Clinically Speaking is a blog that will allow anyone to learn about Social Work, case presentations in psychotherapy, and the relationship of pop culture in psychology. Come one...come all!!!

Monday, January 30, 2012

Technology and PTSD

Over the course of the last 5 years technology and the growth of social networking have cluttered our mental inbox's. We often think about technology with what we see; whether it is time for a new smartphone, or new flat screen TV. Technology has made leaps and bounds allowing those people who otherwise would not be able to learn; obtain information on a myriad of different topics right at their finger tips.

The mental health field has started to give more attention to how professionals and those seeking help could make appropriate use of technology and theInternet. In my research for this blog post, I came across two articles that were published by the National Institute of Mental Health(NIMH) in 2007 and 2008 on how the usage of technology is helping treat veterans coming back from Iraq and Afghanistan with Post-traumatic Stress Disorder(PTSD).

In the 2008 NIMH article, it explained how using technology specifically virtual reality exposure therapy it has helped veterans in reduce the war veterans "acoustic startle — the reflex response to sudden loud sounds". The article goes on to say that "PTSD, exposure therapy usually involves going over the memory of the traumatic event until it becomes less scary to think about and the physical and emotional responses to it diminish." It is a type of flooding which is used in therapy to help patients cope and over come a variety of anxiety disorders. These techniques are still being tweaked and modified but has found success with the veteran populations to date. According to in there June 2011 issue reported that Andrea Webb, who is a psycho-physiologist at Draper Laboratory has been trying "to take data from the sensors and create algorithms to reliably detect who has PTSD. "

I mean that is seriously cool right?

Similarly, in 2007 the NIMH conducted a study that showed the use of Internet based Cognitive Behavioral Therapy (CBT) was a more practical and effective form of treatment than face-to-face interventions. Due to the stigma that comes along with therapy and the lack of resources and cost it may be a more viable option to some.

As technology continues to be part of our lives, we simply need to take stock of how we can benefit from technology other than getting our emails and texts to our fingertips. The achievements have been great, but we need to continue in looking for new ways to help better the lives of those who suffer from mental illness.

Here are the links to those articles!

Have a Super Monday start to your Super Week!!!!

Friday, January 27, 2012

Be Afraid....Be Very Afraid!

Today was a busy day but I didn't want to neglect my readers so here is a shorty but a goody.

The classic saying "you have nothing to fear, but fear itself" may not just be a cliche and may actually hold scientific water. I came across an article New York Magazine blog about fear and anxiety their correlation. Over the weekend if you have literally 3 minutes take a look at this article. It is a quick read and interesting. There is a chance that the topic of fear and anxiety will come up next week in the blog so this would be a good precursor to that. Copy and paste the link.

Have a great day and rested weekend!
PS-If any of you are a bit more tech savvy then me and you could help me correct as to why when I copy and paste a link, it doesn't show it on the blog as a link but just a website address that would be most helpful to me and the other readers!

Thursday, January 26, 2012

Misconceptions in Psychology

Often I will hear on TV and movies and even talking with your friends: "holy cow that guy is so schizo...or she has so many personalities its like she is bipolar". It gives me, and I'm sure other mental health professionals a nice laugh when we hear this. Though after my initial amusement, you can usually hear me yelling at the TV saying "stop being ignorant Hollywood you're using it wrong!!!" So I thought, maybe this would be a good time to explain the misconceptions or stereotypes of certain mental health disorders. There aren't too many people who confuse so many of the disorders (mainly because there are over 300 mental disorders listed in the DSM-IV-TR), but I think the following three are the ones many people misuse: Schizophrenia, Bipolar Disorder and Obsessive Compulsive Disorder (OCD). So here we go!

Schizophrenia: Schizophrenia is a chronic, more or less debilitating illness characterized by perturbations in cognition, affect and behavior, all of which have a bizarre aspect.Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated): Delusions, hallucinations, disorganized speech (e.g., frequent derailment or incoherence), grossly, disorganized or catatonic behavior, negative symptoms. I think people get it confused with Dissociative Identity Disorder(DID), formerly known as Multiple Personality Disorder. I have heard people use their understanding of DID, but tag it as Schizophrenia. They couldn't be more wrong. As stated, none of the symptoms above show any part of a person displaying other personalities Delusions, hallucinations, slurred speech...yes. An adult male thinking he has another personality but in a child version of himself...No.

Bipolar Disorder
: Bipolar is characterized by having significant mood changes that last from weeks to months at a time. Patients will experience at least one manic episode where the mood is an elevated one; followed by a period of normalcy or balance for at least two months before an onset of a major depressive episode. These mood changes cannot be due to schizophrenia, schizoaffective disorder, psychotic disorder or delusion disorder. I have also heard people refer to bipolar as "that guy is seriously delusional at times-he must be bipolar or something". Clearly, he will not have those symptoms if he is Bipolar. I always think about Bipolar being similar to a pendulum swing on speed(manic episodes) and on weed(depressive episodes). The above definition makes it very clear how it is not like any of disorder in the DSM-IV-TR.

Obsessive Compulsive Disorder
: is an anxiety characterized by complaints of persistent or repetitive thoughts (obsessions) or behaviors (compulsions). The person feels compelled to continue despite an awareness that the thoughts or behaviors may be excessive or inappropriate, and feels distress if they stop them. In response to their obsessions, most people with OCD resort to repetitive behaviors called compulsions. I am guilty of using OCD incorrectly at times myself. For instance, I like to make sure my apartment and my desk at work(even my lunch) is neat, not so much as in clean, but that if I have piles of papers at least they are in a neat pile on the table, so those of you who don't know me, I usually say "I am OCD about neatness". If you read the above definition, I don't really have OCD. If my apartment or desk aren't clean, but I need to take care of something, I will be able to put off making it neat until I come home or finish the task. My day can continue without me being able to make my desk or apartment neat. Those who suffer from OCD will be unable to move onto other tasks and their daily life unless they are able to complete their compulsions which will help combat their anxieties displayed by their obsessions.

I hope today's post gave you a little insight, and hopefully helped you in how you use these terminologies in your everyday vernacular...

Have a fantastic day!

Wednesday, January 25, 2012

I am amazing...or am I just good?

For years psychologist have researched how some one builds self-esteem, is it innate, or it plain old ego? A classic question that reporters love to ask athletes or business start-ups are: How did you know what you have was special? Rightfully so, it is a question I think people ask themselves all the time, not just those who have been able to accomplish alot of things. Is it self-esteem? will? Their ego to say to themselves "I am awesome and this will work out" when it might actually be a total failure? C'mon Vamans!

In a recent article in Psychology Today, Harriet Brown reported that according to Joanne Wood, a professor of psychology at the University of Waterloo in Ontario, set out to test the notion that affirmations and other such self-talk make people feel better about themselves. The subjects in her study who started out with high self-esteem did report feeling a little better after engaging in positive self-talk. But those with low self-esteem—the very people you'd expect to use such techniques—felt worse. This means that those with already good self-esteem don't really need external stimuli to feel good about themselves, they always will feel good about themselves. Conversely, those who didn't have good self-esteem may be trying to find external stimuli to feel good...but that may not work.

Which returns us to our question: Are you born with self-esteem? or it not self-esteem, it's ego?
Ego and the notion of being overconfident has always been associated as negative trait we all say "oh that guy is so egotistical" or sports analyst say "its really important that they are confident but not overly confident because on any given Sunday etc." Yet, recent research has shown that when someone is over-confident in their abilities they will more often than not be successful in that area. The University of Edinburgh found that "overconfidence actually beats accurate assessments in a wide variety of situations, be it sport, business or even war...overconfidence frequently brings rewards, as long as spoils of conflict are sufficiently large compared with the costs of competing for them."

There is so much more research and this is only the tip of the iceberg, but I'd like to suggest, that there is a fine line between ego and self-esteem. Neither of which can be learned, they are both innate. One can increase their self-esteem from good to great, but if it is not inherent within them I dont believe it can be obtained. When it involves the differentiation between self-esteem and ego that is something entirely different. Having good self-esteem does not mean you dont need assistance, it's the opposite. It means you are fully aware of what you're good and what you suck at. Ego, on the other hand is a false sense of inflated self-esteem. You may actually excel at something and it may help you, but you may also just think you excel at something and be detrimental to the task. When you are cognizant of this you wont be the guy or girl at work who people say "ugh that egoistical ass".

Have a splendid day!

Monday, January 23, 2012

Case Presentation: Jake B.

A very happy good morning to all NY Giant fans out there.

As discussed in the first posting, I will speak about cases that I read about or actual patients that I treat. There is no greater feeling in the world than vindication that the field you work in and the techniques you use are a truly successful with the patient and professionally. I had this recently when working with a patient.

**PLEASE NOTE: This posting is in accordance with HIPAA rules and regulations. There are various parts of this case that are changed to protect the identity of the patient. If you would like to learn more about HIPAA. Click the link.

Jake B. is a 15 year old Latino male, who was referred to me by an after school program. He reported "not feeling well and being really lazy with stuff". After making collateral contact with his medical physician to rule out any physiological problems, he and his parents decided entering into therapy would be the best solution. During the initial phase of treatment, Jake was displaying and reporting a lot different symptoms that would fit the criteria for a diagnosis of Dysthymic Disorder. According to the DSM(Diagnostic and Statistical Manual)-TR-IV, which is the bible of mental health that lists all the psychiatric disorders. When someone receives a diagnosis they must fit a certain amount of criteria for them to be clinically appropriate for the disorder. If it doesn't fulfill it a mental health professional cannot give the patient that diagnosis. DSM-IV-TR defines Dysthymia: As a chronic mood disorder with a duration of at least 2 years (1 year in adolescents and children). It is manifested as depressed mood for most of the day, occurring more days than not, and accompanied by at least 2 of the following symptoms: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration, difficulty making decisions, feelings of hopelessness.

The patient reported low energy, low self-esteem, and poor concentration, yet he was not having any of the other symptoms. I was therefore able to give him this diagnosis. As treatment progressed, I noticed that he while he was engaged during our therapy sessions, but his improvement was minimal, and then the patient said to me: "You see my hands? They are all dry and cracked, they bleed because they are so dry. "Shortly after Jake told me that he goes through a little bottle of purell hand sanitizer every two days. Jake went on to tell me about his excessive need to wash his hands after every activity regardless of whether the activity was "dirty" or not. After further assessment, it was clear that not only was Jake suffering from Dysthymia, but also Obsessive Compulsive Disorder aka OCD. The DSM gives a lengthy explanation for OCD, but in short when some has certain obsessive tendencies that they feel the need to act compulsively on those obsessions= OCD.

There is so much to talk about regarding OCD, but that will have to wait for different post. For the purpose of this post, Jake was suffering from it in the very classic sense. Not only the need to feel germ free but it was ritualistic which is also a very classic symptom of OCD. At this point, I felt that this may be the cause to a lot of his problems even the Dysthymia. There are various reasons why someone develops OCD, but a big factor is the need for control. When someone feels out of control or unable to achieve a short term goal, they often tend to look for ways they can gain control and this is can sometimes lead to OCD. When Jake is able to control and keep himself germ free it releases his anxious feelings for the moment and he able to move on. After telling Jake this he said "that makes perfect sense, I don't know where I am going to college, I don't have good relationship with my dad, and i am having girlfriend problems...I feel completely helpless."

When Jake and I realized all these different parts of his life which are unstable, we started to work on trying to take more control of the aspects of life he can. That became the focus of our treatment.

I am happy to say that 4 months later, Jake has decided on a college, re-established the relationship with his dad, decided the girl he was dating was not right for him, and only uses purell after using the bathroom. After taking control of his life, he has gained confidence, improved his self-esteem, and his energy level is age appropriate. While he still has poor concentration and has his good days and bad, he is not the same person I started seeing six months ago.

For those in the mental health field I hope this gives you chizuk that what we do is not always for nothing. For those doubters of the mental health profession, are you really still doubting this?

Have a very good GIANTS NFC CHAMPS MONDAY!!!

Wednesday, January 18, 2012

Do protesters and underdogs share the same psychological qaulities?

In another life, I am secretly a nerd(depends on who you ask, the wife says its not in another life, its the present life). I like to add some street cred to my nerdiness by subscribing to a fantastic magazine called Wired. In this month's issue of Wired, the cover story is titled "#Riot: Self-Organized, Hyper-Networked Revolts—Coming to a City Near You". The bulk of the article is to depict that in today's times you don't need to go door to door with your pamphlet saying "Give peace a chance join us at the park for a peace rally, man" like it was in the 60's, 70's or even 80's. With the emergence of social networks like Facebook, Twitter, Tumblr and fast text messaging like Blackberry Messenger aka BBM. You can organize a rally, protest or as the article refers it to a "mob" just by posting a time, place, date, and a reason. The "mobs" in recent months have become less peaceful and more violent than ever before. Why? Why have they become violent?

Clifford Stott, senior lecturer in social psychology at the University of Liverpool, points out that "Based on a set of ideas that he and other social psychologists call ESIM (Elaborated Social Identity Model)." Which means that "crowds form what are essentially shared identities, which evolve as the situation changes". As a mob or protest becomes larger in numbers so does the intensity of the cause and the mood. Gives new meaning to strength in numbers doesn't it?

Later in the article, Stott gives two reasons for crowds potentiality for violence. The first, legitimacy "in combustible situations, the shared identity of a crowd is really about legitimacy, since individuals usually start out with different attitudes toward the police but then are steered toward greater unanimity by what they see and hear." The second, power,"the perception within a crowd that it has the ability to do what it wants, to take to the streets without fear of punishment." I read on and finished the article and that was that.

As anyone who knows me can tell you that I am a very big New York Giant fan(during a game I broke one of my daughters dolls...its was last years phili/giant game), I was pumped and nervous for the game yet it was 5 hours later, so I sat down at the kitchen table and happen to open a news article from Newsday called "Being the underdog has its advantages". I started reading about what the underdog means for teams, not from a historical standpoint who have nothing to lose and end up winning, but rather much to my surprise and delight, from a psychological and physiological outlook. According to Dr. Jack Bowman of says "when you engage the underdog position, it automatically gives you a psychological and physiological advantage...these are some very powerful psychological effects that they're engaging here. This is stuff that actually gets the job done." Dr. Bowman goes on to say that "When you are in the underdog position, it activates a perceived lack of pressure...studies show underdogs produce a different type of hormone that gives them a "positive energy" as opposed to anxiety-causing adrenaline." Article later talks about the coach and others in history played the underdog card perfectly and you cannot self-proclaim yourself "underdog".

After finishing this article in Newsday and the previous article in Wired, I think one could make the correlation between the psychology of "mobs" and "underdogs". As mentioned above mobs rely on shared identities which evolve as the situation changes and power of the crowd. If you take a look at underdogs in sports, teams (in general) have a shared identity, but a team that is the underdog evolves(when they are not picked to win) which gives them power or "positive energy" to often achieve the unlikely. Furthermore, I don't think it is a stretch to say that the "having nothing to lose" mentality is consistent with the mob mentality of acting "without fear of punishment".

Whether you agree with mobs, or the idea of an underdog. One overall constant remains, there is obvious strength in numbers, for better or worse. Goals can be achieved more efficiently when people work together. As cliche as it sounds the idea of "two heads are better than one" are evident in various outlets in the social construct from mobs to underdogs.

As a great team once said "Ducks fly together"

Last post, the link didn't work. Lets hope these links work. For the full articles click on the links below.

Sorry there was no post yesterday. I hope this makes up for it!

Have a great day!

Tuesday, January 17, 2012

Therapists=Handy Men/Women

If you are a therapist, you will hear at least once a day "Can you fix my child?" or "You need to help fix me". I didn't realize I was a handy man, apparently I have Masters in Tools or Construction...(do they even give such degrees out?)

So I ask, Why is it that so many people come with this question and desire to be fixed?

For those who ask, they must believe that something is wrong, because if ain't broke they wont fix it. More often than not, the individual is referring someone else to get the fixing, they aren't seeking help for them self, but rather a child, a spouse, a mother-never for them self.

Maybe they should...

In a interesting article written by Michael J. Formica in Psychology Today, he talks about expectations of the world and ways you can free yourself of certain pitfalls that lead you to misguidance. He lists 5 different ways to avoid these pitfalls, but I found that the most poignant point was "Check Your Premise" as he writes:

"Checking your premise means taking a hard look at whether
or not what you believe actually matches with reality.
Neurosis is often touted as doing something over and over
again expecting it to change. The belief system version
of that is a sort of frozen world view - "That's just how it is"
or "That's just the way I am". Taking a step back from a
consistently disappointing experience and looking at whether
or not we're starting from a realistic place will help us adjust
our perspective in such a way so as to more accurately match reality and get a potentially different outcome".

When someone comes in and says fix that about my son or fix my wife, yes that individual may have some deficiencies, but if you were to take a good look at yourself and the situation you will realize that it takes two to tango, something that you are doing or not doing is causing and may be exacerbating the issue at hand. Again, the person who is need of therapy may need it, but it may be that they are not the only one who needs it and it could be beneficial for the referring person to get help as well. When you self -assess you will realize that maybe I didn't handle the situation in the right way, or maybe I could have said something different, or maybe use a different tone. It will really open your eyes to a whole new perspective of the person you are dealing with who "needs to be fixed".

Getting fixed isn't like bringing your car to the shop and have the mechanic say "Ok I know that this car needs some new brake pads and needs the tranny needs to be fixed, pick it up on Tuesday"(thank you Marissa Tomei). It is more like being a farmer, you need constantly rake, plow, hoe, plant, seed, harvest until you have the perfect produce. Therapy is the same. Coming for therapy, working on the issues, utilizing the skills learned in session, it may take months could be years, but it certainly is not done by pointing fingers and no effort or work on the part of the client/patient. As therapist, we are assistants in your endeavor to correct certain habits or behaviors, we in no way shape or form do WE fix you, YOU fix you!

To read the full article from Michael J. Formica, Click the link!

Have a Great day!

Monday, January 16, 2012

Welcome to Clinically Speaking!

I guess it would be appropriate to begin with who I am and why should you read this. Here goes, I am Yehudah E. Schochet and I obtained my Masters in Social Work from New York University, I am LMSW/LSW(Social Worker) in NYS and NJ. I am currently a psychotherapist in NY and NJ. I primarily see adolescents and couples, but do treat patients from all demographics. I decided to start this blog because whether family members or friends, I often get asked "so what do you actually do?" or "so what do you think about this, your a therapist right?" I think there is a lot of misinformation regarding the world of social work and psychology that people might think they know but really have no clue. This blog will hopefully enlighten some of you regarding treatment of those with psychiatric illness, interesting articles on mental health, how psychology is pretty much everywhere you look from sports, to politics, to TV and movies. Even though what i just wrote looks super boring. If you want to fill 5 minutes of your day at work when your bored (lets be honest folks...some of you are bored for at least 5 minutes a day) I promise to make it as easy and entertaining to read as possible. I will very often link articles, interviews with professionals and here and there some video posts. If you like what you read and think there is something missing. I will do my best to incorporate it into a blog.

The question I get the most is "What is the difference between a social worker, psychologist and a psychiatrist?"

The pay! I'm just kidding (No but seriously there is a difference). Here's the breakdown:

Nowadays psychiatrist, are Medical Doctors (M.D.) with a specialty in psychiatry. Much like an Oncologist. They have an MD and is specialized in cancer treatment. I specifically said "Nowadays" because back 20-30 years ago, psychiatrists would get additional training in talk therapy and psychotherapy techniques. Since the field of psychology and social work had risen most them became medication dispensers (kind of like a gum ball machine-you put a quarter in the machine and pop out a gum ball. In this case you put in $300 he pops out your drug of choice and see you when you don't feel happy or hyperactive again...Bon Voyage!). Don't get me wrong they are needed to dispense medication to those who need it.

Here's where it gets tricky...
Psychologist: There are two degrees given out in psychology: One: Ph.D. in Psychology and Two: Psy.D- Doctorate in Psychology. If you obtain a Ph.D. you have been in school for seven years and generally will have a focus on more intensified research curriculum. If you obtain a Psy.D. you have five years of school which will focus on clinical training in multiple disciplines of psychotherapy. Whether you are in a Ph.D. program or Psy. D. program they are taught to look at the individual and how they are effected by biological and environmental changes. They will also train in testing of all kinds. They tend not to work in social service settings, but can. Many if not in private practice work in academia and hospital settings.
Social Work: Social Worker will have two years of schooling before earning the MSW degree. We are trained to look at each individual in their environment(i.e. social and economic) . Not only look at what is going on with the particular person but external factors that contribute to how this person will or wont react to presenting problem. Social worker also tend to be the chameleons of the social service world. We are not only trained as psychotherapist, but we also will work with homeless, poverty stricken populations, as well as mental health issues in hospitals. With a certain amount experience a social worker can open up a private therapy practice, which they can bill insurances for. It is a field that is very flexible and allows anyone who has an MSW to do a lot of different things professionally. There are those who continue their education and obtain a Ph.D. in Social Work or D.S.W.-Doctorate of Social Work(not the shoe store) . One obtains these degrees to either teach in universities or research (or to be called Dr. c'mon be honest)

Ok, so really whats the real practical difference enough of my "Jibba Jabba"as mister T says:
Psychiatrist=Gum Ball Machines
Psychologist=Therapists and researchers.
Social Worker=Therapists and social service workhorses.

Psychologist and Social Workers will use the same principles in treatment, diagnosing, assessment. They both can diagnose, and they can both have private practices and bill insurance if they so choose.

I hope this helps...i promise it wont be as long next post.
Have a good day!!