Recent News from MHS

Mindfulness Exercises

Posted March 16, 2017

Mindfulness is one of the pillars of DBT and has become increasingly important across contemporary therapies. Yet many therapists are at a loss for examples to suggest and use with their clients. Taken from Dr. Lane Pederson’s new second edition of The Expanded Dialectical Behavior Therapy Skills Training Manual, enjoy this free handout you can use with any client looking for mindfulness exercises…and remember, mindfulness is not what you’re doing, but how you are attending to what you’re doing!

VIEW HANDOUT HERE

5 Tips for Completing Paperwork on Time

Posted January 30, 2017

Paper cuts are becoming outdated with new mandates for electronic medical record keeping, but that does not mean all our paperwork woes have vanished. As a professional, there is no avoiding paperwork because of it being so important, but it can also be the first thing to slide when things get hectic. Here are some tips to help you get your paperwork done more efficiently.

1. Routine
Work to develop a routine and stick to it! Completing your notes in session or making sure your notes are complete by the end of each day is ideal. Figuring out what works for you and establishing a routine takes energy on the front-end, but will likely pay off.

2. Consistency
Once you have developed your routine, make sure that you stay consistent. Scheduling time for paperwork on your calendar is a great way to do this if you can stick to it!

3. Backup Plan
We work in a field where things can be unpredictable and throw off our game plan. Make sure to have a backup plan when these things happen. Sometimes we need to be flexible to meet the needs of our clients!

4. Support
If you are struggling to get paperwork done on time and have tried implementing these strategies reach out for support. Sometimes we need some support, problem-solving advice, or even accountability to help manage our workload.

5. Reward
We all know about reward and reinforcement, right? As professionals, we can use this on ourselves as well. When you complete your paperwork, find a way to reward yourself. Go for a walk, have a cup of tea, or chat with a co-worker.

We do very important work, but no one can see that if we do not get our paperwork done in a timely and complete fashion.

DBT at the Top of The World

Posted September 8, 2016

by Dr. Lane Pederson

Training professionals in DBT has brought me to amazing places with opportunities to meet truly wonderful people. In the past year I trained a grateful audience in Mexico and experienced Mex-ican culture and urban life not seen within resort destinations, passing my free time in community spaces teaming with people young and old playing sports, laughing, and visiting. I also visited Australia for the third time, this time having familiar and favorite restaurants, botanical gardens, landmarks, and jazz clubs to venture back to during the nearly month-long stay. In between these international destinations I dropped into places both rural and metropolitan across the con-tinental United States, always looking to get out and about to meet people and see the sites. However, perhaps the most unique destination I visited this year was Barrow, Alaska, where I provided a DBT training for Arctic Women in Crisis.

Barrow is unlike any other place I have visited. Located at the top of Alaska within the Arctic Circle on the Arctic Ocean, Barrow is accessible only by plane. The landscape is tundra, with not a tree or hill in sight, and none of the roads within this town of 4500 are paved because of the permafrost. The population is 65% Inupiat Eskimo, whose ancestors have occupied semi-permanent settlements in this region for thousands of years including a 1500 year time period that overlapped with woolly mammoths! Mammoth tusks and artifacts are on display in various places around town along with whale bones, walrus tusks, bison skulls, and the various pelts that come from native animals including wolves and polar bears. Surprisingly (to me), Barrow is also home to 185 species of birds that can be viewed in the tundra during the summer months, which makes this area a destination for bird watchers.

The weather in Barrow is cold and windy, which is an understatement. During my stay in mid-April, the high temperatures were in the single digits but the wind chills were around negative 25. Being a Minnesotan, I braved the cold and walked around Barrow, usually staying out for only 30 to 35 minutes at a time before the cold winds blew me back inside. I have not been cold like that for a long time, bringing back distant memories of being a kid outside in the middle of winter, having wandered too far from home, and trudging slowly back only after realizing the sting of frostbite setting into numb extremities. The cold and wind in Barrow did the same, chilling my bones, numbing my face, hands, and legs, and making my eyes water. And this was April weather! During the coldest times the air temperature can be negative 50 (or below!) without the wind chill, and “summer” really does not get much warmer than the 40s. Aside from a few heavily bundled children playing and an occasional person passing on a snow machine, four-wheeler, or in a pickup, I was the only person out wandering what seemed in many ways like a ghost town. The solitude made me long for the warmer months here, when the community is out and about after a long winter that has over 60 days of darkness (one therapist characterized the darkness as a beautiful indigo, and of course the northern lights are beyond incredible during the darkest time of year). Contrasting the winter months, the height of the whaling seasons in spring and fall bring excitement and celebration, and during the summer months the community holds vibrant outdoor gatherings, tossing one another into the air from blankets, and soaking in the Midnight Sun from May through August.

The houses in Barrow are modest, usually no more than hundreds of square feet in space sitting on blocks, often occupied by full families. Most houses are in some state of disrepair, with peel-ing paint, boarded windows, and makeshift repairs. Old cars and trucks, snow machines, and other broken down things, like appliances, grills, and other household items are frequent sights around town. Barrow is much closer to the North Pole than to a Home Depot, so basic supplies are hard to come by and are extraordinarily expensive. Fixing up your home, should the weather be nice enough, is a luxury, as is tending to your yard. Nonetheless, there is a certain attraction in seeing the natural cycle of things, and I was reminded of the Japanese concept of Wabi Sabi, a philosophy in which one finds beauty in decline, knowing that rebirth in everything happens in time. I found the surroundings fascinating with a simple beauty that held my interest much more than fancier but more pedestrian places. It is a place where community is much more valuable than possessions.

Eventually I gathered enough courage to walk to the edge of Barrow, over the snow drifts, across the beach, and out onto the ice covering the edge of the Arctic Ocean. Why courage? For one, fear of polar bears. Although polar bears rarely come into town, they can certainly be out on the ice, and when they are roaming toward the beach they are likely hungry. One of the therapists at my training is married to a whaling captain who had just killed a polar bear the night before. The bear had been following him and the confrontation was inevitable. This bear was processed and every part of it used. However, I had no use for a bear, no gun, and no Arctic experience passed down through the generations to me, so I felt a bit like dinner. I also sus-pected that having to spot a polar bear on a totally white landscape could put the bear at an ad-vantage, as would its ability to move quickly on the ice. Somehow knowing that these bears usually swipe with the left paw, which is why hunters approach them from the right, seemed more like trivia then any useful survival ploy to me.

The other dangers on the ice are that there may be a fissure that you could fall through or that the chunk you are standing on could break free and move out into the ocean. The ocean ice is constantly moving and changing creating unseen dangers to people without experience. Inupiats know over a dozen “types” of ice and what dangers to look for when traveling on it. This knowledge is essential since in the event of a fissure or drift you would for die from the elements or be food. Although these calamities were low probability events, I still stayed relatively close to shore even though I was tempted to walk further out. In a brief amount of time, the cold and wind motivated me to turn back toward the safety of town, feeling awe that whaling captains and their crews had recently set up camps on the ice sheets with the beginning of whaling season.

Whaling is an ancient and primary form of subsistence for many families here, and it is central to the cultural identity of Barrow. The Inupiat treat whales with great reverence, and because whal-ing is for subsistence only, you cannot buy whale meat or get it in a restaurant. A therapist whose family is native to Barrow, Daisy, brought me a snack of raw whale skin and blubber along with raw whale meat. To have an opportunity to try food that is so meaningful to their community was an honor, and it was both delicious and a highlight of my visit.

Like Daisy, the people of Barrow are kind and friendly, with gentle demeanors that sharply con-trast the harsh elements in which they live. However, the time of year decreased opportunities to talk with many people other than the therapists and advocates at the training, a group who are extraordinary dedicated to the work they do on the North Slope. The therapists and advocates are a diverse team with some who grew up in Barrow or other parts of Alaska and others moved here from the lower 48 and from other countries. Those who immigrated came from warmer climates and communities that had access to music, entertainment, sports, fine dining, and relia-ble cell phone and internet service…the trappings that many of us take for granted. When I asked many of the therapists who moved here, “Why Barrow?,” that simple question resulted in a variety of polite answers that all seemed to boil down a calling to be here.

I guess that is why I came too, if only for a short visit. Barrow is a place unlike any other in the world, with an exceptional climate and location that is inhabited by people with an amazing herit-age that goes back thousands of years. I started to miss Barrow as I boarded the plane on my long journey back to warm Minnesota, and I hope to be back again someday. In summer.

Myths About Mindfulness

Posted May 5, 2016

By: Dr. Lane Pederson

Many people, therapists included, have misconceptions about what mindfulness is and what it is not. Sometimes these misconceptions get in the way of engaging in mindfulness practice. Below are some of the most common myths about mindfulness.

• Mindfulness is Buddhist (or some other philosophy or religion)
While a large variety of philosophies and religions promote mindfulness practices, mindfulness is best thought of as a human activity that is owned by no group or person. Mindfulness belongs to us all, and furthermore, mindfulness and its benefits are supported by robust research that clearly shows its psychological, emotional, physical, and performance-based benefits.

• Mindfulness is all new-age-y, wavy-gravy or (insert your judgment here)
For some reason, mindfulness seems to conjure images of people in flowing robes, sitting in serene settings, existing in some unreal world disconnected from your or my reality (admittedly, many photos showing people practicing mindfulness promote those stereotypes). The facts are that mindfulness is for everyone, and that people across all races, ethnicities, cultures, religions, occupations, and socio-economic statuses practice mindfulness.

• Mindfulness is a fad or trend
Mindfulness has been around since the dawn of consciousness, making the Beatles or Rolling Stones look like fads by comparison. Not much stands that test of time. When the end of the world comes, only cockroaches and Keith Richards, practicing mindfulness, will remain. Enough said.

• Mindfulness takes a lot of time
While some advocates of mindfulness stress 45 minutes (or more) of meditation or other mindfulness practice daily, the fact is that you can achieve benefits from taking just a few minutes (or even moments in some cases) to re-center yourself mindfully in the moment. When you consider how much time we all spend distracted by problems, taking a few minutes to breathe or otherwise practice mindfulness is a great tradeoff.

• People who practice mindfulness are always mindful (and effective)
A mindfulness student once saw his teacher eating while watching TV. Angry at the apparent hypocrisy of doing more than one thing at a time, the student challenged his teacher. “You always teach one-mindfulness, lecturing ’when you walk, walk, when you pray, pray, and when you eat, eat,’ and now I see you both eating and watching TV!” The teacher calmly replied, “When you eat and watch TV, eat and watch TV!” Mindfulness does not create perfection, and practitioners will likely experience the benefits but will certainly not always be in the moment. Further, seeking to be ever-mindful means you are clinging to a goal and as such not in the moment.

• Mindfulness is done only during meditation or other mindfulness practice
This myth is one of the biggest, and it is analogous to saying people only move their bodies when they exercise. Think of meditation and other mindfulness practice as exercise for the brain, building the skills needed to collect and focus your attention and then guide your behavior. Just as physical fitness is about developing a healthy body, meditation and other mindfulness practices are about building healthy mental processes so you can be mindful in the moments of everyday life.

• Mindfulness is only about pleasure, peace, and relaxation
While mindfulness can be pleasurable and promote peace and relaxation, mindfulness is also about relating to experiences that can be aversive, uncomfortable, and even painful. Think about how often we try to escape these types of experiences only to make them worse! Perhaps paradoxically, using mindfulness to accept and relate to what is painful can transform it; mindfulness is fundamentally acceptance-based and non-judgmental, which releases the helping of suffering we often dump on pain.

• Mindfulness can turn off problems, or otherwise make them go away
Mindfulness is not about turning anything on or off. Rather, it is about deciding what to focus on and when. What mindfulness can do is offer a way to focus away from your problems when you choose, getting a break, and to focus on your problems when you choose with a different approach that might transform your relationship to them, as mentioned above.

• People with attention-deficit, racing thoughts, intrusive thinking, or other problems cannot practice mindfulness
Even though mindfulness does not turn off or make problems go away, it is a set of skills you can practice to eventually minimize the impacts of these problems on your life. For example, if your problem was racing thoughts, you would simply notice when they distract you (gently and non-judgmentally), and then turn your mind to the chosen focus of your attention. If your problem is attention deficits, then practicing the skill of (re)focusing your attention (i.e., mindfulness) is perfect for you!

• Children, people with cognitive disabilities, or (insert another category of people) cannot do mindfulness
Watch young children eat, play with their toys, and explore. They are engrossed, and there. This is mindfulness. People of most developmental and cognitive levels have the ability to focus their attention and connect to the present moment, and can have that ability fostered. To this end, having a parent, friend, or loved one practice mindful engagement with them will gently pull along their mindfulness skills, even if they cannot explain mindfulness conceptually. For those without abstract thought, we simply make explanations of mindfulness more concrete. Smell the flowers, and blow out the candles.

• You are unable to do mindfulness
See above, and also remember that you already practice mindfulness sometimes, with some things, in some places. Where and with doing what do you find yourself totally connected and inhabiting the moment? Maybe it is when you play an instrument or sport, or when you are doing a hobby, or into the flow of your work. Maybe it’s when you are in your garden, cooking, or connecting spiritually. Use existing times of mindfulness to branch out and develop your skills, remembering that mindfulness is like any other skill-set: You get out of it what you put into it. Practice your practice, and the rewards will come with time.

MHS Clinical Director Elected to be President of the Minnesota Psychological Association

Posted December 14, 2015

MHS’ own Dr. Steve Girardeau was recently elected to be the President of the Minnesota Psychological Association (MPA) for the 2017 calendar year. Serving as the President-Elect this coming year, Steve will assist the current president and serve on the executive committee.

During his presidential year, Dr. Girardeau will organize a Presidential Conference on the topic of his choice, as well as inform and promote the many causes that influence mental health care in the State of Minnesota and beyond.

We are proud of Steve and wish to recognize this defining accomplishment! The MPA, Minnesota, and the many people affected by mental illness both directly and indirectly will benefit from his advocacy and expertise.

Congrats Dr. Girardeau!

5 Tips for Effective Parenting

Posted December 14, 2015

Pat Harvey, ACSW, LCSW-C , the co-author of Parenting a Teen Who Has Intense Emotions, was kind enough to write and share parenting tips for our blog.  Read more about her book here. Thanks Pat for sharing your expertise!

1. Parent wisely by:
-Slowing down, calming down, and managing your own emotions before responding or making decisions so you can think more clearly
-Remembering both your short and long term goals and responding in ways that will help you achieve them
-Not judging, assuming or labeling; describe what you see without making any evaluation or assumptions about intent
-Remembering that your child – and you – are doing the best you can in this moment even while you may be working on developing more effective behaviors

2. Parent dialectically by:
-Recognizing that different perspectives can have validity and trying to listen and synthesize them
-Not reacting with extreme or rigid responses
-Finding a balance between being too strict or too lenient, fostering dependency or giving too much freedom too quickly, having and maintaining limits and giving privileges, being firm and being gentle, providing structure and also being flexible

3. Validate, validate, validate
-Listen when your child talks, take him/her seriously and acknowledge what he/she is saying to you
-Respond to the affect beneath the words and understand what your child is trying to express
-Do not deny his/her reality or feelings, accept them before providing any feedback

4. Reinforce, recognize and acknowledge when your child is behaving in healthy and positive ways
-Remember that behaviors can be changed; new behaviors can be taught and learned to replace problematic behaviors
-Pay more attention to healthy behaviors and less attention to unhealthy behaviors; using your attention strategically can help your child develop more adaptive behaviors
-Remember that reinforcement is more effective than punishment and teaches your child HOW TO behave

5. Take care of yourself
-Be kind to yourself
-You can only help someone else if you are also doing things that you enjoy and that bring you pleasure and a sense of accomplishment

 

Practical Advice for Stuck Clients

Posted November 30, 2015

So many of us consult on the intervention level when a client is not making significant progress.  We offer therapists advice like, “try a cognitive reframe,” or “be mindful of the behavioral contingencies,” or offer some other “ingredient” from our preferred therapies that we think will be the catalyst for change.  And why not?  We need interventions to do therapy, and our treatment manuals are basically recipe books full of ingredients that promise results for our clients.  In fact, most seminars rally around a particular treatment manual, and some even go so far to say they have the 5 (or 10) best strategies to help even your most stuck client!

Therapy manuals and their ingredients are important, and we should learn to do our therapies well, but research shows that the interventions we use in therapy actually account for a small amount of the variance in change.

So what influences outcomes more than interventions? 

Unsurprisingly, the therapy alliance is of vital importance.  However, you may be  surprised to learn that the therapy alliance accounts for 5 to 7 times more of the variance in change than treatment manuals and techniques!

Thus, while intervention-based consultation will always have its place (again, we need interventions to do therapy), it may be more wise to consult on the how the quality of the alliance is affecting the outcome.  To this end, consider these three factors related to alliance, ALL of which research shows need to be present for a positive outcome:

1) Relationship: This is the third of alliance most obvious to therapists.  Relationship is definitely about rapport and the therapist-driven variables of authenticity, empathy, and respect.  While providing these qualities along with a nonjudgmental stance seem like common sense, it can nonetheless be difficult at times when working with a stuck client.

2) Agreement on a Goal: Having a common goal for the therapy defines the work and speaks to the active part of alliance.  Often when therapy is not working it is because there is not a shared goal to bind the alliance and create active roles in the therapy.  Ask yourself: “What does the client want?”  Without a shared goal, there is no therapy!

3) Agreement on the Therapy and its Methods as being Legitimate to Reach the Goal/Solve the Problem: This third part of alliance speaks to how successful outcomes result from an interactive connection between therapist, client, and therapy/interventions in the pursuit of the identified goal.  To be effective, agreement on the therapy and methods needs to be based in genuine belief and expectancy on the part of the client and allegiance on the part of the therapist.

Without therapy alliance, virtually no intervention will carry much success. Therefore, whenever you have a stuck client, start with making sure all three parts of the alliance are present and in play!

5 DBT Skills to Enjoy the Holidays

Posted November 18, 2015

Finding yourself or your clients stressed out and dreading the holidays? While many struggle through the holidays, that doesn’t mean we are powerless to use our skills. Building on our 5 skills to survive the holidays blog, we offer 5 more skills to actually enjoy the season. Here they are:

1. Build Positive Experience (BPE):
BPE starts with being mindful of positive events that are happening all around us. Often we miss opportunities for fun or connection because we are lost in our problems and worries. Time to awaken and take advantage of positives that are possible now. Listen to favorite holiday music, watch time-honored movies, and commit yourself to investing in the season. Make sure to schedule times to get out and about to get-togethers, community functions, services, and other events that pop up during the season. BPE takes investment, planning, follow-through, and sometimes a dose of opposite-to-emotion too!

2. Attend to Relationships (A2R):
A2R is a specialized type of BPE. Relationships are like plants in that they need to be watered or they wither. The holidays are the perfect time to send cards, pictures, or to write a meaningful note or letter. Connect by phone, Skype, or in person if possible. Take extra time to let others know that they matter to you.

3. Contributing:
Surprise a friend, loved one, or co-workers with cookies or another treat. Participate in parties and events in whatever way you can…even your presence is contributing. If you are able, consider volunteering your time with any organization that helps those less fortunate, or take time to set aside and donate items you no longer need. Support an organization like Toys for Tots or volunteer to be a Salvation Army bell ringer. Whenever you can, think about how you can give, which is a true meaning of the season.

4. Self-Soothe:
Get into your senses. The holidays are filled with sights, sounds, smells, and tastes that are pleasing to our senses. Connect mindfully to these moments, and allow yourself to relax into what the holidays have to offer.

5. Participate:
Participate is a core mindfulness skill, and it means fully immersing yourself in what you are doing in the moment. Truly inhabit each experience with your full self, gently letting go of distractions to get back to being with what you are doing and who you are with during this season. Remember that we can participate in stress and misery, or in the many opportunities for joy that the season can offer us.

5 DBT Skills for Surviving the Holidays

Posted November 10, 2015

Holidays can be a time of joy or misery. While we cannot control the world around us, or make reality unfold according to our preferences, we can practice our skills to navigate challenges and focus on what is most important to us…thereby influencing our mood for the better. Create a more stress free holiday season for yourself and others with the following skills. And stay tuned for the next email on 5 skills to not just survive, but to enjoy the holidays!

1. MINDFULNESS
Mindfulness is about paying attention to the present moment, on purpose, with an open heart and nonjudgmental stance. It is about directing what we want to focus on and when based on our wisdom and what will work. During the holidays our minds get hijacked by worries about families, get-togethers, gifts, and balancing the competing pressures of the season. The remedy is to slow down and focus on this moment, taking one thing at a time, and doing exactly what is needed (which might be just being present and not doing a thing!). We can only influence the future through this moment, so live it as effectively as you can. Also remember to take time to practice breathing, imagery, or to simply contemplate the true meaning(s) of the season.

2. OPPOSITE TO EMOTION (O2E)
The holiday season might mean that you have a lot to do. When pressure builds, procrastination and avoidance can grow. Avoidance behaviors get reinforced by what we call negative reinforcement…there is temporary relief that comes with avoiding any activity that causes stress. Step out of this trap by acting opposite to procrastination and avoidance behaviors by doing tasks and activities that need attention…take the first step and throw yourself into it. Also, don’t be afraid to balance this strategy by simplifying and letting go of task and activities that are truly non-essential.

3. PLEASED
The PLEASED skills are all about self-care. Halloween candy is still around, and more holiday goodies are on the way. Unfortunately, many of us cope with stress by indulging in the excesses of the season. It feels good in the moment, but probably works against our larger goals. This is the time to be more mindful of eating healthy, balanced food, getting more movement in our day, and improving the amount and quality of our sleep. We like to think that self-care can wait until January 1, but really the time for it is today. An increase in these skills will help make the holidays more joyful with less stress. We all do better when we feel better!

4. RADICAL ACCEPTANCE
This skill means letting go of fighting reality. When you accept and give up the fight, then you free up your mental and emotional resources to be as effective as you can. Almost by definition, needing to use acceptance means that the situation you are choosing to accept is not your preference and you do not like it. For a greater good you might need to see your in-laws (or your own family), or go to that holiday or office get-together, or make some kind of compromise. Practicing an attitude of acceptance with life’s difficulties is a nice alternative to fighting every battle and making yourself suffer over what is. That is not to say give up and give in. Sometimes we do need to set boundaries or solve a problem…but if you need to do that, you will still be more effective if you start with acceptance.

5. WILLINGNESS
This skill is the opposite of trying to control everything or take a my way or the highway approach to others and life. Being willful limits our options and forces everyone into corners. Maybe it does not have to be your way! When appropriate, learn to let go and go with the flow. Be willing to do whatever is necessary to accomplish a goal or to contribute to a get-together or another person. Let go of your preconceived notions of how you think a situation should be and practice flexibility. Holidays can make us feel out of control, which we sometimes react to by trying to control everything. People who practice willingness learn to bend so they don’t break!

MHS wishes you, your friends and family, and your clients a joyful holiday season!