Drinking, Drugs, and Your Teenage Child

Group Of Teenagers Drinking Alcohol In Bedroom

Do you worry that your child may be drinking, smoking pot, or using other drugs? “Drugs and alcohol don’t discriminate,” says Vanessa Walker, a therapist who has years of experience working with young people.  “It’s a way to socialize, and it can ease the way for kids who have difficulty making friends.  This includes kids with autism spectrum disorders.”

Parents should be alert for unexplained changes in their teenage child’s behaviors or habits.  “Do they seem to have a new group of friends? Are their grades dropping? Do you notice the odor of alcohol or marijuana, or other physical signs?” It may be time to have a difficult conversation, “Hopefully one without judgment,” where you as a parent ask the tough questions. Young girl wearing leather jacket smoking a joint

Rather than becoming angry or threatening, Ms. Walker reminds us, it may be more helpful to ask, “Are you willing to talk to someone about it?” Therapy works best if the teenager agrees to it, but the situation may be serious enough that you decide to make it non-negotiable.

When she sees teenagers in therapy and learns they have been using alcohol or other drugs, Ms. Walker is able to help kids by showing that she understands.  She uses a technique called  “motivational interviewing” as a way to help them figure out how the substance abuse “gets in the way of their own goals.”

Vanessa Walker, LSW has worked for a number of years for the Delaware County Office of Mental Health, where she has conducted drug & alcohol education programs, counseled families, trained staff, and managed other community mental health programs.  In September 2015, she’ll be starting a new career as Chichester Middle School’s school social worker.  She also has weekend and evening hours at Psych Choices of the Delaware Valley.  To make an appointment with Ms. Walker, please use our Make An Appointment page or call 610-626-8085, Ext. 213 for Intake.

Reflections on Grief and Loss

Winter nature, alley in park, snowstorm

Bereavement is about loss… of any kind. Loss of a pet, home or job, health, friendship or romantic relationship. Loss is such a pervasive part of life that it challenges our basic assumptions. When what we hold dear is no longer certain, our ability to trust may be shattered. The challenge of restoring balance in life and a renewed sense of purpose can be daunting.

Let us focus on loss of life ­­in particular, that of loved ones… family members, children, parents, or friends. To lose another can be an experience in losing a part of oneself, or alternatively, an occasion for deepened self knowledge. The capacity to listen to our internal experience calls on a different relationship with oneself. I call this inner way of knowing… ​discernment. ​ Bereavement work is ultimately about discerning a new truth.

Experiencing the death of a loved one may provoke extreme emotions: ­­ fear and anger, shame and helplessness, sadness and loneliness, abandonment and isolation. These emotions may keep us from being fully present with a loved one in the last moments of life. Sadness and regrets make it difficult to find peace and rest, or to feel complete in our goodbyes.

Too often, our best efforts get derailed by newly ignited family conflict, or revelations of once tightly­-guarded family secrets. All of our basic insecurities about feeling loved and valued in our families of origin come into finer focus. Translate these feelings of vulnerability onto one’s life partner and/or children, and there is more room for confusion and hurt.

Finally, a recent loss can trigger memories of prior losses ­­often unresolved, or never fully grieved.

boardwalkIn my approach to bereavement counseling, I bear witness to your experience of loss: ­­how it was shaped by your relationship with the deceased, and how that absence compels the start of a new story. I view the client-­therapist relationship as a container for rebuilding safety and healing. I encourage clients to become progressively more self­-directed at pacing the content and timing of themes explored in session. I, in turn, modulate the intensity of exposure to difficult feelings such as ­­anger and rage, hatred and animosity, jealousy and resentment,­­ gently coaxing or slowing down storms of raw emotion. This is an ongoing process that restores wholeness and trust in life, and allows one to take ownership of his/her story with renewed hope. I do this work weaving a variety of approaches informed by my professional training, spirituality, and life experiences that enable me to help restore wholeness and peace for the bereaved.

Dr. Elanah Naftali, the author of this article, is a licensed marriage & family therapist who sees clients at Psych Choices of the Delaware Valley in our Haverford office.  To make an appointment with her, please use our Make an Appointment page.

A New, Interactive Approach to Psychological Testing

8 years old school girl wearing glasses holding tablet pc

Psychological testing, which used to be extremely time-consuming and costly, has entered the digital age.  “Interactive” testing via iPad is now available.

History of Psychological Testing

“IQ testing”, for measuring “intelligence” or cognitive abilities, began in this country after the turn of the last century.  Americans have always been a pragmatic people, sticklers for precision and for measurement in an effort to make psychological processes and functioning more tangible.  In Europe at that time, Sigmund Freud had invented the “talking cure”, or the therapy method called “psychoanalysis”, that many considered to be a very subjective process.  Psychoanalysis also found its way to America, but there was another complementary movement in this country toward objective measurement of psychological processes.

One example of this trend was employed on a large scale with the testing of soldiers recruited to fight in the First World War.

Monument to the Heroes of the First world war. Kaliningrad (formerly Koenigsberg), Russia

This may have been the first instance in which psychological methods and tools were utilized to support the need to build a better organization (supposedly by screening out those recruits believed to be inappropriate for enlistment).  After that initial effort, most formal psychological testing was associated with schools and education, and today, it is strongly associated with learning problems, Special Education, and the determination of learning disabilities.

Psychological Testing: the Old, Paper-and-Pencil Way

As a psychologist who has spent 15 years completing these formal school evaluations, I can tell you (and I think parents would tell you), these evaluations are massively time-consuming, requiring months of work before the people who want and need the results get the chance to consider them.

Answer sheet with pencil

An enormous amount of time goes into completing a report.  In my experience, over the years it seems that these reports have been getting longer and longer: once a 10 page report was considered to be too long-winded.  Now it’s not unusual to see reports that are 20 and even 30 pages long.  Professionals in the field of psychology seem to have adopted the belief that if they explained their results more, their evaluations would be more appreciated and valued.

Surely, a 30-page report on a single child or adult is overkill.  A lot of the time that is spent cranking out a report could be better utilized applying professional skills and experience to mulling over, thinking about, meditating on the test results in conjunction with other observational data and feedback that is usually provided for these formal evaluations.

Compared to the lengthy amount of time it takes to get the results of a psychological testing, medical test results are returned with blazing speed.  With the long wait for results and many other factors, psychological testing continues to be viewed with a lot of skepticism, and even with suspicion.  It is right to wonder if the time and the cost are really worth the end result?

Psychological Testing: the Interactive, Online Way

In the last few years, one of the big psychological testing companies (Pearson) started adapting their tests for administration using Apple iPads.  They adapted a relatively large number of the most frequently used psychological tests for a psychologist to administer using one iPad, and for the test-taker to take the test with another iPad, connected to one another by Bluetooth.  In addition to the enormous potential for increased convenience associated with managing test materials using this technology, the application provides the capacity to get the test results quickly and conveniently because the scoring can be done automatically as each subtest is completed.

With the new iPad administration (called “Q Interactive”), anyone who can use and benefit from this type of information can have quick access to the results.  Test scores are presented in a standard format (in tables), along with a brief interpretation of the meaning of those scores.  That should be enough to answer the question: What do the test results mean to the person who was tested?

Psychological testing can measure many types of mental function

Psychologists often start testing with a measure of verbal abilities (associated with the use and understanding of language), as distinguished from non-verbal, or perceptual reasoning abilities (which most people associate with hands-on tasks).  This type of testing is usually thought of as “IQ testing” but encompasses much more than that implies.  In the digital world in which we live,  the things that we do require a combination of these verbal and non-verbal mental functions and abilities, a combination of thinking and doing.

Another priority of testing is to measure some of the supporting mental functions, including memory, attention, and rates of information processing.  Measuring these supportive functions is especially critical in diagnosing attention problems and ADHD.

It may be useful to think of psychological testing as a process that often confirms what is already suspected.   A doctor might strongly suspect that you have any number of physical ailments, like a broken bone, but no matter how certain, an X-ray will be ordered.

Just as a psychological test might confirm a suspected problem, testing can be very helpful in ruling out psychological issues.    For example, take a teenager who is experiencing a lot of conflict with his or her parents and is not completing school work.  Testing results might show that this child or teenager had significant problems with attention or memory that negatively impacted on learning.  Tests can also measure other aspects of the teen’s personality, including his or her social or emotional functioning.  Perhaps tests reveal that this teen’s development, socialization, and even academic achievement is normal, or typical of peers.boy in detention

This is not an uncommon situation.  Many people with a behavioral disorder, like ADHD, might be relieved to find out through testing that their learning problems and attention issues have nothing to do with an emotional problem, or a failure to develop relationships, or to understand ideas and gain knowledge.  Testing can distinguish between problematic and non-problematic areas of mental functioning.

Why Do Testing?

In some cases, testing may be suggested by teachers or employers.  In other cases, a psychiatrist or therapist may request help from a psychologist who uses testing to confirm or rule out a diagnosis. Often, the patient him- or herself may wish to confirm or disconfirm what others have suspected or other professionals have diagnosed.

For example, many children and adults are suspected to have or are referred to see if they have the diagnosis, Attention Deficit Hyperactivity Disorder (ADHD).  Various standardized tests and observational rating scales can go a long way to demonstrate the validity and severity of such a diagnosis, as well as the type of ADHD.

Psychological testing can also help to diagnose dementia (such as Alzheimer’s Disease), or brain damage from an injury.  Currently, there is much concern about the prevalence of concussions, especially in school-age children.  While specific concussion testing (often done by a medical doctor) is good for measuring performance parameters, these are superficial measures when compared to the range of functions and the strengths and weaknesses that can be assessed by formal psychological testing.

For academic purposes and learning problems, schools generally want to see a full battery of tests on their students, but partial batteries may supplement the school’s evaluation by confirming, challenging, or updating the results.  When a pediatrician refers a child or adult for testing, it’s likely that they are seeking to support their own assessment needs with objective test data and other information from outside the environment of the doctor’s office.  The same would be true for physicians who are treating patients who are suspected of suffering from depression or anxiety, or children who are exhibiting unusual behaviors, such as those seen in Autistic Spectrum Disorders.  Therapists, counselors, and other clinicians might be able to profit from information provided by partial batteries of testing that target specific areas of concern, like cognitive functioning, memory, attention, or executive functioning.

Testing at Psych Choices of the Delaware Valley

Charles Gallagher, PsyD

At Psych Choices, psychological testing is now available through the state-of-the-art, innovative Q-Interactive technology.  If an entire testing process or full battery is needed, I estimate that it may be completed in about 4 hours, and  the results can be analyzed and presented in a report within one week.

Unfortunately, psychological testing is rarely covered by insurance.  The cost will depend on the specific tests administered, but it is estimated that a full, formal evaluation will generally range from $500 to $700.  In some cases, your insurance company may reimburse some of the cost of testing; you can call them ahead of time to find out if this is an option for you.

To make an appointment for Q-Interactive psychological testing by Dr. Charles Gallagher at Psych Choices, please use our Make An Appointment page or call the Intake Coordinator at 610-626-8085, ext. 213.

Hoarding, Compulsive Shopping, and Overwhelming Clutter

When does a cluttered house become a mental health problem? When is a collection no longer a hobby but a compulsion, or a health hazard?

messy room

If you are concerned about your own or a loved one’s collecting, compulsive shopping, cluttering, or hoarding, you are not alone. Dr. Randy Frost, a world-renowned expert in the subject, tells us that that as many as 1 in 20 Americans  have serious problems with hoarding. Still others have trouble with compulsively buying things they do not need or even want, while others are chronically disorganized and may have difficulty with daily tasks because of their inability to keep track of notes, documents, bills, or possessions.

Hoarding becomes a “disorder” when it prevents normal use of living space, causes significant distress to the hoarder and/or family members, and has a negative impact on health and safety.

People may hoard food (long past its expiration date), clothing, packaging materials, or animals – even when the number of animals makes it impossible for the animals themselves to stay healthy.  Hoarders may become isolated, when family and friends begin to avoid visiting them.  Homes may become unsanitary or dangerous because of blocked exits or falling objects.  Often, the person who is hoarding becomes depressed, and yet seems to be unable to part with their “collection” or even to admit it has become a problem.

Treatment for hoarding, compulsive shopping, and chronic disorganization is available, but a complete “cure” can be hard to find.  Often, what we can best hope for is to create safer and more sanitary conditions, in order to reduce harm to the person and their family.

What we know doesn’t work is a forced cleanup.  It will be far more effective and safer to gradually help the person to agree to the need for change.  If they are forced to clear out clutter, or someone does it without their permission, they may become extremely upset and refuse further help.  And the hoarding is likely to begin all over again.

A psychotherapist can help guide the individual and family members to take gradual steps to reduce clutter.  The therapist will usually take a very practical approach to changing behavior, and try to help the person begin to challenge their own thinking patterns.  They will help the person set small goals and accomplish them one by one. Psychiatrists can also prescribe medication that may help with the depression, anxiety, and obsessive-compulsive symptoms that are typically associated with this condition.

Often, a professional organizer can visit the home and provide one on one support as the hoarder begins to organize and part with possessions. There are also support groups and 12-step programs for those with hoarding, cluttering, and compulsive shopping problems.

Several of the providers at Psych Choices of the Delaware Valley have been trained in the treatment of hoarding disorder and related conditions. To make an appointment, please use our Make an Appointment page or call us at 610-626-8085.

Online resources:

http://hoarding.iocdf.org/hoarding/

http://theshulmancenter.com/

http://psychcentral.com/lib/10-things-you-should-know-about-compulsive-hoarding/0006787

Books about hoarding:

Stuff: Compulsive Hoarding and The Meaning of Things by Randy O. Frost and Gail Steketee

Cluttered Lives, Empty Souls: Compulsive Stealing, Spending and Hoarding, by Terrence Shulman

Buried in Treasures, by David Tolin, Randy O. Frost and Gail Steketee

Overcoming Compulsive Hoarding, by Jerome Bubrick, Fugen Neziroglu and Jose Yaryura-Tobias

Digging Out: Helping Your Loved One Manage Clutter, Hoarding, and Compulsive Acquiring, by Michael A. Thompkins and Tamara Hartl

It’s All Too Much: An Easy Plan for Living a Richer Life with Less Stuff, by Peter Walsh

Support Groups and Community Programs:

The Philadelphia Hoarding Task Force http://www.philadelphiahoarding.org/

Clutterers Anonymous – 866-402-6685; www.clutterersanonymous.net

Facing Mortality

graveyardYou watch the news: An earthquake in Nepal suddenly claims thousands of lives. You receive a phone call: Someone close to you has been diagnosed with cancer. Facebook suggests an old classmate as a friend for you – but you know she passed away last year. You look at the calendar: too soon you will turn 50, or 60, or 70. You visit a parent’s grave, and surrounded by headstones, reflect on how short life is.

How do we face the knowledge of our own mortality? Whether we are young or old, sick or well, it is hard to avoid the reality that life ends, and we cannot know for sure how long or how short our lives will be. We all hope to bury our parents and not our children – yet sometimes we are faced with the reality that some parents do lose their children. No death, not even the death of someone who lived a long and happy life, is easy to bear.

Many of us turn to religion for answers, or for sustenance when loss is near. For some, faith in life after death makes mortality easier to bear. For others, faith may be shaky or nonexistent. How do we go on, knowing that we will end as “dust unto dust”?

This question is central to human existence.  Knowing life will end, and living with the certain uncertainty of when that end will be – how do we find meaning and purpose in the lives we have?

This question is a place where spirituality and psychology may intersect.  Where spirituality fails, mental health treatment may help restore hope.  Where treatment meets its limits, faith may sustain us.

A mentally and spiritually healthy person can live with the knowledge of death, and yet not despair, knowing that our time on earth can be important, and that life is both beautiful and precious.  In fact, many sense that mortality gives life meaning.  If we knew were going to live forever, what would be the point?  Isn’t the central challenge of life how we are going to live, knowing that life will end?

You may talk about these issues with a religious leader, with a trusted adviser, or with a mental health professional.  Just don’t be afraid to talk about it.  There may be no solid answers to your questions – but when you ask them, you are not alone.

To make an appointment with a therapist at Psych Choices of the Delaware Valley, please see our Make An Appointment page.

Esther Perel Speaks About Intimacy and Affairs

Esther Perel is a world-renowned couple therapist who speaks and writes about relationships and sexuality.

Woman Suffering From Depression Sitting On Bed And Crying

In a recently-begun video series, Perel talks compassionately and non-judgmentally about infidelity, how and why it happens, and how marriages can heal.  She also explains how to help a friend if they have recently discovered their partner has been having an affair.  Follow her video series here: Infidelity Series.

To see more of Esther Perel, check out her book or her famous TED talk.  In her book Mating in Captivity, she talks about the seemingly impossible challenge of maintaining intimacy and passion when you’ve shared a home and a bed with someone for a decade, or two or four. She also has a wonderful and much-watched TED talk on this topic, asking the million-dollar question, “Can we want what we already have?”  Watch her TED Talk here: The Secret to Desire in a Long-Term Relationship.

And on May 21, her latest TED talk is an eloquent and challenging exploration of why people have affairs.  Watch it here: Rethinking Infidelity – A Talk for Anyone Who Has Ever Loved.

To make an appointment for relationship counseling at Psych Choices of the Delaware Valley in Drexel Hill, PA, please complete the form on our Make An Appointment page.

Why I Take My Fish Oil Supplements

Fish oil bottle and capsulesEvery time I change health insurance, which surprisingly has been many times over the past five years, I have had to change my primary care physician. What doesn’t change is that each doctor has recommended taking Omega-3s as a supplement.  I run out to the drugstore, buy the largest bottle I can find of fish oil pills, and start popping the suggested number of milligrams two times a day. Then, after a week or so, perhaps after a late night out with friends or before rushing out the door late for yoga class, I forget to take the pills once, twice, three times. Slowly, the huge bottle of Omega-3 pills gets moved to the back of the medicine closet.

Interestingly, I’m super strict with my dental regimen (and my coffee routine). Perhaps that’s because before now I never really understood the benefits of the supplement. Each doctor would suggest Omega-3s and say the usual line about how the fatty acids are good for my immune system and heart. (The American Heart Association recommends one gram per day of EPA+DHA for people with heart disease and/or everyone else who is not eating two servings of fish, specifically fatty fish like salmon, trout and albacore tuna, a week. See below for a delicious salmon recipe if you’d like to increase your fish intake.) Yeah, and so is getting eight hours of sleep.

But, then, my latest doctor tells me that Omega-3s may also help with depression. I’ve had a bout or two with depression. My ears perk up.

I am afraid of looking stupid so I don’t ask questions. I have a hard time processing anything scientific. My eyes start to glaze over when medical terms are used. My only associations with the word “Omega” are either on sorority sweatshirts or my R&R visit to the spiritual retreat of the same name located in Rhinebeck, NY. I go home to do some independent research. Here, in layman’s terms, is what I find:

Omega-3s are polyunsaturated fats that we need for basic body function, such as building the protein and fat-based cell membrane in our brain. There are two main sources of omega-3 fatty acids.  The first source is plants, especially seeds (flax and chia) and some tree nuts, which containt ALA (alpha-linolenic acid).  The second source is fish and shellfish, which contain a combination of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid).  Bone marrow and brains also contain this type of omega-3 (sweetbreads, anyone?)

omega 3 foodsThe Omega-3s work in tandem with the Omega-6 fatty acids, which are found in cereals, whole-grain breads, certain oils, and some nuts. Omega-6s, although recently given a bad rap, aren’t bad for you in small quantities. But high levels in the body can cause inflammation and worsen diseases such as arthritis and asthma. The key to good health is to maintain a correct ratio of Omega-3s to Omega-6s. Before our modern day of processed food and unhealthy eating, this ratio was usually 1:1. but now it is more likely to be 1 to 10 or 20, with Omega-6s overpowering the body.

This Omega-3 deficiency, according to researchers, has a direct effect on mental health disorders such as ADHD, bi-polar disorder, and depression. The relationship between Omega-3s and depression is a main point of Dr. Andrew Stoll’s groundbreaking 2001 book The Omega-3 Connection.   Since that book’s publication, other doctors and nutritionists have added many other books on this wonder supplement and Omega-3 infused diet plans.

The verdict is still out on the link of Omega-3s and depression, but several recent studies support the theory. In 2009, researchers at Beer Sheva Mental Health Center in Israel found that after taking Omega-3s, many patients’ depression was reduced, with no significant side effects. In 2011, twenty women who had major depressive disorder related to menopause were given two one-gram capsules of a omega-3 a day for eight weeks. The results were impressive – their depression scores were reduced by half, and there was an unexpected bonus: fewer hot flashes. Well, I’m not quite at that dreaded age of menopause, but when my time comes, pass me those pills.

With limited side effects and studies praising its positive results, it seems silly not to take Omega-3 supplements. I’ve diligently taken my prescribed milligrams of Omega-3s for two months. If it’s made a difference, I can’t yet tell.  But I have nothing to lose. (Now if it did help lose pounds, that would really be a magic pill.)  Omega-3s are also being investigated for Alzheimer’s prevention, ADHD regulation, and reversal of age-related loss of brain function.  One study found Omega-3s can help reduce the symptoms of schizophrenia.  A 2007 study, published in the journal Neuroscience Letters, even went so far as to say that the intake of Omega-3s increased the volume of the brain’s gray matter, specifically in the areas associated with happiness. Perhaps the marketing tag line on the Omega-3s supplement bottles should be changed from “heart healthy” to “Happy Pill.”

Adding Happiness to Your Diet

salmon & quinoaOne way to increase Omega-3s in your diet is by taking daily supplements of fish oil or algae. A more natural alternative is to include Omega-3 rich foods in your everyday diet. Want a quick fix: Sprinkle some chopped walnuts, flaxseeds or chia seeds on a bowl of plain yogurt or munch on a bowl of salt-sprinkled edamame. Here’s a quick and tasty recipe perfect for a mid-week dinner when you want something healthy but don’t have a lot of time or energy. The salmon and the edamame are full of Omega-3s, the quinoa and chickpeas are packed with protein, and the turmeric contains curcumin, which has been tested for its antidepressant qualities.

Broiled Salmon on Turmeric Quinoa Salad

4 salmon fillets (about 1 pound) (wild has more Omega-3s than farmed raised)
juice of 1 lemon
1 tablespoon of olive oil
Preheat oven to broil, medium temperature. Rinse and pat dry the salmon fillets and place on the broiler pan. Mix the lemon with the canola oil and brush on the fillets. Broil, on medium, for ten minutes. Increase temperature to high and cook for two additional minutes. The fillets should be crispy but not charred.

Turmeric Quinoa Saladquinoa dish
1 cup of quinoa, rinsed
1-3/4 cup of vegetable broth
1 tablespoon of turmeric
1 teaspoon of cinnamon
1/2 cup yellow raisins
3/4 cups of chickpeas, drained and rinsed
2 cups of frozen, shelled edamame, cooked in microwave for three minutes
1 yellow pepper, cut into 1/2 inch pieces
2 lemons, juiced
2 tablespoons of honey
1/2 cup of olive oil
Salt & Pepper to taste

Bring broth to a boil in medium saucepan; add turmeric, cinnamon, and quinoa. Cover, reduce heat to low and simmer for about 15 minutes. The broth should be absorbed. Remove from heat, and fluff with a fork. Let cool to room temperature and pour into a big mixing bowl.
Add to the quinoa, the yellow raisins, chickpeas, cooked edamame, and chopped red peppers and toss. Whisk together the lemon juice, honey olive oil, salt and pepper and toss with the quinoa mixture.

Serve the quinoa with the salmon on top, and add a handful of arugula, if you wish, on the side. Enjoy and be happy!

 This article does not constitute medical advice. Please discuss all supplements with your doctor.  To consult a holistic psychiatrist at Psych Choices of the Delaware Valley, see our Make An Appointment page.