Markham's Behavioral Health

12% of United States troops in Iraq and 17% of troops in Afghanistan are on anti-depressants

On June 5, 2008, Time Magazine ran a story entitled, "America's Medicated Army". Here is a snippet from the article:

The medicines are intended not only to help troops keep their cool but also to enable the already strapped Army to preserve its most precious resource: soldiers on the front lines. Data contained in the Army's fifth Mental Health Advisory Team report indicate that, according to an anonymous survey of U.S. troops taken last fall, about 12% of combat troops in Iraq and 17% of those in Afghanistan are taking prescription antidepressants or sleeping pills to help them cope. Escalating violence in Afghanistan and the more isolated mission have driven troops to rely more on medication there than in Iraq, military officials say.

It seems that fighting pre-emptive and immoral wars is not good for one's mental health. I wonder when we as a nation will realize the error of our ways and demand that our government do something about it?

I don't know of any other occupation that has this high a rate of mental illness. Would you want your loved one to enter such a career?

Prozac: The Military's Secret Weapon, MSNBC with Joe Scarborough. Video lasts 3:25

This is article #4 on militarism.

Longer term psychotherapy works according to a study published in JAMA

Reuters Healthday reported on 09/30/08 on a study which appeared in the October 1, 2008 issue of the Journal of the American Medical Association which found that long term psychodynamic psychotherapy works. Here is a snippet from the article:

People with complex mental disorders or personality disorders would benefit from long-term psychodynamic psychotherapy that lasts at least a year or longer, according to new research.

Published in the Oct. 1 issue of the Journal of the American Medical Association, the German study found that compared to the more commonly used short-term therapy, long-term psychotherapy left people better off. In fact, the number of therapy sessions the patients had was directly correlated to improvements in symptoms.

"Long-term psychodynamic psychotherapy was significantly superior to shorter forms of psychotherapy applied in the control groups. This was true with regard to overall effectiveness, target problems, and personality functioning," said the study's lead author, Falk Leichsenring, a professor of psychotherapy research in the department of psychosomatic medicine and psychotherapy at the University of Giessen in Germany.

"With regard to overall effectiveness, on average, patients with complex mental disorders were better off after treatment with long-term psychodynamic psychotherapy than 96 percent of the patients in the comparison groups. Thus, this meta-analysis provides evidence that long-term psychodynamic psychotherapy is an effective treatment for complex mental disorders," said Leichsenring.

"This study provides a great value for doctors and for patients, and one would hope could have an influence on policy decisions," added Dr. Charles Goodstein, a clinical professor of psychiatry at the New York University School of Medicine and Langone Medical Center in New York City.

Purpose of marriage video 1

I am planning on doing a series of videos on marriage. I have been a licensed clinical social worker for 40 years and have accumulated a lifetime of experience which I think may be of benefit to people. Here is the first video in the series which I have entitled, "The purpose of marriage." Please leave your comments.

Purpose of marriage video 1, part 1 of 2. Video lasts 4:18.

Part 2 of 2. Video lasts 8:31

Take The Client Where They're At

David G. Markham, L.C.S.W. describes his practice and what he has learned over the years. The video is 6:04.

Antidepressant Scripts Up 16 Million Over 3-Year Period and most not prescribed by mental health professionals

Reuters HealthDay reported on July 24, 2008 on a report from the Agency for Healthcare Research and Quality which found that the prescription of antidepressant drugs has increased significantly over a 3 year period from 2002 - 2005 and less than a third of the antidepressant prescriptions are prescribed by psychiatrists with the great majority prescribed by primary care physicians.

It is interesting that most of the antidepressant medications are not precribed by mental health professionals which leads to the assumption that most depression is being treated without psychotherapy. Most outcome research seems to indicate that depression is better treated by psychotherapy or a combination of psychotherapy and antidepressant medication.

Here is a snippet from the HealthDay article:

Between 2002 and 2005, the number of prescriptions filled for antidepressant drugs increased from 154 million to 170 million, according to a report released Thursday by the U.S. government.

The analysis, by the Agency for Healthcare Research and Quality, of antidepressant prescriptions (not including refills) written after doctors talked with patients in-person or over the phone found that in 2005:

• 29 percent of prescriptions were written by psychiatrists -- medical doctors who specialize in the treatment of mental disorders.
• 23 percent came from general practitioners -- physicians who provide primary care but are specialty-trained.
• 21 percent came from family practitioners -- primary care physicians who complete a residency in family medicine.
• 10 percent came from internal medicine specialists -- physicians who complete a residency in internal medicine and who focus on the diagnosis and non-surgical treatment of adults with illnesses that are difficult to diagnose or manage.

The data used in the summary are from the Medical Expenditure Panel Survey of health services used by Americans.

 

MedlinePlus: Antidepressant Scripts Up 16 Million Over 3-Year Period.

Unproven therapies used on traumatized kids

Reuters reported on September 9, 2008 on a CDC report which will appear in the American Journal of Preventive Medicine that a lot of therapies provided to kids with PTSD are not proven. Here is a snippet from the article:

Many doctors and therapists use unproven approaches such as drugs, art or play therapy on children suffering trauma when old-fashioned talk therapy has been shown to work, a report released on Tuesday said.

A review of a dozen different studies showed no evidence that alternative therapies helped children traumatized by violence or abuse, even though more than 75 percent of U.S. mental health professionals who treat children and teens with post traumatic stress disorder may use them.

But cognitive therapy -- a type of talk therapy aimed at changing negative thoughts -- does work, the group at the U.S. Centers for Disease Control and Prevention said.

"The good news is there is substantial research showing the effectiveness of group or individual cognitive behavioral therapy in treating children and teens experiencing the psychological effects of trauma," the CDC's Robert Hahn, who led the study, said in a statement.

"We hope these findings will encourage clinicians to use the therapies that are shown to be effective."

Children can be traumatized by many things including physical or sexual abuse, witnessing domestic violence, community violence or natural disasters.

In my office, I use cognitive based therapy and, when relevant, include parents and/or caretakers in on the sessions. I find that children and adolescents usually do very well. I am chagrined to hear about the play therapies, sand tables, EMDR, and other things my colleagues are doing with kids which they usually learned at some workshop and now have become born again disciples of the technique. I have often wondered, as the research report above suggests, why they didn't take a workshop and learn how to do therapy that works instead of the latest fad? Like many things in life we are enamored with the new, the novel, the gimicky approach which promises quick and almost miraculous success.

I find it increasingly difficult to find good therapists to refer people to. The mananged care system and the atrophy of the community mental health centers have made it difficult for young therapists to find adequate training environments.

MedlinePlus: Unproven therapies used on traumatized kids -study.

Managing your anger can save your life

The British Health Service has a good video on anger management. It lasts 5:14.

40 Years - Chapter two - Manipulation

            Dr. Maureen Didier, my Casework Professor at SUNY Albany, where I got my Masters In Social Work degree in 1972 also told me that as a Social Worker clients would manipulate me. I remember her telling me that it is OK to be manipulated if you know you are being manipulated and agree to it, but to be manipulated and not realize it will lead to a world of trouble and is incompetent practice.

            Over the course of 40 years of practice, I can’t tell you how many thousands of times I have been manipulated and have known it and gone along with it. Over the same period of time I have been manipulated also by my wife, my children, my neighbors, my friends, my colleagues, my employer, my political representatives, business people, and the list goes on.

            Dr. Didier told me it is OK to be manipulated as long as I am aware of it, and I have struggled for years to become more and more aware. Developing awareness takes ongoing effort. It never ends. Being aware of the need to continually increase one’s awareness requires ongoing willingness to learn, to approach life in a “not knowing” and open hearted way, and to reflect on one’s own experience and sift it for nuggets of wisdom.

            This self-reflection often requires a discussion with trusted others who have the time and interest and willingness to listen carefully, ask good questions, and provide honest feedback. Seeking out consultation and supervision is critical to good Social Work practice and to just about any other endeavor in life whether to manage your own emotions, manage your intimate relationships with others, parent your children, take care of your health, manage your finances, develop your spirituality, or learn any new skill or master any new body of knowledge.

            On the other hand, Social Workers also manipulate clients all the time under the guise of providing service or “treatment”. Social Workers value the client’s right to self determination and we have an ethical responsibility to obtain a client’s informed consent before we engage them in service activities and yet formalizing this idea of protecting clients from unwanted and involuntary manipulation often is illusionary because we are manipulating people all the time when we interact with them to get what we want and to influence other people’s behavior and to move situations in our desired directions.

            Manipulation has taken on a pejorative meaning in our current terminology but if we change the word from manipulation to influence it doesn’t seem so bad. The point to this chapter is that manipulation goes on all the time. It is part of life. There is nothing wrong with it necessarily as long as you are aware, and when ethically required, we disclose our intentions and obtain consent. It is the way we give respect and maintain our self-respect.

40 Years - Chapter One - Take The Client Where They're At

If you asked me “what’s the most important thing you learned in your Social Work graduate education” I would say it was Dr. Maureen Didier telling me, “Take the client where they’re at, take the client where they’re at, not where you want them to be, not where you think they ought to be, where you think they should be, take the client where they’re at!”

I had Dr. Didier for three out of the four semesters of our 64 credit hour Masters in Social Work program. I, as a young person, had some disdain for my graduate work become it wasn’t pure social science but applied social science with lots of methods courses. And so I held a lot of my education in those days in some contempt I am embarrassed to now say because it has served me very well.

Outside of class I would mock Dr. Didier and say to my fellow students, “Can you believe that this is what passes for graduate education, her standing up there saying ‘Take the client where they’re at. Take the client where they’re at” in a high sing song mocking voice. And yet 40 years later I have Dr. Didier on my right shoulder whispering into my ear when I am frustrated, when I am going too fast with a client, when I find myself imposing my values, and hopes and dreams and preferences and desires onto the client, “David, take the client where they’re at.” And I slow down, step back, listen more deeply, try to understand where the client is coming from and what the client wants,  and I realize that things always go better.

I find the maxim, “Take the client where they’re at” to be just as important and just as good advice in my personal life as in my professional life.

After 40 years, I thank Dr. Didier and marvel at her wisdom. I laugh at my vanity, egotism, condescension, and am ashamed to tell you that I laughed and mocked her.

I don’t know where she is, or even if she is still alive. I think she has probably died. I thank her every day and say a prayer of thanksgiving for what she taught me. I am sorry for mocking her. I hope she would forgive me for not appreciating her wisdom when I was younger.

I pass her wisdom along to you and suggest if there is never anything else you learn in your Social Work education and/or practice or life, remember Didier’s dictum – “Take the Client Where They’re At.” It will serve you, your clients, and those with whom you are in relationship very well.

40 years and counting #1

I realized the other day that on October 31, 2008, I will have been a Psychiatric Social Worker for 40 years. I am thinking to myself - "What have I learned in all that time that might be valuable for me to reflect on and remember and might be of value to others?" So I decided to write a book. And part of that book writing effort I am going to put on this blog. I entitleing the book, at least for now, 40 years and counting. (If you have better titles let me know.) So, if you want to follow the progress as I write and comment on this work in progress check in regularly for the latest installment.

Here is installment number 1

On October 31, 2008, I have been a Psychiatric Social Worker for 40 years. I started my career at Kings Park State Hospital in Kings Park, New York half way out on Long Island just over the Nassau County line into Suffolk county on Long Island’s north shore. I started on October 31, 1968 as a Psychiatric Social Worker Trainee II.

My supervisor Fred Ironside asked me where I wanted to work and I told them on the Child and Adolescent unit and they put me in the geriatric building with 900 geriatric patients and where they hadn’t had any Social Worker services in over 1 ½ years.

I learned many things there but most of all to love and respect old folks.

This book is about what I have learned as a Psychiatric Social Worker over 40 years of practice. It is going to be a lot of very personal things. You may find a lot here that you disagree with or even find offensive and that’s OK. Part of practicing any profession is not what you learned in your professional training or what the textbooks say, but how you applied what you learned and made it work for you and made sense out of it.

Social Work is a very personal profession. A good Social Worker uses his/her personality as  their primary professional tool. Most of Social Work depends on developing a helping relationship with individuals, couples, families, groups, communities and representatives of all kinds of organizations, companies, agencies and governmental entities.

The key to good Social Work is the effectiveness of one’s interpersonal skills which depends on one’s emotional intelligence. It also helps if one is smart. It also depends on humility and knowing what one doesn’t know and being able to recognize one’s ignorance, incompetence, and asking for help. Without that humility you are dead in the water and would do better in some other profession or career.

I have taught over the years at various colleges as an Adjunct Professor teaching Social Work courses, Psychology, and Health Education. I have worked over my career as a clinician as well as a manager and administrator and so I bring the experience of several life times to my teaching. Angela and I were married 35 years and have 9 children so I always worked at least three jobs often 60 – 80 hours per week and sometimes more. With all this experience, I find myself saying things to my students like “I know this is what it says in the textbook, but let me tell you how it really works.” Of similarily, “I know this is how it says in the textbook to do it, but this is what it really looks like and feels like as you try to bring those principles, ethics, practices into application.”

Am I cynical? Yes. Do I passionately believe in the field and the value of the profession? Yes and more so with every passing year. I have been abundantly blessed to have entered into the profession of Social Work and my life has been richly benefited both professionally and personally. To be able to earn my living and get paid for something I love doing and passionately believe in is the greatest life any human being could have.

So, enjoy my stories of my 40 years of experience. Hopefully you will find them entertaining, maybe enlightening, and above all else, it is my wish that you find them useful as you go about living your own life and finding your way in the world.

I will be tagging these entries as "40 years"