Dr. Imran Akram Will be Leaving Goose Creek Consulting

Dr. Imran Akram will be with Goose Creek Consulting until the end of December. He will continue to see patients at Goose Creek Consulting until the end of the month. Afterwards, he will be providing psychiatric services at a new location in Vienna. Please call 703-574-6311 if you have any questions about scheduling at the Vienna location and for additional information on that practice location.

Dr. Akram and everyone here at Goose Creek have enjoyed working with all of his clients and look forward to working with you in the future. Please let us know if anything that we can do to make this transition smooth for you

Relish Time with Your Family

The holiday season is about being with your loved ones and for many of us that feels exciting and stressful at the same time.  The holidays also means many hours spent traveling, cooking, baking, gift giving, and time together.  Sometimes being with our family members can increase our levels of stress, anxiety, and depression.

All families struggle with various dynamics, issues, and conflicts and every family has their own set of expectations to celebrate the holiday season.  When these expectations are not met or followed the amount of stress within individuals and the family group usually increases, which can lead to arguments and feelings of anger, disappointment, and sadness.

If you are struggling with mood dysregulation, the stress of the holiday months can intensify symptoms.  It is important to take care of yourself so you can have positive and quality interactions with your family members.

To manage your mood during the cold, wintery months you should:
· Get an adequate amount of sleep each night
· Eat healthy meals at least three times per day
· Continue your level of physical activity (or even increase your physical activity)
· Take time individually to relax, recharge, and to engage in individual activities
· Continue to attend social activities
· Balance the amount of time you spend with others and by yourself

To increase positive interactions among you and your family members you could:
· Set aside a specified amount of time as a family to engage in an activity
· Do something creative together (cook, make crafts, play a game)
· Turn off the electronics during family time (no cell phones, televisions, tablets, computers)
· Have fun! And let the conversation happen naturally

By setting a specified amount of time for an activity you are providing structure and a clear expectation for your family.  The kids are more likely to be fully engaged in the activity if they made aware of the length of the activity before it’s started.  If you expect the kids to put their electronic devices away, you have to do the same and remember to have fun!  Sometimes as we get older, we forget what it feels to enjoy the moments we are spending with our loved ones and instead choose to plan future events or worry about the past.  The conversation will flow and happen naturally.  It is easier for many children and adolescents to communicate while they are engaged in another activity (texting is not one of those activities).

Just remember all families are special and unique with their own set of rules and expectations.  If you are attending a new spouse or significant other’s family event, don’t forget some of their traditions and ways of celebrating may seem different or even odd to you.  Do your best to appreciate them for what they are and try your best to participate with an open and curious heart.

The Bipolar Winter Blues

A few days before each Halloween, as grocery store aisles fill with candy and floors become lined with pumpkins, my mind turns to the ghosts and goblins of my past. As my mind turns to how the days get shorter and darker and how night can consume so much of the day, I have a moment of panic. It’s the beginning of my seasonal nightmare, one where joy can be replaced by depression and happiness can be consumed by darkness. It’s a time where night falls fast. And I’m never prepared for that.

I haven’t had a seasonal depression for six years. But the six before  were traumatic enough for me to still feel the reverberations. In the same way that a car backfiring can make a war veteran feel they heard a gunshot, I have a mental jump as the darkness comes.

I had heard briefly about seasonal affective disorder, or S.A.D., prior to my own treatment. I first heard about it in great detail during a talk in 2006 by Norman Rosenthal, M.D. at George Washington University Medical Center that was hosted by the Depression Support Alliance National Capital Area. Rosenthal, author of the book Winter Blues, had been trying to figure out the cause of his own depression during the dark days of winter, when they had documented S.A.D. in a study using light therapy.

I had been diagnosed with bipolar disorder years earlier, but the pull of my depressions, which tended to be longer and deep, was toward some notion of a winter seasonal impact. I would find it more difficult to wake in the morning, spend longer and longer chunks of the day sleeping and gain weight as I consumed more carbohydrates. I can already be a bit squarely in my natural affective state about social situations, but the winters would further my withdrawal – from family, friends and social activities, in the months where social engagement is what it’s all about.

Thanksgiving left me feeling as if suicide would be a better option. I’d often not attend or beg to leave the event early. If it was at my house, I would find a room, turn off all the lights and hide, hoping that if I just leaned into the darkness sleep would take me away from all the pain and sustain me until I was forced again to wake up and repeat the cycle. I just wished it would end. Christmas wasn't much different, although the saving grace was not presents -- it was that it was much shorter. Night fell like a shadow that enveloped me – depressed, irritable, not nourished, fatigued and inattentive – like a cloak that became too heavy to lift anymore.

Needless to say, I fit the diagnostic criteria for both bipolar and S.A.D. This was not too far off my normal depressions, but its intensity was much greater, I believe, because I did not have the natural benefits of warmth and light-filled days to energize me, replenish helpful chemicals and motivate me.

The biggest difference, which came in the winter of 2007, were adjustments earlier that year to my medications that made managing my moods an easier task. Winters then became like starting all the way on top of a hill and sliding a few feet, as opposed to starting halfway down and landing in a gully. Medications aside, there were some other things that helped, including full spectrum light therapy, the use of the hormone melatonin to get better sleep, adjusting my sleep schedule to better line up with the hours of the day, dawn stimulation and increased psychotherapy.

My experiences with those times have been so dark that I don't even like to talk about it.

I associate the winters with my seasonal self-medication and psychiatric hospitals, especially that long winter sitting in an enclosed courtyard with other patients at Silver Hill Hospital. I associate the dawn of spring with the time when I wonder how many leaves it’s going to take to be on the trees for me to stop wondering whether the branches could support my body and a rope. I longed for the spring sun, and do so, even now, even though it’s been years since the demon of depression has stalked me through the winter.

Addiction specialists and addicts, especially, will tell you that holiday stress can also lead to relapse. I too, because of my mood, had a pattern of seasonal self-medication. Substances that brought me up would come out in the winter months and in the spring or summer I used that which would bring me down. Even to this day, the whiff of a crisp winter night air can briefly trigger the smell and the feel of cocaine. In retrospect, I now know, I was trying my best to medicate my moods, just with the wrong tools.

I know that, for me, winter is all the more reason to catch a meeting or see my therapist if I hadn’t been in a while.

I am not without seasonal sadness even now.  It comes at times. But these tools are like scissors, rope and a compass that guide me and help me cut and pull my way from under that dark cloak. Passing along what worked for me is just me sticking my hand back in there to help pull you out.

Despite the years of relative tranquility in comparison, I still worry each time Halloween comes around, when night falls a little faster. If you do too, reach out, see if you can find and hold on to my hand.

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Less Light, More Stress

By Victoria McKenna, MA

After the clocks fall back an hour during the autumn months, it seems like we are starting our days in the dark and ending them in that same darkness. The lack of natural sunlight can contribute to some individuals experiencing mild to moderate symptoms of depression, which can be experienced as varying levels of motivation, fatigue, weight loss or weight gain, loss of interest in activities, isolation or withdrawn, difficulty with concentration, increased or decreased need for sleep, irritability, and suicidal thoughts.* When these depressive symptoms appear during the winter months and seem to be absent during the spring and summer months, the individual is most likely dealing with Seasonal Affective Disorder (SAD).

As a clinician and coach, I have encountered many individuals who are dealing with various diagnosed mood disorders as well as SAD. Usually, individuals consider seeking treatment when they realize that they are no longer feeling like themselves and identify with feelings of being stuck, down, low, sad, or depressed that have persisted for multiple days or weeks.

“I just can’t pull myself out of this.”

“I don’t feel happy anymore.”

“All I want to do is stay inside and sleep.”

Sometimes the people closest to us will notice something is different and comment on our presentation.

“My friend keeps asking me what is wrong.”

“My partner said that I don’t seem like me anymore.”

“My mother keeps asking me if everything is okay.”

It can be difficult to identify these depressive emotions, especially if they are something you have experienced every winter. To you it probably feels normal and perhaps expected, however, you do not need to suffer through this and it is okay to ask for outside help. If you are experiencing similar thoughts and feelings, you may want to seek the guidance and support of a coach to learn skills to successfully manage these during the winter months and for the rest of the year.

*If you are ever experiencing suicidal thoughts seek professional help immediately.

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Work and Life: A Balancing Act

Other individuals may experience dissatisfaction with where they are in their career, earnings, or earning potential. Perhaps they feel satisfied within their relationships and engage in their interests and activities, however, they do not feel fulfilled with their current career or job. Some individuals feel they did not obtain the “right” degree for them and may have been influenced by others to pursue a certain career path. Some individuals feel they should have continued their education to be able to obtain the jobs they desire. Others may feel they are on the career path for them, but their current job is not fulfilling all of their needs. If we are not satisfied with our jobs, we may feel stressed, anxious, angry, or sadness about their current job or career. These thoughts and feelings could be an indication that you may want to adjust the energy and time you put into your career path.

If any of the above sentiments resonate with you, you may be ready to make some adjustments to your work-life balance. Sometimes this could seem overwhelming to do alone. Maybe you do not know how to shift your priorities or you do not know where to start. Maybe you need someone to hold you accountable to make changes. A career coach or life coach could help you identify where the discomfort is within your work-life balance, help you uncover where you truly want to spend your time and energy, and help you identify how to begin making those changes. A career or life coach can hold you accountable for the changes you want to make in your life and be a strong support along the way. For more information about how a career or life coach can help you, call us at 703-574-6271 ext. 1, or visit our website.

Delayed payments for Government Employees Suffering from the Shut Down

The government shut down has caused many government workers to take a huge cut to their family income. We recognize that government workers suffering from this shut down still have expenses. Goose Creek Consulting is now offering delayed payments to Government employees and their families who have been furloughed due to the shutdown. Payments can be delayed until the government employee has gone back to work.

The Dangers of Cyberbullying

The picture of the white casket, too small for a child and too big for a full grown adult, is heartbreaking. You don’t have to read the words on the matching lime green shirts of the six pallbearers to know that there is something different, and tragic, about this funeral. The word “Bullying” is placed on the front, crossed out by the black circle and line through it that we use for scourges like smoking. It’s a universal symbol of unnecessary death.

Last month, 12-year-old Rebecca Sedwick committed suicide after being the victim of cyberbullying.

In Italy, a bullied 14-year-old girl committed suicide after she was taunted by a group of teenage boys on Facebook. Another 14-year-old girl, Eden Wromer, an eighth grader, hung herself a month earlier after being harassed by classmates in school and on the Internet. In 2008, Megan Meir, 13, committed suicide after being tormented by a fake Internet boyfriend who was actually, according to prosecutors, a parent trying to get back at her for some slight.

How do you protect your children from bullies when they are coming from everywhere?

First, you must understand what it is and how often it happens.

The National Crime Prevention Association defines cyberbullying as “when the Internet, cell phones or other devices are used to send or post text or images to hurt or embarrass another person.” This includes situations where people pretend to be others online, spread lies and rumors about the victims, trick people into revealing personal information, send or forward hostile text messages or post pictures of victims without their consent.

According to research from Florida Atlantic University and the University of Wisconsin-Eau Claire, cyber-bullying has increased with technology adoption in recent years and that 10 percent of middle schools report that they had been bullied in the past 30 days and 17 percent report being bullied in their lifetime. In studies of high school students those numbers jump to 14 percent in the past 30 days and 21 percent over their lifetime. There is a correlation, the researchers said, between the rate of cyberbullying and the age of the students. The researchers believe that is because children -- both bullies and the bullied -- have more access to technology as they become older.

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Rebecca’s mother says she felt like she tried everything, she told the school officials but felt they did not respond effectively. So she moved Rebecca to a new school. She also took measures to remove Rebecca from those who were terrorizing her online by taking down Rebecca’s Facebook page and taking away her cell phone. Once at the new school Rebecca seemed to be doing better. Her mother gave her a new cell phone number and Rebecca went back to social media. Rebecca started using new applications that her mother didn’t know about. When Rebecca’s mother went to search her phone to keep an eye on what was going on in Rebecca’s life, she didn’t know to check those applications. Rebecca’s suicide brings up questions about the social media aspect of bullying, but also what can the schools do better. Rebecca’s previous school says that they only received one complaint about traditional bullying so they had changed Rebecca’s school schedule and offered Rebecca an escort to classes, however Rebecca’s mother has said she never received the escort. This instance of cyberbullying leads to some questions of what could have been done differently in this instance.

Being a parent is hard.No one would deny that. It is no doubt made harder when children become teenagers and don’t always feel the need to cooperate with the rules you have set in place to keep them safe. It can be hard for teenagers to see that there are rules there for their own benefit and protection, and not meant to find ways to get them into trouble.

Bullying has moved beyond the big kid on the playground that steals lunch money to a name on a computer screen, and that name could be anybody. The fact that people no longer have to be seen face to face or even have their names on a post makes getting away with it that much easier. The key to protecting your children from these online bullies is communication.
A child needs to see their parents, and their home life, as safe, and secure. The best way to develop this feeling is through honest communication with the child. As a child starts to enter the world of smart phones and social media, keeping track of what your child is doing online may become harder. In the cases of cyber bullying the monitoring of your child’s online activities may be tempting and seem like the best methods of protecting your children from these outside threats. However, to a teenager who is trying to establish an identity for themselves and demands privacy to do so the monitoring of the social media accounts can seem like an intrusion into your child’s life. This intrusion in a child’s mind can seem like a lack of trust, when what you really need is to establish that trust. When a child feels their parents trust them they are more likely to feel as if they can approach their parents when they need help. A good way of establishing this trust is, when your child first establishes a social media account sit down and talk to them explaining what they are opening themselves up to and ask them to tell you if they ever see a situation of cyberbullying, even if it isn’t directed towards them. If they feel they can show you this when it happens to others, they are more likely to bring it to you when it is happening to them. And just opening a dialogue with your child and letting them know that you are there to talk to allows a child to feel safer sharing with their parents when they are in trouble.

Once a concern is shared by the teenager there are some key points that can be addressed. Here are some helpful hints on what can be done:

  • Have an open conversation about your child’s interactions both online and offline
  • Listen to the clues that you hear and pay attention to the ones that you see that suggest that your child might be having a hard time.
  • Teach your children that there is no shame in reaching out for help if someone or something is making them feel uncomfortable.
  • If you uncover cyberbullying, seek professional help if you think your child could benefit from talking to someone.
  • A child needs to understand that they have someone to support them, whether that support comes from their parents, their close friends, or a favorite teacher.
  • Parents need to know exactly what is happening in order to know the best methods of addressing it.
  • Parents can talk to your child’s teachers and the bullying prevention center at the school, ask them what they have seen and give them any and all evidence you and your child have collected about the bullying. When talking to your child’s school, advocate for a solution. Just because you have told them about the issue does not mean it will go away. Become a part of the discussion of finding a solution, and discuss the proposed solutions with your child. Your child better understands the dynamics of the school and will be able to tell you if that solution will help them or not. And once a solution is agreed upon follow up with your child, make sure they feel they are receiving the help and support that was agreed upon and that they feel it is helping.
  • Monitor the use of your child’s cell phone and social networks. Your children may be reluctant to share the details of what’s bothering them out of a fear of being seen as weak, by you or their classmates or teachers.
  • If you can’t figure it out, don’t let your child have access to it -- this counts for cell phones, computers, gaming systems and any other place where there may be online communications.
  • Know who your kids are talking to. Don’t assume that there is a profile for cyberbully or victim.

Woman Killed Yesterday at the U.S. Capitol Had Postpartum Depression, Sister Says

The 34-year-old woman who was shot and killed outside the U.S. Capitol yesterday was suffering from postpartum depression with psychotic features, according to her sister. The woman, Miriam Carey, a dental hygienist is reported to have had delusions of President Obama stalking her. She was killed after leaving what the police described as a typical two-bedroom apartment with nothing out of the ordinary and driving 265 miles from her home in Connecticut to the White House barricades on Pennsylvania Avenue.Shen then turned around and drove toward the U.S. Capitol where she was shot by police officers.

Rep. Michael McCaual, a Texas Republican who is the chairman of the House Homeland Security Committee, said that he had been informed that Carey had been treated for schizophrenia, although her family members described it as a series of psychotic episodes with a postpartum onset. A plausible explanation is that Carey was experiencing psychotic and manic symptoms that lead led to her delusions, paranoia, energy and irritability.

Postpartum depression is the most well known pregnancy-related mood disorder. Individuals can also experience manic and psychotic symptoms.  Postpartum mood disorders are fare more severe than what's called the baby blues, a temporary sadness that can hit women soon after they give birth and law for a few days or a couple of weeks. Postpartum depression and its cousins strike more than 14 percent of women and can last for months.

It is often difficult for mothers to get care because of stigma, a lack of understanding or education on the issues or feeling so overwhelmed that its hard for a mother to put her health priorities first.
 Factors that can contribute to postpartum depression, mania and psychosis include sensitive to dramatic changes in hormone levels that occur during pregnancy and postpartum; sleep deprivation; psychological stresses of new motherhood, previous history of mental illness and family history of mental illness. Other factors that could increase risk include difficult pregnancies, sensitivity to changes, labor or delivery; colicky, difficult or demanding newborns; poor social support systems; psychological stressors, certain personality traits and other factors. Doctors recommend that you consult with a psychiatrist familiar with postpartum issues months prior to birth if you have a personal or family history of mood disorders.

In recent years, several women have opened up about their struggles with mental health postpartum. Brooke Shields, the actress, has publicly spoken about her postpartum depression.  Her memoir, Down Come the Rain, eloquently illustrates both the torture of depression and that double theft that occurs when what is supposed to be such a joyous occasion -- bringing a newborn into the field -- feels like it is being snatched from you.

Valerie Plame Wilson, the C.I.A. officer who became entangled in the debate over weapons of mass destruction in Iraq, told NPR that her experience with postpartum depression tested her in ways that being an undercover operative never did.

If you need help, a great resource is Postpartum Support Virginia, which sponsors supported groups, vets medical professionals and provides other resources. You can find the names of individuals you can call or e-mail who have been through postpartum mood disorders, a list of medical professionals who have said that they have a special interest in postpartum and other resources.

Several of the mental health professionals include Dr. Imran Akram, who works in our offices in Centreville and McLean; Dr. Beverly Reader, who specializes in women's mental health issues and Dr. Jennifer Santoro in Fairfax.

I've posted the list of postpartum support groups in the area below:

Postpartum Support Groups
Updated August 2013

Talking with other women who have experienced postpartum depression can be extremely helpful.  Support groups offer the opportunity to validate experiences, share coping strategies, and gain support and encouragement. 

The volunteers running peer support groups all have firsthand experience with postpartum depression, either personally or with a family member.  However, these volunteers are NOT medical professionals and therefore cannot give professional advice, diagnose, prescribe, or in any way treat postpartum mood disorders.   Support groups are an adjunct to -- not a replacement for -- medical treatment.  Those with medical, mental, or personal issues are strongly urged to seek advice from physicians and/or mental health professionals.

Please contact the support group leader directly for more information about the group:

Arlington Virginia Hospital Center, Wednesday mornings
Jalyn Tiffany, jalyn.psva@gmail.com

Arlington - Spanish speaking group Inova Cares Clinic for Women and Children, 3rd Wednesday of the month
Sonia Gutierrez, Sonia.Gutierrez@inova.org, 703-531-3013

Alexandria  Fairlington United Methodist Church, 2nd and 4th Wednesday evenings
Susan Doyle, 571-403-0673, suzjdoyle@gmail.com

1stand 3rd Tuesday evenings
Benta Sims, benta@bentasimslpc.com, 703-244-9232

Fairfax  Inova Fairfax Hospital, 2ndand 4th Tuesday mornings
Susan Weatherbee, postpartumsupport@inova.org, 703-776-6775

Leesburg  Inova Loudon Hospital / Cornwall Campus,2nd and 4th Wednesday afternoons
Leslie McKeough, 703-909-9877, lamckeough@gmail.com

Newport News  Riverside Regional Medical Center, 1st Tuesday of the month
Diana McSpadden, 757-349-6441, facilitatorPPDWilliamsburgVA@gmail.com
Charlene Smith, 757-880-2650,  charlenesmith76@gmail.com

Richmond  Cypress Counseling, 3rdFriday mornings of the month
McKenzie Casad, 757-553-2780, mckenzie@cypresscounseling.com

Virginia Beach  Kempsville Presbyterian Church, 4th Wednesday of the month
Beth MacFarlane, 757-404-6950,
Alexis Rose, 757-288-6613, arosepsv@gmail.com

Williamsburg  Anahata Yoga Center of Williamsburg, 2ndTuesday mornings of the month
Diana McSpadden, 757-349-6441, facilitatorPPDWilliamsburgVA@gmail.com

Woodbridge Woodbridge Psychological Associates, Sunday evenings by appointment
Elizabeth Wilkins-McKee,


Washington DC Wisconsin Avenue Baptist Church, Wednesday evenings
Lynne McIntyre, 202-744-3639, lynne@lynnemcintyre.com

Perinatal Loss, McLean Presbyterian Church, first Thursday evening of the month
SIDS Midatlantic and Preemies Today, 703-955-6899, sidsma27@aol.com, www.sidsma.org

If this is a medical emergency, or if you feel you might harm yourself or your baby, contact 911 or go to the nearest hospital emergency room.

National Hopeline Network: 1-800-SUICIDE (784-2433)


My Rubix Cube and McLean (Hospital)

This was reprinted from jaysonblair.blogspot.com

I love being home on Saturdays with my family. I enjoy my morning rituals. I enjoy the hikes we tend to take along the Potomac River, the museums we visit and the dinners in Washington. I especially like my morning espresso at the coffee shop down the street from where I live and the espresso at a Georgetown place better known for its cupcakes. I like my rituals.

So, its with hesitation that I interrupt them. Doing so has a tendency to scramble the Rubix cube in my brain. Like any Rubix cube, it can be difficult to get back in order again.

As I headed off to the Harvard Medical School-McLean Hospital conference on Coaching in Leadership and Healthcare this weekend, I thought that my Rubix cube had a chance of being broken if it turned out to be a disappointment. Well, its still in tack and I am walking away from the conference with a few more techniques on how to solve my own puzzles and help others put theirs together.
My concern came from the simple fact that some of the people that I have encountered in professional coaching, both as someone who hires coaches and who works with them, lack the tools to really help my clients where they are. Many coaches do not want to work with people who have certain problems. I’ve met wellness coaches who don’t want to work with people who have serious mental health or addiction problems (I’m waiting to meet the food addict client who isn’t an addict). I have met life coaches who are really cool with working with anyone as long as they don’t have an anxiety disorder, a mood disorder, a personality disorder or any of those other things that would make them prime beneficiaries of coaching. They're there to help, but only if your problems are easy.

There is no question, in many situations where people have serious mental health problems, the client should have a psychiatrist and/or a therapist involved in their treatment. But I firmly believe that there is a role for a good coach to help turn ideas into action, reduce failures and keep crises from turning into derailments. With the backdrop that not everyone in the profession agrees with me on this approach, I came to the conference fearing that it would be dominated by that type of thinking.

I was pleasantly surprised. But, really, I shouldn’t have been. McLean Hospital is the renowned hospital of “Girl, Interrupted” fame that is known for its respected milieu treatment programs and its ground-breaking neuroscience research. Famous former patients include singer-songwriter James Taylor, Nobel-prize winning mathematician John Nash, poet Sylvia Plath and authors and Susanna Kaysen, according to Gracefully Insane: Life and Death Inside America’s Premier Mental Hospital. David Foster Wallace was treated there, according to a recent biography, and so was Frederick Law Olmsted, who both selected the plot of land for the hospital and was a patient. Part of Plath’s memoir, The Bell Jar, includes time spent within the campus walls. I've referred clients to McLean for the treatment of dissociative disorders and borderline personality disorder, two areas where the hospital is considered ahead of the curve.

Most of the debates about coaching as a profession center on licensing as a means to regulate the practice and membership. It’s a debate that frustrates me because I fear that it could lead to an entire population of people who need coaching the most -- those with mental health problems -- to be excluded from receiving services. I also worry that the peer specialists, like the recovery coaches hired by the Fairfax-Falls Church Community Service Board and the public Loudoun County Mental Health, would be left in the dust in a liscened paradam. In essence, I fear the namby pambies will win, and coaching will turn into a profession of yoga, meditation and singing kumbaya for only the people who don’t have a condition in the Diagnostic and Statistical Manual of Mental Disorders.

It shouldn’t come as a surprise that the No. 1 psychiatric hospital in the country, which is among the top 15 recipients of National Institutes of Health grants, would confront mental illness head on and their work would be heavy on the science. Research was presented on the impact of emotional intelligence on leaderships effectiveness, coaching and healing, cross cultural coaching, coaching to create creative learning, coaching for physician leaders and a variety of technique and population specific research. Techniques like motivational interviewing, solution-focused coaching, narrative coaching, cognitive behavioral coaching and psychodynamic coaching were explored in depth. Empirical evidenced based research was littered throughout all the presentations. Discussions about utilizing techniques from mindfulness, dialectical behavioral therapy and other modalities were common. fMRI scans seemed to be in every other presentation.

Pamela Peeke, MD, a physician-coach who is a professor at the University of Maryland School of Medicine, presented on the addicted brain. She discussed the similarities between food addiction and drug addiction, discussing how consistent consumption of either can lead the brain to reduce the number of dopamine receptors to protect the mind. This, in turn, means it takes more to get the same feeling in the rewards center of the brain. That’s how one cupcake a day becomes 13, she said, adding that the research has helped coaches, therapists and psychiatrists to help clients focus on mindfulness, hypervigilance and executive function problems in order to buy time for those receptors to grow back.

Using data from research from Nora Volkow, MD, the director of the National Institute on Drug Abuse (and Leon Trotsky’s great granddaughter)  and her team, Peele laid out strong research showing the reasons why willpower -- the fact that addiction impacts the regulating executive function part of the brain and the rewards center part of the brain -- is such a failure in addressing any type of addiction.  

Robert Kegan, PhD., the Havard professor, discussed immunity to change, noting that the “immune system is a beautiful system, designed to protect us, but sometimes it can get us into trouble when it treats something as a threat that is not.” He compared people’s difficulty with good change to an “autoimmune reaction.” Kegan noted that the amygdala -- the fear center of the brain -- “gets a bad wrap” because its needed to keep us safe, but that when it goes wrong “it’s like having one foot on the gas and one foot on the break.” Kegan laid out strategies in a case study about how to help people with change.

Michael Pantalon, PhD, a Yale University assistant professor of psychiatry and director of the Center for Progressive Recovery, discussed how giving clients autonomy -- acknowledging that they have a choice and empowering them to make one -- has helped increase attendance among parolees for meetings with their probation officers and improved outcomes in drug treatment.

Three physicians in the session highlighted the application of this approach in medicine and mental health.

In the session, a cardiologist noted that physicians are trained to be dietetic -- to tell patients what to do -- and noted that she was beginning to finally see why that was not working. A family physician who is a coach highlighted how this coaching model had changed outcomes for his patients. After becoming a coach, he stopped telling clients what to do, and started casually hanging ideas out there. In one example, instead of telling a client who was trying to lose weight what to do, he mentioned that he had lost 130 pounds. The client asked about the diet and adopted all of it except the part about not eating pasta. Instead of telling the client to not eat pasta, he said ok and the client asked what would change. He replied, "You won't lose weight." The client ultimately decided to give it up. In addition, the director of a large psychiatric hospital described a patient who had long been on their inpatient unit who had become so entrenched that she would grab something to hurt herself whenever she was walking in the hallways. He said the staff all wear mitts to try to slow her down. The hospital director mentioned that they had told the patient she should use the tools she's learned on the unit. Pantalon coached the director on how to essentially say, "You can use the skills you've learned if you want to. You can also continue to hurt yourself. It's your choice." I guess we'll see how it works next year. But if Panaton's own examples from working with addiction clients are any indication, my betting money is that empowering the patient will be successful.

A session by Ronald Schouten, MD, an associate professor of psychiatry at Harvard and the director of the law and psychiatry service at Massachusetts General, was cancelled at the last minute. It’s a shame. He was going to talk about what coaches should do when they come across those who are and who are almost psychopaths, alcoholics and depressed in their practice. Perhaps, this time, next year. I’ll be back. The other speakers included David Peterson, the director of Leadership and Coaching at Google, and Richard Ryan, PhD., a University of Rochester professor who spoke on self-determination, specifically the importance of intrinsic motivation in volitional behavior.

But the most powerful part of the conference was listening to my colleagues themselves. The issues that they are working on, struggling with, researching and tackling are impressive. The skills that they brought to the table -- like the executive coaches who were as skilled in psychology and organizational development as they were in finance, and the life coaches who knew when to bring to bear insight-oriented, cognitive behavioral, dialectical behavioral and action-oriented approaches stood out.

What was most heartwarming, were the side table conversations about clients. The coaches I met showed a passion for making their lives of their clients better with a matching desire to take the most intelligent, evidence-based approaches.

I came out of the conference with dozens of new tools to help my clients, and a lot more hope for the profession. I feel like my Rubix cube isn’t just unbroken. I feel like I got another one. And that means many more tools for my clients.

From Littleton to Washington

Two weekends ago, Andrew Solomon, the writer and author of The New York Times best-selling book, The Noonday Demon: An Atlas of Depression, took a podium at the National Book Festival.

Solomon had narrated his own devastating struggle with depression in The Noonday Demon and had now chronicled the struggles of parents whose children were very different than them in his latest book, Far From the Tree. In the book, Solomon examines those who are deaf, dwarfs, prodigies, those with Downs Syndrome, schizophrenia, autism and other conditions that are both considered illnesses and identities.

In one section of the book and in his speech, Solomon discusses children who commit crime and asks Susan Klebold, the mother of Dylan Klebold, one of the teenage perpetrators of the Columbine High School massacre, what she would tell her son if she had the chance to have one more conversation with him.

Solomon said that Susan looked down at the floor before saying, “I would ask him to forgive me, for being his mother and never knowing what was going on inside his head, for not being able to help him, for not being the person that he could confide in.” She later added, “I’ve had thousands of dreams about Dylan where I am talking to him and trying to get him to tell me how he feels. I dreamed that I was getting him ready for bed and I lifted up his shirt, and he was covered with cuts. And he was in all this pain and I did not see it; it was hidden.”

And so are many tragedies of the mind.

Unlike a leg or an arm or a foot or a hand, a mental wound often remains hidden, often hidden until it’s too late to do anything.

The tragedy of these illnesses are that they, like any other illness, become worse over time, the longer they are not treated. They become worse with self-medication, avolition and inaction.

So when we hear that voice that calls out for help, we should heed that call in a set of illnesses that are not as obvious as others but are equally devastating.

And that is what did not happen on Wednesday, August 7.

On that day, in Newport, R.I., Aaron Alexis, 34, a civilian contractor with the United States Navy, called the police from a Marriott, according to The Washington Post.  He told the police that three people were following him, sending microwave signals through the walls, making his skin vibrated and preventing him from getting any sleep. He told the police that he had changed hotels to get away from the men, the voices and the radiation.  

You do not need to be a psychiatrist, or even an emergency medical technician, to know that delusions, plus paranoia, plus physical hallucinations, plus auditory hallucinations equals some type of psychotic break, a most likely schizophrenia. In any rational world, this is a clear cry for help from a panicked psychotic man.

What did happen?

Instead of being taken to the nearest hospital, the police told, this obviously psychotic man, to “stay away from the individuals who are following him.” Then, they left.
Forty days later, he was at the Washington Navy Yard. He opened fire, killing twelve.
I can’t imagine what forty days of delusions, paranoia and constant voices will do to a man’s mind. But we most likely saw one of the potential results in blood that day. And it saddens me that it was likely preventable.

Just as cancer researchers spend billions of dollars a year on finding a cure while only a fraction of that is spent on changing behaviors that contribute the 62 percent of cancers that are preventable, sometimes we do not intelligently distribute our force.
There is no question that guns, bombs, knives and nunchucks are a part of the problem. There is also no question that people with major mental health disorders – excluding the personality disorders – are less likely to carry out an act of violence than those in the general population. But there is also no question when serious mental illness meets with violence, the results are often spectacular destruction.  

Sandy Hook. Auroa. Littleton. Blacksburg. Tucson. Now, Washington.

It feels like it is time for a new conversation about mental health and it’s an unpleasant one. Charles Krauthammer, the writer and non-practicing psychiatrist who made breakthroughs in the research of mania, wrote, in a powerful column last month, on the Navy Yard shooting saying that we should pause when we hear stories of individuals crying out for help in mental health crisis. He also said that we should have a debate about involuntary commitment to psychiatric facilities.

As someone who is involved in that process, I recognize that it can be hard under some circumstances to get someone involuntarily committed. More often than not, it’s merely a lack of knowledge or will, or the presence of laziness, that get in the way of commitments. In some ways, if you know the magic words and are willing to push the limits, it might actually be a little too easy to get someone committed. In Virginia, at least, I don’t feel the problem is so much the tool as how it is so ineffectively utilized.

So, I would put the focus somewhere else. My next temptation is to take a look at policing. I am happy to work  in a part of the country, Fairfax County, Virginia, where officers are much better trained when it comes to working with the mentally ill. I can’t imagine it happening in the areas around my offices in Centreville and McLean. I’ve worked with the officers there to make sure friends were safe and I’ve worked with them to make sure my clients and clients of others were as well. Several weeks ago, two officers spent three hours in our waiting room talking to a paranoid schizophrenic woman who was presenting with symptoms in order to assist me in coaxing her to take her medication and going to the hospital. It was impressive. My esteem extends to the federal police in the area. I’ll never forget the family that told me about how the CIA special police officers had brought their paranoid and delusion son to get mental health care several times when he showed up over-and-over again at their headquarters.  I know it’s not perfect, and I know there are some places where the training officers receive is deplorable. The Navy Yard case is a good argument for Crisis Intervention Training.

I have little doubt that if Alexis had been in Centreville, as opposed to Newport, R.I., he would have been well into a hospital stay at the time of the shooting and would probably be recovering from his paranoia and delusions.

The police in Newport, R.I. become a part of the ones who missed the signals or were hamstrung by the system. Hindsight is 20-20, but it’s no less painful, regardless of your position, to be the one who missed the single. Ask Susan Klebold. Ask the police officers who took the report from Dr. Lynne Fenton, the psychiatrist of the shooter who killed many at the movie theater in Auroa, Colo. As Dr. Fenton. Ask the teachers at Westfield High School who taught Seung Cho, the shooter in the Virginia Tech shootings in 2007, one of whom was my mother.

As someone who has coached many students who were at Virginia Tech during Cho’s shootings, I don’t want to see many more victims – whether they are the dead, the injured, the witnesses, the shooters, the police or the mothers.