Recent News from MHS

Trauma & Attachment Interview w/ Dr. Eboni Webb Psychologist, PsyD, HSP

Posted February 21, 2018

Lane Pederson: Hi, I’m Dr. Lane Pederson, co-owner of Mental Health Systems and I’m here with Dr. Eboni Webb for an interview on her upcoming training on attachment and trauma.

Eboni, tell us a little bit about your background, that really got you interested in becoming an expert in attachment and trauma.

Eboni Webb: Well, once I moved to the South and started doing private practice, I started working with a lot of families that had adopted and really had not been educated that adoption inherently has trauma to it. That really expanded my need to be more educated, help parents be educated and even their children understanding why they’re experiencing the difficulties that they’re experiencing.

Lane Pederson: Sure. So, when you talk about adoption having trauma inherent in it, what are some of the traumatic situations that you see these children coming from?

Eboni Webb: Oh, well, many of them come from orphanages where there were not enough care providers to even take care of the children that are there, so there’s a lot of neglect. Poor resources, maybe even inadequate food, but then also the circumstances that necessitated being put into an orphanage often have trauma, abuse, neglect as a part of their story.

Lane Pederson: So, naturally, you’re seeing trauma starting in early childhood and really starting to go across the lifespan. At least early lifespan, with some of the clients you’re working with.

Eboni Webb: Absolutely. There are what we would call single incident traumas; accidents, major natural disasters. But then also developmental trauma. Developmental trauma will go across the lifespan and has to be addressed at every stage of development then.

Lane Pederson: For many people, even if it’s one event, in terms of how it’s experienced, it really is much greater than that event. It really sort of affects their whole course of life, so to speak.

Eboni Webb: Mm-hmm (affirmative). Yeah. Because trauma is self-perceived and it’s driven by the individual’s experiences of it, what they were able to do, what they weren’t able to do, and what other environmental resources were available to them. So, it will vary.

Lane Pederson: So there’s a lot of variants with that. One thing that I wanted to ask you about was what are some of the misconceptions that therapists have about people with trauma and misconceptions about how to treat it?

Eboni Webb: One of the big presentations that we’ll see with the client, is that they may be very activated in a session, which makes it very difficult to connect with them. Or they may be very checked out, which a therapist may initially perceive as a person who’s not interested or not invested in the work. And that is a common misperception until you understand that they’re often defending and that their traumatic response has just permeated their life.

Lane Pederson: Right. So, as a therapist, how do you overcome those type of barriers?

Eboni Webb: I think one, educating the client about what’s happening to them. They may not be conscious of it because trauma based defenses are no conscious by very design, right? So, we have to educate and then to be able to help them normalize and feel safe in the therapeutic environment to let those defenses down.

Lane Pederson: Sure. So, a part of it is just orienting the client to what the therapy is about and what their sort of natural, if you will, response will be and educating them about that and that helps set up more therapeutic success.

Eboni Webb: That’s right. Mm-hmm (affirmative).

Lane Pederson: Okay. Along with misconceptions, what are some of the mistakes that people sometimes make? By people, I mean therapists. What are some of the mistakes that therapists make when they’re working with trauma?

Eboni Webb: I think even one of the primary problems that a therapist can do in terms of the therapeutic space, is assume that this space is aesthetically pleasing, the client will feel comfortable in it. But with trauma as a factor, proximity matters. So, even the spacing of seats can be a problem or it can keep them feeling safe and secure. Tone of voice, inflection. Also, I think therapists often personalize how the client is presenting and making sure that they’re mindful constantly that this is how they are defending and that they really cannot help it. And just as I’ve said before, their brain cannot discern between real and perceived threat. So, a therapist may be doing something unintentionally that is perceived as threatening, and that can create a disconnect in the relationship.

Lane Pederson: Sure. So, really I’m hearing a few things there. One is that therapists sometimes are not aware enough of their clients and how their clients are presenting. And at the same time, therapists can sometimes take how their clients are presenting as being very personal, which of course is … We’ll use the word countertransference. Having countertransference get in the way, rather than be useful in the therapy. And then just kind of those environmental things; how the office is set up, use of space, what’s a safe or comfortable environment for one client versus another.

Eboni Webb: Mm-hmm (affirmative). Yeah. And when I think about doing trauma treatment, I pull into those three concepts of basically healthy parenting, right? So, proximity maintenance, and the safe haven, and the secure base. Those are issues that have to be negotiated between therapist and client because those are the areas that have been affected by trauma.

Lane Pederson: Sure, sure. Now, when you think about working with people, what are some of the tools or strategies you think are must have to maximize the chances for a successful outcome?

Eboni Webb: I think absolutely you have to have a very solid psychoeducational base. Helping the client understand how the brain works when it comes to trauma and a language in a way that they really can take it in. I think that is an essential tool, to have something even visually for them to understand. I think also, to be successful, when there is a breakdown in the session, what resources even do you have in your room to bring them back online, and to be able to kind of move forward. So, it’s really critical to have that psychoeducation, but also in the moment resources for when the process kind of goes astray.

Lane Pederson: So, a lot of it is back to that setting the foundation. Does the client actually have an understanding, a real understanding of what happened, how that’s affecting them now, even in this moment, and how that informs what you’re doing as a therapist.

Eboni Webb: Yes.

Lane Pederson: And then of course, it can be at times, really unsettling and sometimes clients can become dysregulated as you’re doing the work. And as a therapist, you need to have the skills to be able to manage those situations when they come up, so the client can leave put together, rather than …

Eboni Webb: Mm-hmm (affirmative). And you have to be very patient because it is a slow process depending on the nature of the trauma. Especially if it’s developmental, it is going to be a slow course.

Lane Pederson: Right.

Eboni Webb: Very, very slow course. So, yeah.

Lane Pederson: Yeah. When you’re thinking about that, the course of treatment, of course there have been times when I’ve thought therapists jump in too soon, too fast with trauma. How as a therapist do you gauge what is an appropriate course of treatment for an individual client?

Eboni Webb: In terms of course of treatment, it’s really determined by the severity of the trauma and the frequency. So, single incident trauma can be cleared pretty quickly and you can go straight to that. But with developmental trauma, you’re going to have to take some time. You really have to work with the client alone, just to be able to tolerate our relationship, right? The relationship between the client and the therapist. And to make sure that they are safe in this moment. So, it can take time to go back to actually the core event. And it’s often not necessary because the brain doesn’t need the original players per se, to be able to work through the trauma.

Lane Pederson: Sure, sure. Well, I know that we’ve really just scratched the surface of what’s going to be covered in the training. I can tell you I’m really looking forward to it. Having worked with people with a lot of trauma in their history for a long time, I know that there’s going to be a lot of new stuff that I’m going to get from this, too. So, thank you for taking a few minutes to talk with me about this.

Eboni Webb: Absolutely. Thank you.

Relaxation Script for Pain

Posted December 13, 2017

Studies indicate that up to 50% of individuals diagnosed with chronic pain will also meet the DSM-IV-TR diagnostic criteria for anxiety. This is because many individuals who experience chronic pain describe anxiety and pain distress as a circular fashion: pain contributing to stress, which leads to muscle tension, which leads to more pain. It is important to practice relaxation strategies to cope with anxiety which will release tension in the body. You will find one example of a relaxation script below. In addition, use your mindfulness skills to pay attention to your body’s needs and shift the relaxation script as needed.

Breathing and Body Relaxation Script:

  • Begin by resting your body in a comfortable position. You may close your eyes, or if you are more comfortable keeping them open, stare at a fixed focal point in the room. Start grounding your awareness into your body. Feel your feet firmly meeting the floor, your back supporting you in your chair.
  • Once you have physically grounded yourself, slowly bring your attention to your breath. Notice the patterns of your breathing- the inhalation, pause, and exhalation.
  • Observe the rise and fall of your belly as you are breathing. If you notice that you are breathing from the chest, work to slow your breathing down, with slower and deeper breaths from your diaphragm. Allow for a few more rotations of this breath, going deeper and deeper into your core.
  • The goal of this breathing exercise is target a slower breath, a soothing breath. Perhaps counting allows you to pace your breathing. Try this experience, perhaps starting with intervals of 4 seconds.
    • Inhale, 2, 3, 4. Pause, 2, 3, 4. Exhale, 2, 3, 4. Inhale, 2, 3, 4. Pause, 2, 3, 4. Exhale, 2, 3, 4.
  • Repeat for a few more rotations.
  • It is natural for distractions to pop up in your mind. If you observe a distraction, identify it as just a thought and redirect your attention to your breathing.
    • Inhale, 2, 3, 4. Pause, 2, 3, 4. Exhale, 2, 3, 4.
  • Continue this breathing until you have found a natural rhythm of inhalations and exhalations that work for your body today.
  • Continuing to move with this rhythm, consider the idea of releasing tension with your exhalation as we expand into meditation with the breath. Feel yourself working to inhale calming energy, and exhaling muscle tension.
    • Inhale calm, 2, 3, 4. Pause, 2, 3, 4. Exhale tension, 2, 3, 4. Inhale calm, 2, 3, 4. Pause, 2, 3, 4. Exhale tension, 2, 3, 4. Imagine your body slowly releasing all of the built up tension.
  • As you work through your muscle groups, observe the experience of feeling lighter in your muscles are you work to cleanse your body of the tension.
    • Inhale calm, 2, 3, 4. Pause, 2, 3, 4. Exhale tension, 2, 3, 4.
  • Continue this process for as long as you find meaningful for you. When you are ready, you may begin the process of orienting yourself back to your surroundings. Feel your back against the chair, your legs against the chair, your feet resting on the ground. When you are ready, you may start to shift your body and prepare to move on to the next part of your day. Remember that you can return to this place, to ground yourself and release tension in your body, at any time you choose.

Learning from Setbacks

Posted November 28, 2017

All clients recovering from addiction face setbacks.  While demoralizing, these lapses provide important lessons that inform sustained recovery in the future.  To help clients apply these lessons, use this FREE Handout and Worksheet from Dr. Lane Pederson’s book DBT in Integrated Dual Disorder Treatment Settings.

Asking for Help With Pain

Posted November 21, 2017

It can be challenging for individuals with chronic conditions to find the balance when asking for help. Many people have experienced barriers with everyday household activities and responsibilities as well as occasions of cancelling plans due to pain. It is common for individuals to feel like they will upset their support system by asking for help.  This leads many people to keep their needs to themselves. It can be easy to think that other people will automatically know what you need, and frustrations can result when they don’t get it.

Even though it may feel this way, keep in mind that we don’t know what other people are thinking.  Other people cannot read your mind to know what you need. It is appropriate to ask for help, and doing so builds self-respect. Use this idea as motivation to prepare and reach out

  • Start by identifying your different support needs. This includes emotional and physical needs.
  • The clearer and more specific you are, the better.
  • Communicate with your supports ahead of time. Ask them what kind of help they are willing to offer. For some, it may be help with chores like carrying laundry. For others, it may be help with getting to appointments or providing emotional support during challenging times.
  • Make sure to reinforce others for jumping in.

It may feel challenging in the moment to follow up and ask for help. Remember that your supports have shared with you what they feel comfortable with, and to trust their word and intention with what they offered. Use mindfulness to work on balancing the acceptance of help from others with the things you can do independently to enhance your quality of life.

Emotions, Thoughts, and Situations That Trigger Addictive Behavior

Posted November 9, 2017

It can be challenging to identify and manage what triggers addictive behaviors. Understanding what sets off these behaviors and knowing which strategies and solutions for change are effective are essential in one’s recovery.

Enjoy this free handout on Emotions, Thoughts, and Situations That Trigger Addictive Behavior taken from Dr. Lane Pederson’s book The Expanded Dialectical Behavior Therapy Skills Training Manual.


Being Your Own Care Advocate

Posted November 6, 2017

Don’t get lost in the shuffle.
When you have chronic pain and mental illness, it is easy to feel like your sense of self gets lost in the shuffle. Between all the appointments, lists of diagnoses, and varying treatment opinions, it is common to feel overwhelmed as you wonder how to become your own care advocate. Pair this with limited appointment availability and you have a recipe for reduced advocacy as you feel unheard and shut down.  It may also lead to treatment burn out and turning to your providers as the directors for your treatment.

You are the expert!
It is true that your providers may be the experts in certain assessments and interventions. This does not mean that they are the experts in your day-to-day experience. Keep in mind that you are not only the consumer and advocate for your care, but also the expert in your daily life. YOU are the one who lives in your body and the only one who knows how this truly feels. You are your own advocate. Hold on to this idea so it empowers you to ask for help as you advocate and direct your care. If something doesn’t feel right, speak up. Ask questions. The goal is to advocate and collaborate with your team—you as the expert in your life meeting with the provider in the middle, to develop the best plan for you based on your experiences, goals, and values.

Thrive for Mental Health and Chronic Pain Management Care Advocate

 

Written by:
Morgan Cusack, PsyD
Program Coordinator of Thrive for Mental Health and Chronic Pain Management at MHS

Preparing for a Provider Appointment

Posted October 23, 2017

It can be sometimes feel daunting to get all of your goals met during your provider appointment. Between your questions and goals, the treatment planning of the provider, and limited appointment length it can feel like there isn’t enough time to get everything accomplished. This can be frustrating and disheartening for individuals who experience chronic pain and medical conditions. To avoid feeling shut down during your appointments, it is important to take active steps in preparing for these meetings. This planning can help to build confidence and sense of control, in addition to working towards efficiently meeting your goals.

Prior to your appointment, take some time to plan ahead. Write down your list of questions and goals. Gather any medical history, medication lists, and any symptom tracking details you have been collecting. It can be helpful to store these details in a folder or binder. Plan out your transportation, and make sure to allow for plenty of time for unexpected traffic or road construction. Will there be parking on or off site? What is the schedule or call ahead policy for scheduling transportation? When you arrive at your appointment, ask your provider to establish the timeline, and share the tools you have gathered and your top priority goals for that meeting. Bring a notepad and pen, and make sure to write down any questions or next steps recommended by your provider. These tips can allow you to not only increase your experience of feeling heard during the appointment, but can also increase your ability to understand the treatment and to follow through effectively afterwards.

Written by:
Morgan Cusack, PsyD
Program Coordinator of Thrive for Mental Health and Chronic Pain Management at MHS

5 Things to Think About When Working With Integrated Dual Disorder Clients

Posted October 19, 2017
  1. A basic truth of behavioral health interventions is that no two clients are alike.
    It is important to remember this as we do our work and it is especially vital to keep in mind with the complication of two significant behavioral disorders. How a client’s chemical health and mental health issues interact, impact daily functioning, affect willingness and even abilities to participate in therapy, is a very individual thing.
  2. Another basic truth is that for all clients, ‘perception is reality.’
    This is important in IDD treatment since mental health symptoms and chemical use (and the effects of long-term use) have real consequences for how a client might perceive their world.
  3. A harsh truth of therapy is that change is difficult, time consuming, and at times, difficult to notice.
    For IDD clients, there can be a significantly higher degree of difficulty paired with a lower level of skills. This can make the process even harder, longer, and more difficult to experience a sense of success.
  4. Acceptance and support are key additive factors to success in therapy.
    IDD clients tend to have heavily damaged, if not absent, systems of support and acceptance.
    There is a drive from payers to identify the primary diagnosis as the target for treatment.
  5. IDD clients have two significant primary diagnoses in all cases, and the majority have significant issues across what used to be the five axis’ of diagnosis. We have to attend to all significant issues.
    ~Steven Girardeau, PsyD, LP, Director of Clinical Services at MHS

At what moment does change happen, and how can clients notice it?

Posted April 17, 2017

Check out this Pain-and-Change1.pdf from CBT for Chronic Pain and Psychological Well-Being by MHS owner, Dr. Mark Carlson. Buy it on Amazon today! Many concepts from Dr. Carlson’s manual are used within the Thrive Program for Psychological Well-Being and Chronic Pain at MHS. Schedule an intake appointment for yourself or your client today!

CBT for Chronic Pain and Psychological Well-Being