We treat these issues for all groups and coordinate care with the primary care physician.
Click on the highlighted words for a definition
- Anxiety Disorders, including fears and phobias, OCD and others.
- Bipolar Disorder
- Panic Disorders
- Attention Deficit Hyperactivity Disorder
- Adults and Children
- Child Behavior Problems
- Chronic/Terminal Illness
- Court-Ordered Psychology
- Depression and Bipolar Disorder
- Developmental Issues
- Eating Disorders and Weight Problems
- Grief and Loss
- Marriage/Family Problems
- Mental Toughness
- Multicultural and Minority Issues
- Pain Management
- Parenting Issues, including parenting and family assessments
- Perinatal Psychiatry (Management of women's mental health issues during and following pregnancy)
- Post Traumatic Stress Disorder
- Psychological Testing
- Smoking Cessation
- Sports Psychology
- Sexual/Physical Abuse/Rape
- Stress Management
- Substance Abuse
Anxiety can range in intensity from slight nervousness to a feeling of total loss of control and sense of disorentiation. Some people with as anxiety disorder are anxious most of the time while others may experience periods of intense anxiety. Anxiety is often felt in the body in addition to the psychological affects. The following criteria are found in the DSM-IV under generalized anxiety disorder, overanxious disorder, and separation anxiety disorder:
Autonomic hyperactivity as evidenced by:
- shortness of breath or feeling smothered
- accelerated heart beat
- sweating or cold clammy hands
- dry mouth
- dizziness or light headed
- nausea, diarrhea, abdominal distress
- hot flashes or chills
- trouble swallowing
- frequent urination
Motor tension as evidenced by:
- trembling, twitching, shaking
- muscle tension, aches, soreness
- easily fatigued
- feeling keyed up or on edge
- exaggerated startle response
- difficulty concentrating
- mind going blank
- trouble falling asleep or staying asleep
In a generalized anxiety disorder or overanxious disorder, the person has an exaggerated and unrealistic feeling of anxiety and worry about people or events in their life. The extent of worry and anxiety is enough that it interferes in the person's ability to function appropriately. Generalized anxiety disorder is usually the diagnosis given to adults while overanxious disorder is more often used with children. Both adults and children with this disorder like predictibility and do not cope well with change. The diagnosis seperation anxiety disorder is used with children who have specific problems with being seperated from their primary care taker.
Bipolar Disorder, along with depression, is a biopsychosocial mood disorder with multiple psychological components.It is a disorder that has been long recognized to have physiologic and genetic factors. However, social and environmental factors and stressors have a contributory factor to the timing of episodes. It is most effectively managed by evidence based pharmacotherapy and individualized psychotherapeutic approaches.
A panic attack is a discrete period of intense fear or discomfort in which at least four of the following symptoms develop abruptly:
- heart palpitation, pounding heart, accelerated heart rate
- trembling or shaking
- shortness of breath, feeling smothered or can't breathe
- feeling of choking
- chest pain or discomfort
- Nausea or abdominal distress
- feeling dizzy, light headed, or faint
- derealization (feeling like things aren't real)
- depersonalization (feeling detached from yourself)
- fear of losing control
- fear of going crazy
- fear of dying
- numbness or tingling sensation
- chills or hot flashes
These criteria are taken from the DSM-IV, American Psychiatric Press, 1994.
A thorough clinical evaluation is needed to establish a diagnosis of ADHD. Sometimes children or adolescents have some of the symptoms for other reasons, or due to other conditions. All of the behaviors should be considered in relation to the child's developmental stage and age. True ADHD is present from birth, so if a child has a sudden onset of symptoms it is unlikely that she/he has this as a real diagnosis. ADHD is known as an attention disorder as well as a disruptive behavior disorder, yet these children may become super focused to the exclusion of other activities. This is especially true for electronic video games or computer games because the feedback is immediate and the action is exciting and non-stop: a real appeal to the ADHD mind! These are the symptoms commonly seen in people with ADHD:
- Fidgets with hands or feet, squirms in seat
- Difficulty remaining in seat
- Easily distracted
- Difficulty waiting for their turn
- Difficulty staying quiet
- Difficulty following directions
- Often doesn't finish tasks
- Difficulty keeping attention in tasks or play
- Shifts from one uncompleted activity to another
- Interrupts others
- Intrudes on others, often intrudes upon personal space of others
- Often doesn't seem to listen
- Often loses things needed for tasks or play
- Often acts recklessly without concern for safety This condition often coexists with other psychiatric disorders, such as oppositional defiant disorder, conduct disorder, mood disorders and substance abuse. Contrary to popular opinion, children do not "outgrow" the condition.
The child and adolescent therapists at Finney Zimmerman Psychiatric Associates, have many years of experience in establishing the diagnosis of ADHD and assisting families to develop a plan of care geared toward success. Reading materials and suggested parenting and teacher interventions are usually recommended and the child may be referred for a medication evaluation to determine whether medicine may help the condition in addition to other parenting and environmental interventions. Newer medications are extremely effective in assisting children to modulate behavior in order to develop social skills, cooperate with expectations and succeed academically.
PSYCHOTHERAPY WITH CHILDREN AND ADOLESCENTS:
Psychotherapy refers to interventions and techniques used by mental health professionals to assist children and young adults who are experiencing emotional or behavioral difficulties. Therapy may involve parents, siblings, extended family, or any other significant people in a child’s life. The extent to which other people are involved is based on the child’s needs and a treatment plan that is mutually agreed upon by the therapist and the client. Therapy is often used with other services such as psychological testing, medication management, and work with schools, courts, foster care, etc.
WHAT TO EXPECT WHEN A CHILD ENTERS TREATMENT:
An initial assessment will explore the child’s current symptoms; developmental stages; family history; medical history; school or work performance; and the child’s ability to participate in the therapeutic process. The therapeutic relationship between the therapist and the child (as well as his/her caregivers) is extremely important. Both child and family must feel comfortable and safe with the therapist because thoughts and feelings are most easily expressed in a trusted environment. The assessment process allows the therapist to gather information and helps the child and family determine if the therapist is a good match for them.
After the assessment phase, if everyone agrees to work together, the therapist and client/s set goals for treatment. These goals can be very specific (for example, “decrease daily fighting to once a month”) or broad (“improve self-esteem”). The therapist will also set a schedule for sessions (weekly, monthly, etc) and discuss a time frame for treatment. These will vary based on the severity and complexity of the child’s problems.
WHAT HAPPENS IN CHILD PSYCHOTHERAPY?
While children may talk about their feelings in therapy, their treatment will not be like an adult’s. Child therapists will draw on a variety of techniques that might include behavioral plans (using weekly ‘homework’ assignments or behavioral charts); creative projects to encourage emotional expression; playing games that target a specific issue or symptom; and play therapy. The development of the young person will guide what interventions are used: for example, a teenager may prefer talking while a pre-schooler will be more likely to play.
The therapist will involve parents by sharing general themes, helpful responses, and progress in therapy. Parent guidance or family meetings can be part of therapy. Confidentiality is essential to help a child feel safe and the specifics of what a child does or says will generally remain private. The two exceptions to confidentiality include allegations of abuse or the threat of harm to self/others.
WHAT IS PLAY THERAPY?
Children express themselves through play. It is their natural form of communication and the way in which they learn about the world, themselves, and others. Even highly verbal children express things more fully through play. Emotions can be hard to understand or share with others. Play provides a non-threatening form of self-expression. Some play therapy techniques include sand-tray play; board games designed to help with behavioral issues; expressive art projects; doll houses/families; physical games; dramatic play with costumes; and representational play with symbolic items.
HOW CAN I PREPARE MY CHILD FOR AN INITIAL CONSULT?
You can tell your child you have noticed that things have been hard for him/her at home (or school, social activities, etc.) and that sometimes it helps to have a special place to play or talk in order to figure these things out. Most children understand the idea of going to the family doctor/pediatrician for physical health. You could explain to them they “will be meeting a special man or woman named (therapist’s name) who will help you with difficult thoughts/feelings, just like (regular doctor’s name) helps your body stay healthy.” You may also want to reassure the child they will be talking or playing and that nothing painful (like getting shots) will happen.
Court-ordered psychology is psychological therapy that is declared by a judge (or panel of judges) that requires one or more parties in a case to recieve counseling from a professional for a given amount of time. A court may request therapy for a number of reasons such as substance abuse, addiction, and anger management.
Depression is a disorder of mood that affects over 10 million people in the United States and costs the economy over $27 billion per year. Depression affects thoughts, feelings, body and behaviors. Some depressive episodes occur for no apparent reason while some are triggered by a stressful event. Some people have one episode of depression in their life and some have recurrant episodes. Sometimes a depression can be so severe that the person can not function as usual. More often people may have chronic symptoms that are bothersome, but they accept as normal for them. Without treatment, symptoms of depression can last for months, years or a lifetime. The following symptoms can indicate that a person may be clinically depressed:
- Persistent sad or empty mood
- Crying for no apparent reason
- Mood swings
- Decreased energy, feeling tired, feeling groggy
- Sleep disturbance (trouble falling asleep, can't stay asleep, wakes often, wakes early, oversleeping)
- Eating disturbance (loss of appetite or overeating)
- Loss of interest in usual activities
- Difficulty concentrating
- Difficulty making decisions
- Difficulty problem solving
- Excessive guilt or worry
- Feeling hopeless, helpless, overwhelmed
- Thoughts of death or suicide
- Physical ailments that have no physical cause
Hypnosis is a lot like daydreaming. You are conscious and aware, and at the same time you are oblivious to external distractions. Hypnosis is a technique the helps you enter this altered state of consciousness deliberately and to direct your attention to specific goals in order to achieve them. It is perfectly normal, safe and healthy phenomenon. In both daydreaming and hypnosis your mind is in the alpha frequency range. The difference is in hypnosis you are directed to specific goals that you want to achieve; i.e. quitting smoking, losing weight, self healing, decrease anxiety, eliminate phobias, aid in sleeping, improving sports performance, conquering test anxiety-----the list of uses is endless.
Hypnosis is one of the most valuable techniques that we can use to enrich our lives and promote a healthy life style. It helps to beak bad habits, create new desirable habits and constructively deal with and resolve many of life’s problems. Why isn’t hypnosis more widely used? There are many misconceptions about hypnosis. There is also lack of knowledge and education about the many benefits. Hypnosis is not like what you see on TV or in the movies.
Four types of brain waves:
Beta is the conscious mind.
Alpha is the unconscious mind. This is where daydreaming, dreaming (while asleep) and nearly all hypnosis takes place. Meditation is mostly in this range but sometimes dips into the theta range.
Theta is the special range where some hypnosis and mediating takes place.
Delta is total unconsciousness.
A hypnotist has magical powers.
A person can be hypnotized and made to do things against his or her will.
Only weak-minded people can be hypnotized.
A hypnotized person is in a trance or is unconscious.
A person can get stuck in hypnosis.
Deep hypnosis is necessary for good results.
Perinatal psychiatry deals with the prevention, understanding and treatment of psychiatric illness related to childbearing. The number 1 complication of pregnancy is depression. The focus is not only on the pregnant or postpartum woman, but includes her partner, family and children. Woman's mental health during pregnancy may influence the baby and has an impact on the family. Identification and management is crucial to promoting optimal outcomes. Dr. Christine Truman has a speciality in this area and she closely coordinates care with the woman's OB/GYN and primary care provider.
Psychological testing, also known as psychological assessment, is a field characterized by the use of small samples of behavior that are valid and reliable in order to infer cognitive or emotional generalizations about a given individual. Samples of behavior are observations over time of an individual performing tasks that have usually been prescribed beforehand.
Tests may be written, visual or verbal. These responses are often compiled into statistical tables that allow the evaluator to compare the behavior of the individual being tested to the responses of a norm group. Multiple tests administered is referred to as full battery assessment.
How to Have Championship Play
- Remember to have fun! Champions win big games because they are having fun! When you are enjoying yourself you will be physically looser and play better. If you are too serious you may become overly tight and tense.
- Focus on the moment-not the outcome- You will play your best when your concentration is in the here and now. Outcome thoughts, whether you win or lose, will make you tight and negatively effect your play. The outcome of the game, which is the future, is out of your control. All you can do is play the best you can play and the way you do that is by staying in the now. The way to do this is to concentrate on what you are doing, while you are doing it. If you find yourself thinking about “what if “, that is a reminder you are in the future and you need to refocus and come back to what is happening now.
- Concentrate-In order to play the best you can play; you have to have your mind in the right place. Concentration is the key mental skill to excellent play and mental toughness. Here is how to do it: Step 1: Recognize if you are mentally in the wrong place; for example if you are focusing on the outcome. Step 2: Quickly and gently bring yourself back to the proper focus. You learn to concentrate better by catching yourself quickly when you are not concentrating! This is the most important thing about championship concentration!
- Learn to QUICKLY let go of your mistakes and failures-Champions do this better than anyone else. FAIL! (Remember the Michael Jordan commercial about missing all the shots at the end of the game; that’s what the commercial was about, all of the times he had failed!) When a champion has a bad game they use this failure for feedback, what did I do wrong and how can I improve? Just as important, they let it go! They don’t dwell on past mistakes! Learn to recognize when your mind is in the past and let it go! If you find yourself telling yourself thing like “Here we go again”,”Why does this always happen” it means you are focusing on the past. Go into the past only if it will help you by focusing on past successes.
- Stay mentally in the PRESENT! You will play your best when you can learn to mentally stay in the present, on what you have to do and what you are doing. Stay in the here by recognizing when you are mentally in the wrong place and bringing yourself back to what you are doing.
- Control your eyes and ears before important games- learn to control what you look at and listen to both before and during the game. Visually focus only on things that keep you calm and ready to play well. Make sure that the things you think about and visualize are positive and make you feel confident. Controlling your ears means listen only on the things that keep you feeling calm and confident. This means you saying positive things to yourself too!
- See what you want to have happen and not what you are afraid will happen-Focusing on positive images will help you feel calmer and more confident and increase the likelihood of having what you want to have happen actually happen. Practice 5-10 minutes per day, when you are relaxed, seeing, hearing and feeling yourself playing just the way you want to play.
- Relax and let it happen-if you make the game too important, you will start trying too hard and that will make you tense. When you are tense you do not play as well as when you are relaxed. Trust that you have done everything you need to do already and just enjoy the game!
- Be positive-nothing good comes from negativity-When you are negative or down on yourself you sap your energy and drain your confidence. No way can you play a good game with a negative attitude! Practice being positive about yourself, your teammates and your coaches, NO MATTER WHAT! A positive attitude helps you overcome hardships and setbacks and keeps you going. A negative attitude will trick you into giving up too soon.
- Act "as if"- if you want to become a winner, first of all you have to act like one. If you act the way you want to become, you will become the way you act. Acting has to do with your posture and the way you carry yourself physically. Have your head up, shoulders back and a look of confidence on your face. Show your opponent someone who looks calm and in control. Remember, no one has more experience in close games than you do!
- Learn to relax-Practice relaxation techniques. One of the best is to learn to slow and deepen your breathing. By taking a few deep breaths you can very quickly calm your self down before the game or at the free throw line. You can practice at home by sitting for 5 minutes at a time and inhale slowly through your nose to a count of 4, and then exhale to a count of 7-8. Continue to do this for 5 minutes. When you practice this at home, you are much more likely to automatically do this to calm your self if you become tense during a game.
Characteristics of Winning versus Losing Teams
Seek first to understand
Are kind and respectful
Are clear on what they expect
Offer an apology if wrong
Are open to positive and negative feedback
Provide helpful feedback
Think of benefit to the team
Seek first to be understood
Are unkind or disrespectful
Are prideful or arrogant
Refuse to provide feedback
Think of benefit to self
Practice is 90% physical and 10% mental; you need to work hard to achieve your goals!
Competition is 10% physical and 90% mental; you need to practice your mental skills as well as your physical skills.
Athletes are always limited by faulty technique but many athletes stop right there and never learn how to mentally prepare.
Stay calm under pressure
Concentrate and block out distractions
Quickly rebound from mistakes, bad breaks and distractions
Avoid psych-outs and intimidation
Set and reach big goals
Develop self-confidence and master negative thinking and self-doubt
These techniques of mental fitness will work for you only if you work and practice the techniques!
There are not instantaneous positive results, just like in physical practice there are not immediate results; you have to practice both!
How to get in control mentally?
Negative thoughts lead to serious underachievement.
Mental mistakes lead to slumps, losing streaks, choking and increased negativity.
To understand the role of the mind: when you learn to control your mind, you improve your performance.
1) Destructive self-talk or thinking leads to poor performance and increased pressure
2) Poor focus or concentration before or during a competition leads to difficulty in your performance.
How to stay cool under pressure?
- Quickly let go of mistakes
- Avoid psychouts
- Master negative thinking
- Maintain motivation
- Properly prepare for upcoming competition
- Build self confidence
If you mentally “trash yourself” you will end up destroying your self-confidence. If you destroy self-confidence you increase nervousness and muscular tension which lead to a poor performance.
What you expect from yourself is a self-fulfilling prophecy; “you always get what you expect, positive or negative”.
What is the relationship between your thoughts or self-talk and the physiology of your body?
It effects you timing reflexes, speed, technique and ability to get it done under pressure.
If you use a lot of negative self talk, for example: “What if we lose? They are so much better. The player I have to guard is quicker, taller, more experienced…” Talk like this makes you nervous. When you are overly nervous, what happens?
Your muscles tighten.
You get an adrenaline rush.
Your heart rate and blood pressure goes up.
Your breathing becomes faster and shallower.
Your stomach may feel queasy.
Hands and feet get cold.
When you have these physiological changes, your performance suffers.
Tight muscles cause poor timing, poor techniques, decreased flexibility, fatigue and increases the likelihood you will get hurt.
When you do not breathe slowly and deeply, you decrease the oxygen to your brain, which leads to poor decision making.
Where did the word choking come from in regards to an athletic performance? Some people become so nervous, they forget to breathe and end up feeling like they are going to choke.
What happens if you have cold hands? It will negatively effect you shot, passing, catching and even rebounding.
What to do?
Remember to breathe slowly and deeply.
Choose to think helpful thoughts.
Practice your visualization regularly.
Focus on the present. Stay in the now!
Practice your mental game regularly.
Pay attention to how you are thinking so you can begin to recognize and eliminate any negative thinking.
Choose to cultivate self-confidence. Show this with your body language.
is an intensive, year long outpatient treatment program for individuals and families experiencing problems due to excessive drinking or abuse of other drugs.
Learn about the illness of chemical dependency, develop the skills needed to aboid further abuse of alcohol and other drugs, learn how to gain and share the support of other recovering people, and begin to develop a new lifestyle based on sobriety.
Learn their role in this illness and the important tasks they can perform in helping the abuser gain and maintain sobriety while ensuring their own well-being.
FORMAT OF THE RECOVERY PROGRAM
- Diagnostic Assessment(s)
- Alcohol and Chemical Dependency Program Director Rose Smith LCSW
- Referral for Medical Detoxification Services, if indicated by history and assessment
- Group Therapy
- Phase 1: Sixteen 3 hour sessions 2-4 times per week
- Individualized treatment plan implemented based on individual needs
- Phase 2: Twelve 1 1/2 hour weekly group sessions
- Phase 3: Continuing 1 1/2 hour group sessions until the participant has completed one year in the RECOVERY program
- Individual, couples, and family therapy as needed
- Psychiatric evaluation by psychiatrist as needed
- Psychological assessment as needed
- Case management services, including coordination of care with the primary care physician,employee assistance counselors, and others
REQUIREMENTS OF THE RECOVERY PROGRAM
A desire to change and willingness to stop all alcohol and other drug abuse, regular attendance at all treatment services and regular attendance at recommended Self-Help groups such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Al Anon. The required minimum attendance is three meetings per week. Participants must select a self-help sponsor within the first two months of the program and invite their sponsor to a special Recovery Program meeting. Participants must be willing to submit to random urine drug screens upon request by the RECOVERY staff.
THE RECOVERY PROGRAM is licensed by the Virginia Department of Mental Health as a Day Support Treatment Program for substance abusers and their families.