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An electronic circular of the Coalition's Center for Rehabilitation and Recovery
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No. 76, October 2011
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The Center for Rehabilitation and Recovery provides assistance
to the New York City mental health provider community through
expert trainings, focused technical assistance, evaluation,
information dissemination and special projects.
THE DIRECTOR’S NEW YORK MINUTE “DENIAL AIN’T JUST A RIVER IN EGYPT” By Courtenay M. Harding, PhD They say that there are only three things in Life which are certain: taxes, death and, ironically, …. change! Changes are happening in New York’s system of care so fast that it makes one’s head swim! One coping mechanism to reduce anxiety is to deny it all away and return to familiar ways of doing things. This strategy turns out to be a very helpful one when contemplating overwhelming changes New York is now facing. Besides, Albany keeps changing the dates of the upcoming changes! We say to ourselves: “I’ll believe it when I see it.” Well, folks, Health Homes and more Managed Care are indeed coming and they will change the way we do business. Denial has been in our own language since at least 1520, but people have practiced it since time immemorial. The dictionary has several definitions for it. First, “an assertion that something said, believed, alleged, etc., is false” as in the unfortunate and all too common occurrence of “The politician issued a denial of his opponent’s charges.” (1) A second definition is “refusal to believe a doctrine or theory” (1) or even empirical evidence to the contrary. I can attest to this version because it has taken over 50 years for people to start believing in the prospect of significant improvement and/or full recovery for people coping with schizophrenia and other serious and episodic disorders despite the worldwide evidence to the contrary and living examples walking among us. (2) The third and fourth definitions include “refusal to satisfy a claim, request, desire as well as the refusal to recognize or acknowledge or a disowning or disavowal.” (1) It seems that humans are well equipped to deny stuff. The Mayo Clinic cites the most common reasons for use of denial which is evoked by “anything that makes you feel vulnerable or threatens your sense of control, such as: a chronic or terminal illness, depression or other mental health conditions, addiction, financial problems, job difficulties, relationship conflicts, and traumatic events.”(3) Nearly everyone who writes about denial admits that, early on, a little bit can be very helpful and protective for people facing such challenges. The problem comes later when denial isn’t so useful and gets in the way of reality. In the Cardiac Intensive Care Unit, nurses found that they were actually killing patients fresh into a serious heart attack. Busy executives wanted their secretaries and a fax machine available; their iPhones and computers to continue their hectic lives. Taking their responsibilities seriously, nurses would explain how serious the heart attacks were and how lives had to be changed. Reality would come crashing in before people were ready to handle it, the adrenal glands would go into overdrive and people would have a second heart attack and die right then and there. Nurses learned to talk about the need for life changes after such patients were better enough to go to step-down units. However, anxiety levels among our participants in services are rapidly increasing as they read the news. Most all clinicians are aware of Elizabeth Kübler-Ross’s famous five steps for grief and loss: denial, anger, bargaining, depression, and finally acceptance or resignation.(4) We use these ideas for almost everything to describe processes our consumers go through to deal with the trauma in their lives. They go through the “no, not me!” stage; “the why me?” stage; “the if I do this, you’ll do that” stage; “it’s really happened - oh woe is me” stage; and lastly “the I’ll have to deal with this” stage. Now, it is our turn to face the new reality of operating in a new world. We will be thinking and behaving in new ways and it is time to get our heads out of the sand next to our fellow ostriches and face the oncoming situation. Resilience is the name of the game. We all have some and it is time to get it out of the closet and use it if we are going to survive in this newly emerging environment. At the very least, we must snap out of denial and get through the stages if we want to be of any help to our consumers of services. They are hearing snippets of the coming changes, which are very anxiety provoking on top of everything else they are coping with such as poverty, unemployment and mental illnesses. “Where will I get my care?” “Will they stop my medicine?” “Can I keep the person I have finally made a relationship with or must I find a new person?” “Help!” Staring the future, right in the face, will help us see what new skills we have to learn and practice. Securing as much information about the changes, and being able to roll with the punches, will help. This means talking with others, seeking out the resources and educating, oneself, will be useful. These challenges also mean that seeing friends, going to the movies, growing a plant, getting more sleep, eating better food, and more exercise…you know…all the advice we freely give to others, might be supportive to ourselves in the process. Our system is about to change again and we must change with it. References: “I Might Need That One Day!” By Susan Blayer
Photo credit: retrieved from the BU Hoarding Research Team website. I had a friend, let’s call her Casey, whose parents were hoarders. When she finally talked about the embarrassment of having others “discover the family secret,” she did not use the term “hoarding.” But there was an undeniable combination of sadness, bitterness and exhaustion in her sharing that made it clear to me that this was not a simple issue of her caretakers being lazy slobs. The Today Show aired a segment about children of hoarders which featured Dr. Randy Frost, Professor of Psychology at Smith College, who co- authored a book on the topic called, “Stuff: Compulsive Hoarding and the Meaning of Things. On the show and in the book, Frost echoes the sentiment of my friend, explaining “doorbell dread,” a common fear expressed by children in hoarding families of the shame and embarrassment which arises at the arrival of an unexpected guest. He added that the psychological damage is more pronounced for kids under the age of ten, who tend to avoid socialization with peers and often end up having conflicted relationships with their parents. (1) Currently, hoarding is only listed in the Diagnostic and Statistical Manual (DSM- IV-TR) as criteria for the diagnosis of Obsessive-Compulsive Personality Disorder, and when extreme, as a symptom of Obsessive-Compulsive Disorder (OCD). OCD is an anxiety disorder characterized by persistent, intrusive thoughts (obsessive) which create a feeling of nervousness and fear. The individual then attempts to alleviate these unwanted feelings by performing largely rigid and repetitive acts that are often excessive (compulsion). These actions are done in spite of the fact that they do not successfully address the source of the anxiety. (2) According to the International OCD Foundation website, “Hoarding Disorder” is being considered for inclusion as a distinct diagnosis in the DSM-V. The site experts (which include Dr. Frost and his co-author, Dr. Gail Steketee, both affiliated with the Boston University Hoarding Research team) list some of the “proposed diagnostic criteria”:
There is evidence that this stand-alone diagnosis is appropriate. Saxena et al(4) found that after administering PET scans to adult subjects with and without hoarding symptoms, “those patients with compulsive hoarding syndrome had a different pattern of cerebral glucose metabolism than non-hoarding OCD patients and comparison subjects.” Zhang et al(5) found that genetically, hoarding has a different inheritance pattern than other OCD symptom factors. These studies suggest that the neurological functioning of “hoarding brains” is distinct from those who present with other OCD behaviors. A discrete diagnosis may also be necessary. A recent article in the Psychiatric Times reports that “clinically significant hoarding affects between 6 million and 15 million persons in the United States….occurring at twice the rate of obsessive-compulsive disorder (OCD) and at 4 times the rate of bipolar disorder and schizophrenia.” (6) Walk into the home of a hoarder, attempt to engage them in a conversation about the mess, and the above symptoms are usually quite obvious. Yet there are often deeper clinical issues just beneath the surface. Frost and Steketee believe that hoarding causes clinical depression, which, like anxiety, tends to be prevalent among the hoarding population. (7) Those of us who have worked with or known hoarders tend to feel ambivalent about their behaviors. While we have compassion and concern, we may also find it difficult to understand how someone could want to live in squalor, or why they would surround themselves with rotting food and animal excrement. One man, who appeared on the aforementioned Today Show episode, had been removed as a child from his mother’s home by Protective Services. A statement he made was a powerful testament to the confusion hoarding creates for those who are witness to the chaos. “All my mother had to do to get me back was clean her house …and so it was really hard for me to believe that [she] actually loved me… Its such a simple thing.” Similarly, Jessie Sholl’s new memoir, “Dirty Secret: A Daughter Comes Clean About Her Mother’s Compulsive Hoarding,” recounts the helplessness of a childhood without any choice but to live among suffocating clutter and filth. Sholl tells about countless attempts to clear away the junk, to help her mother have a new start, only to have her revert back to the same pattern of behaviors.(8) Hoarding has been traditionally difficult to treat. One reason for the high rate or recidivism may be due to a hallmark of the disorder—the hoarder’s inability to recognize the severity of the problem. Combinations of Cognitive Behavioral therapy and medications have been helpful for some people, although according to The International OCD Foundation Hoarding fact sheet, medication alone has not reduced hoarding behaviors. (9) Visit the IOCDF Hoarding Center page and click the “Help for Hoarding” tab on the navigation bar for a comprehensive guide to options for treatment, from self-help to group therapy, backed by sited research studies. One aspect of hoarding that strikes me as profound, and is surprisingly absent from the literature, is the hoarders desperate need to hold on. What irony, that hoarders seem to manifest an intense need to have a tight grip on their stuff, on their lives, by totally abandoning order and calm and forsaking a genuine connection with the wider world. The ancient Taoist art of Feng Shui teaches that clutter and mess block “chi” or life energy. Indeed, the hoarder’s willingness to fully participate in life is thwarted. Perhaps it would be helpful to start focusing clinical conversations and skills- building around the spiritual process of clearing away all that keeps them from letting go. For additional hoarding publications and information, click here: BU School of Social Work Hoarding Research Team website. References
A DJ Saved My Life: The NCC Awards Center Staffer Pat Feinberg The Center congratulates one of our Benefits Experts, Patricia Feinberg (aka Trish in the Mix), who was recently awarded with the 2011 TSI Recipient Council and Peer Advocate Specialists Achievement Award. Here she shares her experience with the DJ program at New Challenges Clubhouse.
Here is an excerpt from that Old School song, Last Night A DJ Saved My Life: “There’s not a problem that I can’t fix because I can do it in the mix.” This speaks to me because it alludes to the healing power of music. I certainly found this to be true for myself as well as for many of my peers. So often we have been uplifted and inspired during the DJ activities, which helped us as a community boost our recovery through music, learning new skills, and friendship. My gratitude goes out to the founder of this program, our instructor, my fellow awesome DJs, as well as the TSI staff and members who supported us through the years. Sadly, as of September 1, 2011, NCC, and along with it, the DJ classes, no longer exist due to budget issues. This has been heartbreaking for many of us, who looked forward to these weekend meetings. It is my hope that sharing my experience will encourage funders to provide the means for great activities like the DJ program to continue.
20 Ways to Overcome Barriers to Recovery Do you have people on your caseload who do not seem to be able to get going in their recovery pathway? In this free, half-day workshop, Dr. Courtenay Harding will provide a window into at least 20 obstacles which may stand in the way and how to resolve many of them. Participants will receive a clear set of questions to ask, new ways to rethink problems and some solutions to remove the roadblocks. Registration begins at 9am. Light refreshments will be served. Facilitator: Courtenay Harding, Ph.D How to Get a Date: A Helpful Way to Teach Social Skills This free, half-day workshop will provide concrete and practical tools and strategies for the clinician to help people move forward in reclaiming their lives. Each clinician needs a “little black bag” with tools of the trade stuffed inside to pull out when needed as the person with whom they are working wants to have a clearer head, a healthier body, “a home, a job, friends, and a date for the weekend!” This workshop will be interactive and fun. Registration begins at 9am. Light refreshments will be served. Facilitator: Courtenay Harding, Ph.D
To register for any Center training or view our schedule of upcoming trainings, please go to: www.coalitionny.org/the_center/training/ Note: If you are typing the URL in your browser, the space between “the” and “center” is in reality an underscore symbol “_”.
SAMHSA's Recovery to Practice Final Webinar in Recovery Series
Date: October 6th Clubhouse of Suffolk’s 19th Annual Mental Illness Awareness Day
Date: October 14th Training from the Geriatric Mental Health Alliance: Older Adults with Depression
Facilitator: Patrick J. Raue, Ph.D, Associate Professor of Psychology in Psychiatry, Weill Medical College of Cornell University The Bridges Institute Cross-Training Program
Click here for the training schedule topics and dates from October through July. Date: Beginning October 20, 2011 Free Rainbow Heights Club Seminar: From Policy into Practice
Facilitators: Rainbow Heights Club Staff Low Levels of Omega-3 Fatty Acids May Increase Suicide Risk
To create a free Medscape account and have access to the full article, go to: http://www.medscape.org/viewarticle/749141?src=cmemp Will the New DSM-5 Classify Everyday Worries as Generalized Anxiety Disorder?
See how you weigh in on this debate by reading the blog at:http://www.psychiatrictimes.com/blog/dsm-5/content/article/10168/1841441?GUID=77229683-C884-4E15-A53F-346B70BE5765&rememberme=1&ts=15092011 Study Explores Gender-Based Diagnoses
Read the article about the study: http://consumer.healthday.com/Article.asp?AID=656051 Or purchase the PDF of the actual study in the Journal of Abnormal Psychology: http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=2011-10191-001 |
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On Saturday, August 13, 2011, I was delighted to be recognized for my efforts and achievements in supporting my peers involved with DJ activities. My own personal involvement with the DJ activities at New Challenges Clubhouse (NCC) was equally delightful. When NCC (a program of Transitional Services for NY, Inc.) created an opportunity for me to learn how to become a DJ and to participate in fundraisers for a nonprofit organization, I was on board. It is my distinct privilege to have been a part of this wonderful initiative that capitalized on people’s strength and creativity and transformed our environment into a place where people could experience the sheer joy of music and dance during the weekend. 
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This final Webinar of a series on the continuum of recovery-oriented care focuses on an important concept: an individual's "graduation" from formal services, which often involves a transition to less formal, community-based supports. The Webinar will discuss options and alternatives for individuals 
who wish to move on from formal services and, more importantly, how to help ensure that those who have optimally benefited from treatment have a meaningful life to return to. Participants are encouraged to call in or submit their questions and comments for presenters to answer at the end of the session.
Former Congressman Patrick Kennedy will serve as Keynote Speaker, addressing the personal and public policy 
The Geriatric Mental Health Alliance will host session of the same training entitled “Problem-Solving Therapy For Use With ![Description: C:\Users\sblayer\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.IE5\37VX3FEH\MC900078739[1].wmf](images/clip_image012_000.gif){kind=small}
Older Adults With Depression.” This training will explain the empirical evidence supporting psychotherapy for late-life depression, provide materials, and give participants an opportunity to practice new skills. It is designed for social workers, psychologists and psychiatrist who work with older adults. ![Description: C:\Users\sblayer\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.IE5\UTVAVCK7\MC900370196[1].wmf](images/clip_image014_000.gif)
Now more than ever it is important for mental health providers to understand how cross-systems of treatment interact with one another. The Bridges Leadership Institute is a 12-session, 10- month cross-training program developed to help social service professionals become more savvy and skilled in helping clients deal with mental health, child welfare and drug treatment issues. These free trainings are designed for organizational leaders, staff who are highly respected by their peers and can influence others. All participants need to have email access. 
Advancing E/Quality Care will explore ways to address clinical issues in providing effective care to lesbian, gay, 
bisexual and transgender clients. Using case conference discussions and interactive consultation, the seminar will illuminate effective ways to build and maintain the therapeutic alliance throughout treatment, as well as address how you can advance LGBT affirming policies and practices within your agency. A light breakfast will be served at 9am. ![Description: C:\Users\sblayer\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.IE5\37VX3FEH\MC900287574[1].wmf](images/clip_image002_016.gif)
A new study conducted by Dr. Joseph Hibbeln ( Acting Chief, Section on Nutritional Neurosciences at the National ![Description: C:\Users\sblayer\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.IE5\JPMKS9OZ\MC900233594[1].wmf](images/clip_image004_009.gif)
Institute on Alcohol Abuse and Alcoholism, National Institutes of Health) found that reduced levels of the omega-3 essential highly unsaturated fatty acids have been shown to be associated with increased suicide risk. A current article in Medscape highlights this study, as well as the American Psychiatric Association recommendation that all patients with psychiatric disorders consume at least 1gm of omega-3 fatty acids per day. In it, Dr. Hibbeln states, “Our finding add to an extensive body of research that points to a fundamental role for DHA and other omega-3 fatty acids in protecting against mental health problems and suicide risks.”![Description: C:\Users\sblayer\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.IE5\UTVAVCK7\MC900441902[1].wmf](images/clip_image006_004.gif){kind=small}
The Psychiatric Times posted a blog this past April discussing the possibility that the workgroup for the 5th Edition of the Diagnostic and Statistical Manual would classify bouts of common worries as Generalized Anxiety
Disorder. The proposed changes would reduce the required duration of anxiety symptoms from the current 6 months to just 3 months. It would also decrease the number of required associated symptoms to 1 out of 4, rather than the more selective criterion of 3 out of 6. ![Description: C:\Users\sblayer\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.IE5\85FC4TEF\MC900389250[1].wmf](images/clip_image010_000.gif)
According to a recent study published in the online edition of the Journal of Abnormal Psychology, certain mental illnesses are linked to prevalence by gender. The researchers found that women are more likely to ![Description: C:\Users\sblayer\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.IE5\37VX3FEH\MC900389248[1].wmf](images/clip_image012_001.gif)
develop anxiety or depression, while men are more likely to be diagnoses with substance abuse or antisocial disorders. Specific manifestations of behavior were also connected to sex—women with anxiety disorders tend to keep their emotions to themselves, often leading to withdrawal and depression, while men seem to express their emotions using aggressive, impulsive or coercive behaviors. The Coalition Home | Center for Rehabilitation and Recovery | Site Map
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