The Practitioner's Dilemma

This is a question of what kind of service you may want to receive from a practitioners with regard to a therapeutic dialog. Above is a link to the new Bill before WASHINGTON State Legislature ~ below are comments from others outside of this blog.


Dispatches ......

Subject: [waproca] Re: In these days of uncertainty ......

Sure the safety of the public is important. But to persecute innocent, dedicated (approximately 17 thousand of us) folks who have been evidently successful in their businesses (to stay in business), and have paid Washington state taxes and for business licenses for many years, as registered counselors and hypnotherapists is a travesty beyond my comprehension.
I have been in private practice for 27 years, first in another state, and now here in Washington state for almost 14 years. In those 27 years, I have had one formal complaint (not regarding sexual abuse) out of thousands of clients and students! It was never taken further than a complaint because there was no valid reason for the client to continue and thus the complaint was dropped.
I have had literally thousands of hours of formal training and certifications in the counseling genre's of expertise and of my choice. In fact, I recently completed a two year practicum in Integral Therapeutic Techniques and certification with a PhD in British Colombia, Canada. I will always continue to educate myself as my greatest effort to do the best work for my clients.
After fifty plus years of life I am unwilling to go back to school for a degree, let alone 3,000 additional hours of observation. Isn't it proof enough that I have been successful in my private practice for 27 years? A wonderful teacher of mine said, "That's why they call it a 'practice' because, not only extensive education but, practical application is where all levels of practitioners learn best." As a matter of fact, I also have over a hundred written, and documented, testimonials of my client's successes and accomplishments as a result of my work. I am sure that my story is not unique, that there are many other registered counselors who have similar experience.
I think Gov. Gregoir's concentration to "protect the public" is intentionally a campaign ploy to get re-elected. "Safe Healthcare" are buzzwords that are near and dear to many peoples hearts and pocketbooks. I'm guessing that the 17,000+ of us that are registered counselors, in this state hopefully will not be voting for her again. That amount of people, plus our clients. spouses and friends, could be the deciding factor in voting her out of office. Referring to the article in the Seattle Times, she is spending FIVE HUNDRED SIXTY THOUSAND DOLLARS (plus a portion of the allocated TWO MILLION) of our tax money to destroy the careers and lives of legitimate, caring, alternative therapists most of whom have the public's safety in their minds and hearts.
If the statistics be known, many psychologists, family therapists, social workers and others, that are supporting the elimination of registered counselors, have been actually prosecuted a myriad of times more than we have for unethical and immoral behavior. Along with The Governess, they are pointing the finger at us and not aware that there are three fingers pointing back at them. My guess is that they are living under an illusion that they might make more money if they eliminate us because insurance companies are not paying them as much as 10+ years ago. I will bet that they find that this is illusory thinking.
All of this is truly a sad state of affairs.
What shall we do so we can continue to assist so many people that continue to be grateful they chose us as alternative professionals to assist them in their lives?
Respectfully submitted,

Gregoire pitches $8 million plan for patient safety

DAVID AMMONS
AP Political Writer

OLYMPIA, Wash. — Gov. Chris Gregoire on Friday proposed tougher policing of health care professionals and more transparency of hospitals' patient safety records.

The governor, who has made expanded health care a centerpiece of her term in office, said patient safety is "the next logical step on the road to reform."

Compared with the more than $1 billion appropriated this year for state health care coverage, including an expansion to cover another 30,000 more children, her ideas for the 2008 legislative session have a tiny pricetag: less than $8 million.

Indeed, Gregoire said she expects full public access to hospitals' track records to be done without extra cost to the state treasury. She said she will introduce legislation giving consumers information about "adverse events," such as infections or patient deaths, at each hospital.

"With full disclosure, the health care system can learn from its mistakes and prevent new ones," Gregoire said in a policy paper released by her office.

Gregoire outlined her proposals at Sacred Heart Medical Center in Spokane after meeting with health care professionals from the area.

"All Washingtonians deserve safe, high-quality health care," she said. "We rightfully expect our health care providers to do their best and, above all, to do no harm."

Other proposals include:

-Strengthening standards for credentialing health care providers. This includes money for national criminal background checks for all out-of-state applicants seeking to get licensed in Washington. Gregoire said the $930,000 appropriation would pay for 13,500 background checks each year.

-Boosting standards for registered counselors. Cost: $560,000.

-"Rigorous" investigation of complaints against health care providers. Her budget will include $2 million for a 30 percent boost for investigations.

-A new state online database would provide a centralized look at all of the prescriptions an individual has from various providers, helping prevent adverse drug reactions or overmedication. Pricetag: $1.4 million.

-Helping hospitals train more nurses, to ease staff shortages. Pricetag: $3 million.

Royal Canadian Air Force 5BX fitness

Simple Sleep .....

Melatonin is a neurohormone produced in the brain by the pineal gland, from the amino acid tryptophan. The synthesis and release of melatonin are stimulated by darkness and suppressed by light, suggesting the involvement of melatonin in circadian rhythm and regulation of diverse body functions. Levels of melatonin in the blood are highest prior to bedtime.

Synthetic melatonin supplements have been used for a variety of medical conditions, most notably for disorders related to sleep.

Sleep enhancement in healthy people

Multiple human studies have measured the effects of melatonin supplements on sleep in healthy individuals. A wide range of doses has been used often taken by mouth 30 to 60 minutes prior to sleep time. Most trials have been small, brief in duration, and have not been rigorously designed or reported. However, the weight of scientific evidence does suggest that melatonin decreases the time it takes to fall asleep ("sleep latency"), increases the feeling of "sleepiness," and may increase the duration of sleep. Better research is needed in this area.

Learning, memory and Alzheimers from Wikipedia

Melatonin receptors appear to be important in mechanisms of learning and memory in mice,^[32] and melatonin can alter electrophysiological processes associated with memory, such as long-term potentiation (LTP). Melatonin has been shown to prevent the hyperphosphorylation of the tau protein in rats. Hyperphosphorylation of tau protein can result in the formation of neurofibrillary tangles, a pathological feature seen in Alzheimer's disease. Thus, melatonin may be effective for treating Alzheimer's Disease.^[33] These same neurofibrillary tangles can be found in the hypothalamus in patients with Alzheimer's, adversely affecting their body's production of melatonin. Those Alzheimer's patients with this specific affliction often show heightened afternoon agitation, called "sundowning," which has been shown in many studies to be effectively treated with melatonin supplements in the evening.^[34]

^{FICTIONAL MEDICATION!!!!}

Reality Bites

Marsha Linehan's Skills Training Manual DBT

Accepting Reality

This concept focuses on learning to accept reality as it is. Accepting it doesn't mean you like it or are willing to allow it to continue unchanged; it means realizing that the basic facts of the situation are even if they aren't what you'd like them to be. Without this kind of radical acceptance, change isn't possible.

Letting Go of Emotional Suffering

Learn ways to observe and describe your emotion, separate yourself from it, and let go of it. One of Linehan's basic principles is that emotion loves emotion, and this worksheet is designed to help you experience your emotions with amplifying them or get caught in a feedback loop.

Distraction

Distraction is simply doing other things to keep yourself from self-harming. Most of the techniques mentioned above are distraction techniques; you bring something else in to change the feeling. Using ice, rubber bands, etc, is substituting other intense feelings for the self-injury. Other things Linehan suggest substituting include experiences that change your current feelings, tasks (like counting the colors you can see in your immediate environment) that don't require much effort but do take a great deal of concentration, and volunteer work.

Improve the Moment

This worksheet focuses on ways to make the present moment more bearable. It differs from distraction in that it's not just a diverting of the mind but a complete change of attitude in the moment.

Evaluating the Pros and Cons of Tolerating Distress

As the name implies, this worksheet leads you through an evaluation: what are the benefits of doing this self-harming thing? What are the benefits of not doing it? What are the bad things about doing it? About not doing it? Sometimes writing this down can help you make a decision not to harm.

Self-Soothing

This, like improving the moment and distracting, is a distress tolerance technique. It's pretty straightforward: use things that are pleasing to your senses to soothe yourself. Some people find that active distraction works better for violent angry feelings and soothing is more effective for soft, sad ones.

Reducing Vulnerability to Negative Emotion

Prevention of states in which you are likely to self-harm is covered in this worksheet, which suggests ways of taking care of yourself in order to minimize the times when you feel the urge to hurt yourself. If you're balancing eating, sleeping, and self-care, you're less likely to be overwhelmed by emotion.

Interpersonal Effectiveness

Being clear about what you want and about your priorities in an interaction are crucial to good communication, and this worksheet offers a series of questions and steps to follow to help you determine how to approach a difficult interpersonal interaction.

Just Kissing .......

We were just kissing

Syphilis:

It may sound like a disease that died out in the 19th century, but syphilis is still well and truly with us, and can have devastating effects if left untreated.

It is also a major problem in our cities.

What is it and how is it passed on?

Syphilis is a bacterial infection, sometimes called 'the pox'. It has several stages: primary and secondary stages, which are very infectious, and the third or latent stage, which occur if the infection is left untreated.

Syphilis is easily passed on through:

• vaginal, oral or anal sex
• sharing sex toys
• intimate close body contact with syphilis sores or rashes
• from a mother to her unborn baby

You can't catch syphilis from hugging, sharing baths or towels, or from toilet seats or swimming pools. But you can catch it from kissing near a sore or rash.

Signs and symptoms

The symptoms of syphilis can be difficult to recognize and can be missed. They can take up to three months to show after sex with an infected person.

Primary stage syphilis:

• Three to four weeks after infection, one or more painless sores appear. In women, these may be on the vulva (lips of the vagina), urethra (tube where the urine comes out) or cervix (entrance to the womb). In men, they may be on the penis or foreskin.
• Sores can also appear around the anus and mouth in both sexes and are very infectious. They may take up to six weeks to heal.

Secondary stage syphilis:

• If the infection isn't treated, three to six weeks after the sores have gone the following symptoms appear: a non-itchy rash that covers the whole body; wart-like growths on the vulva or around the anus; a flu-like illness, including swollen glands, sore throat and headache; white patches in the mouth; patchy hair loss.
• These symptoms can last several weeks or months. Second stage syphilis is very infectious.

What happens if it isn't treated?

Latent stage syphilis:

Once the sores and rash have cleared up, there may be no symptoms for many years. This is called third stage or latent syphilis.

Latent syphilis develops about ten years after first infection. It can cause very serious damage to the heart, brain, eyes, other internal organs and nervous system which can be fatal. The individual may suffer blindness, mania and other heart rending issues.

Tertiary Syphilis:

In tertiary syphilis, the spirochetes have continued to reproduce for years. Pockets of damage accumulate in various tissues such as the bones, skin, nervous tissue, heart, and arteries. These lesions are called gummas and are very destructive.

Lesions in the central nervous system produce neurological disease called neurosyphilis which can include tabes dorsalis, general paresis, and optic atrophy. Lesions of the heart, heart valves and aorta can lead to aneurysms, valvular heart disease, and aortitis.

Tertiary syphilis is less frequently seen today than in the past because of early detection and adequate treatment. The incidence of tertiary syphilis is approximately 5 per 100,000 individuals annually in the US.

Symptoms of tertiary syphilis depend on which organ systems have been affected. They vary widely and are difficult to diagnose. In individuals with tertiary syphilis the primary and secondary stages of syphilis usually have been long forgotten. Medical findings of aortic aneurysms and neurological problems require astute diagnostic ability to link them to syphilis. Some of the symptomatic problems are listed below.

• Infiltrative tumors of skin, bones, or liver (gumma)
• Cardiovascular syphilis which affects the aorta and causes aneurysms or valve disease
• Central nervous system disorders (neurosyphilis)

Testing and treatment

Tests shouldn't be painful, but may be uncomfortable. They may include:

• blood and urine samples
• taking a swab from the sores
• examining the genitals and entire body
• an internal examination for women

Treatment is simple during the primary and secondary stages, and involves either a single antibiotic injection or two-week course of antibiotic tablets. It can also be treated during the third or latent stage, but any damage done to the body may be irreversible.

Any unprotected vaginal, oral and anal sex should be avoided until treatment is completed and the infection has cleared up. Direct contact between the sores and rashes and a partner should also be avoided until treatment is complete.

To avoid re-infection, all sexual partners should also be treated.

All pregnant women in the UK are tested for syphilis.

Treatment can be safely given to pregnant women with no risk to the unborn baby. Left untreated, syphilis during pregnancy can lead to miscarriage or stillbirth.

is of Gonorrhea bacteria.

This is becoming a major problem for all of us - not just those people who have casual sex - ALL of us!

Anyone who has sex can catch a sexually transmitted disease. Left alone any one of these diseases can have long term and dangerous results.

Gonorrhea

About 50% of all women and 10% of men do not show symptoms of "the Clap"

Any symptoms that do occur may be noticed one to 14 days after infection. Gonorrhoea in the throat rarely shows symptoms.

Symptoms in women:

• strong smelling vaginal discharge that may be thin/watery or yellow/green
• pain when passing urine
• irritation or discharge from the anus
• possibly some low abdominal or pelvic tenderness

Symptoms in men:

• white, yellow or green discharge from the tip of the penis
• inflammation of the testicles and prostate gland
• pain when urinating
• irritation or discharge from the anus

Testing and treatment

Tests for gonorrhea shouldn't be painful, but they may be uncomfortable. They involve:

• giving a sample of urine
• a genital examination by a doctor or nurse
• taking swabs from the cervix (entrance to the womb), urethra (tube where the urine comes out), throat or rectum

Early treatment is simple and effective and involves a single dose of antibiotics. This is followed by a second test a month later to make sure the infection has gone. If complications occur another treatment may be needed.

It's important not to have unprotected vaginal, oral or anal sex until treatment is completed and the infection has cleared up.

Once gonorrhea is successfully treated it won't come back unless a new infection is picked up. To avoid re-infection, any sexual partners should be treated too.

What happens if it isn't treated?

Without treatment, gonorrhoea can spread to other reproductive organs causing damage and serious long-term health problems.

In women, gonorrhoea can cause pelvic inflammatory disease. This can lead to:

• blocked fallopian tubes (the tubes which carry the egg from the ovaries to the womb), which can result in reduced fertility or infertility
• long-term pelvic pain
• ectopic pregnancy (a pregnancy outside the womb)

A mother with gonorrhoea can pass an eye infection to her baby at birth. If untreated, this can lead to blindness.

In men, gonorrhoea can lead to:

• pain and inflammation of the testicles
• inflammation of the prostate gland and infertility

Chlamydia

Signs and symptoms

Around 70% of women and 50% of men who have chlamydia show no symptoms at all; others may have symptoms so mild they aren't noticed.

Symptoms in women:

• an unusual vaginal discharge
• pain when passing urine
• bleeding between periods
• pain during sex or bleeding after sex
• low abdominal pain

Symptoms in men:

• white/cloudy, watery discharge from the tip of the penis
• pain or a burning sensation when passing urine
• testicular pain and/or swelling

Testing and treatment

The tests for chlamydia aren't usually painful but they may be uncomfortable. Either a urine test is done or a swab is taken from the urethra (the tube where urine comes out), the cervix (entrance to the womb), rectum, throat or eye.

Cervical smear tests and blood tests don't detect infections such as chlamydia.

Chlamydia is simple to treat with antibiotics, either a single dose or a course lasting up to two weeks. To avoid re-infection, any sexual partners should be treated too. If complications occur, another treatment may be needed.

Once chlamydia has been successfully treated, it won't come back unless a new infection is picked up.

In 2000, more than 39,000 cases of chlamydia were diagnosed among 16- to 24-year-olds in England, Wales and Northern Ireland.

What happens if it isn't treated?

Without treatment, the infection can spread to other parts of the body causing damage and serious long-term health problems.

In women, chlamydia can cause pelvic inflammatory disease. This can lead to:

• ectopic pregnancy (a pregnancy outside the womb)
• blocked fallopian tubes (the tubes which carry the egg from the ovaries to the womb), which can result in reduced fertility or infertility
• long-term pelvic pain
• early miscarriage or premature birth

Chlamydia can be safely treated during pregnancy and breastfeeding, but if untreated can cause an eye infection or pneumonia in the baby at birth.

In men, chlamydia can lead to:

• painful inflammation of the testicles, which may result in fertility problems
• Reiter's syndrome (inflammation of the joints, urethra and eyes)

Pubic lice

Scabies

Trichomonas vaginalis (TV)

Thrush

Genital warts

Non-specific urethritis (NSU)

For information only - this does not represent medical advise. Please talk with your health care professional.

Acupressure Points for Stress Headache

Simple Infection Prevention

STRESS!

DO YOU:

1. find it difficult to say 'no' to additional commitments or responsibilities

2. feel like you have been under intense and sustained pressure for some time

3. feel like other people do not match up to expectations and you dare not delegate

4. you are being asked for more than you can give, or that you are tired of being considered the leader.

5. you just don’t give-a-damn, your work lacks interest , or your performance is not up to your standard – however hard you try!

6. An intense desire to run away. Panic

7. Feel irritable and tired, yawn a lot or swallow without real need

8. Food lacks flavor, nothing is funny, just want to sit …..

Symptoms of Burnout

Burnout will normally occur slowly, over a long period of time. It may express itself physically or mentally:

Physical Burnout

Feelings of intense fatigue

Vulnerability to viral infection

Immune breakdown

Mental Burnout

Feeling of lack of control over commitments

An incorrect belief that you are accomplishing less

A growing tendency to think negatively

Loss of a sense of purpose and energy

Increasing detachment from relationships that causes conflict and stress, adding to burn-out

Late Stages of Burn-Out

If you are in late stages of burn-out, feeling deeply demotivated and disenchanted with life get help from a good friend or someone who is honest in their perception of your behaviors. TALK, DESCRIBE and VALIDATE. Consider therapy.

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If you are in Danger of Burning Out...

If you feel that you are in danger of burning out, or are not enjoying your life, the following points can help you correct the situation:

First:

Learn to say NO to commitments that you do not want to take on - otherwise you will be in severe danger of burning out as you become unhappy with your situation. Involvement must be fun, otherwise there is no point in doing it.

Re-evaluate your goals and prioritize them , even change the way you look at them

Evaluate the demands placed on you and see how they fit in with your desires or choices

Identify your ability to comfortably meet these demands.

If you are over-involved, reduce the commitments that are excessive

If people demand too much emotional energy, become more unapproachable and less sympathetic , then try consciously to involve other people in a supportive role. You owe it to yourself to avoid being bled dry emotionally.

Learn stress management skills

Examine other areas in your life which are generating stress, such as work or family, and try to solve problems and reduce the stress

Get the support of your friends and family in reducing stress

Daily:

Ø Ensure that you are eating a healthy, balanced diet - a bad diet can make you ill or feel bad. Watch your caffeine and alcohol intake . Eat several snacks a day and avoid taking your main meal of the day at night.

Ø Acknowledge your own humanity: remember that you have a right to pleasure and a right to relaxation

Ø Check in with your body several times a day – are you hot, cold, skin dry … and take steps to correct that. To be aware and de-escalate try

Ø Meet with yourself in the morning to plan your day and at night to review and prepare.

Ø When you get home do something that ends your work day

General Issues:

Exercise the body to shake off the dust. It will revive you. The best

cardiovascular activities include walking, swimming, and

jogging. But anything physical works. Simple Office Stretches

Leave your work at work. If you must lug home

work, get it done early in the evening. Better yet,

do it in the office and leave it there.

Don't schedule all of your leisure time. You live by a

schedule all day long. Leave yourself some "open space."

Get plenty of veg-out time. If you are well rested, problems do

not always seem so large. Try napping for less than 20 minutes.

Pursue a project or hobby. Find something that

requires so much concentration that you forget about

work for a while.

Find a friend. Enlist a trusted listener. Talking a problem

out won't make it go away, but it will relieve some of the

stress associated with the problem.

Don't procrastinate. Having something "hanging over

you" can cause more tension than the project is worth.

Don't feel that you must do everything. You can't and

you won't. So why worry about it?

Keep a "things to do" list. Review it daily and do at

least one or two things. But limit yourself to what is possible.

As the list gets smaller, you will

feel a sense of accomplishment.

Recognize and accept your limitations. Most of set

unreasonable and perfectionist goals for ourselves. But,

we can never be perfect, so we can come to feel a sense

of failure or inadequacy no matter how well we perform.

Think “I Want …..”

Learn to tolerate and forgive. Intolerance and judging

others often lead to frustration and anger. Try to really

understand the other person's concerns and fears.

Learn to plan. Disorganization breeds stress. Having too

many projects going at the same time leads to

confusion, forgetfulness and a sense of uncompleted

tasks. Plan ahead. Develop your own method of getting

things done in an orderly manner.

Learn to play. You need to escape from the pressures of

life and have fun regularly. Find pastimes or hobbies

regardless of your level of ability.

Rid yourself of worry. A study has shown that 40

percent of the items people worry about never happen;

35 percent can be changed; 15 percent turn out better

than expected; 8 percent involve needless concern; and

only 2 percent really deserve attention.

Things to Do : and some words for thought!

Body Check

Mind Vacuuming

Bridges

Awareness

Imagine Possibilities

Validation and Vulnerability

Renunciation

Storytelling

Ghost Elimination

Felt-Sense Experience

Meaning

Simple Office Stretches

Ø A. Defer and Revisit:

When a thought bothers you to the point where it interrupts your flow, write a phrase down and promise that you will come back to it later. Then it is out of the back of your head and onto the paper.

Designate a ‘worry period’. Take ten minutes ( no more than half an hour) and sit down with your list.

What can be resolved note for action. What can’t be resolved just note

Get up and change task – do something nice for yourself.

Ø B. Fun or Funny:

Each day look for conversations, scenes, or items that are interesting or fun. Note achievements and write down a phrase that will help remind you when you recollect later that day. If you have a partner – share these with him or her each day

Ø C: Lucid Dreaming:

If you can’t sleep, relax – tell yourself a story and just rest. Weave an issue into the dream by use of metaphors … and above all, do not worry about not sleeping.

Ø D. Food:

Honey and warm milk ( and for some people carbohydrates ) are good relaxants.

Try and eat four smaller meals a day remembering that 4:00am and 4:00pm are Nature’s alarms.

Ø E. Doodle and Coloring

Ø F. Stop Comparing

Ø G. Stretch and breathe frequently throughout the day.

Ø H. Think Wishes not Needs

Try not to set goals but look at aspirations or things that you would like to do. Then you will not feel dissatisfied if you do not realize goals, and you will enjoy the journey.

Ø Chunking

– not Chinese food but a way of managing tasks by doing them in short (20-40 minute ) bursts. Start and end with something you can complete and break up the bursts by a change in task – even looking up and beyond the immediate surroundings.

Ø J. Business Meetings : both domestic and professional

Ø K. An adventure a week!

… And now for some extraneous words --- Looking through the eyes of the other …. And come upon one’s self as Stranger.

Fore-give-ness - rehearsal - passion - the message is more important than the messenger - real-job and job-job – choice not need