Clinical Psychologist

The PTSD diagnosis originated as a description of symptoms combat veterans experienced after exposure to battle. Veterans, when they returned from combat, continued to be troubled by loud or sudden noises triggering recurring images of being on the battlefield. The diagnosis has now been expanded to include persons who have been confronted with actual or threatened death or serious injury to themselves or significant others. Life threatening physical and emotional injuries that often lead to the development of PTSD include: severe auto accidents; observing a significant other being killed or injured; sexual or physical assault; and exposure to life threatening natural events. When confronted with these sorts of traumatic events, the individual experiences intense fear or helplessness.

The body’s’ natural instinct is to block memories of the trauma, because the memories produce anxiety and fear. In extreme form, this effort to repress memories can result in dissociation or amnesia. Unfortunately, events that occur in life, that are reminders of the trauma, inevitably result in intrusive, distressing recollections of the traumatic event. It is as though the traumatized individual is being forced to watch a movie being replayed of the traumatic incident, over and over again in their memory. It is common for the traumatized person to attempt to avoid thoughts, feelings, or conversations associated with the trauma. Activities, places, or people that arouse recollections of the trauma are also avoided. Typically, such persons are unable to recall an important aspect of the trauma. The individual experiences a sense of being chronically anxious and on high alert. When these symptoms interfere with the individual’s ability to enjoy formerly enjoyed activities or result in detachment or withdrawal from significant relationships, it is time to seek professional help. PTSD symptoms include sleep problems, irritability or outbursts of anger, difficulty concentrating, and easily triggered startle responses. Effective therapy involves exploring the memories of these traumatic events in a safe environment that focuses on restoring a sense of power and safety to the individual.

Excessive anxiety or worry, occurring more days than not, can be debilitating and cause clinically significant distress or impairment in social, occupational, and other important areas of functioning. Although everyone experiences worries, when such worries or anxiety interfere with normal functioning it is time to seek help. Intense anxiety can be a biochemical imbalance in conjunction with situational stress that interferes with the normal ability to cope with the tasks of life. Symptoms of anxiety include: restlessness or feeling keyed up or on edge; being easily fatigued; difficulty concentrating or the mind going blank; irritability; muscle tension; and sleep disturbance (difficulty falling or staying asleep or restless unsatisfying sleep). Excessive anxiety is paralyzing. A combination of therapy and medication are the most effective treatment for anxiety and can effectively restore the capacity to deal with the normal stresses of life.

Chronic pain related to an accident or medical condition is one of the most challenging situations an individual can face. When chronic pain is combined with a prior history of being unable to effectively deal with negative feelings and emotional concerns, the symptoms of chronic pain are exacerbated. People deal with negative feelings and stress in a variety of ways. Those who are able to acknowledge their feelings and seek solutions to their difficulties are the most resilient. Alternatively, people who lack the skills of being able to identify and express their feelings often channel such feelings into physical complaints. In other words, when the psyche becomes overloaded and has no direct expression for difficulties, emotional problems often are experienced as physical symptoms. Individuals who experience chronic pain related to an accident or medical condition, and have previously been unable to deal with psychological stress in an adaptive manner, are at increased risk in dealing with chronic pain. Psychotherapy focused on becoming aware of psychological issues and learning how to express feelings is effective in dealing more adaptively with chronic pain.

Anger is usually a cover or strategy for dealing with early emotional injuries that result in negative feelings about oneself.  Therapy for anger issues involves uncovering the core hurts.  Hurts to the core occur when the individual feels disregarded, unimportant, accused/guilty, devalued, rejected, powerless, unlovable, or unfit for contact.  Often these core hurts occur during childhood and adolescence. Anger and attacking others is one of the strategies people use to deal with the inner hurt.  Anger can take the form of: physical or emotional abuse, attempting to control others, feeling superior to others, or using the silent treatment.

Therapy for anger management focuses on helping the patient understand the source of the anger. Therapy also enables the patient to discover the ineffective strategies they are using to deal with Core Hurts. Anger and attacking others only makes the Core Hurts worse. The final aspect of treatment involves helping the patient learn how to regulate emotions.

ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity which is usually discovered in childhood. Adults can also suffer from the disorder and often go undiagnosed. ADHD if left untreated can interfere with developmentally appropriate social, academic, and occupational functioning.

Individuals with the Inattentive form of ADHD often fail to give close attention to details or may make careless mistakes. Work is often messy and performed carelessly. Such individuals find it difficult to sustain attention in tasks, which interferes with the ability to complete tasks as well disturbance in social relationships. They often do not follow through on requests or instructions. This inability to attend usually results in the individual avoiding tasks or situations that require organizational demands or close concentration such as homework, and paperwork.

Hyperactivity is another form of attentional disorder. Typically, those with ADHD exhibit fidgeting or squirming in one’s seat or by having difficulty engaging quietly in leisure activities. Children and Adults who suffer from ADHD have particular problems in sedentary group or individual activities. Impulsivity manifests itself in impatience, difficulty in delaying responses, waiting one’s turn, and interrupting frequently, which often causes social difficulties. Such individuals often engage in dangerous activities without considering the possible consequences.

In order to satisfy a diagnosis of ADHD, the individual must be experiencing impairment in several settings such as home and school. Associated problems, depending on the age of the individual, may include: low frustration tolerance, bossiness, stubbornness, temper outbursts, moodiness, rejection by peers, and poor self esteem.

Therapy for a child with ADHD typically includes teaching the child how to better regulate their emotions. It may also involve a referral to a physician to determine if medication is appropriate. Educational assessment can be helpful in identifying interruptions in the learning process created by ADHD. Educators and parents can help the child by devising strategies for remediating these difficulties. Because these children present many challenges for the parents as well as for the school, intervention also typically involves teaching parents and school personnel more effective ways of managing the child’s behavior at home and at school. Therapy for the children is helpful in a number of ways. Children who have ADHD frequently suffer from low self esteem related to poor academic performance as well as social problems resulting from their impulsivity and irritability. The therapist can enable the child to understand their condition and focus on helping the child learn better self regulation. Intervention with the parents is also useful in helping parents understand and cope with their child’s ADHD. Parenting techniques that foster increased structure and attention to the child’s self esteem are critical. At the same time, parents can receive assistance in teaching the child better self regulation skills.

When your child experiences a traumatic event, such as physical or sexual assault or physical injury, it is normal for parents to feel inadequate. There is a natural inclination to avoid talking with the child about the trauma, in hopes that the child will forget what happened. This is not the case. If children do not receive therapy and talk about their trauma with a therapist as well as their parents, long term damage can occur. Counseling with parents of traumatized children helps the parent understand the impact of abuse on their child. Counseling can also help the parent understand potential behaviors that can develop, such as acting out, and learn strategies for dealing with such behavior. Finally, it is important for parents of traumatized children to realize that the child typically needs to return to therapy as the child’s developmental stage changes. Inevitably parents of traumatized children suffer from guilt. Parent counseling after their child is traumatized is a way for parents to explore their own feelings related to the trauma. Overcoming feelings of guilt enables the parent to resume the normal structure and limits that help the child heal from the trauma.

Divorce Adjustment Counseling for Children. Divorce is one of the most stressful situations that a child can experience. Counseling for children of divorce ideally involves two stages. The first stage is to help the child deal with the initial separation. The second stage of counseling involves utilizing play as well as talk therapy to assist the child in dealing with the losses associated with the divorce and assisting the child in their adjustment to the subsequent changes in their lives.

Ideally the first stage of counseling for children of divorce should involve both of their parents. Meeting with the parents, prior to meeting with the children, can set the stage for addressing the critical issues for children when divorce occurs. Children of all ages believe they caused the divorce. They need to be reassured that their behavior did not cause the parental breakup. The children need to be reassured that parents do not stop loving their children nor divorce their children. Children are comforted by their parents letting them know that when they were born, their parents loved each other very much. Children need to be reassured that even after the divorce, their family will continue to include mom and dad as well as their siblings. Children worry about whether or not they will be able to see both parents after the divorce. Although the parents may be in disagreement about custody and parenting time issues, it is important for the parents to reassure the children they will be able to spend time with both parents. Children also worry about where they will live after the divorce and where they will attend school. If the parents know the answer to these questions, this is another important discussion with the children when both parents are present.

In the second stage of therapy, the child will need to explore the many losses and changes that will occur in their lives. Each child will respond to divorce differently. A combination of play and cognitive therapy enables the child to express their feelings about the divorce and cope with the changes that inevitably occur. The process of therapy teaches the child how to adjust to their changing circumstances and reframe the losses. Such life skills can become a positive aspect of divorce for children.

Divorce, whether chosen or unwanted is one of the most stressful experiences an adult can endure. Divorce forces adults to go back and re-examine their choices: why they made those choices, and why the choices did not work out. Divorce also forces an adult to examine issues of identity. Who am I now? What went wrong? What do I want o change about my life going forward? How do I take care of myself emotionally and financially? How do I learn to be single, rather than part of a couple? Divorce entails numerous losses and changes in identity that can be daunting for even the most stable individual. In addition, the pressures of the legal process, dealing with the children’s adjustment to the divorce, and increased financial stress compound the emotional challenges of divorce. Therapy provides an opportunity for support going through this complicated and wrenching process. Inevitably, divorce forces adults to look at themselves and their previous choices. Divorce also offers the opportunity for growth and a new realization of identity and opportunities for the future.

When a child is sexually abused parents often think it is best to avoid talking about the abuse with the child. They assume that if the child does not talk about the abuse, the child will eventually forget that the sexual abuse occurred. The opposite is true. Children who have been sexually abused need to talk about what happened to them, how they feel, and how they can again feel safe. Children who have been sexually abused also need to know it is not their fault and it is against the law for others to touch their private parts. Therapy with sexually abused children also involves their parents. Parents are traumatized when their child is sexually abused and need an appropriate channel for their sadness and anger. Parents also need help in dealing with the child’s behavior after abuse has occurred. When a family deals with the tragedy together and learns how to cope with the trauma, both the child and the family unit become stronger. Sexual abuse, when the proper treatment is obtained, does not lead to gender identity issues or future sexual problems. Although tragic, abused children can go on to lead healthy, happy, and normal lives. Sexual abuse does not have to lead to permanent psychological damage for your child. Getting early treatment, with a therapist with specific experience in this area, is the way to ensure your child’s recovery.

Parental alienation, prior abuse, and false allegations of abuse can result in a parent losing contact with his or her child. Reunification therapy is often ordered by the court when the court determines the parent should have therapeutic assistance in restoring their contact with the child. In cases of parental alienation as well as documented abuse, the favored parent is often resistant to reunification therapy and is often fearful about the child’s safety with the other parent. The goals of reunification therapy vary depending on the circumstances. Therapeutically, the child is afforded an opportunity to see the estranged parent in a safe environment. Since such children often think the estranged parent chose not to see them or forgot about them, reunification therapy reassures the child that their estranged parent loves them and did not abandon them. The environment is a safe one for the child, where the ultimate goal is to enable the child to explore his or her own feelings about the absent parent. Secondly, the goal of treatment is to find the least restrictive environment for the parent and child to have contact.

In order for parent-child reunification to be most effective, both parents need to participate. Boundaries are established between the child and each parent. The child develops a safety plan with both parents, that each parent agrees to abide by. If effective, the reunification therapist will have meetings with the child and non-custodial parent that eventually move into safe contacts outside of the office. When this is not possible, the child may need to continue to have supervised contact with the parent. Whatever the outcome, the child knows the non-custodial parent has not abandoned them. The reunification therapy also opens the door for future contact as the child ages.

It is a given that parents will experience challenging times with their children. Sometimes children present challenges as they are moving into a more advanced developmental change. In such cases, counseling is designed to help the parents understand the new developmental stage and parenting strategies effective for the child at his/her given age and stage of development. Concurrently, play therapy or counseling (depending on the age of the child) can assist the child in better managing their behavior and finding more effective strategies to accomplish developmental tasks.

Children may also have genetic predispositions that create challenges for their parents. Examples of such conditions include: Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder, Depression, or Learning Problems.

Social problems are not uncommon for children from time to time. However, when such problems continue they can cause long lasting damage to the child’s self-esteem and overall happiness. Therapy can assist the child in developing better social skills as well as dealing with the disappointment in their relationships with other children. Parents can be assisted by learning ways to help their children develop the needed skills at home that will facilitate better adjustment for the child in social settings.

Stress and change in the family created by divorce, death, or a move can often result in children having feelings they are unable to express appropriately. When this happens, it is not unusual for children to display acting out behaviors or to withdraw. Therapy can assist the child as well as the parents in coping with these life stressors.