My Take on Hallucinations

There are lots of various types of hallucinations. A hallucination is a sensory experience without the usual sensory cause. Hallucinations can be visual (seeing things not present), auditory (hearing things not present), tactile/kinesthetic (feeling things not present), olfactory (smelling things not present) and gustatory (tasting things not present).

The most common types of hallucinations have to do with sleep disturbance and are auditory or visual in nature and occur at the onset or ending of sleep. These experiences are disturbances in dream states. While the person believes they are awake when this occurs, their body is actually asleep and dreaming.
Some types of hallucinations are related to neurological disorders. These include tactile hallucinations and a specific type of auditory hallucination of music.

Hallucinations related to mental illness often relate to associated sleep disturbance. Depression and manic states include symptoms of significant sleep disturbance. Problems falling asleep, staying asleep, and waking several hours too early can contribute to hallucinatory phenomena. Medications designed to help improve the loss of energy associated with depression incorrectly taken at bedtime will worsen the sleep disturbance and worsen the hallucinations. Maintaining good sleep hygiene will go a long way to improving hallucinations that are the result of sleep disturbance.

Many people can experience hallucinations as a side effect of medication. Antibiotics, pain killers, and medications that are sedating can cause hallucinations. Substance abuse causes hallucinations in several ways. The actual substance can produce hallucinations. The substance can disturb sleep. And when the substance wears off the withdrawal can cause hallucinations. Alcohol can cause visual, auditory and tactile hallucinations. Seeing pink elephants are likely occurring at the onset of sleep or waking. Hearing your name called or hearing whispers. Getting confused and having the sensation of bugs on skin or snakes wrapping around your arms or legs is a late stage of nerve problems from alcohol abuse and alcohol withdrawal.

There’s a difference between hallucinations and illusions. Illusions are things you experience that seem outside of you but you are producing. They are not a sensory experience. These are dissociated experiences. Traumatic events produce problems encoding cohesive memory. People feel unreal at the time of the event or outside themselves. When similar things trigger the memory of the event the person has an illusion. They may replay the event again in it’s entirety. This is a flashback. They may have only parts of the visual picture as a flash. This is a visual illusion. They may have only the auditory soundtrack. This is an auditory illusion. They may hear a commentary on the event. They may hear conversations of others present at the event. These are fragments of the event that occurred that haven’t been adequately processed. By identifying the triggers for the illusions, the information from the trauma can be more adequately processed.

Some traumatic events cause head injury. Often people hit the back or front of their head. The olfactory bulb which controls smell and 85% of the sense of taste sits right over the bridge of the nose. If this area is damaged by an impact either being hit in the face or head from the front, or hit in the head in the back and having the brain bounce to the front can damage this area. Smell and taste hallucinations can occur as a result of impact. Nerves heal over a long period of time. The sense of smell and taste may return to normal years after the accident or injury.

Infections especially dental or sinus infections can cause inflammation which disturbs the sense of taste and smell causing hallucinations or illusions.

Hallucinations associated with mental illness have unusual qualities to them. There are other symptoms that go along with the hallucinations that correlate with the illness. Delusional material goes along with schizophrenia. Sad mood goes along with depressive psychosis. Grandiosity goes along with manic psychosis.

Extrasensory experiences are not hallucinations although they may include delusional material. Seeing ghosts or dead people are often part of a cultural experience. These events may be experienced by a number of people who report the same phenomena. A trained psychologist or psychiatrist should be able to evaluate the experience and differentiate one phenomena from another.

For most people, hallucinations are an annoying or scary event that quickly passes. Large percentages of people have a single experience of a hallucination. It’s common. Hallucinations that interfere with daily life and interpersonal relationships should be professionally evaluated.

Hallucinations in the News

Hearing 'voices' common for children
Amy Pyle
When young children hear voices, many parents rush to the psychotherapist for an expensive battery of tests.

While hearing voices can be a manifestation of schizophrenia, and so should not be ignored, a new survey out of the Netherlands indicates that while many children hear voices, few are bothered by them.

The study of 3,870 primary school Dutch primary school students, published in the British Journal of Psychiatry, found that nearly one in 10 7- to 8-year-olds heard voices. But only 19% said the voices interfered with their thought process and 15% said they caused serious suffering and anxiety.

Boys and girls were equally likely to hear voices, but girls were more bothered by them. Urban children were less likely to hear voices than those who lived in rural areas, but the city dwellers were more likely to be disturbed by the voices and they were more likely to hear multiple voices speaking at once, a finding that concerned the researchers.The study is interesting news to Los Angeles-area author Hope Edelman, whose recent book, "The Possibility of Everything," traces her journey with her daughter to Belize, to essentially exorcise a particularly nasty imaginary playmate named DoDo via spiritual healing.

"What the (Dutch) study didn't talk about is what the kids were actually hearing (and) what the researchers speculate the cause was," Edelman said. "I'd be interested to know that because, from a western perspective, it's a hallucination, but in Belize it's so matter of fact that these are spirits talking."

Of course not everyone can afford tests even if the voices do seem seriously disturbing to a child. The U.S. Surgeon General has estimated that one in five children has a psychological disorder but that 70% of them do not receive therapy.

Edelman became concerned when Maya was 2 and her playmate, DoDo, became more aggressive. Schizophrenia runs in Edelman's family, so she did not take the situation lightly even though she generally had been advised that Maya's imaginary playmate was a normal developmental phase.

"My daughter seemed tormented; she would wake up with night terrors that he was trying to take her away," Edelman said. "It just really didn't add up to what the so-called experts were telling me to expect. It got...downright creepy."

After reading the memoir of a Belize healer, the family decided to give it a try. Treatment there involved an herbal bath, prayers and incense, Edelman said. At one point during the treatment, Maya let them know that DoDo was gone.

Because of the link between hearing voices and schizophrenia, which often fully emerges later in life, the Dutch researchers do plan to follow their study group for five years to see whether problems arise.

Research

Psychology is based on psychological research.  The research runs from applied psychology that deals with the complexity of what people do, think and feel, to more formal physiological and neuropsychological/psychoneuroimmunology research such as immune functions and stress hormones and functional MRI scans of the brain. 

On average as a psychologist I read about 50 to 150 abstracts or summaries of research in my field each week.  I get about four professional journals sent to my house each month and get another couple additionally every quarter.  I actively follow new developments in internal medicine, specifically cardiology, infectious disease, and immunology.  I have a friend who does cancer research so I follow that area.  In psychology I follow new developments in ethics, law, health, assessment and psychological testing.

Research is an area in which psychologists and psychiatrists substantially differ.  Psychological practice is supposed to be informed by research.  Psychiatric practice is informed by medicine.  There is a disconnect between some of the newer research coming out of academic institutions and clinical psychological psychological practice using that research to inform and improve upon their treatments.  The same disconnect exists in medicine.  It can take several years for solid research to influence clinical practice in either field.

My research has focused on descriptions of what people do and how they describe themselves and clinical treatments in new areas.  When I first started working on anxiety I worked with very young children.  I asked questions like "Can the same treatments for adults with anxiety be used to treat anxiety in a 2 to 4 year old?"  The research showed the treatments were effective.  Or questions like "Do people reporting homicidal rage change their disordered thinking after treatment?"  A large percentage do and the change remains for six months of follow up.  Or "Is rage expressed and experienced differently by different racial groups?"  It is.  Or "Do lesbians have the same types of sexual dysfunctions reported by heterosexual women?"  They do.

Research starts off with a question.  This question is a called hypothesis when the researcher answers it and puts together the study to see if the expected answer is correct or is disproved by the research.   A parent brought a 3 year old into the office.  Someone had sexually abused the child.  The mother wanted to know if the child could testify against the assailant when and if they were caught by police.  So that is a question that can be researched.  So I put together a study to determine if that child could understand right and wrong/truth and fantasy.  Could she understand and describe what happened to her.  Could she identify her attacker from a variety of people and single them out.  So we did all that.  She could explain what happened to her.  She could explain what was real and not real, what happened from what was made up.  She could not identify people to differentiate them.  Since all three aspects would be needed for this child to testify in court, the mother could tell she would not be able to testify even if an attacker was apprehended.

Psychological testing is like individual research.  The question is "How does this person function in these specific areas?"  The hypothesis is "This person functions like most people (the people on whom the test was normed)."  The testing then affirms or disproves the hypothesis.  In some cases of psychological testing we know the person does not match the normative group.  I test disabled people for the most part.  Most psychological tests are not standardized on the disabled.  Small groups of specific disabled populations are used in some tests.  Such as the intellectually impaired, deaf, blind, and learning disabled are with testing of intelligence.  In the cases I test the testing is far more descriptive, single subject case study--what does this person do, in these areas, with these materials.

Any materials can be used for psychological testing in this manner.  When I try to standardize the materials, instructions, and have large groups for comparison, that then becomes a standardized psychological test.  Research provides the clarification on procedures, instructions, materials, methods, and scoring of the results.  So if I ask someone to draw a clock, it might just be me asking the person.  If I follow the instructions for the 7 different clock drawing tasks from the Luria-Nebraska Neuropsychological Test Battery-that's a test.  If I follow the formal instructions for the Draw-a-Clock test, that's a test-and there are comparison photos of clock drawings by hundreds of people with known disorders for me to compare the clock drawing I got from the person I'm evaluating.

Hundreds of thousands of research articles are published in different areas in psychology annually.  There are hundreds of journals and periodicals describing the research being done.  It's not possible for a person to keep up with all the research in the field of psychology because there is simply too much research.  So people specialize in specific areas of research, specific parts of psychology.

The beginning courses in under graduate and graduate school deal with understanding the various areas of psychology and the vast body of research that makes up the field.  Graduate work and post-graduate study clarify the areas of interest into smaller and smaller areas for mastery.  The average psychologist spends between 4 and 7 years after completing a Bachelor's Degree studying an area of psychology for practice.

Managing Anger in Adults-medications and therapy

Problem anger in adults differs from anger in children that is developmental in nature.  It's often not just a sense of being disappointed, there are other ideas that go along with it.  There are ideas that other people are responsible for how angry someone feels, that anger is like a light switch and just suddenly flips on, and that rage is a reasonable response to a problem.  Problem anger is often associated with other mental disorders in adults.  Post-traumatic stress disorder, bipolar disorder, the personality disorders, some forms of depression and anxiety, and substance abuse disorders may all contribute to problems with anger.

Anger disorders are treated with psychotherapy, behavior therapy and or medication or a combination of the three.  There are several classes of medications used to treat anger disorders.  Atypical antipsychotics such as Zyprexa, Seroquel, Invega, and Abilify are often a first line of treatment.   These medications are all extremely sedating, cause impaired glucose metabolism resulting in increased risk for diabetes and weight gain.  If the option is suicide/homicide or incarceration versus one of these medications, the medications are selected as preferred.  When Zyprexa came out initially I had a patient I was following on a daily basis who had a plan to kill her employer.  The plan was serious, her employer had been notified for safety, and she was looking at a lengthy inpatient hospital stay.  Literally 12 hours after her first dose of medication she came in quite sleepy reporting that all those feelings went away.  She still didn't like her employer, but she no longer felt compelled to kill him.  The other medications in the list don't work as rapidly, but they are still effective. 

Antiseizure medications such as gabapentin, tegretol, and depakote are used as mood stabilizers, often effective with bipolar disorder when lithium is problematic.  These must be used consistently to be effective and often require a month or so for the onset of effectiveness.

Antidepressants that are sedating such as trazodone, and elavil, are used when depression is coupled with rage.  These are taken at bedtime.  Activating antidepressants such as prozac, paxil, or zoloft may worsen rage conditions and increase irritability.

Antipsychotics such as haldol, geodon, and others are used when there appears to be a thought disorder.  So paranoid ideas leading to rage would be treated this way.

Anti-anxiety medications are used when fear is coupled with rage.  Issues of abandonment, panic disorders, and difficulty tolerating discomfort and distress are treated with xanax, lorazepam, and many people use alcohol or marijuana to self medicate.   The problem with this class of medications is that they can be addicting, requiring more and more to produce the same effect and risking withdrawal reactions when they are discontinued.

Psychotherapy is extreme effective for rage.  There are a few types of specific therapy that are effective.  Cognitive Therapy (cognitive behavior therapy, rational emotive therapy, and other similar types of treatments) for anger, depression, or anxiety is one type of treatment.  Baseline measures are taken of the problems with tests at each visit.  Homework assignments are given to be completed prior to the subsequent visits.  And the therapy focuses on changing thinking patterns to change feelings and behavior.   Behavior Therapy (neurolinguistic programming, some types of hypnotherapy, dialectical behavior therapy, assertiveness training, negotiation skills training and others) is effective to change skills and physical behavior involved in anger. Mindfulness approaches (mediation, stress reduction, acceptance and commitment therapies) are also used successfully and come from a Buddist tradition of calming and centering.  All of these work.  Supportive psychotherapy, where a client tells the therapist what they have done during the week and the therapist listens, has not been shown to be effective as a treatment.

I used to do a 12 week group therapy for treatment of homicidal rage in adults.  I used a combined approach of behavior therapy and cognitive therapy.  In 12 weeks rage and homicidal thoughts were reduced to negligible levels in 85% of the participants.  Here's the 12 week program:

At every visit the participants completed several questionnaires on depression, homicidal rage, anxiety, and trauma.  At every visit they received homework assignments for the next week. 

Week 1 consisted of the introduction and an exercise designed to reduce shame over trauma.  The participants introduced themselves, discussed the event that brought them to the group and past physical injuries.  They received homework on completing questionnaires to bring back.

Week 2 was about correcting ideas and misconceptions about anger.  The anger/anxiety/depression model of anger and clarification on suicide, homicide, what constitutes self-defense and legal ramifications of assault in the State.  Homework was keeping track of events they got angry to.

Week 3 was about communication skills.  The model of styles of communication from ignoring to rage was explained.  Basic information on assertiveness was provided.  The group had the opportunity to work to clarify examples on changing other types of communications into assertive skills.  Homework was to take a dialogue and apply communication theory to it.

Week 4 was about calming down in the heat of the moment.  Physical techniques were explained.  The group worked in dyads with supervision to practice calming, assertion, and provide feedback.

Week 5 was about triggers to rage.  Ideas about post-trauma triggers and reintegration of information from traumatic events into present day was provided.  Dyads were again used with focus on clarifying what was triggering rage.

Week 6 was about cognitive techniques to change thinking.  Exercises to clarify thoughts were done.  Putting rage into words exercises were done.  Pantomimes for coping with feelings and movements to calm oneself were done.

Week 7 involved non-verbal communication techniques.  Body movements and voice tone were noted to clarify non-verbal triggers to rage. Substance use issues were discussed as non-verbal triggers.

Week 8 involved integrating assertion, cognitive techniques and non-verbal communications in dyadic exercises.  Stages of negotiation were reviewed. 

Week 9 involved specific triggers using weapons.  Weapons were either pantomimed or toy and coping and options were reviewed fo dealing with weapons as triggers and response.

Week 10 involved integrating data on triggers, responses, and events with specific focus on individual problem areas.

Week 11 involved reviewing diaries on triggers, coping skills, communication, and feedback.

Week 12 was a review of where the individual started to now.  The final cognitive measure was done in group.  Final diaries were reviewed.  The course ended.

Psychological Testing

I love psychological testing. It’s the majority of my professional job and it’s what hooked me in graduate school. I spend 7 hours a day, five to six days a week doing psychological evaluations.   I evaluate people who are applying for a variety of programs for people who report disabilities.  They are applying for assistance.

Lots of people dislike the process of being evaluated. I can sympathize with that. I’ve been evaluated. In order to perform the tests I have to take them. I like some of the tests better than others. I think some of them have clearer items. I think some of the items are more challenging. I think some of the items are too simple or not engaging enough. I think some are too hard to see. What people dislike about the process of being tested is the lack of feedback. I can’t tell someone if they got an answer right or wrong. I can’t tell them if they are doing as well as most people. So there is a lot of ambiguity in the process. Ambiguity makes people feel anxious.  My reports go to people who will be able to provide the people I evaluate with some feedback.  But I'm not in a position to do that.

Psychological testing gives me lots of data. I start collecting data from the moment I see the person. I might see the person in the parking lot or elevator or in the waiting room. I might not see them until I get their initial paperwork and call them in to be evaluated. I have a four page intake form. It is mainly check off boxes with brief answers for some history. I review the form with the person. An average person with a high school education can complete the form in 15 minutes.

Most people don’t realize that from that limited interaction of seeing someone walk down a hallway and having them complete a form made up of check off boxes I already have an approximate IQ score. I have an idea about what is wrong with them and what they are applying for. I have some idea about their ability to remember basic information.

After that I get to talk with them. My questions are to confirm or reject the hypotheses I am attempting to develop. Psychological testing has gradiations on how I can score responses. Some responses can get a score of 0. The response isn’t close enough to the answer to merit a number. Some responses get a 1. It’s closer, but it isn’t quite it. The person knows what I’m talking about but hasn’t articulated it or put it together enough. Some responses get a 2. The person knows what it is and can articulate it. There isn’t a test I know of that asks someone to describe a banana. So I can use it freely to describe it as an item. A zero would be a yellow thing. You keep asking the person to go further and tell you more but they can’t go beyond yellow. As far as you can tell it’s a yellow beach ball. A 1 point answer is something you eat or it has a peel or you cut it up for corn flakes. They clearly know what it is. A two point answer goes beyond that to a classification to a fruit. They may go further to a tropical fruit. Tropical fruit tells me they are smarter than the person who just says fruit. Now there are debates about people who use common use versus abstraction. You have to get the person to abstract before you score the response and you get around the debate. The tropical fruit person is going to keep me longer on the test and we are going to go through more items.

There is also speed. People who work quickly get more points than people who work slowly. Speed on tasks stays fairly constant. If it declines over time then the decline is steady. So if someone finishes the forms in 15 minutes then I expect an average perfomance on all the timed tasks. If they suddenly slow down when the timing starts it gets kind of obvious. It’s like they say to themselves “Oh, she brought out her stopwatch, let me slow down by 80% now.”

Then there is memory. People have lots of misinformation about memory functioning. Memory involves lots of parts to it. It involves paying attention long enough to put information into memory storage. Concentration to hold information in memory. Storage in memory in the immediate memory range. Transfer from immediate memory to intermediate memory. Then eventual transfer into long term memory and ultimately retrieval of information from memory. People will tell me they have “no memory.” That almost never happens. In addition they tell me that after completing 4 pages of historical information. Concentration problems are what people usually mean when they report memory problems. Occasionally there are some people who can’t remember. Vascular problems are the most common causes of memory difficulties. Depression is the next cause and is reversible. Finally there are actual problems with the brain. Accidents and diseases impacting the cortex can cause memory problems. People try to fake memory problems about 2-10% of the time. There are tests to evaluate faking. It’s sad that people think they have to exaggerate their real problems or fabricate problems to try to get a check for benefits. It complicates the lives of the people who have problems. It makes a lot of work for all of us in the field.

When everything lines up correctly, psychological testing makes the evaluation process easy. The person comes in with complaints. The complaints match everything the peron says. The complaints match all the data. The complaints match all the history. The complaints match all the statements from all the treating providers. The complaints match the objective psychological test data. There is a report to that effect. The analyst for the person makes a decision which is then comparatively easy. The person either gets benefits or they don’t.

The worst thing someone can do is to try to fake data or exaggerate their illness or problems. When they do that then they are considered suspect. Then everything has to be looked at with suspicion. So the person comes in and says “I don’t know what a banana is I’ve never eaten one. I don’t eat fruit.” That’s not a 0. That’s a 2. But the person is being a jerk. They clearly know the thing is a fruit. If they do that throughout the testing the test will not be able to be scored. They can be classified as above average but problematic. Lot’s of people are problematic. They don’t like testing and are resistant. I end up describing the resistance. I classify them. Resistance doesn’t help them. It hurts their case.
I ask lots of questions.

I also evaluate neuropsychological functioning.  The formal test materials are interesting.  Many of the items were last updated by the test creators in the 1950's.   The materials show things that were common then.  Old dial up telephones, pictures that reflect the 1950's version of modern.  The test still measures all aspects of cortical functioning and is up to date.  The pictures are just old.  They are better than the pictures from the 1940's.  But way out of date for 2010.  So the materials throw people.

Head injury is one reason for people to have neuropsychological evaluations.  The evaluations are a lengthy process, but the information can help dictate treatment plans and rehabilitation efforts.  It can also help to inform family members about what is going on.

Managing Anger in Children

Anger and rage disorders are something I used to treat often. Lots of therapists don't like these disorders because, frankly, they're scary. I like treating these because they make perfect sense to me and I think I know something that can be helpful.

Therapists often don't talk about their personal lives because it can blur boundaries and confuse what's going on in treatment. There's research indicating when self-disclosure occurs it can make the therapy better. Most people learn about how to manage angry feelings in childhood. Child abuse changes the normal developmental response to anger and does not allow the child to practice management of those feelings. As a past victim of child abuse I didn't get the opportunity to learn how to manage anger. I had to figure it out on my own when I was older.

When I treat anger disorders I differentiate anger that is from those types of developmental failings, to other more complicated forms of anger disorders. Anger is a normal emotion that ranges from fear, distress, anxiety, and irritation, to extreme rage and blackouts in a dissociative state. The distress and irritation part is normal and generally responds well to information on negotiation skills, psychotherapy treatment for anxiety and depression, and interpersonal communication skills.

Children learn how to manage rage around age 2 and generally get it mastered basically around age 4. By mastery I mean the child is no longer screaming at the top of their lungs, throwing themselves on the floor, and acting as if they are possessed. "I want the cookie. I Want It NOW. GIVE IT TO ME." The child gets exposed to basic negotiation and limit setting and deferment of gratification. "You can get the cookie after dinner." And the predictable response "NOOOOO."
Then the exposure to distraction as a coping mechanism. "Why don't you help me with making dinner?" Or "Go outside and play for awhile." Or social removal techniques "If you're going to cry and scream go in your room." Some parents try to introduce strategies for thinking "You don't need to be that angry. Try to calm down. Think about something else." I watched my brother mimic my niece's whining until she started laughing. That's a form of reflection as is "you seem very upset about not getting the cookie now."

Rage disorders can start showing up at this age. The child who not only tantrums but then starts injuring themselves or attempting to damage property or hurt others. They may threaten suicide or homicide. Limit setting and professional help with parenting skills can provide support and clarify techniques on what to do. Childhood mental illness such as autism, schizophrenia, and bipolar disorder, can start showing up in early childhood and require specialized assistance. The rage disorders that show up due to parenting issues may look similar. When I'm trying to differentiate an actual mental illness from a childhood rage disorder due to a parenting problem I see the child with the parent and watch what the parent does during rage attacks. I also listen to how the parent describes incidents. Some parents minimize the disorder. I had a parent tell me that sometimes her daughter "gets angry." I told the child she couldn't eat candy in my office. she dropped to the floor and laid there motionless. The mother stood back. I went over to the child who immediately became some version of the Tazmanian devil--all teeth and claws, no ability to speak but she could make animal noises. So I showed the mother safe restraint techniques and got the child calmed down. She was fine after she got calm and her ability to speak returned so we could talk about what happened. She will require help with parenting, but it's not likely this extreme behavior represents mental illness. The mother who brought in the child who "tantrums with any change in routine" didn't mention the difficulty with speaking, fascination with shiny things or the lack of eye contact. Seeing all these things together allows for clarity with a diagnosis of autism and suggestions for assistance in management and early intervention.

The reason child abuse complicates the development of anger management in children is because it trains the child that a fear reaction, coupled with violent behavior is appropriate. Anger is combined with a loss of impulse control. So the child gets to observe an adult getting frightened and feeling out of control, getting enraged, losing control, often feeling remorse, guilt, and sad, and often blaming the child for the lack of control. This becomes what the child thinks is appropriate. So the child will copy this behavior with pets, siblings, toys, peers, and this will persist into adulthood without intervention.

So here are some techniques that can be used for managing anger in children.

1. Have a schedule. The more the child can predict what is happening from day to day, the easier the child can manage their world.

2. Have clarity in what is acceptable and not acceptable behavior.

3. Provide a clear statement about behavior that is not acceptable. "I don't like what you are doing. That isn't acceptable."

4. Distract the child from inappropriate behavior at the very beginning of the behavior or if the child is approaching something that is off limits. "Careful." "No, no." "Come here." "Want to do this?"

5. Have time for play that is physical and active during the day. Lots of problems happen due to boredom.

6. When rage occurs, limit the child's ability to harm themself or others or damage property. Move the child to a safe place and stay near the child until the child calms down.

7. Have the child tell you what happened. What appears obvious to you as an adult may be completely at odds with the perception of the child. Repeat back what the child says. "Johnny took you're ball and you're mad at him because he always takes it and it isn't fair."

8. Clarify the rules of conduct for the family. "It's not okay to hit Johnny."

9. Supervise children who rage closely. Intervene early with separation and distraction.

10. Teach the child to calm down. "Slow down your breathing. Take some deep breaths." "It's not a catastrophe. What can you think of to make the situation better?" "You do not have to be so mad about this. You control how you feel." "Go for a walk and calm down." "Go write down everything that happened and why that made you mad." "What do you think you can do when this happens again?"

11. Show children what you do when you get angry that you want them to copy. "It made me mad when that person cut me off in traffic, but I want to get to where I'm going safely so that's what I'm going to focus on. I got scared so I yelled. I don't have to yell when I get scared."

If you're still having problems with an angry child seek professional help.

What is therapy

I asked someone the other day if they were in therapy for their depression and anxiety.

"I don't believe in therapy. I want to get better on my own."

"How's that working for you?"

Of course it's a rhetorical question. Specific types of therapy are very good for the treatment of mental problems like anxiety, depression, trauma, and situational problems. The basic idea is that feelings like anxiety and depression come from how someone perceives their experiences and what they tell themselves about who they are, and how the world is. By changing what people tell themselves, they can change their thinking, and can further change their mood and change their responses. It's a structured form of treatment. In some cases medication may be used used to augment therapy, but in a number of cases therapy is as effective and often more effective than medication alone.

Types of therapy that are effective have a lot of research that has been done to show effectiveness. These are called empirically supported treatments. There are several types of empirically supported treatments available for therapy for depression and anxiety. These include mindfulness, cognitive behavioral therapy, rational emotive therapy, and behavior therapy. Some types of specific psychoanalytic psychotherapies are also effective. These same therapies and crisis intervention are also effective for trauma.

I used to ask my clients to explain back to me what we were doing in treatment. None of them would ever say that they came in and talked to me. They would tell me they came in and worked on things. Therapy had homework. Therapy had exercises. Therapy involved the setting of goals and the formulating of a treatment plan. The goals would be assessed and the treatment plan revised if needed.

With the internet, most forms of empirically based treatment are described in detail online. People can research what forms of treatment might be best suited to their way of problem solving.

Information about mental problems can also help friends and relatives attempting to provide assistance to someone dealing with the effects of common problems like anxiety or depression, or less common problems like more serious mental illness. The American Psychological Association has specific information on therapy, and many types of mental problems people seek treatment for. In addition, every state has a psychological association that can also provide guidance for seeking treatment. Most State Psychological Associations can provide referrals to licensed psychologists and some have detailed specialty lists.

Psychology

Now a little bit about me. I have a long job title. I'm a forensic clinical neuropsychologist specializing in health and medical psychology. The "forensic" part means that my reports end up in the legal system usually before administrative law judges. The "neuropsychology" part means that I have specialized training in brain functioning. Health and medical psychology means I work with psychological functioning as it relates to health and wellness and medical illness. The "clinical" part means I work with people and not just do research or work with animals. It also means I follow specific diagnostic procedures and that most of the people I evaluate would be considered ill, although not necessarily mentally ill.

My job involves psychological and neuropsychological evaluations including testing and report writing. I have a doctor of philosophy degree in clinical psychology specializing in health and medical psychology and my training included two post doctoral fellowships-one in psychology and law, and one in neuropsychology. I get asked a lot about the difference between a psychiatrist and a psychologist and a therapist. A psychiatrist is a medical doctor who has taken coursework on psychology and mental illness. Following medical school a psychiatrist spends a year of residency and a year or two of fellowship learning about mental illness. A psychologist spends a minimum of four years learning about mental illness and therapy and, before being allowed to practice independently, must complete about 1000 to 3000 hours of clinically supervised practice depending on the State where they practice. A therapist generally completes two to three years learning about how to do therapy and completes around 1000 to 3000 hours of clinically supervised practice. In most States, psychiatrists can prescribe medications, although some psychologists in some States with special training are being allowed to prescribe.

Psychologists can have one of two degrees. A Doctor of Philosophy Degree or PhD, or a Doctorate in Psychology or PsyD. The PhD degree is a research based degree. Holders of that degree wrote a published book in a field of research known as a doctoral dissertation. The PsyD degree is a clinical degree. Holders of that degree wrote an extensive paper similar to a dissertation but it was about treatment not research. There is a Doctor of Philosophy Degree in medicine, but most of the physicians who hold the degree do research as their main occupation.

About 10 years ago I switched from clinical practice to an evaluation practice. I no longer do clinical treatment except under very rare circumstances. I have always liked psychological testing and psychological evaluations give me the opportunity to do a lot of testing.

There are a lot of types of tests and new tests are being created all the time. I've taught psychological assessment to graduate students. They are often surprised to find out that there's a lot of math involved in testing and assessment. Psychologists can assess everything people can think, feel, or do. We can infer internal states based on reported thoughts and behavior. Psychologists can also explain what is normal or abnormal based on population statistics and professional consensus about what constitutes normal and abnormal behavior. We can compare what people say they like and dislike and give them an idea about how well they would be suited to a job, a career, an area of study, or even someone to date.

When I was in clinical practice as a health and medical psychologist my work involved working with physicians and patients to ensure compliance with treatment, understanding of medical conditions and options for treatment, and to ensure that physicians understood the impact of the patient's strengths and weaknesses on their treatment plans. In some cases I helped patients document their medical conditions and provided research on possible diagnoses and treatment options for their physicians. With an average psychological consultation being 50 minutes and an average medical visit being 20 minutes, it's not a shock that things get lost in translation between doctor and patient.

In addition, people of different ages, genders, cultures, educational background and income level all communicate slightly differently. That also contributes to important information getting lost or not understood. So for all the people who "don't believe in psychology" then I explain that what I do is translate what they tell me into medical language and back up what they say with objective test data to support their complaints. That's something most people can understand and get involved with cooperatively.

I do the same thing currently, but I generally am evaluating people who are reporting disabilities. I translate what they tell me into medical language and back up their complaints with objective test data to make their complaints clear and understandable. Sometimes the complaints don't translate well. The person is vague or has a limited way to express how they think and feel. The data then is invaluable. Sometimes the data suggests that the complaints are either too much for the situation or too little for the situation. Then psychological factors can be factored into what is going on. Some people complain easily. Some people never complain unless things are dire. Just listening to complaints alone won't tell me if this is someone from either of those groups. The testing will tell me what is going on. That's why I like doing testing. It helps people get the correct treatment, services and resources they require.

Psychology and Gang Dog

I co-own Gang Dog (Cinnamon) along with my husband. She is a 10 year old rescued liver spotted female Dalmatian. Dalmatians come in black, liver and yellow spots. Black is the most common spot pattern. We got her as a puppy through a Dalmatian rescue organization. We new a little about her when we got her. She was found emaciated, wandering the streets of Pacoima, California at 2 months of age. She was placed into dog foster care with five families for a total of one month prior to our getting her. My husband is retired from law enforcement. One evening he was going out and loaded his gun and Cinnamon just got soooo excited, jumped up on the back of the couch like a little mountain goat, and then ran to the front door like she was expecting a car ride. So my husband and I figured she had originally been some gang members' dog and was expecting to go out for a drive by shooting. We started talking to her in Spanish and Gang slang and she was not only thrilled but seemed to understand Spanish better than English. So we nick-named her Gang Dog. She rides in the back of my Mustang and seems to get a kick out of watching people wave at her. She likes watching people do stupid human tricks.