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Integrative Therapy and Healing
Articles written by Xiomara A. Sosa
Mental Health Responders for Crisis, Trauma and Disaster Events
Mental health responders are often involved in community disasters such as fires. In the area I am currently living there is a high proportion of house fires. There seems to be a general apathy about fire prevention by the community at large. I can’t say why that is because I am unsure. Often when these fires occur, the victims lose almost everything, including their pets. This causes immediate trauma on the scene.
Once the first responders have done their due diligence, mental health responders working as volunteers with the Red Cross to provide disaster mental health, step in to help the victims deal with their immediate crisis. Many times there are children who are victims and they require special attention. The mental health responders are also tasked to monitor and respond to the Red Cross volunteers and other first responders.
Recently there has been an escalating amount of incidents in this area involving dogs or other unknown wild animals mauling and killing babies and toddlers. The community has responded with shock and other potentially volatile responses. Authorities have been introducing mental health responders to handle this unique and very terrifying new disaster. No one wants to have young children die, especially in this way. They also don’t want dogs and other animals to become victims of people attacking and killing them out of fear. This is a fairly new phenomenon here and I am monitoring it to see how it all unfolds. However, it is clear that mental health responders are being asked to play a role in these incidents.
The last one is an obvious one, and that is the effects of storms during hurricane season in this area. It has now become the norm for the Red Cross to train and deploy mental health responders with their cadre of volunteers when these natural disasters occur in this region. I am proud to be one of them, After hurricane Katrina it became obvious that it is very important to make sure these mental health professionals are available not only for the victims, but for their volunteers and staff as well.
I think that the one thing all of these crisis situations have in common is that they create immediate fear and shock for the people who are affected by them. First hand responders are trained to process these extreme events and have more experience with them. However, there is such a thing as secondary trauma so they must be mindful of how they can be affected as well. Second hand responders, such as mental health responders, can help alleviate some of the immediate crisis and trauma by providing hope, help and a sense that things can eventually be better than it is at the moment. The difference is more along the lines of the extreme nature of the incident. For example, a house fire versus a hurricane. The extent of the damage moves from an isolated event to an event that can cover entire communities or even states.
Different people respond differently to a crisis. I’ve come to recognize that people will have different coping mechanisms that they use to get through the immediate stress and crisis. Therefore I’ve learned not to expect that someone is not necessarily handling things effectively simply because they are handling it differently than another person is. It makes sense to consider an individual’s overall traits before making an immediate assumption about that.
Aguilera, D.C., & Messick, J.M. (1982). Crisis intervention: Theory and methodology (4th ed.). St Louis, MO: C.V. Mosby.
Callahan, J. (1998). Crisis theory and crisis intervention in emergencies. In P.M. Kleespies (Ed.). Emergencies in mental health: Evaluation and management. New York: Guilford Press.
Clinical Depression and Psychotropic Drugs
Too many misinformed opinions about this topic out there leads to tragedy or poor quality of life for too many people.
Clinical depression is a mood disorder category. It is not a character or personal weakness. Within that category there are the Depressive Disorders. The Depressive Disorders include Major Depressive Disorder (MDD) and Dysthymic Disorder (DD). MDD includes single, recurrent, melancholic, atypical or seasonal subcategories. DD includes early or late onset categories.
Dysthymia is a less severe, chronic form of depression. It is often referred to as mild depression. It usually has an early onset before adulthood, however late onsets do occur. This form of depression does require treatment because if left untreated it can develop into a double depression which would include a major depressive episode. Psychotherapy and low dose antidepressant medication, along with lifestyle changes can help resolve the symptoms and bring on remission.
MDD, also known as major depression, is a much more severe form of clinical depression that also requires psychotherapy and usually antidepressant medications with higher doses. Diet, lifestyle and environmental changes can also provide relief of symptoms and remission along with clinical treatment.
Clinical depression can be caused by medical problems. It is always best to rule out this possibility by having a health examination performed to check for nutritional problems, thyroid problems, or other medical conditions. If there are no medical issues found, then the depression is likely caused by a combination of biological and environmental conditions (Preston & Johnson, 2012).
Symptoms of clinical depression include negative rumination, irritability, loss of feelings of pleasure, inappropriate feelings of guilt, extreme sadness and a profound sense of emptiness, among others. Antidepressant medication and cognitive behavior therapy used together has shown to be an effective treatment for clinical depression. The medication helps relieve the symptoms so that the talk therapy can be effective.
There is still too much unfounded and learned stigma associated with antidepressants as well as with psychotherapy. As people become better educated about these medications and therapies, it becomes less of a stigma. The more that people understand that clinical depression is based on neuroscience, and therefore its treatment is more effective most of the times when approached from a combination of a psychological and medical perspective, the less stigma will play a role in diagnoses and treatment. It is important to note that physiological symptoms of clinical depression must be present in order to consider medication as part of the treatment. Some of these symptoms include unexplained weight loss or gain, fatigue, insomnia or oversleeping. Substance use and abuse must also be eliminated as a possible cause of the depression.
Although the medication typically takes between two to four weeks to take effect, it is important to remain on the medication for at least six months in order to ensure recovery and prevent relapse. Dysthymia does not always present with the acute symptoms that major depressive disorder does, but it can be just as debilitating in time. People who live with Dysthymia continue with their day to day life, unlike major depression which can be debilitating and cause individuals to isolate, shut down and withdraw completely from society. However, life can still feel difficult to someone with symptoms of Dysthymia.
Preston, J. & Johnson, J. (2012). Clinical psychopharmacology made ridiculously simple (7th edition). Miami, FL: MedMaster, Inc.
Schatzberg, A.F., Cole, J.O., & DeBattista, C. (2010). Manual of clinical psychopharmacology (7th ed.). Washington, DC: American Psychiatric Publishing, Inc.
MedscapeÂ References by WedMD (2012). Retrieved March 22, 2012 from http://emedicine.medscape.com.
Effecting Positive Social Change: Ferguson
Personal disclosure: I come from a family of law enforcement officers and black and white members of society.
I am a social change advocate. Yesterday was a dark day for the social change community. It is a dark day for law enforcement officers who want to do the right thing and are now living under the dark shadow of yesterday. It is also a dark day for the majority of the black community who is also now living under the darkness of yesterday yet is trying to do the right thing. But there is hope that enough people on both sides will make the positive social change necessary as a result.
The only way to truly effect positive social change is to change the system itself. We must pursue positions of power within the system where we are not proportionally represented so that institutional discrimination and culturally based bias is put into proper perspective with the reality that exists. We must balance our systems to accurately and fairly represent who they serve. Just because something is lawful does not mean there is justice.
What we see happening on a local level is a mimicking of what is going on at the highest level of power. When we have so many grown-up white men publicly, viciously and purposely spewing their biased vitriol at the black leader of the free world, what are we to expect white men with lesser power to do to black men with no power on a street level? What do we expect those systems to operate like when we have our highest systems, the House of Representatives, state governments, the media, etc., acting as they do?
Law enforcement officers are not the ones with the real power. They are tasked to enforce laws made and implemented by systems out of their control. Changing the system and replacing those in the position of power within law enforcement is what will effect social change.
Just as rape culture within our higher education and military systems will not change until the individuals with the power to change that culture are replaced. The students, soldiers, marines, etc., are not the ones with the power to change those cultures.
The institutional discrimination and religious and culture based bias that lead to creating hostile and dangerous encounters for the gay community will not change until we change the system and replace the hostile leaders with leaders who promote equality and justice for that community.
Those of us, who are educated, trained and experienced in human behavior and reaction, have our own evidence-based perspective on why the protests, looting, burning, and violent responses to injustice is foreseeable. It is not justifiable, however it is foreseeable. It is human nature. Those who are educated trained and experienced in enforcing the law have their perspective. Both perspectives are equally valid and should be honored and respected.
The Ferguson Police Department is in dire need of an Industrial Psychologist to make the changes it must make at its most fundamental level. Most police departments are. Most institutions are.
It is also predictable that the people who are too uncomfortable with the disturbing precipitating event that caused the looting and burning will focus only on the looting and burning. They will not put the equal amount of attention, judgment and disgust into the precipitating event to the looting and burning. They will instead focus on the looting and the burning now, because it is too uncomfortable for them to focus on the events that lead up to and directly caused the effect they are now unhappy about. Those people will continue to focus on the burning and the looting rather than the precipitating event, rather than trying to understand it without judgment. That is human nature. That is the epitome of bias.
Opinion: People Link Killing Rampages To PTSD Due To Colossal Misinformation
The alarming news of another military service member going on a shooting rampage killing and wounding other service members on a military base is unnerving. For us Latinos it is especially upsetting to know that IvÃ¡n LÃ³pez, a Latino, perpetrated the recent Ft. Hood shooting. I do not care for highlighting a personâ€™s ethnicity or culture in these tragic events, but I feel that I have a responsibility as a Latina, a veteran, and a mental health professional to state the obvious that others are already commenting on.
Cultural and Developmental Implications for Counseling Survivors of Disasters
Hurricane season officially started June 1 and lasts through November. The National Hurricane Center has predicted another busy hurricane season. We have already witnessed devastating tornadoes in Oklahoma. As someone who experienced 9/11up close and personal, I understand intimately how first hand and vicarious trauma from manmade and natural disasters can have an insidious affect on our psychological wellbeing. I was not above it. It was delayed onset for me and I eventually chose to seek help and recovered. I also watched helplessly and lived through the deep personal pain of a loved one battling the damage that came as a result of personal and war zone related trauma. After a long road to recovery for us both, I am now a fierce advocate dedicated to breaking down stigma and advocating for others to seek help when they experience any kind of trauma before it consumes them and their loved ones and causes unnecessary suffering. I now provide disaster mental health services to first and second responders as well as humanitarian workers during emergencies and disasters. And I am beyond proud of my loved one who is now one of the top emergency managers in the field after retiring from an impressive successful Air Force career.
What is a Critical Incident and How Does Culture and Development Affect Survivors?
A critical incident is the actual event that precipitates the trauma. A hurricane is a classic example of a critical incident. I will use my personal experience of living through a hurricane in South Florida. The culture in which this critical incident occurred is the Caribbean, Hispanic and Latin American subcultures living in that part of the country. Many generations of these cultures co-exist, from recent immigrants to those who have been established there as US citizens for decades (James, 2008).
A hurricane is classified as a natural disaster and South Florida is prone to hurricanes. Hurricane season in South Florida begins in June and lasts six months through November. Hurricanes do have a well established and sophisticated warning system in place for the community. However, when a hurricane does hit, many elderly people in the Spanish speaking communities have a tendency to not evacuate when they are asked to by emergency management officials. There are many reasons for this which includes immobility or difficulty with mobility. They also usually do not have transportation, have language barriers and cannot bring themselves to leave their beloved animals, pets or each other behind (James, 2008).
During my experience with one particular hurricane I came across an elderly Cuban American couple. They were in their late stage of life development and had already experienced many hurricane seasons in their homeland of Cuba and in South Florida during their lifetime. This couple escaped the communist regime of Fidel Castro in Cuba and fled to South Florida. They had never returned to Cuba because they were considered political exiles and were not allowed back by their government. Although they experienced hurricane threats in Cuba as young people, they never experienced a tragedy during a hurricane there. However, they have seen destruction, devastation and tragedy in their years living in South Florida, especially when hurricane Andrew devastated the area. That experience profoundly affected them and their response to new trauma.
They often refused to evacuate when hurricane warnings were issued because they are afraid that they would have to leave their animals and pets behind and could not bear that thought. They also required transportation, which they did not have, which means they had to rely on public and community services to do so (James, 2008).
As a professional mental health counselor, I adjusted my counseling approach with this couple based on their cultural frame of reference and developmental stage in life. I based my approach on their late life developmental stage. I also considered their cultural needs and I appropriately attended to their language barriers, immobility issues, and their deep rooted attachment to the caring of their animals and pets (James, 2008).
They also required that my approach accommodate the way in which they process stress and information. Perhaps leaving the only home they have known for decades could be too much of a stressful physical change for them. They had the perspective that they would rather stay and protect their humble home and beloved animals and pets rather than leave everything they have behind because of how long it took them to acquire it all. I chose to include in my thinking the possibility of finding shelters where animals and pets are allowed and reassured them that they would be transported back to their home as soon as it is safe to do so. I used very simple language and small steps in trying to reassure them. A lot of patience and seeing the world through their worldview was the most effective approach in this case (James, 2008).
My counseling approach for this critical incident might have been different if the clients were of a different culture. For example, if they were Caucasian, English speaking (monolingual) and living in a more affluent neighborhood. If so, chances are they would have fewer barriers to contend with. They might own a hurricane fortified home that could withstand hurricane winds or have access to transportation to get to a safe place with their animals and pets. They might also have the ability to replace all of their lifelong belongings. This would likely be the case based on a higher socio-economic status. This is not meant as a generalization; however, in South Florida the socioeconomic levels differ quite distinctly between the ethnic communities for the most part, particularly within the Hispanic community. That difference does play a distinct role in how emergency services operate and are delivered. Cultural competency is a necessary part of delivering emergency management services and mental health disaster services (James, 2008).
James, R. K. (2008). Crisis intervention strategies (6th ed.). Belmont, CA: Thomson Brooks/Cole.ISBN: 0495100269
Diversity in Counseling Couples and Families
Diversity has a significant impact on the effectiveness of counseling with couples and families and on the quality of services that counselors offer them. The impact that diversity has on couples and families becomes evident in how counselors are able to appropriately perceive those relationships within their specific context. Seeing those relationships within the contexts of their specific diversity allows counselors to recognize the strong influence that it has on them as individuals as well as on their relationships with one another. Couples and families live within societies where their gender identity and expression, sexual orientation, race, ethnicity, religion, among other diverse factors, influence their world view. Ignoring this would amount to ineffective interventions and unethical counseling practices (Thomlison, 2010).
Impact on Counselors
Diversity also has a direct impact on counselors because it necessitates that they increase their attention to contextual issues in their practice directly related to many different diversity factors. For example, counselors must pay attention to power differences between the sexes and cultures as well as in spirituality and religion. They must also remain crystal clear about their ethical duty to remain non-judgmental towards non-traditional couples and families that include sexual and gender minorities. Counselors view these issues as metaframeworks, which unifies gender, culture, and other diversity factors (Thomlison, 2010).
One issue related to diversity that may have an impact on a couple’s counseling session is gender identity. A couple that has one partner struggling with issues of gender identity can present with issues that are very different from those of traditional couples. It is important that the counselor have the awareness, knowledge, and cultural competency necessary to provide the appropriate counseling required for the couple and to prevent further distress for them (Thomlison, 2010).
Sexual Orientation and Gender Expression
Other diversity issues in counseling include sexual orientation and gender expression. For example, a family seeking counseling as a result of a child coming out as gay, lesbian, bisexual, transgender, intersex, or questioning can present unique challenges. This requires that the counselor be culturally competent in providing appropriate counseling. It also requires that he or she not allow personal biases, including religious and culture based prejudice or beliefs, to interfere with the appropriate, healthy, and ethically founded response that is mandatory when working in the helping professions. Using affirmative therapy in this instance would be an appropriate, ethical and empirically founded technique rather than using reparative therapy, which is not. It would be vital for the counselor to approach the sessions mindfully to avoid further distressing the family (Thomlison, 2010).
Ethical Counseling Practice
Counselors must address diversity in their practice when providing services to couples and families. Contextual issues have an impact in the lives of individuals in negative and positive ways. It is important that counselors address diversity issues in their practice and that they recognize that ignoring these components is unethical as mental health professionals (Thomlison, 2010).
Thomlison, B. (2010). Family Assessment Handbook: An Introductory Practice Guide to Family Assessment (3rd ed.). Belmont, CA: Thomson Brooks/Cole.
The Influence of Worldview on the Therapeutic Relationship: Counseling Hispanic Clients
The traditional therapeutic worldview of a European American could be a barrier in genuinely understanding why the disconnect exists. Lack of training or experience might be part of the problem as well. Demonstrative, tactile interaction among Hispanics is considered normal within the culture and this might need to be acknowledged in the counseling session on some level although that might not be the same norm in the European American culture. Feeling social and intimate creates a sense of familiarity and comfort for most Hispanics and therefore if the counselor is emotionally and socially distant and cold, it can inadvertently put a barrier between the client and the counselor (Sue & Sue, 2008).
Hispanics might seek counseling from someone who they believe they can relate to better, such as another Hispanic. Although this might not necessarily be fair or guaranteed, it starts them off with a greater sense of trust in the process of counseling. Catholicism influences this group greatly and they are more likely to seek guidance from a church leader before they would a professional, clinical authority figure (Sue & Sue, 2008).
It is also very important that a non-Hispanic counselor recognize how intricate family and friends are to the every day life of most people of Hispanic heritage. This is a fact that must be affirmed and recognized as vital rather than dysfunctional within that group. Godmothers, aunts, cousins and other family members carry a lot of weight in the care of the entire family as a unit. They must be valued and considered influential and important to each client as a general rule (Sue & Sue, 2008).
Sue, D. W., & Sue, D. (2008). Counseling the culturally diverse: Theory and practice (5th ed.). Hoboken, NJ: John Wiley & Sons, Inc.
Being Culturally Competent as a Latina Mental Health Professional
As a Latina mental health professional, I will be faced daily with the challenge of making a culturally relevant diagnosis with each individual client that I provide clinical services to. In making a culturally relevant diagnosis, a professional counselor is ethically obligated to begin with an understanding of the influences that describe identities, strengths, and contexts pertaining to the client. The client’s comprehensive make up must be understood without bias.
Cultural competency must incorporate the ability to consider problems associated with age and generation, possible disabilities, religious influences and identity, racial and ethnic identities, sexual orientation and gender identity or expressions, and socioeconomic status. It is very important that as a professional addressing the needs of multicultural communities that I intentionally and mindfully consider the client’s conceptualization of the problem and not impose my own perception of what his or her presenting problem is, and more importantly, not impose my personal views and belief systems about it. Once I, as a counselor, have been able to do so, it then becomes my duty to explain my diagnosis and possible treatment plan in a very clear way to my client.
As a clinical counselor I should be a good match with my clients. I should be able to understand their perspective and be familiar with their frame of reference. I must also be as prejudice-bias free as possible about customs within other cultures. For example, I am ethically bound to use interpreters in my first session with clients when English is not their first language to ensure that I am culturally competent prior to starting the session with the client.
I must also research and learn about the cultures that I have within my diverse clientele and learn the clients’ detailed history, cultural identity and context prior to beginning a counseling session. Not taking any of these steps can lead to a bad experience for the client who may choose not to continue or return to counseling or seek help elsewhere in the future. I can also inadvertently cause the client irreparable damage. This is unacceptable because above all else, I have taken the Hippocratic Oath oath to “Do No Harm”.
Sue, Derald Wing, David Sue. Counseling the Culturally Diverse, 5th Edition. John Wiley & Sons P&T. <vbk:9780470936641#page(107)>.
May is (also) Skin Cancer Awareness Month
A little over a year ago I was diagnosed and overcame skin cancer, a cancer that is very rare for people of my complexion. The dermatologist was stunned to find it and I was stunned to get the cancer diagnosis, especially for skin cancer, since I am and have always been so diligent about taking care of my skin. I especially am not a “sun goddess”. I was lucky it was caught during an annual routine check up so I am a big advocate for annual screenings of all kinds, including mental health! The surgery was square on my face & the hole it left behind was shocking & frightening. After amazing plastic surgery and ollow up treatment I recovered very well and you can barely notice the scar anymore (unless I point it out which my beloved God-niece Alexia hates when I do). Please follow and share these Prevention Guidelines with your friends and family all year round. I do!