Category Archives: Adolescent Mental Health

8 TIPS to Help Clients Do Homework

Posted June 6, 2018

 

Dr. Lane P.: Hi, I’m Dr. Lane Pederson. One of the most common questions I get from participants in my seminars is, How do I get clients to do homework? In this short video, I’m going to share with you eight tips that I find to be very effective.

Dr. Lane P.: Now, the first one is simply changing the name. I often times say the word “homework” when I talk to other therapists, but I rarely use that word when I’m working with clients. Instead, I might say, “Let’s do a task.” or “Let’s do an experiment.” Sounds kind of fun. Or I might simply say, “Let’s do our skill practice.” Sometimes, just changing the name can make all the difference. I’ve met so many clients who are just simply allergic to the word “homework”.

Dr. Lane P.: The second tip is really important. At the beginning of therapy, I always want to orient and educate my client about why homework is important to them. Why do they need to practice these skills, or why do they need to practice what we learned in session between sessions? An analogy I like to use is: To not practice between session is a lot like going to a personal trainer and talking about exercising but not actually exercising between those sessions. You’re just not going to reach your goals. It really is about plugging into what’s important to clients. Where do they want to be in life? What does recovery look like? What do they want to accomplish? You explicitly make that connection between skill practice and what it is that they desire, what they want.

Dr. Lane P.: The next idea is to always include clients in coming up with ideas for skills practice or tasks, or experiments. A lot of times, we therapists think that we need to generate all of the ideas, but our ideas for what might be helpful in terms of homework might not resonate with some of our clients. So, instead of doing homework to clients, I like to think about doing homework with clients and spending some time with having them come up with what they think would be helpful to do between sessions.

Dr. Lane P.: Which leads us to the next tip, which is: if you want clients to do homework or tasks or experiments between sessions, it’s good to initiate that skills practice in session. So for example, if I want a client to practice guided imagery, we’re going to practice guided imagery in session. If it’s important for a client to fill out an application before the next session, I might have the client just start to fill out the first parts of the application in the session with me. There’s something about breaking the ice in session with homework that gets clients motivated to complete and to finish it between sessions outside of our time together.

Dr. Lane P.: The next idea is to take one problem or opportunity and play it off of another. So for example, let’s say that you have a client who would like to walk to get some self care exercise in and the client also would like to socialize more to decrease isolation. You can set it up so if you don’t do one, you need to definitely commit to doing the other, so in this case, if the client didn’t go for the walk, he or she would definitely need to call a friend or to get out and socialize in one way or another. It’s a strategy that works really well.

Dr. Lane P.: Related to this strategy is another one which is simply making it a game. So, if you have a dichotomous choice like doing a fun activity versus taking care of a task at home, more of a responsibility, you can simply flip a coin. Heads you do one, tales you do the other. Or if you and the client have brainstormed lots of ideas, simply draw a cards. So, one skills practice might be associated with hearts, another one with clubs, another one with spades, and so on.

Dr. Lane P.: The seventh tip that I have is using the Premack principle. The Premack principle means that you make performing a high probability behavior contingent on performing the low probability behavior first. We sometimes call this grandma’s rule. Grandma’s rule is this. When you eat your vegetables, then you can go out and play. So with the Premack principle, let’s say I have a client who turns on the television every night. He or she really loves to watch evening television. I might say, “I want you to do your skills practice and then you can turn on the television.” Of course, many of us naturally do this Premack principle. You know, I need to return my emails and then I can surf the internet. It’s such a great strategy because the reinforcement is built-in.

Dr. Lane P.: And now, for the very last tip … and this one I think is the heaviest hitter. It is so important to simply schedule it. A lot of clients don’t complete their homework simply because they haven’t thought about where and when they’re going to complete it.

Dr. Lane P.: There was a study that happened many years ago and in this study, there was one group of people who agreed to do a task. They were committed to doing it. The second group of people were also committed, but that group also determined when and where they were going to complete the task. They completed it 80% more of the time. Hey, think about you or me. A lot of us don’t complete what would be important to do in life simply because we don’t write it down, we don’t commit to it in the schedule. So, taking a little bit of time to schedule homework is going to make all of the difference for your clients.

Dr. Lane P.: I hope these eight tips help you out a lot and, more importantly, help out your clients.

Dr. Lane P.: Thank you for joining me.

 

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.


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

10 Days to a 10-Minute Meditation Practice

Posted March 23, 2017

Pain 1Developing a Meditation Practice Can Seem Impossible…Until You Discover How Doable It Can Be! Taken from Dr. Lane Pederson’s new second edition of The Expanded Dialectical Behavior Therapy Skills Training Manual, these free handouts explain a step-wise and doable method for bringing a brief meditation practice to your and your clients’ lives. Start today!

Click HERE to view the handouts.

Mindfulness Exercises

Posted March 16, 2017

DBT Manual 2Mindfulness 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

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.

5 Tips for Effective Parenting

Posted December 14, 2015

EAP 15Pat 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

Check out Early Adolescent DBT Programming at MHS.  EAP provides comprehensive therapy and skills to help young adolescents ages 12 to 14 who experience significant emotional difficulties as well as behavioral challenges.

 

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.