COVID-19: Teletherapy & Resources

As a result of the COVID-19 virus, PCS is now providing teletherapy by phone or video for individuals, couples, and families. We want to continue supporting our current Arizona clients and welcome new clients who are looking for a safe alternative to in person therapy.

Approaching 2020 with Open Arms and Hearts

Do you ever wonder what you can tangibly do to get ahead for the New Year? As I reflect on 2019, I think back to many moments during the year that included positive growth, hardship, connection, and loss. I started a life changing internship (Thank you PCS!), while continuing to take classes and work on my Master’s program at ASU. I moved to a new state away from my family and friends. I lost and gained friendships. I felt homesick and leaned on others. With all of this, I will be the first to tell you that I was not prepared for much of what 2019 threw at me! While being unprepared might have served a wonderful purpose (as I grew immensely as a person), I continue to embrace the importance of being present, grounded and mindful when looking forward and taking on new challenges and A NEW YEAR!

Here are some tips for starting your New Year on the right foot:

  1. Reflect (with Self-Compassion): It is important to begin with self-reflection about how you showed up in the last year for yourself and for others. What went well? What could be better? If 2019 felt like a hard year, this is especially important. Giving yourself compassion for the hardships endured or where things fell short allows you to open the door to change for the coming year.
  2. Compassion for others: As you grow your compassion for self, extend this to others.
  3. Get Grounded and Set Intentions: What do you wish to be different for your New Year? This could look like creating a mental or physical list of what you want to accomplish or change. Even if you had a spectacular year, we can always push ourselves!
  4. Get Specific: How will you act on these intentions?
  5. Seek Support and Connection: We are not meant to do this all alone. There are people who will support you in your efforts to create change in your life. Seek these people out and watch the team effort unravel positive growth.
  6. Appreciation and Gratitude: Studies have shown that showing gratitude positively effects one’s social and psychological well-being. Showing your gratitude will also allow your connections to grow.

From all of us at PCS, we wish you a joyful and prosperous New Year!

Article by Kaitlyn Beckham, BA, Intern

Kaitlyn is a Master of Counseling student at Arizona State University graduating in May 2020. She enjoys working with adults who have experienced trauma, as well as those who struggle with anxiety, depression, relationship issues and self-esteem issues.

Siblings of Children with Health Issues

When our children are struggling, or in pain, we scramble for answers, support, interventions — whatever we need to do to get them help, even more frantically when they are fighting for their lives. As adults, with all of our internal and external resources, it is still exhausting, desperate, and heart wrenching. It becomes easy to focus on the next treatment, therapist, or doctor appointment, just to get us through to the next day. With all this energy spent in helping our child, we sometimes lose sight of brothers and sisters. This is especially true when the sibling is cooperating, helping, and being supportive. It is easy to forget, that they may be struggling just like we are, and that they may be internalizing the experience. 

Common experiences for siblings of children with chronic health, or mental health issues include: 

  • Feelings of loneliness and isolation.
  • Confusion over what their sibling is experiencing.
  • Guilt that they are healthy, or that it is their fault (particularly for younger children).
  • Resentment of added burdens such as chores, or lack of opportunities such as lessons, or sports because of time, or financial limitations.
  • Jealousy of the attention the sibling is receiving.
  • Embarrassment of situations where medical equipment is needed in public settings, or of attention drawing behavior. 

As a child, many of these thoughts and emotions go unexpressed, ultimately growing into a burden that we as adults even we have difficulty carrying. Their silence is often praised with words of affirmation, such as “she has been a trooper,” or “he is so helpful,” which encourages the silence.

So, what can we, the parents, do? 

First, you don’t have to do it alone. Enlist the support of family, friends, faith communities, and health care providers.

Second, encourage your children to ask questions and share feelings, by modeling. Let them hear you talk about your feelings. While you should not lean on them for support, it is still okay to say, “I know this is hard, I feel sad sometimes. Do you feel that way, too?” Then, simply listen. If they don’t have anything to say, keep the door open, and revisit on occasion.

Third, reassure them. They did not cause the issue and even though it is difficult for everyone, you will take care of them, and they don’t have to worry about you.

Fourth, try to spend alone time with each child. You may not be able to spend the afternoon together, but you can make a quick run to get an ice cream cone, sit on the end of their bed for 15 minutes after school, or walk around the block. A few minutes of attention can do wonders.

Fifth, get to know each child — their personality, favorite food, interests, names of friends — and start conversations about those things.

Sixth, be honest about information. In my experience, secrecy does more damage than honesty — even with difficult information. If a child can count on a parent being strong for them, it is better to have information than be surprised, or worry. If you have questions about how and when to share age appropriate information, speak with a health care provider.

Also, let go of the small stuff. If the choice is picking up a pizza and being able to have 20 minutes with your son verses making a dinner which takes an hour to make and clean up, choose him. If the house is a mess and your daughter is sitting alone playing video games, take 15 minutes to join her. Finally, take care of yourself, sleep an extra half hour rather than reading another article on the issue. Turn your volunteer responsibilities over to other people. Eat regularly to sustain your energy. And, to restate the first suggestion, ask for help from friends and family with dinners, transportation, over nights, cleaning, and a listening ear. When you care for yourself, you have more reserves to care for your children.

Helping our children through chronic, or life threatening health issues can be overwhelming. Remember, as you help the child who is dealing with the illness, their siblings are there and they also need your love and support.

Article by Douglas Withrow – MDiv, LMFT, MSC, S-PSB

What is the PCS Intensive Treatment Program?

“Participating in a PCS Intensive Treatment Program is an opportunity each of us have longed for, yet avoided. In 8 days and 68 hours your story has time to unfold and be received by a team of compassionate professionals whose primary purpose is to create a safe and equally challenging environment. The treatment process involving 35 hours of individual therapy brings an appreciation and understanding for the journey you have lived, including the detours, and offers the discovery of the journey awaiting you.”

– Dr. Marcus Earle, PCS Clinical Director

How it all begins…The Murray Method

Preparatory Workshop

The preparatory workshop begins your PCS Intensive Treatment Program.  Each group member shares their reason for participating in the intensive, is introduced to our treatment model, and begins constructing a few key elements of their treatment process.  Once the ice is broken, the workshop facilitator presents a framework from Marilyn’s Murray’s work called the Scindo Syndrome.  The presentation sets the stage for much of the work to come, offering a way of understanding how the difficult and disturbing experiences in our early life shapes how we think, feel, and behave.  It outlines what we strive for at PCS:  to become a Healthy Balanced Person intellectually, spiritually, emotionally and physically.  The Scindo Syndrome, along with the Circles of Intimacy, Responsibility, and Impact, provide the foundational scaffolding that the coming work can build.  Not only does it help a person organize and understand their own story, but it also illustrates how we are similar to the others in the group (and in the world).  This preparatory workshop is where the first homework assignments are given.  The assignments include exercises such as the Trauma Egg, Genogram and Scindo Syndrome drawings to encourage clients to explore and identify what has shaped their thoughts, their feelings — their lives. These exercises guide clients to discover what is underneath even if they are uncertain what motivates their behaviors that ultimately led them to PCS.

Concluding Group

The Concluding Workshop on Saturday mornings is the final piece of the intensive program; a space to celebrate the integration of the Healthy Balanced Adult with the client’s Original Feeling Child (the “child” they are at the core).  Clients share with one another their strongest “ah-hah” moments of the week, along with their Trauma Eggs, and their “Child” drawings.  In their final moment, clients reaffirm their gratitude for the group work and the gains they achieved during their time at PCS.

Not Just Mental Health

As part of the intake process, Dr. Rick Isenberg completes a comprehensive medical history to identify significant symptoms and illnesses, along with self-care practices, substance use, and compulsive behaviors which may impact the treatment process.  Our physical well being is entwined with our emotional and relational health.

The PCS Intensive Treatment Program is not just about mental health

Interestingly, for some, the medical history may even identify symptoms, or ailments that point toward an underlying emotional issue that may be unknown to the client. We look for these clues and follow them backwards to see what we find. We also look for medical conditions that may contribute to the client’s emotional issues (like diabetes, sleep apnea, hypothyroidism) that are either not yet diagnosed, or neglected and need to be treated. 

As part of the initial assessment, Dr. Isenberg also reviews the ACE Questionnaire with the client.  This tool looks at adverse childhood experiences and allows PCS to help the client put psychological and medical problems in a family/historical perspective. Dr. Isenberg also administers a neurocognitive screening assessment that helps to identify brain skills that may be lagging. It is important to have our brains working at their best, so we provide tools to allow our clients to buff up brain performance. When our brains work better, life is better. 

How Your Team is Assembled

After the client has filled out the registration materials for the intensive program, they will be required participate in a phone prescreen session with one of our team members. Not only does the prescreen ensure that PCS will be an appropriate fit for the client, but it also assists in selecting the individual and/or couple’s therapists assigned to each program with the background information provided. Every schedule includes at least one EMDR therapist. However, clients who are coming to work on trauma or other related concerns could find two or three therapists that utilize EMDR in their sessions. We also look at the other therapy modalities that would be beneficial for the client such as SE, CBT, DBT & EFT to help in the process of building a schedule for each individual or couple.

Clients who are interested in the intensive program but are on a strict budget can have the opportunity for interns, as well as licensed associate counselors (LAC) to be assigned to reduce the cost of their program. The advantage of having a large team of over 25 therapists allows flexibility in the selection of a client’s team and provides the ability to choose appropriate lower cost therapists while still receiving the full benefits of the process. 


EMDR, SE, EFT, ETC. – What is EMDR?

Eye Movement Desensitization and Reprocessing (EMDR) is a trauma therapy developed by psychologist Dr. Francine Shapiro.  Dr. Shapiro made the chance observation that eye movements can reduce the intensity of disturbing thoughts when she noticed her own stress reactions diminished when her eyes swept back and forth as she walked through a park.

EMDR involves recalling a stressful past event and “reprogramming” the memory in the light of a positive, self-chosen belief, while using rapid eye movements to facilitate the process.  EMDR (Eye Movement Desensitization and Reprocessing) incorporates elements of cognitive-behavioral therapy with bilateral eye movements or other forms of rhythmic, left-right stimulation.  One of the key elements of EMDR is “dual stimulation.”  During treatment, a person is asked to think or talk about memories, triggers, and painful emotions while simultaneously focusing on his/her therapist’s moving finger or another form of bilateral stimuli.  Other forms of external stimuli that may be used in EMDR therapy include bilateral tactile sensations and sounds (e.g. alternating hand taps or a chime that pans back and forth from ear to ear).

How Does EDMR Therapy Work?

At the time of a traumatic event, strong emotions may interfere with our ability to completely process the experience and the moment becomes “frozen in time.”  Recalling the traumatic event may feel as though the person is reliving the event all over again because the images, smells, sounds, and feelings still exist and can be triggered in the present.  When activated, these memories cause a negative impact on our daily functioning and interfere with the way we see ourselves and our world, and how we relate to others.

EMDR therapy appears to directly affect the brain by “unfreezing” the traumatic memories, allowing them to be resolved.  Over time, the disturbing memory and associated beliefs, feelings, sensations become “digested” or processed until the event is able to be thought about without reliving it.  The memory is still available, but it is less upsetting. 

The exact mechanism for the effectiveness of EMDR is unknown.  It appears that using rapid eye movement relieves the anxiety associated with the trauma so that the original event can be examined for a more detached perspective. This is somewhat like watching a movie of what happened.  This enables a person to access positive ways of reframing the original trauma (reprocessing), and to release the body’s stored negative emotional charges around it (desensitization).  Some experts have noted that the eye movements during EMDR might be similar to what occurs naturally during dreaming or REM (Rapid Eye Movement) sleep.  It may be thought of as a physiologically-based therapy that allows a person to see material in a new and less distressing way.  Others believe it reactivates parts of the brain that were “shut down” as a coping mechanism.  In this way, cognitive reorganizing takes place, allowing the negative, painful emotions to give way to more resolved, empowered feelings.


What is Somatic Experiencing (SE)?

Somatic Experiencing was developed by Dr. Peter Levine and is practiced all over the world as an intervention to resolve trauma. Dr. Levine theorized that trauma is not necessarily about an event, but about what happens after the event, at the physiological and biological level. How our nervous system responds, how those around us respond, how we recall the incident and the ultimate meaning we give to the experience will determine our chance of resolving trauma in the moment or increase the likelihood of experiencing PTSD in the future.

SE recognizes that trauma is a natural part of life. Trauma is not a disease or an anomaly. Its effects do not mean a life sentence or permanent incapacitation. Instead, trauma can be viewed as an injury to the autonomic nervous system with the understanding that our bodies have an innate capacity to return to a regulated state of being.  

SE is a short term, holistic and naturalistic approach that encourages mastery, empowerment, self-direction and resiliency. SE focuses on “sensate” or “felt sense” of the body by recognizing and accessing physical sensations, imagery and motor patterns to renegotiate trauma through physiological channels of the autonomic nervous system – from brain stem to limbic system. The body remembers everything even if the brain cannot access certain experiences and unlike traditional therapies, SE brings sensory experience to the foreground while supporting thought, feeling and emotion in the background.  

How Does Somatic Experiencing Work?

SE is a body oriented approach to renegotiate trauma. It involves grounding, orienting, noticing the felt sense of the body and tracking with curiosity how it experiences activation and then de-activation. With the support of a trained therapist, we can touch into the nervous system, mind and body and prepare for a reparative action. This “pendulation” of pleasant, unpleasant and neutral sensations increases our range of resiliency and facilitates nervous system regulation. We enter the “here and now” instead of being stuck in the “there and then.” We become able to recognize and express instinctive responses to threat. Expanding a person’s tolerance of bodily sensations facilitates their trust in the body’s wisdom and capacity to heal itself by uncoupling incomplete and undischarged bio-electric circuits. Symptoms diminish in strength and frequency when the cycle of discharge that have been fueling the symptoms of unresolved trauma are released. Discharge my take the form of flushing, muscle contraction/release, yawning, deep breathing, sweating, tears as well as other somatic responses.

Humans often thwart the natural mammalian instinct for fight, flight, freeze or collapse because we filter our experiences through the frontal cortex, thereby minimizing our “animal” instinct.  For example, if a child cries we often attempt to sooth by telling them “Don’t cry, everything is fine.” This shuts down energetic discharge. Patients often experience shaking coming out of surgery. Instead of allowing an individual to discharge energy caused by a traumatic experience (cutting, being tied down, having a mask over one’s face) they are often given warm blankets or medications to dull the sympathetic nervous system. When individuals fidget, we tell them to stop. We manage to stop energetic discharge throughout our day. Our sedentary lifestyles and cultural beliefs disconnect us from the body. If our natural, self-protective responses are not completed, this energy does not discharge and we are at risk of our nervous system getting “stuck on” or “stuck off.” We may not feel safe in our own bodies and so we “numb” with substance addictions (using alcohol or drugs) or with process addictions (gambling, sex, shopping, work, etc.) By bypassing the thinking brain and accessing the nervous system we can reclaim the body’s ability self-regulate.

Mindfulness

Living Without Awareness = Impulsiveness and Mood Dependent Behaviors.

What is Mindfulness? Mindfulness has been described as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” Mindfulness is the practice of being completely aware of what you are doing in the moment, when you are doing it. It is you being in control of your mind, instead of your mind being in control of you.

Mindfulness is about: learning to maintain awareness of your mind, body, and surroundings. It is about staying in the present moment and noticing when your mind drifts into the past or future. It is learning to enjoy life in the here and now. Finally, it is about finding and connecting with one’s sense of self. When you are aware of what you are experiencing, you can make the choice to change or accept it, thus decreasing your suffering.

Benefits of Mindfulness: Mindfulness increases awareness. It allows us to be completely connected to our environment, reduce stress, and improve our overall well-being. Studies show that practicing mindfulness can reduce blood pressure, increase the immune system function, relax muscles, improve quality of sleep, and increase focus and concentration.

Why Learn Mindfulness?

Mindfulness skills help you to tolerate distress, that is, tolerating emotions and situations that feel intolerable; riding your intense emotions (urge surfing) rather than doing things to shut them off or distract from them, OR from engaging in self-destructive behaviors.

Mindfulness skills help you to regulate your emotions. The more skilled you are at noticing and identifying your emotions, the better chance you have of being able to adjust their intensity. If you are aware of what you are feeling you can change emotions you want to change, OR you can choose to stay with the feelings, knowing you are in control.

Mindfulness skills help you to be more effective in interpersonal situations. Increased awareness helps you decide when and how to make decisions about dealing with people and setting boundaries and limits, i.e. “asking for what you want” and “saying no”. Maintaining healthy relationships (or ending destructive ones!) requires the ability to be able to connect with your emotions and to be able to keep them in check if you want to.

Relapse Prevention: (e.g. relapse to undesirable mood states–depression, anxiety, anger, etc.–or impulsive/unwanted/self-destructive behaviors). Mindfulness teaches you how to recognize and disengage from emotion mind at times of potential relapse. Inability to do so may result in a downward spiral, and eventually, the onset of relapse. To avoid this, you must be able to disengage from emotion mind, bring in reasonable mind, and find wise mind. This will allow you to process mood related information in ways that are less likely to provoke relapse. Awareness of the patterns of thoughts, feelings, and body sensations that characterize relapse-related mind states is an essential first step in recognizing the need for corrective action.

Nutrition Makes A Difference

Taylor Aasand, MPH, RDN, our registered dietitian (RDN), conducts nutritional assessments of the complete diet of clients; including foods, beverages, supplements and medications that could influence medical status.  The dietitian also takes note for any special dietary patterns, food allergies, and religious beliefs that affect intake.

The RDN provides education around the link between nutrition and mental health, emphasizing that the brain and body must be adequately nourished and hydrated to do intensive therapy.    Some clients benefit from additional dietary services depending on a medical diagnosis or an eating disorder or disordered eating history.  The client and dietitian work together to develop a more structured dietary plan for their programming that may include planned meals, grocery lists, challenging food fears and rules, and body attunement exercises to help clients meet their individual nutrition goals.

All this allows PCS to help the team assigned to understand the client more comprehensively and provides additional avenues for intervention. The complete Wellness Assessment allows us to recommend changes in bad habits and lifestyle that may lead to a healthier life, better brain performance, and easier recovery from the addiction, depression, trauma (etc.).

Working Together

We enjoy talking about you. The PCS Intensive Treatment Program is a team approach model.  During your intensive over 7 professionals focus their attention on how best to facilitate discovering those issues inhibiting personal and relationship growth.  The case manager assigned to you communicates with your primary therapist before, during, and after your program while monitoring treatment process.  Through notes, emails, and conversations your individual and group therapists continue to update one another of how best to promote change and growth.  The Wednesday staffing offers a unique opportunity for reviewing your process, with you present, by our entire team of over 25 therapists. 

To learn more about the PCS Intensive Treatment Program, please contact our office at 480-947-5739 where our Intensive Coordinators can supply more information and start you on the journey to discovering a better you.

What Parents of Junior High-Aged Kids Need to Know About Vaping

Vaping, which is the practice of inhaling the vapor produced by an electronic cigarette (e-cigarette), was declared an epidemic in youth by the U.S. Surgeon General in December 2018.  In my therapy practice, which includes specializing in children and adolescents, I have witnessed a stark rise in this behavior, especially among junior high-aged students (i.e., those in 7th and 8th grades).

Many people, even parents, believe that e-cigarettes are a healthier alternative to traditional cigarette smoking, but there are a growing number of studies raising concern that vaping causes the ingestion of toxic chemicals which may be linked to cancer.  Parents may think, “What’s the big deal about vaping?” especially if they experimented with cigarette smoking when they were teens. What these parents may not realize, however, is that the nicotine juice pods that are used for vaping have a higher concentration of nicotine as compared to traditional cigarettes, making the risk of addiction greater, particularly for young adolescents whose brains are still developing.  

I do not claim to be an expert on the health risks of e-cigarettes, nor have I conducted an exhaustive review of research on teens and vaping.  What I am presenting below is a composite of information on this topic collected from my junior high-aged clients, in the hope that this information will be helpful to parents and other teens.

How common is vaping?

My clients report that the prevalence rate “depends on the school,” with their sense being that it is very common in many public schools. They typically report that over 50% of their 8th grade peers have tried it at least once. For 7th-graders, it is not quite as common, but it still occurs. They share that if the group of kids who are vaping are “loud” (i.e., very outspoken, even popular), it might seem like more kids are doing it than actually are doing so. I am told, “There is usually somebody in the bathroom vaping in a stall. Sometimes that kid will ask you, ‘Do you want to hit this?’ or you could ask, ‘Can I rip that?’ Most kids are open to sharing their vape.” There does seem to be a slightly higher prevalence among boys but it is still common with girls, per my clients.

What are the vaping devices like?

My clients have “educated” me that there are two main categories of vapes:

  1. JUUL – They describe this as a long, skinny, flat metallic device that consists of a battery and a pod that connects to the battery. The battery can be charged with a specific charger that looks exactly like a thumb drive (which can plug into a laptop as well). In terms of cost, according to what my clients have reported, a JUUL starter pack with 4 pods, a battery, and a charger is around $40. Pods –or juice – contain the nicotine and flavor. Pods are reportedly sold separately in pack of four for $15 – $24.
  2. Suorin brand – There reportedly are a variety of Suorin devices. The most popular is the Air, which is a flat, metal rectangle, usually colored, with a plastic battery and pod.

How do kids get their hands on vapes?

What my clients report is that usually there are certain kids whose parents do not monitor what they do, and those kids can buy devices and pods online. They report, “Anybody can buy stuff online with a credit card…you just check a box that you are 18…it gets mailed to you.” Once a teen is identified as being able to procure vaping devices, “word gets out…often it’s the ‘cool’ kids who vape, and those that want to appear cool will ask the ‘cool’ kids for vapes.” Young people also tell me that they often get devices from older siblings or can sometimes purchase them at smoke shops that do not require ID.

Why do kids vape?

My clients report a variety of reasons why their peers vape or they vape. “Kids like to do tricks to manipulate smoke out of your mouth.” A “ghost” inhale is reportedly popular. Teens vape to appear “cool” or because they want to fit in. The other draw is nicotine: “It gives you a head rush that lasts 15- 20 minutes…makes you feel kind of stimulated.” Further, many clients report that the juice in the nicotine pods “tastes good.” Popular flavors include pineapple, mango, lava flow (orange/pineapple), desserts, pizza, chocolate, etc.

How do kids vape at school?

According to my clients, because JUULS produce very little smoke, kids are seen in class vaping. They reportedly do this by putting their head down on their desk, taking a hit, and just holding it in their lungs so no smoke comes out. This is considered to be “cool” if one’s friends also vape in class. In addition, during lunch and passing periods, kids report that they will go in groups and vape in the bathroom.

Why don’t they get caught?

Kids tell me “It’s so easy to hide!” Also, there can be a stigma against “snitching” or telling on people: “If you tell, you are the ‘lowest of the low’.” In group vaping, I am told that one person watches the bathroom door to make sure no teacher is nearby, or no kid who looks like he might snitch. Even if an administrator receives a report about vaping, kids believe that there is no action because “it’s so common and there are more serious things to address.”

What can parents do?

Older teens who have experienced a “vaping phase” tell me that parents should have honest conversations with their kids, telling them that there is not scientific evidence of the long-term risks and that we don’t know if vaping is safe or if it will cause lung cancer. One client suggests to say, “While you are under our house and we are paying the medical bills, it’s not allowed!” Teens report that it’s important for parents to have a close enough relationship with their child to be able to talk about this topic, especially if their child is feeling pressure to vape. Kids may believe that “everyone’s doing it,” so they may justify that doing so must not be so bad. I am told, “Anyone cool or popular either has vaped or is vaping.”

Even good kids, with good parents, can experiment with vaping. Kids can be so stealth with vaping; the devices are small, easy to hide, and do not have an obvious “cigarette smell.” I am told by teens that the best deterrent is knowing that their parents might or will “test” them. Just like for traditional drug testing, parents can order urine tests online from sites such as Amazon.com to determine whether cotinine, a metabolite of nicotine, is in their system, which can reportedly stay in the system for a week or so. Kids also tell me that when their parents test them, either randomly or regularly, they have an “out” with their peers. When invited to vape, one teen just says, “Nah, my parents test me,” and there is no further pressure. Additionally, there is no perceived “loss of coolness” since kids as a whole understand that one can’t vape if their parents are going to test them.

In sum, what parents should do is stay connected emotionally with their kids, have the difficult conversations with them about this topic, remain vigilant, don’t assume it can’t happen with your son or daughter, and let your child know that you will urine test them randomly so that they have that “out” and an additional reason to not vape.

Article by Gloria Gilbert, Ph.D.; Child, Adolescent, and Adult Psychologist

Allow Your Children to Fail

Allow my children to fail? Huh? How does that make sense? Why would I not protect my children from failure? If I don’t, my children may feel sad or left out or not good enough. His or her self-esteem will be damaged. Isn’t it my job as a parent to make sure my children are happy?

Although counterintuitive, allowing your children to struggle with disappointment or failure is the hallmark of good enough parenting: babies and children actually benefit when their mothers fail them in manageable ways. Children benefit when they encounter difficulties in their life, not when their parents have snowplowed a perfectly clear path for them. They benefit when they learn to tolerate all feeling states, regulate themselves, manage challenges, and accept failure. They develop healthy self-esteem and healthy relationships with others.

I recently read an article about the mental health crisis on college campuses. College students are stressed out and they lack the ability to cope with failure and disappointment. Parents are seen as failing their children by protecting them from stress and anxiety instead of teaching them how to cope with stress and anxiety. I meet with parents and children who are struggling. Some parents feel bad that they didn’t prevent this struggle or that they have to seek professional help. I try to help them understand that contrary to letting their children down, they are modeling that it is ok to admit to struggling and to seek help.

Stress is an expected part of life. It can’t be avoided. Growth is associated with stress. Maturity and wisdom come from failing and effectively managing stressful situations. We do best by our children by teaching them how to cope with stress rather than protecting them from its experience. Good enough parenting requires us to be able to tolerate our children’s pain although it is difficult and painful for us.

The concept of the good enough mother was first coined by Donald Winnicott in 1953. In his work as a British pediatrician and psychoanalyst, he observed thousands of babies and mothers and came to realize that babies actually benefit when their mothers fail them in manageable ways. They need their primary caretakers to fail them in tolerable ways on a consistent basis to learn to live in an imperfect world. Trees grow stronger roots by being blown around by wind. Children grow stronger by managing challenging events in their lives.

The good enough parent is cognizant of their child’s developmental stage and supports their child’s learning and growth. The good enough parent can tolerate, embrace, and provide a space for her child to work through painful experiences. Good enough parenting is not mediocre. Good enough is thoughtful. Good enough is making rational choices. Good enough frees us and our children to be perfectly imperfect and to fail. Good enough is optimistic and tells us that failure and the painful feelings that accompany it help us to learn and grow.

So, although the advice to allow our children to fail may appear counterintuitive at first glance, the good enough parent will recognize its importance and will support their children through their struggles and emphasize what is being learned. They will praise them for facing and not avoiding difficult, challenging situations where they may fail or that may not go according to their plans. Don’t allow your children to struggle alone and don’t fix their struggles for them. Help them to learn how to tolerate difficult, painful feelings without numbing or denying them. Help them to learn how to problem solve. Teach them how to ask for help when it is needed. By doing this, you teach them that although painful, failure is a part of life. Everyone misses the mark at times. It is only in trying to hide our missteps that we experience shame.

Radical recommendation: Encourage your children to fail. Praise them for trying new things, for thinking outside the box, for taking risks in connecting with others, for being brave enough to be who they are. Teach your children that they are strong and capable, not fragile and definitely not alone.

Article by Cathy Walls, Psy.D

What is wrong with me? Understanding the power of childhood experiences

Many of us grow up with a subtle sense that there is something wrong with us, that we are not good enough or not worthy. Why is this? A growing body of evidence shows that these core beliefs, as well as many mental health and medical disorders, have their roots in difficult experiences we have as children. We have come to recognize that emotional wounding in childhood may have profound effects. Indeed, we often do not outgrow the adverse experiences of childhood; they often go underground and come back to haunt us later in life.

The Adverse Childhood Experiences (ACE) Study and its daughter studies published over the past 20 years have provided conclusive evidence linking childhood adversity to adult emotional, medical and social problems. Ten risk factors were identified: physical, emotional, and sexual abuse, physical and emotional neglect, and five specific forms of household chaos (growing up with mental illness, drug/alcohol abuse, domestic violence in the home, divorce or separation, and incarceration of a family member) have been linked to the development of  adult mental health disorders (such as addiction, depression and suicide, and domestic violence), social issues (such as teenage pregnancy, performance problems at work, and financial insecurity), and medical issues (such as diabetes, severe obesity, heart disease, cancer, sexually transmitted infections, autoimmune disease, and many others).

The increase in risk is shocking. With four or more childhood risk factors, we are 5 times as likely to become alcoholic, 12 times as likely to shoot up drugs, 4 times as likely to be chronically depressed, and 10 times as likely to attempt suicide.

So what do we do?

As troubled adults, we can seek help for our mental health and emotional issues. Therapy techniques directed at healing our childhood emotional wounding—such as EMDR, somatic experiencing, and psychodrama—can reduce distress and allow for healthier functioning. At PCS, we specialize in providing such services to men, women, children, couples, and families struggling with the consequences of childhood adversity. We can heal the wounding that continues to play out in our lives. There is hope.

And we must act to protect our children from toxic stress. Listen to pediatrician Nadine Burke as she makes an impassioned plea for pediatric medicine to confront the prevention and treatment of trauma, head-on, in this TED Talk: https://www.youtube.com/watch?v=95ovIJ3dsNk For more information about the ACE study, check out the CDC’s ACE Study site: https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fviolenceprevention%2Facestudy%2Findex.html

Article by Dr. Rick Isenberg, MD

Discovering Love

This is not a story of finding love in all the wrong places, nor is it going to be an intellectual discussion on love and how to define it. For me, love has been a challenging concept, and I am certain its understanding has alluded me. This story lacks the detail to fully describe a life lived, but instead provides a glimpse of a lengthy journey to discover love.

I think as a child I thought love took the form of a new toy, bike, or book I was immersed in. In my family I heard my parents say they loved me, at times they expressed it through hugs, but mostly love took the form of action. My dad acted on his love for us by providing financially and creating opportunities for family vacations. My mom communicated her love through cooking, she made great meals, and keeping the house organized and clean. I knew my dad loved his work, but I am not sure I ever heard my mom express what she loved doing. I learned love is primarily what you do for others and yet this still did not seem to fully embody the idea of love.

Entering my teen years unfolded yet other dimensions of love. Strong feelings for young women developed. I also found myself drawn to print images of women. I learned that my feelings toward other women, once expressed and acted on would fade with time. On the other hand, my attraction to print images persisted and I kept searching for more. The idea of love became confusing. A love for playing sports continued to develop and oddly enough, growing up in Arizona, snow skiing was where I found myself most comfortable. There was always something about being in the middle of a steady snow and the stillness it created.

My sophomore year in college proved to be magical for me. This is when I first met Robin who is now my wife. This first encounter went beyond the physical attraction, touching something deeper in me, I felt completely drawn and in love with her. Soon after there was an encounter, what I call God, that shifted my perspective and created a sense of feeling loved much like I felt with Robin. Later, in my junior year in college, psychology and religion sparked a love for learning about people, relationships, and God. I continued to find being outdoors in nature and allowing my senses to take in all that surrounded me, somehow, resulted in feeling full and loved. Was it possible that I was now beginning to understand love?

Well from here, it was five years of graduate school in Marriage and Family Therapy, at least I was studying love and relationships. Then I found myself working, loving it, but perhaps loving the way it fed my ego. In work, I loved accomplishing, hearing how well I was doing, and clients telling me how much they appreciated my help. When I failed to help clients, it triggered a deep hidden insecurity. Next was the experience of having children. The birth of our children 27 and 25 years ago created a whole new space and depth to my understanding of love. Just listening to them breath while they were sleeping fostered a connection I did not fully understand. For the first 10 years of their lives, work took a back seat as my focus shifted to their needs. Unfortunately, I did not pursue intimacy with Robin in the same way and as the children became more independent, work beckoned me back. As I reflect, it was easier to work and help others than it was to risk acting on my love for my wife and children by becoming more vulnerable with them.

Truth is, I did not fully understand vulnerability. Not until the past three years of my life, I am now 57, have the circumstances of my life taught me love is found through facing my challenges, my shame, my insecurities, and my arrogance. I am facing the reality I am not in control of my destiny. My judging of those closest to me and the resulting distance it created was not as well hidden as I imagined. Sadly, it took more than one life lesson over the past three years to focus my attention. These lessons came to me in my marriage, with my children, my family of origin, professionally, and with my friends. My universe was telling me it was time to change. I am grateful I ultimately paid attention to the resulting hopelessness, confusion, anger and began reaching out to others with greater honesty and vulnerability. This is when I began to let others in, as a sense of helplessness led me to reach out to others for help. Only as I began living more truthfully, with greater self-awareness, and acceptance of my own powerlessness have I found the ability to begin loving myself. In this space I have begun to reach out to my wife, children, and friends and vulnerably love them. Love them for who they are with a willingness to listen, extend the conversation, and support them without my agenda. I am finding this quiets the tension in me, my defenses let down, and I can be more fully involved with those most important to me – I can love. Equally important, I am finding more compassion deep inside of me for those marginalized in our society.

This time of year, we focus on love in the form of cards, dinners, flowers, and other romanticized versions of it. Perhaps love is found in our relationship with self and others as we courageously visit the memories, experiences, and conversations we have long avoided. I believe this is where we discover our tremendous capacity to love.

Article by Dr. Marcus Earle, Clinical Director

Heart of Gratitude

Gratitude means having an appreciation for life in the present moment. It’s counting our blessings, noticing simple pleasures, and acknowledging the abundance already here. When we are truly thankful for what we already have and content with what is – this is enough. We tend to take for granted all the good that is already in our lives. All too often, we hold out for the big achievements before allowing ourselves to be truly happy. It can be all too easy to fall into the trap of always wanting more and never allowing ourselves to be satisfied and content with what is. It’s as if we believe that life owes us something other than the greatest gift of the present. This mindset of lack and never enough can be a painful way to live, and is a surefire way to keep oneself just short of real contentment. This limited mindset is not in service to us and living in this way is a superficial form of happiness.

Most of us have a story about how our lives “should” be unfolding, and when this story clashes with reality, this creates discontentment. This discontentment is the outcome of placing our own mental projections onto how we believe life should be. There is a beauty in being able to recognize that life is simply unfolding and when we resist what is by placing our own demands on life, we create our own unhappiness. This type of denial and resistance of life as it’s happening in the now creates suffering. This may take the form of denying a reality that one feels afraid to face or may even look like an avoidance of feeling certain emotions. When we habitually focus on what’s not going right, we miss out on the good in our lives. On the most simplistic and basic level, the good is where life is, in the here and now.

The more we shift out of a mindset of never enough and a resistance to life and instead begin to adopt an attitude of thanksgiving, the “more” we find that we receive. Gratitude is often a mental acknowledgement of everything that is going well in our lives, and certainly this is important and valid on its own. However, there is a thankfulness that runs much deeper. This type of gratitude is a deep sense of our very presence and our sense of “being-ness” or aliveness. This is simply just the natural feeling ‘I am’, the sense of existence that is always present when we are not entangled with thinking about the past and future. We can access our natural being-ness anytime, because it’s always here, underneath the noise of the mind. When we are able to find the space between thoughts, there is a natural peace and contentment flowing within. As we become more attuned to this sense of aliveness, true gratitude starts to emerge automatically. Through being fully present with life as it’s unfolding now and recognizing our very presence, there is a felt sense of appreciation for all that is.

So in this way, true gratitude is powerful and transformative. We miss the natural wonderful-ness of life when we are arguing with the present or resisting what is. Being present with life and having a deep acceptance, allows us to find peace even in the midst of difficult situations and allows our choices to be guided from an honest and grounded place. In fact, when we have the maturity to accept the present moment with a heart of gratitude, we discover that peace naturally arises.

Each day it’s important to appreciate this gift of being alive. There are many ways to practice gratitude and acceptance. You might start with keeping a daily gratitude journal and write in it throughout the day or as you go through the day. You can become more aware of all the gifts, joyful moments and love in your life. You might notice the good that has come out of painful events in your life and start to see the grace and blessings in even the deeply challenging experiences.

One of my favorite ways to practice gratitude is to get into the habit of saying “thank you”. This is a very simple practice and can even be a form of prayer for some. On a basic level, one can even acknowledge and give thanks to God or life for their senses and being able to appreciate life so fully, for the breath and for the joy of family and friendship. We can offer thanks for the beautiful things, and, even the ugly things. We can feel gratitude for the small acts of kindness given or received, for the warmth of the sun, the sound of rain and the beauty of a flower. We can say thank you to existence and to the creative power of the universe, to the deeper sense of being that is always here. All of this provides a simple but powerful way to add so much beauty, strength and joy to your life. Thank you, thank you, thank you.

 

Article by Stacy Hall, LPC

Who’d of Thunk?

45 years ago Glenda and I co-founded PCS. 60 years ago, on June 6th, we were married. Glenda is full of grace or we would not be currently married. Among the affirmations that I make daily include having gratitude for the health I do have, for my family, which includes Marcus, whom many of you know and is the Clinical Director at PCS. It is certainly great to have the privilege of working with Marcus for 30 years. It was very helpful to Marcus and me when approximately 32 years ago he and I were “Marilynized”. For those of you who know, have done therapy or read some of Marilyn Murray’s writings, or have been exposed to them in other ways, being “Marilynized” is a great way to get to know yourself.

PCS is a family program that involves Glenda, myself, Marcus full time and our daughter, Michelle as a consultant.

Who’d of Thunk that being married to me could be a good deal for Glenda, or for that matter, any woman. The process of getting to 60 years of marriage has at times been painful. 23 years into our marriage I did individual therapy. We did couples’ therapy and family therapy that led to a 25th anniversary, which was a redoing of our marriage vows in a way that was a process celebrating a much better marriage than when we got married originally on June 6, 1958. I have learned to “rat on myself” and to take accountability. Glenda also has worked on herself. The combination individual therapy for both of us, couples’ therapy and family therapy has been very helpful to getting us to the place where our marriage, at this point, is the best it’s ever been – that’s what Glenda says and what I say. We are still under construction and working on continued improvement and being better at being helpful to ourselves and each other.

Another concept, which is a “new kid on the block” to me is the term “enlightened selfishness”. I am grateful that I am married because I know that I would rather be married than not married and I am married to the person I would most likely to be married to. My story is that on June 6, 1958 I got married before I was ready to get married and didn’t know that. Gratefully, Glenda and I have, and continue to do the work, to have the marriage we both deserve.

Enlightened selfishness helps me to understand that I would rather be married than single. Because I am married to the person that I would most likely to be married to, behavioral changes make me a better deal for myself and for Glenda. Therapy for this therapist has been enormously helpful. The product of therapy means the most to me because of my own growth and continuing need, at age 81, to be under construction.

Another important area is that Glenda has helped me to “listen – learn” in a way that is different than my parents and grandparents did. Because I believe in the golden rule, it makes sense that it is a fundamental necessity that goes against my basic, instinctual nature. Knowing that there is no “cure” for me and at the same time I can keep in “remission” the parts of me that “nuke” my wife and that I am the one who is a bigger loser when I do that. A specific change is that at times when I am thinking about saying something that would be unproductively hurtful to Glenda, and would also then end up hurting me, when Glenda and I are alone, “shut up Ralph”. She doesn’t ask me what was I going to say.

Glenda and I have a commitment that if either one of us believes that we need to get marital therapy, the other will say yes and we know that we are never too old to need therapy. When needed, we will make that happen.

Some of the areas that have become important to me in this stage of life – ala Eric Ericson’s “Generativity” include working with people who are already married who come to PCS either as individuals in a marriage or as a couple. We use the term “premarital therapy” for people who have become legally married and yet need to come to a place in their marriage where the marriage may be in the “ER Room” and either becomes a healthier marriage or may end. We at PCS are biased and would love to see relationships improve and hate to see “divorce for the wrong reasons.” I am privileged to be a part of a group in which there are 27 therapists who have their individual strengths, personalities and specialties which are brought to bear in our Intensive Outpatient Program.

Scott Peck wrote that “life is difficult.” Marriage is difficult and can be incredibly rewarding.

Recently, I heard a friend who started the Arizona Interfaith Movement and our yearly Golden Rule Banquet state “I am the luckiest man in the world.” That friend died of Lou Gehrig’s disease and was quoting Lou Gehrig when he was physically debilitated by what we now call Lou Gehrig’s disease, making that statement at Yankee Stadium. I write this because “I am the luckiest man in the world” and know that. I am lucky to be in the marriage I am in and to be a father and grandfather. The only name our grandkids use for me is “Cuckoo.” Those of you who know me will know that it is a clinical diagnosis from grandkids, as well as an intimate term, which means a lot to me. Within the last couple of years, I have had the privilege as “Reverend Cuckoo” to perform the wedding for two of our grandkids and their partners.

Another piece of gratitude is, the people who have mentored me – my wife, kids and grandkids mentor me. Mentors who have been professors of mine include two people who knew Bill W, who started AA. Reinhold Niebuhr, who authored the Serenity Prayer, which we use regularly Tuesday, Wednesday and Thursday at the end of group was one of my profs. Another prof did his degree at Columbia in Alcoholism and was involved in the beginning of AA. As some of you know, I am an ordained minister who believes that the rigorous honesty that occurs in 12 step groups and in therapy settings such as PCS, provides a depth, including an understanding of what “the Imperfection of Spirituality” really means in all of our lives.

Thanks for your interest in PCS and those of you who have been to PCS as clients, please keep us posted as alumni of our PCS family.

By Ralph Earle, Founder & Clinical Director

What Is a “Psychoeducational Evaluation” and Should My Child Have One?

If your child is struggling at school with learning, you may be concerned about whether he or she might have a learning disorder, such as a reading disability/dyslexia, math disability, or written expression disability. Or, you may wonder if there might be an attentional deficit (e.g., ADHD), or if your child might be just “bored” and not challenged. Alternatively, you may be concerned about emotional issues, such as anxiety or depression, which may be affecting your child’s learning progress.

If you are experiencing any of the above concerns, pursuing a psychoeducational evaluation for your child can be a useful way for you (and your child’s teachers) to discover some answers.

There are several areas that Dr. Gilbert assesses in her psychoeducational evaluations:

  • Cognitive Ability
  • Academic Achievement
  • Social/Emotional/Behavioral Functioning
  • Attentional Functioning

The cognitive assessment provides information about an individual’s intelligence, revealing any strengths as well as weaknesses. Areas assessed include verbal reasoning, visual-spatial skills, nonverbal abstract reasoning, working memory (auditory and visual), and processing speed. This information can be very useful in understanding your child’s thinking and reasoning abilities. For example, if your child’s verbal reasoning skills are significantly better than his or her nonverbal reasoning skills, it may be that your child may understand new information more easily when it is presented in a verbal, rather than visual, format.

Moreover, if your child is found to have a weakness in working memory and/or processing speed, this may mean that, in order to learn, your child may require information to be repeated, or may need to be exposed to material on multiple occasions, or may need the pace of instruction to be slowed down. Further, within working memory, it can be very useful to discover whether your child may have a weakness in recalling either visual or verbally-presented information. In this way, your child’s teacher can then be sure to introduce material in a format that works better for your child. The cognitive assessment may also determine whether your child is a gifted learner, and in need of gifted instruction at school in order to appropriately stimulate and capture your child’s learning motivation. Knowing your child’s intellectual strengths and weaknesses can especially help teachers to understand that your child can learn, but that he or she may need strategies or accommodations to facilitate that learning.

The academic achievement assessment measures a child’s achievement in reading, math, and written language. In reading, the areas of sight-word reading, phonetic decoding, oral reading fluency, and reading comprehension are assessed. When children are young and their reading skills are still emerging, Dr. Gilbert often includes a test of phonological processing to investigate foundational reading skills. For math, timed math facts, untimed math calculations, and math reasoning are measured. In the area of written language, sentence composition skills, spelling, and essay composition skills are evaluated. This information may then be used to determine whether a Specific Learning Disorder is present in reading (dyslexia), math (dyscalculia), or written expression (dysgraphia).

To assess a child’s social, emotional, and behavioral functioning, parent and teacher rating scales are used. When appropriate, the child may also complete a self-rating scale. These scales include a wide range of concerns that children exhibit, including acting-out behavior, symptoms of anxiety and depression, and adaptive skills such as adaptability and social skills. Rating scales are also used to assess whether a child may be exhibiting significant difficulty with inattention, hyperactivity, and impulsivity. Lastly, a computerized test is administered, which measures a child’s ability to sustain his or her attention, as well as to resist impulsive responding, when exposed to both visual and auditory information. Dr. Gilbert is then able to consider all this data, in conjunction with the child’s history, to determine whether ADHD may be present, or if anxiety is a primary factor preventing the child from making adequate school progress, or if depression may be playing a role, or if an Oppositional-Defiant Disorder may be at play. Included as part of the evaluation is a meeting with the parent(s) to review all the assessment data, and to discuss best practice recommendations that are provided by Dr. Gilbert. Because Dr. Gilbert is a certified school psychologist (in addition to being a licensed psychologist), she can guide parents in navigating the complicated world of special education services and IEPs if appropriate.

If you are interested in more information, please contact Dr. Gilbert’s office. The testing typically involves 4-5 hours of direct testing. The cost is generally $1250 – $1450, depending on what assessments are needed. Remember to bring your child’s eyeglasses if they are needed, to make sure your child goes to bed on time the night before, and that your child has a good breakfast/lunch prior to the assessment.

© Psychological Counseling Services