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WCPA Winter 2024 Newsletter

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In the WCPA winter newsletter, topics include Avoiding Despair in Today’s Discouraging World, Loss and Equanimity, Mental Health Stigma in Medical Settings – Family Caregivers, and Psychological Testing Available.


Bad News

How Do We Avoid Despair in Today’s Discouraging World?

Amy V. Maus, MSW, LCSW

I recently received bad news. Not the worst news, mind you. Not the death of a family member or a terminal diagnosis, but still, truly, very bad news. I cried the entire way home and didn’t sleep that night. The next morning, I realized how very much bad news I have absorbed recently. The stories out of the middle east have been shocking and depressing. Political news – no matter your political persuasion – almost always seems disheartening. It’s easy to feel like the world is falling apart. Honestly, I couldn’t care less about football (yes, I know I’m the only one) or Taylor Swift, but since at least a portion of that story seems to be about young love and a new relationship, I find that I don’t mind hearing about it at all. At least it isn’t war. At least it isn’t another story about life around us seeming to fray. I think it’s become hard, at times, to avoid a sense of dread about the future for our kids, our grandkids, and our country. So, when I received my no-good, very bad news, it felt like life was piling on in a way that had become too much. My guess is that many of you can relate. 

I remember a few years ago, during the height of the pandemic, a colleague and I discussed what gave us hope during dark times. It was interesting how very different our answers were. Like many people, my lovely colleague looked for the good, little things in life. She looked for the helpers, as Fred Rogers would say. She found a measure of peace by remembering the kindness of a neighbor, the silliness of one of her children, or the way her front porch flowers were blooming. Never one for the easy route, at that moment I had found comfort in the opposite direction, re-watching Neil deGrasse Tyson’s updated series of Carl Sagen’s Cosmos. As I pondered the incomprehensible vastness of space and time, that pandemic year’s events on the pale blue dot somehow seemed less all-encompassing and more ephemeral. I was able to put it into perspective, and that helped. 

If we’re honest with ourselves, I think it’s hard sometimes to find things that really help us feel better during bad times. All too often, today, we find ourselves reaching for poor substitutes for happiness – scrolling social media, shopping and buying, busying our calendar with constant activities, and consuming calorie-laden treats – that give an immediate burst of Dopamine. The pleasure is quick, but it doesn’t last. We observe that we ourselves and the people around us seem to experience more anxiety and worsened depression, instead of the lifts in mood that we seek. 

In his 2022 bestseller, Stolen Focus, Johann Hari described taking three months out of life, by himself at a borrowed vacation home, to disconnect completely from all forms of technology and social media, to live, think, and eat slowly again, and to set aside modern distractions. He expressed how surprisingly difficult and unpleasant this was for a while in the beginning. Without the constant companionship of his smart phone, he experienced the cravings and panic of an addict deprived of their substance of choice. Things changed, though, as his time there went on. He woke up feeling refreshed after full nights of sleep, not yearning for coffee. He could become absorbed again in reading good books and in completing his work. He wrote about how his health, mental health, and sleep improved over those months. 

Few of us can afford that kind of lengthy reprieve from life’s busy-ness, but there are steps that the majority of us can take which have proven time and time again to bring greater well-being into our lives. These steps are not the quick fix of the bubble bath, glass of wine, or weekend fishing trip. Strategies for emotional survival often do not even feel good in the moment. Instead, the things that are actually effective in bringing long-term well-being can sometimes feel like work. We treat ourselves to sleeping in a few extra moments, but it’s getting up for that morning walk or workout that brings lasting improvement in our mood. We treat ourselves to binge-watching a favorite show late into the night, but it is getting to bed on time, consistently, that helps us feel better day by day. A lazy Sunday morning feels nice in the moment, yet for many of us there are more lasting benefits to engaging regularly with a faith community, and experiencing the support and hope that can bring. 

So where can we find good news for ourselves and our mental health? What avenues toward comfort really work? Few things are better for mental health and overall emotional well-being than regular, moderate exercise. Unfortunately, in our country, we have conflated regular exercise with dieting and attempts to lose weight. Of course, nothing makes something less appealing than to attach it to the concept of calorie restriction. As a result, many people whose emotional well-being would benefit the most from physical exercise avoid it altogether. Research suggests that regular moderate exercise (30-45 minutes, at least 4-5 times per week) is as helpful to mental health as are antidepressant medications, and of course it comes with far fewer negative side effects. 

Similar to exercise, almost nothing beats good, restful sleep when it comes to our well-being. But too often today we reach for melatonin and other sleep medications, which leave us feeling as if we slept through the night, but create a much poorer quality of rest. Far more effective is the work of good “sleep hygiene” – consistently prioritizing enough time for sleep, going to bed at about the same time each night, avoiding caffeine, alcohol, and screens before bed, and having a cool, darkened, quiet place to sleep. For those whose minds start to whir and worry after their heads hit the pillow, learning skills about relaxation, self-talk, and worry scheduling can also be helpful. 

In addition to tending to the body, minding our close relationships also creates high rewards for happiness, studies consistently find. In one such longitudinal study from Harvard, researchers found that close relationships are what matters most to lifetime happiness. More than money or career success, close relationships with friends and family have a protective quality against depression and despair, and clearly appear to boost both longevity and quality of life. Older people who report having many good friends consistently score better on measures of health, cognitive skill, and emotional well-being. And every good therapist knows that what matters most to effective psychotherapy is not the therapist’s theoretical perspective or methods, but the quality of the relationship that develops between therapist and client. 

This year, the American Psychological Association joined with the U.S. Surgeon General and six major national medical groups to make it clear that constant screen time and social media use are creating a tsunami of mental health crises in our country. Many of us are starting to experience the significant costs that come with our modern habits. When we spend our lives looking at little screens, we certainly suffer the negative effects of what we see there: the bullying, the graphic sexual content, the fear of missing out, the poor judgement and boundaries, and the bad news. But we also experience the opportunity cost, namely what we miss out on when we are absorbed in modern distractions. To be sure, this includes physical exercise, restful sleep, and time with our intimate relationships. It also includes spending time outdoors, reading, uninterrupted productive work, involvement with our spiritual or faith life, helping others, and engagement with our community. Among other things, these are the activities that most benefit our mental health and well-being. These are the experiences that make life better. 

Today, so many of us feel in our gut that something is missing, something is wrong, but we don’t know what, exactly. We must make and take time for that which truly matters. These things are often slow, not fast. They require effort, but those efforts pay good dividends. The good news is that, unlike the author and his three-month hiatus, we don’t have to do it all at once. But, if we want to feel better, we do have to make intentional efforts. What can we do today, this week, this month, to decrease our pace of life and incorporate real self-care? Get to bed, take a walk, read a book, help a neighbor, see a friend. Put down the phone. 

Amy V. Maus, MSW, LCSW

Amy V. Maus, MSW, LCSW

specializes in services to schools, serving students of all ages. She frequently provides training for school staff, presentations for parent groups, and consultation and training for Care Teams and community organizations. Amy also leads monthly consultation groups for area school principals and serves as an on-site social worker for schools that contract for weekly services.


From the Director ~ Loss and Equanimity

Mary Fitzgibbons, Ph.D.

Mary Fitzgibbons, Ph.D

As we age, I believe we experience more instances of loss and a greater sensitivity toward it. Yet loss is with us from the beginning stages of our lives. At birth, we are separated from the safety of the womb. We develop a symbiotic attachment toward our parents and other critical caregivers. But, if we want to develop healthy relationships with others, it is necessary that we separate from our parents at two later critical points in life: eighteen months to three years, and adolescence. This enables us to individuate and become our own person. This is the beginning of healthy emotional development. 

As life continues, we experience numerous other losses, many of which we take for granted and may still have an impact on our lives. We feel sad in losing our place as the oldest child. Someone has taken the spotlight from us. We then feel the loss of childhood. Some of us leave it slowly, evidenced by the fact that the average age to leave our childhood home is now thirty. As life goes on, loss continues. We realize we can’t take good health for granted. Our body isn’t responding as it did when we were younger. We look at pictures from twenty years ago and we realize that this isn’t the same face that we now see in the mirror. It seems as though everyone we know is having hip or knee replacements. We talk much more about our health. Forgetfulness becomes an everyday part of our lives. And then the greatest loss. Our parents, our friends are seriously ill. Death of those closest to us becomes more common. We lose our purpose, status, security, and control. We may have not been able to contemplate the emotions concerning our birth, but as we age, we find ourselves spending a great deal of time thinking about our death. 

As difficult as loss can be, there are also benefits that may arise as we age. Judith Viorst, in her book Necessary Losses, says that life consists of a series of losses. In reality, without losses there would be no gains. For example, if we did not lose the symbiosis or dependence with our parents as children, we would not develop the sense of independence of being able to survive in an adult world. What we work to achieve in our adult life is an attitude of acceptance. While there may be hardships, there are also graces to be had. For those who have come to the state of acceptance and serenity, what they’ve come to realize is that we possess tremendous power to make our lives miserable or joyous. In all situations, it is our response that decides whether a situation is a crisis or something to be dealt with. We decide how much emotional energy we want to expend. 

One of the practices that demonstrate this, especially in terms of our troubled and chaotic times, is equanimity. It is not a term we use often. It is a state of psychological stability and composure which is not changed by the exposure to tense emotion or pain. Some would say that it is the secret ingredient in mindfulness, in that it leads to wisdom. It implies an acceptance of what is, not what we want or expect it to be. It helps us not to get overwhelmed and to meet challenging events without being shattered. It is a steadiness of mind and a calm understanding that allows us to be with the constantly changing and shifting landscape of our world. It is an evenness of temper. It is characterized by the ability to remain calm, composed, open, and non-reactive in challenging or distressing situations. Equanimity is crucial for our psychological well-being. 

In the face of loss, we look for that which takes us out of our pain. We search to develop and enhance an inner peace. In the face of loss, we search for acceptance and equanimity. The following suggestions may give us a sense of how we can create this state within ourselves. 

  • Sit comfortably, give yourself a moment to arrive. 
  • Let yourself stop. Be here, in your body and this place. 
  • Let yourself relax fully. 
  • Edit any narrative in your head. 
  • Drop into the present. 
  • Stop the conversation in your head, stop the arguments with yourself and with others. 
  • Realize that there is nothing to do, no one to be. 
  • Feel the sense of being right here and right now. 
  • Don’t create tension with what is arising in your life, 
  • relax with it 
  • Don’t try to fix it. 
  • Let yourself be held by this stillness. 
  • Rest in this quiet, this awareness, this equanimity. 

Loss is painful and it is inevitable, but it also has its gifts. The acceptance of loss brings us to a higher place. It gives us the opportunity to come to know ourselves in a deeper way. It gives us the opportunity to be our best self. It can bring us to a state of equanimity. 


Treating Mental Health Stigma in Medical Settings

Part 3: Family Caregivers

Amy Neu, MSW, LCSW

Amy Neu, MSW, LCSW

Amy Neu, MSW, LCSW provides therapy for adults, older adults, and caregivers who are facing a variety of issues including depression, anxiety, grief, coping with medical issues, dementia, and end of life. Traditional Medicare covers counseling services.
In addition to her work with individual clients, Amy provides on-site counseling, consultation, and education to staff throughout the continuum of senior living communities and home care agencies. She loves speaking with professionals across disciplines about mental health, aging, and grief.

“My husband is in rehab for the next few weeks, and I’m even more overwhelmed than usual. My friends tell me to enjoy time to myself while he’s taken care of there, but somehow, it’s even harder with him away from home. He calls me constantly, begging to come home, and I think the staff expect me to stay because he gets so difficult. I don’t know what to do anymore.” 

– Stressed family caregiver 

Family caregivers of adults with physical and mental health issues often feel stuck in the middle when a loved one is placed in a medical setting. The example above echoes what many family members in this situation express. Common advice given by well-intentioned friends is that while our loved one is at a facility, we should take the deserved time off to recharge and to catch up on all that has piled up while caregiving. However, caregiving comes with its own unique stressors when our loved one is being cared for outside of the home. These pressures often leave us feeling uncomfortable with the idea of “taking a break” away from the facility. 

Caregivers often report feeling overwhelmed, frustrated, and exhausted during this time. While each caregiving situation is unique, there are pervasive stressors that family members face when their loved one is in a new facility. Our sleep quality decreases, anxiety increases, professionals we interact with can be new to our loved ones, communication can be challenging, we put less priority on our own nutrition and hydration, and the environment itself can be overstimulating to our senses. Our loved ones also struggle with the changes in routine, unfamiliar surroundings, continuity of care concerns, and the different assessments, tests, and treatments. Furthermore, these changes often exacerbate the underlying mental health issues of our loved ones, leading to increased erratic, anxious, or difficult behaviors while they are away from home and their usual routines. 

It takes time for anyone to recover physically, mentally, and emotionally from these abrupt changes. We, like all humans, can only operate functionally for a brief period under these circumstances. In this state, we as caregivers cannot expect to rise above the chaos and become our own best self. Many of us, however, belittle ourselves at these times, and in turn become a more critical version of ourselves. Ultimately, this version is one that many of us do not wish to be, fueling a sense of being even more out of control and overwhelmed, continuing a vicious cycle. 

If this sounds familiar, it is time to make some healthy changes and begin to take care of ourselves one step at a time. A good first step is to treat ourselves with more compassion and understanding. One way to treat ourselves with respect is to remind ourselves of the following concepts: We are only one person. We cannot do it all; no one could. This by no means implies that we are weak or failing. Quite simply, it means that we are tired and deserve relief. 

Next, we can reflect on the universal caregiving challenges in this setting, discussed earlier. As we realize that we are not alone in these feelings and are deserving of compassion, we can more clearly explore options available that could alleviate some of the weight we feel. Keep in mind that we may not like the options available to us at a certain time and there rarely is one “right” solution. However, it helps us to recognize that we do have choices in many regards and can select the options that best meet our needs and values at the time. When we remember that we have choices and options, we are often able to be more present-oriented and patient with ourselves and those around us. 

As we implement this new practice of mindfulness, we can more clearly identify what we are realistically able to do and what we cannot do; what is ours to do and what is someone else’s responsibility. There are many things in this scenario that we have little to no control over (i.e., the availability and length of time we speak with providers, how our loved one behaves, the course of illness) which understandably cause us stress. It is important to recognize and begin to accept our lack of control in these areas and try to refocus on the things we can do. 

For example, we can keep records of who we speak with as well as the content of the conversation. We can consider the questions we want to pose to professionals and how we want to express these ideas. We can identify the staff members who genuinely appear to listen, care, and be knowledgeable about our loved ones’ situations and request their assistance for advocacy to the medical team if needed. We can let important people (staff, family, our loved ones) know our availability to discuss care and when we will be unavailable. We can listen to the opinions of our loved ones and do our best to advocate for them in the setting. We can choose to go home and sleep, knowing that a team of professionals is caring for our loved one. Yes, they may do it differently than we do at home; however, our loved one will be safe, and we will be a better family caregiver tomorrow after a night’s rest, shower, and meal. 

It is a new idea to many of us as caregivers that we are not required to be available to people at all times. As with many new ideas, it takes practice to break ourselves of this habit. It is imperative to begin to form healthy boundaries for ourselves that we are willing to enforce. As we begin to brainstorm about the areas in our life we want to change, we can notice what feelings come up for us. What stops us from setting a boundary and taking care of our own needs? Guilt, fear, and feeling responsible if something negative happens are common barriers for many of us. As we gain awareness of what prevents us from doing what is healthy, we can decide what boundaries are worth taking the leap to set for ourselves. The article “Maintaining Boundaries as a Caregiver” provides a brief introduction and offers suggestions on how to create and reinforce healthier boundaries (https://mhanational.org/maintaining-boundaries-caregiver-go-guilt-glow). 

Other ways to alleviate the stress is to take better care of ourselves physically and mentally. Follow basic tips, such as increase water intake, eat healthy meals (or at least pack some quick healthy snacks such as grab and go fruits, veggies, nuts), limit caffeine, and make a point to walk the hall every hour. These small habits help us maintain ourselves physically, mentally, and emotionally. Another way to care for ourselves is to locate resources for caregivers. There are many family caregivers who want and deserve support, and therapy is easier to access than ever before with telehealth platforms and in-person sessions as options. If you or a loved one would benefit from support, please reach out to WCPA to get connected to an experienced professional today. 

*This article is the final 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 second (Fall 2023) was centered around the experiences of medical providers and staff in senior living communities. 


Psychological and Psychoeducational Testing Available

At WCPA, we offer a wide range of comprehensive psychological evaluations tailored to fit your individual needs. We serve children, adolescents, adults, and seniors. 

WCPA clinicians frequently provide evaluation for issues such as: mood and anxiety disorders, ADHD, Autism, specific learning disabilities including dyslexia, intellectual impairment, behavior disorders, and trauma. In addition, we provide clergy evaluations for those considering religious life, pre-adoption evaluations, and disability evaluations. 

Psychological evaluations typically involve a clinical interview, during which the clinician will obtain a thorough history and determine what type of testing is appropriate. The next step involves psychological testing, which may include cognitive, achievement, emotional, and/or personality testing depending on the presenting problem and referral question. After the evaluation, your clinician will prepare a report summarizing findings, diagnoses, and treatment recommendations, and will meet with you to provide feedback. 

If you would like to learn more about accessing evaluation services, contact the WCPA office at (314) 275-8599. 

Treating Mental Health Stigma in Medical Settings*

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“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.

Social Media Comparisons: Our Youth’s Greatest Frenemy

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. With this high pressure, it’s no wonder why our youth are becoming so obsessed with their smartphones and social media.

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 the 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 understand that most of what they see online is not a real representation of others.  Social media is never a reliable, accurate, healthy source for self-comparison.

Understanding Dementia: The Top 3 Causes

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. 

WCPA Fall Newsletter

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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

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

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?

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

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 

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.