Category Archives: General

The Curious Link between Borderline Personality and Chronic Pain

Borderline Personality and PainBy Traci Stein, PhD, MPH, Complementary and Alternative Medicine

Borderline personality (BP) is estimated to affect between 1.5% and 6% of people in the United States. Core features of BP include black-and-white, all-or-nothing thinking, intense, rapidly shifting emotions and difficulties with emotion regulation, challenges in relationships and with self-image, and a tendency toward impulsivity.

All of these can exacerbate distress, decrease coping, and make it harder to function socially, at work, and in general. Furthermore, the prevalence of BP in people with chronic pain is significantly greater than in the general population (30%) and is linked to increased pain severity and poorer coping with pain.

Non-suicidal self-injury is a tool frequently used by those with borderline personality in an effort to decrease emotional pain and induce calm. Those who have BP often report both the absence of pain and an increase in well-being or feelings of euphoria when engaging in self-harm, both of which may reinforce the tendency to continue self-harming as a way of coping.

The Pain Paradox

The relationship between pain, self-injury, and BP is complex. Between 70% and 80% of those diagnosed with BP engage in self-injury to distance themselves from painful emotions and distressing thoughts. On the surface, it is perplexing that BP predisposes individuals to not only higher pain tolerance in the face of acute (short-duration) and self-inflicted pain, but lower pain tolerance, as well as greater pain severity and poorer coping, in response to chronic (ongoing) pain.

The Overlap of Emotional and Physical Pain

Contrary to popular belief, there is no one “pain center” in the brain; multiple brain structures are responsible for the experience of pain. A complex and multifaceted experience, “pain” refers to sensing the location of discomfort, assessing pain severity, registering the quality of pain (e.g., piercing, hot, throbbing, intermittent, etc.), linking to memories related to pain, the emotional response to pain, beliefs one has about the potential for coping with pain, and the ability to devise and follow through with a plan for pain management, among others.

The current and rapidly growing body of research on pain has found that distressing cognitive responses, such as catastrophizing (“I can’t handle this pain; I’m never going to get better!”) and emotional responses, such as depression and anxiety, can worsen both pain severity and coping, as well as challenge one’s ability to stick with a pain management plan that may require patience, persistence, and possibly a temporary increase in pain severity (such as with physical therapy).

Why Is Borderline Personality Common in People with Chronic Pain?

There is no definitive answer for why borderline personality would be so much more prevalent in people with chronic pain than in the general population. Because pain is a complex, mind-brain-body phenomenon, one hypothesis is that pain that feels random or beyond one’s control may induce feelings of depression, hopelessness, helplessness, anger, and anxiety—all of which amp up pain. Invalidation by ill-informed providers is more likely to elicit poor coping, particularly in those who may struggle with coping already.
Reports of increased severity of pain and other bodily symptoms in those with BP are correlated with greater levels of anxiety and depression. When researchers have statistically controlled for anxiety and depression in those who have both BP and pain, symptom severity has been similar to that of those without BP.

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Related Courses of Interest: 

Living a Better Life with Chronic Pain: Eliminating Self-Defeating Behaviors is a 5-hour online CE course by Robert E. Hardy, EdD. Certainly no one would choose a pain-filled body over a healthy, pain-free body. Yet every day, people unwittingly choose actions and attitudes that contribute to pain or lead to other less-than-desirable consequences on their health, relationships or ability to function. These actions and attitudes are what are called self-defeating behaviors (SDBs) and they keep us from living life to the fullest—if we let them. This course is a self-instructional module that “walks” readers through the process of replacing their self-defeating chronic pain issues with healthy, positive, and productive life-style behaviors. It progresses from an analysis of the emotional aspects of living with chronic pain to specific strategies for dealing more productively with it. Through 16 guided exercises, readers will learn how to identify their self-defeating behaviors (SDBs), analyze and understand them, and then replace them with life-giving actions that lead to permanent behavioral change. Course #50-12 | 2014 | 49 pages | 35 posttest questions

Managing Chronic Pain in Adults With or in Recovery from Substance Use Disorders is a 5-hour online CE course by the US Department of Health and Human Services. Medication for chronic pain is addictive; therefore, the treatment of individuals with both substance abuse disorders and pain presents particular challenges. This course is based on a document from the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services, Managing Chronic Pain in Adults With or in Recovery from Substances Use Disorders: A Treatment Improvement Protocol (SAMHSA Tip 54). Intended for all healthcare providers, this document explains the close connections between the neurobiology of pain and addiction, assessments for both pain and addiction, procedures for treatment of chronic pain management (both pharmaceutical and non-pharmaceutical), side effects and symptoms of tolerance and withdrawal from pain medication, managing risk of addiction to pain medication and nonadherence to treatment protocols, maintaining patient relationships, documentation, and safety issues. Written by panel consensus, SAMHSA TIP 54 provides a good introduction to pain management issues and also a good review for experienced clinicians. Course #50-06 | 2012 | 120 pages | 34 posttest questions

Assessing Substance Abuse in Patients with Chronic Pain is a 3-hour online CE course by Ellen Lavin, PhD. This course will demystify the diagnosis and treatment of chronic pain, the role and limitations of pain medications, and how to identify when pain relieving drugs may be harmful to clients. Participants will understand how to conduct a complete evaluation of clients with a pain disorder, chronic pain syndrome and co-morbid psychiatric diagnoses. Although the majority of chronic pain patients do not abuse pain medications, mental health practitioners need skills to assess when active substance abuse is present and develop appropriate treatment objectives. This course will also give special attention to specific clinical challenges for mental health professionals who treat clients with chronic pain, including suicide assessment and treatment non-adherence. Closeout Course #30-35 | 2006 | 34 pages | 20 posttest questions

Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists; by the National Board of Certified Counselors (NBCC) to offer home study continuing education for NCCs (#5590); the Association of Social Work Boards (ASWB #1046, ACE Program); the California Board of Behavioral Sciences (#PCE1625); the Florida Boards of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling (#BAP346) and Psychology & School Psychology (#50-1635); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).

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Posted by on July 29, 2015 in General


Knowing How Doctors Die Can Change End of Life Discussions

Knowing How Doctors Die Can Change End of Life DiscussionsBy Stephanie O’Neill

Dr. Kendra Fleagle Gorlitsky recalls the anguish she felt performing CPR on elderly, terminally ill patients.
It looks nothing like what we see on TV. In real life, ribs often break and few survive the ordeal.

“I felt like I was beating up people at the end of their life,” she says. “I would be doing the CPR with tears coming down sometimes, and saying, ‘I’m sorry, I’m sorry, goodbye.’ Because I knew that it very likely not going to be successful. It just seemed a terrible way to end someone’s life.”

Gorlitsky now teaches medicine at the University of Southern California and says these early clinical experiences have stayed with her.

A lot of time and money has gone into trying to improve end-of-life care.

Gorlitsky wants something different for herself and for her loved ones. And most other doctors do too: A Stanford University study shows almost 90 percent of doctors would forgo resuscitation and aggressive treatment if facing a terminal illness.

It was about 10 years ago, after a colleague had died swiftly and peacefully, that Dr. Ken Murray first noticed doctors die differently than the rest of us.

Hawaii ranks 49th in the nation for use of home health care services during the last six months of someone’s life. Videos from ACP Decisions show patients what their options are at the end of life.

“He had died at home, and it occurred to me that I couldn’t remember any of our colleagues who had actually died in the hospital,” Murray says. “That struck me as quite odd, because I know that most people do die in hospitals.”

Murray then began talking about it with other doctors.

“And I said, ‘Have you noticed this phenomenon?’ They thought about it, and they said, ‘You know? You’re right.’ ”

In 2011, Murray, a retired family practice physician, shared his observations in an online article that quickly went viral. The essay, “How Doctors Die,” told the world that doctors are more likely to die at home with less aggressive care than most people get at the end of their lives. That’s Murray’s plan, too.

“I fit with the vast majority of physicians that want to have a gentle death and don’t want extraordinary measures taken when they have no meaning,” Murray says.

A majority of seniors report feeling the same way. Yet, they often die while hooked up to life support. And only about 1 in 10 doctors report having conversations with their patients about death.

One reason for the disconnect, says Dr. Babak Goldman, is that too few doctors are trained to talk about death with patients. “We’re trained to prolong life,” he says.

Goldman is a palliative care specialist at Providence Saint Joseph’s Medical Center in Burbank, Calif., and he says that having the tough talk may feel like a doctor is letting a family down. “I think it’s sometimes easier to give hope than to give reality,” Goldman says.

Goldman, now 35, read Murray’s essay as part of his residency. He says that he, too, would prefer to die without heroic measures, and he believes that knowing how doctors die is important information for patients.


Related Continuing Education Courses: 

End of Life: Helping with Comfort and Care is a 1-hour CE course. End-of-life care is the term used to describe the support and medical care given during the time surrounding death. Such care does not happen just in the moments before breathing finally stops and a heart ceases to beat. An older person is often living, and dying, with one or more chronic illnesses and needs a lot of care for days, weeks, and sometimes even months. Generally speaking, people who are dying need care in four areas—physical comfort, mental and emotional needs, spiritual issues, and practical tasks. This course is intended to make the unfamiliar territory of death slightly more comfortable for everyone involved. This publication is based on research, such as that supported by the National Institute on Aging, part of the National Institutes of Health. This research base is augmented with suggestions from practitioners with expertise in helping individuals and families through this difficult time. Throughout the booklet, the terms comfort care, supportive care, and palliative care are used to describe individualized care that can provide a dying person the best quality of life until the end.

Mindfulness: The Healing Power of Compassionate Presence is a 6-hour online CE course. This course will give you the mindfulness skills necessary to work directly, effectively and courageously, with your own and your client’s life struggles. Compassion towards others starts with compassion towards self. Practicing mindfulness cultivates our ability to pay intentional attention to our experience from moment to moment. Mindfulness teaches us to become patiently and spaciously aware of what is going on in our mind and body without judgment, reaction, and distraction, thus inviting into the clinical process, the inner strengths and resources that help achieve healing results not otherwise possible. Bringing the power of mindful presence to your clinical practice produces considerable clinical impact in the treatment of anxiety, depression, PTSD, chronic pain, high blood pressure, fibromyalgia, colitis/IBS, and migraines/tension headaches. The emphasis of this course is largely experiential and will offer you the benefit of having a direct experience of the mindfulness experience in a safe and supportive fashion. You will utilize the power of “taking the client there” as an effective technique of introducing the mindful experience in your practice setting. As you will learn, the mindfulness practice has to be experienced rather than talked about. This course will provide you with an excellent understanding of exactly what mindfulness is, why it works, and how to use it. You will also develop the tools that help you introduce mindful experiences in your practice, and how to deal with possible client resistance.

Spirituality & Adults in Later Life is a 2-hour online CE course. This online course provides an accessible tool kit for health care providers and therapists to use in attending to the spiritual well being – as well as the physical, social, and emotional needs – of older adults in their care. Included are ready-to-use exercises and techniques for promoting spiritual self-awareness in seniors, as well as vignettes from the author’s own years of experience. The author makes a clear distinction between spirituality and religion, emphasizing the importance of helping older adults come to terms with the numerous losses they experience in later life. Among the tools described herein are the spiritual inventory, an assessment of spiritual needs, the value of forgiveness and legacy, a discussion of spiritual deterrents, the importance of cultural sensitivity, and how to promote spiritual growth in a group setting.

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Posted by on July 27, 2015 in General


Impulsivity and the Self-Defeating Behavior of Narcissists

narcissist personality and self defeating behaviorsNarcissists are a puzzle. Their bragging and arrogance interferes with the attainment of the status and recognition they so poignantly desire. Why do they continually undermine themselves in this way?

The research literature appears to have achieved some consensus about the nature of sub-clinical narcissism’ with respect to underlying cognitive, social, and affective processes (e.g., Morf & Rhodewalt, 2001).

The consensual model serves as a solid foundation for integrating narcissism research, and provides a partial explanation for narcissists’ perplexing behavior, but it relies heavily on conscious cognitive processes and omits an important category of explanatory variables: dispositions.

We shall argue that one possible key to the puzzle posed by narcissists’ behavior is that they are dispositionally impulsive: They lack the self-control necessary to inhibit the behaviors that thwart the attainment of their goals.

Narcissism is generally seen as deriving from an attempt to regulate and maintain unrealistically high levels of self-esteem (Raskin, Novacek, & Hogan, 1991b; Robins & John, 1997).

Narcissists’ self-views are on the one hand lofty (Paulhus & John, 1998), making it difficult for them to find affirmation, and on the other hand vulnerable or unstable (Jordan, Spencer, Zanna, Hoshino-Browne, & Correll, 2003), making such affirmation particularly important. This combination of arrogance and vulnerability is one of the paradoxes that 154 NARCISSISM AND IMPULSIVITY Morf and Rhodewalt (2001) addressed in their cognitive-affective processing model. As they and others argue (e.g., Westen, 1990), much of narcissists’ cognitive, affective, and behavioral responses are in the service of defending and affirming an unrealistic self-concept.

Cognitive-affective processing models (e.g., Morf & Rhodewalt, 2001) maintain that narcissists engage in ineffective or even counterproductive interpersonal strategies because they are insensitive to others’ concerns. In other words, although their behavior seems self-defeating to the outside observer, it is actually a deliberate, though ill-conceived, strategy that makes sense from the point of view of their internal subjective logic.

We propose a more parsimonious explanation for at least some of these self-defeating behaviors: The behaviors are not strategic at all, narcissists simply can’t help themselves. We propose that narcissists suffer from a dispositional lack of self-control (i.e., impulsivity, a concept closely akin to ego undercontrol; Block, 2002; Block & Block, 1980), and this contributes to their inability to meet the high self-regulatory demands of an inflated, unstable self-concept.

As a result, they are unable to successfully negotiate their social environments to obtain the recognition they crave. Many of narcissists’ behaviors may provide temporary immediate gratification of their desire for recognition, but it comes at the cost of long-term success—the classic framework of the concept of delay of gratification (e.g., Funder, Block & Block, 1983; Mischel & Ayduk, 2002).

Source: Vazire, S., & Funder, D. (2006). Impulsivity and the Self-Defeating Behavior of Narcissists. Personality & Social Psychology Review, 10(2), 154-165. doi:2006

continuing education for mental health professionals

Related Continuing Education Courses: 

Eliminating Self-Defeating Behaviors is a 4-hour online CE course. Self-defeating behaviors are negative on-going patterns of behaviors involving issues such as smoking, weight, inactive lifestyle, depression, anger, perfectionism, etc. This course is designed to teach concepts to eliminate these negative patterns. The course is educational: first you learn the model, then you apply it to a specific self-defeating behavior. A positive behavioral change is the outcome. Following the course, participants will be able to identify, analyze and replace their self-defeating behavior(s) with positive behavior(s). The course also provides an excellent psychological “tool” for clinicians to use with their clients. The author grants limited permission to photocopy forms and exercises included in this course for clinical use.

The Neuroscience of Psychotherapy is an 8-hour test only CE course. This CE test is based on the book “The Neuroscience of Psychotherapy: Healing the Social Brain” (2010, 460 pages), which provides an account of the scientific basis of psychotherapy, based on the newest revelations of neuroscience. Beginning with a neurological analysis of Freud’s theories, the author describes the functioning of the neurons and neural networks that comprise the biological basis of thinking and relationships. Chapters discuss research on anxiety, fear, trauma, neural plasticity, memory, executive functioning, identity, narrative, consciousness, and attachment relationships, interweaving the neuroscientific and clinical literature and providing clinical examples as illustrations of theory and technique. The final three chapters discuss the ability of psychotherapy to rewire the brain, including a review of the existing neuroimaging studies of psychotherapy. The book imparts a scientific understanding of just how and why psychotherapeutic processes have a positive impact on the nervous system.

Handbook of Clinical Psychopharmacology for Therapists, 7th Ed is a 6-hour test only CE course. This CE test is based on the book “Handbook of Clinical Psychopharmacology for Therapists, 7th Ed.” (2013, 369 pages), a highly readable text that has become the go-to resource for thousands of mental health clinicians seeking a reliable and easy-to-reference resource detailing the indications, contraindications, and side effects of psychopharmaceuticals. Organized by disorder and, within each disorder, by medication, this book is a vital addition to any clinician’s bookshelf. An overview of neurobiology is presented which provides a foundation for the discussions of pharmacology and both adult and childhood disorders are explored. This seventh edition includes an important new chapter on withdrawing from psychopharmacological medications that will prove useful for therapists seeking to help their clients change medication or stop taking a psychopharmacological medication. An extensive appendix and sidebars throughout the text provide additional information and discussion.

Therapy with Coerced and Reluctant Clients is a 6 hour test only CE course. This CE test is based on the book “Therapy with Coerced and Reluctant Clients” (2010, 233 pages). In this book, Brodsky examines the difficulties faced by therapists who work with involuntary clients including those who come to therapy through the judicial system. He addresses the challenges faced when working with reluctant clients including problem employees and teenagers or spouses persuaded to enter therapy. By looking at theory and research, Brodsky begins the process of considering alternatives to asking questions. He then identifies interventions and techniques that use assertive statements instead of asking questions to better address patient issues. Brodsky ends by exploring ways to work with client hostility, scorn and avoidance using case-studies as examples.

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Posted by on July 24, 2015 in General


How Does Cyberbullying Affect the Lives of Young People?

cyberbullyingIn our technologically advanced society, not all bullying is physical. Start a discussion about cyberbullying and how young people can protect themselves and their friends

By Beth Cassidy

In the past, bullying occurred in places such as the school playground.

But these days, some young people fall victim to a more sinister type of abuse: cyberbullying.

Using different types of technology, young people can now be subjected to a world of virtual taunting and harassment.

To help protect young people, the Child Exploitation and Online Protection Centre has asked social networking site Facebook to install a panic button on every page of its site which would allow users to report abuse immediately.

Start a discussion with young people about cyberbullying. Are young people aware of what it is? Discuss what it might involve. Cyberbullying is defined as a young person bullying another young person using technology such as text messages, social networking sites, chat rooms or emails. Writing nasty comments about someone on their Facebook page, sending threatening or Cybermentors offer support to victims of bullying abusive texts and writing intimidating emails are all forms of cyberbullying. Some cyberbullies have even created online hate groups about a young person and invited their peers to join.

Have young people ever been victims of cyberbullying? How did they feel? Did they talk to anyone about it? Cyberbullying is particularly nasty because the bullies can get to their victim without even being in the same room, making it more difficult to escape or track down the culprits. Discuss why teenagers being cyberbullied may feel worried about going to school. How might they feel? Paranoid? Anxious? Suicidal?

Discuss what measures young people can take to protect themselves from cyberbullying. Do young people think a panic button on sites such as Facebook is a good idea? Will it make young people feel more secure online? Talk about whether cyberbullying should be discussed in school lessons. Do young people think more awareness would help stamp out cyberbullying? What would young people do if they experienced cyberbullying? How would they advise a friend who was being bullied online?

As with any type of bullying, it’s important that young people tell someone they trust Cyberbullying is serious. Young people can do their bit by keeping an eye on friends and talking to them if they see any signs of cyberbullying. Confidential website services such as Beatbullying’s CyberMentors give young people the opportunity to talk to someone their own age, rather than an adult. Consider how this could empower young people to speak out about bullying.

Source: Cassidy, B. (2010, April 27). How does cyberbullying affect the lives of young people? Children & Young People Now, 22.

Cyberbullying prevention

Related Online Continuing Education Courses: 

Bullying Prevention: Raising Strong Kids by Responding to Hurtful & Harmful Behavior is a 3-hour online CE course. This video course starts with a thoughtful definition of “bullying” and goes on to illustrate the functional roles of the three participant groups: the targeted individuals, the bullies, and the bystanders. The speaker discusses the concepts of resiliency, empathy, and growth/fixed mindsets, and considers the pros and cons of alternative responses to harmful behavior. Included also are an examination of the utility of zero tolerance policies and a variety of adult responses when becoming aware of bullying behavior. The speaker utilizes multiple examples and scenarios to propose strategies and techniques intended to offer connection, support and reframing to targeted individuals, motivation to change in the form of progressive, escalating consequences to bullies, and multiple intervention options to bystanders. Further segments discuss ways in which schools can create safe, pro-social climates.

Electronic Media and Youth Violence is a 1-hour online CE course. This course, based on the publication Electronic Media and Youth Violence: A CDC Issue Brief for Educators and Caregivers from the U.S. Department of Health and Human Services Centers for Disease Control and Prevention, focuses on the phenomena of electronic aggression. Electronic aggression is defined as any kind of harassment or bullying that occurs through email, chat rooms, instant messaging, websites, blogs, or text messaging. The brief summarizes what is known about young people and electronic aggression, provides strategies for addressing the issue with young people, and discusses the implications for school staff, mental health professionals, parents and caregivers.

Building Resilience in your Young Client is a 3-hour online CE course. It has long been observed that there are certain children who experience better outcomes than others who are subjected to similar adversities, and a significant amount of literature has been devoted to the question of why this disparity exists. Research has largely focused on what has been termed “resilience.” Health professionals are treating an increasing number of children who have difficulty coping with 21st century everyday life. Issues that are hard to deal with include excessive pressure to succeed in school, bullying, divorce, or even abuse at home. This course provides a working definition of resilience and descriptions of the characteristics that may be associated with better outcomes for children who confront adversity in their lives. It also identifies particular groups of children – most notably those with developmental challenges and learning disabilities – who are most likely to benefit from resilience training. The bulk of the course – presented in two sections – offers a wide variety of resilience interventions that can be used in therapy, school, and home settings.

Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists. Professional Development Resources maintains responsibility for all programs and content. Professional Development Resources is also approved by the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the California Board of Behavioral Sciences; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board; the South Carolina Board of Professional Counselors & MFTs; and by theTexas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners.

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Posted by on July 23, 2015 in General


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The Right-to-Die Movement

By Rachel Aviv

The Death TreatmentIn Belgium, euthanasia is embraced as an emblem of enlightenment and progress, a sign that the country has extricated itself from its Catholic, patriarchal roots. Distelmans, who was brought up as a Catholic and then rejected the Church, told me that his work is inspired by an aversion to all forms of paternalism. “Who am I to convince patients that they have to suffer longer than they want?” he said.

Belgium was the second country in the world, after the Netherlands, to decriminalize euthanasia; it was followed by Luxembourg, in 2009, and, this year, by Canada and Colombia. Switzerland has allowed assisted suicide since 1942. The United States Supreme Court has recognized that citizens have legitimate concerns about prolonged deaths in institutional settings, but in 1997 it ruled that death is not a constitutionally protected right, leaving questions about assisted suicide to be resolved by each state. Within months of the ruling, Oregon passed a law that allows doctors to prescribe lethal drugs for patients who have less than six months to live. In 2008, Washington adopted a similar law; Montana decriminalized assisted suicide the year after; and Vermont legalized it in 2013.

The right-to-die movement has gained momentum at a time of anxiety about the graying of the population; people who are older than sixty-five represent the fastest-growing demographic in the United States, Canada, and much of Europe. But the laws seem to be motivated less by the desires of the elderly than by the concerns of a younger generation, whose members derive comfort from the knowledge that they can control the end of their lives. Diane Meier, a professor of geriatrics at Mount Sinai School of Medicine, in New York, and one of the leading palliative-care physicians in the country, told me that “the movement to legalize assisted suicide is driven by the ‘worried well,’ by people who are terrified of the unknown and want to take back control.” She added, “That is not to say that the medical profession doesn’t do a horrible job of protecting people from preventable suffering.” Like most doctors who specialize in palliative care, a field focussed on quality of life for patients with severe and terminal illnesses, she thinks legalizing assisted suicide is unnecessary. “The notion that if people don’t kill themselves they’re going to die on a ventilator in the hospital would be humorous if it weren’t so serious,” she said. She believes that the angst propelling the movement would be diminished if patients had greater access to palliative care and if doctors were more attentive to their patients’ psychological suffering.

In Oregon and Switzerland, studies have shown that people who request death are less motivated by physical pain than by the desire to remain autonomous. This pattern of reasoning was exemplified by Brittany Maynard, a twenty-nine-year-old newlywed who moved to Oregon last year so that she could die on her own terms rather than allowing her brain cancer to take its course. Her story appeared on the cover of People, which described her as having the “soul of an adventurer and the heart of a warrior.” She became the poster child for assisted death—a far more palatable one than Jack Kevorkian, who had previously filled that role. Unlike the patients whom Kevorkian attended to with his makeshift “suicide machine,” Maynard appeared neither passive nor vulnerable. Since her death, seven months ago, lawmakers in twenty-three U.S. states have introduced bills that would make it legal for doctors to help people die.

Opponents have warned for years that legalization will lead to a “slippery slope,” but in Oregon fewer than nine hundred people have used lethal prescriptions since the law was passed, and they represent the demographic that is least likely to be coerced: they are overwhelmingly white, educated, and well-off. In Belgium and in the Netherlands, where patients can be euthanized even if they do not have a terminal illness, the laws seem to have permeated the medical establishment more deeply than elsewhere, perhaps because of the central role granted to doctors: in the majority of cases, it is the doctor, not the patient, who commits the final act. In the past five years, the number of euthanasia and assisted-suicide deaths in the Netherlands has doubled, and in Belgium it has increased by more than a hundred and fifty per cent. Although most of the Belgian patients had cancer, people have also been euthanized because they had autism, anorexia, borderline personality disorder, chronic-fatigue syndrome, partial paralysis, blindness coupled with deafness, and manic depression. In 2013, Wim Distelmans euthanized a forty-four-year-old transgender man, Nathan Verhelst, because Verhelst was devastated by the failure of his sex-change surgeries; he said that he felt like a monster when he looked in the mirror. “Farewell, everybody,” Verhelst said from his hospital bed, seconds before receiving a lethal injection.

The laws seem to have created a new conception of suicide as a medical treatment, stripped of its tragic dimensions. Patrick Wyffels, a Belgian family doctor, told me that the process of performing euthanasia, which he does eight to ten times a year, is “very magical.” But he sometimes worries about how his own values might influence a patient’s decision to die or to live. “Depending on communication techniques, I might lead a patient one way or the other,” he said. In the days before and after the procedure, he finds it difficult to sleep. “You spend seven years studying to be a doctor, and all they do is teach you how to get people well—and then you do the opposite,” he told me. “I am afraid of the power that I have in that moment.”

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What do you think about the right-to-die movement? When should people with a non-terminal illness be helped to die?

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Posted by on July 6, 2015 in General


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Continuing Education Information for Louisiana Mental Health Counselors

Louisiana Mental Health Counselors Continuing Education Louisiana-licensed mental health counselors have a license renewal every two years with a June 30th deadline. Forty (40) continuing education hours are required to renew a license.

Of the forty hours, three (3) hours of ethics and six (6) hours of diagnosis are required. For MHC supervisors, three (3) hours of supervision are required.

Ten (10) hours of home study are allowed if NBCC approved.

Counseling & MFT 
Louisiana LPC Board of Examiners
View the Board Website or Email the Board
Phone: 225-765-2515
CE Required: 40 hours every 2 years (MFTs – 20 hrs must directly relate to MFT)
Home Study Allowed: 10 hours
License Expiration: Counselors – 6/30; MFTs – 12/31, every 2 years
National Accreditation Accepted: Counselors – NBCC; MFTs – AAMFT (not PDR)
Notes: MFTs – 3 hours MFT ethics required for renewal (general course will not count) MHCs – 3 hours of ethics required, 6 hours of diagnosis, MHC Supervisors – 3 hours of supervision required
Date of Info
: 04/24/2015

Professional Development Resources is an NBCC-Approved Continuing Education Provider (ACEP #5590) and may offer NBCC-approved clock hours for programs that meet NBCC requirements. Programs for which NBCC-approved clock hours will be awarded are identified on the Counseling page of this website. The ACEP is solely responsible for all aspects of the program.

Continuing Education Courses for Mental Health Counselors: 

Helping Your Young Client Persevere in the Face of Learning Differences is a 3-hour online video CE course. Clinicians and teachers working with students struggling at grade level are committed to raising their students’ achievement potential by creating opportunities to learn. In order to accomplish this, they need to learn new techniques that can help encourage discouraged students – particularly those who have different ways of learning – by supporting and motivating them without enabling self-defeating habits. This course will provide strategies and techniques for helping students minimize the patterns of “learned helplessness” they have adopted, appreciate and maximize their strengths, develop a growth mindset, value effort and persistence over success, view mistakes as opportunities to learn, and develop a love of learning that will help them take personal responsibility for their school work. The course video is split into 3 parts for your convenience.

Animal Assisted Therapy is an online 3-hour CE course. In Animal-Assisted Therapy (AAT) the human-animal bond is utilized to help meet therapeutic goals and reach individuals who are otherwise difficult to engage in verbal therapies. AAT is considered an emerging therapy at this time, and more research is needed to determine the effects and confirm the benefits. Nevertheless, there is a growing body of research and case studies that illustrate the considerable therapeutic potential of using animals in therapy. AAT has been associated with improving outcomes in four areas: autism-spectrum symptoms, medical difficulties, behavioral challenges, and emotional well-being. This course is designed provide therapists, educators, and caregivers with the information and techniques needed to begin using the human-animal bond successfully to meet individual therapeutic goals. This presentation will focus exclusively on Animal Assisted Therapy and will not include information on other similar or related therapy.

Constructive Clinical Supervision in Counseling and Psychotherapy is a 6-hour test-only course. This CE test is based on the book “Constructive Clinical Supervision in Counseling and Psychotherapy” (2015, 145 pages). The text articulates a practical, theoretical approach to supervision that integrates salient elements of a number of diverse but complementary theoretical perspectives from the fields of human development, psychotherapy, and clinical supervision to assist in facilitating supervisee growth and change from a constructivist framework. Constructive Clinical Supervision is written in a way that is highly accessible and inviting to supervisors who are new to constructivist ideas, while also offering sufficient theoretical depth and practical utility for those already well versed in constructivism. It is written for supervisors from all backgrounds, from beginning graduate students who are learning about supervision for the first time, to seasoned veterans who are exploring ways to deepen their clinical practice.

Original: Louisiana Mental Health Counselors License Renewals and CEU Information

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Posted by on April 30, 2015 in General


Missouri Occupational Therapists Continuing Education Information

From the Missouri Board of Occupational Therapy

Online CEUs for Missouri OTsMissouri-licensed Occupational Therapists (OTs) and Occupational Therapy Assistants (OTAs) have an upcoming license renewal deadline of June 30, 2015.

All OT/OTA licensees are required to complete 24 hours of continuing education in order to renew. The hours must be obtained between 7/1/2013 – 6/30/2015 and may all be taken online. At least fifty percent (50%) of the twenty-four (24) continuing competency credits must be directly related to the delivery of occupational therapy services, and the remaining CCCs must be related to one’s practice area or setting. The continuing education is only to be submitted to the board office upon request. Please visit Continuing Competency Requirements for more information.

Professional Development Resources is approved by the American Occupational Therapy Association (AOTA #3159) to provide online continuing education courses to occupational therapists and occupational therapy assistants. Missouri-licensed OTs and OTAs can earn all 24 hours for renewal through online courses available @


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Posted by on April 23, 2015 in General


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