Author - goweb

Custody and Access Evaluations

I have a long association as a consultant psychologist with the Offices of the Family Advocate in Port Elizabeth, Graaff-Reinet and East London.

My work centres mainly on custody and contact evaluations, or rather, primary residence and contact as it is known in the new Children’s Act, as well as helping couples draw up a Parenting Plan.

Disputes regarding which parent should have primary residence of the minor children and what type of contact the absent parent should have, are major areas of concern for parents as they start the process of divorce.

Some of these issues may be dealt with through the process of mediation by the Family Advocate, but it is often the case that an in-depth psychological evaluation is needed for the Family Advocate to make a fully informed recommendation to court.

An evaluation of this nature always focuses on the best interests of the children, which involves extensive interviews with the parents, often including personality testing.

The children are also sensitively interviewed and assessed and my approach always includes an observation of the interaction between the child or children and each parent.

Collateral sources are also consulted.

It is important to stress that whatever recommendations are made, each of the parties always has a final recourse to the courts.

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Adolescent Emotional Assessment

Adolescents also respond well to the informal and unstructured sandplay assessment method and usually provide worlds which comprise deeper symbolic content and clearly show the degree to which the young person is able to engage creatively and let go of inhibitions.

Discussions about the sandtray construction create a space in which elements of their world are analysed and links are made with the adolescent’s presenting problems.

This non-threatening and non-judgmental approach provides both the adolescent and me a starting point for therapy and also becomes a symbolic creation that is continually referred to.

More formal assessment is also useful when assessing adolescents and in this regard I make use of personality questionnaires that are scored and which provide a profile which can be discussed with adolescents and their parents.

Adolescents are usually faced with the challenges of forming a sense of identity, and a clearer picture of who they really are (and are becoming) is often a central focus of therapy.

These profiles provide a useful road-map for issues that need to be dealt with, especially learning to cope with emotions such as anxiety, depression, and feelings of inadequacy in academic and social situations.

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Child Emotional Assessment – Sand Play Assessment

Assessments for child therapy provide information on what issues the child is struggling with and how best to focus on those areas.

The simplest and most child-friendly assessment that I like to use is the sandplay method of assessment which involves asking the child to construct “My World” in the sandtray using a wide variety of miniature toys.

This is a nonverbal form of assessment and cuts across language and cultural barriers, providing the child with the means of communicating about his or her inner and outer experiences of their world and offers information on how the child is dealing with issues which can be expressed in a safe, contained and non-threatening way.

The child is asked to talk about the world they created and encouraged to talk about the different elements of their creation. The child gives a title to the scene and I invite them to take me on a tour of their world.

We explore emotions and the child encouraged to talk about what the different people/animals are doing and thinking and what outcomes are expected. A photograph is also taken of the child and their world.

In this way I can find a way of understanding how the child is interpreting their world and the way in which they are reacting to the events they experience and the emotions that are evoked.

This provides a starting point for therapy, which usually incorporates further sandplay.

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Child Therapy and Play Therapy

Play therapy is based on a number of assumptions, the most important being that play is to children what language is to adults, and that children are able to express themselves more freely using play. This facilitates them to reveal their inner world in a safe and relaxed way.

Play can be used as an assessment tool but its greatest value lies in its importance in therapy as this offers opportunities for emotional growth and can reduce frightening and traumatic events by relieving anxiety and tension.

Through play, children are able to learn about the world and relationships as play provides an opportunity for reality testing, exploring emotions and finding one’s place in the family as well as the world

Our practice has a well-equipped play therapy room with a wide range of toys, including a big selection of miniature toys for play in the sandtray, a puppet theatre, doll’s house and art therapy materials.

The process usually begins with an interview with both parents, if possible or appropriate, to find out about the presenting problems and to obtain a social and personal history of the child.

This provides me with details about the child’s family and whether there have been significant changes or losses.

It is also important to find out about the child’s developmental and medical history.

Sessions are then set up to best suite all stakeholders. The first session is focused on introducing the child to the play therapy room and parents are encouraged to wait in the waiting-room, which is situated a few steps away from the play therapy room.

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Couples Therapy

Marriage (or a committed relationship) is not a static state between two unchanging people but is instead a psychological and spiritual journey that needs to grow as the relationship develops.

Conflict in a relationship is healthy, but its potential for growth is dependent on the couple’s capacity to deal with conflict in in ways which take into account their individual and shared internal worlds.

The therapeutic goal of couples therapy is to increase the clients’ insight into the unconscious motives that influence the nature of their personal relationships.

In psychoanalytic psychotherapy it is believed that there are important unconscious forces in the person’s emotional life, usually stemming from childhood, that remain hidden and which may emerge in certain situations, relationships or life events.

As couples therapy develops, puzzling aspects of your relationship begin to make sense to you, and you have a greater sense of control.

You accept the fact that, in order to understand each other, you have to develop clear channels of communication.

You learn to value your partner’s needs and wishes as highly as you value your own as you both learn new ways to satisfy your basic needs and desires.

And finally, you find within yourself strengths and abilities you may have been lacking as your confidence grows.

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Psychoanalytic Psychotherapy

In psychoanalytic psychotherapy there is less emphasis on advising people on how to better manage their lives and relationships, but instead there is a greater emphasis on seeking understanding for why people do what they do and experience the negative feelings that sometimes go with poorly adapted behaviour.

This is a flexible and non-prescriptive approach and by working with a client’s distressing life situations and exploring and understanding the client’s early history there is insight into where they became stuck in their psychological development.

This enables the client to make decisions and choices which weren’t possible before.

This is an empowering experience when the client comes to realise that there are reasons for their behaviour and emotions, and knowing the reason, they are better able to deal with their issues.

Many of life’s problems centre on difficulties with interpersonal relationships.  These can create feelings of emptiness, despair, anxiety or depression and also addictive behaviour or even suicidal thoughts.

There is a sense of not knowing who I really am, and I feel hopeless and out of control of my life.

Psychoanalytic psychotherapy enables clients to gain a deeper understanding of who they are, and how early interaction patterns with significant people are often unconsciously repeated in the present.

Once a client is able to understand how past relationships unconsciously affect the way they view themselves and others, there is growth and change and their lives are enriched as they live more fully and effectively.

There is renewed hope that there will be improved relationships with the self and others, deeper self-knowledge and insight, all of which aims to bring about behavioural change and symptom relief and to create meaning when life previously seemed barren and empty.

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Stress and its Management

Stress

For many just thinking about the word “STRESS” may be enough to set your nerves on edge. Everyone feels stressed at times. Some people perform better when in stressful situations and some may more effectively recover from stressful events than others. It’s important to know your limits when it comes to stress especially, which situation triggers greater stress and how to avoid and recognize these situations/triggers.

The Stress of Change

Stress can be defined as the brain’s response to specific demands. Many things can trigger a stress response, including change.

• Changes can be positive or negative, as well as real or perceived.
• They may be recurring, short-term, or long-term and may include things like commuting to and from school or work every day, traveling for a yearly vacation, or
moving to another home.
• Changes can be mild and relatively harmless, such as winning a race, watching a scary movie, or riding a rollercoaster.
• Some changes are major, such as marriage or divorce, serious illness, or a car accident.
• Other changes are extreme, such as exposure to violence, and can lead to traumatic stress reactions.

Of all the types of stress, changes in health from continued routine stress may be hardest to notice at first. Because the source of stress tends to be more constant than in cases of acute or traumatic stress, the body gets no clear signal to return to normal functioning. Over time, continued strain on your body from routine stress may lead to serious health problems, such as heart disease, high blood pressure, diabetes, depression, anxiety disorder, and other illnesses.

How does stress affect the body?

Not all stress is bad. In the case of dangerous situations, the chemicals and hormones released during such stressful times, prepares us to face a threat or flee to safety. In less threatening situations like exams or job interviews, stress may facilitate one to focus ones attention, cutting out many distractions.

When faced with dangerous situation, your pulse quickens, you breathe faster, your muscles tense, your brain uses more oxygen and increases activity; all functions are geared for survival. In the short term, it can even boost the immune system.

However, with chronic stress, the same chemicals that are life saving in short bursts can suppress functions that aren’t needed for immediate survival. Your immunity is lowered and your digestive, excretory, and reproductive systems stop working normally. Once the threat has passed, other body systems act to restore normal functioning.

Problems occur if the stress response goes on too long, such as when the source of stress is constant, or more commonly if the stress response continues after the danger has subsided.


Tips to Manage Anxiety and Stress

When you’re feeling anxious or stressed, these strategies will help you cope:

Take a time-out. Practice yoga, listen to music, meditate, get a massage, or learn relaxation techniques. Stepping back from the problem helps clear your head.

Eat well-balanced meals. Do not skip any meals. Do keep healthful, energy-boosting snacks on hand.

Limit alcohol and caffeine, which can aggravate anxiety and trigger panic attacks.

Get enough sleep. When stressed, your body needs additional sleep and rest.

Exercise daily to help you feel good and maintain your health.

Take deep breaths. Inhale and exhale slowly.

Count to 10 slowly. Repeat, and count to 20 if necessary.

Do your best. Instead of aiming for perfection, which isn’t possible, be proud of however close you get.

Accept that you cannot control everything. Put your stress in perspective: Is it really as bad as you think?

Welcome humor. A good laugh goes a long way.

Maintain a positive attitude. Make an effort to replace negative thoughts with positive ones.

Get involved. Volunteer or find another way to be active in your community, which creates a support network and gives you a break from everyday stress.

Learn what triggers your anxiety. Is it work, family, school, or something else you can identify? Write in a journal when you’re feeling stressed or anxious, and
look for a pattern.

Talk to someone. Tell friends and family you’re feeling overwhelmed, and let them know how they can help you.

Seek professional help. There are many health professionals that are able to facilitate you through tough times. Talk to a physician or therapist for  professional
help.

Information was sourced from various sources please find below to some links:

NATIONAL INSTITUTE OF MENTAL HEALTH
http://www.nimh.nih.gov/index.shtml

ANXIETY AND DEPRESSION ASSOCIATION OF AMERICA
http://www.adaa.org

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My Approach to Psychotherapy

People turn to psychotherapy for many reasons, but I have come to believe that most life problems centre on difficulties with interpersonal relationships.

This can create feelings of emptiness, despair, anxiety or depression and also addictive behaviour or even suicidal thoughts.

There is a sense of, “not knowing who I really am, and I feel hopeless and out of control of my life”.

My approach to therapy is to enable clients to gain a deeper understanding of who they are, and how early interaction patterns with significant people are often unconsciously repeated in the present.

Once a client is able to understand how past relationships unconsciously affect the way they view themselves and others, there is growth and change and their lives are enriched as they live more fully and effectively.

My scope of practice includes play therapy and therapy with adolescents, adults, couples and families.

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Depression

Depression

Most people feel anxious or depressed at times. Losing a loved one, getting fired from a job, going through a divorce, and various other difficult situations can lead a person to feeling sad, lonely, scared, nervous, or anxious. These feelings are normal reactions to life’s stressors. But some people experience these feelings daily or nearly daily for no apparent reason, making it difficult to carry on with normal, everyday functioning.

Clinical depression is more than just the “blues”, “being down in the dumps,” or experiencing temporary feelings of sadness. It is a serious condition that affects a person’s mind and body. It may impact many aspects of everyday life including eating, sleeping, working, relationships, and how a person thinks about himself/herself. People who are clinically depressed cannot simply will themselves to feel better or just “snap out of it.” If they do not receive appropriate treatment their symptoms can continue for weeks, months, or ultimately culminate in complete debilitation.

People who are depressed find daily tasks to be a significant struggle. They tire easily, yet cannot get a good night’s sleep. They have no motivation and lose interest in activities that were once enjoyable. Depression places a dark, gloomy cloud over how we see the world, our future, and ourselves. This cloud cannot be willed away, nor can we ignore it and have it magically disappear.

Depression does not discriminate.

Men and women of every age, educational level, and social and economic background suffer from depression. There is no area of life that does not suffer when depression is present. Marriage, parenting, friendships, careers, finances; every aspect of daily living is compromised by this disease. Once an episode of depression occurs, it is also quite likely that it may reappear. And the impact of depression can be even more severe when it occurs in combination with other medical illnesses such as diabetes, stroke, cardiovascular disease, or with related disorders such as anxiety or substance abuse.

The problems caused by depression are made worse by the fact that most people suffering from the disease are never diagnosed, let alone treated. The good news is that when depression is promptly identified and treated, its symptoms are manageable and there are many effective strategies for living with the disease. Depression and bipolar disorder are both treated most effectively in their earliest stages when symptoms are less severe.

HOW IS DEPRESSION TREATED?

There are several strategies for treating depression. Depending upon each individual’s unique characteristics and symptoms, healthcare professionals may employ one or more psychotherapy approaches based upon interpersonal treatment. In addition, clinicians may incorporate lifestyle changes, including improvements in sleeping and eating habits, physical activity and stress reduction, as they have proven very helpful in managing symptoms.

WHAT ARE THE SYMPTOMS OF DEPRESSION?

Depression commonly affects your thoughts, emotions, behaviors and overall physical health. Here are some of the most common symptoms that point to the presence of depression. An occurrence of any one of these symptoms on its own does not constitute depression.

Feelings:

• Sadness
• Hopelessness
• Guilt
• Moodiness
• Angry outbursts
• Loss of interest in friends, family and favorite activities, including sex

Thoughts:

• Trouble concentrating
• Trouble making decisions
• Trouble remembering
• Thoughts of harming yourself
• Delusions and/or hallucinations can also occur in cases of severe depression

Behaviors:

• Withdrawing from people
• Substance abuse
• Missing work, school or other commitments
• Attempts to harm yourself

Physical problems:

• Tiredness or lack of energy
• Unexplained aches and pains
• Changes in appetite
• Weight loss
• Weight gain
• Changes in sleep – sleeping too little or too much
• Sexual problems

Of course, all of us can expect to experience one or more of these symptoms on occasion. An occurrence of any one of these symptoms on its own does not constitute depression.

Sources:

http://www.depressiontoolkit.org/aboutyourdiagnosis/depression.asp

http://www.allaboutdepression.com

http://www.nimh.nih.gov

http://www.adaa.org

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Trauma, the brain and consequences and PTSD

Trauma, the brain and consequences and PTSD
Have you ever found yourself telling someone after a traumatic experience to “…just get over it” or “it was not that bad” or perhaps you’ve been on the receiving end of such commentary.

Often these comments are born out of frustration or the lack of anything else to say. However, not being able to “just get over it” may be out of your conscious control.

Some people may have grown up being told to not feel, cowboys don’t cry or showing emotion is weakness. Statements like this are fundamentally flawed and ultimately harmful to psychological well-being.

Following a traumatic experience some people may even begin to admonish themselves or tell themselves they are weak or pathetic as they struggle to regain normal functioning following, their traumatic encounter.

The truth however is not so simple. In fact people are usually helpless in the face of trauma and its frightening aftermath.

So how does our brain process information?

Basically our brain has two information-processing systems one hot (amygdala) and one cool (hippocampus).

The cool one is cognitive (thinking); the hot one is emotional (feeling).

◾The cool system records information in a controlled, unemotional and neutral manner, elaborates on autobiographical (first-person) events, complete with spatial-temporal context (stores events in time sequence e.g. it was around 5pm when she called or I was at John’s birthday party when I heard about 9/11).
◾The hot system is closely linked to low-level fear responses; it is highly emotional, acts without much thought, inflexible, keyed to instinct and less easy to control (following a car accident people will often not be able to recall “what exactly happened, I recall being scared/frightened next thing I knew the car had flipped and it was upside down”).

Everybody has a hot and cool system: the cool system stores the context (circumstances) of the events and the hot system contributes the emotional experience of events (specifically the ones associated with fear).

In moments of fright/fear/panic the logical (cool) mind will switch off and the more instinct driven (hot) mind will take over.

As one begins to calm down following the incident the logical (cool) mind takes over again and begins to make sense of what just happened.

Trauma

Trauma breaks this normal processing pattern. It forces the cool system to switch off and the hot system takes over.

Moreover, trauma often forces the brain to corrupt its memory formation and storage process (as the hot system remains on).

It can force one to believe that one is reacting to the present, where as in fact, one is superimposing past experiences onto the present.

This becomes rather problematic as the hot system (remaining on) continually corrupts the cool systems information and memory processing sequences.

Our every experience is something we create inside of our heads. Reality is not experienced directly because the brain filters all sensory input.

It is continually deleting, distorting and generalizing our perception of reality.

Moreover, as we seek to alleviate or escape disturbing thoughts or forget painful experiences, the brain will create more acceptable thoughts/memories, often convoluted and contrived, in order to facilitate day-to-day survival.

This often causes people to re-experience situations as if they where happening “now” even when “now” is a memory fragment from the past. This diminishes the ability to separate “now and safe” from “now and danger.”

The cool system puts memories in time order (So you don’t confuse today with five years ago). However, the cool system is very weakly enabled during trauma.

Thus the brain fails to put the right time stamp on the trauma experienced. Consequently, a stimulus can evoke a hot memory, causing us to relive the original low-level response. (e.g. following being high-jacked at a traffic light, you may become anxious every time you again have to stop at one; the emotions keep flooding back forcing one to re-experience the event. Some people begin to take routes that have no traffic lights or even refuse to drive again).

This re-experiencing is not a conscious choice and often the more one tries to ignore the intrusive thoughts the more invasive they tend to become.

The longer one continues to “live the past as if it is the present” the greater chance there is of permanent damage.

This heightened state of awareness and anxiety may eventually push the brain to extremes, damaging it and culminate in PTSD (Post-Traumatic Stress Disorder).

Conclusion

Trauma is not always one big event and it  may often be a culmination of many small incidents or exposures e.g. police officers confront traumatic incidents/events daily.

Trauma is real, painful and potentially disabling if minimized, ignored or bottled-up. It is not a sign of weakness if one begins to suffer from anxiety, compulsive/intrusive thoughts or sleep disturbances following a traumatic event/experience.

It is the body/mind’s way of highlighting that a disturbance (traumatic experience/event) has created disharmony in the system.

Research has highlighted how even brief psychological intervention following traumatic experiences can alleviate many negative symptoms experienced or help to “just make sense of it all”.

So think twice before telling someone to “just get over it” or “it was not that bad”.

For them it really may have been “that bad”, it could have forced them to confront a traumatic experience/event they had forgotten as children or just something they have suppressed and denied.

Each individual person experiences the world in vastly different ways. Getting help is not a sign of weakness; it is a sign of maturity and respect for your self and those that love you.

Criteria of PTSD:

◾The person goes through or sees something that involves actual or threatened death or serious injury. The person responds to this with intense fear, helplessness or horror.
◾The person then relives this traumatic event through dreams, or recollections. He or she can behave as if the trauma is actually happening right then, and can react strongly to events that even resemble the original trauma.
◾The person tries desperately to avoid this, and to avoid anything associated with the trauma, in fact, may not even remember the trauma yet still react strongly to certain stimuli.
◾The person often has difficulty sleeping and concentrating. He or she may be hyper-vigilant.
◾All this lasts longer than a month
◾Causes significant distress in daily life.

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