IEP's and Autism Spectrum Disorder

I've just returned from my third IEP meeting this week. These IEP meetingss were for children, all in grades 4-8, with Autism Spectrum Disorder, all high functioning, two were students who would be better diagnosed with Asperger's Disorder.

Oddly none of these IEP's mentioned an intervention for social cognitive deficits! None! There were concerns for behavioural issues (that's usually how I get asked to a meeting, because I specialize in behavioural disorders), academic problems and anxiety, two IEP's mentioned anxiety.

An IEP needs to FOCUS on the disorder which lead the child to be classified or designated ("coded" in BC schools) and bringing about the IEP.  At the team meeting I discovered the reason for this lack of focus on the student's social cognitive deficits: No properly trained staff to implement an intervention. Sad, but true!

Academic goals were the most common issues addressed in the IEP. Parents of course want their children to do well academically so they often go along with an IEP that addresses one academic goal after another. Who doesn't want their child to do well in reading or math? But the child is receiving support services for a deficit of social cognition - not an academic deficit. Why don't these IEP's address this issue?

Almost always there was this, "Tommy will learn to ....." Fill in the blank. Seldom did the IEP mention how he would "learn to...."  And seldom did it mention any issue in relationship to the psychoeducational assessment the student should have had prior to the IEP? (I can't tell you how often I go to schools in BC and find no real psychoeducational assessment for a child that is "coded." This is NOT suppose to happen,  but it does. )

The psychoeducational assessment should be on the table, literally on the table, at every team meeting. It contains valuable information on the student's strengths and weaknesses that can help us determine which interventions will be successful, and which will not be. Often the "list of strengths and weaknesses" is nothing more than a list of comments taken at the beginning of the meeting. Don't waste this valuable information! And every parent should review the psychoeducational assessment with the school psychologist to see how the real data (as compared to opinions) relates to the IEP.

If your child has autism spectrum disorder, Asperger's Syndrome or another related problem with social cues and communication his or her IEP needs to address that. The IEP needs to say what the deficit is, how it will be supported, what tools and techniques will be use, who will implement them, how often for how long (so important!) and how we will measure the outcome. How will we know things are getting better. It's as simple as that.

Here is a simple IEP outline I like:
http://trainland.tripod.com/sample.htm

Ontario's IEP can be found here:
http://www.ontariodirectors.ca/IEP-PEI/IEP-PEI_Eng_Downloads/autism%20-%20sec.pdf

What's important is to ask yourself, "Are the areas that had deficiencies during the assessment for my child's diagnosis addressed in the IEP?" (This means the original assessment for the autism diagnosis done at the hospital or by a private clinician - you were asked to supply this in order to get services, and the psychoeducational assessment that was either part of that or came later.)

This means sensory issues, social cognition/social reciprocity (NOT social skills!), communications, behaviour, motor issues. These must be covered!

Recently I spoke with a parent who told me that she didn't get a copy of her son's IEP, but the school would send it if she wanted it... I was rather surprised to say the least. I asked what services her son was getting. Remember, he has autism, has an IEP, his school gets specific funding to provide support. Her answer was: "They are keeping an eye of him." Regretfully I've heard this too many times. Keeping an eye on things means we will wait for failure, then act. That's not a plan.

A key issue to remember is this: Your child, no matter how high or low functioning he or she is, needs to develop a set of skills they can use to approach life with. These skills are best taught when things are going well. Not during a crisis. This is why I tell parents and teachers not to avoid the use of basic tools like visual supports - so often abandoned because "my child is more advanced..." Visual supports, anti-anxiety skills, relaxation skills.

An IEP is an important document. It's a contract between you and the school. Make sure it tells you enough to know what to expect as outcomes for this year ....and upon graduation. Take the IEP process serious. Look up sample IEP's on the web. Talk to other parents. See a psychologist and ask him or her to look over the IEP before you sign it. Bring someone to the IEP with you. Go to every meeting.

Autism Rate continue to Climb and Climb and Climb

The likelihood of a child’s being given a diagnosis of autism (ASD), Asperger's Syndrome or a related disorder seems to have increased more than 20 percent from 2006 to 2008. The New York Times and other major papers have proclaimed a definite rise.

Click here to view the article from the NYT
http://www.nytimes.com/2012/03/30/health/rate-of-autism-diagnoses-has-climbed-study-finds.html

Reading the New York Times we see there is a new report from the US Center for Disease Control (CDC) which estimates that in 2008 one child in 88 received one of these diagnoses (by the age of 8), known as autism spectrum disorders or ASD, compared with about one in 110 diagnosed with ASD two years earlier. Does this indicate that we are seeing an epidemic of autism, as some have speculated, or is the issue one of changes in the way we diagnose autism, or that we (doctor, teachers, parents) now pay more attention to the symptoms and therefore notice and then diagnose more children? At this point, it's not clear.

As some have suggested, one possibility is that we are seeing the result of better detection rather than a real surge in autism. However, there are some striking parts of this new CDC study that again makes us wonder if there isn't really an increase in the number of cases.

One report notes, "The rate of autism increased by more than 45% from 2002 to 2008 in numerous sites. It was a larger and more consistent increase than from 2002 to 2006. The increase was also very uneven in terms of geography, gender, race and ethnicity. Some sites had nearly five times as many children with autism as others. In several sites, almost 1 in 33 8-year-old boys were diagnosed with autism. This seems difficult to believe, particularly when these sites had smaller samples and children with less severe intellectual disabilities. One wonders if some sites became part of the study because of a long-term commitment to autism services, and this had drawn certain families to live nearby, resulting in an increase in the frequency of diagnoses made by local medical centers or educational programs." In other words, people may move closer to some centres that study autism and therefore the local rates are, indeed, higher.

Also, since the children didn't just meet the CDC study criteria for autistic characteristics -- 80% of them had autistic diagnosis from community physicians -- it may be that there is truly a higher rate of autism. Granted, the children were not actually seen by CDC researchers, so it's possible that the methods of diagnosis varied among the sites. All of these variations make it difficult to really understand this data. Apples and oranges.

So, what are the implications of this new study?
The CDC researchers are aware that it's critical to identify the sources of variability in their data. For example, why were nearly twice as many children diagnosed with autism in Utah than in Colorado or Arizona? If the rates are really increasing, does it mean that many more children, particularly those from ethnic or racial minorities who are often missed, could have autism and we just don't know yet? If we do a better job of identifying children with autism, the rate will certainly continue to increase. How do we address this issue, which is not unique to autism?

Thomas Insel, director of the National Institute of Mental Health, commented that the most useful approach right now is to assume that there is an increase in autism and try to figure out why this is happening. He says, "Regardless of all the unanswered questions, we should keep in mind that autism is a common condition. More children need autism services than ever before. We need cost-effective ways to identify the disorder at early ages, provide adequate support and work with affected families to help their children transition to adulthood."

"For families concerned that their child might have autism, it's important to be persistent in seeking help. The study suggests that children with autism in some parts of the country are much more likely to be recognized than in other parts, so seek the best resources possible and do not give up until you are sure. It may be that your child does not have autism since the disorder overlaps with various other common conditions such as delayed language ability and attention deficit disorder. Far more children don't have autism than do."

So, lets sum this up:
That is apparently a relative increase of 23% from a previous analysis of data from the same network of clinics and doctors for 2006, when the estimated prevalence was one out of 111 children, and a 73% relative increase from 2002, according to a surveillance summary in Morbidity and Mortality Weekly Report.

Understanding this is tricky because of a lack of objective diagnostic markers and changes in clinical definitions over time, so it's unknown how much of the increase is real and how much is related to changing diagnostic criteria and better identification of cases. But here is the important point: If these children really meet the diagnostic criteria for autism spectrum disorder, new, previously missed, finally noticed doesn't matter as much as: Are we funding research properly? At a rate that is commiserate with the seriousness of this disorder? Have we wasted enough money, time, research effort on false theories like autism and vaccines already? Is it time to start a "war on autism" like the war on cancer? Time to devote a lot more money to both treatment and research into prevention? Those questions can be answered, and the answer is yes.

Adults, Work and Asperger's Disorder

Social Thinking at Work

“a game changer…” — Special Education Advisor

I am often asked to recommend books for children, adolescents and adults with Asperger’s Syndrome. As many of you know my first choice is usually something by Michelle Garcia Winner, and again, for adults facing social cognitive deficit problems in the workplace it’s another book by Michelle Garcia winner.

Here is some of what is said about this excellent book:
“Needing help to understand social interaction in the workplace? Michelle Winner and Pamela Crooke are the ones to show you the ropes. This user-friendly guide to understanding social thinking on the job is a much-needed guide which simply and clearly outlines why brilliant workers might not be succeeding socially. If you are puzzled about why your work is of exceptional quality, but you are still not accepted by your co-workers, this guide is for you!” – Donna B. Wexler, MA, CCC-SLP

This is a 205-page book based on the clinical experiences of these two top notch practitioners working with very high functioning adults (Aspergers) who have social learning challenges. They suggest that another possible title for this book was, “Good Intentions Are Not Good Enough,” given our observation that our clients have such good intentions and simply want to appreciated for what they are attempting to contribute (just like all of us)!

The authors say, “In this book, we have explained the ideas and lessons we often review in our clinical sessions to help our professional adults learn about the social world cognitively since they have struggled to learn this intuitively. Many of our adults who struggle socially don’t identify their problems with diagnostic labels. We also find our students/clients learn from a stronger base when exploring their own social cognition/social learning abilities and challenges rather than exploring which label fits them best. For this reason, we have avoided referring to diagnostic labels in this book.”

There are simply few practical books for individuals who are high functioning – productive workers who still need help understanding the social and emotional complexities of the workplace. This is a book about building and sustaining relationships in the workplace, a skill that is critical to adult and workplace success.

From Michelle’s site review: “Social functioning in the workplace is complicated for us all! Most adults continue to learn to develop better social coping strategies with age; our clients with social learning challenges are very capable of learning but need information about the social emotional relationship process presented in a more directed, stair stepped manner.”

Contents
The title’s from the book’s chapters help to convey the scope of the information covered in the book. In each chapter we explore the issues in depth with specific ideas for the reader to explore.

Introduction: The Social Mind: It’s Always on the Job, Even When You’re Off the Job
Chapter 1: Social Thinking: What Is It, and How Is It Different From Social Skills?
Chapter 2: What Plays Into Good Communication Skills?
Chapter 3: Emotions: The Uninvited Guest That Keeps Showing Up
Chapter 4: Perspective Taking: Are You Thinking What I’m Thinking?
Chapter 5: The Four Steps of Communication
Chapter 6: The Core of Communication
Chapter 7: Fitting In
Chapter 8: Relating at Work
Chapter 9: Social Technology: How It’s Changeing the Way We Communicate
Chapter 10: Social Behavior Maps: Navigating the Social-Emotional World
Chapter 11: Strategies: Tips and Pointers

The final chapter provides points of exploration for the reader to develop better self-awarenss of their own social functioning as well as tips to help them continue to learn new concepts and skills related to each of the previous chapters in the book.

The audience for this book is intended to be the person with social learning challenges -but it is useful for HR departments, college counselling centres and professionals working with individuals with these social cognitive challenges.

Reviews
Special Education Advisor, by Dennise Goldberg:

“`Social Thinking at Work: Why Should I Care,’ by Michelle Garcia Winner and Pamela Crooke is a game changer. This book provides practical advice to every adult whether you are on the Autism Spectrum, Neurotypical (NT), or somewhere in between on how to navigate the social intricacies involved with the workplace. I have long held the opinion that the ability to socialize and get along with people is as important to creating a successful career as being good at your job. Thus, success very often requires a combination of academic intelligence and social intelligence. Social Thinking at Work creates a roadmap for those individuals with weaknesses in social intelligence to `better understand the expectations of the social mind’… I highly recommend this book to anyone that has ever experienced social challenges at work but especially for those adults on the autism spectrum or with known social weaknesses.”

Special Needs Book Review:

“Social Thinking at Work: Why Should I Care? is helpful to all adults in the workplace who wish they could blend in and have a better relationship with the others they meet or work with every day. You will benefit greatly from this book if:

You are unable to pick up facial or verbal cues.
You miss subtle behaviours used to convey emotions.
You struggle to recognize people’s feelings.
You have problems entering or exiting a group.
In a group you do not know what to do if you are not talking.
You do not know how to interpret sarcasm or read between the lines.
You can’t get people to listen to your ideas.
Social Thinking at Work: Why Should I Care? is also for parents, educators and service providers to teach the Social Thinking required for the development of real social skills. If your are an employer or work in the Human Relations department for a company, this book will help you understand human behavior and help you be more aware of the different feelings and needs of some of your employees.”

About the Authors
Michelle Garcia Winner is a Congressional-award winning speech-language pathologist who specializes in treating individuals who are experiencing social and communication problems. She runs a clinic in San Jose, CA, has authored number books and speaks internationally on the Social Thinking treatment approach she developed. She serves on the panel of professional advisers of the Autism Society of America.

Pam Crooke is part of the clinical faculty at San Jose State University and senior therapist at the Social Thinking Center in San Jose, CA. Prior to joining Social Thinking, she conducted research published in the Journal of Autism and Developmental Disorders on the effectiveness of the Social Thinking Vocabulary in the teaching of students with high-functioning autism.

Great book, available through Amazon.ca For more information on treatment for adults as individuals, couples and family units, please feel free to contact me or visit my web page at www.relatedminds.com

Adults with Aspergers and ASD in the workplace

I am often asked to see young adults with Asperger's to help them find "the right career." What is the right career for someone with Aspergers? Well that's really hard to say because the truth is individuals with Asperger's come in all shapes, sizes, colours, temperaments, with different dreams, wishes, hopes, abilities, skills, interests, talents and...deficits. Some people do find with working a full day...but have difficulty when they come home continuing a long period of social interaction, while some others can deal with 20 hours of work a week, or can only deal with work that involves few social interactions. But keep in mind, the vast majority of adults I see with Aspergers hold full time jobs, in exciting careers, doing complicated and demanding tasks. Some that I can't imagine myself doing. What work would suit them best? Ask them! And try different experiences out. If your working with a therapist there are ways to get a better idea about what might be more to your liking. This includes interest inventories, psychoeducational assessments and things like Michelle Winner's Social Thinking- Social communication Profile. (www.socialthinking.com) 

Adults with AS can be very capable workers in the work force who are highly productive but struggle to relate socially. An example of this is the worker who is asked to sign a get well card for someone they don't know, and refuses. Or someone who just can't participate in the "small talk" that goes on and is necessary to be part of a team. These are often skills that need to be explained (psychoeducation), modelled and practiced in the workplace with feedback and....more practice. This can be difficult and anything but rewarding at first. These individuals need support throughout the process.

There is a good book available for those trying to learn about counseling adults with AS, Cognitive Behavioural Therapy for Adult Asperger Syndrome by Valerie Gaus. This is really a book for the therapist rather than the client, but its a minimal requirement for anyone you might find yourself working with.

So what are some of the types of issues I've dealt with in the past few weeks with my own clients with AS? Heres a short list:

1. Dealing with anxiety through Cognitive Behavioural Therapy

2. Dealing with depression through Cognitive Behavioural Therapy

3. Learning to listen to others and hold a conversation that's two way - using reflective thinking and understanding the perspective of others

4. Using Michelle Winner's "Social Behaviour Mapping" program

5. Dealing with a spouse and child after a full day at work

6. Understanding appropriate limits in email (a pretty common problem for everyone at work!)

7. Dealing with panic attacks

8. Dealing with OCD behaviours

9. Anger management and assertiveness training

10. Staying awake and off the internet

11. Goal setting, time management and planning large projects

12. Workplace romanace, and sexual appropriateness

13. Going to Vegas with workmates

14. Going out after work and engaging in small talk

15. Asking for a raise

When I look over this list I realize it isn't that much different than anyone else's list of problems and concerns. So don't be discourages, get to work, find a coach or therapist and get ready to jump in!

For more information on my practice and services I provide, including full diagnostic services for autism spectrum disorder (ASD) for children, adolescents and adults, as well as individual, couple and family therapy, please see my website at http://www.relatedminds.com or at http://www.relatedminds.com/autism/

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Psychological services (including assessment, testing and therapy) provided in my offices include (covered by most extended health care insurance):
ADHD (click here: http://www.relatedminds.com/adhd-attention-deficit-hyperactivity-disorder/)

Anxiety and Stress (click here: http://www.relatedminds.com/anxiety-stress/ )

Autism and Asperger’s Disorder (Click here: http://www.relatedminds.com/autism/)

Individual Counselling (click here: http://www.relatedminds.com/individual-therapy/)

Child Counselling / Therapy (click here: http://www.relatedminds.com/child-therapy/)

Testing and Assessments and Learning Disabilities (Click here: http://www.relatedminds.com/testing/)
Couples Counselling / Therapy (click here: http://www.relatedminds.com/couples-therapy/)
Depression
The Angry Child (click here: http://www.relatedminds.com/dealing-with-angry-aggressive-and-explosive-children/)
Anger Management (Click here: http://www.relatedminds.com/anger-management/)
Pain Management and PTSD (Click here: http://www.relatedminds.com/pain/ )
Forensic Services (Independent Medical Examinations or IME)
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About Dr. Roche
I am a Registered Psychologist and a Registered Marriage and Family Therapist (RMFT) in British Columbia. In addition to my doctorate in clinical Psychology (The Union of Experimenting Universities), I hold a master’s degree in family therapy from Goddard college, a certificate of advanced graduate studies (CAGS) in school and educational psychology from Norwich University, and have completed two years of post doctoral studies in neuro-psychology at The Fielding Institute in Santa Barbara, California. I am also a certified school psychologist, certified teacher of special education (New York and California), and a Clinical Member of the American Association of Marriage and Family Therapists (AAMFT). Finally, I hold a doctoral degree in law (JD) with an emphasis in medical malpractice and education law. Beyond my academic credentials, I have completed two years of supervised clinical experience in both hospital and community based clinics and two years of post doctoral training in neuropsychology. I have served as director of behaviour programming for several school districts, as a consultant on autism for the province, and have held numerous academic positions including Clinical Instructor in Psychiatry at New York University and Bellevue Hospital in New York as well as being a faculty member at NYU, Brooklyn College, SUNY New Paltz, and Norwich University.

My offices in Burnaby and Vancouver serve Burnaby, Vancouver, Coquitlam, Port Moody, Port Coquitlam, New Westminster and Maple Ridge. Clients often come to my Vancouver office from North Vancouver, West Vancouver and even as far as the Sunshine Coast. For more information on the location of my Burnaby and Vancouver offices, please see my “Office Location” page, which contains a Google map.

Key Words

ADHD | Anxiety and Stress | Autism and Asperger’s Disorder | Individual Counselling | Child Therapy | Testing and Assessments and Learning Disabilities | Couples Counselling | Depression | The Angry Child | Anger Management | Pain Management and PTSD | Forensic Services | Attention Deficit Hyperactivity Disorder | Vancouver | Burnaby | Coquitlam | New Westminster | Maple Ridge | Port Moody | Child Psychologist | Psychologist | Learning Disability | Assessment | Testing | Psychoeducational Assessment | Neuropsychological Assessment
http://www.relatedminds.com

http://Therapists.PsychologyToday.com/rms/70682

http://www.therapistlocator.net/member?183420

http://www.bcpsychologist.org/users/jimroche

http://www.actcommunity.net/jim-roche.html

About Counselling and Therapy Services (Burnaby/Vancouver)

As a Registered Psychologist I provide individual therapy and counselling services using the evidence based techniques of Cognitive Behaviour Therapy (CBT) and Rational Emotive Behaviour Therapy (REBT). Individuals are seen in both my Burnaby and Vancouver offices for a variety of issues including chronic pain, depression, anxiety, stress, panic, anger management, ADHD and work or relationship issues. 

I hold an Advanced Certificate in Cognitive Therapy from the Albert Ellis Institute in New York. If you are looking for a cognitive therapist you should ask what training they have in CBT, as many individuals claim they practice CBT after completing only a workshop or reading a book. The Advanced Certificate Program at the Albert Ellis Institute included extensive CBT readings, group and individual training and supervised practice of Cognitive Behaviour Therapy/Rationale Emotive Behaviour Therapy under the supervision of a licensed mental health practitioner. In addition to my practicum at the Ellis Institute I also focused on CBT during my graduate studies and post doctoral internship. Registered Psychologists undergo one year of of full time supervised practicum experience, as well as a year of post doctoral experience. Since graduation I have practiced counselling and therapy for over 20 years and have served as the program director and practicum supervisor in several hospitals, universities and community mental health centres.

FAQs:

Could you tell me more about Cognitive Behaviour Therapy (CBT)?

My primary mode of practice is rational-emotive/cognitive therapy. Cognitive Behaviour Therapy or CBT (including Rational Emotive Therapy) is a highly effective, research driven approach that helps people to combat and overcome such difficulties as high anxiety/stress, panic attacks, depression, anger, relationship problems, phobias, worry, obsessions, compulsions, addictions (food or drugs), social anxiety, sexual problems, ADHD and low self-esteem. The course of treatment is typically short-term (approximately 8-12 sessions), and people often enjoy rapid and enduring relief from their symptoms. I am also trained in other counselling and therapy techniques, and use these when and where appropriate. Overall I try to match  the skills and techniques to your needs. My office provides a supportive, caring and safe environment to work on change and focus on growth and future success.

I have heard about "Schema Therapy," what's that?

Schema-Focused Cognitive Therapy goes further, to help people address and break long-standing or particularly stubborn patterns of thinking, feeling and behaving that arise from deep-seated beliefs, such as “I’m unlovable,” “I’m a failure,” “People don’t care about me,” “I’m not important,” “Something bad is going to happen,” “People will leave me,” “I will never get my needs met,” “I will never be good enough,” etc. Remarkable results have been achieved via the Schema-Focused approach, even for people who have previously found other therapies to be ineffective. Results of course cannot be guaranteed, however, compared with other types of therapeutic intervention research has shown Cognitive Therapy to be effective.

Schema-Focused and Rational Emotive and Cognitive Behaviour Therapy do more than address symptoms, they address a way of thinking that causes you problems in life, work and relationships. In addition to individual therapy I often recommend readings which emphasize the personal growth aspects of cognitive behaviour therapy as well as those that focus on symptom relief.

Do you do any "Mindfulness" work?

In collaboration with other health related professionals I have recently (the past two to three years) begun to offer a longer and more intensive form of Cognitive Behaviour Therapy called Mindfulness Based Cognitive Therapy (MBCT). This method of therapy blends together features of two disciplines: Cognitive Behaviour Therapy (CBT), which aims to identify and alter cognitive distortions (irrational or inaccurate thoughts) and Mindfulness, which is a meditative (mental focusing) practice taken from Buddhism which aims to help people identify their thoughts, moment by moment, but without passing judgement on the thoughts. As with other medically based meditative interventions, this is not a religious oriented practice, but a scientifically supported methodology used in many medical and mental health centers throughout the world. This particular intervention is based upon Mindfulness-Based Stress Reduction (MBSR), an eight week program developed by Jon Kabat-Zinn in 1979 at the University of Massachusetts Medical Center. MBSR research has shown that this combined intervention method is enormously empowering for patients with chronic pain, hypertension, heart disease, gastrointestinal disorders, ADHD, as well as psychological problems such as anxiety, panic and depression.

More about Cognitive Behaviour Therapy

Albert Ellis and the Institute for Rational Emotive Behaviour Therapy

In 1955 Dr. Albert Ellis developed  Rational Emotive Behaviour Therapy or “REBT”  which is an action-oriented therapeutic approach that stimulates emotional growth by teaching people to replace their self-defeating thoughts, feelings and actions with new and more effective ones. REBT teaches individuals to be responsible for their own emotions and gives them the power to change and overcome their unhealthy behaviors that interfere with their ability to function and enjoy life.

Today the Albert Ellis Institute is a world center of research, training, and practice of REBT, its founder Dr. Albert Ellis remains one of the most influential psychologists of our time, and authored more than 70 books and 700 articles all designed to help people overcome destructive, self-defeating emotions and improve their lives.  Later Dr. Aaron Beck developed what is commonly called Cognitive Behaviour Therapy (CBT) along the same lines as REBT. Today these two cognitive based therapies are very similar, although some specific techniques may differ in the two schools of practice. Both are referred to as Cognitive Behaviour Therapy. I have received both my Basic and Advanced Certificates in Cognitive and Rational Emotive Therapy through the Albert Ellis Institute in New York City. For more information you can click here:

http://www.rebt.org Albert Ellis Institute in New York City

What will I be learning in Cognitive Behaviour Therapy (REBT/CBT)

and Schema-Focused Therapy?

You will learn to:

1. Identify the themes and patterns in your thoughts, feelings and behavior that cause you emotional wear and tear;

2. Learn how to handle your thoughts and manage your emotions so that you feel better and cope more effectively;

3. Learn how to handle problematic situations to maximize positive outcomes and experiences;

4. Prevent maladaptive cycles of thinking, feeling and behaving from repeating over and over again;

5. Find ways to reach your goals and get your needs met rather than running up against the proverbial brick wall.

Could you say more about Schema-Focused Cognitive Therapy?

Schema-Focused Cognitive Therapy is the approach developed by Jeffrey E. Young, Ph.D., who was a protégée of Dr. Aaron Beck. Prior to his founding the Cognitive Therapy Centers of NY and Connecticut, as well as the Schema Therapy Institute, Dr. Young served as the Director of Research and Training at the Center for Cognitive Therapy at U. Penn with Dr. Beck, where he trained many clinicians in the application of CBT. In working with clients, however, Dr. Young and his colleagues found a significant segment of people who came for treatment but had perplexing difficulty in benefiting from the standard approach. He discovered that these people typically had long-standing patterns or themes in thinking and feeling—and consequently in behaving or coping—that required a different means of intervention. Dr. Young’s attention turned to ways of helping patients to address and modify these deeper patterns or themes, also known as “schemas” or “lifetraps.”

The schemas (listed below) that are targeted in treatment are enduring and self-defeating patterns that typically begin early in life, get repeated and elaborated upon, cause negative/dysfunctional thoughts and feelings, and pose obstacles for accomplishing one’s goals and getting one’s needs met. Although schemas are usually developed early in life (during childhood or adolescence), they can also form later, in adulthood. These schemas are perpetuated behaviorally through the coping styles of schema maintenance, schema avoidance, and schema compensation. Dr. Young’s model centers on helping the person to break these patterns of thinking, feeling and behaving, which are often very tenacious.

In formulating the Schema-Focused approach, Young combined the best aspects of cognitive-behavioral, experiential, interpersonal and psychoanalytic therapies into one unified model of treatment. Through Young’s work and the efforts of those trained by him, Schema-Focused Therapy has shown remarkable results in helping people to change patterns which they have lived with for a long time, even when other methods and efforts they have tried before have been largely unsuccessful.

Schema’s that REBT / Cognitive and Schema Focused Therapy Focus on:

Emotional Deprivation: The belief and expectation that your primary needs will never be met. The sense that no one will nurture, care for, guide, protect or empathize with you.

Abandonment: The belief and expectation that others will leave, that others are unreliable, that relationships are fragile, that loss is inevitable, and that you will ultimately wind up alone.

Mistrust/Abuse: The belief that others are abusive, manipulative, selfish, or looking to hurt or use you. Others are not to be trusted.

Defectiveness: The belief that you are flawed, damaged or unlovable, and you will thereby be rejected.

Social Isolation: The pervasive sense of aloneness, coupled with a feeling of alienation.

Vulnerability: The sense that the world is a dangerous place, that disaster can happen at any time, and that you will be overwhelmed by the challenges that lie ahead.

Dependence/Incompetence: The belief that you are unable to effectively make your own decisions, that your judgment is questionable, and that you need to rely on others to help get you through day-to-day responsibilities.

Enmeshment/Undeveloped Self: The sense that you do not have an identity or “individuated self” that is separate from one or more significant others.

Failure: The expectation that you will fail, or belief that you cannot perform well enough.

Subjugation: The belief that you must submit to the control of others, or else punishment or rejection will be forthcoming.

Self-Sacrifice: The belief that you should voluntarily give up of your own needs for the sake of others, usually to a point which is excessive.

Approval-Seeking/Recognition-Seeking: The sense that approval, attention and recognition are far more important than genuine self-expression and being true to oneself.

Emotional Inhibition: The belief that you must control your self-expression or others will reject or criticize you.

Negativity/Pessimism: The pervasive belief that the negative aspects of life outweigh the positive, along with negative expectations for the future.

Unrelenting Standards: The belief that you need to be the best, always striving for perfection or to avoid mistakes.

Punitiveness: The belief that people should be harshly punished for their mistakes or shortcomings.

Entitlement/Grandiosity: The sense that you are special or more important than others, and that you do not have to follow the rules like other people even though it may have a negative effect on others. Also can manifest in an exaggerated focus on superiority for the purpose of having power or control.

Insufficient Self-Control/Self-Discipline: The sense that you cannot accomplish your goals, especially if the process contains boring, repetitive, or frustrating aspects. Also, that you cannot resist acting upon impulses that lead to detrimental results.

Reference: "A Client's Guide to Schema-Focused Cognitive Therapy" by David C. Bricker, Ph.D. and Jeffrey E. Young, Ph.D.,

Cognitive Therapy Center of New York. 1999

Summary

I hope you have found this very brief introduction to Cognitive Behaviour Therapy useful. In the office we discuss these issues, practice understanding our “automatic” and often irrational thinking, and learn to apply cognitive behaviour techniques to stop and change these debilitating thoughts. Progress is made through a combination of in-office counselling/therapy, readings and homework during which you apply what you have learned and practiced in the real world. While CBT may often be the primary therapy technique we use I often also involve psycho-education (direct teaching about your mental health issues), behavioural techniques and sometimes use my skills in Systemic and Family Therapy to address issues you may have with relationships, family or at work.

Fees

EAP and EFAP consignment, crime victims assistance program as well as extended insurance and self-pay are accepted. Session fees are $175.00 per hour. There is a sliding scale available to those will lower incomes. I also accept credit cards through on-line PayPal.

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Psychological services (including assessment, testing and therapy) provided in my offices include (covered by most extended health care insurance):

ADHD (click here: http://www.relatedminds.com/adhd-attention-deficit-hyperactivity-disorder/

Anxiety and Stress (click here:) http://www.relatedminds.com/anxiety-stress/">http://www.relatedminds.com/anxiety-stress/

Autism and Asperger's Disorder (Click here:)  http://www.relatedminds.com/autism/

Individual Counselling (click here: ) http://www.relatedminds.com/individual-therapy/

Child Counselling / Therapy (click here: ) http://www.relatedminds.com/child-therapy/

Couples Counselling / Therapy (click here:)  http://www.relatedminds.com/couples-therapy/

About Dr. Roche

I am a Registered Psychologist and a Registered Marriage and Family Therapist (RMFT) in British Columbia. In addition to my doctorate in clinical Psychology (The Union of Experimenting Universities), I hold a master's degree in family therapy from Goddard college, a certificate of advanced graduate studies (CAGS) in school and educational psychology from Norwich University, and have completed two years of post doctoral studies in neuro-psychology at The Fielding Institute in Santa Barbara, California. I am also a certified school psychologist, certified teacher of special education (New York and California), and a Clinical Member of the American Association of Marriage and Family Therapists (AAMFT). Finally, I hold a doctoral degree in law (JD) with an emphasis in medical malpractice and education law. Beyond my academic credentials, I have completed two years of supervised clinical experience in both hospital and community based clinics and two years of post doctoral training in neuropsychology. I have served as director of behaviour programming for several school districts, as a consultant on autism for the province, and have held numerous academic positions including Clinical Instructor in Psychiatry at New York University and Bellevue Hospital in New York as well as being a faculty member at NYU, Brooklyn College, SUNY New Paltz, and Norwich University.

My offices in Burnaby and Vancouver serve Burnaby, Vancouver, Coquitlam, Port Moody, Port Coquitlam, New Westminster and Maple Ridge. Clients often come to my Vancouver office from North Vancouver, West Vancouver and even as far as the Sunshine Coast. For more information on the location of my Burnaby and Vancouver offices, please see my "Office Location" page, which contains a Google map.

Key words

ADHD | Anxiety and Stress | Autism and Asperger's Disorder | Individual Counselling | Child Therapy | Testing and Assessments and Learning Disabilities | Couples Counselling | Depression | The Angry Child | Anger Management | Pain Management and PTSD | Forensic Services | Attention Deficit Hyperactivity Disorder | Vancouver | Burnaby | Coquitlam | New Westminster | Maple Ridge | Port Moody | Child Psychologist | Psychologist | Learning Disability | Assessment | Testing | Psycho-educational Assessment | Neuropsychological Assessment

http://www.relatedminds.com

http://Therapists.PsychologyToday.com/rms/70682

http://www.therapistlocator.net/member?183420

http://www.bcpsychologist.org/users/jimroche

http://www.actcommunity.net/jim-roche.html

What is Different about Gottman Therapy?

Gottman Family Therapy is a science based form of couple's therapy. Information about Gottman Therapy, along with books, DVDs and audio books can be found at the Gottman Institute's website. Gottman Family Therapy is offered by both Registered Psychologists and Registered Marriage and Family Therapists in British Columbia. Please visit my website for more information on relational therapy that I offer: http://www.relatedminds.com

New Definition of Autism May Exclude Many

Usually, once a week, I teach a graduate class in diagnostics at a local college. Students are surprised to hear that the definitions of different mental health conditions such as ADHD or autism spectrum disorder can change. Any every few years, when the new edition of the DSM (Diagnostic and Statistical Manual of Mental Disorders) there are often changes. Most of these are brought about by new science, new understanding, experiments and research that helps re-define and make more specific how we make a diagnosis. This time around, as we prepare for the 5th edition, some people are concerned about the effects of many of the changes, especially those for Attention Deficit Hyperactivity Disorder (ADHD or ADD as it was once known) and autism spectrum disorder (ASD).

The proposed changes in the DSM for autism would, according to many, sharply reduce the skyrocketing rate at which this disorder has been diagnosed. And honestly, some days almost all of the calls to my office are from individuals who talked with a friend, read a newspaper article or saw something on the web that made them think they might possibly have autism. After talking with their family doctor, who usually has no idea how to make such diagnosis, they call me. Many want, more than anything, to get a diagnosis so they know what is wrong. But this is exactly where the new DSM is struggling. As a recent article in the New york Times puts it, "where to draw the line between the unusual and abnormal..." The new proposed guidelines are most likely going to exclude many people from the diagnosis who are "higher functioning" and move them from that the "category" of abnormal- or "diagnosable" to "unusual." Many people who are currently diagnosed as having Aspeger's disorder will most likely be left out.

currently at least a million children and adults have a diagnosis of Asperger syndrome (or disorder) or "pervasive developmental disorder-not otherwise specified- PDD-NOS - and endure many of the same social struggles and deficits that people with autism have, but they do not meet the criteria for ASD - autism spectrum disorder. The proposed changes to the DSM would put all three of these categories -PDD (Pervasive Developmental Disorder), Asperger's Syndrome, and Autism Spectrum Disorder (ASD) together, eliminating PDD-NOS and Asperger's from the manual entirely. Under the current criteria for a diagnosis a person can qualify for the diagnosis by exhibiting 6 or more of the 12 required observed or reported behaviours; under the new proposed definition a person would be required to exhibit 3 3 deficits in social interaction and communication and at least 2 repetitive behaviours, a much narrower definition for diagnosis. The problem is, especially in places like BC where a strict diagnostic procedure is enforced, kids may no longer qualify for a diagnosis of ASD (autism spectrum disorder) even though they have fairly significant behavioural and social deficits.  Some services are always driven strictly by a persons diagnosis.

Research shows that the new definition seems to have more of an effect on the "cognitively able" rather than the "classically autistic" child. Currently several studies are looking at how the new definition would effect diagnostic decisions. But if a diagnosis is suppose to guide treatment interventions, the real purpose of a diagnosis, then some changes really do need to be made. We will have to wait to see what the outcome is. No matter what happens, we do know the end result will be that some children (and adults) who currently qualify for a diagnosis will no longer qualify. Effort will need to be made to expand the criteria for getting help that even the "cognitively able" and "unusual" child needs to be successful.