This chapter discusses the client’s ability to self-regulate and handle high levels of affect. The maintaining factors of the effects of trauma- or anxiety-based disorders include fear, avoidance, and loss of control. Building or reinforcing coping strategies allows the client to regain some sense of control over what is happening, which, in turn, can have a positive impact on the fear and avoidance. Many novice Eye Movement Desensitization Reprocessing (EMDR) therapists report additional performance anxiety when their client is a mental health professional. Hyperarousal after a traumatic experience is normal. It occurs when a person’s brain believes that person is at risk again because it misreads an external signal or trigger. Grounding techniques can be taught very easily to clients and are another tool to help the client prepare for dealing with a possible abreaction while undergoing EMDR therapy.
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Turning relationships with health care providers into social support sounds great for all aspects of medicine. There is no harm in using social support and humor together. A close look at the research on immune function, allergies, erectile dysfunction, and longevity reveals some promise for laughter’s health benefits. Nevertheless, throwing away antibiotics in favor of animation is ill advised. In addition, a blithe, nonchalant attitude about symptoms of sickness might lead people to avoid health professionals, making illness worse. White blood cells of various types play an integral role in the battle against illness. Most experiments on humor and health focus on these indices by sampling a test tube full of blood or spit. Finding out the exact number of antibodies in human fluids is not a kitchen-sink exercise. Nevertheless, researchers put together as much data as possible on shoestring budgets.Source:
A person-centered collaborative approach to drug withdrawal requires a trusting relationship between the patient and healthcare providers. In difficult cases, the patient will need a person-centered collaborative team effort involving the prescriber, a therapist or counselor, the patient, and the patient’s family or social network. Person-centered drug withdrawal calls on the clinician to express many human qualities, including empathy, honest communication about the dangers of staying on psychiatric drugs and the dangers of withdrawing from them, and a respectful relationship that empowers the patient to make decisions and to manage his or her own life. When a patient explores or considers the possibility of psychiatric drug withdrawal, the prescriber should explore the patient’s fears and anxieties about the withdrawal process. Many individuals have experienced severe withdrawal reactions after temporarily running out of medication or after abruptly trying to stop the medications on their own.
Psychiatric medications are not only dangerous to take on a regular basis, but they also become especially dangerous during changes in dosage, including dose reduction and withdrawal. This book provides the latest up-to-date clinical and research information regarding when and how to reduce or to withdraw from psychiatric medication. The book is divided into two parts. While Part I deals with the reasons to consider drug withdrawal or dose reduction. Part II discusses the withdrawal process. Although this book focuses on medication reduction and withdrawal, the person-centered collaborative approach is also a model for helping children, dependent adults, adults who are emotionally or cognitively impaired, and the elderly, as well as those going through psychiatric medication withdrawal. The book begins with reviews of adverse drug effects that may require drug reduction or withdrawal. It then discusses withdrawal effects for specific drugs to familiarize clinicians, patients, and families with these problems. Reasons for withdrawal for antipsychotic (neuroleptic) drugs, antidepressant drugs, stimulant drugs, sedatives and opiates, and lithium and mood stabilizers are described. Medication spellbinding (intoxication anosognosia) is caused by all psychoactive substances, and can lead to dangerous behaviors that are highly uncharacteristic of the individual. Prescribers and therapists who embrace a person-centered collaborative approach to therapy and to medication withdrawal will find it professionally gratifying and will help many patients and their families.
- Go to chapter: Layers of Culture: Its Influence in a Milieu-Oriented Holistic Neurorehabilitation Setting
Cultural beliefs have a tremendous influence on a person’s perception of disability. Viewing culture as a discrete system that encompasses interconnected components should enhance the cultural competence in rehabilitation centers. The manifold layers of culture include the: culture of origin, mainstream culture, brain injury culture, therapists’ culture, and the culture of the neurorehabilitation program. With the increased emphasis on cultural sensitivity, health care training programs have been focusing on enhancing the cultural sensitivity and competency of health care providers. These health care provider aspects also very much apply to the therapists in neurorehabilitation settings. The milieu-oriented neurorehabilitation program creates a unique culture that is different from other cultural influences encountered by an individual. Neuropsychologists in the Center for Transitional NeuroRehabilitation (CTN) milieu program play an important role in fostering a culturally sensitive and competent interdisciplinary team and in translating cultural considerations into concrete treatment approaches and goals.
- Go to chapter: Two Approaches to Developing Health Interventions for Ethnic Minority Elders: From Science to Practice and From Practice to Science
Two Approaches to Developing Health Interventions for Ethnic Minority Elders: From Science to Practice and From Practice to Science
This chapter focuses on more integrated approach or process for developing a health intervention for ethnic minority groups that incorporates accepted principles of medicine and scientific methodology. The changing demographic has led to complex challenges in the U.S. health care system. The delivery of effective health care services hinges on health care professionals’ ability to recognize varied understandings of and approaches to health care across cultures. Health care providers may employ different strategies to increase participation of service users by bridging barriers to communication and understanding that stem from these racial, ethnic, cultural, and linguistic differences. In the context of health or health care improvement, little debate exists concerning the recognized need to help ethnic minority patients maintain and restore health. There are two general approaches for developing culturally appropriate health interventions. The first approach is from science to practice and the second approach is from practice to science.Source:
This book focuses on the key issues surrounding multicultural neurorehabilitation for a wide range of health care professionals. The study of traumatic brain injury has seen a clear evolution in the sophistication, breadth, and depth of findings concerning neuroepidemiology as it affects racial and ethnic minorities. As large-scale epidemiological studies increasingly include and distinguish individuals of color and linguistic minorities together with religion, sexual orientation, physical disabilities, place of residence, and key socioeconomic variables that interact with race/ethnicity, more information will be available to make changes in policy, training, and clinical service delivery. Neuropsychological assessment involves the administration of a battery of tests that assess a variety of cognitive domains to obtain a clinical picture of brain behavior relationships. Within the inpatient rehabilitation setting, neuropsychologists often perform various functions, including neuropsychological assessment, psychotherapy, and assistance with adjustment issues for patients and their families. The book discusses some of the common cultural issues that impact neuropsychology in an inpatient rehabilitation setting. Considerations of race and ethnicity, disability culture, military and veteran culture, and cultural aspects of religiousness and spirituality are all considered in the book. The authors in the book wrote from their own perspectives as clinicians and researchers, representing diverse cultural backgrounds and neurorehabilitation contexts and roles. Hopefully, the book will generate more discussion, research, and literature on multicultural neurorehabilitation.
This chapter examines the conditions under which women and men give each other care when at least one partner has diabetes and explores the ways in which care, as well as the health status of both partners, is often influenced by gendered power structures. It offers clinicians and health care professionals suggestions for how to identify and address this potential gender disparity. Stereotypical gender relations appear to increase levels of stress, especially for women. Little attention has been given to the impact of gendered power on the daily acts of care and attending that intimate partners give each other in the course of routine life. Gender training thus shapes how partners respond to diabetes care. The gendered power structure organizing couple relationships limits men’s involvement in providing care. For many couples, response to illness triggers and maintains automatic gender patterns and hierarchies without conscious thought or deliberate choice.
This chapter explains a set of guidelines to help mental health professionals and clients move away from the gender stereotypes that perpetuate inequality and illness. Identifying dominance requires conscious awareness and understanding of how gender mediates between mental health and relationship issues. An understanding of what limits equality is significantly increased when we examine how gendered power plays out in a particular relationship and consider how it intersects with other social positions such as socioeconomic status, race, ethnicity, and sexual orientation. To contextualize emotion, the therapist draws on knowledge of societal and cultural patterns, such as gendered power structures and ideals for masculinity and femininity that touch all people’s lives in a particular society. Therapists who seek to support women and men equally take an active position that allows the non-neutral aspects of gendered lives to become visible.
This chapter defines emerging disabilities; explores medical, psychosocial, and vocational implications of emerging disabilities that distinguish them from traditional disabilities; and provides demographic characteristics of individuals who are most vulnerable to acquiring emerging disabilities. It examines some social and environmental trends that have contributed to the development of emerging patterns and types of disabilities including advances in medicine and assistive technology, globalization, climate change, poverty, violence and trauma, the aging American populace, and disability legislation. Psychological and physical trauma from warfare, violent crime, intimate partner violence, and youth violence can result in permanent physical, cognitive, and psychiatric disabilities. Diagnostic uncertainties, misdiagnoses, and skepticism on the part of medical providers are frequently associated with emerging disabilities. Women also represent a population that is at an increased risk of acquiring emerging disabilities and chronic illnesses. Rehabilitation systems are still not fully prepared to address the multifaceted needs of individuals with emerging disabilities.