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ALCOHOLISM TREATMENT TECHNIQUES AND APPROACHES: OBSERVATION

admin — Wed, 20 Apr 2011 14:40:47 +0000

Each day we process vast amounts of information without much thought. Our behavior is almost automatic. Without benefit of a clock, we can make a reasonable estimate of the time. When shopping, we can without too much trouble distinguish the clerk from fellow customers. Sometimes, though, we cannot find a person who seems to be a clerk. Take a couple of minutes to think about the clues you do use in separating the clerk from the customers. One of the clues might be dress. Clerks may wear a special outfit, such as smock, apron, or shirt with the store’s logo. In colder weather, customers off the street will be wearing or carrying their coats. Another clue is behavior. The clerks stand behind counters and cash registers, the customers in front. Customers stroll about casually looking at merchandise, whereas clerks systematically arrange displays. Another clue might be the person’s companions. Clerks are usually alone, not hauling children or browsing with a friend. Although we have all had some experience of guessing incorrectly, it happens rarely. In essence, this is the good guys wear white hats principle. A person’s appearance provides us with useful, reliable information about that person. Before a word of conversation is spoken, our observations provide us with some basic data to guide our interactions.

We hope that you are convinced everyone indeed has keen observational powers. Usually people simply do not reflect on these skills. The only difference between a counselor and others is that a counselor will cultivate these observational capacities, will listen carefully, and will attend to how something is said and not merely the content. The counselor will ask: “What is the client’s mood?” “Is the mood appropriate to what is being said?” “What kinds of shifts take place during the interview?” “What nonverbal clues, or signs, does the client give to portray how she feels?”

So, in a counseling session, from time to time, momentarily tune out the words and take a good look. What do you see? Reverse that. Turn off the picture and focus on the sound. One important thing : the questions you ask yourself (or the client) are not why questions. They are what and how questions that attempt to determine what is going on. Strangely enough, in alcohol counseling, successful treatment can occur without ever tackling a why question. Ignoring what or how issues, however, may mean you’ll never even get into the right ball park.

So what is the importance of observation? It provides data for making hypotheses. A question continually before the counselor is: “What’s going on with this person?” What you see provides clues. You do not pretend to be a mind reader. Despite occasional lapses, you do not equate observations, or hunches, with ultimate truth. Your observations, coupled with your knowledge of alcohol, suggest where you might focus attention. An example: a client whose coloring is awful, who has a distended abdomen and a number of bruises, will alert the counselor to the strong possibility of serious medical problems. The client may try to explain this all away by “just having tripped over the phone cord,” but the counselor will urge the client to see a physician.

You do your work by observing, by listening, and by asking the client (and yourself) questions to gain a picture of the client’s situation. The image of a picture being sketched and painted is quite apt to capture the counseling process. The space below is the canvas. The total area includes everything that is going on in the client’s life.

As the client speaks with the counselor, this space is filled in. Now the counselor is getting a picture of the client’s situation. Not only do you have the “facts” as the client sees them; you can also see the client, his mood and feelings, and get a sense of what the world and picture feel like as well.

You have a notion of the various areas that make up the person’s life: family, physical health, work, economic situation, community life, how the person feels about himself, and so on.

You are also aware of how alcohol may affect these areas. As you find it necessary, you will guide the conversation to insure that you have a total picture of the client’s life. You are also aware that if the client is experiencing difficulty, having a problem, it means that the pieces are not fitting together in a way that feels comfortable. Maybe some parts have very rough edges. Maybe one part is exerting undue influence on the others. So you also attempt to see the relationship and interaction between the parts.

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COPING WITH ADULT NIGHTMARES

admin — Thu, 23 Dec 2010 10:17:24 +0000

Some sleep experts advocate methods whereby sleepers train themselves to awaken as soon as a troubling dream begins, by recognizing certain settings, sounds, people, or emotions. They are urged to get out of bed, once awake, and sit calmly for a few minutes, perhaps stroking their arms or wrists as a form of neural relaxation. Another technique is to keep a dream journal, writing down the dreams immediately after waking. The simple act of writing can occupy one’s mind long enough to minimize the damage from the dream; more important, perhaps, the record of dreams may help the sufferer gain insight into his or her dream patterns and reach a reconciliation with the emotional source of the nightmare.

In more severe cases some kind of insight-oriented therapy under professional guidance can be very helpful. especially when problems of fear, mistrust, or deep-seated anger are found to be the cause of nightmares. During the therapeutic process nightmares can be cast in a positive light by interpreting them as clues to the issues that tease and trouble the victim—the emotional stumbling blocks that prevent the attainment of peace of mind.

If time and counseling are insufficient, or if the problem is acute (as in cases involving overtly psychotic behavior), some form of drug therapy with antipsychotic medications may be indicated. A benzodiazepine such as clonazepam (Klonepin), also used in the treatment of nocturnal myoclonus, may help to restore the muscle-paralyzing mechanism in REM sleep. Special attention must be paid to depressed individuals, especially men, because they tend to avoid seeking professional help and are at higher risk of suicide.

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COPING WITH ADULT NIGHTMARESSome sleep experts advocate methods whereby sleepers train themselves to awaken as soon as a troubling dream begins, by recognizing certain settings, sounds, people, or emotions. They are urged to get out of bed, once awake, and sit calmly for a few minutes, perhaps stroking their arms or wrists as a form of neural relaxation. Another technique is to keep a dream journal, writing down the dreams immediately after waking. The simple act of writing can occupy one’s mind long enough to minimize the damage from the dream; more important, perhaps, the record of dreams may help the sufferer gain insight into his or her dream patterns and reach a reconciliation with the emotional source of the nightmare.In more severe cases some kind of insight-oriented therapy under professional guidance can be very helpful. especially when problems of fear, mistrust, or deep-seated anger are found to be the cause of nightmares. During the therapeutic process nightmares can be cast in a positive light by interpreting them as clues to the issues that tease and trouble the victim—the emotional stumbling blocks that prevent the attainment of peace of mind.If time and counseling are insufficient, or if the problem is acute (as in cases involving overtly psychotic behavior), some form of drug therapy with antipsychotic medications may be indicated. A benzodiazepine such as clonazepam (Klonepin), also used in the treatment of nocturnal myoclonus, may help to restore the muscle-paralyzing mechanism in REM sleep. Special attention must be paid to depressed individuals, especially men, because they tend to avoid seeking professional help and are at higher risk of suicide.*306\226\8*

PHENOMENA OF HYPNOSIS

admin — Fri, 08 May 2009 09:39:41 +0000

The power of suggestion. Whilst in the hypnotic state, the person’s awareness is narrowed but is heightened and sharpened. So the suggestions of the hypnotist are totally received with minimal rejection. There are some very good hypnotic subjects who can go into a very deep hypnotic state. They can see imagined objects suggested to them or they can abolish the perception of pain if the appropriate suggestion is given. Hence hypnosis has been used in the management of chronic pain. The suggestion can also be made to change certain behaviours, and this has been used successfully to treat people who wish to give up smoking. The suggestion that the person can relax easily at night re-establishes confidence in sleeping and is very useful in some cases of insomnia.

Memory and age regression. Another most interesting feature of hypnosis is its influence on memory. People under hypnosis can remember things that they cannot remember whilst in the fully awake state. They can be taken back in time, to relive a period when they were much younger, this is called age regression.

Post-hypnotic suggestion. This is another unique phenomenon in hypnosis. Whilst under hypnosis, it is possible to suggest to the person that after he wakes up from the present trance he will perform a task such as blowing his nose when the hypnotist gives a pre-arranged signal. The person is then awakened from hypnosis, and may have apparently forgotten what went on whilst under hypnosis. After a while, conversations unrelated to hypnosis take place; then the hypnotist, without warning, claps his hands, which is the pre-arranged signal in this case. The person, seeing the signal, starts to have an irresistable urge to blow his nose. He may make some excuse that his nose is itchy and then blow his nose. Most people feel uncomfortable until the posthypnotic suggestion is carried out.

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PAIN AND DISTRESS: THE PURE SENSATION OF PAIN

admin — Wed, 29 Apr 2009 10:29:25 +0000

In ordinary circumstances pain hurts. Because it hurts we react to it. We therefore rarely experience pain in pure form.

I have warned you that some of these ideas are at first a little hard to accept. This idea is basic to our management of pain, so please go along with me.

You can actually prove this easily enough. Take a pin and stick it lightly into your forearm. It hurts, you screw up your face and perhaps say “Ow” under your breath. You would tell me that the painful stimulus hurts, and you react to it. This is not quite true. I do not think that there is a time sequence to these two events—the hurting and the reaction to it. I think they occur together, or the reacting may in fact precede the hurting. This is also easy to prove. Now decide to yourself that you will stick the pin in yourself again, but this time you will not in any way react to it. Make sure your face muscles are calm and easy. Now stick in the pin. Yes, you feel it. But this time there is no hurt. If we do not react to it, there is little or no hurt in the painful stimulus. At the same time we feel it. The sensation that we feel in these circumstances is some approach to pain in pure form.

It is important that we fully understand this, and know it to be true; so repeat the little experiment on yourself, and also do it to a friend.

We must conclude that pain is not an unbearable sensation, provided that we do not react to it. This is true of much more severe pain than a pinprick.

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MEDITATION FOR ANXIETY DISORDERS TREATMENT: THE MEDITATION PROCESS

admin — Tue, 21 Apr 2009 06:42:16 +0000

While the meditation process produces a feeling of quiet, don’t expect it to happen. Just let the meditation process happen naturally and easily. If we expect it to happen, it doesn’t. If we expect it to happen we spend the whole meditation session not meditating, but looking for the quiet and wondering when it will happen. When we are meditating correctly our meditation will lead us effortlessly and naturally to the full meditative state. Don’t fight thoughts, feelings or emotions. Let them come and let them go. Don’t become involved with them by hooking into them. Meditation is not a process of trying to eliminate all thoughts or feelings. Nor is it a process of trying to think of nothing, which is a contradiction in itself. The ‘no-thinking’ will happen naturally as we move into the deeper stages. The rising and falling of our thoughts are part of the whole process. They will slow down and finally cease naturally as we enter the full meditative state.

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UNDERSYANDING-ACCEPTANCE: PANIC ATTACKS

admin — Tue, 21 Apr 2009 06:40:26 +0000

A panic attack, either spontaneous, cued or situationally predisposed; is diagnosed when we experience four or more of the symptoms described in chapter two. However, a large group of us also experience other sensations as the attack, and we panic as a result (Arthur Jones et al 1994).

Notice the separation of the words ‘panic’ and ‘attack’. Many of us experience an attack and then react with fear and panic. Learning to see this separation is an important step in recovery.

Some people will dissociate first, and panic at the sensations of dissociation. Other people describe their attack as being like an electric shock, or an intense burning, tingling sensation moving through the body. Some report that it feels like a wave of unusual energy surging through them. The attack itself is usually experienced as beginning in the feet, surging through the body, over the head and back down through the body again (Arthur-Jones 1994). Or it is likened to a white-hot flame, starting ‘just below the breast bone, passing through the chest, up the spine, into the face, down the arms and even down to the groin and to the tips of the toes’ (Weekes 1992).

These sensations can occur at anytime during the day or night. They have been described in sleep research literature since 1890 and are said to occur during the hypnagogic first stage of sleep and/or during the transition from REM sleep to the deeper stage of sleep. Sleep researchers describe it as an ‘upward surge of indescribable nature, an electric sort of feeling ascending from the abdomen to the head, sometimes followed by bodily jerks or a violent explosion and/or a flash of light’. The researchers also note that *a sense of alarm follows the experience’ (Oswald 1962).

For the sake of brevity I call all the above experiences ‘surge’ attacks. Throughout the rest of the book I will refer to all panic attacks as ‘attacks’. When I am describing particular attacks, I will refer to them by their individual ‘name’.

As the ‘surge’ goes through our body, our heart and respiration rates increase, we may feel nauseated, we may feel dizzy as if we are going to faint, we may shake or tremble, we may feel hot or cold flushes, and may dissociate. The attack is extremely powerful and most of us feel as if we are going to die, so it is completely natural and normal to become frightened and panic. Recovery means we may occasionally experience these sensations, but instead of reacting with fear and panic, we now just let them happen. As I have said, we need to develop an attitude towards them of ‘so what’ instead of ‘what if. I will discuss this further in chapter eight.

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ANXIETY DISORDERS: GUILT AND SHAME

admin — Tue, 21 Apr 2009 06:28:30 +0000

We all feel ashamed and guilty about the effect on our family. Despite these feelings, we need to be careful because we can unintentionally create further disruption. Many of us feel we need to have someone with us at all times. This can be very reassuring for us, but we need to make sure we do not restrict the lives of people around us. Until we are able to manage on our own, it is a matter of finding a balance which will answer our needs and the needs of our family.

The guilt and shame sometimes mean we isolate ourselves from our partner or family in an attempt not to cause further worry and grief. Many of us do not realise how devastating this can be for them. If they want to help, don’t shut them out bee ause of guilt and shame.

Unfortunately, the reverse can also happen and we may find our partner or family isolates us. Although we may feel like giving up completely, we mustn’t. We may also feel as if we will never be able to do it without them. We can. Being involved with a self-help group enables us to make contact with other people who are in a similar position. Their support and encouragement can help us to begin to rebuild our lives. Despite the seemingly impossible obstacles, we can all recover.

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