Wednesday, December 19, 2012

Healing Through Advocacy

If you are feeling overwhelmed by feelings of anger, pain, confusion and despair due to the tragic events at Sandy Hook Elementary School, you are in good company. This week most of the people I encountered in my personal life and in my private practice were feeling highly stressed, sad and helpless. As a psychotherapist from Newtown, CT, I am trying to stay strong by working through my own grief so that I can support others through this profoundly painful time.

Healing from trauma takes time, and varies tremendously from person to person.  Factors such as an individual's genetics; thinking style; home, school, community and work environments; and past traumas all shape the healing process.  Cultural traditions and beliefs, and spiritual or religious faith also play a role in the recovery process.

One wonderful way to counteract despair and speed healing is to foster positive change. Many of you have already helped in ways such as donating to funds for the victims' families and signing a national sympathy card. Another way you can take action is to speak out against assault weapons and high-capacity ammunition magazines.

Instructions are detailed below, courtesy of  Josh Sugarman, Executive Director of the Violence Policy Center.  Josh is a fellow graduate of the Newtown High School class of 1978, and I am proud to call him my friend.

"To my Newtown Friends:
As some of you may know, I've spent most of my professional life working to stop gun violence as founder and executive director of the Violence Policy Center in Washington, DC.

And while I know all too well that gun violence can happen anywhere, that such a horrific event occurred in Newtown is almost beyond comprehension. To see young lives destroyed and the anguish of friends and family is beyond heartbreaking. 

Over the past few days, I've talked to fellow classmates and friends from Newtown and the common question has been, what can we do? Right now, one of the immediate actions you can take is to contact the White House, your Member of Congress, and your U.S. Senators and let them know that you're from Newtown and that you demand action. This may not sound like much, and it's only the first step, but it will make a real difference. I've included contact information below. 
--White House Comments: 202-456-1111

President Obama has said that he will support an assault weapons ban. Call and thank him and urge him to follow through on his promise. 
--U.S. Capitol Switchboard at 202-224-3121 

Call the U.S. Capitol switchboard and ask to speak with your Member of Congress and U.S. Senators. Tell them you support a ban on assault weapons and high-capacity ammunition magazines. 

Please follow the Violence Policy Center, on the web, Facebook, and Twitter, and share this information with everyone you know."

I will be writing more soon on healing from trauma. In the meantime, remember that a little extra patience and small acts of kindness will ease your suffering and that of those around you.

Thinking of you,

Sunday, November 25, 2012

Let the Sunshine In

As a clinical social worker, I have observed firsthand the effects that vitamin D levels can have on mood.  The shorter days of Winter are tough on many people. Vitamin D- which our bodies make when exposed to the sun, is crucial for making hundreds of enzymes and protein and interacting with more than 2,000 genes vital for health and fighting disease- is in limited supply.  Vitamin D deficiency has been linked to chronic modern diseases such as heart disease, diabetes, cancer, osteoporosis, and depression. 

Several studies suggests that Vitamin D deficiency and depression are linked, and that increasing Vitamin D levels can help. We do not know whether low levels of vitamin D cause depression, worsen it, or are a symptom of the underlying depression. One study included  adult women with depression, all of whom were taking antidepressants. The women were also being treated for Type 2 Diabetes or an underactive thyroid gland. All were deficient in vitamin D, with levels under 21 ng/mL. Levels below 21 ng/mL are considered vitamin D deficient.  The women received vitamin D therapy for eight to 12 weeks. After treatment, their levels increased to 32 to 38 ng/mL. The women also reported improvements in symptoms of depression following vitamin D therapy. One woman's depression score changed from indicating a major depression to mild depression.  

I believe that many doctors and mental health professionals have had similar experiences with patients. I have had three clients who presented with major depression, tested below 10ng/ml in vitamin D, and after 10 weeks of receiving vitamin D supplements and weekly therapy, experienced a remission in their depression. Of course we can't measure how much improvement was caused by the increase in Vitamin D, and how much was caused by therapy.  My stance regarding treatment is to  use every helpful, healthy tool available to combat depression.

In addition to the clients who have suffered from major depression and had their Vitamin D levels tested, I have had many clients who have described and exhibited increased symptoms of depression in the late Fall and Winter. Seasonal Affective Disorder (SAD) is real, can be debilitating, and is prevalent when vitamin D stores are low.  In one study, eight subjects with SAD received 100,000 I.U. of vitamin D daily and all experienced a significant lessening of their depression as measured by the Hamilton Depression Inventory. Vitamin D blood levels improved by 74% in all eight subjects.  Vitamin D may be an important treatment for SAD. More, larger studies will be necessary to confirm these findings.
Vitamin D is called the sunshine vitamin because our bodies produce it when exposed to sunlight. Sunlight is an excellent source of vitamin D.  A person sitting outside in a bathing suit in New York City gets more vitamin D in 20 minutes than from drinking 200 glasses of milk.  Many experts suggest getting 10 to 15 minutes of sunshine sans sunscreen three times weekly.  Talk to your doctor about the pros and cons of sun exposure for you. 

Vitamin D is also added to milk and other foods, and is available in small amounts in fatty fish like tuna, salmon, and mackerel; beef liver, cheese, and egg yolks. It can be hard to get as much as we need from our diets, which is why supplements are often needed. Many, but not all, doctors include Vitamin D levels in their standard battery of blood tests when patients come in for a physical. Make sure you check with your doc if you are depressed, and request a blood test for Vitamin D levels. Your health depends on it.

Wednesday, February 29, 2012

Teens, Therapy and Privacy

Nervous about coming to therapy? 

Of course you are! That is a healthy and very common reaction. Why? You feel alone and vulnerable, and to top it off you are going to talk to a complete stranger about your personal life! You are entrusting the therapist with information that you may not have shared with your closest family members or friends.

Never fear;  therapists have a code of ethics which states that we must keep your private information to ourselves. There are only a few situations in which a therapist is obligated, by law, to break confidentiality:

1. You present a danger to self or others. If the therapist thinks you might hurt yourself or someone else, they need to tell your parent(s) and possibly others.

2. You are the victim of emotional, sexual or physical abuse or neglect.
In this case, the therapist may need to report the information you share to people who work to protect children. However, most therapists will tell you that they feel they need to do this to keep you safe before they make a call or file a report. In Connecticut, I  need to file a report with a state agency called the Department of Children and Families, and a social worker would then look into the situation, gather information, and make every effort to make sure you are protected from future abuse.

In the vast majority of experiences with clients, there is no need to break confidentiality. However, if it is essential to break confidentiality, I discuss my reasoning and next steps with clients before I do so.

Most of the time teens are understandably worried about less serious issues getting back to their parents- like relationship or school problems-  that they are not comfortable sharing with them.  Here's the good news: in many cases therapists do a great job of working with teens to help them decide if, when, and how to share sensitive information with parents. Two aspects of my work I find very rewarding are helping teens learn more helpful ways of thinking about problems, and teaching new approaches to talking to parents.

If you are working with a therapist or school counselor, you should and can check with them about confidentiality. Let them know what information you are not comfortable sharing with teachers, parents, or others.

If you have any questions or concerns about therapy and confidentiality, please ask, and I will be happy to answer them for you.

Be well,