by: Kira Yanko, MS, LPC | Northwest Passage III Therapist
Don’t Have a Cow?!
For therapists like me, thankfully DBT is highly structured. There are times in every clinician’s work that we are challenged and these difficulties lead to self doubt. In addition to hashing this out through consultation, DBT’s stages and targets allow for grounding and focus in session. They provide a framework to approach clients and guide treatment. This is especially important when working with clients who are emotionally dysregulated because often they will enter session with a new “COW” (Crisis Of the Week) that they would like to discuss. Often these are chaotic and crisis ridden problems that are loosely related to the overall goals of treatment. As such, it would be easy to spend each week addressing these COWs and never get to the gestalt, to the greater pattern of underlying distress, and the need to build a live worth living. Avoiding COWs is a term I heard in a training several years back. In my own practice, I tend to refer to these as “shiny objects” because it is easy to become super distracted by them in session. The stages and targets of DBT help provide a framework to make COWs or “shiny objects” less clinically alluring. They also offer guidance to what problems areas and issues should be addressed when – something that can be of use even outside of the therapy office. (more…)
by: Kira Yanko, MS, LPC | Northwest Passage III Therapist
Nurtured and Nudged…
The first and foremost principle of DBT is dialectics, hence the name. This is the idea that two concepts that seem to be completely opposite from one another can both exist and be true at the exact same time. A person can both love and hate someone. They can seek independence and dependence at the same time. A client can be doing the best that they can and simultaneously need to do better. This isn’t a new idea (and Marsha doesn’t suggest that it is…after all it is the basis of the serenity prayer written in the late 40’s, early 50’s), but for the first time it was encapsulated and formalized it into a therapeutic approach. It is often the belief that only one truth exists that leads to both internal and external turmoil for our clients. If we interact with any of our clients purely from one static vantage point, we present them with opportunities to “power struggle” and this can destroy our alliance – the key aspect of any therapeutic relationship (and I’m not just referring to therapeutic relationship in terms of therapist and client, but in terms of any relationship between two people that can have therapeutic value).
by: Kira Yanko, MS, LPC | Northwest Passage III Therapist
A Rather Loose Metaphor…
In the world of mental health, Dialectical Behavioral Therapy is all the rage. It’s the Channing Tatum of psychotherapies…can you tell I’ve worked with adolescent girls for the past eight years?! Although starting primarily with clients diagnosed with Borderline Personality Disorder who possessed a high suicide risk, research has shown DBT to be an effective treatment for any client whose underlying struggle is rooted in emotional dysregulation. Just as Channing has proved he is here to stay in the cinematic world, any early concern that DBT was simply a “buzz word” in the therapy world or a passing fad has long been laid to rest. Also like Channing, DBT is easy on the eyes…so to speak. DBT’s popularity amongst clinicians (aside from its efficacy, of course) comes from how it took aspects of behavioralism, CBT, mindfulness, and emotional regulation and added some “zhush” transforming it into a package that is more palatable by clients leading to greater adherence and success in treatment. (more…)
Part 2 of 2:
by Melissa Gendreau, MS, LPC – Child and Assessment Center Therapist
In part one, we introduced several environmental factors that can be helpful for parents – part two will expand upon additional strategies. Read part one here.
- Utilize emotion charts- Make a poster with multiple facial expressions on it to help the child identify what emotion he is having. This can be even more useful when incorporating pictures of the child’s various emotions as well as the parents.
- Validate his emotional distress and then work to help problem solve the situation. Making statements like “I can see you’re angry right now” “Let’s figure out what you can do until…”
Melissa Gendreau, MS, LPC
Part 1 of 2:
A child’s environment is vital to his/her future health and success. For the parents of children with a cognitive disability, the task of creating an appropriate environment can be daunting. Children with this diagnosis require an environment that is calm, predictable, and supportive. Children with cognitive disabilities require simple, concrete behavioral expectations in their environment. In addition, they must experience immediate, consistent, non-shaming consequences (that are appropriate for their individual level of functioning) for not meeting those expectations. Short-term behavior goals matched with equally short-term consequences may be the most effective method for children with cognitive disability. The important aspect to remember is to ensure that it is a realistic goal for the individual child. Incorporating all of the above aspects is no small feat.
These children often require intense supervision and structure in the environment. They often do best in their environment when they came to understand the schedule and routine of the day. Parents with children who function at an intellectually disabled level often find their child will require multiple parenting and teaching strategies for him/her to be more successful.
Dr. David Ammend, MD
by Dr. David Ammend
As a general pediatrician by training, I have been taught to try to look at children as a whole when attending to their health needs. In my role as Medical Director of Northwest Passage residential treatment programs over the past 18 years, my practice has been focused on the health of children with a very particular set of problems, and there can be a tendency for me to pay insufficient attention to children’s general health as we are sometimes faced with a child and family in extreme distress due to mental illness. However, my ability to keep the “whole child” in mind has been sharpened by the growing recognition that it is exactly the issue of “lifestyle” in its broadest sense has a profound impact on mental health. Here I would like to discuss some of the challenges that anyone involved with the care of children face when trying to promote a “healthy lifestyle”.
Over the past 5-6 years I have been working with some of my Northwest Passage colleagues to better understand the role of a healthy diet and physical activity in promoting mental health, and to use that knowledge to inform our work with the kids we serve. What has become increasingly clear to me over that time is that there is a large and growing body of scientific evidence that one’s lifestyle – and in particular one’s diet and level of physical activity – can have a significant impact on both the maintenance of mental health and treatment of mental illness. I have been pleased to see evidence of a growing recognition among health care professionals and the lay public that these factors are connected. Sadly, I have also witnessed a seeming glacier pace of tangible progress in the society-wide promotion and achievement of healthier lifestyles for our children.
As a measure of the slow response of our institutions, I believe that a look at the reality of the progress achieved by our schools in the areas of nutrition and physical activity is instructive. I do not mean here to “pick on” our schools, nor do I wish to paint all schools with the same (largely negative) brush. But overall the evidence shows that by-and-large our nation’s schools have done a poor job of promoting healthy living. To those who would say that we already ask our schools to do too much, and give them too much blame, I would say that in general that may be true. However, when it comes to fundamental lifestyle issues like diet and exercise, I don’t see how we can achieve better health for our kids WITHOUT including the schools, given that kids eat 1 or 2 meals per day (plus snacks) and spend nearly one half of their waking hours 5 days/week for 9 months of the year at school.
We were both honored and excited to be a feature on a recent episode of Wisconsin Life!
“Ice Caves Go Viral” by Kaitlyn
As fleeting as they are iconic, the ice caves of Apostle Islands National Lakeshore are considered an endangered national park experience. With spring around the corner, the ice caves will soon be a memory, with no guarantee of their accessibility in winters to come. But the young women of Northwest Passage Prairieview (previously known as Northwest Passage III) are among the lucky ones. Braving the biting cold of a couple weeks ago, they trekked across the big lake to experience–and capture–these elusive cathedrals. Enjoy their photos below.
“Fingers” by Abby
Untitled by Talise
“Icicles Right On You” by Kaitlyn
Untitled by Cody
“People GALORE!!!” by Courtney
Untitled by Kiera
Angela Frederickson, LCSW – Clinical Director
This bit of reflection is dedicated to a beautiful soul who left this world much too early. I have been searching for a way to honor the footprints she left and this blog seems to be an appropriate stage. My experience walking with her down her road is representative of many adolescents’ experiences in the world of mental health treatment. I remember her taking a fiercely protective stance regarding her identity and raging against adults who dared define her as a “disturbed child” or “victim”. She described those who engaged in the sin of categorizing her as “haters” and enjoyed the fight they provided through their ignorance. She was particular about the name others used when they referred to her. She knew what kind of mother she wanted to be and what kind of mother she did not want to be. She asserted herself as “Anishinabe” and educated me that she was of the “original people”. She stated one day, “I know exactly who I want to be and where I want to go”.
In my journey with her I was reminded time and again the power of words, the power of labels. (more…)
Dr. Himanshu Agrawal and Angela Frederickson speak on addressing suicidal and self harming behaviors.
This year’s annual NATSAP conference was held February 6-8 in Henderson Nevada. The conference is a great event that presents useful information to mental health professionals, including clinicians, program directors and more.
This year, Northwest Passage was able to send two staff members to the conference for to present a short program “I’ll be the Death of Me”. NWP’s on-staff psychiatrist, Dr. Himanshu Agrawal, as well as our clinical director Angela Frederickson, spoke to a room full of mental health professionals about assessing and addressing chronic suicidal and self injurious behaviors with adolescents.
The program more specifically focused on the addressing and assessment of the current emotional state in suicidal clients and the use of tools to more effectively increase insight into the precursors to self-harm and suicidal behaviors. They discussed a specific approach to use with clients engaging in these behaviors, including application of the Stages of Change model. Topics of discussion included methods of training, communication, and ongoing consultation within a multi-disciplinary team that promotes critical uniformity among responses. The presentation included a theoretical framework and information about current research and best practice models, while also following the specific case of a teenage girl.