Substance Abuse & Triple C's

Recreational drug use has been a part of societal culture for as long as I can remember. Cannabis, Cocaine, Methamphetamines and a slue of other drugs have been used recreationally for years by teens and adults alike. One drug I am beginning to see more and more in my professional career as psychiatric social worker is the use of "triple c's," or "cold, cough and congestion" medication. Because these medications usually have some degree of ephedrine (a stimulant) many have learned they can take one or more boxes at a time to achieve a 'high.' These drugs have been abused for years by those who manufacture methamphetamine because the ephedrine is needed for the production of meth. What's more surprising is that a majority of individuals using these 'triple c's' are teenagers and young adults as they are more readily available than alcohol or other street drugs. They are found in most stores and unsuspecting parents are unlikely to question their child's needs for a cold, cough and congestion medication.

Trials & Triumphs of Social Work

Ahh... the tragedies, trials, joys and triumphs that come with the territory of social work. It doesn't matter if you work with patients, clients, children or adults there are certain qualities unique to all forms of social work. Frustration and joy, despair and excitement, accomplishments and failures. No matter what you do in social work or who you work with it is certain all of the aforementioned emotions have been or will be experienced. If you haven't expreienced these emotions....just give yourself some time, you will.

In everything we do, what's right for the patient takes precedent. However, does this mean if a patient has poor insight and no clue what they are in need of that social workers should intervene? Does this mean that if a patient yearns for the absolute worse thing they need that social workers intervene? Or, could it possibly mean that compromise reigns paramount and finding a solution acceptable to all is the appropriate answer?

No matter what your personal opinion regarding the matter is, we can remain certain that all emotions within the realm of human emotions are certain to be experienced in the occupation of social work.

AXIS II

Axis II. It's one of the most complicated Axes for clinicians to treat. Primarily because the prognosis for individuals who fall under this Axis is only fair at best. Aside from Mental Retardation, Axis II also holds the diagnoses of Personality Disorders.

Personality is ultimately the determining factor for how we will live our lives. It is directly related to how we think, make decisions and take action. An individual with a Personality Disorder develops traits which are maladaptive and inflexible and ultimately lead to behaviors which cause discomfort, distress and impair an individual's ability to function in society in a manner that reflects stability, security and sound judgement.

There are approximately 11 recognized Personality Disorders. The DSMIV-TR provides the following information regarding Personality Disorders:

"General diagnostic criteria is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas: cognition (i.e., ways of perceiving and interpreting self, other people, and events); affectivity (i.e., the range, intensity, lability, and inappropriateness of emotional response); interpersonal functioning; and impulse control. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. The individual's pattern is stable of long duration and its onset can be traced back at least to adolescence or early adulthood."

Now, the booming question most clinician's will ask regarding individuals with Personality Disorders is "How do I manage them and their destructive behaviors?"

According to the High Conflict Institute there are 12 tips for managing individuals with high conflict personalities. 5 Do's and 7 Dont's:

Part I: Understanding High Conflict People

Tip #1: Don’t Take Their Personal Attacks Personally

Tip #2: Don’t Give Them Negative Feedback

Tip #3: Don’t Bend Boundaries With Borderlines

Tip #4: Don’t Diss the Narcissists

Tip #5: Don’t Get Hooked by Histrionics

Tip #6: Don’t Get Conned by Antisocials

Tip #7: Don’t Be a Negative Advocate



Part II: Managing High Conflict People

Tip #8: Connect Using Your E.A.R.

Tip #9: Analyze Your Realistic Options

Tip #10: Respond Quickly to Misinformation

Tip #11: Set Limits on Misbehavior

Tip #12: Choose Your Battles

If you would like more information regarding managing individuals with Personality Disorders and those with High Conflict Personalities you might want to consider reading the following book IT'S ALL YOUR FAULT! 12 TIPS FOR MANAGING PEOPLE WHO BLAME OTHERS FOR EVERYTHING.

Anger & How to Manage It!!

Anger is one of the most intense human emotions we will ever experience. It's intensity varies and results in behavioral symptoms varying from fits of rage to sulking and pouting. Anger, like beauty is usually in the "eye of the beholder." What infuriates some may go unnoticed by others.

So what exactly is the purpose of anger? Does it serve a reason within the realm of human emotion? The answer is absolutely! The purpose of anger is to alert us that something is 'wrong' and that there is an issue which needs to be addressed. The longer we abstain from addressing the issue, the more the anger has a potential to build and fester within us.

It is o.k. to be angry, even furious. It is the behavioral actions which follow the anger that may or may not be o.k. Some actions carry severe consequences which can extend farther into the future the we ever intended. And seriously, do angry outbursts with severe consequences address the issue which made us angry in the first place? Most of the time these types of reactions only serve to perpetuate the intensity of the anger, do not address the problem at hand and often incur some type of consequence. Thus, the dance of anger begins. It goes something like this: Event occurs, we get angry, we react,consequences of our reactions.

There are numerous ways to react to events which make us angry.
Some of them include: ignoring, biting our tounges, reacting with silence, physical aggression, smart remarks, screaming, yelling, cursing, leaving the situation, and the list goes on and on. This is not to say that each of these actions are appropriate and address the issue to solve whatever the 'problem' may be. Part of the reason we behave this way is because we often blame people for our anger and ignore the patterns which lead us to becoming angry in the first place.

Patterns can include feelings of neglect, abandonement, abuse, being taken advantage of and a slue of other issues which can arouse anger towards someone else.

Consider the following example:

Susan has been working for her current employer, an attorney, for nearly three years. She'd like to find another job, but so far, she is "stuck" with where she is now. Susan claims her boss is demanding and blames her for things that are not even her fault. Once she prepared several documents to be filed with the courts, however, her boss never got around to signing them so they could not be filed. He then proceeded to yell and blamed Susan for not "keeping up" with the business of the law office. Susan then apologizes and assures the attorney it will not happen again.

Do you see what is happening in this example? Susan's anger towards her boss no doubt comes from the manner in which she reacts to the pattern that has been established. Susan reacts by 'biting her tongue.' Her anger most likely stems from being disrespected, taken advantage of, and assuming responsibility for her bosses mistakes. Susan's reaction to these feelings is to say nothing about it and 'tell the boss what he wants to hear.'

Therefore, instead of blaming the pattern of poor communication between Susan and her boss, Susan's anger is directed towards the individual (in this case her boss). As time progresses, this anger may build and Susan may eventually do something which creates problematic consequences.

The source of anger should always be considered. While it seems that individuals are to blame for becoming angry, explore the situation further to determine what pattern exists to the anger and then how to change the pattern not the person.

Acceptance & Commitment Therapy: What Is It?

ACT differs from traditional cognitive behavioral therapy (CBT) in that rather than trying to teach people to better control their thoughts, feelings, sensations, memories and other private events, ACT teaches them to "just notice", accept, and embrace their private events, especially previously unwanted ones. ACT helps the individual get in contact with a transcendent sense of self known as "self-as-context" — the you that is always there observing and experiencing and yet distinct from one's thoughts, feelings, sensations, and memories. ACT aims to help the individual clarify their personal values and to take action on them, bringing more vitality and meaning to their life in the process, increasing their psychological flexibility[3].

While Western psychology has typically operated under the "healthy normality" assumption which states that by their nature, humans are psychologically healthy, ACT assumes, rather, that psychological processes of a normal human mind are often destructive.[4] The core conception of ACT is that psychological suffering is usually caused by experiential avoidance, cognitive entanglement, and resulting psychological rigidity that leads to a failure to take needed behavioral steps in accord with core values. As a simple way to summarize the model, you can say that ACT views the core of many problems to be due to the acronym, FEAR:

Fusion with your thoughts
Evaluation of experience
Avoidance of your experience
Reason giving for your behaviour

And the healthy alternative is to ACT:

Accept your reactions and be present
Choose a valued direction
Take action

6 Core Principles of ACT

ACT commonly employs six core principles to help clients develop psychological flexibility[4]:

1. Cognitive defusion: Learning to perceive thoughts, images, emotions, and memories as what they are, not what they appear to be.
2. Acceptance: Allowing them to come and go without struggling with them.
3. Contact with the present moment: Awareness to the here and now experience with openness, interest, and receptiveness.
4. Observing the self: Accessing a transcendent sense of self, a continuity of consciousness which is changing.
5. Values: Discovering what is most important to one's true self. [5]
6. Committed action: Setting goals according to values and carrying them out responsibly.

Developed within a coherent theoretical and philosophical framework, Acceptance and Commitment Therapy (ACT) is a unique empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility.

Psychological flexibility means contacting the present moment fully as a conscious human being, and based on what the situation affords, changing or persisting in behavior in the service of chosen values.


ACT illuminates the ways that language entangles clients into futile attempts to wage war against their own inner lives. Through metaphor, paradox, and experiential exercises clients learn how to make healthy contact with thoughts, feelings, memories, and physical sensations that have been feared and avoided. Clients gain the skills to recontextualize and accept these private events, develop greater clarity about personal values, and commit to needed behavior change.

Reality Therapy

Reality Therapy suggests that anyone who needs psychiatric treatment suffers from one basic inadequacy: they are unable to fulfill their essential needs. The severity of the psychiatric symptoms reflects the degree to which an individual is unable to fulfill their needs.

No matter how irrational or inadequate their behavior may appear to the culture around them, their behaviors have meaning and validity to them. Reality Therapy also implies that ALL psychiatric clients share a common characteristic: They all deny the reality of the world around them

The therapy that leads patients towards this reality and towards succesful comprehension of tangible and intangible aspects of the real world is called Reality Therapy. This therapeutic model attempts to assisst individuas in facing the reality around them and fulfilling their essential needs.

What Is Cognitive Behavioral Therapy?

The following article discusses cognitive behavioral therapy and helps clinicians and therapists understand how it developed, when it can be utilized in practice, and other interesting aspects regarding this specific form of therapy. The article comes from the National Association of Cognitive-Behavioral Therapists.



Cognitive-Behavioral Therapy...
is a form of psychotherapy that emphasizes the important role of thinking in how we feel and what we do.

Cognitive-behavioral therapy does not exist as a distinct therapeutic technique. The term "cognitive-behavioral therapy (CBT)" is a very general term for a classification of therapies with similarities. There are several approaches to cognitive-behavioral therapy, including Rational Emotive Behavior Therapy, Rational Behavior Therapy, Rational Living Therapy, Cognitive Therapy, and Dialectic Behavior Therapy.

However, most cognitive-behavioral therapies have the following characteristics:

1. CBT is based on the Cognitive Model of Emotional Response.
Cognitive-behavioral therapy is based on the idea that our thoughts
cause our feelings and behaviors, not external things, like people, situations,
and events. The benefit of this fact is that we can change the way we think to
feel / act better even if the situation does not change.

2. CBT is Briefer and Time-Limited.
Cognitive-behavioral therapy is considered among the most rapid in terms of
results obtained. The average number of sessions clients receive (across all
types of problems and approaches to CBT) is only 16. Other forms of
therapy, like psychoanalysis,can take years. What enables CBT to be briefer
is its highly instructive nature and the fact that it makes use of homework
assignments. CBT is time-limited in that we help clients understand at the
very beginning of the therapy process that there will be a point when the formal
therapy will end. The ending of the formal therapy is a decision made by the
therapist and client. Therefore, CBT is not an open-ended, never-ending
process.

3. A sound therapeutic relationship is necessary for effective therapy, but
not the focus.
Some forms of therapy assume that the main reason people get better in
therapy is because of the positive relationship between the therapist and
client. Cognitive-behavioral therapists believe it is important to have a good,
trusting relationship, but that is not enough. CBT therapists believe that the
clients change because they learn how to think differently and they act on that
learning. Therefore, CBT therapists focus on teaching rational self-counseling
skills.

4. CBT is a collaborative effort between the therapist and the client.
Cognitive-behavioral therapists seek to learn what their clients want out of life
(their goals) and then help their clients achieve those goals. The therapist's
role is to listen, teach, and encourage, while the client's roles is to express
concerns, learn, and implement that learning.

For excellent cognitive-behavioral therapy self-help and professional books, audio presentations, and home-study training programs, please click here.

5. CBT is based on aspects of stoic philosophy.
Not all approaches to CBT emphasize stoicism. Rational Emotive
Behavior Therapy, Rational Behavior Therapy, and Rational Living
Therapy emphasize aspects of stoicism. Beck's Cognitive Therapy is not
based on stoicism.

Cognitive-behavioral therapy does not tell people how they should feel.
However, most people seeking therapy do not want to feel they way they have
been feeling. The approaches that emphasize stoicism teach the benefits of
feeling, at worst, calm when confronted with undesirable situations. They also
emphasize the fact that we have our undesirable situations whether we are
upset about them or not. If we are upset about our problems, we have two
problems -- the problem, and our upset about it. Most people want to have the
fewest number of problems possible. So when we learn how to more calmly
accept a personal problem, not only do we feel better, but we usually put
ourselves in a better position to make use of our intelligence, knowledge,
energy, and resources to resolve the problem.

6. CBT uses the Socratic Method.
Cognitive-behavioral therapists want to gain a very good understanding of
their clients' concerns. That's why they often ask questions. They also
encourage their clients to ask questions of themselves, like, "How do I
really know that those people are laughing at me?" "Could they be laughing
about something else?"

7. CBT is structured and directive.
Cognitive-behavioral therapists have a specific agenda for each session.
Specific techniques / concepts are taught during each session. CBT
focuses on the client's goals. We do not tell our clients what their goals
"should" be, or what they "should" tolerate. We are directive in the sense that
we show our clients how to think and behave in ways to obtain what they
want. Therefore, CBT therapists do not tell their clients what to do -- rather,
they teach their clients how to do.

8. CBT is based on an educational model.
CBT is based on the scientifically supported assumption that most emotional
and behavioral reactions are learned. Therefore, the goal of therapy is to
help clients unlearn their unwanted reactions and to learn a new way of
reacting.

Therefore, CBT has nothing to do with "just talking". People can "just talk"
with anyone.

The educational emphasis of CBT has an additional benefit -- it leads to
long term results. When people understand how and why they are doing
well, they know what to do to continue doing well.

9. CBT theory and techniques rely on the Inductive Method.
A central aspect of Rational thinking is that it is based on fact. Often, we
upset ourselves about things when, in fact, the situation isn't like we think it
is. If we knew that, we would not waste our time upsetting ourselves.

Therefore, the inductive method encourages us to look at our thoughts as
being hypotheses or guesses that can be questioned and tested. If we find
that our hypotheses are incorrect (because we have new information), then we
can change our thinking to be in line with how the situation really is.

10. Homework is a central feature of CBT.
If when you attempted to learn your multiplication tables you spent only one
hour per week studying them, you might still be wondering what 5 X 5
equals. You very likely spent a great deal of time at home studying your
multiplication tables, maybe with flashcards.

The same is the case with psychotherapy. Goal achievement (if obtained)
could take a very long time if all a person were only to think about the
techniques and topics taught was for one hour per week. That's why CBT
therapists assign reading assignments and encourage their clients to
practice the techniques learned.