Anonymous asked:

For groups with people with intellectual disabilities: how do you build activities around those who can't/won't speak?

This is a time with individualization is really important, because it depends on the client. Each person and their capabilities are different- which is one of the things that makes group approaches tough -so you have to be willing to identify each person’s strengths, weaknesses, and preferences, and try to figure out what will work for them. 

In some cases, groups are just not the right approach for a specific person. Maybe once you individualize things, it means that it’s just too far away from what everybody else will be doing and won’t fit with the group approach. Hopefully then you can find a group that will work better for that person and their specific needs, but not always. And some people work and their needs work better in a one-on-one setting. That’s another component to individualization.

One question is always, “will this person benefit from this group?” The other is, “will the other group members benefit from this group member being in this group?”

Anonymous asked:

Um, hi. I think I may have something like disassociation or depersonalization, but I'm not sure. I sometimes don't recognize myself in the mirror-I know it's me but it doesn't feel like me. And my name doesn't always feel like mine and I think I numb out feelings and stuff and sometimes I don't think I'm alive, and when I realize I am I get panic attacks and I don't know what's wrong withe me

I can’t give individualized treatment or diagnostic advice. I really encourage you to seek treatment with a competent professional in your area if you are concerned.

Hi, I’m sorry you’re going through a tough time right now. Unfortunately I really can’t do anything except empathize with you. I can’t diagnose through this blog or online and I would be wary of anyone who is willing to without knowing you personally (and having proper, official credentials). It sounds like this is really worrying you, so I do encourage you to talk to a competent clinician in your area. Best wishes, anon. 

Anonymous asked:

Hi there :) I hope I don't bother you... I'm in treatment since 2012- I have had weekly appointments with my therapist. I'm diagnosed with BPD and an eating disorder. I saw him last week. Before this, He didn't have time for me and my therapy since 6 months. (He was "busy") What should I do? He was never there when I needed him. He seems to be bored by my problems and told me I just have to deal with it- bc it's normal I have these symptoms. Sorry for my bad english & have a nice day!!

I can’t give individualized treatment or diagnostic advice. I really encourage you to seek treatment with a competent professional in your area if you are concerned.

You are not bothering me! All I can really say is that therapy is a contract between two people. Both of those people have to hold up their end of the contract or therapy is unlikely to be successful. It doesn’t sound like your therapist is holding up his end of the contract. There are other therapists who might be more willing to do their part in getting you where you want to go. I hope that helps- and I hope you have a nice day too :) 

Anonymous asked:

When you suggest positively reinforcing kids groups do you mean with praise or is it also a good idea to also have some sort of reward system (ex. token economy, raffle tickets, small prizes, etc)?

Yes, both.

When creating a reward system or some other more tangible set of contingency management program, it’s always important to be careful that that program doesn’t start to supersede the behavioral reinforcement and (hopefully!) internal motivation that exists. Ideally the group will be fun and interesting on its own, so the kids will enjoy it, and then the group leaders will use behavioral contingency management to maximize engagement and good behavior. That way the reward program or whatever is a tiny added bonus, rather than the only thing getting the kids to group. 

Anonymous asked:

self-validation anon again, I've been in therapy for 5 years now for C-PTSD, DID and various anxiety disorders. I asked my therapist how I should go about doing it and the only advice she could give me was to ask others who have done so themselves, or to just discover it on my own... so she wasn't very helpful and I don't see her till next February because our sessions allowed per year ran out. I've never had validation in my life so that's why I'm just a bit lost. Thanks for the help though.

Hi again,

So obviously I can’t give you treatment recommendations. I will say that I find it very strange that a therapist who is competent enough to handle a set of complex diagnoses cannot handle a pretty easy therapy goal like validation. I am not saying that validation is easy to achieve (it is not), but it far easier to develop and work on a therapy goal working towards validation than it is to work on dealing with, for example, severe trauma or attachment issues or some combination of a bunch of complex symptoms. A therapist who says they can do the much harder of the two but not the easier… I have a lot of doubts about them. So I guess what I’m saying if this is important to you (and it makes sense that it is! this is a totally valid thing to seek!) then maybe you want to consider whether this therapist is the one for you. You might find that you can figure out some other ways to find validation on your own, but as I said before, it is often easier to figure these things out when you have someone else’s perspective. Best wishes, anon. 

cognitivedefusion:

For sure! I don’t know if you can even be APA-certified without having some sort of coursework devoted to neuropsych-esque assessment (sometimes under the cognitive assessment umbrella). I guess I’m not certain if that’s sufficient to be considered a neuropsychologist as one’s career title? I don’t really know. I assumed it would require more.

Neuropsychologist is a protected title- you need to be board certified through ABPP/ABCN to use it. The method to do this is to first get a PhD or PsyD in clinical psych, then attend a internship focused on neuropsych (there are specific ones that fulfill ABPP/ABCN criteria) and then complete a postdoc in neuropsychology (that again, fulfills the ABPP/ABCN criteria), then apply for certification. In order to get an internship, graduate students generally need to take a bunch of specialized neuropsych classes and get a fair amount of neuropsych experience. 
I believe that only two assessment courses are required for APA-accreditation, one in intellectual/cognitive assessment and one in personality assessment. It’d be easy to miss many of the key pieces that neuropsychologists need if that’s really all you do. 

cognitivedefusion:

For sure! I don’t know if you can even be APA-certified without having some sort of coursework devoted to neuropsych-esque assessment (sometimes under the cognitive assessment umbrella). I guess I’m not certain if that’s sufficient to be considered a neuropsychologist as one’s career title? I don’t really know. I assumed it would require more.

Neuropsychologist is a protected title- you need to be board certified through ABPP/ABCN to use it. The method to do this is to first get a PhD or PsyD in clinical psych, then attend a internship focused on neuropsych (there are specific ones that fulfill ABPP/ABCN criteria) and then complete a postdoc in neuropsychology (that again, fulfills the ABPP/ABCN criteria), then apply for certification. In order to get an internship, graduate students generally need to take a bunch of specialized neuropsych classes and get a fair amount of neuropsych experience. 

I believe that only two assessment courses are required for APA-accreditation, one in intellectual/cognitive assessment and one in personality assessment. It’d be easy to miss many of the key pieces that neuropsychologists need if that’s really all you do. 

Anonymous asked:

i can remmeber a doll i used to have that i would hit in the genitals and cry when i did it . i also remember a bit of some things that were done in front of me but i cant remember specific incidents of anything happening to me. my memories have come slowly to me. have you heard of this happening? do children hurt dolls in genitals even if they have no history of sexual abuse? and is there anyway to speed up the process of rememembering? i dont want to deal with anymore i just want to remember

I can’t give individualized treatment or diagnostic advice. I really encourage you to seek treatment with a competent professional in your area if you are concerned.

Here are some asks that are similar to yours. 

Memories do change over time. It’s hard to tell whether what we newly remember is a more accurate account of what has happened or not, due to the way that our brains work. More often than not, each time we think about something we alter it a little bit, so it becomes less and less like what really happened. That doesn’t mean that memories never come back to someone, but it does mean that when we remember something, it is rarely or ever an objective account of what actually took place. 

There are lots of issues with trying to remember something, particularly a specific something. I covered a lot of those issues in my previous posts. I’d like to also add the issue of confirmation bias- when you think there’s something to remember, and it’s a specific sort of something, you go looking for things that will confirm what you think happened. Everybody does this and it happens in all kinds of ways. For instance- if I think a client is depressed, I’ll think about all my interactions and knowledge of that client looking for information that goes along with the idea that they are depressed. I might totally ignore any information that discounts that they are depressed, or are anxious instead, for instance. So it’s important to keep your mind as open as possible, to the idea that whatever you think happened is true, but also to the idea that other things might be true. 

The other issue is that it takes awhile for the memory parts of the brain to really start firing and holding onto memories in any real sense. Babies remember things, but in an abstract sort of way- they can respond to conditioning and stimuli, but they don’t have memories the way adults do. Memory doesn’t really form- usually- until children are about 3. So some memories just do not exist because they never did. And as I said before, we don’t encode lots of our experiences, and lose other memories, even as we get older, and they don’t come back on command. It would be much easier if they did, but our minds are much more complex and strange than that.

As for the other part of your ask- children do engage in all kinds of play with their toys. Some of it can seem very strange and problematic. I can’t say what your history of play means- no one can. Although dolls have been used as a part of child interviewing and therapy, it is not considered 100% indicative of sexual abuse. Sometimes it is a sign of sexual abuse. Sometimes it is not- children do all kinds of things just to see what will happen. They are also often fascinated with private parts for all kinds of reasons. If you are concerned I really do encourage you to see a competent clinician. Best wishes :) 

Anonymous asked:

Is extreme spacing out a form of dissociation? Like when someone has moments where they can't remember anything that has been said but they weren't like day dreaming, they were just not there mentally. I know dissociation exists on a spectrum of sorts so is that like at the milder end or is it not dissociation at all? I've only really heard of out-of-body experiences and more extreme forms like DID.

Here are two asks that are similar to yours. Although dissociation is on a spectrum, it’s intended to be a spectrum of dysfunctional experience, not including more functional and typical sorts of experiences, like daydreaming and spacing out. It’s also theorized to be a result of fight or flight response. If there’s no functional reason why a person would need to avoid the situation they are in (“flight”) but they are spacing out, then it doesn’t fit in with what we currently understand about how and why dissociation works. Of course, our understanding of these things changes all the time, so in the future I could have a completely different response.

I would more say that spacing out could be on a larger spectrum- maybe called “cognitive awareness” or something -that includes dissociation at one end, functional awareness in the middle, and dysfunctional heightened awareness at the other (like hypervigilance, for example). That’s of course my own thought about it, rather than something I’ve gotten from a source. I hope that’s helpful! 

Anonymous asked:

That is super helpful (dif anon though). Are those suggestions mainly for a group of adults? How would it differ for kids?

Thanks!

When I wrote that list I was thinking about a) group issues, b) group skills training issues (versus process groups or other sorts of groups), c) things that would apply to adults, and d) things that would apply to adults with intellectual disabilities. 

So with a group of kids some things would likely differ. Although there are lots of things that usually generalize across types of groups (for instance: minimize distractions, have the group set rules for everyone to follow) there are lots of things that depend on specific things about the group.

With kids, I’d also think about:

  • What sorts of materials are developmentally appropriate for the participants. Materials are still a very useful thing to use, but you want to make sure it is understandable, helpful, and not distracting or overstimulating.
  • How to get and keep attention for the duration of the group. How can you reinforce the participants for paying good attention and participating? How can you make being in the group fun (without losing the benefits of the group)?
  • Breaking into small groups as often as possible so that the group leaders can spend time with kids 2 on 1 or 1 on 1.
  • Figuring out how to get the parents involved so that kids are attending regularly, getting homework done, and so that the things they learn in group will be reinforced and follow through after group.

I hope that’s helpful!