By William Shryer, LCSW, BCD

Clearly one of the most misunderstood disorders in the field of neuroscience is the diagnosis of “Obsessive-Compulsive Disorder.” It occurs from early childhood all the way throughout the life span.

It is actually a spectrum of disorders generally seen when one cannot get a particular thought out of their conscience mind. They may think they are contaminated, that something horrible will befall someone they love. They may think that they may utter something blasphemous. They may feel convinced that there is something about their body that is misshapen or looks ugly. They may look endlessly in mirrors and ask others of they notice the defect. They may avoid going out, certain that others will notice their defect. The public is generally unaware of the suffering that so many go through dealing with their “stuck thinking.”

Obsessive-Compulsive Disorder has more symptoms than just about any other diagnosis. From the better known symptoms such as those seen in the movie, “As Good as it Gets” with Jack Nicholson, where hand washing and certain rituals were present, to the lesser known symptoms such as “hoarding”, stuck thoughts, and many believe that even anorexia may be a symptom on this wide and unusual spectrum. Clearly one of the most disturbing for some is the, “distress of perceived ugliness,” known as Body Dysmorphic Disorder or BDD.

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Introduction

In recent years, medical advances have produced revolutionary treatments for people with HIV that slow the progression of the disease and prolong life. Unfortunately, various strains of the HIV virus are also evolving, becoming increasingly resistant to drug treatments, which may lead to the drugs or medication therapies failing. Genetic testing is now used for people with HIV to help identify drug-resistant HIV strains so that physicians can prescribe the most effective treatment options.

HIV (human immunodeficiency virus) is a disease that destroys or damages a type of white blood cell (CD4 T-cells) in the immune system and progressively decreases the body’s ability to fight infections and certain cancers. The virus causes AIDS (acquired immune deficiency syndrome).

People with AIDS have a significantly reduced number of healthy white blood cells, and therefore become more susceptible to life-threatening infections caused by microbes that rarely cause illness in healthy people.

Although there is no cure, treatment for HIV has advanced with highly active antiretroviral therapy (HAART), which suppresses the virus. However, HIV is constantly replicating and can mutate so that antiretroviral medications designed to treat a certain strain of virus are no longer effective.

Drug resistance is the most common reason why medication therapies fail. People with HIV may have several different strains of the virus, so determining the optimal treatment option becomes more difficult.

Types of Genetic Tests

Two types of genetic tests are available to determine if a resistant strain of HIV is present in a person using HAART: phenotype and genotype testing. Phenotype testing measures the amount of drug required to completely stop HIV replication in a blood sample. In contrast, genotype testing identifies the mutations in the genetic structure of the virus that have been linked with drug resistance.

Genetic analysis of HIV/AIDS helps researchers to better track the patterns of disease transmission, and to better understand how the virus affects the human body. No one test is sufficient for making treatment decisions.

People with HIV/AIDS work with a variety of professionals who diagnose and treat the disease and help manage the physical and mental health and social issues related to the disease. Social work professionals play an important role in the disease management team.

Social workers employed in community human services agencies, hospitals, and in private practice help people with HIV/AIDS to decide whether or not to have genetic testing and to understand the implications of test results. Additionally, social workers coordinate community services and help their clients address the life changes that often accompany a diagnosis of this life-threatening disease.

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Source material:� HIV/AIDS: Understanding the Role of Genetics by Evelyn P. Tomaszewski, MSW, published in the NASW Specialty Practice Sections Health Connection, Spring 2005.

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Infertility is an experience that strikes at the very core of one’s life. Reproduction is considered the most basic of human needs, propelled by powerful biological and psychological drives. When the ability to reproduce is thwarted, a crisis ensues and impacts relationships with others, life goals, social roles, and sense of self. A host of emotions emerge in a somewhat predictable and repetitive process as one moves through medical diagnosis and treatment. Feelings of disbelief, anger, sadness, guilt, blame, anxiety and depression can be overwhelming and finding appropriate avenues to express these emotions is important.

For most people, in vitro fertilization (IVF) is not the first course of treatment for their infertility—it is the last, best option for having a child. It occurs after long months and sometimes years of treatment failure, often at tremendous emotional, physical and financial cost. Couples beginning IVF usually do so with the burden of grief and disappointment from infertility, and may feel depressed, angry, tired, and anxious. Although emotionally depleted, couples are attracted to a technology that offers hope where none may have existed. They find themselves drawn into new emotional turbulence of contrasting feelings of hope and despair, which seems to be generated in part by the experience of the technology itself.

The opportunities that IVF creates brings with it significant challenges. IVF is considered by patients to be the most stressful of all infertility treatments. Patients have rated the stress of undergoing IVF as more stressful than or almost as stressful as any other major life event, such as a death of a family member and separation and divorce. While general assumptions may be made about stress levels during IVF, the experience for infertility patients will be personal and unique—each patient will experience the stress differently based upon his or her own personality and life experiences.

The aspects of IVF that are perceived stressful to patients are multifaceted and affect all parts of their life: marital, social, physical, emotional, financial, and religious. Time is stressful, both in the time commitment to an intense treatment which leads to disruption in family, work, and social activities, and for some, in long waiting periods for treatment services. IVF stress impacts the marital relationship with an emotionally laden experience and, by removing the conjugal act of procreation, sexual intimacy is lost. Couples, also, are stretched financially paying for the high cost of IVF treatment with a relatively low probability of success. Dealing with the medical staff and with the side effects or potential complications of medical treatment has its own stress: hot flashes, headaches, mood fluctuations, shots, sonograms, future health concerns, and decision making about embryos and multiple pregnancies. Religious, social, and moral issues may also make IVF stressful, especially for those dealing with third party reproduction, when these values are in conflict with the choice of treatment.

The first treatment cycle has been found to be the most stressful for patients, with high levels of confusion, bewilderment, and anxiety. This may be due to inexperience with the process or possibly inadequate preparation of the patient by staff in terms of information and discussion of care. While experience seems to help the stress level in the next cycle, if it is unsuccessful the stress level rises again with the third cycle as the “stakes” have been raised. For many couples, IVF can feel like gambling where the stakes are high and the chance of success unknown. Like gamblers, some IVF patients may have unrealistically high expectations of success or feel compelled to try “just one more time” finding it difficult to end treatment after having already invested so much physically, emotionally, and financially to have a child.

Within a treatment cycle, patients view IVF as a series of stages which must be successfully completed before moving onto the next phase of treatment: monitoring, oocyte retrieval, fertilization, embryo transfer, waiting period, and pregnancy test stages. The level of stress, anxiety, and anticipation raises with each stage, peaking during the waiting period. Research has shown that in order of perceived stress for patients, waiting to hear the outcome of the embryo transfer is the most stressful, followed by waiting to hear whether fertilization had occurred, and then the egg retrieval stage. Patients are aware of the importance of these key phases in the IVF process and the uncertainty of the outcome is highly distressing.

Despite the stressful consequences of infertility and IVF, it is important to note that research has shown that the vast majority of patients are well adjusted. Further, there seems to be no long-term impact on the marital relationship and individual functioning. In fact, some research has shown that the crisis of infertility may actually improve marital communication and emotional intimacy. Couples may learn coping skills and communication patterns that provide life-long benefit.

IVF has the potential to be an emotionally, physically, and financially exhausting experience due to the “high stakes” and “end of the line” nature of this treatment. Thus, patients need to consider thoughtful preparation before beginning the process. If you are a patient about to begin a cycle, here are some tips to help get ready for IVF. (more…)

By Alyson Mischel, LCSW

Introduction

Historically, social workers are trained to work with the populations most in need of assistance. They practice in prisons, with drug users, the severely mentally ill, batterers and domestic violence victims, and with HIV positive clients. But, increasingly, social workers have private practices and treat people who can afford to pay for traditional 50 minute psychotherapy sessions. Regardless of the brand of social work practiced, or the population served, social workers can rely on concepts of media psychology to serve their clients.

Most everyone watches television, listens to the radio, or reads some form of printed press on a daily basis. Media is the 21st century’s glue – it’s what connects us and makes a Wall Street banker able to relate to a struggling waiter in Los Angeles. As a consumer who may communicate with a therapist online, or have a therapist use television and film as case studies, it’s important to understand the following basic concepts of media psychology and how they relate to psychotherapy.

Telemedicine

Telemedicine is the delivery of medical and/or psychological services at a distance with the use of technology like telephones or web-based systems. Treatment via telemedicine could involve� two medical professionals talking over the telephone in real time about a case and also the use of satellite equipment allowing a doctor in California to evaluate, diagnose, and treat, a patient in Brazil.

The focus of telemedicine is largely consultative, which is why there is a growing trend toward online, synchronous psychotherapy. Some psychotherapists offer online and telephone counseling services for marriage, depression, parenting, family, and grief issues.� The International Society for Mental Health Online,� the National Association of Social Workers and the American Psychological Association have issued statements about telephone counseling. Understanding how telemedicine works is essential for consumers since psychotherapists increasing use e-mail and the Internet to provide services.

Cinematherapy

Cinematherapy is the use of film as a metaphor to bring about positive growth in psychotherapy clients. Watching television and films may be a catalyst for healing and change. Movies� can be� “windows” to the unconscious in the same way that dreams and fantasies are. Watching films allows clients to become consciously aware, resulting in gained insight and emotional release. Cinematherapy works best in the tradition of Systems Theory and Cognitive Behavioral Therapy, which are the treatment modalities used by most social workers. Films may help clients become aware of their irrational beliefs and poor coping mechanisms. Cinematherapy is another tool like stories, myths, and fables, that psychotherapists use to treat their clients.

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To read more from Alyson Mischel� visit www.alysonmischel.com

A positive, compassionate, and enthusiastic personality, Alyson Mischel brings a special brand of empathy to her psychotherapy and life coaching work. Alyson combines her education and clinical training with her own experiences, and has developed a common sense approach for addressing life’s challenges. Alyson is a lecturer at the USC School of Social Work, and serves as a consultant for UCLA’s Educational Leadership Program, a doctoral program of education. She was formerly a clinical supervisor for the Los Angeles County Department of Mental Health. Alyson has counseled hundreds of people in the areas of career, relationships, health, and finances. A graduate of Stanford University, the University of Southern California, and a licensed clinical social worker, Alyson has been studying and practicing since 1998.

Ms. Linda Guhe, MSW, LCSW

The History of Tobacco and Health in America

Tobacco has been around since ancient times and� it has been significant throughout American history. When Christopher Columbus discovered America in 1492 he also discovered smoking tobacco. Tobacco proved to be quite appealing to those early explorers. As a result, tobacco from America spread to other parts of the world. Tobacco was first grown commercially in America in the early 1600s. In the 1800s, the revenue from taxed tobacco helped finance the Civil War. In the early 1900s, RJ Reynolds began producing and selling the first brand-name cigarette, Camel.

While popular and appealing, tobacco use has led to serious health problems in the United States and world-wide. Today, approximately 25 percent of Americans smoke. Fifty percent of those who use tobacco will die from a smoking-related illness, approximately 450,000 people each year. The number of Americans using smokeless tobacco ranges from two percent to 9 percent. Financial costs of treating tobacco-related illnesses in the US are more than� 50 billion dollars a year.

Health Care Providers and Tobacco Dependence

It may be surprising to learn that tobacco dependence is actually under-diagnosed by providers in the health care community. However, because of an increasing awareness in recent years of the physical dangers to health, along with financial burden for society, tobacco has been gaining more attention in public health education and research. For example, the federal government is focussing on the problem with its� Healthy People 2010 initiative.� � Among the government’s� health objectives for the years 2000� through 2010� is a campaign to promote the cessation of tobacco use.

There are reasons why healthcare professionals have failed in the past to recognize, diagnose, and treat tobacco dependence. For one thing, until recently, the subject of tobacco dependence as a treatable disorder has been limited in the formal training of health care professionals. As a result, in comparison to experts in other kinds of disorders, there are only a small number of researchers and specialists who provide scientific information about the effects of tobacco use and effective methods of treatment.

Money became available to fund tobacco dependence research as a result of the financial settlement of lawsuits filed against the tobacco companies by 46 states in 1994 and 1995.� The lawsuits were filed in response to financial burdens experienced by states in treating tobacco-related illnesses. Money and publicity from the 1998 Master Settlement Agreement (MSA) made between tobacco companies and the states that filed the lawsuit has helped fund, draw interest to, and generate tobacco research.

Because of an increase in research in the last several years, we now have a better understanding of tobacco. We now know that tobacco products contain both (1) harmful toxins that damage health and (2) nicotine, which is a powerful addictive drug. Research has also led to the development of evidence-based methods of tobacco cessation treatments. As a result, the number of specialists in tobacco and the treatment of tobacco addiction have been increasing.

Tobacco researchers and specialists are now providing health care providers with the necessary tools and guidelines to talk with their patients about smoking, and for offering tobacco cessation treatment. In addition, there are multiple agencies providing information to the public on smoking and tobacco addiction, and help for quitting.

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By LeslieBeth Wish, Ed.D, MSS

Introduction

It’s holiday time of year again when thoughts turn to shopping, giving, partying and—yes—making New Years’ resolutions. Even if a person doesn’t want to make them, reminders about resolutions are on the Internet, talk shows, the news and magazines. Unfortunately, these reminders highlight last year’s broken promises and the reality of breaking the same or new ones this coming year.

Many people avoid making them and secretly are ashamed of their previous failure. Jeanie, a teacher, summed up the feelings perfectly: “It’s like starting the New Year already defeated.”

The following guide to making resolutions that work can’t guarantee success, but it can lay the groundwork for changing old habits.

Start Small

One of the major problems with resolutions is that the freshness of the New Year often propels people to think too big. It’s easy to get swept up into the appeal of a clean slate and make big promises to change old habits such as quitting cigarettes or waking up earlier.

Janet, a free-lance writer, got caught up in false hopes by vowing to wake up before six-thirty every morning. By the third day, she had broken her promise twice. A wiser plan would have been to go to bed earlier once a week, plan to wake up earlier the next morning and then add more days slowly a week at a time.

Don’t take on too many resolutions at once. Janet thought she could both wake up earlier and then run two miles.

Expect the Inevitable Discomfort and Anxiety That Accompany Change

One of the mixed blessings about being human is the ability to manage pain, insecurities, anxieties and other problems through behaviors that work well enough. For example, eating may not be the best way to soothe feelings, but it works well enough so that giving up old eating habits then becomes at least as difficult as continuing to eat unwisely.

In general, behaviors that are biologically-based are the most troublesome to modify. These behaviors include actions that involve anger and aggression and all the pleasure-inducing activities such as sex, gambling, drinking, eating and shopping. Not surprisingly, because people are prone to excesses in these areas, promises to change these tendencies make up the bulk of New Years resolutions.

It takes tremendous will power to alter disheartening habits. As a result, many people fool themselves into thinking that the beginning of a New Year is a potent enough motivator. Such hopes result in global and bittersweet resolutions that are doomed to fail. A typical list of these resolutions includes:

• I promise not to hide my purchases from my husband.
• I promise not to eat candy and junk food while driving alone.
• I promise to fit into my high school clothes.
• I promise not to get upset any more with my pet, family and colleagues.
• I promise not to be sexually turned on by looking at other people.
• I promise not to lie to my partner—at least not big lies.
• I promise not to fudge my work at my job—at least not big fudges.
• I promise to stop cheating on my partner.
• I promise not to lie about dents in the car.
• I promise not to carry a balance on my credit card.
• I promise not to buy things I don’t really need—whatever that means.

Making resolutions that address these issues, however, is often the most important decision. Aim small for big results. For example, a resolution that addresses secret spending might be to designate one credit card or checking card for the home budget that includes a set limit on fun purchases. (more…)