My biggest takeaway from reading this module's materials, visiting links, and taking quizzes is that I didn’t realize the true impact of mental health on communities, what communities are most impacted, and who gets help. I was surprised about a few things. Depression is the leading cause of disability worldwide. I had no idea. Serious mental illness costs the US over $190 billion a year. That is mind-blowing. I am also surprised that the population with the highest rates of mental illness identifies as being two or more races. I want to search for studies that can tell me more about this.

I have experienced mental health conditions in my life and experienced various levels and varieties of treatment. I am interested in exploring and reflecting on these experiences through the course to make more meaningful connections. 

I am looking to use the experiences in this course to more easily connect with future clients.  I plan to use experiences from this course and develop practices that focus on destigmatizing mental illness and those who seek support after trauma or a crisis. Even as someone who has received treatment for mental health treatment, I know I have a lot to learn.

One process that I am eager to incorporate into my discussions through this course is narrative counseling. I believe that we are experts in our own lives and sometimes need help telling stories that separate us from the problems we experience in a respectful, non-blaming way. The Dulwich Centre is a great resource for more information on this topic. 

 

I took the ACES quiz and discovered that I had a score of seven. This is not surprising to me. What was surprising was how the process of answering these questions provided an “ah-ha” moment. It was as if I could say to myself, “Of course! This explains how you struggled. It makes total sense that you had the difficulties that you have.” I tend to be a rather evidence-based person, so to see the connections with this tool was rather empowering. I say this after years of talk therapy and work. Still, I feel this would have been beneficial for me earlier in my process too. 

I found three types of experiences or trauma interesting. The first was grief and how children can struggle when someone they love has died. There are many complicated and painful outcomes experienced during the grieving process that can easily overwhelm a child and negatively impact their development if they aren’t provided proper support. The second was neglect. We don’t always consider neglect as a form of trauma because, by definition, nothing was done. The reality is that children require adult connections to feel safe. When children don’t have these connections, they can develop anxiety that prevents healthy development. The third was the impact of mental health in the family. When a parent or family member has a mental health disorder it can impact the development of a dependent child, especially if it is untreated. Children may believe an adult who insults them, for example, when the insults are a result of a mental health disorder that is untreated. 

When we look at Linda, we might see a person who married as a child (sixteen) and did not have the opportunity to develop healthy systems and mechanisms based on possible Adverse Childhood Experiences (ACEs). At the same time, we might also want to consider the mental health history of Linda and her family. Is there a history of mental illness and what impact might that have on her behaviors? We also don’t know about her mother, father, or siblings.

The same can be said for Walter. He seemed to be older than Linda. How much older was he and why was his preference for a wife an underaged girl? We know he ultimately demonstrated abusive behaviors, but we don’t know what may have fueled them. What was his home life like and his history in terms of mental health in the family?

Both Linda and Walter did not seem to have a network that sensed danger or intervened in any way. We hear about Walter’s family in a negative light from Linda but do not hear from Roxanne who, apparently, was cared for by them after her father’s death and mother’s incarceration. Every member of this family would have benefited from an intervention. My guess is that the children likely demonstrated, then, behaviors in school that, today, would be a red flag for interventions. Back in the 1980s, systems to identify child abuse were not in place like they are today. I feel that Linda was isolated, by design, and had few she trusted. From all accounts, Walter was a stand-up guy, and nobody seemed to suspect he was abusing his wife and daughter- namely his parents. It seemed that there was no intervention needed, as far as his family was concerned.  

In terms of Roxanne, we note possible ACEs but don’t have access to how things turned out for her. How has her life evolved? What has she struggled with? What does she do to cope? How is Roxanne’s mental health now? How might this be connected to her ACEs? How has this impacted her overall well-being?  

I think that a good start to counseling someone in situations like this is to build awareness of traumas and the generational cycles of trauma. A wonderful place to start is the Center for Disease Control and Prevention’s page on ACEs, risk factors, prevention strategies, treatment options, and other resources (https://www.cdc.gov/violenceprevention/aces/).

As a counselor, I think it is important to recognize and respect the scope of services I can ethically provide. I am unable to provide medical treatment or clinical services. I think this case is a good reminder to maintain a professional network of clinicians for referrals when needed. It is important to think of the client first and find them professionals who are suited to address some or all of their specific needs.  

I look to primarily leverage narrative practices when working with clients who have experienced ACEs. Narrative counseling practices view problems as separate from people. It is a non-blaming approach that focuses on individuals as the center of their lives and the idea that individuals have tools that they can use to feel comfortable or even thrive. A great introduction to the idea can be found on the website of the Dulwich Centre in Adelaide, Australia (https://dulwichcentre.com.au/what-is-narrative-therapy/).

There are differences between planning for a long-term counseling intervention and a short-term crisis intervention. Some examples include (Edwards & Jones, 2002):

 

·      Counseling is for increased functioning whereas crisis intervention is to decrease suffering and stabilize.

·      Counseling is for both short and long-term goals whereas crisis intervention is for addressing crisis-related short-term goals.

·      Counseling treatment strategies progress toward positive outcomes based on wide-ranging goals and objectives whereas crisis intervention is focused on safety and the client’s readiness to handle a crisis. 

·      Counseling helps to identify a client’s strengths whereas crisis intervention focuses on protective actions and how to use strengths to cope with a crisis.  

The key in crisis situations is getting individuals into care that addresses their current needs. Typically, programs and practitioners who accept referrals of individuals and families in crisis are prepared to eventually transition clients to long-term programs and resources when they are ready. 

 

There are many trauma-informed strategies one may apply specifically to children. The National Child Traumatic Stress Network’s Child Trauma Toolkit for Educators (2008) identifies several (p.5) including:

 

·      Giving children choices and/or control when appropriate can offset feelings of chaos and help them feel safer. 

·      Be open to the idea that behavioral problems may be related to trauma. Even disruptive behaviors can be related to the anxiety of past traumas. 

·      Be open to children coping by reenacting their trauma through play or interactions. Be aware of children provoking others to reenact past abuse. 

 

I believe that it should be mandated that all health professionals receive education about the effects of trauma and how to assess for trauma. As our materials said this week, trauma is part of a web that connects to everything. Normalizing open discussions about and creating safe spaces to explore trauma can have positive outcomes in the long term.