Medication Management and Mental Health

In my career in healthcare, I have seen far too many patients who have been prescribed medication and continue to take that medication faithfully; Yet after a time, they are not really sure why they are taking that specific medication or if it is even helping with the diagnosed issue.  

 What is missing for these patients? Medication management 

Medication management is the process of following up with the healthcare provider on a regular basis to assess the effectiveness of the prescribed medication therapy, discuss any side effects that may go along with the medication, and make adjustments in order to achieve proper dosing. In some cases, the follow-up may be to change the prescribed medication therapy, if it is not providing the desired outcomes. Medication management should be an ongoing process. It should include open dialogue between the patient and provider about the effects of the medication combined with any other therapies or treatments that may be in place. This is to ensure useful data is being collected, so decisions can be made based on the whole picture; not just the medication piece. 

When it comes to psychiatric and mental health services, the importance of quality medication management cannot be overemphasized. Not all people who seek psychiatric help will require medication. In some cases, amino acid therapy may be appropriate or continued therapy and counseling with regular psychiatric follow-up is warranted. If medication is prescribed, the patient should plan to see the psychiatric provider within 2 weeks (in most cases) for the first medication management visit.  Continued follow-up visits should be scheduled monthly, or as needed depending on the individual case. 

During these visits, the patient should plan on communicating openly with the psychiatric provider about their use of the medication, any side effects that they may be noticing, and any changes they are feeling in relation to their mental health diagnosis. At times, genetic testing can be used to pinpoint what medications are more likely to work for each individual patient. This testing can be used not only for patients who are just beginning psychiatric treatment but also for patients who have been prescribed medication therapies that aren’t working. The patient should also plan to consult with the psychiatric provider before taking any other medications. They should inform the provider of other mental health therapies being used or medical complications that may arise during treatment. The patient should expect the provider to ask questions that will direct and lead the conversation, so time is well spent and modifications can be made with confidence. 

Ultimately, the key to effective psychiatric medication management is open and continual communication between the patient and provider. At the Center for Couples and Families, our psychiatric providers strive to provide thorough psychiatric assessment, follow-up, and medication management. 

Originally published on http://utvalleywellness.com/

 

 

Cleaning Out your Marriage Closet: Couples Counseling

People are often worried about drudging up the past with their loved ones. There is controversy as to what is healthy for the relationship. People certainly don’t like to bring up an old fight when everything is going well. The issue is that we all have a closet of sorts where we hide everything that “isn’t worth the fight.” At first this closet is empty and the intention of putting things in there is good, you intend to talk about it later, it’s just not the right time.

The problem is that you enjoy the times you’re not fighting, who wouldn’t! You soon forget about what you’re storing in the closet, and you continue to throw everything “not worth the fight” into the closet. Your closet becomes full, and when you try to fit one more thing in there everything topples over. This is the fight of all fights, this is when you seemingly “loose it” out of nowhere about nothing and everything. This fight happens at a time when something was already “not worth the fight” and you were trying to put it in the closet. Therefore, you are probably not up for resolving everything in that closet either. It’s like if your junk closet toppled over just as company is coming over, you’re going to scoop everything up and stuff it back into the closet because you don’t have time to sort through it. This fight leaves everyone upset and confused and often nothing is resolved in this fight.

So how does one clean out this closet? Well its much like spring cleaning, you are going to take everything out and you begin to sort everything into categories. You evaluate if it is something that only happened once and will never happen again, if this is the case it truly isn’t worth the fight and can be thrown out. If it is something that continues to happen you need to address it, you will be bringing up the past not as a weapon against the other person, but as a justification for bringing it up as an issue. It is absolutely necessary that cleaning this closet is done at a time when your calm and you remain calm to be able to assess what the core of the problem is, what does their behavior tell you about your relationship with them. For instance, If someone is always late, how does their behavior effect you, why does it feel disrespectful to you and how does it create distance in your relationship, what is the message you receive about their feelings toward you. As opposed to judging their behavior as something you wouldn’t do and lecturing them about how it affects them.

When you clean out the closet you are transferring responsibility to the people it will be useful with. You will find that the cleaner your closet becomes the more clarity you will have in your relationships. Your intent in cleaning out the closet is not to change other people’s behavior, it is meant to change your relationships. You will find that some people will choose to become more distant because they are unwilling to make changes, but the relationships that become closer and the internal peace will be worth the distance in others.

Written by Madison Price, MS, LAMFT – therapist at Holladay Center for Couples and Families

Shared originally by the Holladay Center for Couples and Families

Couples Counseling with an expert

Couples counseling, if done right, isn’t a refereed fight in a therapist’s office. A trained therapist will help you to identify underlying, unmet emotional needs after helping you to deescalate from the tension and fighting you have been experiencing with your spouse. The problem is that most couples come into therapy years too late and it is difficult to change course – to learn a new way. It is possible, however! John Gottman, a world-renowned researcher on marital stability and satisfaction, has found that it is not the presence of argument that causes divorce, but rather it’s how a couple argues that causes divorce. Knowing this, couples don’t have to ignore what they are feeling, but rather they can communicate it differently and in a healthier manner.

Marriage and family therapists are trained to do this type of work. This is a specific degree and license type that focuses on relationships between people (husband and wife; father and son; mother and daughter, etc…) as the point of intervention rather than just focusing on fixing symptoms (depression; anxiety, etc…). Its important to alleviating depression and anxiety and its crucial to build relationships that help someone deal better with anxiety and depression in the first place.

Pornography Counseling

Pornography addiction is becoming more prevalent in our society. Organizations like Fight the New Drug do a great job of educating the public on the harmful effects of pornography. What do you do if you struggle and can’t seem to find a way out? For many, the way out seems elusive and unobtainable. It’s difficult to find how when you have tried so many things, only to have this problem keep coming back. Many that come into counseling have already been before and are discouraged that they just can’t ‘get over it’. Knowing how to use the power or education and relationships is part of the answer. A good therapist can help you access both in your efforts to let go of this addiction. At the Center for Couples and Families we specialize in relationship therapy in regard to pornography use. Knowing how to communicate with your loved ones about this difficulty is an important part of the process.

An Ethic to Live: Building Barriers to Suicide Around Ourselves & Those We Love

In cities throughout the world, notable high buildings and bridges increasingly have additional fencing built atop of them with the specific purpose of preventing suicides. Suicide fences tend to work because research has shown that suicidal actions are frequently impulsive, hence such fences serve to forestall that impulse and buy individuals precious time to further think about their decisions. In studies of suicide fences, it appears that individuals don’t leave such barriers to go look for another bridge or tall building to end their lives from, but instead return to the business of living for yet another day.  

Presently suicide is the leading cause of death among young people ages 10-17 here in Utah, and over the last decade, it’s also doubled amongst adults in our state. As concerned friends, neighbors, and parents, how do we help our community build more barriers to suicide; protecting and empowering those we love? Over the next year, I’ll be writing a series of articles in answer to this question; offering my perspective as both a therapist, who has stood on sacred ground in helping others walk back from suicidal thinking, and as one who’s felt and ultimately rejected the dark pull to end my life amidst heavy times.   

Perhaps you’ve already noted that there’s no way to build suicide fences everywhere or to somehow block all of the endless ways in which someone might consider ending their life. Sound public policies on prevention and physical barriers like suicide fences are only some of the important ways to help. So in addition to these forms of prevention, the focus of my writing will be on how to build barriers to suicide directly into the thinking and values of individuals, and into the culture of our community as a whole. In this first article, I want to introduce how we help foster an ethic to live within ourselves and in others as a key barrier to suicide.  

An ethic to live means valuing our lives and holding a commitment within ourselves to continue living — even when we’re unsure of how we’ll cope or move forward. In my experience, helpful conversations about consciously building an ethic to live, begin by first taking care to turn our attention to the reality that to live is to be vulnerable to an array of difficult life experiences, with the potential to evoke within us the thought to end one’s life to escape them. Throughout human history, individuals and peoples have had to confront extremely painful and unjust challenges which have overwhelmed their sense of being able to continue on, and it’s important to acknowledge that when we confront such considerable pain, it is the most human thing in the world to want relief from it. This is real; excruciating human suffering beyond one’s current sense of how to reduce or stop it is real, and in these concentrations of pain, we may find ourselves having suicidal thoughts.  

When we acknowledge and honor that such excruciating life experiences do show up for many of us, it’s then that we can locate where we need to begin building internal fences to prevent suicide. It’s here that we recognize the need to develop a strong ethic to live even though there are times that we might not yet fully know how we’ll cope or be able to see brighter ways forward. It’s also here that we find the need to define as individuals what makes life worth living with specificity to our own life experiences, as well as the need to find a listener who we can turn to and voice what’s going on inside of us. 

As you navigate life’s difficulties, no matter how hard things may get, make the commitment now to live and identify your personal reasons to do so. Additionally, identify suicidal thoughts as a  sign to find a listener who you feel safe enough to talk to. It’s worth thinking about right now who it is you might feel comfortable turning to during your hardest times. By doing so, you’ll begin to build your own internal fence between you and suicide as well as have greater insight as to how to help others you care about to do the same.  

* If you or someone you care about is currently having thoughts of ending their life, caring help is available 24/7 by texting 741741 from anywhere in the USA or you can call 1-800-273-8255 to speak directly with a Counselor from the National Suicide Prevention Lifeline. 

Bio: Laura Skaggs Dulin holds a master’s degree in Marriage and Family Therapy from San Diego State University. She currently sees clients at the Spanish Fork Center for Couples and Families and at Encircle LGBT Youth and Family Resource Center in Provo.  

How You Can Create a Happy, Healthy New Year in 3 Simple Steps

Life Coaching is the favorite part of my job. I love sharing personal stories and real-world experiences as I help clients overcome addictions to food and other substances. When they understand that challenges with food are just symptoms of greater core issues, often related to emotions, they begin to overcome them as I teach how to change the behaviors for good.  

I was a cake decorator for over thirty years. This was my life’s passion, but it ultimately ruined my health. Giving this dream up was a huge sacrifice but one that led to greater health, energy and joy in my life. From this experience and others, I understand what it feels like to be an addict and the behaviors associated with it. I also understand the emotions and fears that come when giving up comfort and an artificial kind of love.  

Food is meant for fuel, nutrition and energy but we take it a step further and use it for comfort, love, and numbing out so we don’t have to feel what is truly going on inside. Emotional eating creates health challenges like addiction, obesity, fatigue, mental instability, and eating disorders of all kinds. It is fine to derive pleasure from food, but that should be a secondary result of making healthy food choices. 

We know now that scientists have engineered processed food to increase our cravings and desire to keep coming back and purchasing their products. Sweet tastes, for example are what we are biologically programmed from infancy to gravitate toward. Mother’s milk is sweet and toddlers often choose fruit over vegetables. High fructose corn syrup is added to many products from ketchup to cereal to satisfy the cravings for sweets. The unfortunate consequence of eating it, however, is that it turns off the mechanism in our brain saying we are full, so we continue to eat until we are stuffed or feeling sick. Processed sugar feeds candida and causes a host of health problems if eaten regularly over time. 

So, we are not completely to blame for our addictions, but there are things we can do to change our behaviors around food and make wiser choices that will reap greater benefits. As we enter a new year, I’d like to give 3 suggestions to help you make better decisions before going into the kitchen. 

  1. CREATE A PLAN: People who fail to plan, plan to fail right? Look through your recipe books and decide what to make for breakfast, lunch, dinner and snacks. Go shopping and get the ingredients needed.  
  2. PREPARE AHEAD:Prepare your mealsahead and refrigerate or freeze them for use throughout the week to save time and money.  
  3. ASK YOURSELF QUESTIONS: Sometimes we eat because we’re bored or tired and we aren’t even hungry. Here is a series of questions you can ask yourself before going to the refrigerator or pantry for a snack.
  4. What do I want to eat?
  5. Is it something that will give my body nutrition,fuel and sustained energy?
  6. Why do I want it?
  7. What emotion istied to thisfood? 
  8. Will _____ serve me for the better or worse?
  9. What physical symptoms will I feelafter eating _______ ? 
  10. Is it worth it?

 

Asking yourself these questions will help you become conscious of your decisions and help make better ones. If you want to eat it, just because, then own that and don’t make yourself feel bad. Good habits are learned as we practice over time. Taking baby steps forward will help us see and feel the progress. Create a Happy New Year! 

 

 

Looking for Happiness and Finding Addiction

Our community is the epitome of mainstream America. We have deeply rooted family values, safe streets, moral standards, and most families stand guarded against outside influences that threaten our happiness. Recently, however, Utah achieved the 7th highest drug overdose rate in the nation. How can a community named Happy Valley have some of the highest rates of adult mental illness and teenage suicide in the country? 

Treating addiction is clearly a necessity. However, explaining these alarming and confusing statistics may also come down to understanding some myths, or assumptions, about happiness.  

Myth No. 1: I Should Be Happy All the Time 

Some aspects of our local community amplify and reinforce the well-intended message that “good people” or “my kid” should not or would not encounter pain. At times, we may even feel entitled to getting our way and therefore feel betrayed when we stress and we encounter unwanted but normal life struggles. These challenges show up as: loneliness, divorce, work stress, relationship issues, domestic violence, bullying, prejudice, low self-esteem, and chronic pain to mention a few.  

Myth No. 2: If I’m Not Happy, Something is Wrong with Me 

For decades, mental health symptoms have been twisted and misunderstood to the point that painful or overwhelming thoughts and feelings are now presumed to be products of weak, faulty, and unworthy minds. Labels like ‘Anxious’, or ‘Addict’ are now used so frequently and in such negative ways it distracts us from the real issue at hand. Those labels not only build a wall but also mask the reality that we all struggle in similar ways. Combine these objectifying terms with a competitive culture this myth grows more powerful and exponential.  

Myth No. 3: For a Better Life, I Must Get Rid Of Negative Feelings  

Every single one of us experiences self-judgment, fear, and shame of not measuring up. It can be overwhelming and discouraging. Unfortunately, we live in a culture that promotes numbing and hiding as the solution to any pain or discomfort.   

Anger, over-working, blaming, over-booking schedules, and isolation has been dependable sources of distraction for years. Some argue how safe and how little impact these behaviors have on themselves and others. Ironically, they assume that dependent or ‘addictive’ thinking and behaviors are only appropriate if describing illicit drugs and alcohol. Recently, more camouflaged options like sugar, caffeine, over the counter medication, smoking, power drinks, and trendy diets have become legal and justified ways to remedy unwanted thoughts or deal with social pressures. All of these behaviors, and others, are designed to alter reality, enhance social performance, and reduce stress. Unbeknownst to us, we end up trading one form of addiction for another.  

Everyone considers himself or herself an unwilling and/or unaware accomplice and each would avoid the road of undue suffering if possible. Here are three practical take home ideas that can help you start breaking yourself free from the shackles of these myths and identify and strengthen your core values so you can stay connected with reality.  

  1. Take time and energy to notice core values that you have and may share with others. Write down and/or share thoughts, feelings, and memories that help identify and strengthen your core values. Yoga, meditation, and other quiet activities will improve focus and self-awareness. 
  2. Compare less. Look for opportunities to learn about and accept the uniqueness of others. Admitting and accepting our weakness and vulnerability to others actually creates meaningful emotional and social bonds.  
  3. React less. Take a deep breath and refocus values that you can practice today.  

All of us long for acceptance, empathy, and connection from others but sometimes get stuck in the attractive web of addictive behaviors. If help is needed, reach out to others or professionals. Enjoy the search for happiness in the everyday pursuit of values, not distractions.  

The answer is YOU!

This time I was determined to fix this on my own. After all, I had a certification in corrective exercise, how could I not fix this? At that point I realized the only person that can help me was me. I was sick of paying chiropractors and doctors to temporarily ease the pain, but never giving me a path forward so that I could enjoy aggressive sports, lifting heavy, snowboarding, or whatever I felt like doing. I thought to myself, shouldn’t these professionals know how to fix this? Well yeah, but their answer was surgery. Not mine. By the way, I realize that sometimes the only answer is surgery in certain cases. And that’s okay. But I wanted to give my body a chance to see if I could figure this one out on my own. Feeling frustrated, but hopeful, I started to study every article about sacroiliac joint pain related to exercise and nursing it back to full strength, if it was even possible. There was a lot of trial and error, stumbling along the way, and figuring out which exercises were doable and which ones I needed to avoid. I slept different. I changed my posture. Patience was needed because this was a slow process. I slowly began building up my joint strength, my core strength, hip mobility, working in different planes of motion, and finally lifting heavier and heavier weight. I succeeded. I felt as if I had never experienced this injury because I was pain free and felt strong enough that I could do anything. This was probably one of the most satisfying experiences of overcoming something that seemed impossible to do. 

I feel like we all have something like this, whether it is losing fat, getting stronger, eating healthier and living a healthy lifestyle, training for a difficult event, overcoming an injury, getting over an addiction, succeeding at a business or career, and so on and so forth. My challenge to you is to be patient and be hopeful. Don’t give up. If it’s worth it to you, then give it all that you can whether that be physically, mentally, emotionally, or spiritually. Be your best self. You have the potential and you are well worth it! 

 

 

Behavioral Health: Integrated Care and the Future of Whole-Person Treatment

The term behavioral health has gained exposure and popularity more recently, particularly among medical providers and those involved in healthcare reform in the United States. Burg & Oyama1 define behavioral health as, “the psychosocial care of patients that goes far beyond a focus on diagnosing mental or psychiatric illness… [encompassing] not only mental illness but also factors that contribute to mental well-being”. This is the first of a series of articles which will introduce essential concepts and goals for integrated behavioral health treatment.  Why is this important?  The correlation between comorbid mental health and medical issues has mounting evidence for impacting healthcare cost, treatment outcomes, and patient satisfaction.  Comorbidity in this sense refers to the presence of two co-occurring issues influencing the progression and prognosis of either condition.  Well researched comorbid conditions include diabetes & depression2asthma & anxiety/panic3, and chronic pain & psychosocial issues4.  The good news is we are learning innovative ways to effectively treat comorbid conditions concurrently, thereby increasing the likelihood of successful outcomes and improved quality of life for patients. 

The sustainable future of healthcare in the U.S. will likely require efforts to improve consultation/communication, cross-discipline competency, and collaboration among clinical teams.  Traditionally, mental health specialists (i.e. psychologists, LMFTs, LCSWs, LPCs, CMHCs, etc.) have operated in relative isolation from the medical community.  Aside from psychiatrists, who are primarily trained as Medical Doctors (MD), many practicing psychotherapists have minimal training in the biomedical model of treatment.  And the inverse is true as well, wherein medical practitioners often have limited understanding of psychotherapeutic theory, psychosocial problem etiology, and effective behavioral intervention.  This is exceptionally problematic for the patient because practitioners involved in treatment may have dramatically different, and often conflicting, beliefs about mental health problems and their respective solutions.  Sperry5  suggests, “the goal of health care integration is to position the behavioral health counselor to support the physician… bring more specialized knowledge… identify the problem, target treatment, and manage medical patients with psychological problems using a behavioral approach”.  The future of medicine may very well be found in systems which prioritize such supportive collaboration, encourage patient-centered policy, and deliver on whole-person treatment options.  

Hopefully this educational introduction to behavioral health integration can serve as a starting point for further interest and exploration of the topic.  While this is a relatively new concept, I predict we will see a dramatic increase of integrative efforts emerge over the next several years as clinicians, administrators, policy makers, and third-party payers (i.e. insurance companies) recognize the cost-effectiveness and clinical efficacy of interdisciplinary collaboration.  We do not live our lives in a vacuum, and our problems are rarely isolated conditions in themselves.  Therefore, we will need innovators across various disciplines to create efficient and effective systems which benefit all parties involved with the daunting task of healthcare reform.  As patients, we can empower ourselves with education about how the biopsychosocial model might positively influence our role and options in treatment.  So, the next time you are at the doctor’s office and they ask you questions about mood and/or behaviors, and you think, “What does this have to do with my medical problem?”, now you’ll know.   

References 

1.Burg, M.A., & Oyama, O. (2016).  The behavioral health specialist in primary care: Skills for integrated practice. New York, NY:  Springer Publishing Company.   

 

  1. de Groot, M., Golden, S.H., & Wagner, J. (2016).  Psychological conditions in adults with diabetes. American Psychologist, 71(7), 552-562.    

 

  1. Ritz, R.,Meuret, A., Trueba, A.F., Fritzche, A., & von Leupoldt, A. (2013).  Psychosocial factors and behavioral medicine interventions in asthma.  Journal of Consulting and Clinical Psychology, 81(2), 231-250.  

 

  1. Gatchel, R.J.,McGeary, D.D., McGeary, C.A., & Lippe, B., (2014).  Interdisciplinary chronic pain management.  American Psychologist, 69(2), 119-130. 

 

  1. Sperry, L. (2014). Behavioral health: Integrating individual and family interventions in the treatment of medical conditions.  New York, NY: Routledge.  

 

When the Holidays Hurt

For many people, the holiday season is a time of joy and magic, a time where people relive and create happy memories. They are moments of joyous gatherings filled with love, laughter and crowded tables. But if you are not one of those people, the holiday season can be very difficult to endure. For individuals who have experienced the loss of a loved one, abuse in childhood, or another tragedy or trauma, the holidays just remind you of that loss and pain. Your days may not be merry and bright. Your days may feel more gloomy, more isolating, and you may feel more disconnected from the world around you.  

The holidays are here, and the holidays can hurt. 

Maybe it’s because of the chairs that will be empty or the phone calls that won’t come. Maybe it’s the time off from work that allows you to think about your life and feel the pain. Maybe it’s the reminder that all of your holidays your whole life were negative and filled with dysfunction and abuse. And maybe it’s the perception that everyone else has the picture perfect holiday gatherings with all their loved ones. Whatever the reason may be, a heavy sadness can take hold of you and you don’t know how to shake it off.  

For many of us, depression, grief, and sadness are constants and we get used to fighting them off and keeping them at bay. There’s nothing like the holidays that make you feel like you not only have to have it all together, but you have to wrap it up with a bow and display it for the world to see.  

If you happen to be hurting this holiday season, I’d like to offer some helpful advice. 

Let it hurt. Allow yourself to feel the pain and allow it to come fully without altering or inhibiting it. Life is difficult and painful sometimes and it is okay that you are not okay during this time. You don’t need to pretend that you are. Emotional reactions are expected and there are no right or wrong feelings.  

Don’t hide it. Be as authentic as you can with the people you are closest to. Allow people who love you to be there for you and support you in your time of pain and distress. Let them see you and know you–not an edited, “better” version of yourself.  

Today is really just another day. Don’t fool yourself into thinking that it must be the most wonderful time of the year. It doesn’t have to be, and it clearly isn’t that this year.  

Practice self care. Be aware of yourself and what you’re feeling and if something is triggering and overwhelming.  Allow yourself to disengage or leave a painful situation and attend to your pain. Only you truly know how you are feeling and what your boundaries and limitations are. Be true to yourself.  

Embrace this holiday as-is. You may feel overwhelmed and in pain, but there is still goodness to be experienced, even in the pain. There will be holidays in the future that are lighter and happier, and these difficult days are part of the healing path to get there.   

New traditions. New traditions can be healing and can help you create better connections to the loved ones in your life. If you have survived the loss of a loved one you can start a new tradition that symbolizes letting go, such as sending balloons or floating lanterns in the air. 

Above all, know that is okay to be blue during the holiday season.  

If you need someone to talk to you can contact the Center for Couples and Families at (385) 312-0506, text  HOME to 741741 to reach the crisis hotline or call the suicide hotline at 1-800-273-8255. 

 Originally published on Utah Valley Health and Wellness Magazine