“I gave up on having a future. And I was strangely okay with it.”
By Cassie Jewell, M.Ed., LPC, LSATP
Without delving too deep into my past, I will tell you that my late teens and early to mid 20’s were not the best of times. They were dark. Lonely. Depressing. I was living a life of chaos and hopelessness. At one point, I didn’t think I was going to survive; I gave up on having a future. And I was strangely okay with it.
My turning point was a spiritual awakening of sorts. A
near-death experience led to a realization that I didn’t want to die; and it
was either die or change my life. I picked change.
What helped me to live again (and ultimately find fulfillment)?
You might guess family or a relationship or God. But at the time, I wasn’t close
with my family, I didn’t have any significant relationships/friendships, and God
wasn’t a part of my life. It was the following that helped me become the person
I am today:
Having not a single shred of self-esteem, I went to see a counselor. She created a safe space and then uplifted me, making me feel worthwhile. She normalized what I was going through; I felt less alone. She affirmed me for positive choices I made. She initiated the mending of my fragile self. I gradually gained confidence, not only in myself, but in the idea that I could live a better life.
She loved me unconditionally… and she depended on me fully. If I died, she would think I purposely left her. I couldn’t bear the idea; I wouldn’t do that to her. She played a huge role in my recovery. I sometimes think she saved me.
I’ve always known I have potential. I’m smart and creative. I’m motivated and driven. But that potential died somewhere along the way in young adulthood. In moments of clarity, I mourned my lost potential. I wanted to be better and to do better with my life. I was meant, maybe not for great things, but for better things than living out of my car, broke and friendless. When I decided to live, my potential reawakened; it became a driving force – a bright, glowing beacon that revitalized and inspired me.
“You have to forgive yourself.”
I couldn’t bear to tell my therapist about some of the things I’d done. I was ashamed; late at night, lying in bed, I would think about past events. I’d feel sick to my stomach – then, an unpleasant head rush heart racing not able to get enough air… (That’s the feeling of shame seeping from your mind into your being.) My therapist didn’t push me to share; instead, she said, “You have to forgive yourself.” It became my mantra, quietly uttered in the dark. I would repeat, “I forgive myself, I forgive myself, I forgive myself…” until I internalized it. (That being said, it didn’t happen overnight… it took weeks, months, years. But all was set in motion with that one simple statement.)
I went back to school and was able to fully immerse myself in my studies. As a naturally curious person, learning is a sort of fuel for me. The more I learn, the thirstier I become. My classes provided me with not only knowledge, but with a spark that generated purpose.
While in school, I discovered a new passion; I fell in love with research. (#nerd) I thrived in my research/statistics class; my undergraduate study was even published in a national journal. It felt good to be passionate about something again; it stirred up (from the dust) long-forgotten loves, like reading and writing – passions I thought I’d left behind in childhood.
A Meaningful Career
After finishing college and starting graduate school, I became a counselor… and found meaning in helping others. My first job in the field was tough, heart-breaking at times, and deeply fulfilling. It solidified what my education had started to shape – I no longer needed to survive or endure life; I found my purpose for living.
(Updated 5/4/20) A list with links to other sites’ resource pages
By Cassie Jewell, M.Ed., LPC, LSATP
I have a knack for finding resources. To compile the lists for this blog, I spend countless hours searching the Internet.
My main resource list has grown tremendously since I started blogging. In my quest to compile the most comprehensive resource list ever, I came across a few lists that rival my own.
This post will link you to a variety of resource pages (in case you can’t find what you’re looking for on this site!) If a link isn’t working, try going to the site’s homepage or sitemap to look for the resource section.
ACEs Connection | An ACEs community for connecting with others who practice trauma-informed care. You can also access the latest news and research related to ACEs; this site also has a huge resource section with guides, surveys, webinars, and more.
ACT Mindfully | A variety of free worksheets, handouts, book chapters, articles, and more. Acceptance and Commitment Therapy (ACT) is a unique and creative model for both therapy and coaching; a type of cognitive behavioural therapy based on the innovative use of mindfulness and values.
The Centre for Applied Research in Mental Health and Addiction – Tools and Resources | The Centre for Applied Research in Mental Health and Addiction (CARMHA) is an internationally recognized research centre based at the Faculty of Health Sciences, Simon Fraser University, Vancouver. CARMHA conducts innovative and interdisciplinary scientific research related to mental health and substance use, primarily in the areas of clinical or other intervention practice, health systems and population health and epidemiology. Access free downloadable workbooks for stress in the workplace, depression, coping with chronic pain, and other topics.
Character Lab | A collection of “playbooks” for character-building in children
Confident Counselors | A collaborative blog written by school counselors, school psychologists, and school social workers
Counselling Resource | A resource site for mental health professionals and consumers. Includes interactive assessments, free PDF printables, and information related to online practice and clinical supervision.
Get Self-Help – Free Resources | This website provides CBT self-help and therapy resources, including a large collection of worksheets and information sheets and self-help mp3s; a useful tools for therapists or individuals seeking to manage a mental health condition.
Personality Lab | Articles, assessments, dissertations, etc. on personality intelligence
Positive Psychology Program | This site contains a wealth of free assessments, PDF printables, activities, handouts, worksheets, and more. Search by category or browse blog posts.
PsyberGuide | A nonprofit organization that discovers and reviews mental health apps, which are rated as unacceptable, questionable, or acceptable. You can also search target conditions and treatments. Use this site to make recommendations to your clients.
PsychCentral | Articles, news, blogs, forums, interactive quizzes, and more
Society of Clinical Psychology (Division 12) | A division of the American Psychological Association, this site provides an up-to-date list of evidence-based treatments, and includes links to free assessments, manuals, handouts, etc. for many of the treatments
TherapyAdvisor.org | A searchable database of empirically supported treatments for SUD and MH
Kim’s Counseling Corner – Therapy and Self-Help Worksheets | Kim Peterson, LPC-S, specializes in child and teen issues, parenthood, play therapy and relationships. She provides links to online worksheets or PDF versions that she has collected over time as a therapist. Topics include abuse, depression, anxiety, self-harm, and more.
Therapist Aid | An extensive collection of free evidence-based education and therapy tools. Download customizable worksheets or access articles and treatment guides. An invaluable resource for therapists.
(Updated 5/21/20) An extensive list of support groups for recovery
Compiled by Cassie Jewell, M.Ed., LPC, LSATP
There are a variety of 12-step support groups for recovery. 12-step meetings are not facilitated by a therapist; they’re self-run. Support groups are not a substitute for treatment, but can play a crucial role in recovery.
The following list, while not comprehensive, will link you to both well-known and less-familiar 12-step (and similar) organizations and support groups for recovery.
Click below for a downloadable PDF version of this post.
Words have power. They are impactful. They can contribute to stigma and divide humanity. To help fight stigma, change your language.
By Cassie Jewell, M.Ed., LPC, LSATP
Have you ever been called a bitch? A creep? A whore? An idiot? Maybe someone said you were lazy or worthless or stupid. Words can hurt. They have power. (Consider the power of your name spoken aloud… you immediately respond by answering or turning your head… the sound commands your attention and response.)
Furthermore, words are impactful… not only for the person being labeled, but for an entire group of people. They contribute to stigma while fueling biases. They divide humanity. Retard. White trash. Crazy. Junkie. Nigger. Slut. Spic.
A while back, a colleague made a racial slur in my presence. He seemed unaware, so I gently corrected him; he immediately lashed back, calling me the “PC Police.” Not only did this person perceive the slur as perfectly acceptable, he seemed to have a negative perception of “political correctness.” It was a joke to him: “People need to stop being so sensitive!” (Um, no… maybe people need to stop being degrading to each other!)
Honestly, I have trouble understanding the negativity surrounding political correctness. Why strive for anything other than accuracy? (Especially knowing the power language holds.)
If you side against ignorance and want to end the stigma associated with mental illness, change your language. The following words or phrases contribute to stigma:
There are many negative connotations surrounding this word. Similarly, “alcoholic” can be demeaning. A person who is addicted to drugs or alcohol has a medical condition. Instead of calling them an addict (or junkie or tweaker or crackhead), say “individual with a substance use disorder.” Demonstrate the same empathy you would for a person who has cancer or MS or paralysis.
Don’t label a person who suffers from mental illness. They are more than the disorder they’re afflicted with. Calling someone “schizophrenic” or “borderline” or “bipolar” reduces them to an illness, not a person. It’s dehumanizing.
True, “mental retardation” used to be the diagnostic terminology for classifying individuals with lower IQs. Today, however, it’s mostly used as an insult. The American Psychiatric Association has eliminated the term as a classification; the correct term is “intellectual disability.”
This phrase suggests that the person who dies by suicide is criminal. Criminals commit crimes. An individual who dies by suicide should not be placed in the same category. Instead, say “died by suicide.” This demonstrates respect for both the individual and their loved ones.
Words have the power to influence and shape the world. You have power. Be a positive influence and choose to fight stigma instead of contributing to the toxicity.
A person who struggles with a substance use disorder is choosing that life. Why interfere? (Especially when all that money could be spent saving more DESERVING lives.) “Junkies” don’t deserve second chances because #JunkieLivesDontMatter
By Cassie Jewell, M.Ed., LPC, LSATP
Disclaimer: If you happen to believe that addiction is a choice – “They’d quit if they really wanted to” or “They made the choice to use; they made the choice to die” – then scroll on to the next blog. You’d only scoff at this post because #JunkieLivesDontMatter
This blog post is inspired, in part, by a Facebook meme.
The meme said,
“So if a kid has an allergic reaction the parents have to pay a ridiculous price for an Epi pen. But a junkie who has OD’d for their 15th time gets Narcan for free? What a screwed up world we live in.”
Implications: “Junkies” don’t deserve a second chance at life. They’re a waste of resources because they lack the willpower to stop using. A person who struggles with a substance use disorder is choosing that life. Why interfere? (Especially when all that money could be spent saving more deserving lives.)
If you believe it’s screwed up for a “junkie” to have a chance at life (and recovery) because they “chose addiction,” your opinion is contrary to the National Institute of Health, the American Medical Association, the American Psychiatric Association, and decades of scientific research. You’re either ignorant (maybe willfully so) or impressively arrogant. (Alternately, you could just be a jerk.) You’re a part of the movement: #JunkieLivesDontMatter
Many have joined the movement, as evidenced by the following Facebook posts:
“Out of all of the houses, 2 hobos decided to overdose on my front steps… thank god the medics got here in time to ensure they could die another day…”
“I think we had less ODs before Narcan came on board. They realize they can be saved if gotten to in time. Maybe they need to be locked up & not let out until they attend rehab while in jail.”
“If it can be easily established that they have a recent history of drug [abuse]… then yes… withhold the lifesaving drug because they chose this. It’s harsh, but justice is not served by saving them.”
“If you don’t have it figured [out] by the 3rd overdose, you are just prolonging the inevitable and wasting tax payers money.”
“If we are repeatedly saving your life and you are not willing to change this behavior, why should we be obligated to keep saving you?”
“My personal opinion is we can’t keep letting people overdose and saving them just so they can repeat the cycle.”
“By continuously administering Narcan, sure, we’re saving their life, but are they really living? I don’t think so.”
“No CPR for You, Fatty — You Chose Soda and Fast Food… Now Suffer the Consequences!”
According the the American Psychiatric Association,
Addiction is a scientifically proven brain disease. Despite this, many persist in the belief that it’s a choice, or worse… a moral failing. (Note: This notion comes from an early model of addiction, “the moral model,” which was deeply rooted in religion. Addiction was attributed to a sinful nature and weakness of character. Therefore, the addict must repent… or suffer the consequences of his/her actions; addiction warranted punishment, not empathy. Unsurprisingly, this created stigma. It also prevented those struggling with addiction from seeking treatment. Centuries later, many hold on to the view that an individual suffering from a substance use disorder is lazy or weak.)
Today, in the midst of the opioid epidemic, stigma’s unrelenting grip perseveres. Stigma is a poison; it’s dehumanizing. It’s easy to forget a person is a person when you view them as garbage, trash… a “junkie.” Stigma tells us, “Take out the trash.”
To fully recognize stigma’s impact, compare addiction to other diseases. Consider common medical emergencies; many are related to lifestyle. Imagine being hospitalized after your third stroke, and the doctor telling you, “This is the third time I’ve saved your life, yet you refuse to exercise. I shouldn’t be obligated to continue to provide life-saving care.” Or, imagine a long-time smoker who develops lung cancer; they’re not demeaned, called names, or denied treatment. Moreover, an EMS worker wouldn’t withhold CPR from an individual in cardiac arrest if they were obese. It’s not a debate.
If you’re unfamiliar with the term “enable,” it means “to provide with the means or opportunity.” When applied to substance use, it means a person in active addiction is provided with the means to continue to use. With substance use disorders, how can you know the difference between helping and enabling? This post explains how to tell the difference and provides 7 tips for helping a loved one who struggles with addiction.
By Cassie Jewell, M.Ed., LPC, LSATP
With substance use disorders, how can you know the difference between helping and enabling? I’ve worked with family members who inadvertently fueled their loved one’s addiction. They “helped” by bailing them out of jail, giving them money, etc., which only permitted the individual to continue to get high. It’s hard for family members to differentiate between behaviors that help versus enable.
If you’re unfamiliar with the term “enable,” it means “to provide with the means or opportunity” or “to make possible, practical, or easy” (according to Merriam-Webster). When applied to substance use, it means a person in active addiction is provided with the means to continue to use.
When I worked at a substance use treatment center, I taught families and loved ones that helping a person in active addiction means supporting their basic needs, such as food, water, shelter, and clothing. (If someone is in jail or treatment, their basic needs are met; therefore, bailing them out would be enabling.) Thinking in terms of “needs vs. wants” helps you to recognize enabling.
Distancing yourself (or setting a boundary) with your daughter will be difficult because you want to help. In the past, by “helping” her, you’ve enabled her addiction (which hurts her in the long run) and leaves you emotionally depleted. There’s a very fine line between helping and enabling; it’s not clear-cut. (Plus, it can be counterintuitive for a parent whose job has always been to protect your child.)
When a parent has a son or daughter who struggles with addiction, it’s especially difficult to make the distinction between helping and enabling. A parent’s natural inclination is to nurture and protect from harm. It’s heart-wrenching to see your child in pain. But if a parent doesn’t set (and adhere to) healthy boundaries, they will quickly become emotionally drained (as they enable their child’s addiction).
Here are some suggestions for helping (instead of enabling) a loved one who’s actively using:
Never (ever) offer money.
If asked for cash for food, for example, buy groceries instead (or offer to take them to lunch). I worked with a father who bought a bag of groceries for his son, who struggled with severe alcoholism and was homeless, on a weekly basis. This is an excellent example of helping a loved one versus enabling their addiction.
If asked for help paying bills, say no.
If your loved one doesn’t have to pay the electric bill, they’ll spend the money on drugs or alcohol. Furthermore, if you protect them from the consequences of not paying bills (i.e. having the power shut off), your loved one is less likely to see a need for change. (People don’t change when they’re comfortable.)
If you’re unsure where local trainings are offered, a Google search for “Narcan training” or “opioid reversal training” will link you to resources in your area. Most trainings are free. Keep a Narcan kit on your person at all times. Provide your loved one with a kit (or two) as well. This is not enabling. This is potentially saving a life and offering an opportunity for recovery. (A dead opioid-user will never recover.)
Offer to help them get into treatment.
Become familiar with the different treatment options in your area. Don’t give ultimatums (i.e. “If you don’t get treatment, I’ll divorce you”) or make threats (especially if you’re not willing to follow through). Be supportive, not judgmental. Be patient; when your loved one is emotionally and physically drained from addiction’s painful consequences (or when they hit “rock bottom”), they may decide it’s time to get help. And you’ll be ready.
Recognize that your loved one is not the same person they were before addiction.
Substance use disorder is a debilitating disease that damages the brain; it changes how a person feels and thinks. With addiction, the brain’s reward center is rewired, resulting in a biological “need” for drugs/alcohol. (Compare this to your need for food or water or air.) Your loved one’s addiction will lie to you; they will do whatever it takes to get their “needs” met. Your loved one’s addiction will steal from you. (Lock up your valuables if they have access to your home… and even if they don’t. I’ve worked with more than a few individuals who have broken into their parents’ home for either money for drugs or valuables to pawn for money for drugs.) Your loved one’s addiction will betray you. Accepting the nature of addiction allows you to set healthy boundaries.
By engaging with others with similar struggles, you’ll learn more about supporting your loved one (without enabling their addiction). You’ll also build a supportive network by connecting with others, strengthening your emotional health.
When in doubt, try asking yourself one (or all) of the following questions:
Will my actions allow my loved one to continue to drink or use? Is this a “want” versus a basic need? Will my actions prevent them from experiencing a natural consequence? If the answer is yes, it’s probably enabling.
Addiction is a devastating, but treatable, disease. The road to recovery is difficult and long (with many detours). If your loved one has a substance use disorder, be kind and compassionate; they’re in an unthinkable amount of pain. They didn’t choose addiction. The best way to support them is by setting healthy boundaries to ensure you’re not enabling continued use. Boundaries allow you to help them without furthering their addiction. Boundaries also serve as protection for you and your emotional health; you’re in no position to help if you’re emotionally, financially, and spiritually depleted.
Please share in a comment your suggestions for helping a loved one who is struggling with addiction.
(Updated 5/4/20) A list of sites with a variety of assessment tools for mental health and related issues, including mood disorders, relationship attachment styles, suicide risk, communication skills, and domestic violence. This list includes both self-assessments and screening tools for clinicians to administer and score.
Compiled by Cassie Jewell, M.Ed., LPC, LSATP
The following list will link you to a variety of mental health assessments and screenings for clinicians or for self-assessment. While an assessment cannot take the place of a clinical diagnosis, it can give you a better idea if what you’re experiencing is “normal.” (For additional screening tools to use with couples, see Marriage & Relationship Assessment Tools.)
Free Online Assessment & Screening Tools for Mental Health
ACE Questionnaire | Adverse childhood experiences (ACEs) are associated with a variety of health (both physical and mental) conditions in adults. To find your ACE score, take an interactive quiz. Learn more about ACEs on the CDC’s violence prevention webpage. You can also download the international version (PDF) from the World Health Organization’s Violence and Injury Prevention webpage.
ADAA Screening Tools | The Anxiety and Depression Association of America provides links to both printable and interactive tests for depression, generalized anxiety disorder, OCD, panic disorder, PTSD, social anxiety disorder, and specific phobias. This site does not provide test results. (It’s recommended that you print your results to discuss with a mental health practitioner.) This is an excellent resource for clinicians to print and administer to clients.
Borderline Symptom List and Scoring Instructions | (Source: University of Washington Center for Behavioral Technology) Citations: Bohus M., Limberger, M. F., Frank, U., Chapman, A. L., Kuhler, T., Stieglitz, R. D. (2007). Psychometric Properties of the Borderline Symptom List (BSL). Psychopahology, 40, 126-132.
Demographic Data Scale | (Source: University of Washington Center for Behavioral Technology) A self-report questionnaire used to gather extensive demographic information from the client. Citations: Linehan, M. M. (1982). Demographic Data Schedule (DDS). University of Washington, Seattle, WA, Unpublished work.
Depression Self-Assessment | A simple self-assessment tool from Kaiser. Results are provided on a spectrum, ranging from “None” to “Severe” depression.
DrugScreening.org | An interactive test that provides feedback about the likely risks of your drug use and where to find more information, evaluation, and help
Danger Assessment Screening Tool | Clinicians can download this PDF version of the assessment, which helps predict the level of danger in an abusive relationship; this screening tool was developed to predict violence and homicide.
DBSA Mental Health Screening Center | The Depression and Bipolar Support Alliance offers screening tools for both children and adults (including versions for parents to answers questions about their child’s symptoms). Take an online assessment for depression, mania, and/or anxiety.
DBT-WCCL Scale and Scoring | (Source: University of Washington Center for Behavioral Technology) Citations: Neacsiu, A. D., Rizvi, S. L., Vitaliano, P. P., Lynch, T. R., & Linehan, M. M. (2010). The Dialectical Behavior Therapy Ways of Coping Checklist (DBT-WCCL).: Development and Psychometric Properties. Journal of Clinical Psychology, 66(61), 1-20.
Keirsey | Take this interactive assessment to learn your temperament. (There are four temperaments: Artisan, Guardian, Idealist, and Rational.) My results were consistent with my Myers-Brigg personality type. (Note: You must create an account and enter a password to view your results.)
Learn Your Love Language | Choose your version: Couples, Children’s Quiz, Teens, or Singles. An online assessment to determine your primary love language. (You are required to enter your information to get quiz results.)
Library of Scales (from Outcome Tracker) | 25 psychiatric scales (PDF documents) to be used by mental health practitioners in clinical practice. Includes Frequency, Intensity, and Burden of Side Effects Ratings; Fagerstrom Test for Nicotine Dependence; Fear Questionnaire; Massachusetts General Hospital Hair Pulling Scale; and more. (Note: Some of the assessments have copyright restrictions for use.)
Lifetime – Suicide Attempt Self-Injury Count (L-SASI)InstructionsScoring | (Source: University of Washington Center for Behavioral Technology) The L-SASI is an interview to obtain a detailed lifetime history of non-suicidal self-injury and suicidal behavior. Citations: Linehan, M. M. &, Comtois, K. (1996). Lifetime Parasuicide History. University of Washington, Seattle, WA, Unpublished work.
Lineham Risk Assessment and Management Protocol | (Source: University of Washington Center for Behavioral Technology) Linehan, M. M. (2009). University of Washington Risk Assessment Action Protocol: UWRAMP, University of WA, Unpublished Work.
Mental Health Screening Tools | Online screenings for depression, anxiety, bipolar, psychosis, eating disorders, PTSD, and addiction. You can also take a parent test (for a parent to assess their child’s symptoms), a youth test (for a youth to report his/her symptoms), or a workplace health test. The site includes resources and self-help tools.
Non-Suicidal Self-Injury Assessment Tool Brief Version | Full Version | Assessment tool created by Cornell Research Program on Self-Injury and Recovery
Open Source Psychometrics Project | This site provides a collection of interactive personality and other tests, including the Open Extended Jungian Type Scales, the Evaluations of Attractiveness Scales, and the Rosenberg Self-Esteem Scale. On the whole, I’m doubtful of the scientific accuracy of the assessments. (For example, I took the site’s DISC assessment; my score did not match the score I received when I took the certified test through my employer.) Furthermore, the site’s “About” section maintains, “[The site] exists to educate the public… and also to collect research data.” (Collect research data? For who/what?) I would recommend using the site mainly for entertainment purposes (or not at all if you’re concerned about how your personal data is handled).
Parental Affect Test | (Source: University of Washington Center for Behavioral Technology) The Linehan Parental Affect Test is a self-report questionnaire that assesses parent responses to typical child behaviors. Citations: Linehan, M. M., Paul, E., & Egan, K. J. (1983). The Parent Affect Test – Development, Validity and Reliability. Journal of Clinical Child Psychology, 12, 161-166.
Patient Health Questionnaire Screeners | This is a great diagnostic tool for clinicians. Use the drop down arrow to choose a PHQ or GAD screener (which assesses mood, anxiety, eating, sleep, and somatic concerns). The site generates a PDF printable; you can also access the instruction manual. No permission is required to reproduce, translate, display or distribute the screeners.
SAMHSA Screening Tools | Valid and reliable screening tools for clinicians. This sites links you to PDF versions of assessments/screenings for depression, drug/alcohol use, bipolar disorder, suicide risk, anxiety disorders, and trauma.
The SAPA Project | SAPA stands for “Synthetic Aperture Personality Assessment.” This online personality assessment scores you on 27 “narrow traits,” such as order, impulsivity, and creativity in addition to the “Big Five” (Agreeableness, Conscientiousness, Extraversion, Neuroticism, and Openness). You’re also scored on cognitive ability. This test takes 20-30 minutes to complete and you will receive a full report when finished.
Social History Interview (SHI) | (Source: University of Washington Center for Behavioral Technology) The SHI is an interview to gather information about a client’s significant life events over a desired period of time. The SHI was developed by adapting and modifying the psychosocial functioning portion of both the Social Adjustment Scale-Self Report (SAS-SR) and the Longitudinal Interview Follow-up Evaluation Base Schedule (LIFE) to assess a variety of events (e.g., jobs, moves, relationship endings, jail) during the target timeframe. Using the LIFE, functioning is rated in each of 10 areas (e.g., work, household, social interpersonal relations, global social adjustment) for the worst week in each of the preceding four months and for the best week overall. Self-report ratings using the SAS-SR are used to corroborate interview ratings. Citations: Weissman, M. M., & Bothwell, S. (1976). Assessment of social adjustment by patient self-report. Archives of General Psychiatry, 33, 1111-1115. Keller, M. B., Lavori, P. W., Friedman, B., Nielsen, E. C., Endicott, J., McDonald-Scott, P., & Andreasen, N. C. (1987). The longitudinal interval follow-up evaluation: A comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry, 44, 540-548.
Substance Abuse History Interview | (Source: University of Washington Center for Behavioral Technology) The SAHI is an interview to assess periods of drug use (by drug), alcohol use, and abstinence in a client’s life over a desired period of time. The SAHI combines the drug and alcohol use items from the Addiction Severity Index (ASI) and the Time Line Follow-back Assessment Method to collect information about the quantity, frequency, and quantity X frequency of alcohol and drug consumption. Citations: McLellan, A. T., Luborsky, L., Woody, G. E., & O’Brien, C. P. (1980). An improved diagnostic evaluation instrument for substance abuse patients: The Addiction Severity Index. Journal of Nervous and Mental Disease, 168, 26-33.
Suicidal Behaviors Questionnaire | SBQ with Variable Labels | SBQ Scoring Syntax | (Source: University of Washington Center for Behavioral Technology) The SBQ is a self-report questionnaire designed to assess suicidal ideation, suicide expectancies, suicide threats and communications, and suicidal behavior. Citations: Addis, M. & Linehan, M. M. (1989). Predicting suicidal behavior: Psychometric properties of the Suicidal Behaviors Questionnaire. Poster presented at the Annual Meeting of the Association for the Advancement Behavior Therapy, Washington, D.C.
Suicide Attempt Self-Injury Interview (SASII) SASII Instructions For Published SASII | SASII Standard Short Form with Supplemental Questions | SASII Short Form with Variable Labels | SASII Scoring Syntax | Detailed Explanation of SPSS Scoring Syntax | (Source: University of Washington Center for Behavioral Technology) The SASII (formerly the PHI) is an interview to collect details of the topography, intent, medical severity, social context, precipitating and concurrent events, and outcomes of non-suicidal self-injury and suicidal behavior during a target time period. Major SASII outcome variables are the frequency of self-injurious and suicidal behaviors, the medical risk of such behaviors, suicide intent, a risk/rescue score, instrumental intent, and impulsiveness. Citations: Linehan, M. M., Comtois, K. A., Brown, M. Z., Heard, H. L., Wagner, A. (2006). Suicide Attempt Self-Injury Interview (SASII): Development, Reliability, and Validity of a Scale to Assess Suicide Attempts and Intentional Self-Injury. Psychological Assessment, 18(3), 303-312.
Therapist Interview | (Source: University of Washington Center for Behavioral Technology) The TI is an interview to gather information from a therapist about their treatment for a specific client. Citations: Linehan, M. M. (1987). Therapist Interview. University of Washington, Seattle, WA, Unpublished work.
Treatment History Interview | Appendices | (Source: University of Washington Center for Behavioral Technology) The THI is an interview to gather detailed information about a client’s psychiatric and medical treatment over a desired period of time. Section 1 assesses the client’s utilization of professional psychotherapy, comprehensive treatment programs (e.g., substance abuse programs, day treatment), case management, self-help groups, and other non-professional forms of treatment. Section 2 assesses the client’s utilization of inpatient units (psychiatric and medical), emergency treatment (e.g., emergency room visits, paramedics visits, police wellness checks), and medical treatment (e.g., physician and clinic visits). Section 3 assesses the use of psychotropic and non-psychotropic medications. Citations: Linehan, M. M. &, Heard, H. L. (1987). Treatment history interview (THI). University of Washington, Seattle, WA, Unpublished work. Therapy and Risk Notes – do not use without citation. For clarity of how to implement these items, please see Cognitive-Behavioral Treatment of Borderline Personality Book, Chapter 15.
University of WA Suicide Risk/Distress Assessment Protocol | (Source: University of Washington Center for Behavioral Technology) Reynolds, S. K., Lindenboim, N., Comtois, K. A., Murray, A., & Linehan, M. M. (2006). Risky Assessments: Participant Suicidality and Distress Associated with Research Assessments in a Treatment Study of Suicidal Behavior. Suicide and Life-Threatening Behavior (36)1, 19-33. Linehan, M. M., Comtois, K. A., &, Ward-Ciesielski, E. F. (2012). Assessing and managing risk with suicidal individuals. Cognitive and Behavioral Practice, 19(2), 218-232.
Wellness Self-Assessment | A PDF-version of Princeton University’s tool to measure your wellness in seven dimensions (emotional, environmental, intellectual, occupational, physical, social, and spiritual) – Calculate your results and then create an action plan.
Where can you find the help you need? While there are plenty of resources out there for mental health and recovery, they’re not always easy to find… or affordable. (Plus, the Internet is full of scams!) This article is a starting point for getting help when you aren’t sure where to turn. This post offers practical guidelines; all of the resources in this article are trustworthy and reliable… and will point you in the right direction.
By Cassie Jewell, M.Ed., LPC, LSATP
This post is not comprehensive; rather, it’s a starting point for getting the help you need. There are plenty of resources out there for mental health and recovery, but they’re not always easy to find (or affordable). The resources in this post are trustworthy and reliable… and will point you in the right direction.
If you need treatment for mental health or substance use, but aren’t sure how to find it…
If you have insurance, check your insurer’s website.
For substance use and mental health disorders, you can access the SAMHSA treatment locator. You can find buprenorphine treatment (medication-assisted treatment for opioid addiction) through SAMHSA as well.
Consider using Mental Health America’s interactive tool, Where to Get Help. NeedyMeds.org also has a locator to help you find low-cost mental health and substance abuse clinics.
At campus counseling centers, grad students sometimes offer free or low-cost services.
You could look into community mental health centers or local churches (pastoral counseling).
In some areas, you may be able to find pro bono counseling services. (Google “pro bono counseling” or “free therapy.”) You may also be able to connect with a peer specialist or counselor (for free) instead of seeing a licensed therapist.
As an alternative to individual counseling, you could attend a support group (self-help) or therapy group; check hospitals, churches, and community centers. The DBSA peer-lead support group locator tool will help you find local support groups. Meetup.com may also have support group options.
Additional alternatives: Consider online forums or communities. Watch or read self-help materials. Buy a workbook (such as The Cognitive Behavioral Workbook for Depression: A Step-By-Step Program) from amazon.com. Download a therapy app.
Lastly, you could attend a free workshop or class at a local church, the library, a college or university, a community agency, or a hospital.
If you’re under 18 and need help, but your parents won’t let you see a counselor (or “don’t believe in therapy”)…
Some, but not all, states require parental consent for adolescents to participate in therapy. Start by looking up the laws in your state. You may be able to see a treatment provider without consent from a legal guardian. If your state is one that mandates consent, consider scheduling an appointment with your school counselor. In many schools, school counseling is considered a regular educational service and does not require parental consent.
Alternatively, you could join an online forum or group. (Mental Health America offers an online community with over 1 million users and NAMI offers OK2Talk, an online community for adolescents and young adults.)
Lastly, consider talking with your pastor or a trusted teacher, reading self-help materials, downloading a therapy app, journaling, meditation or relaxation techniques, exercising, or therapy podcasts/videos.
If a loved one or friend says they’re going to kill themselves, but refuses help…
Call 911. If you’re with that person, stay with them until help arrives.
Explore Learn to Cope, a peer-led support network for families coping with the addiction of a loved one. Alternatively, you could attend Al-Anon or Nar-Anon.
Keep in mind that it’s almost impossible to help someone who doesn’t want it. You can’t control your loved one or force them into treatment. Instead, find a way to accept that there’s no logic to addiction; it’s a complex brain disorder and no amount of pleading, arguing, or “guilting” will change that.
If a friend or family member overdoses on heroin or other opioid…
You can receive free training to administer naloxone, which reverses an opioid overdose. Take an online training course at Get Naloxone Now. You can purchase naloxone OTC in most states at CVS or Walgreens.
In addition to talking to your doctor about medication, the patch, and/or nicotine gum, visit Smoke Free, Be Tobacco Free, or Quit.com for resources, tools, and tips.
Call a smoking cessation hotline (like 1-800-QUIT-NOW) or live chat with a specialist, such as LiveHelp (National Cancer Institute).
Download a free app (like QuitNow! or Smoke Free) or sign up for a free texting program, like SmokefreeTXT, for extra support.
Attend an online workshop or participate in a smoking cessation course; your insurance provider may offer one or you may find classes at a local hospital or community center. You could also contact your EAP for additional resources.
If your therapist is making unwanted sexual remarks/advances…
Contact the licensing board to file a complaint. Each state has a different licensing board. Additionally, contact the therapist’s professional association (i.e. American Counseling Association, American Psychological Association, etc.) Provide your name, address, and telephone number (unless filing anonymously). Identify the practitioner you are reporting by his or her full name and license type. Provide a detailed summary of your concerns. Attach copies (not originals) of documents relating to your concerns, if applicable.
Are mentally ill people violent? Can mental illness be overcome through willpower? Is addiction a choice? This post addresses some of the myths and misconceptions about mental illness.
By Cassie Jewell, M.Ed., LPC, LSATP
In this post, I’ll address some of the myths and misconceptions about mental disorders. There continues to be stigma attached to mental illness; and the media is partly to blame. Every time (yet another) mass shooting occurs, the media attributes the act of violence to mental illness. This message is repeated by various news sources and then spread through social media.
Acts of senseless violence are for sure a “sickness,” but they’re not criteria for a diagnosable mental disorder. It’s not fair to compare violent criminals to individuals who struggle with depression, anxiety, schizophrenia, etc.
Mental illness misconceptions run rampant, even within the healthcare professional field. For example, I know a surgeon who believes mental illness isn’t real and a neurologist who uses words like “crazy” and “retarded.” I came across a substance abuse counselor (on Facebook) who believes addiction is a moral failing. I know a social worker who believes that severely mentally ill individuals are more likely to be violent.
Ignorance is at the root of stigma. The more you know, the less you fear, and the less you’ll stigmatize. Read on to learn what’s myth versus fact.
1. Bad parenting causes mental illness.
Even today, there is no single identified cause when it comes to mental illness. Instead, there are multiple risk factors that contribute to mental disorders. The biggest risk factor is genetics. Genes frequently determine whether or not a person develops schizophrenia, depression, substance use disorder, etc. Physiological factors (such as abnormalities in the brain) are a second risk factor.
Environmental factors, such as fetal exposure to a toxin or childhood abuse, are a third risk factor. Childhood abuse undoubtedly falls into the “bad parenting” category, but as a standalone, it can’t cause mental illness.
It’s more likely that a combination of risk factors will lead to the development of a mental disorder.
2. Mental illness is not a medical disease.
Heart disease affects the heart. Colon cancer affects the colon. Autoimmune disorders affect the immune system. Brain disorders (i.e. mental illness, addiction) affect the brain.
You can’t “see” mental health symptoms the way you can see physical health symptoms, but mental illness is without a doubt physiological in nature.
Like other organs, the brain can become diseased, and it manifests as symptoms of mental illness. You can’t “see” mental health symptoms the way you can see physical health symptoms, but mental illness is without a doubt physiological in nature.
3. All sociopaths are dangerous.
The term “sociopath” (or psychopath) is frequently associated with serial killers. The reality is that you probably know a sociopath and he/she isn’t a murderer.
In fact, “sociopathy” and “psychopathy” are no longer recognized diagnoses in the mental health world due to negative connotations. The correct term is “antisocial personality disorder” (ASPD), a mental illness characterized by an ongoing disregard for and violation of the rights of others. An individual with ASPD may also be exceptionally charismatic. (Some of the most charming and engaging clients I’ve ever worked with had ASPD.)
This is 100% myth and a huge pet peeve of mine. It goes hand-in-hand with the belief that mental illness is not a “real” medical condition. A mental disorder typically requires treatment, such as medication and therapy, and ongoing illness management.
All the willpower in the world won’t help someone “overcome” heart disease. And it doesn’t work that way with mental illness either.
5. Addiction is a choice.
Substance use disorder is no more of a choice than diabetes or cancer. Like most diseases, addiction develops when a combination of genetic, physiological, and environmental factors are present. Lifestyle choices also play a role.Unfortunately, the myth that addiction is a moral failing persists.
An individual who struggles with addiction receives more blame than someone with a heart condition, even though lifestyle choices heavily impact both disorders. I’ve even heard it said that addicts who overdose shouldn’t be revived because it was their “choice” to use. If that’s the logic, then should we stop providing life saving care to someone who’s having a heart attack or to a smoker with lung cancer? Of course not. At times, we all make poor decisions. For someone with a predisposition for addiction, the choice to drink may lead to alcohol use disorder. For the person with a predisposition for diabetes, eating an unhealthy diet or living a sedentary lifestyle will result in consequences.
Furthermore, once a person develops a substance use disorder, physiological and structural changes in the brain dissolve the element of choice. The brain misinterprets a craving for drugs or alcohol. (Remember the last time you experienced extreme thirst? That’s what it’s like to be addicted to something.)
Having a substance use disorder is miserable, lonely, and shameful. No one would choose that.
6. People with mental illness are violent.
A person with mental illness is no more likely to be violent than someone in the general population. In fact, acts of violence are not diagnostic criteria for any of the known mental disorders.
If I had to choose someone to hold a loaded gun, I’d pick the person with schizophrenia over someone who’s prone to anger or has poor self-control.
I work with clients who hear “command” voices (auditory hallucinations that tell them to harm or kill); yet I’ve never felt unsafe. In my experience, it’s uncommon for an individual to obey the voices. If I had to choose someone to hold a loaded gun, I’d pick the person with schizophrenia over someone who’s prone to anger or has poor self-control.
While the media would have us believe that mental illness is at the root of every mass shooting, that isn’t the case. (Not to say that mental illness can’t play a role, but it’s not always the trigger.) The biggest risk factor for violence is a history of violence, especially domestic violence, or crime.
Regarding violence, what’s true is that individuals with mental illness are more likely to die by suicide. Persons with schizophrenia have higher rates of suicide than the general population. Depression, bipolar disorder, and borderline personality disorder are also linked to suicide.
Don’t confuse mental illness with a lack of morals.
A mental disorder is a medical condition; having weak morals is a personality trait, and while it seems mentally sick, it’s not fair to compare a lack of morals to a condition like depression or anxiety.
7. Mental illness is the same thing as mental retardation.
I’m friends with a nurse who didn’t even know the difference (until I pointed it out). A person with a mental illness may seem less intelligent due to various factors, but mental illness is not comparable to mental retardation. Today, we refer to mental retardation as intellectual disability (due to the negative connotations attached to the word “retarded”).
A person with an intellectual disability (ID) struggles to understand, comprehend, and/or form memories. A person with mental illness, on the other hand, may have superior intelligence, but could seem “slow” due to distractions brought on by their illness. (For example, it’s difficult to focus on a conversation when you’re having racing thoughts or hearing voices.)
8. A person with schizophrenia has multiple personalities.
Nope; total myth. In fact, multiple personality disorder (MPD) doesn’t exist (technically). What was formally known as MPD in the DSM-IV TR (the previous version of the Diagnostic and Statistical Manual) is now termed disassociative identity disorder [DID]. A person with DID has at least two distinct personality “states” and suffers from gaps in memory. DID is incredibly rare.
A person with schizophrenia, on the other hand, has one personality state. However, he/she may hear voices that take on distinct identities.
In addition to auditory hallucinations, someone with schizophrenia may experience visual hallucinations, delusions, disorganized thoughts, cognitive deficits, and/or what’s referred to as “negative” symptoms. (A negative symptom is a lack of something that’s typically present in someone without schizophrenia. For example, a person with schizophrenia may be socially withdrawn or he/she may seem very “flat” [without emotion]).
9. Alcohol makes you depressed because it’s a depressant.
Yes, alcohol is a depressant; but as a “depressant,” it depresses your central nervous system, leading to slurred speech, trouble with coordination, etc. The “depressant” effects of alcohol are unrelated to clinical depression.
However, heavy alcohol use is associated with depression and other mental disorders. Someone who is struggling with depression or anxiety may drink as a way to self-medicate. Alternatively, someone with an alcohol use disorder may develop depression, as alcohol upsets the chemical balance in the brain. The lifestyle of someone with alcohol use disorder may also lead to intense guilt, shame, and/or hopelessness, which can in turn lead to depression.
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