7 Signs You Might Need Professional Help

Marriage Counseling: 7 Signs You Might Need Professional Help
By Jenny Tiegs

This article originally appeared on GalTime.com

There’s no question — marriage can be challenging. Maybe marriage
counseling should be something you register for when you tie the knot.
Much like a new set of dishes that gets scratched from constant use,
relationships can also show wear and tear over the years. So how do
you know if your marriage has hit a rough patch or it’s something more
serious… requiring professional help?

Sign 1: Poor Communication.

Martin Novell, a Licensed Marriage and Family Therapist in Los
Angeles, urges couples to seek professional help when they aren’t able
to talk about their problems. According to Novell, “When It’s just too
frightening to even bring issues up — from sex to money, or even
annoying little habits that are being blown out of proportion, a
therapist’s job is to help the couple become clear about their issues
and to help them understand what they are truly talking about.”

Sign 2: Your Sex Life has Significantly Changed.

Most feel that when there is a loss of intimacy, there are problems.
While this is true, it is also important to be mindful of a sudden
increase. Valerie Jencks, Founder and Executive Director of Prairie
Family Therapy in Chicago, warns that either an absence or a sudden
increase of sex in your relationship can signal danger. “If you have
not been having regular or passionate sex and all of a sudden your
partner behaves like a courting lover or wants to experiment with new
activities that s/he has never expressed an interest in before, it
could indicate that he is experiencing feeling of arousal that are not
originating from his relationship with you!”

Sign 3: Holding on to the Past.

Silvia M. Dutchevici, the founder and President of the Critical
Therapy Center in New York City, suggests that it might be a good idea
to talk to a professional when there has been a traumatic event in
your lives, like the loss of a child or an affair — and one partner
cannot let the past go. “Whatever the situation, every person
processes trauma differently.”

Sign 4: A Reoccurring Issue.

“One type of red flag that usually can be greatly helped by therapy is
an issue that has been difficult in the relationship from the
beginning, but regardless of endless discussions, never seems to
pass,” explains Dr. Julie Gurner. “When you see that the same issues
are coming up again and again in disagreements, it is a good sign they
are not effectively being resolved and the couple is at a ‘sticking
point.’” Dr. Gurner encourages couples to seek help to save “many
years of trouble down the road.”

Sign 5: Finances.

Disagreements over money are one of the top reasons couples find
themselves in conflict. If your spouse keeps you in the dark about
family finances or feels the need to control everything related to
money, it may be time to speak up. Christine K. Clifford,
CEO/President ofDivorcing Divas, suggests you say, “I want to be aware
of our debt, our monthly bills, the balance on our mortgage, how many
savings/checking accounts we have, etc.” Clifford explains, “If your
spouse objects, it’s time to see a counselor.”

Sign 6: Kids.

Yes, children are a blessing, but they can also add stress to your
marriage, especially if the two of you are not a united front.
Clifford suggests seeking counseling if you disagree with each other’s
parenting styles and frequently argue about how your children should
be raised. “Think Katie Holmes — and how she doesn’t want Suri raised
as a Scientologist,” states Clifford. “These are major issues that
need to be resolved.”

Sign 7: You Still Love Your Spouse.
If you still love your spouse, really want to make things work, and
haven’t been successful, then consider finding a counselor. Dr. Gurner
also stresses the point that you need to seek advice before things
escalate and you truly despise the other person. “Be a proactive
couple who strives to solve issues before they tear at the fabric of
your deepest bonds of trust and intimacy.”

Link: http://www.huffingtonpost.com/2012/08/27/marriage-counseling_n_1833482.html

Does Tricare Pay for Marriage Counseling?

FALLS CHURCH, Va. – It’s important for military couples to talk to someone about marital struggles or stress they may be experiencing. Marital, couples and family therapy, often referred to as counseling, are all types of professional behavioral health interventions available to eligible married couples enrolled in TRICARE Prime, TRICARE Prime Remote and TRICARE Prime Overseas. 

            “Military life can often cause stress for couples and families,” said Rear Adm. Christine Hunter, deputy director of the TRICARE Management Activity. “Long deployments, worries about job-related danger, and frequent moves can take their toll. For these reasons, TRICARE considers marital therapy an essential part of behavioral health care.” 
  
            Marital therapy or counseling can be covered by TRICARE Prime when it’s based on a behavioral health diagnostic evaluation by a TRICARE provider. TRICARE Prime-enrolled spouses of active duty service members can seek marital therapy or counseling in the U.S. or overseas as part of the first eight outpatient behavioral health care visits allowed per fiscal year. This can be done without a referral from a primary care manager or prior authorization from their regional health care contractor. Active duty service members need a referral for all behavioral health care received in the TRICARE network.

            Professionals in the TRICARE network authorized to provide marital therapy include psychiatrists, psychologists, certified psychiatric nurse specialists, clinical social workers and certified marriage and family therapists. TRICARE-authorized pastoral and mental health counselors can provide therapy or counseling services under a physician’s supervision.

            After the first eight visits, non-active duty beneficiaries must get authorization from their regional health care contractor to continue treatment. To reduce their out-of-pocket expenses, beneficiaries are encouraged to use a TRICARE network provider.

            Active duty family members enrolled in TRICARE Prime or TRICARE Prime Remote can call their regional Behavioral Health Care Provider Locator and Appointment Assistance Line for help locating and making appointments with network behavioral health care providers in their area. The toll-free numbers are: North Region, 1-877-747-9579; South Region, 1-877-298-3514; and in the West Region, 1-866-651- 4970. Hours vary according to region. TRICARE Prime Overseas beneficiaries can get information about host nation providers from their local military treatment facility or TRICARE Service Center. The nearest TRICARE Service Center can be found at www.tricare.mil/overseasTSC.

Sign up for TRICARE e-mail updates at www.tricare.mil/subscriptions.

Connect with TRICARE on Facebook and Twitter at www.facebook.com/tricare and www.twitter.com/tricare.

The TRICARE Management Activity administers the worldwide health care plan for 9.6 million eligible beneficiaries of the uniformed services, retirees and their families.

How to Get Off-Post Counseling for Yourself or a Family Member

Mystery Solved: How to get Off-Post counseling for yourself or a family member by Verna Dority, MSW, LCSW

If you are a dependent or a retiree, you do NOT need a referral or an authorization of any kind of get counseling off post.  Simply look in the phone book or do an online search and call the place you would like to set up an appt with.   They will do your authorization paperwork for you.  Just make sure you bring your Military ID card to your first appt. *************** When an active duty military individual needs to talk to a counselor and does not want to talk to anyone on post, they have a choice of how to go about getting the services they need: 1.  They may use their Tricare insurance. (Which pays for as many sessions as needed to provide relief or resolve the situation for the soldier).  2.  They may pay for sessions with cash or check and not use either their Tricare insurance or their Employee Assistance Program.  (They may pay for as many sessions as they can afford) *************** Insurance vs. the Employee Assistance Program (EAP) for the active duty soldier.  Again,  dependents and retirees can use their Tricare Insurance by simply  making an appt off post. They do not need to worry about using the EAP.  The Employee Assistance Program is for the employee (the active duty soldier). Tricare is the insurance (managed health care) program for military, dependents and retirees.  (It replaced the previous CHAMPUS plan).  The TRICARE Management Activity (TMA) contracts with several large health insurance companies.  The company Healthnet provides services for Tricare North Region, which includes the Ft. Bragg area.  (See www.myTricare.com) Advantages of using Tricare Insurance: If you are needing more than 6 sessions, you don’t have to switch therapists.  You can start and finish with the same therapist.    Disadvantages of using Tricare Insurance:  You have to get your pcm to fax a referral to Tricare.  This can take anywhere from 24 hours to several weeks’ wait.  (However, once Tricare receives the referral, they fax the authorization to the therapist  usually within 24 hours) Since using a one source referral (EAP) may result in the soldier still having to go through the same paperwork process to start using the Tricare Insurance, and since they will not be able to see the same therapist they started with for longer term therapy, some soldiers (who don’t meet the criteria below) decide to skip the EAP and just use their Tricare insurance. If you have any questions about this topic or would like me to address different topics in future articles, please contact me through my website below. Thank you for your Service and for all you do for us!   Verna Dority, MSW, LCSW, a veteran, is a Licensed Clinical Social Worker and owner of Carolina Counseling Services in Fayetteville, NC.

Bedtime Fears: Helping Overcome Them

From the Cincinnati Children’s Website

It is normal for young children to have fears of the dark and going to bed at night. Most children experience nighttime fears at some point during childhood. If a fear of the dark or going to bed is preventing your child from falling asleep or sleeping through the night, you may consider some of the following recommendations to help reduce your child’s fear at bedtime or during the night and help him / her to get better sleep.

1.     It is important to understand your child’s fears. Give your child a chance to tell you what makes him / her scared at bedtime. However, don’t force your child to talk about the fear if he / she is not ready. The nature of children’s fear is different throughout development. It is not uncommon for younger children to have difficulty telling the difference between what is real and what is imaginary. Never dismiss or make fun of a child’s fear. A fear that may seem silly to an adult may seem very real to a child.

2.     Once you understand the nature of your child’s fear, it is important not to support or build up these fears. For example, if he / she is afraid of monsters, don’t get out the monster repellant spray or broom to sweep the monster away. These actions tend to make children think you believe in the imagined object as well. It may be helpful for your child to explore fears in the safety of the day. Be careful not to establish rituals to “clear the room of monsters.” These attempts to comfort your child may inadvertently create a situation in which you are delaying bedtime and providing entertainment for your child as opposed to providing comfort.

3.     It may be helpful for your child to have a security object (e.g., special blanket, toy, stuffed animal) that he / she can keep during the night to help him / her to feel more relaxed a bedtime.

4.     A nightlight may be helpful for providing security at night even if your child is not afraid of the dark. As long as the light does not interfere with your child’s sleep onset, it is appropriate to have dim light on at bedtime. Leaving your child’s door open at bedtime can also create a sense of comfort that may alleviate fear that is associated with separation from parents at bedtime.

5.     A pet for companionship (preferably an animal that does not sleep in the bed; a fish tank is a great option) can also provide security at night and reduce nighttime fear. Sometimes sharing a bedroom with an older sibling can help reduce bedtime fears as long as the children are not interfering with each other’s sleep.

6.     Do not allow your children to be exposed to scary television shows, videos or storybooks that may increase his / her fears at bedtime.

7.     It is important for your child to have daytime experiences that serve to build his / her self- confidence. If he / she feels confident during the day, this will help with security at night as well. Depending on the age of your child and how well he / she is able to talk about his / her fears, you may want to give your child the option of telling you about the fearful experiences and what might help him / her to feel less frightened at night.

8.     If your child has a difficult time separating from you after she / he has been tucked in for the night, or if she / he calls out for fear soon after bedtime, go back in and ask her what is wrong. Reassurance can be provided by making statements that communicate the safety of your child. For example, you might say “You are OK. We are here to make sure that you are safe. We will make sure that nothing bothers you so that you can sleep comfortably in your own bed all night.”

9.     Don’t encourage your child to get out of the bed. The goal is to help your child overcome fears. If able to stay in bed and experience that everything is OK, he / she will learn to trust the bed is a safe place. If children are allowed to get up from bed and come into your room or into the room with other family members that are awake, they may learn that their room is not a safe place. It is better to join children in their room to provide comfort than to let them leave their bedroom.

10.   If child is extremely frightened and you believe she cannot tolerate being in her room alone, it is OK to occasionally stay by her bed until she falls asleep. It is not recommended that this happen too often, or even two nights consecutively, as your child may come to depend on your presence. If your child is anxious about being left alone, you can tell her that you will check on her periodically. Begin by briefly checking and reassuring her in 5 minutes, then 10 minutes, then 15 minutes, then 20 minutes until she is asleep. Be careful not to spend much time during the period of reassurance.

11.   If your child wakes up during the night and is afraid to go back to sleep because he is frightened go to him and briefly reassure him that he is safe and that you are there to make sure that he is OK. If your child gets out of bed during the night and comes to your bedroom, take him back to his bed and reassure him that he is OK. It is important not to get your child up and out of bed; it is important for him to learn that his bed is a safe and comfortable place.

12.   If your child’s problems at bedtime and during the night continue despite efforts at implementing the previous recommendations, your child may have become dependent on your attention. If you have reached this point, you may need to increase your efforts to be firm and consistent at bedtime while also providing comfort to your child and reassuring her that it is safe to be in her bed.

13.   If your child’s bedtime fear and anxieties continue, are severe, or are also present during the day, you should consider having a formal psychological evaluation of your child to identify and treat anxiety.

link to article:
http://www.cincinnatichildrens.org/health/b/bedtime-fears/

When to Seek Help for Your Child

from the American Academy of Child and Adolescent Psychiatry website

Parents are usually the first to recognize that their child has a problem with emotions or behavior. Still, the decision to seek professional help can be difficult and painful for a parent. The first step is to gently try to talk to the child. An honest open talk about feelings can often help. Parents may choose to consult with the child’s physicians, teachers, members of the clergy, or other adults who know the child well. These steps may resolve the problems for the child and family.

Following are a few signs which may indicate that a child and adolescent psychiatric evaluation will be useful.

YOUNGER CHILDREN

• Marked fall in school performance
• Poor grades in school despite trying very hard
• Severe worry or anxiety, as shown by regular refusal to go to school, go to sleep or take part in activities that are normal for the child’s age
• Frequent physical complaints
• Hyperactivity; fidgeting; constant movement beyond regular playing with or without difficulty paying attention
• Persistent nightmares
• Persistent disobedience or aggression (longer than 6 months) and provocative opposition to authority figures
• Frequent, unexplainable temper tantrums
• Threatens to harm or kill oneself

PRE-ADOLESCENTS AND ADOLESCENTS

• Marked decline in school performance
• Inability to cope with problems and daily activities
• Marked changes in sleeping and/or eating habits
• Extreme difficulties in concentrating that get in the way at school or at home
• Sexual acting out
• Depression shown by sustained, prolonged negative mood and attitude, often accompanied by poor appetite, difficulty sleeping or thoughts of death
• Severe mood swings
• Strong worries or anxieties that get in the way of daily life, such as at school or socializing
• Repeated use of alcohol and/or drugs
• Intense fear of becoming obese with no relationship to actual body weight, excessive dieting, throwing up or using laxatives to loose weight
• Persistent nightmares
• Threats of self-harm or harm to others
• Self-injury or self destructive behavior
• Frequent outbursts of anger, aggression
• Repeated threats to run away
• Aggressive or non-aggressive consistent violation of rights of others; opposition to authority, truancy, thefts, or vandalism
• Strange thoughts, beliefs, feelings, or unusual behaviors

If problems persist over an extended period of time or if others involved in the child’s life are concerned, consider speaking with your seeking a consultation with a child and adolescent psychiatrist or a trained mental health professional.

Excerpts from Your Child on When and Where to Seek Help

Parents are often in the best position to recognize when their child is having a problem. Even when parents do recognize that their child is having trouble, it is not always apparent that professional help is necessary.

The first step in assessing the cause of your child’s difficulty is to ask him. Sometimes, gently asking your child questions Why are you constantly sad? Why did you steal that toy from Annie’s house? You seem upset, is something bothering you? Why are you so mad? ‑ will reveal the issues with which he’s struggling. Giving him adequate time to respond is necessary; talking honestly with your child about his feelings may also be helpful.

Consulting your child’s physician or teacher, or your minister, priest, or rabbi may help you identify problems‑both in the child and within the family ‑ that could be causing the upset. Frequently, a teacher will notice your child’s trouble and call you in. Working together, you can often get the child back on track before schoolwork or social interaction is affected.

As a rule, it is the combination of parents’ growing concerns and the observation of outsiders such as teachers, physicians, and family members, that lead parents to consult a clinician for their child. There are a few signs, when present over an extended period time, that indicate that your child has problems which could benefit from treatment.

Link to this article:

http://aacap.org/page.ww?name=When+to+Seek+Help+for+Your+Child&section=Facts+for+Families

Couples’ Therapy Reduces PTSD, Improves Relationship

Article written by Rick Nauert

As an individual recovers from posttraumatic stress disorder (PTSD), his or her partner often confronts significant caregiver burden and psychological distress.

A new study discovers that participation in disorder-specific couples therapy resulted in decreased PTSD symptom severity and increased patient relationship satisfaction, compared with couples who were placed on a wait list for therapy.

The study is discussed in the Journal of the American Medical Association (JAMA).

Experts all agree that there are well-documented associations between PTSD and intimate relationship problems, including relationship distress and aggression.

“Although currently available individual psychotherapies for PTSD produce overall improvements in psychosocial functioning, these improvements are not specifically found in intimate relationship functioning.

“Moreover, it has been shown that even when patients receive state-of-the-art individual psychotherapy for the disorder, negative interpersonal relations predict worse treatment outcomes,” study authors said.

In the study, Candice M. Monson, Ph.D., and colleagues examined the effect of a cognitive-behavioral conjoint therapy (CBCT) for PTSD, designed to treat PTSD and its symptoms and enhance intimate relationships in couples.

Researchers conducted the randomized controlled trial from 2008 to 2012, and included heterosexual and same-sex couples (n = 40 couples; n = 80 individuals) in which one partner met criteria for PTSD.

Symptoms of PTSD, co-existing conditions, and relationship satisfaction were collected by assessors at the beginning of the study, at mid treatment (median [midpoint], 8 weeks after baseline), and at post-treatment (median, 16 weeks after baseline).

An uncontrolled 3-month follow-up was also completed. Couples were randomly assigned to take part in the 15-session cognitive-behavioral conjoint therapy for PTSD protocol immediately (n = 20) or were placed on a wait list for the therapy (n = 20).

Researchers studied if the intervention helped reduce PTSD symptom severity (as a primary outcome); and if intimate relationship satisfaction, patient- and partner-rated PTSD symptoms, and co-existing symptoms were also improved (secondary outcomes).

The researchers found that PTSD symptom severity and patients’ intimate relationship satisfaction were significantly more improved in couple therapy than in the wait-list condition.

Additionally, PTSD symptom severity decreased almost 3 times more in CBCT from pretreatment to post-treatment compared with the wait list; and patient-reported relationship satisfaction increased more than 4 times more in CBCT compared with the wait list.

The secondary outcomes of depression, general anxiety, and anger expression symptoms also improved more in CBCT relative to the wait list. Treatment effects were maintained at three-month follow-up.

“This randomized controlled trial provides evidence for the efficacy of a couple therapy for the treatment of PTSD and comorbid symptoms, as well as enhancements in intimate relationship satisfaction,” said researchers.

Notably, improvements occurred in a sample of couples in which the patients varied with regard to sex, type of trauma experienced, and sexual orientation.

Researchers discovered the treatment outcomes for PTSD and related symptoms were comparable with or better than effects found for individual psychotherapies for PTSD.

In addition, patients reported enhancements in relationship satisfaction consistent with or better than prior trials of couple therapy with distressed couples and stronger than those found for interventions designed to enhance relationship functioning in nondistressed couples, report the authors.

In summary, researchers believe cognitive-behavioral conjoint therapy can be an effective strategy to address individual and relational dimensions of traumatization. The therapy technique may be of benefit to individuals with PTSD who have stable relationships, and partners willing to engage in treatment with them.

 

link: http://psychcentral.com/news/2012/08/15/couples-therapy-reduces-ptsd-improves-relationship/43152.html

Childhood Fears

Article written by Colleen Shemeley and featured on the Focus on the Family website

Just as your children grow and change, so do their fears. Monsters under the bed, thunderstorms or loud noises probably no longer cause your child to need your reassuring words and hugs. Fourth and fifth graders’ most common anxieties are being kidnapped, parents divorcing, someone dying, fires, burglars, school failure and being a social outcast.
Psychologists have discovered that distinguishing between fear and anxiety is often difficult in children. Fear is a response to a situation (a neighbor’s dog), while anxiety is being worried about something that hasn’t happened yet (a shot at the doctor’s office). Once parents realize this difference, they can better help their child cope.

• The first and most important thing is to believe your child’s fear. Talking about and affirming the existence of her fear will help your child. But be careful not to overtalk the fear or express your own fears. If your child doesn’t want to discuss it, encourage her to write a fictional story about another person with the same fears or draw a picture of what could happen.
• Fears can often be removed or reasoned through to a logical conclusion after evaluating reality. Make a plan of action if a mean dog comes too close. Practice on dolls the day before a visit to the dentist. Memorize certain Bible verses that fit your child’s fear (check out Psalm 27:1, Psalm 31:24 and John 14:27). The more independent your child feels, the smaller the fear can become.
• Try to recognize your child’s signs of anxiety in order to quickly help. Some children may become introverted. Others will misbehave, and still others will have sleeping problems, headaches or stomachaches.
• Know the fine line between being a protective parent and being overprotective. Your child should feel safe but shouldn’t be so insecure as to never want to be alone. Shielding unpleasant situations is part of a parent’s responsibility, but children also must have the freedom to learn from their experiences and their mistakes.

If your child’s anxiety repeatedly interrupts her daily life, consider consulting a counselor, pediatrician or pastor for advice on minimizing these heart-pounding fears.

 

link to the article: http://www.focusonthefamily.com/parenting/your_childs_emotions/childhood_fears.aspx