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Ask the Expert  

Good marriages do not “just happen”, relationships require effort. Healthy marriages are not problem free, but couples are able to work through problems that surface.  In successful relationships, individuals are able to use problem solving skills and have the ability to resolve conflicts by speaking openly about issues, keep the challenges in perspective, and discuss the specific behavior that is a concern.

 Honestly checking in with yourself and your partner about the relationship regularly will help couples identify areas of concern as well as areas of success.  When there are children in the family, it is especially important to set example with your words and actions.  People that live in broken relationships may often wonder, “Do we need marriage therapy?”  Questions to ask yourself if you and your partner may need  marriage therapy include:

 Do we argue too frequently? 

 Is there aggression or violence when a conflict arises? 

 Can we talk through our differences? 

 Is there a substance abuse issue in the home? 

 Has infidelity occurred in the relationship?   

  Is there a challenging child in the home that creates parenting stress? 

 Is there affection in the relationship? 

 Are my needs being met? 

 Can I ask for what I want or need from my partner? 

 If I ask for changes, will my partner be responsive?    

 Answering yes to any of these questions does not necessarily mean that marriage therapy is needed.  If there are areas of concern, it may be a good time to start identifying changes that are needed to have a more happy, peaceful marriage.   

 When challenges surface in a relationship, talking with family, friends, neighbors, and pastors can help.  There are many self help books available, the  internet offers many free and easy resources to help couples as well.  When conflicts in marriage become persistent or a person starts to develop symptoms that are interfering with their ability to perform daily tasks, it is time to consider seeking professional help. 

 A marriage therapist can serve many different roles and assist couples in addressing areas of conflict by helping couples increase relationship skills, communication skills and conflict resolution skills.  Many couples benefit from having a neutral person to help couples verbalize painful feelings and address issues that are underlying conflicts. Working with a therapist can help to resolve the crisis and rebuild the relationship. Many times couples can end a difficult episode in a marriage and begin a new phase with a renewed commitment that recognizes the relationship is forever changed but now includes love, respect and honesty. 

Jody Lashbrook is a Licensed Clinical Social Worker that works as Therapist at Four County Counseling Center.   Jody graduated with her Masters Degree in Social Work from Indiana University in 2002.  She has worked as an Outpatient Therapist in Community Mental Health Centers for 5 years and has had experience working for a variety of social service organizations, ranging from hospitals, small local non-profits, to large statewide universities & organizations. 

 Any outpatient therapist with Four County Counseling Centers can assist and assess any your mental health needs. Appointments can been made for outpatient therapy by contacting1-800-552-3106.

What is play therapy?

Play therapy is based upon the fact that play is the child’s natural medium of self-expression. It is an opportunity which is given to the child to “play out” his/her feelings and problems, just as, in certain types of adult therapy, an individual “talks out” his/her difficulties.

Before therapy begins a complete assessment/history of the child is obtained which will include information provided by the caretaker or parent. In all cases the treatment is play based and child centered, focusing on the individual needs of the child.  For example, some issues that could be addressed in play therapy are:

Children dealing with loss:

Children caught in the middle of divorce and children who have been abused have all experienced various forms of loss. Through the healing medium of play, they are given the opportunity to express their feelings and understand the events that have taken place in their lives.

Children who have attachment related problems, play therapy can be designed to enhance attachment, raise self-esteem, improve trust in others and create joyful engagement activities between parents and their children.

Children who have been adopted or are in foster care

Children who have witnessed domestic violence

Children with attention deficit problems

Children who have experienced serious accidents or disasters.

The benefits of play therapy are:

Reduces anxiety about traumatic events in the child’s life

Facilitates a child’s expression of feelings

Promotes self-confidence and a sense of competence

Develops a sense of trust in self and others

Defines healthy boundaries

Creates or enhances healthy bonding in relationships

Enhances creativity and playfulness

Promotes appropriate behavior

Q:  When would you seek psychiatric services for a child and adolescent?

 A:  As any parent knows, even the best child will have difficult spells with their emotions or behaviors.  This is an unavoidable part of life and most often the parent and child can work through these times with the help of family, teachers, friends and other support systems. However, when these types of assistance are not enough and the problem goes on too long or causes too much stress, then it might be a wise idea to seek professional help.  Many people first go to their family doctor or pediatrician and often these physicians can provide a useful evaluation and suggestions.  If the difficulties still persist, then it may be time to seek the evaluation provided by a child and adolescent psychiatrist. 

 Common problems that might lead a parent to pursue this type of evaluation include:  problems with temper and anger; excessive sadness; poor attention span; hyperactivity; impulsivity; school difficulties; low grades; defiance; behaviors dangerous to self or others; irritability; sexual misconduct; drug and alcohol use/abuse; strained family relationships; anxiety; physical abuse; sexual abuse; fighting; legal problems; low self-esteem and lack of confidence. 

 What can a psychiatrist provide for your child or adolescent?

A child and adolescent psychiatrist is an M.D. (medical doctor), just like your pediatrician or family practice doctor.  The child psychiatrist has completed medical school, finished a 4 year residency training problem in adult psychiatry and gone on to do two additional years in child and adolescent psychiatry.  Training has prepared them in many areas including psychotherapy, behavioral therapies, cognitive therapy, family therapy, individual therapy and medications.

 The first task is a psychiatric evaluation which includes an initial interview in which the psychiatrist reviews many aspects on not only the current problems the child is facing but the background story of this child’s life including family, medical history, school history, relationships, etc.  If further information is needed from school, family, other doctors, then this is collected.  Sometimes blood work or other medical exams might be useful.  After the assessment is done, the child psychiatrist comes up with a diagnoses and treatment recommendations.  Not everyone needs medications and even if meds are suggested, the family has to decide if that is an option they wish to pursue.  Often other treatments are suggested such as family therapy, individual therapy, play therapy or group therapy.  If meds are prescribed and the patient starts on the meds, then they will meet back with the child psychiatrist usually every few weeks to see how the meds are working and review the benefits or any side effects. 

 In the last fifty years, much of the stigma of mental illness has been lifted.  At some point in their life, most people will have some degree of difficulty with dealing with their moods or behaviors just as most people will have physical illnesses on and off throughout life.  Seeking an evaluation from a mental health professional is seen more and more just like seeing your pediatrician or family doctor.   Most people understand that having depression, anxiety, problems in school, difficulties with friends or family are common to most people.  When you’ve not been able to handle these problems on your own, it may well be time to ask a child and adolescent psychiatrist to take a look. 

  Q:  Addictions; “What are they?”  “How can I get help, if I have an addiction?”

A:  First, Addictions, as some statistics state, affect over 23 million Americans.  In fact, in the United States nearly 2 Million people enter treatment programs each year.  These individuals uncontrollably feel compelled to do something. They are enslaved to a habit or practice. The following is a list of some common addictions:    

Alcohol                        Internet                       Food                Over the Counter Medications

Shopping                     Prescriptions                 Sex                 Gambling       

Caffeine                      Pornography               Drugs               Tobacco

Four County Counseling Center employs the services of John George as the Manager of the Addictions Department. John has over 30 years experience in the Mental Health Field.  He is joined by ten other qualified addiction clinicians on his staff that helps people address their various addiction issues.  Their many degrees, addiction certifications and state licenses along with their compassion and conscientiousness help them to assist the person in the struggle to break free from their addition.  

Yes, help is possible.  Addiction doesn’t mean you can’t get better.  Whatever addiction problem you may be facing call to schedule an appointment.  The addiction staff will see that you get guidance and help that you can put to good use.  Individual or group help is only a call away.

Q:  Why a Psychiatric Evaluation?

A:  The purpose of a Psychiatric Evaluation is to determine what is happening in a child’s, adolescent’s or adult’s life that may be blocking their ability to behave, feel or act in a positive, appropriate and constructive manner.

Four County Counseling Center is pleased to announce that we have another top notch psychiatrist, Dr. Despina Moise, who can perform such evaluations.  She received her Medical License in Indiana and a Certification from the American Board of Psychiatry and Neurology.  Dr. Moise was prepared with outstanding Postgraduate Training where she was awarded “Career Directions” in 2000:

* Fellowship in Child/Adolescent Psychiatry, St. Vincent’s Catholic Medical Center, New York

* General Adult Psychiatry residency – State University Health Science Centre of New York

* Chief Resident, SUNY HSC at Brooklyn, N.Y.

Dr. Moise has been very active in studies and publications concerning the mental health field.  Some of the studies and publications in which she took a part include:

·         Psychiatric and neuropsychological abnormalities in Huntington’s disease.

·         Hyponatraemia associated with psychotropic medications – a review

·         Psychiatric manifestations of brain tumors:  a review and analysis.

·         Risperidone – induced hyperprolactinemia in adolescents:  a case study.

·         Schizoaffective Disorder in the elderly.

·         Psychiatric manifestations of brain tumors:  diagnostic implications.

·         Brain tumor location and psychiatric symptoms – is there any association?

Dr. Moise comes to us from Wanganui Hospital, Mental Health Services, in New Zealand, where she had been the attending Psychiatrist.  Her services included:

·         Child and Adolescent Clinics – Child, Adolescent and Family Services

·         Adult Psychiatric Clinics        - Community Mental Health Services

·         Crisis Clinics                              - Outpatient and Medical/Surgical Wards

At Four County Counseling Center Dr. Moise will use her certified expertise, great knowledge and vast experience specializing with adults, children and adolescents.   She will be in the Peru Office on Monday and Thursday mornings.  On Tuesday, Wednesday and Friday mornings she will be in our Rochester Office.  In both offices she will be completing psychiatric evaluations and follow up medication clinics for her adult, children and adolescent patients. 

Q:      What is Biofeedback and how can it help me?

A:      Biofeedback is a treatment technique in which people are trained to improve their Mental and Physical Health by using signals from their own bodies.  Physical Therapists use Biofeedback to help stroke victims regain movement in damaged muscles.  Psychologists and Clinical Social Workers use it to help tense and anxious patients learn to relax.

          Biofeedback Instruments allow clients to “see” or “hear” activity inside their body.  For example, one instrument picks up electrical signals into an audio or visual form which the patient can observe.  This allows the patient to learn to control their own wellness.  The Biofeedback Therapist acts as a coach, setting goals on what to expect and giving direction on how to improve self-healing performance. 

          Biofeedback can be an effective treatment for a variety of conditions and symptoms.  Some of these ailments include:  Stress and Headaches, Panic Disorder, Anxiety and Physical Ailments that could be caused by Emotional Problems.

          Dean Bontrager is a Certified Biofeedback Therapist.  As a Biofeedback Therapist and a Clinical Social Worker; Mr. Bontrager may be able to help you with your problems and ailments.

          To learn more about how Biofeedback works and how you can learn to help yourself; call Dick Farrer at 1-800-552-3106 Ext. 360.   

Q:          Should children, as well as adults, see a Psychiatrist?

A:         First, a Psychiatrist is a Licensed Medical Doctor. After earning a medical degree, the doctor has had further specialized training on the mind and emotions for an additional 4 to 5 years.

            For adults it was thought in the past someone who was “crazy” or had a “nervous breakdown” had a reason to see a Psychiatrist.  Today people see a Psychiatrist for help in many areas, including:  Anxiety, Depression, Family Issues, Performance Enhancement, Trauma, Substance Abuse, Eating Disorder, Pain Management, Smoking Cessation, Stress Management and Wellness.

            Most children who see a Psychiatrist have difficulties that interfere with their ability to succeed in school, get along with friends or parents.   Many of these difficulties have to do with handling everyday situations and stressors.

            Psychiatrist Dr. John Yarling, who graduated from Indiana University School of Medicine, is the Medical Director at Four County Counseling Center.  Dr. Yarling has over 40 years experience working with adults and children.  He can be seen for Outpatient Appointments.  For individuals who do not have insurance coverage, a financial aid Fair Share Application can be completed.