u06d2 Creative Interventions
ASSIGNMENT
For the first portion of this discussion, provide a brief
overview of the two articles you read from the Capella Library on creative
techniques in counseling. Share an example of how the interventions discussed
might benefit a client who is severely and persistently mentally ill. Where
could you seek training regarding the interventions discussed?
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My interest currently
(due to client circumstances and due to a relative’s experiences with
dysregulation of mood) is in the treatment of bipolar disorder and mood
disorders. Looking for creative
treatment protocols was not particularly effective. I found significant literature about new
applications of medications dedicated to other disorders now applied to
treatment of bipolar disorder, such as the Zarate webinar on Ketamine infusions
for treatment of mood disorders (Zarate, 2013) . I found research about the biomechanical
pathways which are perhaps responsible for the symptomology of bipolar disorder. However, there was a paucity of information
about creative counseling techniques.
Treatments utilizing psychopharmacology compromised the
majority of the research articles and literature/body of knowledge. Treatments based on CBT were prevalent. There are also self-help books available
incorporating CBT (Basco, 2006; Bauer, Kilbourne, Greenwald, Ludman, & McBride, 2008) or Family-Focused
Therapy (FFT) (Miklowitz, 2011) . None of these things are particularly
creative. In fact, CBT and FFT
modalities are reputed to be evidence based practices and considered to be
fairly clear-cut.
A person is experiencing “treatment resistant” mood disorder
NOS with hypomania, mixed episodes, irritation, suicidal and homicidal
ideation, severe depression, insomnia, anxiety, cognitive dysfunction in
thinking and perceiving, inability to concentrate, etc. The person cycles on a weekly basis. I have tracked this person’s moods since
March when Prozac prescribed for depression triggered severe mania and resulted
in hospitalization for a week. The
person’s mood-cycle is fairly consistent oven the time since March. The person has tried, and failed, multiple
medications used to treat bipolar disorder including Depakote, Remeron,
Seroquel, and about 8 antidepressants trialed before the manic episode… of
which Prozac was the worst one.
Currently the person is somewhat stable with Zyprexa – which was very
effective for 4 days and now has decreasing effectiveness. This person’s experience shows me that
psychopharmacology is not the “magic bullet” to resolve mood disorders.
I have several clients who have seen multiple counselors,
psychiatrists, medical doctors, and other health practitioners. Medication is often worse due to side-effects
than the disorder, is non-effective, or has limited effect. One client has seen counselors for over 20
years. This client’s medical history and
mental health history is very extensive.
The client is intelligent, creative, and dedicated to trying to find
resolution for bipolar symptoms. I
provided the client with copies of the three books I mentioned as available
self-help books. The client read all
three books and we discussed what the client has tried and not tried. The client’s experience shows me that CBT and
FFT are not able to help everyone.
I have been reading extensively. For my client who was feeling quite hopeless,
we have worked together to develop a way to return some control to the
client. This plan was based on the
reading I have been doing and the observation of my relative's life. Therefore, it is NOT evidence based, but
instead the start of a theory.
The idea starts with an understanding of eustress and
distress. If humans are considered to be
systems (dynamic systems theory, Freud’s theory, other theories) at
equilibrium, then things that cause change in that equilibrium are stressors. Each stressor has specific cost of energy
required to return the system back to an equilibrium. Maintaining equilibrium is the function of
any system. Therefore, stressors can be
conceptualized by assigning them a ratio.
We talk about eustress as taking less energy to return to
equilibrium than distress. We also talk
about the system’s resistance to change (which we conceptualize as resources or
balancers). The description I use is
this:
If I go walking in the woods and see a little black snake with a red ring around its neck, I get all excited. I like snakes, that is a very obviously non-poisonous snake, and so, I can hold and play with the snake. If my friend is walking with me and sees the snake, she is running the other way – screaming. She is phobic about snakes. (About 30% of the people I tell this are shaking their head at this point because they are not so fond of snakes either. We laugh for a minute and move on).
If I go walking in the woods and see a little black snake with a red ring around its neck, I get all excited. I like snakes, that is a very obviously non-poisonous snake, and so, I can hold and play with the snake. If my friend is walking with me and sees the snake, she is running the other way – screaming. She is phobic about snakes. (About 30% of the people I tell this are shaking their head at this point because they are not so fond of snakes either. We laugh for a minute and move on).
Now – the snake is the same.
It is just a snake, nothing has changed except the perception of the
snake. Furthermore, we talk about how
much less energy it takes me to return to my normal than for my friend to
return to her normal. So we talk about
how for each person discovery of the ratio of eustress to distress is
important. For some people eustress is
worth one point, while distress is worth 3 points. For others, eustress is worth 2 points and
distress is worth 7. It is something
each person needs to find out for him or herself.
So, the next couple weeks are spent tracking activities
versus moods. Sleep is also very important
and so are life activities like eating, cooking, interacting with others, etc. All these things are tracked - through
smart-phone apps, journal entries, graphically, or otherwise. After the events are tracked, we spend a
session analyzing the data. This usually
gives us a ratio. Often the tracking also
gives us a “flip-point”. The flip-point
is where mood switch happens.
As a side note, from my observations, it seems the
flip-point is where the most self-loathing and distress is felt. For my client, this is the point in which the
client experiences suicidal urges. I do
not understand why.
Then, the client learns how to use that ratio to moderate
moods. For example, understanding that at
a flip-point of 12, moods are likely to switch; and that eustress is worth a 4
and distress is worth a 6, then the client can decide that going out to a
movie, having a church function, and dinner with family is enough to be up to
the flip-point. Therefore, picking two
things to do instead of three can delay or avoid mood-transitions. Some clients are starting to find that there
is a correlation between energy-expenditure dealing with stressors and length
of time in mood-switch.
The other side of this tracking is to build resilience or
balancers. This things help make the
system of the client less responsive to stressors. To explain this, we talk about money in the
bank and cars. If I have an extra
$1000.00 in the bank and my car has a problem, it is inconvenient. If I have $1.00 in my bank account and the
car has a problem, it is a crisis. The
money is a resource… It is something
that buffers me from feeling as much distress from the exact same stressor of
the car having problems. Humans can
build resilience. This is done by some
things as simple as breathing exercises, meditation, and other wellness
practices. It can be done by things as
complex as changing where you work, live, and who you have in your life. However, ALL THESE THINGS are directly under
the control of the client.
By using tracking and this conceptualization, the clients I
am working with have been able to gain some control of their moods. While mood switches are not completely
alleviated, the distress felt by the client is decreased, mood switches are
decreased, and suicidal urges are less likely to be acted upon. One reason for this is that if length of
moods can be predicted (even in a very small way), it becomes more
tolerable. Understanding and control
seem to make it easier to accept the disorder.
Further, when energy is not spent fighting against the disorder, the
stressor of having a chronic condition/illness can be reduced, which benefits
system response and is a source of resilience.
So, while this is not a journal credited source of creative counseling
practice, it is the beginning of my hope that somewhere there is information
which will provide holistic treatment of a disorder that is pervasive across
all domains of a person’s life, which does not have particularly favorable
prognosis in treatment-resistant forms, and which can be very debilitating.
Laura Collins
References
Basco, M. R. (2006). The bipolar workbook: Tools
for controlling your mood swings. New York, NY: Guilford Press.
Bauer, M. S., Kilbourne, A. M., Greenwald, D. E.,
Ludman, E. J., & McBride, L. (2008). Overcoming bipolar disorder: A
comprehensive workbook for managing your symptoms & achieving your life
goals. Oakland, CA: New Harbinger Publications, Inc.
Miklowitz, D. J. (2011). The bipolar disorder
survival guide: What you and your family need to know [2nd Ed.]. New
York, NY: Guilford Press.
Zarate, C. (2013, August 13). Meet the scientist
webinar: Ketamine and next generation therapies. Retrieved from Brain
& Behavior Research Foundation: bbrfoundation.org/august-webinar
