Working with Other Professionals

            Janet was diagnosed with Autism when she was about 4 years old.  Her parents brought her to a Developmental Pediatrician who made the diagnosis then.  She was then referred to various other professionals.  She initially saw a Speech and Language Pathologist to help her with her speech.  At 4, she was barely able to say words clearly, much less say phrases or construct sentences.  After a couple of months of intensive speech therapy, she was then referred to an Occupational Therapist.  She appeared to have delays in being able to control both her big muscles and her small muscles.  Her gait and coordination was also not very good, and her attention span was rather short.  Janet eventually had to enter a school that could accommodate her special needs. 

            Clearly, a few professionals are involved in making sure that Janet’s needs are met.  This is not unusual, particularly with children who have special needs.  Some questions that come to mind when a few professionals are involved in serving the same person are as follows: 

-   To what extent should the professionals work together?  Is it enough that progress reports get passed on from one professional to another or should there be a greater collaboration and coordination among these professionals? 

-   If they are to coordinate, how often should they meet and what should they discuss in these team conferences? 

-   How can parents and guardians get involved in all these collaborations?  What roles do family members have in these situations? 

-   When there are decisions to be made, who makes it for the client?  To what extent can medical professionals recommend appropriate educational environments for these youngsters?  When there are conflicting opinions, who has the last say?     

            The questions I am raising above are very pertinent questions both for professionals like myself who work with various clients seen by different professionals concurrently, and clients and their families.  Unfortunately, there are no easy answers to many of these questions.  In the end, the primary stakeholder in any situation is the client.  When this client is a child, parents take the lead in making sure that the best interests of the child is protected at all times.  At the same time, all professionals must have this in mind as well. 

            Maximizing the team collaboration among various professionals in the Philippines is a huge challenge.  With various professionals working in different settings and hardly having a common venue to meet and discuss common clients, clients and their families may find themselves taking at least some effort to coordinate various professional services.  Many families also lack the necessary knowledge and resources to even do this.             

            My colleagues and I in PsychConsult regularly experience the challenges of closely collaborating with various allied professionals who work with both children and adults alike.  Because of this, we have chosen to discuss this important matter as our main program in celebration of our 10^th anniversary.  We entitled our round table discussion “Enriching Filipino Minds and Hearts: A Multidisciplinary Collaboration among Allied Mental Health Practitioners.”  Various professionals and stakeholders will be there to express their views on the concept of professional collaboration, and how these are translated into everyday practice.  Speakers are also invited to express ideas and strategies on further improving this collaborative thrust. 

            You are invited to attend this free event, which will be held at the Ateneo School of Medicine and Public Health on Saturday, 26 November 2011, from 1-5pm.  For more details, visit our website at www.psychconsult.com.ph or our Facebook account named PsychConsult Grp.  Do pre-register by calling Chona at 4212469 or 3576427 or sending an Email to psychconsult@gmail.com. 

Hoarding

            Glenda hardly invites people to her house.  She lives alone and is ashamed of how it looks.  Her entire apartment, albeit small, is just full of things that she is unable to dispose.  She keeps thinking that she will find some use for her things some day.  She keeps all sorts of objects, from old magazines and newspapers to souvenirs she picked up from the different places she has been.  She also finds herself buying many things she does not really need, which only add to the pile of things in her house.  Because of all her things, she can hardly move around her house.  In fact, she has chairs and furniture that cannot be used because they are just piled up with various objects. 

            Glenda is said to be hoarding.  This is a habit that ranges from a common fear of not having something when the need arises to a debilitating pattern of hoarding for its own sake and being unable to let go of the cycle.  Some of us might buy a few more of a certain product for fear that stocks might run out, and consequently end up with more items in our cupboards than is really necessary.  This habit can reach an extreme when one is unable to distinguish the value of different items, holding all items as equally valuable and being unable to let go of any of them. 

            When the pattern of hoarding becomes so extreme that clutter in one’s living area gets in the way of using space and furniture efficiently and one is unable to distinguish the relative value of the items being stashed, a more serious problem can be considered.  Hoarding can be considered a subtype of Obsessive Compulsive Disorder.  Obsessive doubts often give rise to anxiety that the hoarding habit temporarily assuages, which can repeat itself to form a kind of coping pattern. 

            Ironically, many people who suffer from this pathological habit of hoarding often do not understand why they do it.  In fact, this is one question they keep on asking themselves.  The real causes of Obsessive Compulsive Disorder is likely to be an interaction among biological (meaning both biological and neurological) and learned behaviors from childhood.  The anxiety that these people experience has been reported to be at a very young age. 

            Treatment is often a combination of the use of medications and psychotherapy.  In psychotherapy, people who suffer this behavior are often taught to deal with their feelings in more effective ways.  Their hoarding behaviors are also directly addressed in helping them address their anxious feelings more effectively.  They are also taught various strategies in gradually lessening their hoard and slowly managing their clutter. 

            Learning to moderate one’s standards by accepting that less than perfect is “good enough” is fostered among these people.  Discriminating between more important matters that need more detailed attention and other concerns that can be set aside indefinitely (e.g., medication and money vs. extra towels and old newspapers) is crucial in recovery.  Ultimately, these people need to define for themselves what is just “good enough.”  This will then determine the extent to which they will stash on some items, but maybe not on most. 

            It’s a long and difficult road to recovery for Glenda, but with continued treatment and conscientious effort, she can get better manage her anxiety and deal with her hoarding behavior more effectively. 

Rules in Disciplining Children

            Rules and limits are important in disciplining children.  In order to establish a sense of responsibility in our children, we need to be clear about our expectations of them.  In effectively guiding our youngsters, parents often are unclear as to how rules need to be stated and implemented, both at home and outside. 

            In many families that I meet, however, rules are not explicitly stated.  They are often embedded or implicit in the daily habits and values that parents impart to their children.  These values are encountered in day to day interactions.  For example, discouraging children from talking back at older people implicitly teaches the children to respect elders and to do so in this manner.  With repeated encounters of this, the child learns what is appropriate from inappropriate behaviors. 

            In as much as there is nothing wrong with the style of parenting I just described, a clear articulation of rules to children is often an effective and purposive way to guide our youth.  This begins with being clear about your priorities and values that you would like to pass on to your children.  There is really no clear right or wrong here, but rather a choice that each parent needs to make.  For that matter, both parents also need to agree on what these values and priorities need to be emphasized.  In following the earlier example, parents might decide that respect for elders is a very important value they want their children to imbibe.  And so, this might be emphasized and stated as such.  It is also important to clarify how this rule is seen and heard.  What are the word and actions that would show that a child respects his or her parents? 

            Another matter that parents need to decide when creating and implementing rules is making a decision on the level of importance a particular rule might have.  We can then categories the rules and expectations we have according to what we think are negotiable and what are non-negotiable.  For instance, respect for elders might be held in great importance and is a non-negotiable at all times.  On the other hand, being prompt or being on time might not be as important.  Whereas promptness is still a rule that is enforced, it is implemented less sternly and a compromise will likely be entertained when expectations are not met.   

            This idea of clarifying negotiable from non-negotiable rules at home is integral in communicating to children that all these behaviors are important, but there are some things that take precedence over others.  Now some of us might be tempted to just make all rules non-negotiable and make everything clear from the beginning.  This might not work as effectively because we naturally have short attention spans and poor memories.  Realistically, we can only remember three to five things that will be given priority.  Many of the others might be neglected, especially when there are many rules and guidelines to remember.  And so, parents also need to limit the number of non-negotiable rules, and anywhere from one to five would suffice.  Try to make them general (e.g., “respect elders,” rather than “always use ‘po’ and ‘opo.’”) so that the rules have a broader applicability.  Writing them down in places where children can access them is also a good idea, to help reinforce the idea of the most important rules to follow. 

            In the end, being clear about what is important to us as individuals will guide us to making rules clear.  We also need to identify how these values are manifested in words and deeds.  Only then can we really communicate what we want to impart to our children.    

Improving Our Memories

            There are some exceptional people who have extremely good memories.  Some of them are so good that psychologists decided to study how they remember things so well in the hope of helping those of us who have not been blessed in the same way. 

            In short-term memory, we are able to maximize its limited space by putting information together.  As we are better able to do this, we are able to take in more information for quick and immediate recall.  This phenomenon is called “chunking.”  We often use previous experiences to “chunk” bits information into one unit, enabling us to put in more information in the limited space available. 

            Mnemonic devices are the strategies that have been identified as strategies that can aid people develop better long-term memories.  It is a way of making sense of the new information that would enable us to store information effectively, so that we are able to recall them quicker and more efficiently.  Some of these mnemonic devices are as follows: 

-   Acronyms – using the first letters of a string of words as a cue to remember the ordered set of words (e.g., ROY G. BIV are the colors of the rainbow in order). 

-   Categorical clustering – putting all words that go together under one label to condense the information and make them easier to recall. 

-   Interactive Images – Imagining two things that are moving or interacting with each other, something preposterous perhaps, such as, an a house walking away from its place, and connecting them to the concepts that need to be remembered.

-   Method of Loci – Going through a familiar place in your mind (e.g, the way to your room from the entrance of your house) and associating objects that you come across along the way with steps that you need to remember. 

            Apart from mnemonic devices, being able to rehearse the same set of information over and over again and in different contexts can help one master the knowledge well.  It is important to give various kinds of meaning to the same set of information to ensure that it will be remembered across different kinds of contexts. 

            Good restful sleep is also thought to be an important factor in ensuring that what one has learned will be integrated into one’s memory for a long time.  This is probably one of the reasons why cramming will only get one so far.  Cramming is often done in a heightened state, usually in the brink of anxious fear that one has not yet finished what one needs to cover for an exam.  As such, it works only in the short term.  After the exam, most people who cram will tend to forget most of what was studied. 

            In the end, there is no substitute for repeated practice and making meaning of what one wants to remember.  Even if the meaning placed on what on is making sure to remember is rather personal, it will still be remembered well.  After all, the only things that are absolutely real to us are our personal experiences.   We need to rely on prior knowledge so that we are better able to integrate new information learned.  The more organized the information we have, the better they will also be remembered.