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WCPA Fall Newsletter

Posted on August 29, 2023 - 11:48 am by
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In the WCPA fall newsletter, topics include online versus in-person therapy, the importance of fathers, mental health stigma, reflections from an educator, presentation topics available, and the three most common types of dementia.

To Zoom or Not to Zoom? That is the Question

Julia Osborne, MSW, LMSW

 Since 1959, with the introduction of videoconferencing to provide therapy, psychiatry, and medical student training at the Nebraska state hospital in Norfolk, telehealth care has had a place in the field of mental healthcare. Even though telehealth 

had become more widely utilized to allow service access to individuals with limited resources over the past few decades, the era of telehealth did not have its heyday until COVID. With increased awareness of mental health concerns and amplified need for mental health care during the pandemic, telehealth care became commonplace. Today, ads for virtual therapy appear everywhere, touting its many benefits not only as a mental healthcare service but additionally promoting it over in-person care, creating a contentious debate amongst therapists. 

Telehealth was originally envisioned to provide care to clients who would otherwise not have access to mental healthcare, i.e., people with reduced mobility or without care in their area. But now, teletherapy is competing with in-person therapy for well-resourced clients who simply may be averse to in-person therapy. Advertisements state that teletherapy is better than in-person therapy, because of zero travel time, increased location convenience, and reduced stigma with increased anonymity. Some teletherapy sites claim they are at a better price point than in-person therapists, though this is disputable. Some services even attempt to persuade potential clients to join their network because they make switching therapists easy and non-confrontational – clients never have to feel stuck with a therapist they do not like or admit to a therapist that they no longer want their services. 

Could teletherapy really be a better option? There is no question about the convenience of having a therapist able to meet with you anywhere you choose, though telehealth sessions often cost around the same as in-person therapy. It’s important to know that the ability to switch therapists is acceptable with in-person care too, as getting a therapist who you feel understands and will appropriately challenge you is important. Typical in-person clients often try several different therapists over their treatment time, before settling with one who is the right fit. Finally, the increase in perceived anonymity online is potentially more of an illusion than believed – other people in your space may hear you during your appointment. Most therapists providing telehealth services during the pandemic told stories of  clients sitting in their cars during sessions, as nowhere else offered any true privacy. 

With in-person therapy, the therapist gains insights into the client’s situation and idiosyncrasies at a faster rate, with the advantages of being able to observe body language and having fewer environmental distractions (for example, having the appointment while the client is driving, which is distracting and dangerous, or having other people or pets come into the room during the session). This benefit of in-person therapy is bolstered in Jaime Herndon’s Healthline article, Teletherapy 101: What You Should Know, in which she states, “The cues in teletherapy are different than cues from in-person therapy, since the therapist and client are interacting over the screen, and may take time to get used to.” 

Some therapists who have worked with clients virtually and in-person argue that the therapeutic alliance, a key player in treatment success, is stronger among clients who come in-person, because the benefits of reading body language go both ways. Clients can read a therapist’s body language for acceptance, intrigue, and comfort with what the client is expressing. According to the American Psychological Association, the therapeutic alliance promotes several benefits to the client, such as fostering mutuality and collaboration, allowing the therapist to be more flexible and responsive through client feedback, helping to repair therapeutic ruptures, and improvements in handling a client’s negative emotions. 

Further, there is an observable increase in client investment with in-person treatment – they have to commit to making time to come into the office. With the increased pace of therapeutic alliance development, clients are less likely to end treatment abruptly, which gives the therapist more opportunity to discover the many layers of the client’s issues and how to help the client resolve them. Additionally, in the article The Experience of In-Person Versus Online Therapy, by Joseph Rauch on Talkspace, the point is made that, “Traditional therapy sessions offer a physical space where there is nothing but dialogue on important mental health issues. This experience can feel like a respite from the stresses of work and relationships.” The client can really focus on themselves and their mental health over their environmental variables. 

If you do lack access to in-person therapy, for whatever reason, it is important for you and your online therapist to set some ground rules. For example, when therapy is in session, the session is all that you are doing. You are replicating the office conditions (without other people in the space or distractions like pets); you are not walking around or driving. And of course it’s vital that clients do not have other applications or websites open on their phone or computer that could interfere with focus on the session or the internet connection. Without ground rules, clients often feel less obligation to create a therapeutic atmosphere. This can be distracting to the client and therapist and impair their alliance or session quality. Moreover, when clients get repeatedly distracted by other people, pets, or objects around them that would not be there during in-person sessions, therapists spend a portion of the session time in efforts to refocus the conversation, leading to reduced treatment efficacy. 

As a side note, for people who think teletherapy is the better option because they believe in-person care will be anxiety-inducing, it is important to remember that anxiety flourishes with avoidance. The more we avoid, the more anxious we become. So teletherapy over in-person therapy may not be in your best interest. According to Hofmann and Hay (2019), “Avoidance is typically considered a maladaptive behavioral response to excessive fear and anxiety, leading to the maintenance of anxiety disorders. Exposure is a core element of cognitive-behavioral therapy for anxiety disorders.” They explain further that exposure is supported to be one of the best treatments for anxiety, therefore it bodes better for your anxiety about therapy to expose yourself to therapy in-person. 

All other points aside, it’s simply often easier to hide your true feelings during teletherapy than in-person therapy, which impedes the entire point of the therapeutic process. This is not to say that teletherapy is not a valuable resource; for those without access, teletherapy can be a great option. But for those with the means to do in-person therapy, it would be a valuable effort to try that first. 

Julia Osborne, MSW, LCSW

Julia Osborne, MSW, LCSW

With mental health experience working with many different populations, Julia enjoys working with adolescent clients in the clinical and school settings, dealing in large part with school-related problems, behavior, and anxiety, and adult clients as well. Her professional passions include individual, couples, and family therapy. Employing evidence-based practices, Julia frequently utilizes cognitive behavioral therapy and psychodynamic therapy, to best meet her clients’ needs.

From the Director

Mary Fitzgibbons, Ph.D

In our last newsletter, I wrote an article in regard to Attachment Figures in our lives. I explained the need for good nurturing being the bedrock of a child’s emotional and physical well-being. I wrote about the belief that for many of us, mother has generally been seen in that role. The good mother attunes to her child. She “gets” her child and understands his or her needs. The good mother also mirrors her child. The child sees in her expression the value that the child has. I went on to say that there are many other attachment figures in our lives, such as grandparents, aunts, uncles, teachers, even spouses. The one person that I did not mention was father. 

I received two e-mails after the newsletter came out – both with the same message. Why would I not have included fathers? When I read the first message, I thought how can that possibly be. Of course, I would have mentioned fathers. I went back to the article and realized she was right. I never specifically spoke of fathers. And then the second e-mail came with the same message. I wrote to both parties and apologized, certainly not meaning to have intentionally omitted fathers. 

The Evergreen Psychotherapy Center, an Attachment Treatment and Training Institute, put out an article on the importance of a father in a child’s life. It says that fathers are capable of the same motherly behaviors as women. The sight of their newborn triggers a similar range of loving behaviors, including protection, giving, and a responsiveness to the infant’s needs. In fact, the father’s confidence increases as he handles the child. As his parenting instincts emerge, so does his level of commitment. It was also found that the more actively involved a six-month-old had been with his father, the higher the baby scored on infant development scales. 

If I were to look at my own experiences with fathers and children, I have been fortunate to watch my sons and grandsons with their children. There is no question that these children know that they are cared for and loved by their fathers. My own more personal experience with my father also bears this out. My fondest memory of my father is my being a little girl. He is holding my hand and taking me on long walks. I also have the same memories of his taking my children on walks also. I cherish these memories. It was his time to be with us and I knew we were loved. 

I am again apologetic for initially omitting “fathers” from the original article, but I am also appreciative in that it called to mind how critical that relationship is in the emotional development of our children. Fathers play a very important role in children’s lives. They can be the deciding factor in a child’s eventual well-being. 

– Mary 

Treating Mental Health Stigma in Medical Settings*

Amy Neu, MSW, LCSW

Amy Neu, MSW, LCSW

“We have so many patients that need care, and I don’t think many of us have been trained to work with the mental health side. I got into this field to help older people, and I don’t feel like I really get to do that right now with everything we need to get done in a shift.” 

– Staff member at nursing facility 

There is enormous strain on professionals in medical and senior communities to accomplish numerous tasks and be fully present for their patients during a shift. Most workers were drawn to this field to help older adults and patients live with dignity, care, and compassion. It can be disheartening for many professionals when they experience the reality of working in these settings: the amount of paperwork, logistics, and coordination required by the system take time away from direct care with patients. Furthermore, staff see that residents’ needs are not merely physical, but mental, emotional, spiritual, and social as well. Over time, staff can feel increased pressure to meet each of these needs, all while working under time, staffing, financial, and training constraints. 

Accumulating stressors from the pandemic on the healthcare system have compounded the problem. A recent survey from the American Health Care Association found that 86% of nursing homes in the U.S. are experiencing moderate to severe staffing shortages, 96% of nursing homes are struggling to hire additional staff, and 78% have hired temporary agency staff to fill the gaps. Furthermore, over the past decade many medical systems have made financial cuts to departments such as social service and chaplaincy, who offer care for patients beyond their physical needs. While these services have been eliminated from the budget, the need for this care has certainly not reduced. Who, then, is left to address these needs for patients? 

In addition to staffing dilemmas, providers across medical settings find themselves increasingly limited to one piece of the healthcare puzzle. Researchers have found that there is often a lack of ownership for mental health care, leading to staff not seeing it as part of their job. It often feels like it is (or should be) someone else’s responsibility to manage mental health care symptoms. As a result, patients with mental health issues have poorer outcomes from surgery and medical procedures, as well as worse experiences of care than those without a mental health diagnosis. 

In a fractional medical system, it makes sense that providers feel the best thing for patients is to refer out to a specialist and distance themselves from patients who appear out of their scope. The consequences of this model, however, are that patients with mental health conditions feel as though they are falling through the cracks. Meanwhile, staff continue to feel unprepared, stuck, and out of their scope with a subset of patients in their communities. How can we begin to approach these obstacles? 

The first suggestion is to provide staff with more training on mental health topics. Without quality training, staff and residents are placed in difficult and potentially harmful situations. Often conscientious staff become fearful of doing or saying the wrong thing, which in turn leads them to distance themselves from residents with mental illness. This action alone can unintentionally foster an increased sense of mistrust, isolation, or fear in their residents (which can exacerbate symptoms like anxiety, paranoia, depression, or withdrawal) and negatively impact functioning. WCPA offers training and consultation programs to senior communities, and NAMI offers mental health first aid training for the general public which has also been a promising tool for staff in medical settings (https://namimissouri.org/resources/about-mental-illness/mental-health-first-aid). 

Another idea is to provide staff and leadership with ongoing consultation with local mental health clinicians. While it may seem ideal to outsource our residents’ mental health care to a psychiatrist or therapist alone, the reality is that humans are complex social beings. Therapy and psychiatry are incredibly beneficial and should be consulted whenever necessary. However, once residents return home from their appointments with these specialists, the staff in the senior community are their primary social contacts and caregivers. What staff says and does matters immensely, and these helping professionals deserve the space to discuss the challenges they experience and the opportunities to learn new ways of approaching residents with complex needs. 

Healthcare professionals are the backbone of our medical and senior care systems. They deserve more opportunities to learn and be supported as they serve patients with medical and mental health needs. Patients and residents also deserve to be understood, addressed, and properly cared for by compassionate staff. If your community would like more information on training and consultation, please feel free to reach out to WCPA to discuss how we can collaborate and help support your staff. 

* This article is the second in a three-part series, which covers the issue of mental health stigma in healthcare. The first article (Spring 2023) focused on individuals with mental health issues as they navigate the medical system. The final article will spotlight the experiences of family and loved ones who support an individual with physical and mental health issues. 

Reflection Diaries
A series of reflections written by a developing school leader

Carol Hall-Whittier, Ed.D.

Carol Hall-Whitter

Twenty-seven years ago, I embarked upon a path of leadership supported by prolific education practitioners, college professors, and school district leaders. I was tremendously fortunate to have influential educators in my life to mentor and teach me. As I look back on my professional growth, the first principle I learned as a developing school leader was the power of reflection and personal mastery. I am hoping that my reflections will impact and motivate today’s budding leaders to excellence and influence organizations to collaborative learning. 

August 17, 1996 Reflection 1 ~ My Journey as a New Teacher

There is nothing profound about my choosing teaching as a profession. I was quite young when graduating from high school: sixteen. I simply didn’t know what I wanted to do, but I knew I had to go to college. I had an aunt who was the first-generation college graduate in my family. She was a teacher; therefore, I chose Harris Teacher’s College to attend with a major in elementary education.

I now know that God’s providence was at work in my life. I cannot imagine myself being or doing anything else but teaching. It was what I was born to do.

I started my career at age 21, fresh out of college with lots of enthusiasm, determination, and energy. My first class was a group of rowdy 6th graders that no one else wanted. This is where my reflective practice began; reflecting on how I got into this mess! I had never felt so incomplete and unprepared in my life. However, this precipitated my early belief in ongoing professional development for educators. 

I began to visit my colleagues, asking them for input and suggestions. I requested help from the district curriculum specialists, and I attended workshops. I wanted to make a difference. I began to grow as a teacher, as a human being. 

After nine years of teaching, my practice was still lacking in many areas. I began looking deeply into my teaching practice, my contributions to children and their development. I became discouraged and concluded that I was not impacting my students’ learning when 30% of my students left my class not able to read, the school’s expectations and standards were low, and my teaching colleagues and I worked in isolation. 

I could no longer work in a profession where I could not see positive results. Was I truly making a difference in the lives of my students? I decided to leave the profession. Well, you just don’t decide to leave a career in which you’ve invested time and energy without careful consideration and prayer. After much prayer, I decided not to leave the profession I loved. 

Now we have come to the most exciting part of my journey. What happened next was “metanoia:” a Greek word meaning a fundamental shift of mind. I began to question my own commitment to excellence and my inability to affect my student’s academic performance. I concluded that I was not nearly the teacher I could be, and I had so much more to learn. However, I did have what was needed to move into a better place; my ability to engage in continuous reflection of my teaching and learning. 

Today, when I read a reflection of my life as a novice educator, I know the concerns and issues I grappled with 30 years ago are still present, but have quadrupled in intensity causing teaching professionals to leave the profession in droves. A culture of collaboration, comprised of professional development, team learning, and problem-solving embedded in the school day, will increase teacher effectiveness and give educators a systematic approach to teaching and learning. Daily reflections should be an integral part of a culture of collaborative learning. 

Characteristics of good reflection include: 

  • Self-Analysis
  • Identifies what was learned
  • Establishes a plan for usage of information
  • Identifies areas of growth
  • Thoughtful

Establishing new structures and systems for the school day will scaffold the learning and development of new teachers and support the evolvement of teacher leaders. Daily reflections will build a capacity for self-evaluations as well as enable one to be open-minded to the thoughts and ideas of others. 

Professional Development Available for Schools/Districts

Professional Development presentations are now being scheduled for the 2023-2024 school year. You may call the WCPA offices with questions or to schedule presentations, (314) 275-8599, or contact a WCPA presenter directly. Presentations may be led in-person or online. Depending on topic, length of training can last from one hour to full-day workshops. 

Available topics include:

  • Anxiety in Students and Helpful School Responses
  • School Anxiety, Avoidance and Refusal
  • Responding to Anxiety in Preschool-Age Students
  • Interacting with Anxious and Depressed Youth in Schools
  • Using Healthy Professional Boundaries in the School Setting
  • Recognizing and Responding to Depressed Students
  • Dealing with Difficult Parents
  • Building a Culture of Collaboration among School Staff
  • Strengthening Collegial Relationships in the School
  • Cultural Competence, Diversity, and Inclusion Topics
  • Understanding Attention-Deficit/Hyperactivity Disorder and Helpful Strategies
  • Stress Management and Anxiety Reduction Strategies for School Professionals
  • Suicide Awareness and Prevention
  • Suicide Risk Assessment in the School Setting
  • Counseling Strategies and Safety Planning for Suicide Prevention
  • Safety and Support Planning with Dysregulated Suicidal Youth
  • Suicide Postvention in the School Setting
Professional Development

Understanding Dementia: The Top 3 Causes

Brigid A. McGuire, MA, PLPC, NCC, CRC

Dementia is defined as memory loss symptoms caused by a certain disease or condition, and is not part of the normal aging process. While normal aging is marked by challenges such as temporarily forgetting names or where you left your keys, forgetting why you entered a room, or occasionally struggling to find the right word, dementia is an umbrella term describing a decline in mental ability severe enough to interfere with daily life. There are over one hundred different types of dementia. 

Alzheimer’s Disease is the most common form of dementia, accounting for sixty to eighty percent of dementia-related cases. It is a progressive and irreversible disease. Alzheimer’s Disease is marked by difficulty remembering new information, disorientation, mood changes, behavior changes, increased difficulty regarding time, events, and places, as well as delusions or suspicions related to family, friends, and caregivers that are untrue or inaccurate. There are many factors that impact the chances of acquiring Alzheimer’s Disease, such as age, genetics, family history, and heart health. By eating a healthy diet, exercising regularly, maintaining good cholesterol and blood pressure, remaining socially active, avoiding smoking, limiting stress, and getting enough sleep, you are keeping your heart and brain healthy. There is currently no cure for Alzheimer’s Disease, although there are FDA-approved treatments, including hopeful new treatments only recently approved for use. 

The second-most common form of dementia is Vascular Dementia, accounting for 5%-10% of cases. Vascular Dementia is marked by inadequate blood flow to the brain, which causes cell death throughout the body, but especially the brain. The effects of Vascular Dementia depend on how severe the blood vessels have been damaged and what part of the brain has been affected. There are many common symptoms of Vascular Dementia, including: confusion, disorientation, trouble speaking, trouble understanding speech, stroke symptoms such as a sudden headache, difficulty walking, poor balance, and numbness or paralysis to one side of the face or body. Many of the same risk factors and protective factors for Alzheimer’s Disease apply to Vascular Dementia as well, including cardiovascular health. There are currently no FDA-approved treatments for Vascular Dementia, however preventing and treating underlying cardiovascular conditions can increase an individual’s protection. 

The third most common form of dementia is Dementia with Lewy Bodies (also referred to as “Lewy Body Dementia”). Dementia with Lewy Bodies causes a decline in thinking, reasoning, and independent function, as well as changes in attention and alertness, visual hallucinations which recur, disruption to REM sleep, which may cause reenactments of dreams physically and vocally, slow movements, tremors, and muscle rigidity. Additionally, individuals who have been diagnosed with Dementia with Lewy Bodies may have difficulty interpreting visual information, and issues within the autonomic system within the body, which controls sweating, blood pressure, heart rate, digestion, and sexual response. Currently, the only way to diagnose Dementia with Lewy Bodies conclusively is by autopsy, however Dementia with Lewy Bodies can be diagnosed by a physician using their professional judgment. There are also no known cures or treatments to slow or stop the disease process, however there are beneficial medications that can help to treat the symptoms of Dementia with Lewy Bodies. 

A diagnosis of dementia can seem overwhelming and heart breaking. You might feel like you have no one to turn to. After receiving a dementia diagnosis, finding a mental health clinician who is knowledgeable about dementia, its various types, its progression, and what to expect can help you feel less overwhelmed and help you to focus on your own mental health and being present for your loved one during this journey. It is also beneficial for a person with dementia to see a mental health clinician themselves; benefits can include improved quality of life, improved mood, and improved symptoms of dementia at times. 

Feel free to contact a therapist at WCPA who specializes in serving older individuals, including those with dementia, and their loved ones. You can also contact your local chapter of the Alzheimer’s Association, which provides support and resources for many types of dementia, and utilize their twenty-four hour helpline or attend one of their many support groups. Taking these steps can help prepare you for the journey ahead and give you more time to enjoy with your loved one. 

Brigid A. McGuire, MA, PLPC, NCC, CRC

Brigid A. McGuire, MA, PLPC, NCC, CRC

Brigid provides private therapy for individuals and facilitates groups for adults, older adults, and caregivers. She has significant experience working with older adults and their families who face a variety of issues including memory loss, depression, anxiety, grief, isolation, and end of life planning. She also provides therapy for frontline/healthcare/ essential workers who worked through the pandemic, people with disabilities, and their caregivers and families.

Addressing Mental Health Stigma in Medical Settings

Posted on July 14, 2023 - 8:12 am by

Part 1: The Patient

“I dread going to the hospital…I have to explain myself every time and prove to them I’m not ‘crazy.’ I’m there feeling terrible, but need to be on my ‘best behavior’ so they can see I really do know what’s happening and what I need.” – Client with cancer and schizophrenia 

A common fear for people who have both a diagnosed mental health disorder and a physical illness is that they will enter a medical setting only to have their symptoms dismissed. Clearly, there are many facets of this topic. In this article, we will focus on individuals with mental health issues who are navigating the medical system. Next time, we will discuss the experiences of medical providers and residential facilities, and the final article will discuss strategies for family members and loved ones who support an individual with physical and mental health issues. 

The client’s statement above exemplifies what studies have concluded about the experience of people with mental illness and the medical system in the U.S. The article, “Mental Illness-Related Stigma in Healthcare: Barriers to Access Care and Evidence-Based Solutions” states, “Mental illness-related stigma, including that which exists in the healthcare system and among healthcare providers, has been identified as a major barrier to access treatment and recovery, as well as poorer quality physical care for persons with mental illnesses.” Furthermore, “People with lived experience of a mental illness commonly report feeling devalued, dismissed, and dehumanized by many of the health professionals with whom they come into contact.” 

Common questions clients often wonder include: Will a doctor take my physical concerns seriously? Will they assume that it’s an issue with my psych meds? Will medical staff be watching my behavior more closely than other patients? Will doctors believe me and treat my medical issues accordingly? Essentially, patients in this situation fear that in a quick-paced medical setting, their physical concerns will be overlooked, downplayed, or go untreated. There is fear that if they speak up about a concern of being overlooked, the provider will again point to a mental health issue; that they are being “anxious” or “paranoid.” In reality, when we look at past experiences of the patient coupled with conclusions of studies which highlight the barriers people with mental health issues face in medical settings, their concerns make a lot of sense. 

How, then, can someone with a mental health diagnosis prepare to interact with medical systems? In sessions with clients who are facing medical stressors, therapists often discuss several key points: What have their previous experiences with the medical system been like? How do they feel about their current providers? What skills can they use to communicate with healthcare providers effectively? Who are the supportive people in their lives who can help? As we gain a better understanding of our experiences, both positive and negative, we get more information about what drives us and scares us. Negative experiences in the past can inform how we feel going into new experiences, even if the providers or situations are different. Mental health stigma in society, institutions, and from individuals impacts how we have been treated and how we anticipate new situations. 

Once we understand how our past experiences have affected us, we can begin to mindfully address our needs in the present. Individuals in this situation can bring to mind what they need now and what they CAN do. For instance, we can learn new communication skills to advocate for ourselves or request support to amplify our voice. We can track physical symptoms or side effects in a daily log to bring to appointments with doctors to help guide our discussions. We can purposefully seek out doctors that listen and respond to our needs in a meaningful way. Yes, each of these tasks take time, energy, and focus. We can acknowledge the difficulty of these tasks while understanding that working toward these goals together will help our overall well-being in the long run. 

It is daunting to face a large system alone. Clients in this situation are encouraged to seek out the individuals in their lives who help them feel seen. This could be anyone from a close family member or friend who could help them advocate for themselves to a friendly receptionist at their doctor’s office. When we find the good people, the individuals who make up a larger setting, then the system feels more manageable. We can focus on one good interaction at a time as a touchstone to generate more positive exchanges. We are better able to remind ourselves that we matter and that we are human beings with needs worth discussing. 

It is particularly difficult for people with mental health diagnoses to navigate the medical system for a myriad of factors. If you or a loved one would benefit from support, please reach out to WCPA to be connected with a therapist who can help. 

Caregiver Sibling Resentment

Posted on June 12, 2023 - 3:48 pm by

Is caring for your elderly parents causing tensions between you and your siblings? Have your sibling relationships deteriorated due to disagreements about care for your parents? Arguments often flare up over issues like sharing responsibility for private care, methods of care, money, inheritance, and emotional problems. Even siblings whose bonds remain strong say caring for an aging parent often takes a toll on their relationship.

These conflicts often come as a surprise. No one anticipates that they will be thrust in to emotionally charged interactions with their siblings. It is a shock to go from seeing your siblings at family dinners to navigating parents’ needs together daily. Often, long buried grievances resurface. Siblings can fall into the resentment trap, asking, “Why is this on me?” “Where is the help?”

One of the biggest reasons for sibling resentment is perceived “favoritism.” When one sibling seems to be a parent’s favorite, it can cause other siblings to become angry with the favorite child or with their parents. Adult children often internalize a perception of favoritism. Regardless of when or how this perception of favoritism comes about, it can often cause tensions and rifts between siblings in their adult years – especially when discussing care for aging parents.

Duties and roles of care for parents can also cause sibling conflicts. Some adult children might think everyone should take care of their parents, while others think that it is not their job as adult children. Some may think that putting parents in a nursing home or paying for in-home care is sufficient. Other family members might believe that adult children should provide hands-on care for their parents.

Geographical distance can add to the conflict for siblings. If one sibling lives closer to their parents, those farther away may feel less responsibility. The closer child might feel guilty if they don’t or can’t care for their aging parents. They might also experience caregiver burnout and resentment of the siblings who seem to bear less responsibility for care.

Regardless of the causes, what are some strategies that adult siblings in this situation can use?

Listen Well An excellent way to begin working together is to listen to each other. Take time to ask questions and make a point to try to understand your sibling’s point of view. Listening well can be challenging, but it is a powerful way to move forward positively. It often helps to ask, “Can you tell me more about that?” Listening can help deepen understanding and trust for all parties involved.

Find Common Ground It is also beneficial when dealing with family disputes over elderly parents to find a common ground. For example, you might all agree that none of you will personally take care of Mom and Dad. It could also be as simple as starting with a general plan of care.

Learn to Compromise Making compromises does not mean that you lose the argument, though it might mean that you will not get exactly what you want, exactly how you want it. Remember that you are seeking to do what is best for your parents, but what you think might be best may not be what your sibling thinks is best. Compromising provides a way for all parties involved to do their part.

Involve a Third Party If you can’t have productive conversations, consider bringing in a third party. The third party could be a professional mediator, medical provider, therapist, religious leader, or professional care manager. A third party could help facilitate and guide discussions while seeking to provide what’s best for your parents. Since they do not have any emotional or relational issues with you, your siblings, or your parents, a neutral third party can offer outside advice that is helpful and constructive.

In an ideal world, we’d all work together harmoniously to give our parents the best end of life in return for the love and support they gave us. It rarely – if ever – works out exactly as we would like it. But that doesn’t mean we shouldn’t try our best.

West County Psychological Associates has trained professional counselors who specialize in senior care issues. You can reach us at 314-275-8599 or see information about our therapists at www.wcpastl.com.

Who are Your Attachment Figures?

Posted on June 11, 2023 - 3:47 pm by

There is probably nothing more beautiful and intense as watching a nurturing mother look into the eyes of her infant child. There is probably nothing more critical to a child’s development than having this ongoing experience with her mother or caregiver. What the child sees in her parent’s face is a precursor of healthy or unhealthy emotional development. This can determine this child’s development style, from healthy attachment to others to avoidant and ambivalent relationships.

Psychologists like Bowlby and Winnicott tell us there are two behaviors that describe healthy attachment – mirroring and attuning. In mirroring, the child looks at the mother’s face and sees in her the reflection of himself. He also looks in her face and sees the value of himself. This is critical, because if mother (or caregiver) is emotionally distracted or unavailable because of stress, fear, anxiety, or their own inability to nurture, the infant perceives himself as being unlovable because the mother’s face doesn’t project love. In fact, psychologist Mary Ayres says that the consequence for those who miss out on being mirrored adequately is a primary sense of shame. The result of this sense of shame is a felt sense of being unlovable or somehow defective.

The next behavior is attuning. In successful attuning, the caregiver is able to emotionally join in with the child. She is matching the baby’s tone and emotion, whether the baby is expressing anger, fear, joy, or distress. Mother is conveying that she senses what the baby is experiencing. Mother does this through her words, voice, and touch. The baby feels understood. However, in order to be attuned to another, it’s necessary to be attuned to oneself. This means that we don’t negate our feelings. We don’t stay distracted so that we neglect our feelings. Through our feelings, we come to know ourselves. Attuning to ourselves allows us to become attuned to others. When we are attuned to others, we are able to tap into their emotional needs; they feel a sense of security and safety with us, and they are able to be open with their feelings.

We speak of these behaviors generally in terms of early child development. But they exist in relationships that go beyond early caregivers. In varying relationships, we are able to develop a healthy attachment. For example, teachers can be secondary attachment figures. Children who may not have had healthy parenting from early caregivers can feel that sense of being cared for and valued by a teacher who develops an emotional tie with his students. He cares about their emotional and academic needs. Most importantly, the students know that they are cared for. I had a French teacher in high school, Sr. Ann Francis. Besides being an excellent teacher, all of her students had the sense that she cared about us. Occasionally she would tell very funny stories on herself. I loved her stories. They made her sound very real and very human. Years later, a few of my high school friends and I decided to visit her convent in Kentucky. Of course, we were all hoping that after many years she would remember us. Not only did she remember us, she was able to tell a story about each of us that she remembered from our high school days. I know that she could not have been aware of the impact she had on our lives.

Loving grandparents, aunts and uncles, or older siblings can all be secondary attachment figures. Hopefully, we all have a few of these people who have impacted our lives. There is a beautiful Irish movie that came out recently called The Quiet Girl. It tells the story of a nine-year-old girl who lives in a harsh poverty-stricken home with an alcoholic father and harried mother and numerous siblings. She appears very quiet at home and at school. She has no friends. She barely responds when asked a question and spends most of the time by herself. An aunt and uncle offer to take her for the summer. At first, she is very quiet and withdrawn. However, from the beginning, her aunt and eventually the uncle show her consistent kindness and caring. Slowly we see the girl come into her own. It is as though her personality awakens. Throughout the movie, viewers see multiple instances where she is mirrored and attuned to.

Sue Johnson, author of the book Hold Me Tight, discusses Attachment Theory in marital relationships. She talks about the ability to be tuned into our spouse, letting the other person know that we understand them. In other words, we “get them.” Marriage can be very difficult. We often stop trying to know our spouse within a few years after the wedding. Children come and we have no time for the other. In fact, the person that we wanted to spend a lifetime with is often the person from whom we are most distant. In good marriages, each person has a sense of safety with the other. We feel that there is someone who “has our back.” That person may not agree with us, but they want to understand us; they want to know us. They’re the person who says, “I feel badly for you,” when we’ve had a bad day. They’re the person whose face lights up when we walk into the room. We see in their face the value that we have.

The therapeutic process is an excellent example of an attachment relationship. Empathy, in the form of attunement and mirroring, is the basis of the therapeutic relationship. The therapist empathetically attunes to the client by tuning into and resonating with their experiences. In the process, the therapist maintains his or her own presence and identity. It is not about becoming the other, but rather momentarily experiencing what the client experiences, whether it be emotional or physical. This implies that the therapist is attentively listening. He or she responds in a way that tells the client that the therapist is actively engaged. The client experiences the sense that they are understood. The therapist “gets” the client.

As we can see the mirroring and attunement process is critical to our well-being. Being conscious of how we relate to others can have extraordinary benefits for them and for us. The questions we may want to ask ourselves are: who have we attached to? Who has attached to us? Who was instrumental in our emotional development?

WCPA Spring Newsletter

Posted on May 10, 2023 - 4:02 pm by
Article image

In the WCPA spring newsletter, topics include social media’s impact on youth, the importance of attachment figures, Covid and loss, cultural competence, caregiver sibling resentment, and mental health stigma.

                         

ARTICLES

Social Media Comparisons:
Our Youth’s Greatest Frenemy

Julia Osborne, MSW, LMSW

Social media has connected us all in ways unimaginable to past generations. As adults, many of us are all-too-aware how social media has proven to be both a wonderful but also a challenging and, at times, discouraging experience; our youth, however, often lack this critical awareness. A study conducted by Sun et al., 2022, at Stanford Medicine found that about 25% of children received their first phone by 10.5 years old and over 60% of those children had smartphones. The study indicated that most children received their first phone between the ages of 11-13 years old, which is a critical time for any child’s physical, emotional, and social development. 

Children in this age range typically begin puberty, which can cause a cascade of shifts in self-esteem due in part to hormonal changes, growth spurts, and peer influence. At this time, youth develop what Elkind (1967) calls Adolescent Egocentrism, or the belief that others are preoccupied with the child’s appearance or behaviors and the inability to differentiate their personal beliefs from the perceived beliefs of others. Because of this, the weight of their peers’ opinions increases dramatically. They begin to believe that adults cannot relate to them or understand their problems like a friend can, so they begin to ask other youth for life advice before a parent or other adult. This leads many young people to attempt to solve their problems using poor coping skills, such as food restriction and over-dieting, substance use, and self-harm. 

These conditions lead to the perfect storm for the harmful influences of smartphones and social media. Children today are so easily connected with texting, video-chatting, and social media, that the expectation to stay in touch with peers has become astronomically high. It is inducing social anxiety in our youth at a greater rate than adults, according to the National Institute of Health. Youth express fears and describe experiences of losing friends if they do not “keep up the streaks” on Snapchat or respond within a few minutes of receiving a message or text from a friend. 

Moreover, many tweens and teens are terrified of missing out on social experiences with their peers. Social experiences, with the help of smartphones, now encompass interactions that other generations may not perceive as impactful, like being included in a group chat, but these situations can have major ripple effects. All too often, middle schoolers’ group chats include a great deal of gossiping about others. Not being in a group chat can mean that the child is the focus of the gossip, which can evolve into isolation from the friend group in real world situations, like school and social events. 

In addition to sharing videos, pictures, and texts, Snapchat projects users’ locations and a rating system for how frequently each user responds to others. This allows users to know where their friends are, if they are there with other mutual friends, and if that person is responding at a desired consistency. In sum, it makes it very easy to know if someone is being excluded and, in the case of direct messages sent to the excluded person about the social event, when that exclusion is purposeful. 

Tik Tok and Instagram feature an onslaught of content that ranges from thoughtful advocacy to hateful propaganda. These apps primarily send customers media based on previously identified preferences – the apps attempt to send users more and more content that mimics what the user already follows, which can create an unhealthy echo-chamber experience. Users can find themselves bombarded with content from an unhealthy community, like “thinspo,” (eating disordered thinness inspiration), or an overload of misinformation based on public opinions. 

Just as would be expected, public opinions are often body-shaming, diet-glamorizing, and hateful toward anyone who disagrees with the group. This, for many, leads to poor body image and entering the diet culture at younger and younger ages. In a study by Neumark-Sztainer and Hannan (2000), dieting was reported by 31.1% of 5th-grade girls increasing to 62.1% among 12th-grade girls. Disordered eating was reported by 13.4% of the girls and 7.1% of the boys. Understanding that thinness does not equate to health and that most images and videos are edited is hard enough for someone with a fully-developed, adult brain, but when children’s limbic systems are developing faster than their prefrontal cortexes, and tweens are being persuaded by their emotions and only beginning to develop abstract thinking and deductive reasoning, it would be preposterous to believe that our youth are not developing negative self-concepts using social comparison to others online. 

In addition to negative thoughts about their bodies and images, youth are experiencing existential crises about their futures, long before launching age. Seeing “influencers” gain fame and fortune on social media formats by means of self-exploitation at younger and younger ages has led adolescents to feel like they are falling behind the curve when it comes to making a life for themselves. They voice concerns about their comparative lack of popularity and persuasion of others [or number of followers] and how well they have planned their future careers and lifestyles. Not to have a plan for the future by high school, for many, means to be unprepared for life and to be at risk of never accomplishing anything. This hyperbolic outlook contributes to adolescent dependence on social media, because they have started using it as an outlet to discover potential passions to pursue through their lifespan, which can be as defeating as it is inspiring. 

To believe that young people, especially in early adolescence through young adulthood, are not engaging in self-comparison on social media is to have too high of expectations for them. No child is immune to online social comparison, unless someone in their life intervenes by stepping in and talking about how they view themselves and others. In doing so, low self-esteem or maladaptive cognitions can be identified and interrupted through discussions about the false realities of social media, developing realistic views of the self, and, critically, reduced time spent on social media. 

Newly freed-up time can be channeled into real-life activities that not only engage the young person socially in a healthy way, but can also help them discover their personal passions and build their self-esteem – think team sports, art classes, playing in a band, or joining scouts. In addition, getting a young person engaged in activities that involve self-exploration, like journaling, can inspire helpful insights that will allow a child to see their personal value without external validation. Counseling intervention with a therapist the youth trusts can help further, when needed. 

Notably, when users search for unhealthy topics, some social media apps provide responsive statements with links to healthy supports. This is a glimmer of hope for social media as a way to get youth connected with the resources they need to support their mental health, but there is nothing else in place to prevent children from exploring a world that could severely harm them as they develop. Caring adults need to be talking to their adolescents about social media, to ensure that they are using it safely and that they understand that most of what they see online is not a real representation of others. Social media is never a reliable, accurate, or healthy source for self-comparison. 

Julia Osborne, MSW, LCSW

Julia Osborne, MSW, LCSW

With mental health experience working with a multitude of populations, I currently am accepting clients with all clinical issues. I enjoy working with adolescent clients in the clinical and school settings, dealing in large part with school-related behaviors and anxiety, and adult clients as well. My professional passions include individual, couples, and family therapy. Employing evidence-based practices, I frequently utilize cognitive behavioral therapy and psychodynamic therapy, to best meet my clients’ needs.

From the Director
Who Are Your Attachment Figures?

Mary Fitzgibbons, Ph.D

There is probably nothing more beautiful and intense as watching a nurturing mother look into the eyes of her infant child. There is probably nothing more critical to a child’s development than having this ongoing experience with her mother or caregiver. What the child sees in her parent’s face is a precursor of healthy or unhealthy emotional development. This can determine this child’s development style, from healthy attachment to others to avoidant and ambivalent relationships. 

Psychologists like Bowlby and Winnicott tell us there are two behaviors that describe healthy attachment – mirroring and attuning. In mirroring, the child looks at the mother’s face and sees in her the reflection of himself. He also looks in her face and sees the value of himself. This is critical, because if mother (or caregiver) is emotionally distracted or unavailable because of stress, fear, anxiety, or their own inability to nurture, the infant perceives himself as being unlovable because the mother’s face doesn’t project love. In fact, psychologist Mary Ayres says that the consequence for those who miss out on being mirrored adequately is a primary sense of shame. The result of this sense of shame is a felt sense of being unlovable or somehow defective. 

The next behavior is attuning. In successful attuning, the caregiver is able to emotionally join in with the child. She is matching the baby’s tone and emotion, whether the baby is expressing anger, fear, joy, or distress. Mother is conveying that she senses what the baby is experiencing. Mother does this through her words, voice, and touch. The baby feels understood. However, in order to be attuned to another, it’s necessary to be attuned to oneself. This means that we don’t negate our feelings. We don’t stay distracted so that we neglect our feelings. Through our feelings, we come to know ourselves. Attuning to ourselves allows us to become attuned to others. When we are attuned to others, we are able to tap into their emotional needs; they feel a sense of security and safety with us, and they are able to be open with their feelings. 

We speak of these behaviors generally in terms of early child development. But they exist in relationships that go beyond early caregivers. In varying relationships, we are able to develop a healthy attachment. For example, teachers can be secondary attachment figures. Children who may not have had healthy parenting from early caregivers can feel that sense of being cared for and valued by a teacher who develops an emotional tie with his students. He cares about their emotional and academic needs. Most importantly, the students know that they are cared for. I had a French teacher in high school, Sr. Ann Francis. Besides being an excellent teacher, all of her students had the sense that she cared about us. Occasionally she would tell very funny stories on herself. I loved her stories. They made her sound very real and very human. Years later, a few of my high school friends and I decided to visit her convent in Kentucky. Of course, we were all hoping that after many years she would remember us. Not only did she remember us, she was able to tell a story about each of us that she remembered from our high school days. I know that she could not have been aware of the impact she had on our lives. 

Loving grandparents, aunts and uncles, or older siblings can all be secondary attachment figures. Hopefully, we all have a few of these people who have impacted our lives. There is a beautiful Irish movie that came out recently called The Quiet Girl. It tells the story of a nine-year-old girl who lives in a harsh poverty-stricken home with an alcoholic father and harried mother and numerous siblings. She appears very quiet at home and at school. She has no friends. She barely responds when asked a question and spends most of the time by herself. An aunt and uncle offer to take her for the summer. At first, she is very quiet and withdrawn. However, from the beginning, her aunt and eventually the uncle show her consistent kindness and caring. Slowly we see the girl come into her own. It is as though her personality awakens. Throughout the movie, viewers see multiple instances where she is mirrored and attuned to. 

Sue Johnson, author of the book Hold Me Tight, discusses Attachment Theory in marital relationships. She talks about the ability to be tuned into our spouse, letting the other person know that we understand them. In other words, we “get them.” Marriage can be very difficult. We often stop trying to know our spouse within a few years after the wedding. Children come and we have no time for the other. In fact, the person that we wanted to spend a lifetime with is often the person from whom we are most distant. In good marriages, each person has a sense of safety with the other. We feel that there is someone who “has our back.” That person may not agree with us, but they want to understand us; they want to know us. They’re the person who says, “I feel badly for you,” when we’ve had a bad day. They’re the person whose face lights up when we walk into the room. We see in their face the value that we have. 

The therapeutic process is an excellent example of an attachment relationship. Empathy, in the form of attunement and mirroring, is the basis of the therapeutic relationship. The therapist empathetically attunes to the client by tuning into and resonating with their experiences. In the process, the therapist maintains his or her own presence and identity. It is not about becoming the other, but rather momentarily experiencing what the client experiences, whether it be emotional or physical. This implies that the therapist is attentively listening. He or she responds in a way that tells the client that the therapist is actively engaged. The client experiences the sense that they are understood. The therapist “gets” the client. 

As we can see the mirroring and attunement process is critical to our well-being. Being conscious of how we relate to others can have extraordinary benefits for them and for us. The questions we may want to ask ourselves are: who have we attached to? Who has attached to us? Who was instrumental in our emotional development? 

– Mary 

COVID and Loss

Bryan Duckham, Ph.D., MSW, LCSW

Bryan Duckham, Ph.D., MSW, LCSW

“The pandemic is over!” These pronouncements from the top simply reflect what everyone is experiencing – the world has re-opened. The previous concerns about infecting, or being infected, are giving way to a more relaxed approach to being with friends, family, and participating in public and social events. People are resuming in-person relationships and the activities previously experienced. Many are making up for lost time by traveling or taking on a new hobby. Nevertheless, as one keeps their ear to the ground they hear rumblings, a lingering sense in the zeitgeist of what was lost during the shutdown. COVID led to a wide array of losses including life, money, interpersonal connection, and activities that give purpose and meaning. 

A counseling axiom I heard early in my career as a therapist was “you can’t know what you lost until you begin to get it.” This statement reflects the idea that grief over loss surfaces, or is compounded, when one has the experience of getting what was lost. The psychologist, Carl Rogers, had a way of thinking about this paradox. He is credited with developing the concept of “congruence” and “incongruence.” Essentially, Rogers suggested that unpleasant emotions occur when there is a discrepancy between the experienced self and ideal self (incongruence). These “unpleasant emotions” can include guilt, hurt, sadness, and anger, among others – feeling states created by the pandemic. As one becomes congruent by experiencing what is ideal (the return to meaningful relationships and activities), these feelings intensify and demand release. 

If Rogers is correct, this would indicate that, post-COVID, much grief is floating about demanding an outlet, lingering and haunting reminders of what was lost: serious losses such as the friend or family member who lost their life, the high school prom that didn’t happen, the not being able to say goodbye to the dying parent in a nursing home, the isolation and lack of purpose. Since grief can be experienced in healthy and unhealthy ways, it makes sense that we would experience indications of both in our social worlds. 

Dealing with grief means negotiating certain stages and feelings. Although many ideas exist regarding the type and number of stages one may go through in grief, and the timeframe to grieve varies, grief universally means accepting and expressing painful feelings and working with the ways one copes with feelings. Healthy signs of grieving include the ability to be sad and cry, to be able to understand that the guilt one may feel is related to the difficulty accepting anger, and to lean into the anger. Signs that one may be stuck and in need of help with grief can be irritability, lack of motivation and energy, feelings of hopelessness and helplessness, dread, panic, or excessive anger or rage, to name only a few. These kinds of symptoms are an indication that one may be in need of professional help to facilitate the working through of the grief process for one to reclaim or discover a newfound sense of purpose and meaning. 

The Importance of Mental Health Professionals being Culturally Competent

Conscious and Subconscious Biases
(Hidden Biases of Good People)

Dr. Charlotte V. Ijei, L.P.C., Ed.D.

Dr. Charlotte V. Ijei, L.P.C., Ed.D.

Riddle: A man and his son are driving in a car one day, when they get into a fatal accident. The man is killed instantly. The boy is knocked unconscious, but he is still alive. He is rushed to the hospital and will need immediate surgery. The doctor enters the emergency room, looks at the boy, and says, “I can’t operate on this boy, he is my son!” How is this possible? 

Congratulations if you were able to solve the riddle. We all have biases. Some of the biases are known to us and other biases hide very deep in the subconsciousness of the brain. Because we have all been socialized differently, it is hard to imagine anything other than what we know. 

The socialization process begins when children are in their early years. Because of bias, we often give our children misinformation, missing history, and biased history that leads to stereotypes about any groups whose cultures are different from our own. This information is reinforced by people, systems, and institutions we know, love, and trust, through continued stereotypes and distortions. Some of these institutions are family, neighborhoods, education, media, government, houses of worship, economics, and class. If we do not purposefully interact with, understand, and study people who are not members of our own groups, we carry those stereotypes throughout adulthood, and they become a part of our belief system. 

The way we were socialized can influence our decisions today, producing discriminatory outcomes. How we view others who do not share the same “cultural” norms as we do can interfere with decisions we make. If we are in a position of power to hire employees, we can form opinions about who can or cannot do the job based on subconscious and conscious biases that have not been dealt with, due to the thinking of what society considers as the norm to follow. Who and what influences our social group? People who do not believe or look like us are usually left out of our social circles if we do not get to know people unlike ourselves. The way we were socialized could keep us in our comfort zone, which causes us to make mental judgments about all others who do not “fit” within our social group. 

Mental health professionals cannot afford to take a chance of not understanding their clients or students “whole selves.” Understanding our own biases will ensure we are able to assist with the healing aspect of those whom we serve. 

For mental health professionals and school mental health professionals, cultural competency is the ability to provide mental health services that can acknowledge cultural differences between the client or student and the professional. The more the clinician knows about clients’ or students’ culture, ethnicity, or background, the more likely clients and students will feel comfortable in therapy. When the professional is culturally competent, having prioritized their understanding of a client’s or student’s background, gender, abilities, sexual orientation, ethnicity, religious or nonreligious beliefs, and other factors, and connecting this important knowledge to mental health services, it enables clinicians to accommodate and respect differences in opinions, values, and attitudes. At the same time, it is important to be aware that no group of people is monolithic. 

The book, Blind Spot: Hidden Biases of Good People, written by Mazarin R. Banji and Anthony G. Greenwald, talks about “mindbugs.” These are ingrained habits of thought that lead to errors in how we perceive, remember, reason, and make decisions. The eye receives, the brain registers, and the mind interprets visual and audio information. If we don’t bring these ingrained thoughts to the conscious level, they lead to negative stereotypes capable of oppressing certain cultural groups. For example, mindbugs can get in the way of mental health professionals’ ability to help in a crisis if they are unfamiliar with a client’s or student’s religious or non-religious beliefs. Therefore, mental health professionals must understand their own cultural biases to become culturally competent professionals. 

There will always be differences within the same cultural group. However, culturally competent mental health professionals are continually working on their own subconscious and conscious biases to support all their clients and/or students. We begin to understand the richness and beauty of the tapestry when the world connects, and we get to know and appreciate each other. 

By the way, what was your first thought about the riddle? Remember, we ALL have biases. 

Caregiver Sibling Resentment Over Elderly Parents: Could This Be You?

Lori Goldberg, MSW, LCSW

Lori Goldberg, MSW, LCSW

Is caring for your elderly parents causing tensions between you and your siblings? Have your sibling relationships deteriorated due to disagreements about care for your parents? Arguments often flare up over issues like sharing responsibility for private care, methods of care, money, inheritance, and emotional problems. Even siblings whose bonds remain strong say caring for an aging parent often takes a toll on their relationship. 

These conflicts often come as a surprise. No one anticipates that they will be thrust in to emotionally charged interactions with their siblings. It is a shock to go from seeing your siblings at family dinners to navigating parents’ needs together daily. Often, long buried grievances resurface. Siblings can fall into the resentment trap, asking, “Why is this on me?” “Where is the help?” 

One of the biggest reasons for sibling resentment is perceived “favoritism.” When one sibling seems to be a parent’s favorite, it can cause other siblings to become angry with the favorite child or with their parents. Adult children often internalize a perception of favoritism. Regardless of when or how this perception of favoritism comes about, it can often cause tensions and rifts between siblings in their adult years – especially when discussing care for aging parents. 

Duties and roles of care for parents can also cause sibling conflicts. Some adult children might think everyone should take care of their parents, while others think that it is not their job as adult children. Some may think that putting parents in a nursing home or paying for in-home care is sufficient. Other family members might believe that adult children should provide hands-on care for their parents. 

Geographical distance can add to the conflict for siblings. If one sibling lives closer to their parents, those farther away may feel less responsibility. The closer child might feel guilty if they don’t or can’t care for their aging parents. They might also experience caregiver burnout and resentment of the siblings who seem to bear less responsibility for care. 

Regardless of the causes, what are some strategies that adult siblings in this situation can use? 

Listen Well An excellent way to begin working together is to listen to each other. Take time to ask questions and make a point to try to understand your sibling’s point of view. Listening well can be challenging, but it is a powerful way to move forward positively. It often helps to ask, “Can you tell me more about that?” Listening can help deepen understanding and trust for all parties involved. 

Find Common Ground It is also beneficial when dealing with family disputes over elderly parents to find a common ground. For example, you might all agree that none of you will personally take care of Mom and Dad. It could also be as simple as starting with a general plan of care. 

Learn to Compromise Making compromises does not mean that you lose the argument, though it might mean that you will not get exactly what you want, exactly how you want it. Remember that you are seeking to do what is best for your parents, but what you think might be best may not be what your sibling thinks is best. Compromising provides a way for all parties involved to do their part. 

Involve a Third Party If you can’t have productive conversations, consider bringing in a third party. The third party could be a professional mediator, medical provider, therapist, religious leader, or professional care manager. A third party could help facilitate and guide discussions while seeking to provide what’s best for your parents. Since they do not have any emotional or relational issues with you, your siblings, or your parents, a neutral third party can offer outside advice that is helpful and constructive. 

In an ideal world, we’d all work together harmoniously to give our parents the best end of life in return for the love and support they gave us. It rarely – if ever – works out exactly as we would like it. But that doesn’t mean we shouldn’t try our best. 

West County Psychological Associates has trained professional counselors who specialize in senior care issues. You can reach us at 314-275-8599 or see information about our therapists at www.wcpastl.com. 

Addressing Mental Health Stigma in Medical Settings
Part 1: The Patient

Amy Neu, MSW, LCSW

Amy Neu, MSW, LCSW

“I dread going to the hospital…I have to explain myself every time and prove to them I’m not ‘crazy.’ I’m there feeling terrible, but need to be on my ‘best behavior’ so they can see I really do know what’s happening and what I need.” – Client with cancer and schizophrenia 

A common fear for people who have both a diagnosed mental health disorder and a physical illness is that they will enter a medical setting only to have their symptoms dismissed. Clearly, there are many facets of this topic. In this article, we will focus on individuals with mental health issues who are navigating the medical system. Next time, we will discuss the experiences of medical providers and residential facilities, and the final article will discuss strategies for family members and loved ones who support an individual with physical and mental health issues. 

The client’s statement above exemplifies what studies have concluded about the experience of people with mental illness and the medical system in the U.S. The article, “Mental Illness-Related Stigma in Healthcare: Barriers to Access Care and Evidence-Based Solutions” states, “Mental illness-related stigma, including that which exists in the healthcare system and among healthcare providers, has been identified as a major barrier to access treatment and recovery, as well as poorer quality physical care for persons with mental illnesses.” Furthermore, “People with lived experience of a mental illness commonly report feeling devalued, dismissed, and dehumanized by many of the health professionals with whom they come into contact.” 

Common questions clients often wonder include: Will a doctor take my physical concerns seriously? Will they assume that it’s an issue with my psych meds? Will medical staff be watching my behavior more closely than other patients? Will doctors believe me and treat my medical issues accordingly? Essentially, patients in this situation fear that in a quick-paced medical setting, their physical concerns will be overlooked, downplayed, or go untreated. There is fear that if they speak up about a concern of being overlooked, the provider will again point to a mental health issue; that they are being “anxious” or “paranoid.” In reality, when we look at past experiences of the patient coupled with conclusions of studies which highlight the barriers people with mental health issues face in medical settings, their concerns make a lot of sense. 

How, then, can someone with a mental health diagnosis prepare to interact with medical systems? In sessions with clients who are facing medical stressors, therapists often discuss several key points: What have their previous experiences with the medical system been like? How do they feel about their current providers? What skills can they use to communicate with healthcare providers effectively? Who are the supportive people in their lives who can help? As we gain a better understanding of our experiences, both positive and negative, we get more information about what drives us and scares us. Negative experiences in the past can inform how we feel going into new experiences, even if the providers or situations are different. Mental health stigma in society, institutions, and from individuals impacts how we have been treated and how we anticipate new situations. 

Once we understand how our past experiences have affected us, we can begin to mindfully address our needs in the present. Individuals in this situation can bring to mind what they need now and what they CAN do. For instance, we can learn new communication skills to advocate for ourselves or request support to amplify our voice. We can track physical symptoms or side effects in a daily log to bring to appointments with doctors to help guide our discussions. We can purposefully seek out doctors that listen and respond to our needs in a meaningful way. Yes, each of these tasks take time, energy, and focus. We can acknowledge the difficulty of these tasks while understanding that working toward these goals together will help our overall well-being in the long run. 

It is daunting to face a large system alone. Clients in this situation are encouraged to seek out the individuals in their lives who help them feel seen. This could be anyone from a close family member or friend who could help them advocate for themselves to a friendly receptionist at their doctor’s office. When we find the good people, the individuals who make up a larger setting, then the system feels more manageable. We can focus on one good interaction at a time as a touchstone to generate more positive exchanges. We are better able to remind ourselves that we matter and that we are human beings with needs worth discussing. 

It is particularly difficult for people with mental health diagnoses to navigate the medical system for a myriad of factors. If you or a loved one would benefit from support, please reach out to WCPA to be connected with a therapist who can help. 

The Importance of Mental Health Professionals being Culturally Competent 

Posted on May 9, 2023 - 3:55 pm by

Conscious and Subconscious Biases
(Hidden Biases of Good People)

Riddle: A man and his son are driving in a car one day, when they get into a fatal accident. The man is killed instantly. The boy is knocked unconscious, but he is still alive. He is rushed to the hospital and will need immediate surgery. The doctor enters the emergency room, looks at the boy, and says, “I can’t operate on this boy, he is my son!” How is this possible? 

 Congratulations if you were able to solve the riddle. We all have biases. Some of the biases are known to us and other biases hide very deep in the subconsciousness of the brain. Because we have all been socialized differently, it is hard to imagine anything other than what we know. 

The socialization process begins when children are in their early years. Because of bias, we often give our children misinformation, missing history, and biased history that leads to stereotypes about any groups whose cultures are different from our own. This information is reinforced by people, systems, and institutions we know, love, and trust, through continued stereotypes and distortions. Some of these institutions are family, neighborhoods, education, media, government, houses of worship, economics, and class. If we do not purposefully interact with, understand, and study people who are not members of our own groups, we carry those stereotypes throughout adulthood, and they become a part of our belief system. 

The way we were socialized can influence our decisions today, producing discriminatory outcomes. How we view others who do not share the same “cultural” norms as we do can interfere with decisions we make. If we are in a position of power to hire employees, we can form opinions about who can or cannot do the job based on subconscious and conscious biases that have not been dealt with, due to the thinking of what society considers as the norm to follow. Who and what influences our social group? People who do not believe or look like us are usually left out of our social circles if we do not get to know people unlike ourselves. The way we were socialized could keep us in our comfort zone, which causes us to make mental judgments about all others who do not “fit” within our social group. 

Mental health professionals cannot afford to take a chance of not understanding their clients or students “whole selves.” Understanding our own biases will ensure we are able to assist with the healing aspect of those whom we serve. 

For mental health professionals and school mental health professionals, cultural competency is the ability to provide mental health services that can acknowledge cultural differences between the client or student and the professional. The more the clinician knows about clients’ or students’ culture, ethnicity, or background, the more likely clients and students will feel comfortable in therapy. When the professional is culturally competent, having prioritized their understanding of a client’s or student’s background, gender, abilities, sexual orientation, ethnicity, religious or nonreligious beliefs, and other factors, and connecting this important knowledge to mental health services, it enables clinicians to accommodate and respect differences in opinions, values, and attitudes. At the same time, it is important to be aware that no group of people is monolithic. 

The book, Blind Spot: Hidden Biases of Good People, written by Mazarin R. Banji and Anthony G. Greenwald, talks about “mindbugs.” These are ingrained habits of thought that lead to errors in how we perceive, remember, reason, and make decisions. The eye receives, the brain registers, and the mind interprets visual and audio information. If we don’t bring these ingrained thoughts to the conscious level, they lead to negative stereotypes capable of oppressing certain cultural groups. For example, mindbugs can get in the way of mental health professionals’ ability to help in a crisis if they are unfamiliar with a client’s or student’s religious or non-religious beliefs. Therefore, mental health professionals must understand their own cultural biases to become culturally competent professionals. 

There will always be differences within the same cultural group. However, culturally competent mental health professionals are continually working on their own subconscious and conscious biases to support all their clients and/or students. We begin to understand the richness and beauty of the tapestry when the world connects, and we get to know and appreciate each other. 

By the way, what was your first thought about the riddle? Remember, we ALL have biases. 

I Only Do What I Want to Do: Taking Care of Myself and Others

Posted on February 28, 2023 - 1:38 pm by

“I only do what I want to do.” That sounds incredibly selfish, doesn’t it? Most of us would feel guilty saying that to ourselves, let alone to another person. Many of us were taught to be self-sacrificing. Do for the other person and not ourselves. People are praised for thinking of others first and putting their own needs aside. Years ago, I found that there was a fallacy in this thinking. As I was doing what others wanted, I did not give myself permission to do what I wanted – and I resented it and eventually resented them.  

The first time that this occurred to me was when I was in my thirties, married with three adolescents, working full-time as a teacher, and going to grad school. Our psychology professor had recommended that if we were going to be in the counseling profession, we should have the experience of seeing a therapist. At that point, I was feeling frantic. It was two weeks before Christmas, and I was finishing the academic semester. The house wasn’t decorated. No gifts were bought. And there were numerous discussions among family members about who was doing Christmas and Christmas Eve dinners.  

I was referred to a young therapist (a doctoral psychology student doing his residency). I remember spewing out my anxiety and confusion. I felt that I was being torn in a thousand different ways and I didn’t know how I could please everyone. After listening to this, he asked me a very simple question. “What do you want to do?” I felt as though no one had ever asked me that question. I am sure I had never asked myself, “What do I want?” It was always about what others wanted from me and for me. The question literally changed my life. I made the decision that seemed reasonable, doable and would make me happy without adding a burden onto other people. Everyone seemed fine with what I chose. I had a great Christmas. Most importantly, I also decided that I would never spend another holiday not doing what I wanted. All of these years, I’ve kept that promise to myself. 

After this, I discovered two things. The first was that, in pleasing myself, there were no resentments. I enjoyed what I was doing and I enjoyed others with whom I was with. Resentments are toxic to a relationship. How many times do we do things essentially to please another person but end up resenting them in the process because this is not what we want to do. For example, if I would have gone ahead and had Christmas or Christmas Eve dinner to please my mother, I’m afraid my resentments would have spilled over into our relationship. We see this in relationships all too often. One party tends to give to the other regularly and eventually builds a wall of resentment. After years of this resentment, the couple finds themselves in a therapist’s office because, in time, this behavior has destroyed the relationship. The less I resent someone or something, the more willing I am to do what others ask of me.

The second thing I learned was that I could make choices for myself as long as my behavior didn’t negatively impact the other person. For example, in the case of the Christmas events, I told my mother that I would have a very difficult time doing Christmas or Christmas Eve dinner because of the time crunch, but I would love to do New Year’s Day dinner with my family and my cousins, whom I really enjoy. Everyone seemed pleased and we had a great holiday. If I had offered no solution to the Christmas dinner dilemma, it wouldn’t have been fair to the other family members. My rule of thumb is that as long as my decisions do not negatively affect others, it is my choice to make. For example, if I go dress shopping with a friend and she insists that I buy a dress that I’m not really happy with because she loves the way it looks on me, I have the right to say that I appreciate her opinion but I much prefer the other dress. If I were to buy the dress that she chose, it would be to please her and not myself. 

Realistically, however, there are many things that we do that we feel we should do. I would suggest that if we could take the word “should” out of our vocabulary we would be much happier. We all have activities in our life that we don’t particularly want to do, but we know we need to do them. Very few of us enjoy mopping the kitchen floor, washing clothes, or paying bills. I may not enjoy these activities, but I know they are necessary in living an ordered life. I do want the peace of mind that comes when I’ve taken care of daily living activities, so I choose to do these things. I do not enjoy going to the Funeral Home, but I choose to pay my respects to my friend’s husband. While I may not enjoy doing this, it is something that I choose to do. This is not a “should” but rather a “want.” It is made out of an expression of choice.

The key word in this theory is “want.” What do I want? Many of us have spent much of our lives doing what others expected of us. We live and make our choices based on what others want. Many of us either have never asked the question of ourselves or, if we have, we don’t know the answer. Sometimes we don’t know because we’ve not allowed ourselves the question. This is either because of the guilt in putting the emphasis on what we want or no one was ever really interested in what we wanted. We didn’t know we had the option.  

I find that asking clients what they want is a key factor in helping their emotional growth. When they can’t identify these wants, we concentrate on what they feel. We can start by asking ourselves what is important to us. Is this activity worth my time or energy?  Is this something that I would choose to do? If they can start identifying their feelings, they’ll soon come to a recognition of what they want. Most of my turmoil that Christmas was that I knew what I didn’t want, but I hadn’t asked myself what I did want. I honestly didn’t know that that was an option.

What I’ve discovered through these years is that I have more choices than I thought. In some cases, when I no longer enjoyed an activity that I regularly participated in, I found ways to eliminate it from my schedule. I have also found that having a conscious awareness of the people that I value in my life allows me to be more proactive about spending more time with them. Acknowledging what I want allows me to make more definitive choices in my life. It has also forced me to look at how my choices affect others. All in all, knowing that I have the freedom to choose has given me the opportunity to experience a well-lived life. For that, I am very grateful.

Dating Apps and Today’s Relationship Anxiety

Posted on February 21, 2023 - 1:36 pm by

Marriage through matchmaking was the original form of courtship, recorded as far back as the Bible, but the concept of finding a loving partner and getting to know them through dating before marriage has only been in existence since the late 1800’s to early 1900’s. This shift from parental and community decisions about who we spend our lives with to allowing freedom and exploration has never been as apparent as it is in this current era with online dating.

Dating online has had an interesting journey from the humble beginnings of paying for matchmaking services through match. com to its current state of freedom, hype, and confusion. Back in 2001, when match. com merged with love. aol, individuals paid $24.95 per month for a membership to take a survey and be matched with other singles with similar interests and values. Now people can hop onto one of countless, free “dating” apps, which all provide different ends. Most dating apps advertise as a way to help singles meet and find a life partner, but anyone who has ever explored them discovers they often have very different purposes. Certainly, there are a few people who meet their partners through these apps, but the more prevalent experience is that the apps provide some users with false hope and others with stories of frustration and even violation. 

For many Gen X-ers, Gen Z-ers, and other millennials, it has become obvious that the transition from meeting people at school, work, clubs, and bars to meeting them on the smartphone has had deleterious effects on the way we interact with potential partners. People are not only utilizing apps more, but they are becoming more averse to the “old fashioned” way of meeting others. Many younger people talk about the great risks inherent to meeting people at public places and saying things such as, “Well, they’re a complete stranger. Who knows what they may be like? I’d rather get to know someone first [via online chatting].”  

This change has impacted our public interaction in a way that has almost encouraged social phobia. The mentality that we can only feel safe meeting a potential partner if we text them for weeks in advance has led countless people down the rabbit hole of endless conversations that never led to an actual in-person experience. Contrarily, this behavior pattern has led many others down a dangerous path of false security with individuals who are pretending to want a connection when all that is desired is a sexual experience, are presenting as one person when they’re an entirely different individual, or the all-too-friendly bot profile which tries to trick app users into sending cash. 

In addition to these hazards, dating apps have enabled those who suffer from social anxiety to fully envelop themselves in a world where they never truly need to take social risks. They can gain the minimal social interaction they desire by interacting through apps, without ever actually meeting another person. They may feel socially fulfilled, but what they are truly doing is enabling their anxiety. Those who experience social phobia fear the scrutiny of others through social interactions, like meeting unfamiliar people, being observed while eating or drinking, performing in front of others, and acting in a way that is embarrassing. Meeting unfamiliar people, eating and drinking together, and risking embarrassment through personal exposure are all key elements of early dating. As exposure therapy has evidenced, engaging in behaviors that make one nervous, over time, lessens anxiety. Therefore, engaging in dating behaviors, safely and appropriately, inherently will help a socially anxious person gain control over that aspect of life and have more fulfilling life experiences. 

This is not to say that dating apps are all bad. They have merit in connecting others in ways unimaginable to past generations. If a single person wants to date and find a partner for life, dating apps can certainly be one option. However, users can be mindful not to spend too much time chatting online. Connect with a potential partner, find a safe public place to meet, and meet them. Daters can get to know potential partners in real life and make sure to set clear expectations for what is wanted out of the relationship. In short, today we can use technology to enhance dating, not to replace it.

Other options exist besides dating apps, though. It’s still possible to use more traditional routes of meeting a partner. If meeting at bars feels scary, singles can try connecting with a classmate or coworker – someone we can take our time getting to know, flirt with, and develop something special with in a structured environment. This may lead to building social skills, such as boundary setting, empathy, and cooperating, as well as reducing social anxiety. 

Finding a significant other in the real world can boost confidence. Real-life dating partners can see us for who we really are, not merely our internet identity, and this can feel incredibly validating. On the internet, we have time to come up with clever responses and confident self-statements, but in person we may be awkward and fearful that people will not take the time to get to know the real person that we are; this is understandable. But as we worry about deficits in our competence, we likely also under-appreciate what virtues and talents we actually possesses that may be attractive to a partner. By avoiding in-person relationships, daters can make ourselves inaccessible to growth opportunities, preclude further maturation, and becomes more dependent on the apps.

As daters, whether we choose to try dating apps or to engage with the people in our everyday lives, we must put our personal boundaries and respect first. To be sure, some people will be inappropriate partner options; they just aren’t the right fit. Others may actually be manipulative, deceptive, or simply unkind. But this does not mean we are unlovable or deserve mistreatment. Dating requires that we find the qualities in ourselves that make us unique and bolster them; bring them to the surface and show them proudly to the world. If we choose, we can promote this self-expression first through dating apps and maintain it throughout the process of making a real-world connection. Dating takes courage. Finding someone we want to spend our life with can take time – but this is OK. Though social media comparisons make us feel like there is a timeline for life, there is no rush.

Mary Fitzgibbons, Ph.D.

Posted on February 10, 2023 - 8:45 pm by
Mary Fitzgibbons

I am a licensed psychologist and the director of West County Psychological Associates (WCPA). I began this practice in 1986 after having worked in education for twenty years. Previously, I had been an elementary teacher, and then a counselor and Guidance Director at Lafayette High School.

Because of my familiarity with working with elementary and secondary schools, we, at WCPA, began working extensively with numbers of schools in the form of training and consulting with administrators and teachers through Care Teams, doing presentations for parents in regard to effective child rearing and consulting with various business and educational groups. I have also taught counseling/psychology classes at Webster University, Fontbonne University, the University of Colorado, and the University of San Francisco. 

One of the great joys of my life has been being able to practice therapy in a way that I believe has long-lasting and effective results. I believe that a good therapist never stops learning. I also believe that the efficacy of therapy comes from the relationship between the therapist and the client. The therapeutic relationship is the basis of what creates change. I have thoroughly enjoyed working with pre-adolescents, adolescents, adults, seniors, and couples. My hope is that this work has been helpful to my clients. I am fortunate in that it has also given me great satisfaction.

Do I have Adult ADHD?

Posted on January 31, 2023 - 1:30 pm by

I recently listened to a podcast in which a doctor referred to Attention-Deficit/ Hyperactivity Disorder, or ADHD, as a gift that needs to be unwrapped. As we come out of the holiday season, it’s hard to imagine such a gift being as popular as the ones that arrived from Amazon deliveries or trips to the mall. It’s certainly not a gift that anyone places on their list. But it’s important to remember that ADHD isn’t gifted only to those who were naughty rather than nice. It’s a gift that does not discriminate – despite prevailing myths, such as, “Only kids get it,” “People just need to try harder and get organized,” and “I don’t have it because I can stay focused for a long time when I watch my favorite shows on Netflix.” The true gift in realizing that you have ADHD is in the knowledge that you can do something about it to help you better control its effects on your life. 

What exactly is ADHD, and what does it look like? 

Attention-Deficit/Hyperactivity Disorder is a neurodevelopmental disorder. It’s caused by genetics and other biological causes, not bad parenting, too much screen time, or food additives. Not enough dopamine is produced in the prefrontal cortex, which leads to problems with executive functioning, impulse control, and emotional regulation. According to the DSM-5, there are three types of ADHD: inattentive, hyperactive-impulsive, and the combined type. 

Features include problems with paying attention, impulsiveness, and overactivity. Other traits include poor executive functioning, difficulties with organization, and struggling to stay on task or pay attention in meetings. Then there is cognitive hyperactivity, meaning that the mind has trouble winding down. You might have a difficult time relaxing and feeling that you’re always on the go, in overdrive, restless and impulsive. 

ADHD may also manifest itself through poor activation, or procrastination. You may get easily overwhelmed and shut down, especially when the activity is not in your wheelhouse or else seems hard or boring. Other ill effects include a poor working memory, a struggle to shift focus (especially when hyper-focused on something interesting) and poor emotional regulation – that is, frequent outbursts due to low frustration tolerance. 

Some gift! So now what do I do?

Remember, knowledge is the gift! If you identify with any of these behaviors and think that ADHD could be the reason, don’t panic. A good place to start is with your primary care physician. Along with assessment, lab work is often ordered to rule out thyroid disorder. Often, doctors recommend psychological testing to help rule out other possible causes of your symptoms.

If the diagnosis is clear, you could ask a psychiatrist to do a psychiatric evaluation to clarify the need for medication. Stimulant medication, such as Ritalin or Adderall, is not recommended for everyone, but is often worth trying, when you have a doctor that you trust to work with you to find the right medication and dosage. There are also many non-medication treatment options available, such as behavior modification, nutritional recommendations, and therapy, to name a few. A therapist who specializes in ADHD can help individualize a treatment plan that targets decreasing problematic symptoms, while increasing more positive habits and practices.

Treat yourself to this gift!

Without treatment, negative messages such as, “You can’t pull it together,” or “You’re such a bad parent!” can continue to imprint on your mind, leading to feelings of inadequacy, low self-esteem, anxiety, and even depression. So get help if warranted and “unwrap the gift” of knowledge about your attention deficit. Realize that your brain works in a different way, and with it come strengths, including the ability to think outside the box, be creative, multitask, be laser focused on what you’re passionate about, and be empathetic.

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