Mental Health on the Web

I was just reviewing my Delicious bookmarks for a curriculum I am revising and I revisited several articles that really capture the diversity of online therapy and how varied and wide the delivery methods are now.

I thought I would share the articles here. These are not academic articles so the yawn factor should be minimum. These are all article that appeared in the news- about everything from phone therapy to webcam therapy, email therapy and avatar therapy. Take a peek.  It’s pretty awesome!

Phone Psychotherapy: Fewer Hangups?

Online Advice

On the Couch Online: Does Tele-Therapy Work?

Japanese get psychotherapy via mobile phone

Asperger’s Therapy Hits Second Life

London psychiatrist wants to offer online counseling through WoW

A Talk With the Creator of eGetgoing, the First and Only Accredited Online Recovery Program

Here’s to keeping warm!

DeeAnna

I had the pleasure of seeing Wishful Drinking at Studio 54 Sunday in New York. Wishful Drinking is Carrie Fisher’s life story given quite conversationally from her chair on a warm broadway stage.   I never had the opportunity to go to Studio 54 in it’s hey day as a thriving disco for celebs and those who were somehow part of the “in” crowd of the early 80’s drinking and drugging haze. Instead, I sat in what is now a lovely theatre, as a 40-something psychotherapist listening with awe and respect to the provocative life of Carrie Fisher.

The play is only running for two more weeks so if you have the opportunity, GO! Carrie Fisher gives voice to the decadent aftermath of living in the spotlight and using substances to cope. She talks of her struggle with being diagnosed with bi-polar disorder and her bouts with rehab. But what shines through is her surviving and thriving spirit. She tells her story with candid humor and grace. This is a show worth seeing!

To everyone here in the greater New York area, keep warm on this cold, windy day!

DeeAnna

It is a cold cold day in New Jersey. I won’t be going to NYC on days like this.  But I imagine there may be warmer days soon and I might venture into the city to see two exhibits currently on display at the Rubin Museum of Art. I stumbled across these exhibits as I was surfing the net (avoiding writing and work yet liesurely strolling through cyberspace). One exhibit is Mandala The Perfect Circle showing until 1/11/10.

I absolutely LOVE mandalas…

I find that mandala art carries a healing energy.

The other exhibit is The Red Book of C.G. Jung on display until 2/15/10.  This exhibit includes regular cinematic showings of movies that capture Jungian themes. Cabaret Cinema – The Red Book Series. For the movie viewings it would be handy to actually live in the city!

And so, if I warms up a bit, I might go take a looksee!  But if it doesn’t I can still learn and read about the exhibits and even view them to some extent right now, right here!

Check out Rubin Museum of Art’s Multimedia Resources online!!!

Nobody noticed the thread of psychology running through these two exhibits, eh?

Keep warm!

DeeAnna

In the fall of 1991 I was an undergraduate student at Georgia State University. I was a student in the health sciences department and I majored in Mental Health and Human Services.  To be sure all students received hands-on experience, we were required to complete 3 practicums.  And so, approaching time to register for my first practicum,  I was introduced to a homeless shelter that was housed at Clifton Presbyterian Church in the Lake Claire neighborhood of Atlanta. 

Thirty homeless men found shelter sleeping on mats in the church sanctuary. In the morning a volunteer team prepared breakfast and afterward the men were taken downtown on the church bus driven by another volunteer. In the afternoon the men were picked up and brought back to the church greeted by another volunteer team that prepared dinner. The church offered shelter 365 days a year. On Sunday mornings the mats were taken up and chairs took their place. Church commenced.

And so, what could an undergraduate student do to help? I facilitated a weekly meeting for the men- a community meeting to offer an outlet for them to express whatever needed to be talked about.  The shelter was considered an emergency shelter but we did have long term residents as well.  Joe Coppage was the inspiration for church members to begin the mission a decade before I arrived.  Joe had a chronic mental illness and would not comply with the typical expectations of community mental health and so he sought shelter on neighborhood porches.  Finally, neighbors who were members of Clifton decided to start the homeless mission.

In weekly meetings I met men from all walks of life who had fallen into homelessness for varying reasons.  I learned from them and I grew.  When my practicum was over I moved on to other practicum experiences but I remained at Clifton for another five years as volunteer, paid staff and eventually, an active member of the church community. I wore the hat of food coodinator,  organizing volunteers and preparing meals; taking inventory of supplies and interfacing with local community resources such at the Atlanta Food Bank and Atlanta’s Table. In 1996 when Atlanta hosted the Olympics, I helped coordinate efforts to house the men during the day at local suburban churches.  In the evening when the men returned to Clifton, gourmet Olympic  leftovers were delivered to Clifton’s door.  One evening the men feasted on cornish hen.

So what does any of this have to do with my current pursuits? EVERYTHING. The experience helped shape who I am as a mental health professional.  I grew in so many ways. My comfort zone was stretched from the very beginning but I remained and I learned the true meaning of hospitality.

The other day I received the Clifton newsletter in the mail. Clifton Presbyterian Church has since closed but the building remains and the mission continues, supported by hundreds of volunteers in the Atlanta community. Now known as Clifton Sanctuary Ministries, homeless men continue to receive hospitality. They not only serve homeless men needing emergency shelter, they also transition men to a house located across the street from the shelter. The men are offered case management, as well as health and vocational services from agencies in the community. 

I visited the website and saw many familiar faces; many of the same volunteers still give hospitality to the men on a regular basis.  Receiving the newsletter is like going home.  Clifton is a place that allowed my compassion and hospitality to grow. My professinal roots are at Clifton and I have used those skills throughout my career.  But most of all, I learned about grace~ I had many teachers at Clifton from the homeless men themselves to Pastor Currie Burris (now at Silver Spring Presbyterian Church in Silver Spring, MD) to members of the congregation as well as volunteers and professionals I interfaced with in the greater Atlanta community.

Clifton shaped me.  It makes sense I would share Clifton with you. 

http://www.cliftonsanctuary.org

Wishing everyone cool and comfortable fall days!

DeeAnna

I was recently interviewed by the Stars and Stripes regarding online counseling and the article entitled Tricare Programs Offer Online Counseling posted last week.  Some of you may know that Tricare is offering online services now with a pilot program called TRIAP in which military and their family members can obtain assistance online via webcam.  The military has also launched services through Tricare using a platform developed by American Well for behavioral telehealth services including the ability to prescribe.

Just a few weeks ago, the EAP Digest published an article about online counseling having finally crossed the chasm, suggesting that after a decade or so, the concept of online counseling is not really such a foreign idea.  The article refers to an EAP (Employee Assistance Program) company in Canada that facilitated over 10,000 email cases in 2008.  The same is true for EAPs in other parts of the world.

And most recently, a new study that will appear in the well-respected medical journal, Lancet, is indicating that online therapy is just as effective as face-to-face therapy. In fact, this study has been tweeted and retweeted countless times on twitter. In this same week results of another study from New South Wales, St. Vincent’s Hospital utilizing online therapy as an intervention for social anxiety disorder show similar efficacy. People seem to be very receptive to the idea that online therapy can be helpful to some individuals.

Perhaps it is because technology has become such a part of our social fabric that resistance is futile, or maybe there is a shift in the profession’s consciousness about thinking through new ways to reach out.  I would love to hear feedback from people who may or may not consider online counselling for themselves. I have said all along that online counseling will not replace face-to-face counseling. Online counseling offers another way to deliver interventions. And I was a decade early when I said in 1999 that online therapy would become mainstream.  Has the time come?

DeeAnna

I recently was introduced to an awesome website that I thought I would share with everyone.  The name of the site is the Kristin Helms Internet Safety Foundation and the website is http://www.kristinhelmsfoundation.org/.

It is through tragedy that we are privy to such a wonderful collection of tips and information. Kristin met a sexual predator online and the ending was not a happy one.  I encourage all parents to read this website and understand, as the site states, that it is not just about monitoring your child’s computer usage at home. Computers are available at school and now with the advent of Smart Phones kids can go online with ease. 

Remember to educate your children from an early age about internet use and forming relationships online.  I gave some tips in an earlier post- Protecting Your Children from Cyberbullying.

And there are tools to keep your computer at home safe as well as your child’s mobile phone as well.  InternetSafety.com offers such products for purchase.

Do take the time to read the information offered at the Kristin Holmes Internet Safety Foundation. Let’s do our part to keep our kids safe! Thank you to Kristin’s family for turning thier tragedy into a resource we can all use.

Best to all!

DeeAnna

I recently had a conversation with a colleague who said she just couldn’t find her “calling.” She is a counselor and she knows she was led to help people but she feels she is called to deeply fulfill her vocation- she just doesn’t know what or how. She told me about her jobs (plural). One of her jobs is as a counselor at a juvenile detention center. She said she knows she helps her clients. And then with pause she said, “But the work environment is toxic.” And I knew exactly what she meant. Having worked in various settings over the years- many of which were crisis-oriented settings, I could relate. As I dealt with the concerns and needs of my clients I often had to deal with the negative attitudes of burnt out staff people who had seen way too many lives torn apart by abuse, neglect, poverty, disaster, illness and death.

It is not just counselors who are faced with trauma at work- it is our police force, fire fighters, emergency hospital workers, grief and hospice workers, child welfare workers, 911 operators- the list is quite long. And so as I walked through airports these past two weeks and saw our men and women in uniform, I wondered to myself just how much pain and suffering they have seen- and how much more they will be expected to endure.

Upon reflection, and knowing how much I have witnessed in my career, I am thinking that each of us can only take in so much before it begins to taint us and deeply hurt us at a soul level. Maybe we should only be allowing ourselves to work in these difficult environments for a much shorter time than we think we can handle. Maybe only a few years at most, and then it is time to move on and let someone else take the challenge. In that way, we can remain whole and be able to continue to have positive impact on the world around us without our own souls being in the balance. I realize there are exceptional people who may be able to do crisis work for years but I am talking to the rest of us.

I didn’t realize the toll all of those years really had on me until I moved away from that level of intense work. Now I know that even as I was helping, I may not have been able to give anything my all, because it was not in me to give. So now I spend time nurturing and feeding my soul so that I give again the way I did way back in those early years of my career…

What do you think?

I have relocated my counseling and psychotherapy practice to 25 Memorial Parkway (Hwy 36) in Atlantic Highlands.  My new location is just a few miles from my previous location in Rumson and all other contact information remains the same.

Enjoy your summer!

DeeAnna

I have spent time lately training therapists and writing about a therapist’s boundaries online.  And so now I am curious from the other perspective, what people think about connecting with their therapist online via social media sites like Facebook, MySpace or other similar social networks?

I guess it might help for those of you who are not in the counseling profession, to talk first about our code of ethics- what we as therapists, counselors, psychologists, social workers and psychotherapists must carry out to remain ethical.  Regardless of the discipline, we all have a code of ethics that we are expected to follow, and with a few differences in intent and wording, there are some ethical tenents that remain universal.  Two of these tenents are with regard to confidentiality and dual relationships.

While most ethical codes have not yet addressed social media in their codes, some of us in the field have interpreted the existing codes as applied to social networking as follows:

Friending a client on Facebook or MySpace could potentially breach confidentiality. While the client may agree or even initiate the connection, others who are friends of the therapist and/or the client may “connect the dots” and assume or confirm that the person is indeed a client of the therapist.

Friending a client on Facebook or MySpace could be interpreted as a dual relationship. As a therapist I do not socialize with my clients.  I don’t meet my clients for coffee and I don’t go to their home for dinner.  Inviting a client to my Facebook page is like inviting a client into my living room.

Feedback anyone?  What do you think?

Have a beautiful summer day!

DeeAnna

I have used this infomation for over 10 years helping parents modify aggressive parenting styles that include spanking and corporal punishment. In the years that I have been in the mental health field this has by far been the most controversial topic I have presented- whether to friends, family, colleagues or clients. I wonder if the pendulum has begun to shift at all?

Ten Reasons Not to Hit Your Kids
by Jan Hunt, M.Sc.

“Of all tyrannies, a tyranny exercised for the good of its victims, may be the most oppressive. Those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience.” – C.S. Lewis, 1952

In 24 countries around the world, it is illegal for a parent, teacher, or anyone else to spank a child, and 113 countries prohibit corporal punishment in schools.1 Yet in all of North America, physical punishment by a parent, as long as it is not severe, is still seen by many as necessary discipline, and condoned, or sadly, even encouraged.

For the past several years, many psychiatrists, sociological researchers, and parents have recommended that we seriously consider banning the physical punishment of children. The most important reason, according to Dr. Peter Newell, coordinator of the organization End Punishment of Children (EPOCH)2, is that “all people have the right to protection of their physical integrity, and children are people too.”3

1. Hitting children teaches them to become hitters themselves. Extensive research data is now available to support a direct correlation between corporal punishment in childhood and aggressive or violent behavior in the teenage and adult years. Virtually all of the most dangerous criminals were regularly threatened and punished in childhood. It is nature’s plan that children learn attitudes and behaviors through observation and imitation of their parents’ actions, for good or ill. Thus it is the responsibility of parents to set an example of empathy and wisdom.

2. In many cases of so-called “bad behavior”, the child is simply responding in the only way he can, given his age and experience, to neglect of basic needs. Among these needs are: proper sleep and nutrition, treatment of hidden allergy, fresh air, exercise, and sufficient freedom to explore the world around him. But his greatest need is for his parents’ undivided attention. In these busy times, few children receive sufficient time and attention from their parents, who are often too distracted by their own problems and worries to treat their children with patience and empathy. It is surely wrong and unfair to punish a child for responding in a natural way to having important needs neglected. For this reason, punishment is not only ineffective in the long run, it is also clearly unjust.

3. Punishment distracts the child from learning how to resolve conflict in an effective and humane way. As the educator John Holt wrote, “When we make a child afraid, we stop learning dead in its tracks.” A punished child becomes preoccupied with feelings of anger and fantasies of revenge, and is thus deprived of the opportunity to learn more effective methods of solving the problem at hand. Thus, a punished child learns little about how to handle or prevent similar situations in the future.

4. The phrase “Spare the rod and spoil the child” is not from the Bible but from Samuel Butler’s “Hudibras”, a 17th Century satirical poem. The poem, like his novel, The Way of All Flesh, was written to expose and denounce violence against children.

While the “rod” is mentioned many times in the Bible, it is only in the Book of Proverbs that this word is used in connection with parenting. The book of Proverbs is attributed to Solomon, an extremely cruel man whose harsh methods of discipline led his own son, Rehoboam, to become a tyrannical and oppressive dictator who only narrowly escaped being stoned to death for his cruelty. In the Bible there is no support for harsh discipline outside of Solomon’s Proverbs. By contrast, the writings in the Gospels, the most important books in the Bible for Christians, contain the teachings of Jesus Christ, who urged mercy, forgiveness, humility, and non-violence. Jesus saw children as being close to God, and urged love, never punishment.4

5. Punishment interferes with the bond between parent and child, as it is not human nature to feel loving toward someone who hurts us. The true spirit of cooperation which every parent desires can arise only through a strong bond based on mutual feelings of love and respect. Punishment, even when it appears to work, can produce only superficially good behavior based on fear, which can only take place until the child is old enough to resist. In contrast, cooperation based on respect will last permanently, bringing many years of mutual happiness as the child and parent grow older.

6. Many parents never learned in their own childhood that there are positive ways of relating to children. When punishment does not accomplish the desired goals, and if the parent is unaware of alternative methods, punishment can escalate to more frequent and dangerous actions against the child.

7. Anger and frustration which cannot be safely expressed by a child become stored inside; angry teenagers do not fall from the sky. Anger that has been accumulating for many years can come as a shock to parents whose child now feels strong enough to express this rage. Punishment may appear to produce “good behavior” in the early years, but always at a high price, paid by parents and by society as a whole, as the child enters adolescence and early adulthood.

8. Spanking on the buttocks, an erogenous zone in childhood, can create in the child’s mind an association between pain and sexual pleasure, and lead to difficulties in adulthood. “Spanking wanted” ads in alternative newspapers attest to the sad consequences of this confusion of pain and pleasure. If a child receives little parental attention except when being punished, this will further merge the concepts of pain and pleasure in the child’s mind. A child in this situation will have little self-esteem, believing he deserves nothing better. For more on this topic, see “The Sexual Dangers of Spanking Children” (also in French).

Even relatively moderate spanking can be physically dangerous. Blows to the lower end of the spinal column send shock waves along the length of the spine, and may injure the child. The prevalence of lower back pain among adults in our society may well have its origins in childhood punishment. Some children have become paralyzed through nerve damage from spanking, and some have died after mild paddlings, due to undiagnosed medical complications.

9. Physical punishment gives the dangerous and unfair message that “might makes right”, that it is permissible to hurt someone else, provided they are smaller and less powerful than you are. The child then concludes that it is permissible to mistreat younger or smaller children. When he becomes an adult, he can feel little compassion for those less fortunate than he is, and fears those who are more powerful. This will hinder the establishment of meaningful relationships so essential to an emotionally fulfilling life.

10. Because children learn through parental modeling, physical punishment gives the message that hitting is an appropriate way to express feelings and to solve problems. If a child does not observe a parent solving problems in a creative and humane way, it can be difficult for him to learn to do this himself. For this reason, unskilled parenting often continues into the next generation.

Gentle instruction, supported by a strong foundation of love and respect, is the only truly effective way to bring about commendable behavior based on strong inner values, instead of superficially “good” behavior based only on fear.

1 Sweden, Finland, Denmark, Norway, Austria, Cyprus, Croatia, Latvia, Israel, Germany, Bulgaria, Iceland, Romania, Ukraine, Hungary, Greece, Netherlands, New Zealand, Portugal, Uruguay, Venezuela, Spain, Chile, and Costa Rica. (Source: Center for Effective Discipline)
2 EPOCH Worldwide, 77 Holloway Road, London N78JZ UK
3 Personal communication.
4 End Violence Against the Next Generation (EVAN-G), 977 Keeler Avenue, Berkeley, CA 94708, USA.

Note: An earlier version of this article appeared as Appendix D in Alice Miller’s book Breaking Down the Wall of Silence (New York: Penguin USA, new edition 1997).