made possible by having someone there to listen and ask those questions we would never think to ask ourselves.

The most challenging part of listening is remembering that when you are talking, you aren’t doing it. And when you aren’t listening, you may be missing an opportunity to strengthen an important relationship.

About the writer:  Dr. Scott Mohler is a licensed, clinical psychologist and Senior Consultant with ORConsulting Inc., an international organization development firm. His current activities include executive coaching, leadership development, team-building, cultural assimilation, change management, and improving employee motivation and performance.  Previously, Dr. Mohler practiced as a psychotherapist for 17 years and was VP of Operations for a regional healthcare company that served the southeastern U.S. and Texas.  He can be contacted at (859) 322-1952 or scott.mohler@orconsulting.us.com. He has been a Daniel Island resident since July 2008.

 

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Oct. 15, 2009 – Why do women think the way they do? By Scott Mohler

Why do women think the way they do?

By Scott Mohler, Ph.D.

From the publisher: Today clinical psychologist and DI resident Scott Mohler continues our mental health series. Mohler’s piece is in response to the reader question: “Why do women think the way they do?”

Of course, the phrasing of this question implies that women think differently than men. And they do.

By comparison women are generally more nurturing, more cooperative, more likely to develop intimate friendships, more likely to discuss personal topics and disclose emotions, better at remembering (or not forgetting) emotional events, and less preoccupied with sex. While that statement is perhaps consistent with how females are stereotyped, it is also supported by a considerable body of cross-cultural, scientific evidence.

This does not mean that these differences exist between all men and women; nor does it mean that the differences are large or play out the same way under all circumstances. For example, while it’s true that men tend to behave more aggressively overall, women become nearly as aggressive as men when provoked by insult.

OK, some of the differences research has found are in the ways women and men behave—not, strictly speaking, in the way they think. Studies have found women more likely than men to express agreement with the majority view on things they don’t truly believe—but only when others are watching. If no one’s looking, there is no difference in conformity rates between the sexes.

This suggests that women in our society are subject to a social norm that teaches: go along to get along; whereas, the norm for men encourages more independence under social pressure. This may be only part of the story though. Studies that find men to be less influenced by social pressure are more likely to be conducted by men! Other biases may be operating here.

In addition to how cultural influences and learning may differ for each gender, there are indisputable structural, chemical, genetic, hormonal, and functional differences between human female and male brains. Certainly, our brains are much more alike than not, but importance differences do exist.

The areas of the brain that are responsible for language, hearing, and communication are larger and have more connections on average in women than in men (e.g., the insula). In addition, the female human brain tends to be larger than the male brain in those areas involved in processing and regulating emotions (e.g., the prefrontal cortex) as well as storing emotional memories (e.g., the hippocampus).

Some of the associated behavioral differences between the sexes appear at a very early age. Female babies and children are much more likely than their male counterparts to make eye contact and to prefer mutual gazing. They are also much more attuned to and skilled at understanding body language and tone of voice.

By contrast men have 2.5 times greater allocation of brain matter to those areas determining sex drive. Men also tend to have larger amygdalae, the parts of the brain where fear and aggression are triggered.

Last, but not least, are the hormonal differences that affect the thoughts, feelings, and perceived realities of both males and females. Hormones also determine differences in brain development, beginning before birth.

Given all this, perhaps it’s more remarkable that women and men sometimes think alike!

About the writer:  Dr. Scott Mohler is a licensed, clinical psychologist and Senior Consultant with ORConsulting Inc., an international organization development firm. His current activities include executive coaching, leadership development, team-building, cultural assimilation, change management, and improving employee motivation and performance.  Previously, Dr. Mohler practiced as a psychotherapist for 17 years and was VP of Operations for a regional healthcare company that served the southeastern U.S. and Texas.  He can be contacted at (859) 322-1952 or scott.mohler@orconsulting.us.com. He has been a Daniel Island resident since July 2008.

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Nov. 12, 2009 – Managing Holiday Stress, by Susan West

Mental Health Series

Holiday Stress: The Meaning of the Holidays

by Susan West, Ph.D.

Just a couple of weeks ago, my daughter innocently remarked, “I see a pumpkin. You know what that means, my brother’s birthday is soon, then it’s Halloween, then Thanksgiving, then my birthday” (she definitely emphasized her birthday in her account), “and then Christmas!”

In her quick accounting of the upcoming holiday season, I realized, she is right. The holiday season is here. Once again it snuck up on me, and I began to panic! I thought of all that needs to be done and all that I want to accomplish.

So when I got home I immediately proclaimed to my husband that I needed us to be completely moved into our new house and sitting at our table to eat Thanksgiving dinner. I provided no discussion, no explanation regarding my declaration. Now that seemed to be a quite extreme ultimatum that I presented to my husband (considering at the time we still had not finalized a closing date on our house).

Yet I began to wonder what was driving my absolute need to be settled for the holidays. Yep, the old familiar holiday stress. We all know it. We all can see if coming, yet many of us fall prey to it each and every year. It can manifest in a variety of ways.

My panic was associated with my emotional memories and needs of what Thanksgiving should be. Should is one of those words that can get us in trouble. We associate a great deal of blame, shame, and other negative emotions associated with shoulds. If we do not accomplish what we “should”, then we perceive our behavior as a failure. Holidays can have a great deal of shoulds.

I began to explore what emotional needs would be accomplished by being moved and settled by Thanksgiving. Well, my family has many special traditions, associated with the Thanksgiving holiday. Beside the abundant and delicious food (my aunt insisted on making two 25-30 lb turkeys plus every side dish you could imagine all by herself) it means family. Every year we would all gather at my aunt and uncle’s house with family and friends to cook, laugh, and catch up with one another.

Then there are all our unique holiday traditions:

• The betting pool of when we might actually eat (without my aunt knowing we are betting);

• Playing football in the yard;

• Searching and finding all the pumpkin pies. My Uncle would take all the pies (usually eight or so) and hide them through out the house, much to my Aunt’s chagrin;

• Writing down what we were thankful for (placing the notes of thanks in a basket) and before we ate, all the responses would be read. Now most of the thankful responses were very touching yet there would be always be a couple of funny ones.

After I calmed down, I began to think about my ultimatum. Being moved and settled was all about the “shoulds”. I wanted to have a perfect Thanksgiving, with the food, family, and all the traditions. I realized that it does not matter if we are unpacked or completely moved by Thanksgiving. Rather it is more about honoring the true meaning of the holiday. If I am honest with myself about our move, we won’t be able to be with my family this year and won’t have enough family here to play football. Yet, realistically, does that mean Thanksgiving will be any less special? Absolutely not! Especially if I am able to focus on the true meaning of the holiday. No matter how settled we are, I know in my heart that we will be able to share our thanks and be with one another; and that I will be fine.

As I shared my insight regarding my ultimatum with my husband, he smiled and said, “Of course we will still have to hide the pumpkin pies”. This year on my long list of things to be thankful for, first will be that I have a great husband who gets how important it is to me to hide the pumpkin pies.

Some tips to keep your emotional stress down during the upcoming holiday season are:

1) Focus on the meaning. Remember what the holiday season represents to you and your family. Don’t give in to your “should.”

2) Establish personal/emotional boundaries. Establish a plan of what you can and cannot do e.g., whether to travel, accept a party invitation, or host the family dinner.

3) Be realistic. Identify potential problems. If you have family and in-laws that both expect you to be there, you are going to have to say no to someone.

4) Communicate your needs. Having open communication about what you need and balancing your needs with others can greatly reduce disappointment and conflict.

5) Handle conflict assertively. Sometimes conflicts cannot be avoided. It might be a long standing family issue or a minor frustration. There is fine line between assertive and aggressive communication. Remember to share your concerns in a respectful manner.

6) Take time for you. In this time of giving and thanks, remember to take care of yourself. Remember that self care if not selfish, it’s self-interested.

7) Seek professional help. If you are struggling to cope effectively this holiday season, you may wish to seek the support of a professional.

About the writer: Dr. Susan West has been practicing on Daniel Island since 2005. She has a special interest in providing psychological services tailored to meet needs of individual, families, and couples. If you have any questions, please call Dr. West of Daniel Island Psychological Associates, LLC at (843) 278-5402.

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Nov. 12, 2009 – Managing Holiday Stress, by Barbara Fowler

Enjoy the Holiday that is Right for You

by Barbara Fowler, M.A.

If you are feeling stressed you’re not alone. How will you do the decorations, make meals, buy gifts, entertain friends, and travel to see family? How will you find time for meaningful experiences with family and friends or celebrate the spirituality of your holiday?

If you have been here before and tried to do it all, you’ve probably found it didn’t work. Maybe you set yourself up with “shoulds” or strived for perfection which led to feeling stressed, overwhelmed, and exhausted. You can change this by setting yourself up for success. Below are questions to help you find your goal, break your goal into manageable steps, keep it simple, and enjoy the holiday that is right for you.

Choose your goal

What is the number one thing you want from your holiday, having a party, decorating your home, meals for Christmas/Hanukkah, buying/making great gifts, giving to others in need, enjoying family and friends?

I hear it so often, “I want to do it all!” My question is, “Did it work in the past and how did it make you feel when you tried to do it all?” Identify your priority. What will make you happy? If you priority is enjoying friends and family at holidays events, you will need to insure your holiday schedule is manageable. Whatever goal you choose, follow the same steps. Choose your goal, break your goal into manageable steps, and keep it simple.

Break your goal into manageable steps

Start in November to make a plan and update it weekly as invitations and schedules change. If your normal weekly schedule is busy, is it manageable for you to accomplish all your holiday chores in two weeks and enjoy the festivities? After Allison and I broke down the time it took to shop for presents, make cookies, and travel to see family she realized she needed to start several weeks earlier. Allison said, “It really reduced my anxiety level.”

Mark your calendar with work/school/church schedules, parties, and commitments. How much free time is available? Don’t forget to factor in time to sleep. How many social events can you attend and still do your weekly schedule as well as the increased holiday work? Is it manageable for you to add to your schedule one, two, three social commitments in one week? If you overdo with parties, will they turn from fun to stress? Do you still have time in your schedule for accomplishing the other items needed for your holiday?

Keep it Simple

You have chosen your priority goal, scheduled your month, determined your free time, now let’s simplify or eliminate other responsibilities: decorating, buying presents, preparing a food basket for your church/charity. Nancy took two days to decorate her house for Christmas even though cooking was her priority. Does the decorating have to be perfect? Nancy decided she would take four hours to decorate. She put up one Christmas tree instead of two. She enlisted her daughter to help decorate the tree and her husband did the outside decorations. And she didn’t add her thoughts or change their decorations. A huge step for Nancy. This allowed her more time for cooking which is her passion.

Make lists. Identify the time it will take. Remember your goal. Maybe you could make meals a family affair. One client had each member of her family cook a different part of the Christmas dinner. Each chose their course, got ingredients, and it relieved Mom from doing everything. They decided in was their new family tradition.

Kathleen, a busy single 35 year old professional, wandered through stores aimlessly for the “right” present. She simplified her efforts and time by deciding on gifts ahead of time, when and where she would buy gifts by store name or internet, grouping errands together so she wasn’t retracing her steps from the shopping center to town and back again. She recognized the gift did not have to be the “perfect” one, but a gift she thought the person would enjoy. She also combined weekly food shopping with her charity food basket or that hors d’oeuvre for the holiday party. Kathleen found she was able to stay on task at work, get enough rest, and enjoy her holiday activities.

Enjoy the Holiday that is Right for You

The season is a difficult one. The pressures and anxieties are there from TV ads, magazines, and family expectations. This is your holiday as well. Find a goal and make it manageable are processes that help you set yourself up for success not stress. These are suggestions; pick and chose the ones that might be helpful in your life. If your stress level is lowered you will be able to give more of yourself in the way you choose. Communicate and work with your family. Ask for help from family and friends on ways to simplify. People love to share their insights.

If it becomes too overwhelming or you are dealing with other issues around the holidays, there are professionals that can help. Coaching is about doing and changing your life one step at a time. Try to make small changes in your holiday preparations so you can enjoy, find happiness, and have the holiday that you want.

Barbara A. Fowler has a MA in Clinical Counseling, a BA in Organizational Management, and completed an ADHD Coaching Course. She has offices on DI and Mt. Pleasant as an ADHD Specialist and Coach. She works with children, adolescents, and adults. Barbara can be reached at 843-377-8794 or bfowler22@aol.com

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Nov. 19, 2009 – The truth about PPD, by Risa Mason-Cohen

Mental health series

You are not alone: The Truth about Postpartum Depression

By Risa Mason-Cohen

Psychologist Risa Mason-Cohen, who has a practice here on Daniel Island, is Executive Director of the Ruth Rhoden Craven Foundation for Postpartum Depression Awareness. She also runs the PPD support groups at the Church of the Holy Cross on Daniel Island.

In the spring of 2000, a woman named Helena Bradford created the Ruth Rhoden Craven Foundation for Postpartum Depression Awareness- a nonprofit organization dedicated to raising awareness about the proper screening and treatment of postpartum depression (PPD) and providing support to the individuals and families whose lives have been negatively impacted by this illness. Helena lost her own daughter, Ruth, to PPD ten years ago, therefore this particular cause is very near and dear to her heart. Ruth Rhoden Craven had no prior history of mental illness. She took her own life at the age of 33, only two and a half months after the birth of her son. Helena started the foundation together with two of Ruth’s friends to honor her daughter’s memory and prevent similar tragedies from occurring in the future. The foundation’s mission is to impart information, offer emotional support and act as a gatekeeper for families seeking guidance, social support and professional treatment.

Approximately 1 out of 10 new mothers will experience symptoms of PPD. This illness is far more serious than the more common baby blues- a condition many new mothers experience as they acclimate to the sleep deprivation, hormone fluctuations, martial stress, lifestyle changes and the perceived loss of control that tends to go hand in hand with caring for a newborn. How does a woman know if she is suffering with symptoms of PPD, rather than a passing case of the baby blues? The answer lies in the severity and duration of her symptoms. When PPD goes untreated, the symptoms tend to worsen over time. Although a prior history of depression and a difficult pregnancy/labor/deliver can increase one’s risk for PPD, many women, like Ruth, report no prior history of mental illness and no identifiable cause for PPD.

A common thread seems to emerge as women with a history of PPD often report the following types of experiences: “My doctor told me it was just the baby blues, but I knew something felt very wrong; I felt as if I was sinking into a black hole and I could not find my way out; As the days went on I kept feeling worse; I did not even recognize myself anymore; All I wanted was for my pain to stop; I felt everyone would be better off if I were not here; I was afraid to be alone with my baby; I had no desire to hold or care for my baby.

A subgroup of women with PPD also report intrusive thoughts- highly disturbing and fleeting images that often involved a feared scenario of harm to the baby or the self. Intrusive thoughts are one of the most devastating symptoms of PPD, as women often suffer in silence with these thoughts out of fear they will be perceived as crazy or unfit to parent. In a very small percentage of cases, PPD can occur together with psychosis, where the lines between reality and fantasy become blurred. The good news is, PPD is highly treatable, and with the right medications and therapy, most women are able to make a full recovery.

The Ruth Rhoden Craven Foundation for Post Partum Depression Awareness sponsors an ongoing support group, rain or shine, on the first and third Thursday of each month at 7PM at the Church of the Holy Cross on Daniel Island. There is no charge for the groups, and the entire family is welcome. Women find enormous comfort in learning that PPD is a very real and treatable condition, they are not bad parents, and they are not alone with their suffering. For many women, the decision to attend the support group is their first step towards healing and recovery.

If you or someone you know is suffering from PPD, remember that professional help is readily Visit www.ppdsupport.org/ for more information on the Ruth Rhoden Craven Foundation for Postpartum Depression Awareness, and stay tuned to the website for upcoming details on the May 2010 Annual PPD Awareness Race, to be held right here on Daniel Island. For additional information on Postpartum Depression visit the Postpartum Support International website at www.postpartum.net and click on “Postpartum Resources” for information about seeking support in your local area.

Risa Mason-Cohen is a Clinical Psychologist with a private practice on Daniel Island. Dr. Mason-Cohen specializes in women’s issues, parent coaching and divorce/blended family issues. She may be reached for questions or comments at www.risamason.com or risa@livedreamthrive.com.

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Nov. 26, 2009 – “What’s Wrong with You?” by Scott Mohler

Mental health series

“What Is Wrong With You?”

By Scott Mohler, Ph.D.

Have you ever said (or wanted to say) to somebody, “What is wrong with you?”?

If so, you are not alone. We all feel that way at times. But you may be committing what psychologists call the fundamental attribution error (a regrettably clumsy term for a powerful phenomenon).

Fact is, the human brain is hardwired to perform various functions and does some of these remarkably well. For example, our brains are particularly adept at detecting visual patterns. When you look up at a clear night sky you don’t just see a random scattering of stars, you see various groupings—possibly including some well-known constellations that have been recognized since ancient times.

What may be less evident is that those stars that appear close to one another in the night sky may actually be much farther apart in three-dimensional space than those points of light at opposite ends of the horizon. We see a pattern in the way the stars are grouped only because of our particular vantage point (earth). From some other distant place in the galaxy the pattern would look altogether different.

Human brains are also adept at determining cause-and-effect. But as with our pattern-detection abilities, sometimes we “see” cause-and-effect when it’s not there. Have you ever tried to get an elevator to come faster by pushing the button when it’s already lit? Logically this makes little sense, but a lot of us do it anyway. (Psychologists call this superstitious behavior.)

It turns out that similar brain processes operate when we look at other people’s behavior. When I see you doing something different (especially if I don’t like it), I am inclined to attribute the cause of that behavior to something inherent to you. In other words, I tell myself you have done this thing I don’t like because of who you are. I conclude that there must be something wrong with your personality, attitude, intelligence, values, generation, race, gender, eye color (whatever). Why? Because those are the things that are most noticeable to me from my vantage point.

But when I do something different that others don’t like it’s not because of any defect in my character or who I am. It’s because of my situation. Any reasonable person would do exactly as I have done given the circumstances. The problem, I explain, is that you don’t really understand my situation.

Notice the double-standard. When you do something unpopular, it’s because there is something wrong with you. When I do something unpopular, it’s because the situation called for it. That’s what is meant by the fundamental attribution error, and it appears to be a universal human tendency.

While being aware of this common bias can help guard against it, that’s no guarantee of preventing it. Even psychologists and other mental health professionals are sometimes offenders. It is all too easy to blame undesirable client behavior on a diagnosis instead of understanding situational factors that may be involved. And when we decide that the problem is who someone is, it pretty much sabotages the opportunity for change.

About the writer:  Dr. Scott Mohler is a licensed, clinical psychologist and Senior Consultant with ORConsulting Inc., an international organization development firm. His current activities include executive coaching, leadership development, team-building, cultural assimilation, change management, and improving employee motivation and performance.  He can be contacted at 859-322-1952 or scott.mohler@orconsulting.us.com. He has been a Daniel Island resident since July 2008.

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Dec. 3, 2009 – Psychiatrists v. Psychologists, by John Pybass

Mental health series

Psychologist vs. Psychiatrist: What’s the difference?

By Dr. John Pybass

Today we welcome a new columnist to our mental health series, psychiatrist John Pybass, who explains the difference between the fields of psychology and psychiatry. Dr. Pybass, who has set up shop here on Daniel Island in the last few weeks, works out of the same office as two of our regular columns – psychologists Susan West and Lindsey Davis.

As there seems to be some confusion in the community with differentiating between the disciplines of psychiatry and psychology, I have been asked to explain and contrast the practices and backgrounds of these two professions. To begin, the two have differing degree pathways, a psychiatrist is a physician (M.D. or D.O.) while a psychologist is a Doctor of Philosophy in Psychology (Ph.D) or a Doctor of Psychology (Psy.D.)

A psychiatrist attends medical school after their completion of undergraduate or graduate education. In medical school the first two years are largely academic work including biochemistry, cell biology, gross anatomy, pathology, etc. but there are also some clinical responsibilities. The final two years involve clerkships in the various medical disciplines (surgery, neurology, internal medicine, obstetrics and gynecology, pediatrics, etc.)

After the completion of medical school, a psychiatrist completes a residency in "psychiatry." The first year is generally an internship that includes internal medicine, neurology, family medicine, and emergency medicine, but may include other disciplines. A psychiatrist's last three years of training are in psychiatry specific areas of medicine including but not limited to: inpatient and outpatient geriatric, adult, and child psychiatry, psychosomatic medicine, emergency psychiatry, forensics, addiction medicine, and psychotherapy. Generally during a residency program the physician will take "night call" for inpatient services, floor psychiatric consults, and emergency rooms at one or more local hospitals in addition to their daytime duties.

The amount of training in psychotherapy is greatly determined by the residency program attended but this component is getting more focus per national guidelines of training after many years of decline as psychiatrists moved more towards medications and a “medical model” of psychiatric illness.

Within the highly trained and specialized psychologist arena, there are several varieties of programs, including but not limited to clinical psychology, counseling psychology, educational psychology, and organizational psychology. If you are seeking assistance with an emotional difficulty you will most likely come in contact with a clinical or counseling psychologist.

A psychologist completes a traditional academic line of education with progression through bachelors, masters, and Ph.D (or Psy.D) programs. In the United States, a Psy.D is a non-dissertation, professional degree, while a Ph.D. is an academic degree requiring a significant research component and completion of a dissertation. Ph.D programs are highly selective with several hundred applicants for approximately six to eight positions yearly at any given university. Psy.D. programs are somewhat less competitive. Both degree pathways must obtain high levels of skill in individual, group, and family counseling modalities, and both receive experience in both the inpatient and outpatient setting. A psychologist generally will also obtain some training in the neurobiology basis of psychiatric disease.

A Ph.D. program will generally require more background in psychometric testing than a Psy.D. program. And both generally receive more background in testing than a M.D. Further, both will likely receive more training in psychotherapy than a physician, but this varies greatly depending on the program of study of the psychologist and the psychiatrist.

In the community I often hear, "but which one prescribes drugs?" Well, that would be a physician- a psychiatrist. There are some psychologists that are obtaining prescription privileges in some states, however because of the complexities of pharmacology and organ systems, the need for a background in the major medical disciplines, and the medico-legal liability involved, this is likely to remain extremely limited or disappear altogether.

To fairly answer the prescription question- both practitioners“prescribe”interventions, but on average, a psychiatrist will tend more towards medication with secondary attention to psychic and social interventions, whereas a psychologist will concentrate on more in-depth and explicit psycho-social prescriptions. The content of these non-pharmacologic interventions are varied with numerous schools of thought, and beyond the scope of this discussion.

Finally, the two disciplines work in concert with one another, often referring their patients between each other. An M.D. will likely request a psychologist to do psychometric testing if it is more than rudimentary in nature. A psychologist may refer a patient to a psychiatrist for medical management of a disorder while the psychologist works with the psychosocial aspects. Both disciplines will generally do some psychotherapy, though depending on the psychiatrist, they may refer a patient to a psychologist if their practice does not allow for intensive psychotherapies due to the time intensive nature of the endeavor.

About the author: John Pybass, M.D., is an outpatient adult psychiatrist, who treats affective, personality, psychotic and dementia related disorders through psychopharmacology, psychotherapy, and family/social intervention. He can be reached at 843.514.4172 or by email at pybass@yahoo.com.

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Dec. 10, 2009 – Depression, part 2, on PPD, by Susan West

Mental Health Series

Q&A on Postpartum Depression (PPD)

By Dr. Susan West

Dr. West expands on her last article on depression to provide information regarding postpartum mood disorders, in particular postpartum depression. She answers this reader question: “What are the symptoms of postpartum depression, and how long does it typically last? Can you have a mild case of it?’

As many of us know, the adjustment from pregnancy to parenthood can be difficult. The majority of new mothers will experience the “baby blues” (up to 85%). The “baby blues” are a real condition. Many new moms report feeling:

• Depressed mood

• Decreased concentration and motivation

• Difficulty sleeping (even when the baby is sleeping)

• Loss of appetite

These symptoms usually occur within 3-5 days of delivery and end around the tenth day postpartum. These symptoms are to be expected. They are due to hormonal changes, exhaustion, and sense of being overwhelmed by the new responsibilities of motherhood. It is critical for new moms to remember to ask for help and do try to not to put pressure on herself to be perfect; with a little time and rest these symptoms often go away.

Q: What happens when the “baby blues” don’t go away?

A: The “baby blues” become a depression. The depressive symptoms can become more severe and impact a new mother’s ability to function. The symptoms of postpartum depression (PPD) are the following:

• Decrease in pleasure

• Significant appetite, weight, and energy changes

• Excessive sleep or the inability to sleep

• Uncontrollable crying

• Feeling of worthlessness

• Irritability

• Hopelessness

• Social isolation

• Lack of interest in the newborn

It is normal to occasionally have any of the above symptoms here and there after childbirth. Yet if you have three or more of the symptoms and they last more than two weeks, you may have postpartum depression (PPD).

There are a couple of PPD symptoms that are more severe and more strongly indicate PPD. They are:

• Suicidal or homicidal thoughts

• Strong thoughts of harming self or baby

If you or a loved one has either of these symptoms, please contact a mental health provider immediately.

Q: When can PPD occur?

A: PPD can occur any time during the first year after childbirth. The length and severity of the symptoms vary. Approximately nine to sixteen percent (9-16%) of new mothers will experience PPD.

The good news is that postpartum depression (PPD) is treatable. The most effective treatment for PPD includes a medical evaluation (to rule out physical causes for the depressive symptoms), psychotherapy, and medication. It is important to find treatment providers that have experience treating PPD symptoms. If you have PPD, you may find joining a support group helpful. PPD support groups can provide women with PPD a place to talk to other women who are experiencing the similar struggles as themselves. There are many local support groups, in particular one meeting at Holy Cross Church on Daniel Island.

Q: Are you at risk for postpartum depression?

A: Have you had any of the following:

• PPD symptoms in previous pregnancy? Forty one percent (41%) of new mothers who have had PPD in a prior pregnancy will undergo PPD again.

• Do you have a history of personal depression and/or family history of depression, bipolar, or anxiety disorders?

• Do you have a history of severe premenstrual syndrome symptoms?

• Did you have increased depressive symptoms during your third trimester?

If you answered yes, to any of the above questions, you have an increased chance of experiencing PPD. Let your physician know about your increased risk for PPD. There are preventive measures that can be taken to minimize PPD symptoms.

A very rare form type of postpartum mood disorder is postpartum psychosis (PPP). Only 1% of women experience PPP. The symptoms of PPP are:

• Loss of touch with reality

• Confusion

• Hallucinations (usually auditory)

• Delusions (usually religious in nature)

• Severe inability to sleep

• Extreme anxiety and agitation

• Suicidal thoughts, plan, and intent

• Homicidal thoughts, plan, and intent

• Manic behavior

If you are experiencing any of the above symptoms, please seek treatment immediately.

Treatment for PPP includes medical evaluation, psychotherapy and medication. If the woman’s plan to harm herself or others is active, then hospitalization may be needed. PPP usually occurs within four to eight weeks after delivery. The duration and severity of PPP varies.

Q: What can women do to reduce postpartum depressive symptoms?

• Sleep. Poor sleep can aggravate depressive symptoms. Although it is difficult to have a “good” night’s sleep with an infant in the house; when possible try to nap when the baby is sleeping.

• Get out of the house. Try to leave the house at least once a day. It will reduce your social isolation. It will force you to get dressed and interact with others.

• Take time for yourself. Even if it is for 15 minutes, make sure you have some alone time to do something just for you. Some great examples are: take a bath, shower, take a walk, make a phone call, sit on the porch and read, etc.

• Reach out to friends. Often with depressive symptoms, people have a tendency to isolate. Tell friends that you are having a difficult time and let them know what you need.

• Accept help. It can be challenging to ask and/or accept help from others yet it important to rely on others when you are struggling. If a friend offers to cook you and the family dinner. Say yes!

• Realistic expectations. Do not believe that you have to be a “super” mom. There are no “shoulds” in parenting.

Q: What about the dads?

A: I have spent a great deal of time talking about the women who struggle with postpartum depression (PPD). What about the dads? How does all of this impact them? Well, the birth of your child is generally met with excitement. Yet with all the excitement there are many new responsibilities. When your partner has postpartum depression (PPD), these responsibilities may seem daunting.

PPD can be difficult to understand. It is not something you can see or measure. You may be frustrated that your partner seems unable to take care of herself and/or the baby. You may feel alone, scared, angry, or all theses emotions combined. It is important that you get help assistance too!

Often moms with PPD get support and help, yet the dads seem to be on the sideline. Don’t be shy to ask for help from friends and neighbors for babysitting, cooking, or just listening. Make sure there is time for you to talk to friends about what you are going through. This might mean letting others know that you are struggling too.

Get involved in your partner’s treatment. Ask her psychologist, psychiatrist, or other mental health provider what you can do to help. Also let them know what is going on from your point of view. It is also important that you have someone to talk to about what you are going through.

About the writer: Dr. Susan West has been practicing on Daniel Island since 2005. She has a special interest in providing psychological services tailored to meet needs of individual, families, and couples. Dr. West offers assessment and treatment for a broad range of areas including: depression, anxiety, adjusting to various life changes (marriage, divorce, parenthood, career change, etc.), post-traumatic adjustment concerns, academic difficulties, addictions, coping with chronic pain/health problems, body image concerns, and/or relationship difficulties. If you have any questions, please call Dr. West of Daniel Island Psychological Associates, LLC at (843) 278-5402.

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Dec. 24, 2009 – Adolescent Suicide – on the rise? By Cherie Tolley

Mental health series

ADOLESCENT SUICIDE – ON THE RISE?

By Cherie D. Tolley

Our mental health series continues with a column crafted by Cherie Tolley, CEO of Palmetto Behavioral Health. Today she tackles adolescent suicide. Her next piece will discuss the stigma of mental health disease.

It is hard to imagine that a child or teenager would be in so much emotional distress that ending their life is a viable option. After all, supposedly our high school and college years are the best years of our lives! Is that really the case?

I know I am very happy to have survived adolescence and would not want to be a teenager again. During adolescence every problem or situation seems much bigger than it really is – something I refer to as the “drama effect” of adolescence. Consider the normal stressors every teen faces: peer pressure, competition for college acceptance, boyfriend/girlfriend issues, substance abuse, bullying (cyber and face-to-face), family concerns, being accepted – the list goes on. Too often adults tend to discount or minimize the impact these problems have on their teenager. From a purely developmental standpoint, the normal adolescent still lacks the ability or maturity to effectively problem solve, make sound decisions, or understand the emotional rollercoaster of raging hormones. Also, most youth typically live in the moment without considering the impact of their actions or decisions long term. Given all these factors, it is understandable that suicide is the third leading cause of death among adolescents in the United States!

No parent wants to consider that their child is so unhappy or distressed that suicide would be an option. It is difficult for parents to separate fleeting times of sadness from actual clinical depression. As is often the case with substance abuse in adolescence, many parents are in denial that their child would ever consider suicide. According to research from the Substance Abuse and Mental Health Services Administration (SAMSHA) and The National Institute of Mental Health, for every completed suicide, it is estimated that there are around 25 suicide attempts. Studies show that in approximately 4 out of 5 suicide attempts there were warning signs that were missed. Some of those signs include:

• Disinterest in favorite extracurricular activities 

• Problems at work or home and losing interest  

• Substance abuse, including alcohol and drug (illegal and legal drugs) use

• Behavioral problems 

• Withdrawing from family and friends 

• Sleep changes 

• Changes in eating habits 

• Begins to neglect hygiene and other matters of personal appearance 

• Emotional distress brings on physical complaints (aches, fatigues, migraines) 

• Hard time concentrating and paying attention 

• Declining grades in school

• Loss of interest in schoolwork 

• Risk taking behaviors 

• Complains more frequently of boredom 

• Does not respond as before to praise

• Giving away personal belongings to friends or family members

It is essential that adults pay attention to these warning signs and not dismiss them. Most youth who attempt or complete suicide have told someone they were considering it. Parents, teachers, coaches and friends are in the best position to notice the warning signs. Don’t be afraid to talk with your teenager about the subject. Ask their opinion about the subject – is it something they would ever consider or have they ever thought about it? Make sure they know they can always talk to you about problems they are experiencing. Don’t discount their feelings, even though their feelings or thoughts may not seem rational to you. Remember, adolescence is by its very nature not a time of rational thought or behavior, so keep an open mind and a keen eye on the potential warning signs.

If you are concerned about a teenager, don’t keep your concerns to yourself. Share your concerns with their parents, teachers, or another adult who may be in a position to get help. If you are the concerned parent, get help for your teen. Don’t ignore the signs. Teen suicide is a very serious, real problem in our society. Your willingness to listen, observe, and pay attention to the signs may just save a life.

For more information on teen suicide visit The Jason Foundation website at www.jasonfoundation.com. You may also call 1-800-SUICIDE (784-2433) if you know someone at risk of suicide. Teen Suicide Warning Signs Main Source Material: “Teen Suicide.” Ohio State University Medical Center. Ohio State University. [Online.]

Cherie Tolley has served as CEO for Palmetto Behavioral Health since August 1, 2007. She leads a three facility behavioral health care system totaling over 260 beds. Ms. Tolley joined Palmetto Behavioral Health in 2002 as the lead administrator for Palmetto Pee Dee Residential Treatment Center.

Since 1977, Tolley has held numerous positions in the mental health field, having served as a social worker in both South Carolina and California; Program Director for the Berkeley Community Mental Health Center and for the South Carolina Continuum of Care; Clinical Director for Willowglen Academy in Greeleyville, SC and as a private consultant. Over the years, Tolley has served on several advisory councils related to children’s services and mental health issues. A graduate of the University of North Alabama, she holds a Master’s Degree in Clinical Counseling and Counseling Education.

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Jan. 14, 2010 – Understanding your teenager, by Barbara Fowler

Mental Health Series

Understanding Your Teenager, and the Teen Brain

By Barbara Fowler

Our mental health series continues today with advice from Barbara Fowler, who responded to this reader request: “Teenagers can’t determine speed well, don’t realize consequences, etc. Get some research on it.” Fowler talks about the adolescent brain as well as how parents can work with their teenager.

Teenagers are some of my favorite people. Fifty percent of my clients are teenagers. They are fascinating! The majority of their personality style has psychologically developed. The older teenager is usually the person he/she will be in adulthood. Yet, family life can be stressful for everyone. When the child was younger parents used to be able to direct, reason, and/or control their child’s actions and behaviors. During adolescence it can be extremely difficult to make a teenager do something he/she doesn’t want to do.

Hallowell and Ratey, two child and adult psychiatrists from Massachusetts call family life with teenagers the “big struggle.” It is like a war on different fronts: attitude, homework, chores, and cooperation. Teenagers seem intelligent, well spoken, academically accomplished, socially aware, and then they misplace things, aren’t logical, can’t follow simple directions, and make poor decisions such as texting and driving. Below are some studies that help explain the teen brain.

Research studies reported by the National Institute of Health say MRI’s (magnetic resonance imaging) indicate that the frontal lobe of the brain is not fully developed until young adulthood. The frontal lobe is responsible for “executive function” which regulates planning, organizing, making decisions, paying attention, managing time, and remembering details. In some areas your teenager is not “connecting the dots” well. He/she may be driving the car, talking with friends, listening to music and not focusing on the speed limit.

The teenager is trying to make decisions but the executive function is not working efficiently. Therefore, teens may ask friends for advice, take longer to make a decision, or act without completely thinking through a situation. If a teen is feeling pressure or stress in a situation, a teen might become frustrated, angry, or retreat to his/her room, computer, or cell phone. He/she may be trying to deal with the situation but become overwhelmed and give up.

Other MRI studies from Harvard Medical School reveal that the teenage brain is fast growing but sections remain unconnected. Dr. Jensen, a professor of neurology says, “These people have very sharp brains, but they’re not quite sure what to do with them.”

Dr. Corey talks about Erikson’s Stages of Development for ages 12 to 18. Erikson says it is a time of transition between childhood and adulthood. Corey describes this as teens testing limits. During adolescence teens clarify their self-identity, life goals, and life’s meaning. This is a positive and essential process for teenagers.

While your teenager is going to school, doing homework, connecting socially, joining sport teams, participating in clubs, doing volunteer work, he/she is also trying to achieve a sense of self-worth personally, with his/her friends, and with his/her community. It sounds overwhelming for the teen. Below are some ideas that can help the parents and family.

Acknowledge strengths Positive Psychology came from the University of Pennsylvania and is also the groundwork of Coaching. One way of focusing on the positive is by enumerating your son’s/daughter’s strengths and talents on a regular basis. Strengths are adjectives such as: accommodating, adventurous, affectionate, alert, artistic, authentic, capable, careful, cheerful, confident, considerate, determined. In coaching I start by identifying a person’s strengths from Fowler’s list of 150 adjectives.

The number of times a parent reinforces strengths or talents should be greater than the number of times a parent teaches or corrects behavior. Research shows reinforcing positive strengths of your teenager increases his/her self-awareness, self-esteem, motivation, and the positive relationship between parent and son/daughter.

Let go It is a fine line which will change according to your teen’s needs and behaviors. At this point in his/her life, home is your child’s safety net. It is a great time to let go. Parents are still there, but giving your teenager some power, control, and freedom to make choices (with boundaries) in his/her life and still be safe. If things aren’t working well at school or with friends they know they can come home, be loved, cared for, and talk if they choose.

Set Boundaries Rules help your teen. Expect your teenagers to test the rules, but let them know what is expected in your home and the consequences. Schools have rules and consequences. Usually students know and follow them. Parents can ask other families their rules and decide what is realistic.

Be Consistent The truth is: consistent consequences do work. If necessary, reinforce with your son/daughter the consequence of breaking a particular rule beforehand. Make the consequence reasonable and follow through. State the rule and the consequence as though you were a State Police Officer giving a speeding ticket. It is said directly and without emotion. It takes practice to give a consequence without an emotion.

Pick Priorities In order to be consistent, parents might need to limit their focus. Choose several priorities that are important for your family and be consistent. Parents cannot be on top of everything all the time.

Have Fun Enjoy your teenager. You have instilled in him/her your values and priorities. Fun and enjoyment are basic concepts for human motivation. As your teenager grows into adulthood, motivate him/her to be the person he/she wants to be. Find activities that everyone enjoys. Ask for suggestions from your teen. Have fun and enjoy your time with your teenager.

Barbara A. Fowler, M.A. works with children, teens, families, and adults. In Philadelphia she was in private practice for over 7 years as a Psychotherapist and Coach and for over 1 year has continued her work in Charleston as a Coach with offices on DI and Mt. Pleasant. Barbara is an international speaker, writer, trainer, consultant to schools and professionals. Her areas of expertise are: academic, career, organization, relationship, personal, executive, and ADHD coaching. Barbara can be reached at 843-377-8794 or bfowler22@aol.com.

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Feb. 4, 2010 – Cooperative parenting, by Risa Mason-Cohen

Mental health series

You are Still a Family: Cooperative Parenting after Separation and Divorce

By Risa Mason-Cohen

In my private practice I have treated many families in the midst of separation/divorce. Although such cases tend to vary dramatically in terms of the unique circumstances involved, there is one common denominator- the children are the most vulnerable victims. The extent of emotional damage inflicted on children in high conflict separation/divorce situations is directly proportional to the level of anger, bitterness and resentment harbored by the parents. I am a strong advocate of the old adage, children are better off in a broken home than a home that is broken but I would like to qualify this notion by adding, only when the parents are able to behave appropriately by taking the emotional needs of the child into account. Children identify with both parents. When one or the other parent falls under attack, the child perceives it as personal assault and a painful loyalty bind.

Many people fail to realize that whether they like it or not, the family system does not cease to exist simply because the divorce papers are signed. One of my favorite things to teach young patients is that they are still a family and always will be even after a divorce is finalized. It really does take a village to raise a child. When parents behave in a vengeful, immature and vindictive manner towards one another they deny their children a healthy sense of stability, continuity and personal identity. The greatest prognostic indicator of long term emotional adjustment in children following divorce is the quality of the relationship between the parents. Even in cases where one parent cannot be physically present due to geographic location or restrictions on custody/visitation, consistency goes a long way and the quality of the time spent together is often more important than the quantity.

Consider a young child who looks forward to Wednesday night sleepovers at dad’s place each week. The child anticipates the visit; perhaps he even tells his friends or teacher about it and he is able to prepare himself emotionally for the transition between households. Now consider a child who lives in a perpetual state of inner turmoil, never knowing when he will see or speak with dad again. This child will very likely suffer the emotional fallout of sudden unanticipated encounters and anxiety provoking transitions characterized by intermittent reunions and separations. Young children who are left wondering when and how they will see mom or dad again often exhibit symptoms of anxiety, depression, grief or even full blown panic. I often recommend that parents purchase a large month-at-a-glance desk calendar to help children conceptualize-often with the help of multi- colored markers- the revolving visitation schedule. For example, green days are spent with mom and red days are spent with dad.

Even in the healthiest cases of amicable divorce where both parents behave in a calm, respectful and cooperative manner and manage to co-parent effectively for the benefit of the children, transitioning between two separate households can still be quite stressful for young children. The level of stress involved tends to be directly proportional to the age and temperament of the child, with younger children and highly sensitive/fearful children requiring more nurturing and preparation. It is helpful for parents to evaluate the individual needs of each child based on age and temperament and adjust accordingly.

First and foremost, parents should strive for consistency and continuity during times of family transition and reorganization. Children tend to be highly resilient and adaptive but even so, healthy emotional adjustment is supported when there is minimal disruption of daily schedules and activities. I have seen parents arrive at many creative ways to manage the transition, from designated weekdays and rotating weekends to the common joint custody scenario of one week on, one week off. It does not matter so much the type of schedule, as long as it is consistent and predictable and tailored to meet the unique emotional and chronological needs of all children involved. A very young child might not be emotionally prepared to handle an overnight visit at dad’s new home. I like to advise parents to take baby steps towards the ultimate goal, for example, several weeks of dinner with dad after school followed by a full weekend day with dad and finally, spending the night. Some children find comfort in bringing along a favorite toy or familiar object when transitioning between homes, for example a favorite blanket or stuffed animal. Ideally, the child should have a safe space of his own at the new home such as a bedroom or loft area where he can leave personal belongings and even decorate if possible. Older children and adolescents benefit from continued participation in the same extracurricular activities and hobbies they enjoyed prior to the separation/divorce, as this provides a sense of continuity and healthy social interaction.

In high conflict cases where anger and resentment prevail, parents tend to cling tightly to formalized visitation schedules. Such rigidity is rarely good for the children. For example, perhaps dad always attended soccer practice on Wednesday evenings but Wednesday is now mom’s designated day. In a cooperative parenting relationship this problem is easily resolved because both parents are equally committed to tolerance, compassion and flexibility for the benefit of the children. Dad and child enjoy soccer practice followed by a fun pizza dinner, the child is delivered safely back to mom’s home later that evening and everyone is happy. Similarly, perhaps mom is hosting out of town relatives for a special family reunion but the event falls on dad’s designated weekend. In a cooperative parenting situation, dad is happy to swap out weekends with mom to allow the children to visit with extended family and everyone benefits from the exchange.

In cases of high conflict divorce the emotional needs of the children are forgotten as parents compete for a sense of power and control. Most parents love their children and yet, in cases of high conflict separation and divorce the children are lost inside a blinding storm of unrelenting anger, bitterness and resentment. When I sit across from parents in my office, look them in the eye and ask if they would willingly place their beloved children directly in harm’s way, the answer is always a resounding no. There are very few parents in the world that would intentionally cause harm to their children, however periods of anger and rage render people temporarily insane and divorce is no exception. The good news is that it is never too late to reverse the damage. Even if one parent refuses to change, the other (healthier) parent can choose not to engage with the bitterness. When one parent learns to resist provocation and remain calm, grounded and centered, the other parent is left with a one sided battle and the raging storms of destruction eventually begin to clear. Why not quiet the storm and calm the child? It is a small price to pay for the return of a child’s smile. When the clouds part and the fog of anguish finally lifts that smile will shine brighter than the golden sun.

Risa Mason-Cohen is a Clinical Psychologist with a private practice on Daniel Island. She specializes in women’s issues, parent coaching and divorce/blended family issues. She may be reached for questions or comments at www.risamason.com or risa@livedreamthrive.com. You may also follow Risa’s columns at www.charelstonmercury.com.

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Feb. 11, 2010 – The Art of Giving Feedback by Scott Mohler

Mental health series

The Art of Giving Feedback: It’s All About the Relationship

By Scott Mohler, Ph.D.

One of the toughest things to do is to give feedback to someone to get them to change their behavior. It doesn’t matter whether you are a parent, partner, friend, manager, teacher, coach or therapist. It is hard giving corrective feedback in a way that it can be heard and accepted.

Sometimes, it doesn’t matter how good your intentions are. There will be occasions when it all goes in one ear and out the other, or worse, it blows up in your face—causing hurt feelings and an even greater resistance to change.

When this happens, the temptation for both the giver and the receiver of the feedback is to blame the other person. We tell ourselves that there must be something wrong with the other person for acting this way. If we are the giver, we say the other person is too difficult or defensive. If we are on the receiving end, we see the giver as too demanding or critical. Either way, we see the other person as the problem and lose sight of the behavior.

Therein lies the key to what’s wrong. It’s the relationship that’s not working, and when that’s the case, there is almost no way for feedback to have a positive impact. Even the most heartfelt compliment will sound like phony baloney when the relationship is in trouble. And by the same token, there’s miniscule chance that a “helpful suggestion” will be heard as anything other than finding fault.

On the other hand, when the relationship is strong and working well, there is a great deal more latitude. We are much more forgiving about the exact words that are used, the tone of voice, body language and most of all what the concern is. In short, if you want me to care about what’s important to you, then I need to know you care about me to a degree I think is appropriate for our relationship (e.g., as a family member, friend, employer, etc).

That doesn’t mean you have to care about me above all else for all time. It does mean that at this moment you genuinely value me despite what you think I may need to change. It also means that you have enough respect for me to look at this issue from my perspective and will try to understand what I think, how I am feeling, and what I want.

It also doesn’t mean that I won’t be satisfied until things are done my way. There is interesting psychological research that shows it is sometimes more important for people to be heard than for them to get monetary justice. In one study participants were given the option of either having their day in court (literally) but thereby forfeiting compensation or receiving a small financial incentive in exchange for silence. Most chose to forego the monetary award in favor of having their say.

So the next time you have difficult feedback to give, consider your relationship with that individual and whether that needs to be the real focus of your concern.

About the writer:  Dr. Scott Mohler is a licensed, clinical psychologist and Senior Consultant with ORConsulting Inc., an international organization development firm. His current activities include executive coaching, leadership development, team-building, cultural assimilation, change management, and improving employee motivation and performance.  He can be contacted at 859-322-1952 or scott.mohler@orconsulting.us.com. He has been a Daniel Island resident since July 2008.