The AAMFT Blog

President signs $1.1 trillion omnibus bill into law: What does it mean for mental health?

On December 18th, President Obama signed into law what is known as the “omnibus” appropriations spending bill that would fund the government through September of 2016. This is following the passage of the two year budget deal that was struck in October. That bill included a lift of the sequester spending caps that have been in effect since 2013 and included an agreement to increase discretionary spending by about $80 billion over two years. A budget is largely a symbolic blueprint that dictates to appropriators how, and how much, to spend. The omnibus appropriations bill is the end result of that effort and contains several provisions relating to funding for mental health. Below is a brief rundown of these provisions. 

• The National Institutes of Health received a $2 billion funding increase, the largest budget increase for NIH in over 12 years;

• a $91 million increase in funding to combat the growing heroin and prescription drug abuse epidemic;

• Fully funds court-ordered treatment for severely or chronically mentally ill individuals known as Assisted Outpatient Treatment (AOT). This would allow courts to mandate treatment for mentally ill people who have shown to be chronically in and out of jails or psychiatric hospitals. Grants for the similar programs have recently become a contentious issue in Rep. Tim Murphy's (R-PA) mental health bill. AAMFT is has serious concerns about the Murphy’s bill in its current form because it would require states to begin using AOT as a condition of receiving federal mental health dollars as well as make changes to HIPAA laws that could lead to an erosion on patients’ rights.   

• more than $1.5 billion for the National Institute of Mental Health;

• more than $1.1 billion for the Substance Abuse and Mental Health Services Administration;

• $15 million in funding for the Mental Health First Aid program, which provides training for people to identify signs and symptoms of mental illnesses and addictions, and to identify how to intervene and help in a crisis;

• $10 million for mental health courts and adult and juvenile collaboration program grants;

• $73 million for grants to states to upgrade criminal and mental health records for the National Instant Criminal Background Check System;

• $532.6 million for Mental Health Block Grants, which is an increase of $50 million above last year’s levels;

• $414.6 million for Mental Health Programs of Regional and National Significance, which is an increase of $36 million above last year’s levels.

• $1.9 billion for substance Abuse Prevention and Treatment Block Grants –, an increase of $38.2 million above last year’s levels. These funds provide funds to support and expand substance abuse and prevention services based on local need.

Warning! New Year’s Resolutions May Be Hazardous to Your Health

By guest author Warren Holleman, PhD, LMFT. Originally posted here.

When we make big changes in our lives–or try to make big changes–they can be like a sunset I saw last week, as I was walking to my car at the end of the workday. The Texas sky looked like it was on fire. I couldn’t decide if it was beautiful or eerie, alluring or scary, an exciting omen or the dusk of doom.

New Year’s resolutions are like that. They have the potential to make our lives new and different and better than ever. But for most people I’ve known, New Year’s resolutions do more harm than good. That’s because we put all our energy into setting the goal rather than into the homework necessary to meet that goal. By the time February arrives, we’ve not only relapsed to our old habits, but also we’ve given up hope of ever losing that weight or running that 5K, and on top of that we feel incompetent, ashamed, and/or depressed.

It takes a lot more than a “resolution” to change. It takes preparation and planning, motivation and self-efficacy. It takes self-understanding, skills, strategies, and social support.

So, if you’re thinking about losing weight, ask yourself not only why you want to lose weight, but also why you might be ambivalent about losing weight. Be honest and ask what positive purposes comfort foods play in your life. Analyze, make lists, journal, discuss with friends.

Or, let’s say you’re thinking about watching less TV. Then you need to identify not only the no-so-good-things about watching TV, but also the benefits of watching TV. There must be some positive reasons you like watching TV. You’ve got to identify those reasons—those personal needs that TV meets—and find other, healthier ways to meet them. Or not! Who knows? Maybe you’ll conclude you actually need that time in front of the television.

After all this thinking, you might be like my cat Martin here, and conclude that things are pretty good just the way they are. You might decide the cost of changing isn’t worth the benefits. Or that you aren’t yet mo­tivated to do the hard work necessary to change a life-long habit. That’s okay! That’s a lot better than a precipitous decision that is doomed to fail, and to leave you feeling incompetent, ashamed, and depressed.

But let’s say you decide the cost IS worth the benefits, and that you ARE motivated to do the hard work. So now it’s time to make a New Year’s resolution—right? Wrong! You’ve still got some preparation to do. Specifically, you need to identify the skills, strategies, and social sup­port you will need to make this fundamental change in your lifestyle.

Let’s say your goal is to lose weight. Here are the tools you’ll need in your toolbox BEFORE you set your goal or resolution.

• Skills: How will you respond when your office serves doughnuts and bagels at the Monday morning meetings, or birthday cake and ice cream at the monthly birthday celebrations? How will you say “no” to your relatives when they serve you high-carb feasts over the holidays? You don’t want to appear rude, but you don’t want to eat all that food, either. You might actually consider asking someone to coach you in handling difficult conversations.
• Strategies: What will you do about your triggers—the candy in your pantry and the ice cream in your freezer? If your Achilles Heel is eating junk food and drinking beer while you watch football, what are you going to do to keep that from sabotaging your success? Stop watching football? Eat apples? Drink Lite beer? Walk on the treadmill while you watch the game? Go out and play football instead of watching it? These are HUGE changes and they don’t come easily.
• Social support: Who will hold you accountable to these changes and help you get back on track if and when you relapse? Will you give them permission to call you out? Will you listen to their input while taking full responsibility for doing the hard work yourself? Are you going to join a formal accountability group, such as Weight Watchers, or form your own personal support group of friends and family?

So, if you’re thinking about a New Year’s resolution, that’s good! My advice is to keep thinking and thinking and thinking until you have a really good plan. If you decide you’re not ready to make a change, that’s fine, too. Changing a life-long habit requires honest reflection, careful analysis, and comprehensive planning. Premature resolu­tions are not only doomed to failure but also may cause you to give up hope of making lasting changes in the future. It’s better to take all the time you need to prepare before you commit to a goal or resolution.

To summarize, here are the 3 things you should do before setting a New Year’s resolution, or any other major goal, for that matter.

1. Think through the pros and cons of change. You should ponder this for weeks and months, not hours and days.
2. Make lists, make schedules, journal, discuss with friends. Imagine that you’re the CEO of a large organization, and you’re plotting a major restructuring. You wouldn’t do that impulsively on December 31 with a notion to implement on January 1. Would you?
3. Marshal the skills, strategies, and social support you’ll need not only to “make” the resolution but to complete it. You might need to take a course or read a book to develop a key skill. You will definitely need to identify sabotaging situations and develop strategies for dealing with them. And you will need to share your plan with key friends who can encourage you toward success.

Given all the preparatory work that’s needed, it might make more sense NOT to make a New Year’s resolution for a major lifestyle change. Rather, make a resolution “simply” to accomplish the 3 steps above in the coming year. That in itself would be a major accomplishment.

 

 

Warren Holleman, PhD, LMFT is Professor of Behavioral Science and Director of the Faculty Health & Well-Being program at the University of Texas MD Anderson Cancer Center. His scholarly papers have appeared in Nature, Lancet, JAMA, and numerous other journals, and his workshop “Nurturing the Spirit of the Healer” has been presented in 27 cities throughout the United States. Warren also enjoys writing plays and telling stories. His romantic comedy, “The Turning of the Screw,” was recently presented at the Pittsburgh New Works Play Festival, and one of his stories was recently selected for The Moth Radio Hour. He writes a blog on work-life balance: http://www.workwellbewell.com.

Sexual Desire Issues in Couple’s Therapy

On Monday I meet with Julian and Ken who are describing a typical weeknight in which they come home from work and have 2 hours together, exhausted in front of the TV, and then drop in to bed with only a fleeting thought, “We haven’t had sex in awhile”.

The next day I sit with Karen talking about her ADHD diagnosis and how her symptoms may be related to her difficulty switching into sexual energy or enjoying sex when she is having it.

Tom and Aamani cry together as they share that they stopped feeling sexual desire for each other long ago and have decided they don’t want to work towards reestablishing their sex life. They wonder what this will mean for them now?

Julio shares with me a deep resentment from the near constant bickering with his wife and admits he does crave sex, just not when they feel so disconnected and hostile all the time.

Sarah angrily tells her partner, “I might have sexual desire if you weren’t pestering me for sex all the time! And besides it’s over so fast, why bother?!”

All of these clients may present in your practice for issues of low sexual desire. But their needs for support are incredibly different. Assessing what the issues really are and how they play out for each unique client is a complex process, requiring us to take in to account lifestyle, health, diagnoses, relationship patterns, social expectations, beliefs, myths, and more. There is no one size fits all definition or solution for low sexual desire.

Our sexuality is entwined with all aspects of self and our lives in each new phase. Issues and questions of low desire open deep conversation and exploration into the walls and barriers that clients or others in their lives have put up to keep sexual energy at bay. The consequences for clients with low desire are real, relationships end or can lose vitality, self esteem can be hurt, and an integral part of the self feels lost.

These are tender areas, and clients often tell me that this is the topic they left unspoken for years, until it felt too hard to endure. Sadly, I also often have clients tell me that they did bring this up with a past therapist and felt shut down by discomfort in the therapist, dismissed as though sex is not important enough to focus on, or in one recent case, told to just drink a glass of wine and that would take care of it.

Why is desire so hard to talk about? We have been trained over time to see sexuality as compartmentalized; its own set of private issues. We certainly have been exposed to an unrealistic view of sex based on the desires and abilities of 18 year olds. We have been encouraged to believe that love will automatically be linked to sexual desire and that this energy will take care of itself if we just have enough intimacy. And we have fears and hesitations to talk about sex at all. I use “we” consciously here – we as therapists often share these limiting perspectives with our clients, making it even harder to support them in navigating the intricacies and vulnerabilities of repairing sexual connection. We can do better.

As we think more deeply about what healthy sexuality really looks like in this diverse world, we open new possibilities for healthy expression of sexuality. As we expand our understanding of the holistic aspect of sexuality, we can help clients find their way to a sex life that works for them in their changing and evolving lives and relationships. And as we honor sexuality as a valuable and complex part of who we are, we all benefit.

Explore this topic in-depth with Melissa Fritchle, LMFT, Sex Therapist & Educator during a webinar on 02/19, titled "Sexual Desire Issues in Couple’s Therapy." Click here for details.

Melissa Fritchle is a licensed marriage and family therapist, sex therapist and sex educator in Santa Cruz, CA. She is the author of The Conscious Sexual Self Workbook and writes an ongoing blog on sex and relationships. She is adjunct faculty for two Bay Area graduate programs in Counseling Psychology and travels in the US & internationally to provide workshops and trainings. In 2011, she was awarded the Sexual Intelligence award for her groundbreaking work providing sex positive training for counselors and caregivers in Uganda. In 2014 she worked in Kenya with a group of priests and nuns addressing sex positive approaches to sexual issues within the clergy.

The Holidays are Coming! The Holidays are Coming… MFT Thoughts on Managing the Stress of the Season

 

It’s that time of year again! Friends and family gather to celebrate the holidays.  We come together with or without significant others, with or without children. And the spirit of the season brings fun and excitement. At least for some, it is enjoyable, maybe even magical. Yet for others, the season turns stressful and sad.  

The recipe that makes the season jolly, or not, can be complicated. It is not as formulaic as a spoonful of this or a cup of that. Well, actually multiple cups of this or that may be contributing to your seasonal anxiety—if, for example, you have a relative who has a drinking problem and predictably does something that is dreadfully uncomfortable for everyone involved.

There are a number of ways that the holidays can be stressful for all of us.  With the season of jolly come reminders of life events both happy and sad.  For some, it can be a reminder of an unhappy childhood, shuttling back and forth from mom’s house to dad’s house after a divorce. It can also be a time of sadness for those who have lost a family member recently, or perhaps even on the actual day of the holiday.

A range of difficult emotions can resurface during the holidays in connection with parents, in-laws, divorced parents, the loss of family members, or falling short of your hopes in life. Perhaps you desired to be married or have a child by this year’s holiday and spending time with family members who enjoy those things can be painful.

Marriage and family therapists have a unique perspective when viewing problems.  We think that our concerns must be examined in the context of relationships and that our relationships with family play a pivotal role in our well-being. As clinicians, we have witnessed how easily one negative remark or action can undo many positive ones, leaving us vulnerable to emotional injuries from holidays past. Many of us carry a narrative about how things will go at the dinner table, which can affect the experience of the day. The holiday season calls especially for the ability to see things systemically, recognizing that the whole is greater than the sum of its parts.

It is helpful to think of strategies for dealing with some of the emotional challenges of the season. Keep in mind that you are not alone and that everyone has some level of anxiety around the holidays. For better or for worse, we are all connected to our families in ways that have shaped our identity.

Here are some suggestions for managing the ups and downs of the holiday season:

Mindfulness: Don’t go into your family gathering with a laundry list of past grievances or overthink all the ways that the day will likely be a disaster. Be present and open to the experience of the day. Keep your mind on being where you are – not the hurt 10-year-old who had to take care of mom or dad when they were depressed. Let your mantra be “a moment at a time.”

Breathe: When we feel nervous or anxious, our bodies respond in ways that make the experience worse and before you know it you may find yourself in a full-blown panic. Slow down your negative thoughts by focusing on your breath. Prepare yourself for the possibility of anxious moments and download a 5-minute meditation or breathing exercise. 

Expectations: The holiday season is often idealized through media hype, which can let fantasy hijack our thoughts and lead to disappointment when the day doesn’t live up to what we had envisioned. Be realistic! Keep expectations low and in check. You might be delightfully surprised by the outcome.

Boundaries: Set clear boundaries for yourself around what you can and cannot do. If you are struggling with issues related to spending time with your in-laws, for example, make it clear to them that you will be spending a set amount of time with them. Predetermine the amount of time with your spouse or partner and stick with the plan.  Be respectful and do not give long-winded explanations about your choices.

Honoring Your Losses: It can be helpful to have a ritual to honor and remember loved ones that have passed. Some find it helpful to light a candle, place a commemorative ornament, participate in a religious service, visit the grave site, or write about your grief in a blog (it can be cathartic, even if the blog is kept private).

Be Kind to Yourself: This tip is a reminder to be good to yourself, give yourself permission to slow down and to live within your emotional means. Pay attention to healthy life choices that include exercise, sleep, hydration and healthy eating. When we are kind to ourselves, it makes it easier to be kind to others – even that relative that drives you crazy!

 

Vanessa Bradden, LMFT is a staff member at AAMFT, collaborating with the Communications Department as a product development specialist. She has a private practice in Chicago and is an AAMFT Approved Supervisor. Vanessa’s clinical interests and expertise include working with individuals and couples coping with perinatal mood disorders, pregnancy loss as well as grief and other losses.