Thursday 31 January 2013

Maybe the best darn website out there...

If you're looking for some levity in your chaotic day, I highly recommend the Onion website.  For those of you who don't know, the Onion is an online "newspaper" that presents a cheeky take on current events.  And it never fails to make me laugh out loud with its uber-satirical take on some of the most compelling issues of our time.

Here's one that had my husband and I laughing uncontrollably:

http://www.theonion.com/articles/teenage-girl-blossoming-into-beautiful-object,31061/

Hey, if you can't laugh, there is no mental health...

Be well,

Barb

Sunday 27 January 2013

The Best Non-Fiction Read of 2012

If you read only one non-fiction book this year, make it "How Children Succeed: Grit, Curiosity, and the Hidden Power of Character" by Paul Tough.  Tough, a Canadian-born journalist and broadcaster, has written extensively about poverty, education and politics.  He's a regular contributor to my all-time favourite podcast, This American Life, as well as to magazines including Harper's, The New Yorker, Slate, and GQ

In "How Children Succeed," Tough examines a wealth of research from diverse fields of economics, politics, child development and education.  He points out that over the past decade, experts have shown that character traits are more important than cognitive ability (i.e., IQ) in predicting success in later life.  As such, character traits (sometimes termed "non-academic" or "soft" skills) like perseverance, openness to new experience, and ability to regulate one's emotions are critical components of equipping our kids for life's rigours.

The good news here is that, unlike cognitive ability which is relatively static past the age of 6 or 7 years of age, character traits can be learned throughout the lifespan.  And so it follows that all kids, regardless of cognitive resources, can benefit from learning how to deal with difficult things, how to keep trying in the face of adversity and how to keep their emotions in check.

Let's be honest.  These are skills that even some grown-ups struggle with.  How best, then, to teach these elusive qualities to our kids?

First, let me say that I wholeheartedly agree with Tough when he asserts that our public education system could be (and is, in some rare instances is) an ideal forum for helping our kids acquire these skills.  In my perfect world, school curriculum would address, in equal parts, children's emotional, physical and academic needs.  For example, conflict resolution and mediation would be a bone fide curriculum goal that all kids must acquire some skill in.  Similarly, curriculum infused with the importance of emotional intelligence would be non-negotiable.  And the importance of physical activity would be consistently emphasized from K-12 - not only because it is good for one's body but because a wealth of research has demonstrated that better physical fitness is intricately related to improved brain functioning.

From a parenting perspective, there are many things that you can do to help your child develop solid character.  In fact, you probably already are.  Every time you listen respectfully (and no, not that half-assed-messing around-with-your-iPhone-and-listening-crap) to your child, you build her sense of worth and therefore her character:  you're conveying that she is worthy of being listened to.  Every time you encourage your child to try again, even though it sucks and he hates it, you're building character.  When you praise your child for the effort she put in rather than the outcome she obtained, you're building character.

Here are some other practical character-builders (in no particular order):

1) Do something new with your child.  This type of learning stimulates growth and development in the frontal lobe of the brain (i.e., the combined parts that control higher-order thinking like planning, initiating and abstract thinking), as well as helping to build confidence in trying new things.  To solidify the learning, set up opportunities for your child to apply his or her newly-acquired skills.

2) Encourage your child to keep a "rose file" - that is, a scrapbook or journal of mementos and examples that demonstrate your child's great character qualities.  Include, for example, reminders of when he was a particularly good friend to someone, or made the right choice even though it was really difficult.  When your child is experiencing challenging times, check out the rose file and show her the "evidence" that demonstrates the great qualities she possess.  Reminder her of how good she felt when she exercised these qualities.

3) Let your kids try things you know they'll be horrible at.  And then be there to support them when they fail miserably.  Remind them that failing is a really important part of learning, as well as a necessary part of life.  Help them understand what they might do differently next time to improve.  And insist that they do it again.  Resist, at all costs, the urge to do it for them.  Watching your kid suffer is excruciating but it's a critical way for her to become adept at coping with feelings of all kinds in a productive, healthy way.

4) Learn to manage your own stress effectively.  This is key.  Consider Paul Tough's exploration of the compelling research findings that kids who grow up in impoverished circumstances are most adversely impacted not by the deprivation per se, but by the stress that the circumstances cause in their family unit.  Otherwise stated, kids suffer when their parents are stressed - probably for a lot of reasons, including the fact that their parents have less time to spend with them, as well as fewer psychological resources to share with them.

And, last and certainly most importantly, try to model good character qualities for your kids.  Your kids will probably remember very little of what you say.  They will remember the things you do.  So, be nice to other people - even when they are rude to you.  Next time you're in the car with your kids and that ass-face cuts you off, take a deep breath and count to ten rather than shrieking what you're really thinking.  If you make a promise, keep it.  Be consistently reliable (and that includes being on time).  If you make a mistake, take responsibility.  Do the right thing, even when it's difficult.  Share your failures with your kids, and talk about how you dealt with them.  In the words of H. Jackson Brown, "Live so that when your children think of fairness and integrity, they think of you."

Be well,

Barb











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Thursday 24 January 2013

7-year old wisdom

Dad:  "Hey, I'm almost up to Level 70 on this game!"

7-yr-old: "Awesome!  You should try for the next level...after all, it is your birthday and you should get lucky on your birthday."

Enough said.

Monday 21 January 2013

The Parent Trap



Your kids have an uncanny way of breaking your heart, like no one else in your life.  Take tonight, for example.  I had occasion to say no to my teen daughter who, in turn, has given me the silent treatment for the past few hours.  I know that I made the right decision - that's not in question.  Yet, I still feel pulled to run to her and say, "I've reconsidered. The answer is yes."

Why?  Because it's way harder to be a good parent than a bad one.  It takes effort.  It would be way, way easier to say yes to my kid, be the hero and bask in the "you're the best" accolades that would surely ensue.  Saying no is really hard.  It means setting limits and exercising my judgment in what, I think, is her best interest.  And weathering the fall-out.

Many years ago, before I had children, a friend said to me, "Sometimes I wake up and think 'I don't want to be a mom today'."  I was horrified.  How could she say such a thing?  Having children was surely the most wonderful, gratifying and rewarding job ever!

Wasn't it?

Some years and two kids later, I hear her.  Boy, do I hear her.  Don't get me wrong: parenting is all those things I thought it was before I had kids.  Some of my most cherished memories have to do with my girls: breastfeeding and rocking them during a quiet, still night, gazing at them sleeping peacefully like wee angels, or the look on their faces when they saw something incredible for the first time.

But, these moments are, understandably, punctuated by the everyday work of raising kids - hard, financially-draining, marriage-straining work that it is.  Indeed, a plethora of academic studies demonstrate that parenting does not equal happiness.

Probably the most frequently cited research in this area is that of Daniel Kahneman, a Nobel-prize winning behaviour economist who studies the irrationality of how humans make decisions.  Kahneman's 2004 survey of over 900 Texan women found that child care was ranked 16th out of 19 possible pleasurable activities.  Interestingly, activities such as exercise, shopping, napping and watching t.v. were all ranked higher than child care.

So there you have it.  You're not alone in preferring a good spin class to spending time with your kids.

I suspect this is because parenting is the most difficult, unrelenting and yet rewarding job most of us will ever do.  Above all, it requires countless sacrifices.  This is perhaps the most diabolical part of parenting:  sometimes the decisions that are good - nay, even necessary - for us are entirely at odds with what might be in our children's best interest.  And so our job as parents is to figure out this precarious balance.  Sometimes we get it right.  And sometimes not so much.

My advice?  If you don't have kids, think long and hard about it before you do.  And if it's not for you, then don't do it because you think you should.  If you do have kids, talk about your experience with people who aren't afraid to be brutally honest about parenting.  Book regular dates with trusted others who will both laugh and cry about their parenting challenges and triumphs.   When someone tells you that parenting's a breeze, immediately place them in the same category as smarmy men who endeavour to sell you cheap real estate.  Learn, as best you can, to live it the moment and remember that whatever's happening right now, it won't last.  When you make a mistake, say you're sorry and mean it.   Invest in an TSP (Therapy Savings Plan) for your kids.  Because, despite your very best efforts, they'll probably need it.

I'll leave you with poet, Philip Larkin's cheeky take on parenting.  For what it's worth.

Be well,

Barb

This Be the Verse
By Philip Larkin

They fuck you up, your mom and dad
They may not mean to, but they do.
They fill you with the faults they had
And add some extra, just for you.

But they were fucked up in their turn
By fools in old-style hats and coats,
Who half the time were soppy-stern
And half at one another's throats.

Man hands on misery to man.
It deepens like a coastal shelf.
Get out as early as you can,
And don't have any kids yourself. 


Thursday 17 January 2013

Checking in.

Hi, all...

Thanks again for all the great ideas and comments...I've been a little off my game this week but I'll be posting more shortly.

If you're having trouble receiving posts by e-mail and/or leaving a comment on the blog (I think you can just click on the "no comment" or "comment" word below the relevant post), please let me know.  I'm working through the technical bugs as I go.  Which, for a non-techie like me, is painfully slow!

Thanks for your patience.

Be well,

Barb

Monday 14 January 2013

Basics

Thanks, all, for the great feedback so far about the blog!  I'm having a lot of fun writing, and I've got several posts in the works based on your ideas and suggestions.  Please stay tuned...

For today's post, I figured that the beginning is a good place to start.  Not my beginning (it's spectacularly unremarkable, really - grew up in Southwestern Ontario...same house for 18 years, youngest of 6, blah, blah, blah), but some basic info about clinical psychology.

After more than 10 years in the business, I've fielded a lot of questions.  People are curious.  There's a mystique (some call it stigma) about mental health and what psychologists do.  So here, in no particular order, are answers to the the top 4 questions people ask.  (I know.  "Top 5" has so much more cachet but there are only 4):

1) What's the difference between a psychologist and psychiatrist?

Psychiatrists are trained as physicians.  They typically complete an undergraduate science degree, followed by a degree in medicine (an "m.d.") which earns them the privilege of using the title, "Dr."

Following completion of their medical degree, they undertake extensive (6 years in Ontario) practical training in how to identify and treat mental illness.  Their training is usually hospital-based and, as such, they tend to treat individuals with severe mental health issues.  That being said, some psychiatrists do practice in community-based settings such as clinics and treatment teams.

Because they are physicians, psychiatrists can prescribe medication and they may have "admission privileges" - that is, they can admit individuals to hospital for treatment.  Psychiatrists can also formally "diagnose" individuals with mental disorders (e.g., schizophrenia, bipolar disorder, borderline personality disorder).

Psychologists are trained in a "scientist-practitioner" model.   They complete a Ph.D in clinical psychology which involves extensive research and academic training in mental health issues, as well as intensive practical work with clients.  Most psychologists have completed an undergraduate degree (usually in psychology or a related field) and then a doctoral degree in clinical psychology (5-6 years).  All of this gives them the legal right (in Ontario) to use the title "doctor" and call themselves a psychologist.

Like psychiatrists, clinical psychologists are experts in the assessment and treatment of mental health issues.  Unlike psychiatrists, they do not prescribe medication and they do not admit people to hospital.  Like psychiatrists, they are permitted to formally diagnose mental disorders.  Clinical psychologists typically receive more intensive training than psychiatrists in the process of doing research, as well as the use of the standardized assessment human behaviour (such as thinking, learning and socio-emotional functioning).

Because they are physicians, the services of psychiatrists in Ontario are paid for by the provincial health care plan (OHIP).  The services of clinical psychologists are sometimes covered by OHIP, but only if they work in a publicly-funded institution, like a hospital or community clinic.  Clinical psychologists who work in private facilities charge a fee for service.  Fees are, to a large extent, regulated by their professional college.

So, big difference.  Very confusing.  Call them both doctor.  They've earned it, given the massive student loans they've probably accrued.

These are the basic differences but please keep in mind that there are many more I haven't covered here.  Sometimes the differences arise because of varying provincial and state laws that govern professions.  But, more practically-speaking, psychiatrists and psychologists each tend to have a unique way of seeing mental health and illness, which affects how they approach assessment and treatment.

The best discussion that I've seen about these differing perspectives is Steven Kingsbury's 1987 article in American Psychologist: Cognitive Differences Between Clinical Psychologists and Psychiatrists. Kingsbury is trained as both types of professionals (not sure...glutton for punishment maybe?) so he oughta know.

2) What's a psychological assessment?

A psychological assessment is a process for evaluating facets of human functioning such as thinking, learning, emotional functioning and/or behaviour.  Assessment can include information gained through interviews, observations, review of other documentation and/or the administration and interpretation of standardized tests.

As mentioned above, clinical psychologists are trained extensively in how to use standardized tests.  "Standardized" means that the test is given and scored in the same way for everyone.  It also means that an individual's pattern of responses can be compared to the collective (or "normative") responses of other people of the similar culture, age and (usually) gender.  Standardized assessments are one tool among many that psychologists use to gather information about an individual's current functioning.

Psychologists assess for different reasons.  The reason is usually based on the question at hand, or, the "referral" question.  A 9-year old boy might be referred for an assessment because he isn't doing well at school, relative to other kids his age.  As such, the assessment would involve an analysis of the his learning strengths and needs and, ultimately, recommendations about how his teachers and parents can support him at home and at school.

Similarly, a young woman might be referred because she is feeling down, has lost quite a bit of weight, and is spending increasing amounts of time alone in her room.  A psychological assessment with her might, involve an analysis of her functioning using a combination of clinical interviews (i.e., asking her formulated questions about her history and background and current functioning), her responses to a series of standardized tests, as well as a review of any other available and relevant information.

Reviewing all of this information in context can help the psychologist formulate a better understanding of what is happening for this young woman and what might help her get back to good.  She might, for example, be suffering from clinical depression and, as such, she could benefit from some counselling sessions to help her learn new ways of thinking and coping.  Similarly, it might be beneficial for her to see her family physician to discuss medications that help fight depression.  Maybe both strategies would be helpful.

Psychological assessment is a complex process requiring much thought, experience, expertise and analysis.  Hence the many of years of schooling in order to do it thoroughly and well.

Also.  If you are someone who dreams of dating either of my daughters, (I'm thinking when they reach the age of 30 or so, but I can be flexible), please understand that you will first be asked to submit to a full psychological assessment.

Just sayin'.

3) Are you "analyzing me" right now?

Typically posed at parties.  Makes me want to lie and say that I am a hair stylist in response to "So, what kind of work do you do?"

Short answer?  Nope.  When I'm not at work, I'm just Barb.  Have you tried the dip?

4) What's it like in a psychiatric ward?

The psychiatric wards I have spent time in look much like any other hospital ward you've visited.   There are people milling about, some wearing scrubs and Crocs, some wearing hospital gowns/robes and some wearing street-clothes.  A few wear white coats and carry clipboards.  There's typically a cubicle in the middle where people are typing away at computers and/or talking to each other or on the phone.  From time to time, there's an announcement over the P.A. system paging somebody.

People are not typically violent, per se, but it happens.  You might be aggressive too if your brain was chemically imbalanced such that you couldn't trust your own perceptions and the world was, therefore a chaotic and frightening place.  But aggression is a lot less frequent than you might think.  I found that if someone did become agitated, the well-trained staff (usually nurses and orderlies) functioned together beautifully to help diffuse the situation before it became a crisis.

Sometimes you hear and see odd things.  After all, folks who are admitted to hospital for treatment of mental illness are, by definition, quite ill and sometimes out of touch with reality.  This can lead them to say and do relatively bizarre things.

For example, I was once working away in my office when I swore I heard a monkey in the hallway.  I called a colleague down the hallway.  Luckily, he heard it too so we ignored it and kept working.

There you are.  The top 4 questions and answers.  Now you know.

Be well,

Barb




Saturday 12 January 2013

Resolutions


Well, a new year and a new...er, um...well...my life is a bit in flux right now so I'll get back to you on that.  Anyway, I generally don't make resolutions, seeing as how they tend to remain largely unresolved.

I can, however, resolve this: herein will be a blog about all things mental health.  As a clinical psychologist, I have considered mental health issues from a research angle, as well as worked in hospitals, clinics, schools and private practices.  I've worked with people struggling with a variety of issues including depression, trauma, anxiety, eating disorders, psychoses, and regular, garden-variety life stuff.

As a wife, daughter, friend and mom (2 girls, ages 7 and 13) I've also watched countless loved ones struggle with mental health issues.  Heck, in trying to make my way through life and balance the aforementioned roles (as well as the far less glamourous ones like pet-waste picker-upper and last-minute dinner-maker) I'm also struggling to stay relatively sane (with the emphasis here being on relatively).

Which is why, after more than 40 years (not counting anymore) on planet earth, and a decade of experience as a mental health professional, I'm still astounded that we don't talk more about mental health issues.  We don't make mental illness a funding priority - and yet the cost is truly staggering: an estimated 50 billion dollars annually to the Canadian economy (Smetanin, et al, 2011: The life and economic impact of major mental illnesses in Canada: 2011 to 2041. RiskAnalytica, on behalf of the Mental Health Commission of Canada). And that's not including the human cost which, as anyone who has suffered with a mental health issue can attest, can never be quantified.  

Much discussion about youth mental health has happened in my community over the past 3 years.   Unfortunately, it took the deaths of several adolescents from high-profile families to make this happen.  Fortunately, out of these profound tragedies has come increased awareness and discussion.  We have a significant amount of work to do with respect to building systems and funding structures that can address the tremendous need.

So, regardless of your political stripe, I think we can agree that mental health issues need more air-time and more funding.  The answers, like many things in life, are complex and varied, and change will require time.

For now, I'll resolve to write about all things mental health.  The purpose will be to share ideas, information, helpful links, sage advice from a 7-year old, anecdotes, resources and strategies that I've been lucky enough to inherit from clients and colleagues.

Please do let me know what you think.  Suggest ideas for discussion and submit questions.  Comment on the good and critique the bad and ugly.   I've birthed two children, divorced one husband, hammered out a doctoral dissertation, and been on the receiving end of a 13-year-old girl's wrath.  I got this.

Be well,

Barb

Photo by flash photography.ca