Treatment issues of special interest include the following five primary areas:
- Stress management
- Attention-deficit and disruptive behaviors disorders
- Couples and parent-child relational problems
- Anxiety disorders
- Depression and mood disorders
My areas of interest range across the life span from young children through adults. Much of my work is with school-age children, adolescents, and college students. When working with young people, of course, it is often necessary to work with the parents in family counseling, too.
Additional Information on Areas of Interest
Depression and Mood Disorders:
- Depression is both emotional and physical – depressed people feel hopeless, fearful and experience a loss of interest in daily life. Physical symptoms may include fatigue, insomnia, appetite changes and even vague aches or pains. Depressed children and adolescents are often irritable.
- 19 million adults in the U.S. experience a depressive disorder – the rates of depression for women are approximately twice (21.3%) those seen in men (12.7%).
- Imbalances in serotonin and norepinephrine may contribute to both emotional and physical symptoms of depression.
- Goal of treatment is to feel good again, not just better – thus, the goal is a complete resolution (remission) of symptoms and a restoration of work and school abilities, family life, and social activities.
- Treatment to remission prevents the progress of this chronic disease – Partial treatment response increases the risk for more severe relapses of increasing frequency.
- Anxiety disorders make up the most common group of psychological disorders – about 25% of people experience an anxiety disorder at least once in their lifetime, and the symptoms may fluctuate over time.
- Anxiety disorders are thought to be related to a common gene that creates an overactive nervous system – individuals cannot relax, sleep or concentrate.
- Most anxiety disorders can be treated effectively with a combination of psychotherapy (especially cognitive and behavioral therapy) and medication (especially SSRI medications).
- 50-70% of depressed people also exhibit anxiety or obsessive brooding
- A screening questionnaire published by the NIMH can help people determine if they may have obsessive compulsive disorder -
Couples and Parent-Child Relational Problems:
- Profound suffering can be caused by distressed interpersonal relationships – yet marital success can be predicted by men who accept influence of their wives and women who present requests, complaints or suggestions in a warm or humorous manner (Gottman – University of Washington ). Consequently, couples therapy
- In most male-female relationships, conflict arises when the man wants to act and the woman wants to talk – the solution for this type of conflict is to allow the other’s style to be experienced: men need to be willing to listen and respond while doing, and women need to be willing to do as a stage for talking.
- Issues confronting families of children and adolescents include referrals from school for conduct or learning problems, anxiety or moodiness symptoms, and developmental issues such as disenchantment in relationship to parents, peer group loyalty, privacy and identity development.
Problems for adolescents may be conceptualized according to three types :
- emergent/urgent – according to a particular situation (changing family residence)
- tumultuous growth – in response to typical transitions (starting high school)
- chronic/continuous – generally themes of power, dependability, money, anger, love, sexuality, and social subgroup values (clothing, drug use, curfew, and family responsibilities).
- Supporting the adolescent’s adjustment over time and across different settings is critical to future success in the world as an adult – research suggests that early intervention is the most effective strategy to reduce psychopathology and to promote leadership, identity, and interpersonal learning. Common treatment techniques include individual and family counseling to teach communication and conflict negotiation skills. These skills facilitate learning to relate to authorities. Anger management and problem-solving skills can facilitate acquiring responsibility for one’s own behavior and learning.
Attention Deficit/Hyperactivity Disorder/ADHD:
- The most frequent behavioral complaint in pediatrics is about attention, distractibility and impulsivity – approximately 5% to 7% of children (with a male-to-female ratio of 3:1) will be diagnosed with ADHD.
- Generally the child with ADHD wants to be in control but lacks both impulse control and the ability to sustain focus.
- The core symptoms are inattention and/or hyperactivity – inattention is the inability to sustain attention or responding to a task; think “impersistent.” Hyperactivity is poor or absent self-regulation; think “disinhibited.”
- Treatment often involves medication – For example, ritalin is FDA approved for children six years and older and is the most commonly used medication.
- Psychological treatment involves strengthening “performance” not “knowledge” – the problem is doing what one knows rather than not knowing what to do.
- The Stress response is a three-step process – alarm, resistance and coping, and ultimately exhaustion. We experience the world as “falling apart.”
- Stress management does not include being told “go relax” or “quit worrying” – stress management has the objective of changing your behavior, thinking, life-style choices, and situations in which you’re participating.
Typical stress management techniques include – discontinuing caffeine use; increasing regular aerobic exercise; learning abdominal breathing and visualization techniques; developing more realistic self-speech; and strengthening assertive communication and problem-solving.