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, February 27, 2012

Class is in session...

Today's post will be a precursor to upcoming posts. Today's discussion: Post Traumatic Stress Disorder or PTSD. This disorder is under the scope of what the DSM-IV-TR label's as an Anxiety Disorder.  Within the next couple of days the blog will talk about PTSD and our veterans. I thought it would be a good idea to get some background on the disorder. Please click see the full list of Anxiety Disorders and definitions that are in accordance with the DSM-IV-TR: Anxiety Disorders from the Cleveland Clinic.

Pencil's ready? Begin!

Post Traumatic Stress Disorder(PTSD): 
The person has been exposed to a traumatic event in which both of the following were present: 
1) A person experienced, witnessed, or was confronted with an event that involved actual or threatened death or serious injury or a threat to the physical integrity of others.
2) A person's response involved intense fear, helplessness, or horror.
The traumatic event is persistently re-experienced in at least one of the following ways:
1) Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.
2) Recurrent distressing dreams of the event.
3) Acting or feeling as if the traumatic event were recurring, including a sense of reliving the experience, illusions, hallucinations, and flashback episodes.
4) Intense psychological distress at exposure to cues that symbolize an aspect of the traumatic event.
5) Physiologic reactivity on exposure to cues that symbolize or resemble an aspect of the traumatic event.
Duration of the disturbance is more than 1 month. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Interestingly, very often certain disorders, one would need at least 2 or more characteristics for the person to meet criteria for a diagnosis. Yet, with PTSD one would only need to have one "persistently re-experience" . There are additional symptoms that go along with having PTSD, which can be read as mentioned above. I am sure you are thinking "oh I definitely have PTSD, I have had traumatic experiences". No doubt, but the game changer is that true PTSD is having those symptoms for at least a month. Duration plays a big role in having PTSD, as well as any of the Anxiety disorder.

DDx(Differential Diagnosis): Acute Stress Disorder: Which has many of the same characteristics as PTSD, but with one caveat....any guesses? If you Comment, or tweet, or email me the right answer. You can pick the next topic for the blog?(Exciting right? lol)

If you do feel that you may be experiencing any of these symptoms you can take this online questionnaire to determine if you should contact a professional. Click PTSD Questionnaire to complete it.

Twitter: @Clinicallyspkng

Class is dismissed!

Thursday, February 23, 2012

Case Presentation: Jack and Jill

Hey sorry for the recent lack of posts. I thought today would be a good day for a case presentation. Jack and Jill...

**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. Click here to learn more about HIPAA

Presenting Problem: Improve parenting skills.
Jack, a 40 y/o and Jill, a 39 y/o Caucasian couple who have been married for 15 years. They have 5 children ranging in ages of 14-5. When they entered therapy they wanted help to improve their parenting skills at home with their children. Jill reported "they sometimes just don't listen, when they don't listen I get angry and frustrated, and the kids start screaming and becoming slightly out of control". Jack reported "Its hard for my wife, often I am not home, so when I am home I might be a little more forceful, and then all the kids yell". It was clear from the beginning that Jack and Jill  needed to establish more effective ways in harnessing their frustration and anger. When they are able to do that, they will be in more control to parent more effectively. As a clinician though, I wanted to be able to understand how they as a married couple relate to each other. Jill reported "well overall I think we have a good marriage, but there are times when I feel we don't talk enough and when I need him he isn't there, whether he is working or doing charity work". Jack reported "I agree, but I think she down played when she gets angry and frustrated, she could explode in a matter of seconds".  What was clear after a further exploration was that the root of the problem was not necessarily due to the children not behaving and becoming out of control, but rather in the manner they become out of control. 

When it comes to parenting a large part of behaviors that children learn are adaptive from the parents, aka Modeling.  Both Jack and Jill were able to admit that they have spouse-to-spouse anger management problems. When the children see that this is how mommy and daddy act when they get mad, they interrupt that, as a productive or accepted manner to react, which obviously it is not. Myself and the couple decided to first work on better ways to, as I like to call "bringing the boiling point down". Meaning, it is unnatural to never get angry, but if your boiling point of anger before even becoming angry is at 100 degrees one can "explode" in anger in a matter of seconds. However, if you are able to bring that starting off point down, your tolerance and propensity for "high conflict situations" will be a lot more tolerable and calm which will allow a person to think more rational. 

How does one bring that point down? When it comes to a couple, it is very simple:Reliance/Trust and Communication.
Reliance/Trust: You need to be able to rely and trust your partner that they can step in when you feel that you are becoming angry and frustrated. 
Communication: is actually saying to your partner "I am becoming frustrated and angry, please help me". 

When these steps are implemented, being able to combat your anger and lower your boiling point to handle these situation will be easier. 

Fast fwd 3 months later: Jack and Jill reported to decrease their anger, how they relate when angry to each other and Jill reported "I started to see a real difference in the way i react to the children and how they are reacting to us at home". Jack reported "I feel myself not being as angry went the kids are going at it, which is good". 

Trust and Good communication can solve a lot of relationship issues. Jack and Jill were able to correct how to better model for their children by understanding and implementing these principals to help their won weaknesses.   
Trust and Good communication are the foundation of a good relationship, but if the foundation is made on quicksand you could never build a house.

On the horizon for the blog:
-PTSD and our veterans
-Bullying and Teens 
-...More Psychology 101.

Happy Thursday!

Thursday, February 16, 2012

They fight for us...sadly they cant fight for themselves

Whether you are mental health professional or someone who follows our wars, hopefully you have been made aware of the ever increasing problem of our veterans not given the proper mental health care. In the past 5 years, mental health problems increased by 20% due to some sort of traumatic brain injury. President Obama as well as his predecessor had tried to combat(excuse the pun) these problem that veterans are encountering. Obviously they cannot protect our troops while in active duty, but they can implement less bureaucratic steps for when they return home to get proper mental health treatment.

Check out this story written by Lena Groeger, in June 2011 called, Veterans Die Facing Mountains of Red Tape . It isn't a long article, it is just the tip of the iceberg of what these veterans are going through when returning home from Iraq and Afghanistan.

Please comment and continue to vote!
We're almost there soon it will be TGIF...Till then hang in there!!!

Wednesday, February 15, 2012

Let me hear ya!

It has been about a month since the inception of this blog. We have spoken about a lot of different issues from understanding disorders, Facebook and it's effects on people with mental illness, to case presentations. I am the one who posts, but now I want to know from my readers what they want to see more of or less of. If you have 20 seconds to take the poll below that would fantastic! Leave comments and sound off. I want to "foster the people" into enjoying social work and psychology!!!

Thank you again for reading, keeping reading and spread the word!!!
Have great hump day!

Tuesday, February 14, 2012

Religion, Spirituality and Psychology Part 3

In this final installment of Religion, Spirituality and Psychology. I had the honor and pleasure to speak with Rabbi Simcha Feuerman, LCSW-R. He is a Rabbi in the community as well as Clinical Social Worker who operates a private practice in New York. He was able to answer a few questions on this topic which could give us a small perspective of how mental health is being view within the community.

CS: Hi Simcha, Thank you so much for letting me pick your brain about this topic.
SF: Sure, no problem happy to do it.

CS: How or Has the view of mental illness changed in the recent years in the Jewish community?
SF: For many, stigma has been reduced and there is a realization that psychotherapy and mental health treatment is an important tool. Of course, there are still many people that feel going to therapy is for "crazy" people, or fear that the therapist’s ideas, values and beliefs will contaminate the patient with ideas that are against the client’s
religious view.

CS: Do you find that people who are willing to enter therapy would like to see a therapist who is also a member of the clergy?
SF: There is a small percentage who feel that way. Some of them expect a blend of psychology and religious counseling. Personally, I stay away from that. I inform the clients that because of my rabbinic training and religious sensitivity I am more likely to understand some of their challenges, with greater nuance. At times, when psychosocial concerns intersect with genuine religious conflicts, I encourage them to seek out separate religious counsel if that will help them move forward. I have a warm and respectful relationship with various clergy persons of my clients, in situations where the client has asked that we work together.

CS: Do you find that religion exacerbates some mental illness? more specifically OCD?
SF: Actually, I have heard studies that indicate people who are religious are less likely to suffer from OCD. Perhaps this is due to the comforting boundaries and containment that a fulfilling a meaningful religious life offers to some. People may feel that religion exacerbates OCD because some OCD symptoms will manifest themselves through religious ritual. However, there are many non-religious people who obsess over whether the door is locked, germs etc.

Does the use of CBT or Psychoanalysis ever become inconsistent with religious practices?
SF: Certain interventions may involve confrontation, paradoxical work and exposure/desensitization to various behaviors. If the behavior itself is forbidden by religious practice, the cure may involve initially engaging in the behavior purposefully, or in psychoanalytic work especially regarding forbidden thoughts such as heresy or lust, it may involve a degree of open ended exploration and dis inhibiting, which may be a problem for some religious people. I share with my clients what I believe could help, based on previous experience. If they feel it is in conflict with their religion, I encourage them to consult with their clergy person and also make myself available to the clergy person if clarification is needed.

Bottom line...Religion and Spirituality have it's place in psychology and therapy, but it has to be harnessed and used appropriately in order for it to be an asset to each person in their situation.
If you would like to contact Rabbi Simcha Feuerman, he can be reach via email at . You can also read his column every week in the Jewish Press.

Have an inspired Tuesday!

Monday, February 13, 2012

Religion, Spirituality and Psychology Part 2

In continuing with Religion, Spirituality and Psychology, today's post will be focused on the role of Spirituality and Psychology. In regards to the previous post, there was little literature on the psychological effects of religion and psychology. However, there was a bit more didactic literature of spirituality and psychology on the web. Everybody in their yoga positions?

Spirituality and Psychology

As mentioned above, there is not too much concrete information on the effects of spirituality that I was able to obtain, although there is a lot that can be said about the interconnection of therapy and spirituality. Dr. Stephen Diamond wrote an article in
Psychology Today, The Psychology of Spirituality, stated that "...psychotherapy, when properly practiced, is an inherently spiritual venture. Understanding the psychology of spirituality is of tremendous importance to psychotherapy today. In the final analysis, the task of both psychotherapy and spirituality is to accept and redeem rather than avoid, deny, cast out, eradicate or exorcise our devils and demons. By bravely facing our inner "demons"--symbolizing those scary, shameful, primitive, uncivilized, irrational, unconscious complexes, emotions, passions and tendencies we most fear, flee from, and hence, are obsessed or haunted by--we transmute them into helpful spiritual allies." I find this to be so poignant and true, especially with those who consider themselves spiritual. For those who do consider them self spiritual, one could say you have a mini therapy session everyday whether in prayer or meditation with your God.

I found a short video from the 1970's I believe that interviewed a Frances Vaughan, Ph.D. who is a psychologist, educator and author of books, chapters and articles on psychology and spirituality. Its not that long and if you have 4:15 to spare.

Take a look.

I don't think we will ever truly understand spirituality's place in psychology, mainly because I don't think we will fully understand spirituality as a whole. It may be interesting to make a mental note of how we all view spirituality in our own lives a bit differently but at the same time, quite similarly...

Part III-I interviewed Rabbi Simcha Feuerman, LCSW-R, who is a Rabbi as well as a private practitioner in New York. We will talk to him about Religion and its role in mental health and psychotherapy. Stay tuned...

Have a good one(or two or even three)


Thursday, February 9, 2012

Religion, Spirituality and Psychology Part 1

In the next few post we will be examining the role of religion and spirituality in psychology and psychotherapy. This post will first examine the religion and its place in psychology. The following post will examine spirituality. The final post will be an interview with a psychotherapist who is also a member of the clergy to talk about areas of psychology, psychotherapy and religion.

I am sure you are asking yourself, what is the difference between religion and spirituality? I think a lot of people may think they are one in the same. Religion, is organized and has set rules and practices. Spirituality I believe is described most appropriately by the Black Eyed Peas: "I got a feeling..." Spirituality isn't bound by the same set of rules that religion is. Spirituality is more of an emotional identity attached to a belief.

Religion and Psychology
Through my research for this blog post, there is little proven research based psychological methods used within psychotherapy or psychology. The only known statistic I was able to obtain was a study done by Smith, MacCullough, and Poll. (2003). Religiousness and Depression. Psychological Bulletin, reported in Does Religion Make People Happier? stated that: "According to a 2003 meta analysis (2) that combined the results of 147 different studies, religiosity explains less than 1% of the differences in vulnerability to depression. If religion has such small correlations with depression, it may not be a huge factor in happiness either."

Otherwise all other known correlation of religion and psychology have purely been related to social psychology themes. Which means that religion plays a role in social psychology with being a part of something bigger, advantages in social support system, it is also used as a coping skill to relieve anxiety, as well as improving social skills with peers.

Part II will be a bit more substantial but this should hold you over.

You can follow me on twitter @clinicallyspkng or email me at

Have a good Thursday!

Monday, February 6, 2012

Superbowl Psychology Part 2

And a very happy good day to all NY GIANT FANS on their Superbowl 46 Win!! Last post, I wrote about the negative effects of watching the SuperBowl and everything involved, in part two, we will see the potential positive side effects of the SuperBowl. Though through my research for this post, I did not find any publications on the web or otherwise any documented research on positive effects of the Superbowl. So I am going to fly this post solo... There were a few social psychology themes that came to mind when I looked around the room at my Superbowl party and sports in general.

1-My first overall thought was the idea and notion of unity and comradery. Sports has this unique way of bringing people together. Often it breaks ethnic and racial barriers, doesn't matter if you're Black, White, Latino, Asian, it brings us together. They say that food is the international language, but I think you can throw sports and particularly football as the national language. You may be not interested in the least about the game, but in the atmosphere you almost certain to swept up in the feeling. There is strength in numbers and sometimes that leads to good and bad reactions.

2-Feelings. I think the best and the worst of people come out when they are involved with sports. I see this as a fascinating idea because that means those who claim "they don't feel". Those emotions really come out when sports are involved, I have seen the most introverted of people become these emotional Juggernaut screaming at the TV. Furthermore, an array of emotions are exhibited during and after. I read that Greg Jones of the NY Giants proposed to his girlfriend after their Superbowl win, or Vernon Davis of the San Fransisco 49ers, scoring a winning touchdown to seal the 49ers into the NFC Championship game.

I think there is a lot we can learn about sports and how people handle themselves on and off the field and what could be the positive attributes of players and fans.

Enjoy this Win Big Blue fans!!!!


Friday, February 3, 2012

SuperBowl Psychology Part 1

Yes, I am huge huge New York Giants fan. Yes, if you ask my mother I cried when the Giants lost a 4pm game against the New Orleans Saints when I was in 8th grade. And yes, 4 years ago I was quoted saying: "Greatest Februrary of my life: 1-Giants won Superbowl 42, 2-Johan Santana was signed by the New York Mets, 3-I got married", Yes in the at order. And yes, last year during that infamous Giant/Eagle game I broke one of my daughters toys. This year...I almost took a running start punch at my father-in-law when he was talking too much during the Jets/Giants game I had DV-R'd and he knew the winner... Seriously huge Giants fan. Maybe too much...

Can the Superbowl give you physical or psychological ailment?

Physical Health:
Kelly McGonigal, Ph.D. wrote an article entitled When Your Home Team Wins The Super-Bowl, You Live Longer about how sports, specifically the Superbowl can be detrimental to your physical health, she writes: "Researchers at the Heart Institute, Good Samarian Hospital and Keck School of Medicine at USC in Los Angeles, have found that cardiovascular emergencies such as heart attacks increase significantly during and immediately following close games." She ends the article with "Hope your team wins". Lol...Thank you!

Psychological Health:

John M. Grohol wrote an article SuperBowl Sunday Domestic Violence & Your Health, reported: "On Super Bowl Sundays, compared to non-Super Bowl Sundays, Redelmeier & Stewart (2003) found a 41% relative increase in the average number of fatalities after the telecast on Super Bowl Sunday(in relation to behavioral problems and alcohol consumption)."

There clearly is some risk related to the Superbowl and in part 2 we will examine the positive effects of the Superbowl and psychology!

Have a great pre-Superbowl Friday!!!


Wednesday, February 1, 2012

Facebook...Hurting or Helping psychologically?

I have been really getting into how role of psychology has been intertwined with technology this past week. This is the reason for the last post and the current post.

I was watching a special on CNBC about Facebook and Mark Zuckerberg, more about the evolution since its inception and why it is so successful, but also the social and psychological dangers of it. I decided to dig a bit further whether Facebook and other social media outlets have psychological danger or was it just good fodder for the special. Turns out, there maybe some credence that Facebook could potentially be dangerous psychologically...but can it also help?

Dr. B.J. Fogg is a psychologist who studies online behavior at Stanford University, he was interviewed for the special and said that even though you may be able to connect to people who you haven't seen in 10 years, and re-established those connections, they are not connections which are strong ones, which in turn makes your current strong relationships weaker because of the amount of "friends" you have on Facebook, you will not be able to connect to all of them authentically.

As technology evolves, the necessity to call someone or meet face to face has become a "bother". We are more willing to "shoot you an email" or "send me a text". Facebook has created an artificial world that can even conduct business without even picking up a phone. According to Dr Aric Sigman reported by said:"this [lack of face-to-face contact] behavior can increase the risk of serious health, such as cancer, stroke, heart disease, and dementia (senility), thus by in The Biologist, the journal was released by The Institute of Biology...these sites do not become a tool that can improve the quality of life, but rather a tool that makes us the wrong direction." Meaning Facebook and social media should act as an enabler for your social life, not the actual social life.

So can Facebook and social media outlets help someone psychologically?

In an article written by Naomi Nix in today's Chicago Tribune, she reports on a college sophomore who posted on her Facebook wall that she wanted to commit suicide. She expected no response and "give up on it". Something very different happened, support for the girl from her Facebook friends and a call from an administrator of the college came to her aid. Happily, she was able to seek help and is now a junior in college. In the past two years as reported the American Psychological Association(APA) have set up a task force on how psychologist should use electronic communications professionally.

Dr. John M. Grohol, the founder of writes: "blaming Facebook or some other social networking site is simply trying to sweep students’ feelings of pain under the rug...If we stop them from posting, then they won’t be able to express these painful sentiments, and nobody else will commit suicide...Facebook is simply the conduit students are now using to express their feelings of loss, pain and remorse. Trying to cut it off is missing the point — that these students need an outlet."

I am torn. I am not going to lie. Obviously, there are always positives and negatives to pretty much everything in life. Does the positive outweigh the negative? Even though Facebook and Twitter are not new to the world, it is new to psychological and social construct outside of our computer. There is still more research that needs to take place in order for there to be a definitive answer on whether or not to "Like this" or "Dislike this". Wink.

Links to these articles for your viewing pleasure.,0,2988256.story

Sorry for the late post! Enjoy!