Grief

Grief is a healthy response to situations such as death, divorce, injury, disability, loss of a job, property or a crisis.  We suffer grief over the loss of loved ones, movie stars, and pets openly but there are other forms of grief we prefer to keep hidden.  Loss of innocence from child abuse be it physical or sexual in nature.  We like to believe that like scars most grief heals with time, after all everyone experiences loss, right?  

Facing the reality of the loss or abuse is critical but not always timely, for a child for instance.  So it takes revisiting that loss in adulthood with a competent therapist, and guide one whom your trust will not be violated again.  Normal grief is not easy, when it is complicated by these other issues, your vulnerability grows and develops with your inability to trust others until you find yourself isolated in a lonely place of self blame and criticism.  

With therapy you can face your reality, learn to grow again and develop less self sabotaging habits.  It requires being honest, facing your pain, dealing head on with your denial, anger, and confused guilt feelings.  These are usually followed by feelings of despondency, and depression and the desire to drop out of treatment: but don't.  It is your mind re-hardwiring positive messages and truths about your experience, and building stronger defenses against the habitual self sabotaging "old fail-safe" behaviors of your past.  

The depression will be followed by new feelings of hopefulness, so fresh and new to you that you will be amazed.  it requires expressing your feelings asking for and accepting help and learning to be kind to your yourself (a new concept for many of you). Throughout this process get plenty of rest when you need it.  Set goals, both short and long term.  these are all workable with a competent therapist.  

As always I hope you found this informative and helpful.  Feel free to contact me for a consultation.

Dr Kevin

Managing Yourself

Why do we seek to manage ourselves? What are the goals one expects  to gain from self  discipline? Without trying to be to lofty, these are the  two key questions to ask yourself.  Next would come  the work of looking at the strengths you believe you possess vs the ones you actually possess, rather than weaknesses.  Peter Drucker's "Managing Oneself"in the Harvard Business review, 1/2005 page 100-109 also speaks to the values and ethics one holds.  

Taking this a step further I believe, successful self-management comes from treating ones self the way we would want a "good parent" to treat us, with rewards and corrections appropriate to the behavior at hand.  This means regardless your history, you now have the opportunity and the ability to "change the tapes" to a more positive inner self dialogue for change.  

We can start this by looking at how we view others, whether we consider them at all.  Then looking at how we want others to treat us we  can begin to treat those we come in to contact a little more graciously.  Helping co-workers solve problems, being a little more patient waiting for someone to understand what we mean when we are giving instructions, being less demanding of the waiter at the restaurant.  It is just as important for the boss to communicate effectively as it is for the subordinate to be productive.  This breakdown often causes undue anxiety, and stress and repeated workload in the subordinate.

The same rules apply at home, communication breakdowns are the primary reason couples come in to see me.  Effective listening and speaking are learned tools and require respecting the time and efforts of the other party involved.  Listening to the simple request for more time together is so often missed by underlying anger and frustration of years of not having been listened to; or ones over involvement with work. 

So in managing yourself, you need to be fully responsible for the effectiveness in your presence of mind in all of your other relationships as well.   We do not live in a vacuum, and are innately social beings that require the affections and acknowledgement of others, as do those around us.  

As always I hope you found tho informative and helpful. Feel free to contact mr for a consultation.

Al the Best,

Dr Kevin 

"New Normal" following PTSD and TBI

My experience running a Vet Center has proven time and again, that the  primary emotional problems confronting returning  veterans  are relating  to both post traumatic stress (PTSD)  and traumatic brain injury (TBI). Often the symptoms are experienced by the men and women who were near Improvised Explosive Devises (IED)  explosions  which in very mild cases  can cause similar  concussion injuries seen in boxers and footballers who been battered repeatedly. I'm speaking mostly to these milder head injuries here although some of these principles can apply to more severe trauma as well.  

Having worked in the field of trauma for more than 18 years and written my doctoral thesis on resiliency following trauma after  9/11.  I have found that a lot of progress lies in ones ability to accept his "new normal." A normal where the baseline is sometimes substantially lower than it was before their injury, but nonetheless is now a starting point from where progress can be made.  Apart from the symptoms of PTSD or TBI there are the co-morbidity or co-occurring issues like hyper-vigilence; and anger management that have received much public attention, as has substance abuse.  All of which are also very stressful and disconcerting to the Veterans with both PTSD and TBI and their families.  

Veterans are often angry at themselves and feel they have no "true" outlet for their pent up rage which often comes out in self destructive ways e.g.; substance abuse, reckless behavior, etc.  This impulsiveness is displaced and obviously misunderstood by their families and let alone themselves.  

Basically, you can get better, but you are no longer the same as you were before your injury. This this is tough to hear, it is the truth though and that will free you from some of your suffering and the need to go it alone.  One plus one doesn't quite always equal 2 anymore.  Those once simple tasks are now herculean efforts, tying your shoes, to making change for a taxi. Instead of getting angry at yourself for this, accept it as a new baseline and with a therapist get help to better understand where you are at today compared to where you once were and move toward acceptance.  

TBI differs in that it is primarily a physiological disorder, with genuine cognitive impairment that is measurable.  Although it presents often in very similar ways as PTSD, it is best treated early by a neurological psychologist or someone specializing in working with TBI in conjunction with neuro- psychological testing to measure the degree of damage.  

There is no cure for either of these conditions as yet, but with counseling we can teach veterans how to control their reactions to known triggers. Education, normalization, humanization, self-forgiveness, and coming to and understanding of a new normal are essentials to treating Veterans with and helping them move on to far more productive lives.

For more information or a consultation feel free to contact me at DrKevinOBrien@me.com  or visit my webpage DrKevinOBrien.com

All the Best,
Dr Kevin

Resilience and PTSD

Resilience is the capacity to bounce back from a crisis; be it physical or psychological.  We often associate it with trauma, and the impact of trauma which varies from one person to the next.  In my more than twenty years of clinical experience working with HIV and AIDS, bereavement, combat trauma (PTSD) and Military Sexual trauma (MST) and traumatic brain injuries (TBI).  I have a broad experience in working with trauma and grief.  Suffice it to say that I have seen such a wide variety of presentations of how often people face these challenges firsthand and have been impressed by their courage and willingness to fight on.  That drive is the impetus of resilience.  It's encouragement should be every clinicians goal in dealing with all clients, but especially these listed here.

In my work I take these issues very seriously, and plan on helping you to fully understand what it is and whether you need to take additional action to seek help in getting the appropriate care for it. Often further evaluations are needed in addition to treatment.  This blog is in no way is meant to substitute for a clinical workup of diagnosis or treatment.  It is meant to serve as a guide for you to help alleviate some of your concerns about these conditions or those of someone you care about.  Hopefully this will help you raise questions to bring to your existing providers, and ask about ways of improving your own resilience and your care.

For more information or a consultation feel free to contact me at DrKevinOBrien@me.com or visit my web page DrKevinOBrien.com

Dr Kevin
www.DrKevinOBrien.com