Month: March 2014

Active Listening

By Jeff Dwarshuis LMSW ACSW 

What is Active Listening? 

Active listening is a communication technique that requires a listener in a relationship to use specific language to show an understanding of a speaker’s expression. The language, which consists of suggested phrases combined with the listener’s response, is designed to create psychological safety for the speaker. This structured process is highlights the importance of the speaker’s words and meaning and leaves no room for advice giving. Active listening is a developed skill which can be learned by most anyone to improve understanding and relational closeness between two people. Active Listening has four main parts; they are paraphrasing, clarifying, giving feedback and listening with your body. 

A. Paraphrasing – Paraphrasing is the first step in the active listening process. After hearing what the speaker initially says, the listener provides what is called a mirroring statement. A mirroring statement is a set of words that are nearly identical to the words said by the speaker and are preceded by one of the phrases below.  The use of these phrases followed by a mirroring statement creates a paraphrase and an atmosphere that is centered on the speaker. Following this structure keeps the attention off of the listener by eliminating the possibility of advice giving, question asking or interpretation. With this combination of a heightened focus on the speaker and the diminished importance of the listener’s thoughts, a sense of communicative predictability allows the speaker to feel emotionally safe. Generally when people feel safe they will express more. Consider using one of the phrases below to start the mirroring statement.

                       So you are saying…In other words…If I understand you correctly…What I hearing you saying is that…Let me get this straight…

                     After paraphrasing is complete the speaker should have the sense that they were heard and are understood. The listener, however, does not have to agree with what was said.

B. Clarifying – After giving feedback, the listener should clarify to the speaker what they heard. This is done by asking questions about the presented topic and making sure there are no misunderstandings. Since the listener is actively seeking understanding, clarifying should make the speaker feel important and that their concerns have value. The listener also should be sure to have a goal of understanding the meaning of what the person said rather than being preoccupied with the factual information the person provides. Too much attention to facts will cause the speaker to feel interrogated.

                     To establish language that leads to clarification ask the “who, what, when, where” questions to make sure the speaker is understood.

C. Feedback – After paraphrasing and clarifying the listener should give feedback. Feedback is a supportive yet honest expression of the listener’s opinion regarding the topic. Feedback should be given at the same time as the discussion because the speaker is then more likely to hear the feedback. Feedback gives the speaker an understanding of the impact of their language and it can provide a fresh point of view.  

                        Feedback should be honest but supportive. For example to say “I think you may have made a mistake” rather than “You blew it!”  

D. Listening With Your Body – Listening with your body is an unspoken gesture that is done while listening to someone. These gestures make it easier for the speaker to talk. This can be done in many ways. For example,

                      Maintain eye contact, move closer or lean forward, nod as positive reinforcement, smile or frown in sympathy, keep posture open, remove distraction and remove objects between self and presenter. 

Active listening is a developed skill. Begin by practicing each part separately and memorizing the suggested phrases before listening. Active listening can be used with family, employees, colleagues and friends. You will discover that this tool increases understanding and closeness in relationships. 

The NLP Performance Technique of Surveying Cause and Effect

By Jeff Dwarshuis LMSW ACSW

Neuro–linguistic Programming (NLP) is a branch of psychotherapy that is based on the idea that people experience the world through their senses and translate sensory information into both conscious and unconscious thought processes. These thought processes activate the neurological system that affects physiology, emotions and behavior. The linguistic aspect in NLP refers to the idea that language helps us to capture, conceptualize and communicate our experiences. Programming has to do with the idea that we have patterned internal processes that help us learn, act and get results.

Cause and Effect

How we make personal decisions and act behaviorally has a great deal to do with our perception of personal control. We all maintain the assumption that every effect has an underlying cause. Because of internal dialogue and past history, individuals can be programmed to unrealistically view themselves as victims of their circumstances. In NLP the concept of “cause and effect” attempts to create a method of understanding one’s thoughts to recognize if they are thinking as if they are in or out of control of their circumstances. In NLP terms people are said to be “at cause” or “at effect” as follows:

At Cause – When an individual has the thoughts and behavior that reflect the idea of “I am not making excuses.” or “I am in control of my destiny.” or “What lessons do I need to learn from this situation.”

At Effect – When an individual has the thoughts and behavior that reflect the idea of “I am out of control”. The “at effect” person blames others, makes excuses and passively watches his or her experiences pass through time.

Where are you at right now in your perception of cause and effect both at work and in the family? Understanding one’s own patterns can impact mood, productivity and attitude.

Tuning Into Language

NLP maintains that our internal world of conscious and unconscious thinking is reflected in our words and body language. Someone’s perception of their own level of control over their circumstances is reflected in their language. Notice the differences in the examples below –

“At Effect” language –

  1. “He made me do it.”
  2. “I have to stay late and work because my manager makes me feel guilty.”

“At Cause” language –

  1. “I don’t want to talk now. I am giving myself time to respond.”
  2. “I took time off last week and I have enough energy to complete the project.”

Notice the differences. The “at effect” responses represent an unconscious thought of not being in control. The “at cause” responses represent an attitude of self responsibility and taking control of one’s circumstances.

Examining Internal Dialogue

Individuals live in a private world of internal dialogue and have the capacity for what is called the “What if reasoning processes” or the ability to mentally rehearse different scenarios. People have the tendency to repeat the same thought patterns and if this is with the internal dialogue of being “at effect’ self management will take a great deal of unnecessary energy and will limit productivity and natural capacity.

To change this, first recognize internal dialogue that reflects an “at effect” perspective. Then interrupt this unconscious process by adjusting physical sensations through deep breathing or meditation and alter negative thought process by writing affirmations of positive self beliefs. Then list the “at effect” statement and then respond to it with an “at cause” statement.

For example “My colleagues are in my way” would be replaced by “I can create space to work freely when I want.” Another example might be “My boss’s suggestions make me stressed.” This would be replaced by “I have been chosen for this job and I am the best qualified to understand suggestions.”

Interrupting the negative patterns though recognition, altering thoughts and body sensations allows one to change negative unconscious patterns and instead think more creatively about one’s own abilities and accomplishments.

The Anger Checklist

By Jeff Dwarshuis LMSW ACSW

People who have quick or extreme levels of anger may also have difficulty recognizing the signs of anger. Fortunately people can increase their recognition of anger by learning the physical, emotional and behavioral signs of anger.

Physical signs of anger 

Clenching of the jaw or grinding of the teeth

Headache or stomach ache

Rapid heart rate, sweating and feeling hot in the face

Shaking, trembling and/or dizziness

Emotional signs or triggers for anger 

A feeling of flight or wanting to get away

Sadness, irritation, or feelings of resentment

Feelings of guilt or a sense of contempt for another or others

Aggression and the desire to strike out verbally or physically

Behavioral signs of anger

Rubbing of one’s head or cupping fists

Pacing, raising one’s voice or beginning to yell, scream or cry

Aggressive behaviors of throwing, name calling or crossing into someone else’s personal space

Craving a drink, a smoke or other substances that relax oneself

Getting Anger under Control 

If you think that you often or occasionally have these warning signs then see the list below for seven steps to manage anger.

1. Take a Timeout – Before reacting in anger count to 10, take deep breaths and allow yourself to leave the situation. Slowing oneself down helps to defuse anger.

2. Express your anger – Use assertive language to express frustration. Keep from being aggressive, controlling or confrontational. Also, think first before speaking to avoid saying something you might regret.

3. Identify solutions for changing what causes anger – Instead of getting angry identify what is causing the anger and create solutions for change.

4. Use “I” statements – Avoid criticizing or blaming others by expressing your anger using “I” statements. For example instead of saying “You never spend time with me.” say “I feel upset because you came home late.”

5. Don’t hold a grudge – It is unreasonable to expect that others will always behave as you want. Forgiveness allows you to not become crowded by your own anger and sense of injustice and makes it easier to see the positive qualities in others.

6. Use relaxation techniques and physical exercise to decease anger – Physical exercise releases chemicals in the brain that can leave one feeling more happy. Relaxation, such as deep breathing, reading, or positive self talk can allow control over anger.

7. Know when to seek help – It can be difficult to manage anger. Consider getting help if you find your anger is out of control, hurts others or causes you to do things you regret. Help can be found through anger management classes or anger management counseling.

 

The Depression Checklist

By Jeff Dwarshuis LMSW ACSW

Depression is a common problem with a specific course and set of symptoms. It is not uncommon for people to feel depressed from time to time but the severity and length of symptoms determine if outside help is needed. The causes for depression might involve stress reactions and biochemical and hormonal complications. Other causes involve negative thinking patterns, poor emotive processing, traumatic memory and delayed emotional development from child abuse. Although depression can be a serious problem, it also is very treatable.

Symptoms of Depression

1. The individual has a depressed mood most of the day, nearly every day, and feels sad, empty or tearful. In children and adolescents, depressed mood can appear as constant irritability.

2. The person has a diminished interest in things that used to give pleasure.

3. The person has significant weight loss when not dieting, weight gain, or a decrease or increase in appetite. In children, failure to gain weight as expected can be a sign of depression.

4. The person sleeps very little or has a desire to sleep most all of the time.

5. The person is either restlessness or has slowed behavior that can be observed by others.

6. The person feels fatigue or loss of energy nearly every day.

7. The person has feelings of worthlessness, or excessive or inappropriate guilt nearly every day.

8. The person has trouble making decisions and concentrating.

9. Recurrent thoughts of death or suicide, or a suicide attempt.

Treatment for Depression 

The treatment for depression usually involves several interventions. Treatment is generally done in psychotherapy sessions, group therapy or in a hospital setting.

 1. Medication – Medication is generally used in moderate and severe cases of depression. In moderate cases, medication is used temporarily to decrease symptoms. Medication use is slowly deceased as other interventions are learned and used. In severe cases the timeline to decease medications may not be as clear. Antidepressants should be taken in conjunction with psychotherapy as this is statistically the best way to end depression.

2. Cognitive Therapy – It is recognized that depression causes people think in a very specific way about themselves, others and the future. Cognitive Therapy is used to recognize unhealthy thinking patterns that contribute to depression and provides exercises to change these patterns.

3. Emotive and Communicative Therapy – Deceasing depression also comes from increased recognition of individual thoughts and feelings and the ability to clearly express them. Communication exercises can assist someone in knowing and sharing emotions that otherwise had been repressed or forgotten.

4. Eye Movement Desensitization and Reprocessing (EMDR) – EMDR is a type of treatment that eliminates the negative thoughts, feelings and body sensations that come from negative memory. Some negative memories such as child abuse contribute to negative self beliefs that contribute to depression.

5. Problem Solving Therapy – Depression can have a negative impact on decisions, self perception and relationships. Problem Solving Therapy consists of problem identification, goal setting and solutions that lead to more productive and rational behavior. Problem Solving Therapy is done in the therapeutic setting and involves therapeutic questions, confrontation and directives.

6. Life style Changes – Treatment for depression might also involve changes in self care and health. Examples include diet, exercise, healthy family time and interaction.

Recognizing and Managing Stress

By Jeff Dwarshuis LMSW ACSW 

The work environment can be very stressful and without proper management of stress the negative impacts on an employee can be surprisingly harmful. Stress, also called anxiety, creates symptoms that are physical, psychological and emotional. Left unmanaged, anxiety can leaving the employee with mild behavioral symptoms to chronic anxiety requiring medical leave and long-term follow-up treatment.

Symptoms and Types of Anxiety

The most common form of anxiety is called Generalized Anxiety Disorder and it has a number of symptoms. First there are physical symptoms of headaches, muscle tension, tightness in the chest, stomach pain, difficulty swallowing, restlessness, being easily tired and tingling in the hands or feet. There are psychological symptoms of excessive worry, feeling on edge, poor concentration and then behavioral symptoms of irritation, having a hard time getting to sleep and pacing. People who are stressed often appear angry, keyed up, directionless, over paced, argumentative, flushed and unhappy.

There are several types of anxiety in addition to Generalized Anxiety Disorder. For example, there are Phobias, Posttraumatic Stress Disorder, Obsessive Compulsive Disorder and Panic Attacks. These have more specific behavioral patterns and are much less common than Generalized Anxiety.

Managing Stress

The most important thing to do is to recognize stress symptoms early and treat them quickly. Anxiety, especially if it has continued for a long time, can be unpredictable with symptoms emerging in a way that seems to be ”for no good reason”.  Unmanaged Generalized Anxiety can lead to Panic Attacks and Major Depression. At this level the person generally requires inpatient psychiatric hospitalization. Early treatment of anxiety ranges from homecare to medication and psychotherapy. Most intensive treatment can be avoided by following the suggestions below. Remember also that managing stress is both a conscious process and a life style.

  1. Recognize the Symptoms – Read and memorize the symptoms listed above. If you have more than a few of these symptoms you should make changes.
  2. Critical Problem Solving – Unsettled problems create stress and completed projects decrease stress. Clearly define unfinished projects, create a list of brainstormed options and come up with the best solution quickly.
  3. Assertiveness – Recognizing and saying or writing one’s feelings will dramatically decrease stress. When self expression is used with people it leads to problem solving and increased quality in the workplace environment.
  4. Time Management – Develop time management skills. Be organized by mapping out tasks and allow a proper amount of time for each task. Stay away from perfectionism while also spending enough time to do a good job. Also, keep clear boundaries between work and home.
  5. Self Care – Maintain a balanced and healthy diet. Avoid excessive caffeine, get proper sleep and keep from substance abuse. Exercise is critical because it has an effect on the body that decreases stress. Also, body relaxation is important and can be done by stretching, breathing exercises, reading, laughing and having fun.
  6. Social Support – A fulfilling family and social life is enjoyable and allows a healthy distraction from routine stress. Social fulfillment helps to keep values in perspective and gives a sense of purpose and belonging. Distraction, perspective and purpose are central to a calm attitude.

Take some time to evaluate if stress is a problem for you. Addressing and decreasing stress will lead to a happy, healthy and more productive life.

Five tips for strengthening your marriage WHILE raising teens

By Jeff Dwarshuis LMSW ACSW

1. Align in discipline and decisions – Outside of inappropriate methods of discipline, the choice of discipline is much less important than the spouses’ staying aligned. Even if you disagree, present a united front verbally and physically. Discuss differences in private.

2. Hold off on directives and exercise negotiation – Adolescents need to increasingly make decisions independently. Parents can talk alone to discuss the parameters of teen decisions then assist the teen in making decisions by asking questions. This facilities parental influence and decreases opposition.

3. Tell Your Story – Does your teen “act out” the same way you did? Are you divorced or recovering from substance abuse? Tell your story of change first to your spouse and then to the teen in an appropriate way they can understand. The teen is most likely experiencing the same thing but does not know how to end it.

4. Don’t do for a teen as they can do for themselves – Rescuing a teen from the realities of adulthood is destructive. Assist teens in being independent by increasingly having them take on adult tasks such as earning money, spending money with limitation, cooking and cleaning. Parents can use the extra time to date.

5. Talk together to make plans of success for the teen and then tell them what you did – Following this suggestion will demand from your teen that they visualize their parents as loving, bonded advocates for their well-being. It makes it very difficult for the child to consciously be oppositional.

 

Posttraumatic Stress Disorder (PTSD) – Signs and Symptoms

By Jeff Dwarshuis LMSW, ACSW

PTSD can happen to anyone at anytime at any age. Here is a list of symptoms to watch. Not all symptoms need to exist for diagnosis.

  1. Exposure to or witnessing an event that is horrific beyond what is typically endured by a person. (All PTSD cases have this symptom.)
  2. The person experiences intrusive thoughts or flashbacks of the event(s).
  3. The person has nightmares about the event(s).
  4. The person feels as if the event(s) is continuing to happen.
  5. The person has emotional overwhelm when reminded of the event(s).
  6. The person has physical reactions when reminded of the event(s).
  7. The person avoids thoughts and feelings about the event(s).
  8. The person cannot recall all of the event(s).
  9. The person withdrawals from others.

10. The person does not experience the peaks of good or bad emotions.

11. The person believes they will not live long or have a good and productive life.

12. The person has sleep disturbance, hyper vigilance and extreme anger.

Also, because of the PTSD, the person almost always has Major Depression and Generalized Anxiety.

Substance abuse is very common as a self medicating attempt. This is often the initial reason for seeking treatment.

People are fearful of treatment because they think they will have to talk about the traumas.

High Functioning Families

By Jeff Dwarshuis LMSW, ACSW

The McMaster Model of Family Functioning was developed as a measurement device for family health. This model suggests six important and well researched dimensions needed for family health. Knowing and following these six dimensions will help any family or group to better functioning and health.

Problem Solving

Problem Solving consists of a family’s ability to solve problems in an effort to maintain effective functioning. It is known that most all families, whether healthy or dysfunctional, have the same amount of problems. However, the differences in functioning are related to the family’s ability to resolve problems thoroughly. Thorough problem solving consists of problem identification, recognition of the key players in the problem, developing alternatives to the problem, deciding on an alternative, monitoring the decision’s effectiveness and then evaluating the effectiveness of the process. High functioning families do these steps in a very quick and spontaneous way. Most high functioning families have little or no unresolved issues

Communication

Communication is seen as the exchange of information in a family. For families to be functioning well the members need to be communicating both clearly and directly. Clear communication is determined by whether the message has been clearly stated or if it is unclear, camouflaged or “muddied”. Direct communication occurs when the family members give information to the intended recipient rather than talking through people.

Family Roles

Family Roles are seen as the repetitive patterns of behavior that members use to complete family tasks. Healthy families tend to follow three distinct characteristics regarding family roles. First, the members arrange themselves in a way that allows their collective work to fulfill all family needs and developmental demands. Also, members expect only what are appropriate tasks of its members. Overwhelming members is not an option and no task can be too intellectually, emotionally or developmentally beyond capacity. Also, healthy families have a built-in accountability process by which members are evaluated on their role performance. Family roles are clear so that evaluation is fair and accurate.

Affective Responsiveness

Affective Responsiveness refers to a family’s ability to respond to a given situation with the appropriate amount and type of emotional expression. Healthy families have a wide range of emotions and can apply the correct emotional response to a given family problem or success. Expression is neither overblown nor disengaged but is an appropriate response to the situation. Family members have the expectation that their actions will be followed by appropriate and consistent emotional reactions. Family members are not left in question regarding how members feel about their behavior.

Affective Involvement

Affective Involvement is the extent to which the family shows interest or involvement in activities and interests of individual family members. Healthy families are involved in the process of understanding each other. Family members need to have a reasonable response to members’ interest, neither being too engaged or uninvolved. At all levels of family activity, members need to be open and spontaneous with emotion. Healthy families take a basic tone of being invested and encouraging.

Behavior Control

Behavior Control is the pattern a family develops for managing family activity. Healthy behavioral control is seen as having standards that are reasonable for its members while also allowing for an opportunity to negotiate and change. Behavioral control is neither too ridged nor inflexible nor is it Laissez- faire with few standard requirements. Expectations for behavior are clear, negotiation is an option and accountability is the norm. Individuals in these families maintain a sense of responsibility and insight into the consequences of their behavior.

Optimal family functioning is acquired through knowledge and practice. Long standing research on healthy functioning has allowed people to follow suggested methods of change that lead to family health. Learn these six things, discuss them at home and invest in positive group change.

 

EMDR for a Vietnam Veteran – The Puzzle Method

By Jeff Dwarshuis LMSW ACSW

Background

A Vietnam Veteran with chronic Posttraumatic Stress Disorder (PTSD) and Major Depression was referred to the writer from the treating staff of a local psychiatric hospital. The veteran had a history of numerous inpatient hospitalizations for PTSD and despite decades of individual, group and psychotropic therapy the client could not find relief from his traumatic memories of Vietnam. The referral source thought Eye Movement Desensitization and Reprocessing (EMDR) could be of benefit. (For a description of EMDR see blog article “Eye Movement Desensitization and Reprocessing”.)

EMDR Treatment

Following an assessment the client agreed to EMDR therapy but due to past treatment failures the client felt hopeless of any change.

EMDR treatment began with complications. During the treatment of the first identified disturbing memory the client quickly responded with intense fear that caused frequent occurrences of nausea. With the treatment disrupted the possibilities for success were in question.

The Puzzle Method

Because of the complications the writer developed “The Puzzle Method” which is an extension of the EMDR Safe Place exercise combined with techniques of Ericksonian Hypnotherapy.

Milton Erickson is the father of modern hypnotherapy and developed a unique method of hypnosis that concentrates on multilevel communication and client capacity. Regarding trace states involving memory he explained that deepening a trance state occurs when the therapist deliberately limits their own helping directives and instead teaches the client to themselves move in and then out of a trance state using their own abilities.

Erickson also taught that client safety is increased when the client has more choice regarding both self disclosure and the extent to which they want to think about something that is disturbing. Within this framework Erickson argued that the client should be given choice about treatment pace and the self disclosure of memory. Based on Erickson’s understanding of client resistance to change he also suggested the therapist intensify the client’s sense of safety by instructing the client to “hold back” from focusing on particular memories thus eliciting the client’s natural opposition which indirectly influences the client to focus more on their memory.

The Puzzle Method combines Erickson’s techniques of self initiated focus and increased safety with the EMDR Safe Place exercise in an effort to increase the likelihood of success for clients dealing with intense reactions to traumatic memories. This is done by telling the client to imagine that the traumatic picture is broken into several pieces like a puzzle and to focus only on a few pieces of the puzzle at one time. If the client becomes emotionally overwhelmed by the traumatic memory they should stop their focus on the memory and return their thoughts to the safe place picture until they feel relaxed. Following the relaxation the client should return their focus to the traumatic memory, focus on a little more than before and continue this process until the whole traumatic memory can be imagined. When using this method the client is in charge of their level of traumatic exposure as well as their level of relaxation.

The client returned to EMDR therapy, followed the steps of the Puzzle Method and was able to successfully reprocess the first memory in thirty minutes without any disturbance of nausea. The client returned to treatment for six more sessions to reprocess other traumatic memories of Vietnam using the EMDR Protocol and the Puzzle Method only when needed. The client ended therapy after seven EMDR sessions with no symptoms of PTSD or Major Depression. Follow up sessions showed a continuation of symptom reduction. The client reported that he had not felt so good since before going to Vietnam.

 

Bullying in Children and Youth – Warning Signs

By Jeff Dwarshuis LMSW ACSW 

Here is a description of the behavioral warning signs of both victims and bullies.

Victims

  1. Socially victims may appear to be isolated, unable to defend themselves, cautious, having low self esteem and having poor social skills.
  2. Psychologically victims may appear anxious, depressed and impulsive with a poor ability to regulate their emotions. Depressive thinking and hopelessness in the victim can lead to suicidal thoughts and attempts.
  3. Victims’ behavioral warning signs of abuse are a loss of interest in school, taking a different route to school, having physical injuries, withdrawing from family and school activities, emotional upset after receiving a call or email or using derogatory statements about specific kids.

Bullies

  1. The bully’s primary characteristic is a persistent expression of contempt towards someone he or she sees as being different, inferior or not deserving of respect. The bully’s abusive behavior is not a single act but an on-going pattern of abuse towards another individual.
  2. The most common targets of the bully are people who are physically disabled, obese, who appear to be of a different sexual orientation or in a racial or religious minority.
  3. The bully will show warning signs of his or her behavior through displaying a lack of empathy, having a favorable view of violence, being aggressive towards adults, having a hard time following rules and having a need to dominate others.

Bullying happens most commonly when kids travel to and from school, in unsupervised school areas, in sports team settings that normalize aggression and over the internet.

Factors that contribute to bullying are not having anti-bullying policies, inconsistent school discipline, high teacher turnover and a lack of support for children with special needs.