The Danger of a Label

The danger of a label: You deserve more than just an educated guess.

Whether its Dr. Google, Social Media, something else or a combination of them all, a growing challenge has emerged. The challenge is the eadocse in which curiosity can become fact. Quite often a label (diagnosis) is imposed by others who really have no place to deliver such judgement or diagnosis. I’m increasingly seeing young adults in particular, enter the room with impressive confidence, and having barely sat down, will state ‘ I have clinical depression and if I could crack on with the first of 6 CBT sessions that would be marvelous’. This has quite an impact coming from young ones as young as 11.

When this is delivered by a health professional a label can take on so much more traction. A recent example I know of was a young man who presented to a GP with a headache. They then conducted a HEADSS assessment (Home, Education, Activities, Drugs, Suicidality and Sex). They then conducted a GAD 7  diagnostic tool for anxiety. The result was then relayed to the teenager that they had Anxiety. The next day after a sleepless night he had 3 panic attacks, couldn’t cope with school and the family had already made an appointment with the mental health team for his anxiety. This young man had taken absolute ownership of the diagnosis, as had the family, due to it coming from a health professional. These symptoms and issues had seemingly appeared overnight causing a significant barrier in his life, both at school and home. The facts and reality were quite different. He did present with a headache. He had stayed up all of the previous night to start and complete an assignment that had been set some time ago and was now due. stressHe was simply tired and stressed, both normal and short-term responses.

 

What prompted me to put ‘pen to paper’ on this topic was a student that presented to me recently and for the first time. This young woman had been managing her bipolar for the last 5 years. This was confirmed on the young woman’s school medical records as well as known and being managed by her parents. The young woman who was sat in front of me was not like any client I have seen previously with diagnosed bipolar. After exploring the bipolar it was the specificity of the time line that quickly directed our conversation. The response was quite staggering. 5 years earlier she was sat in class doing her work as usual. She was then continuously distracted by a peer who continued to take her pencil, tap it on his desk over and over before throwing it on the ground. She would then pick it up and place it on her desk, where shortly after he would continue with his routine. The young woman had by this point had enough, and snapped at the young man to ‘stop it’. His response, ‘stop being so bipolar’. And that was it. It was later confirmed with her parents that they had never sought medical advice or challenged the young girls ownership of the label. There had been no symptoms or concerns of any nature before this point. She had carried this label which had continued to limit the incredible potential this young woman had. It didn’t take long before she made significant gains through an initial approach combining narrative therapy with a strong thread of strengths based exploration.
pencilNow, it is not the label that is the issue. Depression, Anxiety, Bipolar, ADHD and lots of other acronyms all exist, are very real and can all be addressed. It is being aware of who and where the label is coming from and whether they are equipped and able to deliver such a diagnosis. As a parent, be aware of a false diagnosis, and question and demand the right person with the right answers. It’s not to say they are wrong, you just deserve more than an educated guess.

Everybody’s experience is completely unique and one word doesn’t and won’t do justice to your own needs and reflections. The more authentic and original your discussion, the more productive and effective the time and therefore outcome.

Unpack the experience towards a way though, reclaiming power and control from the label back to the person, you. Just have a quick go at saying the below and take the time to reflect on how you feel for each, and then decide for yourself which platform you want to work from.

I am depressed or I feel depressed

I have Anxiety or I feel anxious.

words

Technology & Counselling (Virtual Reality)

This is a short intro into what I am up to in counsellor land. I have often felt that professionals in the field of mental health in NZ are a private pedigree and less than confident or willing to share ideas. I say ideas not best practice because its okay to have ideas, give them a go and embrace if they work and file away if not. Not to mention what works for one person may not work for another. I hope to share my experience and feedback of incorporating technology into my practice in the hope it raises questions, which can only be a good thing.

Firstly why? why not just do what I do and sit back on the masses of evidence that tells folk it works and makes a difference (counselling that is). Also, technology costs money and I want to reduce overheads for maximum profit margin. As the head of a large counselling department we can barely buy refill let alone a VR headset. I will certainly in future posts on this topic return to addressing and discussing challenges such as these.

Why? I want to access and engage with clients that wouldn’t ordinarily access counselling. I want to make it more interesting and challenging for my client and yes for me too. I want to fill my tool box with as many strategies and resources as possible that can support me in my work and my clients in their process. Technology is here and now and I would like my work as a counsellor to keep up with the needs, expectations and opportunities that come with innovation. Most importantly I want to continue to ask questions of myself and how I work so I continue to evolve, whether this means technology is a welcome addition, or whether it is an unhelpful gimmick. I want to make that decision from the coal face rather than being directed by those that may have their own agenda or insecurities about such change or ideas.

663275 Google Expeditions_03

To begin with I’d like to introduce:

Virtual Reality (Samsung VR Gear $199 NZD)

good vr

This device works with a Samsung S6 upwards and I use it with my S7. You upload the Oculus app via the app store and once done you connect your phone behind the front protective fascia and adjust so its nice and tight to your head. It takes only a few minutes to get used to it and how you select something from the menu, focus, volume and the ‘go back’ button. Pretty straight forward.

samsung vr

Context: I have used these in two roles. In my private practice with adults around social anxiety, anger and stress. Also in my role as a school counsellor (Age group 11-18 years). You will certainly see students requesting appointments that you may not have previously seen.

How do I use it?

Mindfulness. There are a couple of free apps that are ‘OK’, but the graphics aren’t as good as they could or should be. What you can do is take your pulse pre and post session to monitor its effectiveness using the phone as a senser. I have found it works and my clients, adults, adolescents and children love it.

Apps: Both would get a 7/10, however the future scenes for Guided Meditation VR would take it to an 8/10 and make it the better of the two.

guided med vr                                exvreience

 

Anxiety. There are again a few apps for public speaking, fear of flying etc. Really not many right now but they are coming through quite quickly. The main distinction is previously VR has meant a programmed virtual reality, so quite grainy computer generated simulation. The cameras now however mean the content is using real images and footage and in HD. This is far better. Again, I have used it for students with a fear of public speaking at my school. I simply recorded our hall with no spectators, 10 spectators, 20 and then 35. Time was limited and students so I plan to sepnd a bit of time on this concept building towards a full assembly. This is great for both students and staff. I turn the sound down and through desensitization we gradually build the scene up with the student reading their presentation. Again we look at anchors in the room and capture the sensations of a successful delivery.

heights

Sports Counselling. Visualisation can be anchored in real-time and specific to the individual and their sport and needs. For example in Rugby, a kicker would be recorded completing a successful kick. This recording is then utilised to replay and rehearse the conditions and enable you both to explore anchors whether on the field, physically or verbally. This principle is used in most golf shops nowadays to improve your swing without having to wade through rivers or apologise to the next green to retrieve your ball.

How do I intend to use it?

Behaviour Modification. I hope to simply record scenarios that cover the gambit of student challenges. Conflict resolution and bullying for example. Recording scenarios that we can use to explore the A B C’s of behaviours and also the opportunity to apply what we discuss in a safe but realistic environment -role play.

I hope to utilise a specific camera to increase the quality and availability of footage and content that is specific to my client base, community and presenting issues, so NZ rather than courtesy of The States. The fly 360 (below) seems like the best ‘normal folk’ or no commercial grade device retailing at about $950 NZD. However there are others in your local store such as the Samsung Gear 360 ($650 NZD). However, if you want to keep it even more low-budget then use your 360 option on most of the newer phones.

fly360

It’s very new and specific reviews of apps and uses will grow in time through future blogs. Early signs are extremely positive, my clients love it and it can really fit in nicely as part of a wider session making a great additional resource to work with clients.

For more info etc. check out:

http://www.vrs.org.uk/virtual-reality-healthcare/therapies.html

Virtual Reality Therapy: Treating The Global Mental Health Crisis

http://www.apa.org/research/action/speaking-of-psychology/virtual-reality.aspx

http://www.wsj.com/articles/virtual-reality-as-a-therapy-tool-1443260202

(These articles offer further reading, they are not necessarily my thoughts and opinions)

 

 

You Get What You Look For

Two children, two different approaches. The first child stands in front of you and you direct them to ‘head outside and somewhere on that sports field you’ll find $20’. This young one then turns and heads on over towards the sports field. The second bowls on in and you deliver a different instruction, ‘head out there and somewhere on that sports field you’ll find some rubbish’. For both children they are instructed to bring what they are tasked with finding back to you. Which one do you think will complete the task in the quickest time and with a slight spring in there step? Secondly, which is more likely to find the rubbish and which is more likely to retrieve the money. To be fair, i’ll eliminate two variables that many school staff or parents will be quick to highlight. No, the second one doesn’t slide down in the seat and stage a sit in, and thanks to the impressive building budget, the sound proofing is second in impressiveness to only a Sony recording studio, so the second is unaware of the $20 floating around outside. The point: You get what you look for. This principle remains a struggle in many schools and families. Why? well, perhaps we haven’t come as far as we would have liked, from children are to be seen and not heard, and the understanding that we are the adults so if i say, you do. We all know that that in many situations this simple and wonderfully hopeful mantra is destined for a less than positive outcome.

discipline

We do love our consequences, and for 98% of young folk that works, heck it works for everyone. If we were to as much as see a car in the distance flashing its headlights, we slam on the breaks and look with an indescribable intensity for the mobile speed camera, so we can glare and shake our heads with suitable disapproval. Most of us are more than eager to conform to social expectations and the notion of what is right and wrong. Reigning this in from my own drive home from work this afternoon to working with our young ones. The challenge we face is the 2% ‘ers, for which consequences are entertainment rather than a deterrent. I believe it is so important to then delve deeper into the function of the behaviour but for many school staff and parents it is paramount we change tact, as if you do what you always have done, you continue to see the same outcome. This makes little sense, and quite possibly reinforces the behaviour and damages the relationship that could potentially be the best opportunity for positive change.

lifting the lid

We can modify behaviour  by challenging the children to lift the lid. That is lifting the lid of their expectations of themselves, as well as challenging ourselves to lift the lid of our expectations of the child and limitless and being available to see the enormous potential of the children. This requires retraining the children and adults that connect with each other to acknowledging the positive steps and embracing positive steps forward towards a better outcome.

One example i’d like to offer is terribly simple but continues to work without failure (touch wood). Get your conduct books or daily report cards out and have a look at the wording, tone and direction. So, look for what the booklet or strategy is aiming to highlight. Is it catching the negative behaviours for the student to then carry around for the day or celebrating moments of positive behaviours in the hope that it reinforces what you want to see and hear? Who is taking responsibility for the behaviour? Are you enabling change or disabling change?

It doesn’t take long to flip the approach so it is both enabling positive change, and the responsibility for behaviours is positioned with the right person, the student or child themselves. This objective can then be supported  by adults.

So, you get what you look for. Expect the student or child to raise their own expectations of themselves and lift the lid in terms of reaching their potential. Quite possibly the greatest challenge is to refresh/retrain the adults to search for, capture and acknowledge the positives. Damned hard at times, but worth it, especially when investing in the long game.

 

 

Connecting through Disconnection

Adolescent mental health, depression, suicide, risk taking behaviour, positive change and importance of connectedness.

Prevalence of mental health problems continues to be a challenge, often beyond the capacity to keep up, especially for most school counsellors. What if, rather than a mental health epidemic we are in the thick of a cultural crisis for adolescents. The challenge being, as adults and professionals, many are blindingly fast to formulate an assessment and diagnosis. Folk aren’t so open to  closing the text books and inquiring further into the why’s as it looks and sounds on the ground.

For each of us, the incredible uniqueness brings a collage of opinions and philosophies on the how’s, when’s and what’s of just about anything. The moment a penny dropped for me was after speaking to a male teenage client of mine. As part of my thesis I conducted a interview reflecting on a programme I had created targeting the reduction of adolescent depression. The quantitative data made for comfort reading as it affirmed, with bells and whistles, the efficacy of the programme I had developed.The qualitative side of things presented a real headache to start off with, and the participants clearly didn’t get the memo. What I had was three different, tried and tested measures for depression symptomatology showing clear improvements pre and post intervention. The participants I had in front of me mirrored through both sight and sound the positive changes the data suggested. It was the absolute commitment to being depressed that rang confusingly loud and clear. No better example was that offered by the client I mentioned. Without skipping a beat he reflected that he ‘did better than he wanted to’. Thank heavens it was a multi tasking head space day, as this statement has stayed with me ever since.

Psychiatrist

After five years and thousands of adolescent clients later my observations and experiences have continued to build around this topic, as both a an issue around barriers to engaging, but primarily around how to both identify risk and support positive change and increase resiliency to prevent escalating challenges in the first place.

Apart from societies eagerness to have a label and the discussion around increased diagnosis vs increase actual growth, I believe we are in the middle of a cultural shift where adolescents are connecting through disconnection. This is nothing new if you consider drugs, alcohol and gangs etc. but technology and social media is new (ish) and it’s impact-or exploration of- is a work in progress.

social-media-technology-teenagers

This topic is too huge to discuss fully within a couple of hundred words and a funky picture. One example of what this looks like is when I reflect on the substantial increase in students that confidently march into my office, outlining with immense energy their newly diagnosed Depression, Anxiety and ADHD, and then ordering the first of six CBT interventions, before looking at me expectantly and my return look of surprise.

We are now seeing social groups developing from the common grounding of having an emotional difficulty, so connecting through disconnection. Social media offers extensive input into what this may look and sound like, and all too often to excess.

When adolescents are embarking on the confusing journey that is identity formation, I feel it is really important to support and introduce as many positive connections as possible, otherwise they will find connections elsewhere, and in this technological age, that tends not to end so well.

This observation refers to an emerging adolescent culture, and certainly not a universal broad brush of all adolescents that visit a Counsellor, Psychologist or Psychotherapist. What it perhaps highlights is the real need for caution in terms of knee jerk diagnosis, to ensure professionals don’t create the very problem we strive to overcome.