I'm still here.....

Just really, really swamped with family stuff.....mostly.

Diagnosis Diatribe

ONO is the director of a large-ish sleep disorder clinic. He's been in the field for roughly 20 years and tells me that in recent years there's been an increase in younger children being seen for sleep studies.

This week he came home and told me there was a six year old girl who was in for a sleep study. She had a diagnosis of Bipolar Disorder. Six. Years. Old. This just doesn't make sense to me. AND, it really annoys me.

Maybe she is one of the 7% percent of children who are now being diagnosed with bipolar disorder. You know what that means? If you have a group of 100 children, 7 of them will have this diagnosis. In a group of 20, there will at least be one, maybe two kids with this diagnosis. And it’s believed that kids who actually should be diagnosed with bipolar disorder have been misdiagnosed with ADHD. This really annoys me too.

According to one study, the diagnosis of ADHD in kids increased by 381% between 1989 and 2000, and even more frightening, the diagnosis of bipolar disorder among youth (age 0 to 19) increased by 4000% between 1995 and 2003 according to another study.

Are our children really becoming more hyperactive and inattentive? Are six year olds really having mood swings erratic enough to fit the DSM IV criteria for bipolar disorder? I don’t think so. In fact, Bipolar disorder is not even included in the section titled “Disorders of Infancy, Childhood or Adolescence,” but I bet it will be included in the DSM V.

If anyone’s wondering what I think the cause of these increases in diagnoses are due to, I’d be happy to tell you (and here’s where the diatribe begins. You’ve been warned.)

I think it’s a combination of a number of factors, but NOT an increase in kids actually meeting the DSM criteria. Parents with complaints about their kids’ behavior (“He’s so hyper!” “She gets SO angry!” “He won’t listen to me.” “She throws these awful tantrums!” ) usually start with their pediatricians. Most pediatricians have only a cursory knowledge, if that, of the DSM. But many, who want to pacify parents (and drug companies), will prescribe some medication for kids and voila, the kid has a diagnosis (read “label”) but without meeting the DSM criteria for a disorder.

Now parents can point to the diagnosis as the cause of their kid’s challenging behavior, rather than, oh, say….the crappy food they feed them, or the crappy screen content they let them take in, or the lack of emotional support and empathy they give them, or the lack of clear expectations and guidelines for acceptable behavior.

I really think the increase in ADHD and bipolar disorder diagnoses is the result of the most self-centered generation ever becoming “parents,” and I use that term loosely. It’s also the result of a broken public education system that expects too much from too few teachers. Many teachers of kindergartners (5 and 6 year olds) have upwards of 30+ kids in their charge. That is WAY too many! And if the boys in that classroom are being typical boys (active and aggressive), those teachers would want some type of help in classroom management. Let’s call those teacher’s aids “Ritalin” and “Adderall.”

What a heavy burden for such little children.

I was on TV!

I'm at home with the mini-muffins and my phone rings. I check the caller ID and don't recognize the number so ignore it. I do this when I'm with the mini-muffins because it's nearly impossible to have any kind of conversation with them in the background. I check the messages regularly and if it's a client, I stuff the kids in the closet and call them back. (JK)

I check the message and it's a reporter from one of the local news stations. Weird, and.....curious. She's asking me for an interview about couples fighting. OK, I can talk about that (both professionally AND personally) -- I've been interviewed before....over the phone. I call her back and say Sure! You can interview me, thinking it'll be over the phone. But no, she wants to come to my house and film me at 1 pm. It's now 11:30 am. OMG. I almost decline but then thought "Why not? You can't pay for that kind of advertising."

My brain flips into high gear as I survey the ever-present unkempt-ness in the house (if only the Feds would declare a State of Emergency for it. What I could do with a couple of billion!) Anyhoo, I get the house lookin' spiffy, call a friend, ask if I should wear white or black, whisk on make-up, tame the hair, secure one muffin in his room for "nap time." OK. I'm ready.

The reporter and camera man arrive, set up and I talk for about 30 minutes. You can see for yourself how much of that they used.

Here it is:

Oh well. I think this is why researchers and clinicians don't like the media.

Looking into the future (Part II)

Except for the frightening drop-off in clients last summer, I'm really happy with the development of my private practice. This May 1 I will have been seeing clients on my own for 2 years. Sometimes it's hard to believe! What started as a wish, turned into a little bit of hope, and then, almost like a miracle, it was a reality. It didn't happen without the support of a lot of people and some fortunate events (special thanks to ONO, Hiromi, Wilma, Joanna and Tim, and the Midwest Center for Sleep Medicine). And, most surprising to me is how new clients keep calling, without a whole lot of effort on my part. In other words, I haven't done that much marketing of my self/practice and have plenty of work!

It's good to be in a comfortable place and I have enjoyed that for the last few months. Being comfortable has allowed me to see how I can improve the good work I'm already doing. So I think this year is going to be mostly about "tweaking," with one goal to help me stretch a bit. There are a number of things I'm hoping to accomplish this year. They are:

1. Become an in-network provider for at least 3 more insurance carriers.

2. Improve my current handouts and create some new ones.

3. Locate some new furniture. In particular, I want to find a new desk. The one I have now is fine, except it takes up a lot of room. After making more space, I'd like to find two arm chairs that couples can sit in and turn to face each other when I want them to do some interaction. (I know -- sounds scary, huh? That's why a lot of people never go to therapy cuz they think the therapist will make them do something uncomfortable like.....talk. About a problem. With their spouse. Crazy!!)

4. Once I find the chairs and the new desk, I'll rearrange my office to create a new set-up. I need more seating because I'm seeing more families.

5. Go to a John Gottman training. He's researched couples for over 30 years. He's pretty much THE expert in the field.

6. Up-date and flesh-out my professional web site. It has been hanging in limbo for about 18 months now.

7. Get a professional photo taken and upload it to my Psychology Today listing, my AAMFT listing, and my web site.

8. Follow-through on a workshop idea I had this year. Because I have something of a specialty in this community (couples therapy), I think offering "relationship check-up" workshops (or some such thing) on a few weekends here and there is an option that couples who normally wouldn't go to therapy would be willing to do. This is the "stretch" goal.

Alrighty......let the tweaking begin!

Filth

It will sound pathetic, but I spent most of New Year's Eve cleaning the carpet in my office. It had seen two years of foot traffic, and the dirt from the shoes of clients (and myself), was ground in. It literally took 2 1/2 hours to get it "clean enough."

While I was soaking the rug with cleaning solution and then sucking it up with the steam vac, I thought about my clients....who I had seen this year, who I had said good bye to, who should be done, who had a ways to go (all my opinion, of course). I guess I was doing a year end accounting of my work.

Each time I emptied out the dirty water, I was appalled at the amount of filth that had been in the rug. My metaphoric brain played with that, thinking about the "filth" that had been in my office. Now before you get upset, I don't mean that any of my clients are "filth." I really don't think anyone is "filth." But many of the things clients bring in with them would definitely fit the definition of filth. The cruelty, humiliation, abuse (in all its depraved forms), and injustice suffered by my clients appalls me. Sometimes they, in turn, have been cruel, abusive and unjust. But I believe they want that to change.....at least many of them. I think most, if not all, come in because they are trying to find some comfort, some healing, trying to get just a little relief from the heavy burdens of pain they drag around with them. When I open my door to greet the next client, I could say "Come on in -- take a load off!" What I often want to do is cut the ropes that bind them to their burdens, like the South American Indian did for the Robert De Niro character in The Mission. But that's not how I see my job. (BTW, if you haven't seen that movie, I HIGHLY recommend it.)

So, they come in, they talk, and they leave. They leave behind some of their filth, in my rug and in my "space." Last night was a literal and symbolic cleansing of my professional space. I resolve to do that more than once every two years.

Two things you can always count on

Last Friday I went to a symposium at the University of Chicago. My colleagues/friends/landlords (not in that order) Tim and Joanna made up the three-some and we cleverly called it a "retreat" because we planned to have dinner together afterward. The symposium was an oral festschrift for one of the biggest scholars/clinicians in my field -- a woman who studies, writes about and incorporates into her practice spirituality, diversity and family resiliency. This sounded like something we'd be willing to shell out $120 plus traveling expenses and loss of a day's income for.

When we got to the campus and walked the short distance to the School of Social Service Administration, I was briefly charmed by the stately, gothic buildings and all the young, mostly bright faces of students hurrying to class. There is something magnetic about a university campus, especially an old, rich, famous university like U of C. Sometimes, just every now and then, (pretty rarely actually), I see myself on a campus teaching again. This past Friday was one of those rare occasions.

But it only took 5 minutes into the first presentation for me to remember why I left academia in the first place......the rampant narcissism. Oh, and the agonizing tedium of the academic process of doing anything -- by committee and very slowly. The folks involved in this Symposium would make their academic mamas proud because the introducers of the presenters had introducers.

You read that right.....it went like this: there was a peon-type person in the field who introduced a middle tier person in the field who then introduced the big-whig speaker. Sadly, the 8 presentations themselves, with the exception of 1 or 2, were disappointing, with lots of droning on and on about "my study this" and "my study that." This goes to show that some things never change.

After 7 hours of sitting on a backless bench and trying to stay awake, we "retreated" uptown to Lincoln Park for a little S & P (shopping and people watching). Then we went a little further north for dinner at a new Italian restaurant called Il Fiasco (except for a red wine incident, it wasn't). The restaurant had been recommended by a friend of Joanna's and we weren't sure exactly where it was. As we looked for the address, I realized that we were in my old stomping grounds. My eyes widened and my jaw dropped as I took in all the changes that had taken place since I left the City 8 years ago. A trendy restaurant? In my old neighborhood?? And look at that new place! And THAT new place!! Those look really cool!

I probably sound like one of those people that thinks when they move the place they left becomes frozen in time, as a sort of memorial to their presence. I know that doesn't happen. It was just a lot of change in what seemed like a short time. So, along with my very pricey 6 CEUs, I brought home a lingering wistfulness for certain parts of an old life, but a bigger sense of gratefulness that things are always changing.

The Iceman Cometh

According to the calendar, today is officially the first day of fall and the autumnal equinox -- equal amounts of daylight and darkness. I pay close attention to these things, not because I'm a practicing Wiccan, but because I have a really, REALLY hard time during the winter. By DSM-IVtr criteria I could be diagnosed with SAD (seasonal affective disorder). Last winter was especially bad as it was the first time I have stayed at home, almost full-time, with two VERY little children. Stuck in the house with toddlers and poop for weeks on end.....can't imagine why I got depressed!

When Bethany and Carter were toddlers, I was a full-time graduate student and we lived in Athens, Georgia. It snowed twice in the six years that we lived there. The University of Georgia closed campus for two days even though the snow had all melted by noon of the first day. On New Year's Eve you could easily do all your reveling outside, so I really didn't have a problem with winter until we moved to northern Illinois in 1994.

I remember the first snowfall in DeKalb that winter. My colleague Beth and I stood at the window and watched the fluffy, soft flakes floating down. She'd graduated from UGA too and asked me if I thought we better get to the store and stock up on provisions in case we got snowed in. Looking back now, that's pretty funny as DeKalb knows how to handle it's snow. Compared to UGA, Northern Illinois University only closed campus once in the six years I was there, not because of snow fall, but because it was so cold the gas lines on the university buses froze and couldn't transport students around campus. If you think about it, it has to be pret-ty damn cold to freeze gas lines.

That first winter was kind of fun because Christmas really felt like Christmas, and I got to buy a winter coat that was all white with gray fur around the hood -- it made me feel like one of those Russian models. But the first "spring" (if you want to call it that) just about killed me. In my mind, spring kicks in sometime in late March, early April. In northern Illinois, the week to ten days of spring usually arrive in late May, a little sheepishly like a party guest who couldn't decide whether or not to accept the invitation and then says "what the hell. I guess I'll go" and comes traipsing in when things are just starting to wrap up. The snow usually stopped in early April but the gray, cold drizzle went on and on and on. It went on forever. I can't remember a single commencement or Mother's Day that was warm and sunny.

Moving 150 miles south has certainly helped. There's a definite spring here with a gradual warming of temperatures, blooming of traditional spring flowers like tulips and daffodils, and sun. It helps. But for about the next six months I will still have to take my little blue pill once a day, exercise like a demon, and turn on all the lights, even the hideous fluorescent one in the kitchen, to keep me from killing myself or a family member (I'm being hyperbolic here....please don't call DCFS).

It could be a lot worse. I have a client who has one of the worst cases of SAD that I have ever seen, either personally or professionally. Besides Prozac and individual therapy with me, we have come up with a long, long list of tools and resources to help her get through the winter. They include aromatherapy, acupuncture, massage, yoga, mindfulness, cognitive restructuring, a light box, journaling, and exercise.

Working with her has been one of those personal/professional intersects that happens a lot in my line of work. In therapy-speak it's called an "interface issue" or for traditionally trained folks...."countertransference." It's one of those junctures where I wonder if I should self-disclose my personal experience with the same issue (I have with this client). At the very least I wonder about each of the tools to fight SAD and think about using them myself.

I think mindfulness would be one of the best tools for me right now. A couple of weeks ago I smelled that autumn smell in the air (you know the one) and found myself slipping down, down into a dark place. It didn't help that Bethany had just left home for a year and I missed her terribly (still do). I usually enjoy autumn so much but this year my mind keeps jumping ahead to the dead of winter. Mindfulness will help me stay with what's right in front of me, and enjoy it. But check back with my in January.

Do you people have any kids of your own???

As a therapist, I get lots of catalogs of resources and tools in the mail. I got one yesterday called Creative Therapy Store." Most of the products are designed to be used with kids. Here are some examples:

Exploring My Anger for ages 5-12

Peacetown: A Conflict Resolution Game for ages 7-12, (YAWN). Or the ever popular

Escape from Anger Island (for grades 1 to 5) that looks like a board game version of Survivor. Then there's

The Good Mourning Game

which looks like a game for Wiccan children , and

Teen Sense

which, honest to God, was designed for teens.....yes, 13 to 18 year olds! Come on!! Just look at that game board! Can you imagine any teenager with an IQ above 90 that would find that the least bit interesting?!

The designers and marketers of these games.....what are they thinking? Who ARE these people anyway?? It's scary to me that professionals would be so out of touch with what kids would find interesting.

Before I went into private practice I worked at the Youth Service Bureau in DeKalb, Illinois which serves kids 8-18 and their families. There was a pair of brothers that Paul (another therapist at YSB) and I worked with. These boys, who were 8 and 10 at the time, were in foster care because their mom was an alcoholic and their dad had been murdered. You might say they'd seen a lot in their short lives.

Paul and I worked really hard to come up with ways to connect with them and find things to do during the sessions that would keep them busy and would get them talking. YSB had an activity/ supply closet so we went in there and grabbed a bunch of stuff -- cool little fiddly toys, balls with suction cups that would stick to the wall and then "walk" down it, etc. We put the stuff in a bucket and presented it to them as the "Bucket o' Fun." I knew it was sort of cheesy but I was trying to be light and playful. The 10 year old, without missing a beat, says "looks more like the Bucket o' Dumb."

It's a good thing we didn't come in with the "Imagine" game (for ages 6 and up) or this "magical, wand-wielding wizard" that Creative Therapy Store promises will bring "Imagine" to life.














Are these people serious?? The really crazy thing is that these games typically cost $50 or more! That wizard scares me. He's worse than the Chucky doll.