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JimRP

Psychology Guide

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JimRP    171

The guide below was made (previously private for L.I.F.E but now public) with a lot of research (googling etc), my previous RP experience among other docs I had laying around on my PC. 

Psychology

Table of Contents

- About Psychology

- Rules and Regulations

- Rank Authority

- Psychological Resources

- The psychological process

What is Psychology?

Psychology is both an applied and academic field that studies the human mind and behavior. Research in psychology seeks to understand and explain how we think, act and feel. As most people already realize, a large part of psychology is devoted to the diagnosis and treatment of mental health issues, but that's just the tip of the iceberg when it comes to applications for psychology. In addition to mental health, psychology can be applied to a variety of issues that impact health and daily life including performance enhancement, self-help, ergonomics, motivation, productivity, and much more.

Goals of Psychology

There are four main goals that a psychologists aims for; explain, predict, modify and improve behavior:

  • To be able to describe human thought and behaviour
  • Explain why the behaviours occur
  • To predict triggers of these behaviours in the future (How, why and when).
  • To better the lives of individuals and society by modifying/improving these behaviours.

Types of Psychology

There are many areas to Psychology due to it being such a broad and diverse field. All of these aren't studied within the L.I.F.E due to the vast amounts of research and training needed. Within L.I.F.E the following sub-fields/speciality areas are used:

Clinical psychology


  • Treatment of people who exhibit mental or emotional disorders which range from uncomfortable reactions to the stress of daily life to extreme psychological disorders.

Community psychology


  • specializes in human behavior at home, at school, and in neighborhoods.

Counseling psychology


  • Help patients adjust to life, make important decisions, and help people cope. This field of human behavior is similar to clinical psychology.  

Health psychology


  • A branch of human behavior that is concerned with the psychological implications of actions on health. For instance: Addiction, smoking, weight gain, stress management and fitness can affect our mental health – and that’s what health therapists focus on.

Rules and Regulations

__________________________________________________________________________________________

1) As a member of L.I.F.E you are first and foremost obligated to follow the organization's rules. As such breaching of said rules will follow with disciplinary actions being taken on a departmental and divisional scale. Even if you are simply a part-time member, rules always apply from L.I.F.E.

2) As a member of the Psychology clinical team you are obligated to follow the rules listed here as well as keeping the ethical rule of conduct. Should a conflict arise between the rules listed here and the L.I.F.E rules the latter has the upper authority.

3) You must always listen to orders given you by a higher ranked member in the division, even when against the rules listed here. Should the situation arise you are to report the incident to the Lead Psychologist. You will not be punished for doing so under this rule. Exception: In a situation where the order violates the patient's rights or seen as a extremely grotesque and out of place, you are obligated by federal law to Refuse the order and report the incident to the Lead Psychologist immediately.

4) While working under the psychological unit and it's duties you are not only representing the division but UN it's self, therefore you are to maintain high level of professionalism at all times.

5) All patient information is strictly classified to members of the psychological unit, you are not to discuss your patient with anyone but psychological unit staff, unless under the patient's written consent or if there is a suspicion of an imminent threat to the patients life or the life of others, in which case you are obligated by federal law to report the situation to a law enforcing officer. Breaching this rule is a federal offence.

6) All prescription must to be documented in the patient's case-file and in the department's prescription database.

7) Your rank in the division has no authority on manners which do not concern the division, you have no privileges what so ever over other members of the department.

8) All psychological activities must take place in either the Crisis center, or one of the huts. Exceptions can be made by contacting Dr Manuel or Dr Hope.

9) There are no psychological patrols unless you are a part-time psychologist, you are on psychology duty only when you are with a patient.

Below I will list the hypothetical, realistic hierarchy for the psychology department from real life.

Command Staff

Lead Psychologist


  • - Leads the Psychology clinical team as its Commander.- May promote and demote members as he/she sees fit.- May suspend or discharge members as he/she sees fit.- Command in unit related tasks over lower ranks.- Everything mentioned below.

Vice Lead Psychologist


  • - Leads the Psychology clinical team in the absence of the Lead Psychologist.- Assists in the overall management of the clinical team.- May suspend members if deemed pressing without permission from the Lead Psychologist.- Command in unit related tasks over lower ranks.- Ability to promote members if they meet requirements.- May give final verdict on applications based upon the reviews.- Everything mentioned below.

Supervising Psychologist


  • - May give opinions on applications for the unit.- May supervise case files made by lower ranks and make an input with his/her opinion on them.- May vote on a promotion for lower ranks.- Ability to hold group sessions completely on their own even if they are unscheduled- Discuss promotions for every rank below them, including Auxiliary Psychologist.- Can grant permission to Psychologists to prescribe medication.- Command in unit related tasks over lower ranks.- Everything mentioned below.

Auxiliary Psychologist


  • - Part of the Command team.- Ability to mark psychology exams.- Discuss promotions.- May supervise case files made by lower ranks and make an input with his/her opinion on them.- Assists in the overall management of the clinical team.- Ability to hold unscheduled group sessions if with any other psychologist that is part of the unit.- Able to hold scheduled group sessions on their own, completely.- Command in unit related tasks over lower ranks.- Everything mentioned below.

Non-Command Staff

Senior Psychologist


  • - May prescribe medication without permission, must be documented.- Able to host group sessions on their own if scheduled group sessions and no command is available.- Everything mentioned below.

Psychologist


  • - May assist a trial psychologist during his/her session.- Able to prescribe psychiatric medication with permission from Supervising Psychologists or higher (see exceptions).- Able to assist in any group session.- Everything mentioned below.

Trial psychologist


  • - Most request permission from a Auxiliary Psychologist+ higher to give medications (see exceptions).- Authority over all part time psychologists.- Must take their examination if they want to rank up and begin one (1) casefiles.

Rank Authority

__________________________________________________________________________________________

Part time psychologists:

__________________________________________________________________________________________

Psychologists


  • - Ability to hold psychology sessions on their own, fully.- Unable to attend group sessions.- Unable to prescribe any medication.- Does not attain any authority over full time employees.

Psychologists that have passed their exam are able to prescribe medication and attend all group sessions. The examination is optional for part-time, required to rank up for full time.

Exceptions:

- Psychologists do not require permission to administer medication on the spot in cases of imminent threat to the patient's well being or those of others. However those are short-term prescriptions only and must be discussed about with a senior psychologist or higher and informed about.

Psychology Resources

Medical Cabinet

There will be times when a prescription is needed to aid a patient, these are to be used as a last resort and not something given out lightly. Ensure all other techniques have been used first. There are medical cabinets located in each of the Psychologist offices, to the right as you walk into the room. All cabinets are locked and you have been provided with the key for access on acceptance into the team.

Journals/photoalbums

It is common practice in the unit whereby in some cases we give patients journals to document their thoughts for their own benefits — for example, those with anger problems may be asked to write about their feelings before the situation, during it and afterwards, how they have calmed down and whatnot — this helps themselves to understand how they are thinking, either negatively or positively. In another case it may be asked that one dealing with grief produces a photoalbum of good memories with their deceased relative/friend and is able to remember and celebrate their lives.

Resources Library

Our library contains a large amount of reading material which you can refer to to expand your knowledge. Everyone is required to read and study the books's topics in order to function properly. You may study the rest if you feel like expanding your knowledge to shine in the team. As the division continues to operate our database will slowly grow, and of course if you want to add something feel free to contact the Lead Psychologist.


Depression

__________________________________________________________________________________________

Depression is a mental disorder with the main effect of mental depressiveness. In psychiatry, the disorder is classed under the ICD-10, separated in: 

  • Recurrent depressive disorder
  • depressive episode
  • mild depressive episode
  • moderate depressive episode
  • severe depressive episode without psychotic symptoms
  • severe depressive episode with psychotic symptoms.

Recurrent depressive disorder (RDD)

Recurrent depressive disorder describes the tendency of the patient to suffer recurrent episodes of depressed mood. RDDs have different severity.

Mild RDD:

- sad feeling and appearance

- sad thought processes

- biological symptoms

Severe RDD:

- delusions of worthlessness

- hallucinations

- suicidal ideas

Diagnostic

Key symptoms:

- persistent sadness or low mood; and/or

- marked loss of interests or pleasure

- at least one of these, most days, most of the time for at least 2 weeks

if any of above present, ask about associated symptoms:

- disturbed sleep (decreased or increased compared to usual)

- decreased or increased appetite and/or weight

- fatigue or loss of energy

- agitation or slowing of movements

- poor concentration or indecisiveness

- feelings of worthlessness or excessive or inappropriate guilt

- suicidal thoughts or acts

RDD Treatment

Depending on the associated factors of the patients depression the following treatments are to be provided:

1. General advice and active monitoring:

- Four or fewer of the above symptoms with little associated disability symptoms intermittent,

- Less than 2 weeks' duration recent onset with identified stressor

- No past or family history of depression

- Social support available

- Lack of suicidal thoughts

2. Active treatment in primary care:

- Five or more symptoms with associated disability

- Persistent or long-standing symptoms

- Personal or family history of depression

- Low social support

- Occasional suicidal thoughts

3. Referral to mental health professionals:

- Inadequate or incomplete response to two or more interventions

- Recurrent episode within 1 year of last one

- History suggestive of bipolar disorder

- The person with depression or relatives request referral

- More persistent suicidal thoughts

- Self-neglect

4. Urgent referral to specialist mental health services

- Actively suicidal ideas or plans

- Psychotic symptoms

- Severe agitation accompanying severe symptoms

- Severe self-neglect.

Severe depressive episode with psychotic symptoms

According to the National Institute of Mental Health, a person who is psychotic is out of touch with reality. For example, they may think that others can hear their thoughts or are trying to harm them. Or they might think they are possessed by the devil or are wanted by the police for having committed a crime that they really did not. 

People with psychotic depression may get angry for no apparent reason. Or they may spend a lot of time by themselves or in bed, sleeping during the day and staying awake at night. A person with psychotic depression may neglect appearance by not bathing or changing clothes. Or that person may be hard to talk to. Perhaps he or she barely talks or else says things that make no sense.

Treatment of SDEWPS

Usually, treatment for psychotic depression is given in a hospital setting. That way, the patient has close follow-up with mental health professionals. Different medications are used to stabilize the person's mood, including combinations of antidepressants and antipsychotic medications. A common medicine is Risperidone.

Schizophrenia

One in a hundred people will develop schizophrenia. It is a long term illness that can be developed and thus far has no cure available but psychologists can always help. The causes are unknown. The media and social culture has provided much misinformation about schizophrenia more than anything else. It is commonly associated with "hearing voices" and whilst this can be true schizophrenia doesn't always mean the patient has schizophrenia.

The early stage is called ‘the prodromal phase’. During this phase the patient's sleep, emotions, motivation, communication and ability to think clearly may change.

If the patient becomes unwell this is called an ‘acute episode’. They may feel panic, anger or depression during an acute episode. Their first acute episode can be a shocking experience because they are not expecting it or prepared for it.

"Schizophrenia is a brain disorder that affects the way a person behaves, thinks, and sees the world. People with schizophrenia often have an altered perception of reality. They may see or hear things that don’t exist, speak in strange or confusing ways, believe that others are trying to harm them, or feel like they’re being constantly watched. This can make it difficult to negotiate the activities of daily life and people with schizophrenia may withdraw from the outside world or act out in confusion and fear.

Although schizophrenia is a chronic disorder, there is help available. With support, medication, and therapy, many people with schizophrenia are able to function independently and live fulfilling lives."

Myths

"Schizophrenia means someone has a split personality"

One error is that schizophrenia means that people have multiple or split personalities. This is not the case. The mistake may come from the fact that the name 'schizophrenia' comes from two Greek words meaning 'split' and 'mind'. 

"Schizophrenia causes people to be Violent"

People with a diagnosis of schizophrenia are more likely to be a danger to themselves than other people. Unfortunately some people with the illness may become violent because of delusional beliefs or the use of drugs or alcohol. Because these incidents can be shocking, the media often report them in a way which emphasises the mental health aspects. This can create fear and stigma in the general public. Only a small minority of people with the illness may become violent, much in the same way as a small minority of the general public may become violent.

Symptoms

A large variety of symptoms that also are dependant on the type of schizophrenia.

  • a lack of interest in things
  • feeling disconnected from your feelings
  • difficulty concentrating
  • wanting to avoid people
  • hallucinations
  • hearing voices
  • delusions
  • feeling like you need to be protected.
  • unable to tell what is real and what isn't

Effects

When the signs and symptoms of schizophrenia are ignored or improperly treated, the effects can be devastating both to the individual with the disorder and those around him or her.  Some of the possible effects of schizophrenia are:

Relationship problems. Relationships suffer because people with schizophrenia often withdraw and isolate themselves. Paranoia can also cause a person with schizophrenia to be suspicious of friends and family.

Disruption to normal daily activities. Schizophrenia causes significant disruptions to daily functioning, both because of social difficulties and because everyday tasks become hard, if not impossible to do. A schizophrenic person’s delusions, hallucinations, and disorganized thoughts typically prevent him or her from doing normal things like bathing, eating, or running errands.

Alcohol and drug abuse. People with schizophrenia frequently develop problems with alcohol or drugs, which are often used in an attempt to self-medicate, or relieve symptoms. In addition, they may also be heavy smokers, a complicating situation as cigarette smoke can interfere with the effectiveness of medications prescribed for the disorder.

Increased suicide risk. People with schizophrenia have a high risk of attempting suicide. Any suicidal talk, threats, or gestures should be taken very seriously. People with schizophrenia are especially likely to commit suicide during psychotic episodes, during periods of depression, and in the first six months after they’ve started treatment.

Diagnosis

The presence of two or more of the following symptoms for at least 30 days:


  • 1.Hallucinations2.Delusions3.Disorganized speech4.Disorganized or catatonic behavior5.Negative symptoms (emotional flatness, apathy, lack of speech)
  • Significant problems functioning at work or school, relating to other people, and taking care of oneself.
  • Continuous signs of schizophrenia for at least 6 months, with active symptoms (hallucinations, delusions, etc.) for at least 1 month.
  • No other mental health disorder, medical issue, or substance abuse problem is causing the symptoms.

Types

Voluntary/involuntary psychology hold can help with finding out the specific type if you choose so.

Paranoid schizophrenia

  • Common form of schizophrenia. 
  • Prominent hallucinations and/or delusions
  • May develop at a later age than other types of schizophrenia. 
  • Speech and emotions may be unaffected.

Hebephrenic schizophrenia

 

  • Behaviour is disorganised and without purpose. 
  • Thoughts are disorganised, other people may find it difficult to understand you. 
  • Pranks, giggling, health complaints, grimacing and mannerisms are common. 
  • Delusions and hallucinations are fleeting.
  • Usually develops between 15-25.

Catatonic schizophrenia

  • Rarer than other types.
  • Unusual movements, often switching between extremes of over-activity and stillness. 
  • You may not talk at all.

Undifferentiated schizophrenia

  • Your illness meets the general criteria for a diagnosis and may have some characteristics of paranoid, hebephrenic or catatonic schizophrenia, but does not obviously fit one of these types.

Residual schizophrenia

  • You may be diagnosed with this if you have a history of psychosis but only have negative symptoms.

Simple schizophrenia

  • Rarely diagnosed. 
  • Negative symptoms are prominent early and get worse quickly. 
  • Positive symptoms are rare.
  • Other, including ‘cenesthopathic’ schizophrenia
  • Schizophrenia which has traits not covered by other categories. 
  • For example, in cenesthopathic schizophrenia, people experience unusual bodily sensations. 
  • Unspecified schizophrenia
  • Symptoms meet the general conditions for a diagnosis, but do not fit in to any of the above categories.

Symptoms

"Positive" symptoms:

The terms ‘positive symptoms’ and ‘psychosis’ are generally used to describe the same symptoms. This can refer to:

  • Hallucinations (all senses, smell, touch, visual, auditory [hearing voices, most common hallucination] etcetera)
  • Delusions 
  • Disorganised thinking

Hearing voices or other sounds is the most common hallucination.

Hearing voices can be different for everyone. The voice itself can be one you know or one you’ve never heard. It can be female, male, in a different language, or have a different accent to the one you’re familiar with. The voice may whisper, shout or talk. They may be negative and disturbing. You might hear voices every now and then, or you might hear them all of the time.

Delusions

Delusions are fixed beliefs which do not match up to the way other people see the world. You may not be able to balance evidence for or against your belief, and you may look for ways to prove the way you see things.

Delusions may take on different themes – if you experience paranoid delusions you may believe you are being chased, plotted against or poisoned. You may believe that a member of your family or someone close to you is making this happen. It is also common to believe that the government or aliens are responsible. Another theme could be a delusion of grandeur, in which you believe you are a famous or important person.

Other types of delusions include believing that people on television are sending messages to you, or that your thoughts are being broadcast aloud. You may feel overwhelmed and act differently due to your beliefs.

Disorganised thinking

Another symptom is ‘disorganised thinking’. You might start talking quickly or slowly, and the things you say might not make sense to other people. You may switch topics without any obvious link. This is known as ‘word salad’.

If you get a diagnosis of schizophrenia, it does not mean you have all these symptoms. The way that your illness affects you will depend on the type of schizophrenia that you have. This is explained in the next section. You may meet the criteria for a diagnosis without having hallucinations or confused thinking, for example.

"Negative" symptoms:

These are symptoms that involve loss of ability and enjoyment in life. They can include:

  • lack of motivation
  • slow movement
  • change in sleep patterns
  • poor grooming or hygiene
  • difficulty in planning and setting goals
  • not saying much
  • changes in body language
  • lack of eye contact 
  • reduced range of emotions
  • less interest in socialising or hobbies and activities 
  • low sex drive.

Negative symptoms are much less dramatic than psychotic symptoms. They may last longer, and stay after positive symptoms fade away. Many people with schizophrenia feel that the negative symptoms of their illness are more serious than the positive symptoms. Negative symptoms can vary in severity.

Treatment

Following is the recommended treatment plan but is subject to adjustment at your discretion. It has been adapted for roleplay purposes.

1) Motivate the patient for change. Schizophrenia is treatable. Currently, there is no cure for schizophrenia, but the illness can be successfully treated and managed. The key is to have a strong support system in place and get the right treatment for your needs. They can enjoy a fulfilling, meaningful life. When treated properly, most people with schizophrenia are able to have satisfying relationships, work or pursue other meaningful activities, be part of the community, and enjoy life.

2) Educate the patient about schizophrenia. All the information is listed above. Go through some myths if you want to as well! (Psycho-education)

3) Medication can be given but it is not a cure. The negative symptoms are relived but not all of them. You can use: Chlorpromazine, Haloperidol and Loxapine. 

4) Cognitive behavioural therapy (CBT).

Good resource on CBT, different to below.

CBT is based on the idea that the way we think about situations can affect the way we feel and behave. For example, if you interpret a situation negatively then you might experience negative emotions as a result, and those bad feelings might then lead you to behave in a certain way.

If your negative interpretation of situations goes unchallenged, then these patterns in your thoughts, feelings and behaviour can become part of a continuous cycle:

cbt-diagrams_500x369.jpg

What will you do? How can you treat a patient with mental issues?

In CBT you work with a therapist to identify and challenge any negative thinking patterns and behaviour which may be causing you difficulties. In turn this can change the way you feel about situations, and enable you to change your behaviour in future.

You and your therapist might focus on what is going on in your life right now, but you might also look at your past, and think about how your past experiences impact the way you see the world.

"CBT is learning to stop the cycle of negative thinking. I still have relapses now and it is the one tool that I use to get me out of the truly dark spots."

5) Avoiding alcohol and all drugs apart from prescribed medication.

6) Regular exercise, plenty of sleep.

7) Do things that make them feel good about yourself. If you can’t get a job, find other activities that give you a sense of purpose and accomplishment. Cultivate a passion or a hobby. Helping others is particularly fulfilling.

Subject: Drug/Alcohol Addiction

People in Chernarus constantly have problems with drug addiction and being addicted to having alcohol, it is hardly even moderated. For this reason we are going to take action and help the people who want the help or who need the help desperately. People use drugs and alcohol as a form of self medication for other problems (e.g. depression) and some people just use it recreationally and end up addicted.

What we have is two things, drug abuse and drug addiction. Whilst some people use these terms interchangeably, this is incorrect. Abuse is simply a generic term for abusing any drug, including alcohol and cigarettes. However drug addiction is different, it is moreso the inability to stop using the drug in spite of numerous attempts definitions so as to correctly identify problem.

Diagnosis

Drug Abuse:

In order to be diagnosed with drug abuse, an individual must exhibit a destructive pattern of drug abuse that leads to significant problems or stress but not enough to qualify as being addicted to a drug. This pattern is manifested by at least one of the following signs or symptoms in the same one-year period:

  • Recurrent drug use that results in a lack of meeting important obligations at work, school, or home
  • Recurrent drug use in situations that can be dangerous
  • Recurrent legal problems as a result of drug use
  • Continued drug use despite continued or repeated social or relationship problems as a result of the drug's effects

Drug Addiction

In order to be diagnosed with a drug addiction, an individual must exhibit a destructive pattern of drug abuse that leads to significant problems as manifested by at least three of the following signs or symptoms in the same one-year period:

  • Tolerance is either a markedly decreased effect of the substance or a need to significantly increase the amount of the substance used in order to achieve the same high or other desired effects.
  • Withdrawal is defined as either physical or psychological signs or symptoms consistent with withdrawal from a specific drug, or taking that drug or one chemically close to that drug in order to avoid developing symptoms of withdrawal.
    Larger amounts of the drug are taken or for longer than intended.The individual experiences a persistent desire to take the drug or has unsuccessful attempts to decrease or control the substance use.
  • Significant amounts of time are spent either getting, using, or recovering from the effects of the substance.
  • The individual significantly reduces or stops participating in important social, recreational, work, or school activities as a result of using the substance.
  • The individual continues to use the substance despite being aware that he or she suffers from ongoing or recurring physical or psychological problems that are caused or worsened by the use of the drug.

Complications

Drug addiction puts its sufferers at risk for potentially grave social, occupational, and medical complications. Drug addiction increases the risk of domestic violence in families. Individuals with chemical dependency are also much more likely to lose their job and less likely to find a job compared to people who are not drug addicted. Children of drug addicted parents are at higher risk for poor social, educational, and health functioning, as well as being at higher risk for abusing drugs themselves.

In addition to the many devastating social and occupational complications of drug addiction, there are many medical complications of chemical dependency. From the respiratory arrest associated with heroin or sedative overdose to the heart attack or stroke that can be caused by cocaine or amphetamine intoxication, death is a highly possible complication of drug addiction. People who are dependent on drugs are also at higher risk of developing chronic medical conditions as complications of drug addiction. Liver failure and pancreatitis associated with alcoholism and brain damage associated with alcoholism or inhalants are just two such examples.

Tolerance and compulsions

Tolerance: Over time, the brain adapts in a way that actually makes the sought-after substance or activity less pleasurable.

In nature, rewards usually come only with time and effort. Addictive drugs and behaviors provide a shortcut, flooding the brain with dopamine and other neurotransmitters. Our brains do not have an easy way to withstand the onslaught.

Addictive drugs, for example, can release two to 10 times the amount of dopamine that natural rewards do, and they do it more quickly and more reliably. In a person who becomes addicted, brain receptors become overwhelmed. The brain responds by producing less dopamine or eliminating dopamine receptors—an adaptation similar to turning the volume down on a loudspeaker when noise becomes too loud.

As a result of these adaptations, dopamine has less impact on the brain’s reward center. People who develop an addiction typically find that, in time, the desired substance no longer gives them as much pleasure. They have to take more of it to obtain the same dopamine “high” because their brains have adapted—an effect known as tolerance.

Compulsions

At this point, compulsion takes over. The pleasure associated with an addictive drug or behavior subsides—and yet the memory of the desired effect and the need to recreate it (the wanting) persists. It’s as though the normal machinery of motivation is no longer functioning.

The learning process mentioned earlier also comes into play. The hippocampus and the amygdala store information about environmental cues associated with the desired substance, so that it can be located again. These memories help create a conditioned response—intense craving—whenever the person encounters those environmental cues.

Cravings contribute not only to addiction but to relapse after a hard-won sobriety. A person addicted to heroin may be in danger of relapse when he sees a hypodermic needle, for example, while another person might start to drink again after seeing a bottle of whiskey. Conditioned learning helps explain why people who develop an addiction risk relapse even after years of abstinence.

 

Causes

There are a number of causes related to drug and alcohol abuse, including psychological, biological, social, and physiological reasons. A family history of substance abuse can make a person more vulnerable to addiction, and social factors, such as peer pressure and ease of availability can increase the likelihood of a person developing a problem with drugs or alcohol.In addition, once a person begins using heavily, physiological changes take place, and that person may then become physically dependent, requiring him or her to continually use the substance in order to avoid withdrawal symptoms.

People who misuse drugs or alcohol often do so as a way of coping with experiences, memories, or events that emotionally overwhelm them. Whether they are equipped with appropriate coping strategies or not, people who misuse rely on the immediate gratification of the drugs and alcohol as an alternative to facing the issues at hand. In the long term, however, reliance on drugs and alcohol will almost surely worsen any emotional or psychological condition. Chronic self-medication may be a sign that therapy is warranted to address an underlying condition or difficulty. 

Treatment plan

a) Honesty must be achieved. An addiction requires lying. You have to lie about getting your drug, using it, hiding its consequences, and planning your next relapse. An addiction is full of lying. By the time you've developed an addiction, lying comes easily to you. Recovery requires honesty to the patient themselves, to the psychologist, to their family and friends. If they can't be honest, they will not do well in recovery comparatively.

1) Very very often people with drug/alcohol addiction don't have addiction as their sole problem. They can have anger problems, depression and stress and much more. Treatment should be provided for both concurrently.

2) Group therapy worked alongside this treatment plan will be an amazing strategy, people coming together to cope as a group is proven to be more effective for most people.

3) Ensure the patient understands negative effects of drugs - you can list some symptoms of a drug addict, talk about how tolerance and the reward system works in the brain and cravings. If the patient still needs convincing, resource 1 and resource 2.

4) Find out why they are still using drugs and challenge this, or provide them help with it. For example, they can be using drugs for recreational uses and not be addicted yet and this is where you've got to convince them they shouldn't abuse drugs. If they are using it to self-medicate, they need to become aware of this and you need to help them with the underlying problem. Both you and your patient should be aware why they are still taking drugs and that they need to stop (even if it's an addiction phase where they can't control it, they need to be aware and admit to their addiction).

5) If they don't feel an urge to change, use motivational interviewing. As the name implies, the goal of motivational interviewing is to strengthen the motivation to change. We accomplish this by encouraging an accurate appraisal of the costs and benefits of change. Unlike some types of addiction treatment that attempt to coerce people to change, motional interviewing honors and respects ambivalence. Motivational interviewing recognizes there are valid reasons not to change, just as there are valid reasons to change. Through a structured sequence of inquiry, the therapist works directly with a person's ambivalence. Therapists guide therapy participants to make their own decision about whether or not they wish to change. In a sense, MI allows therapy participants to convince themselves of the need to change. This approach avoids the so-called "resistance to change."

Example, a therapy participant may be reluctant to give up cocaine. The therapist would explore this. Through this exploration, the therapist may learn he fears he'll no longer have fun with his friends. An MI therapist would agree this is a valid concern. The therapist then encourages a more thorough and accurate exploration of this concern. Were there times before cocaine use when he had "good times?" Do the people called "friends" have anything else in common with each other besides using cocaine?

6) Identify high risk situations that will cause one to abuse drugs or do their addiction. Make the patient list them and write them down in their journal. People, places and things. They need to be find a way to avoid them however that's not always possible but they need to be aware of these situations so those situations don't catch them out! They need to monitor themselves and see when and where they get cravings.

7) Medication can be given for drug and alcohol addictions, in these cases they don't need to be used as last resorts.

Haloperidol can be given and must be documented in the casefile, this is mostly for things such as cocaine, ecstasy, heroin and other common drugs.

For alcohol we prescribe naltrexone. 

In case of cigarette addictions, bupropion can be prescribed along with common nicotine patches, gums and other products available over the count.

Medication is only used to help with physical and health issues, however it doesn't help with psychological issues, same with detox (see below).

8) Detoxification. Also known as detox, this allows people to live in a drug free environment for a time period of their choosing and is highly effective. It can be from 7 days to 28 days. They are able to go through their withdrawal symptoms with ease and have no drugs around them, all belongings and visitors are searched but it isn't a "prison" environment, there's wifi, cafateria, tv, pool, easily accessible visitors. Before entering the program they will be checked for what drugs they have in their blood along with a person search for any drugs on them obviously. 

// This can be NPCed or roleplayed on the lower floor of the Crisis Centre, but if there's no staff to do a search for new people and such this has to be NPCed by the patient.

9) Coping strategies, this is a big one indeed. Practice relaxation techniques, exercise, altering attitudes to their problems in life and having a more optimistic outlook, mindfulness can help (link). Adopting a new hobby also works.

Get involved in some distracting activity. Reading, a hobby, going to a movie, exercising (jogging, biking) are good examples of distracting activities. Once you get interested in something else, you’ll find the urges go away. Another effective response to a drug craving is eating (but be careful what you eat, as eating junk will only add stress and inches to your waistline).

 

Adequate sleeping and setting goals for oneself also helps people cope. It's through a combination and techniques listed below to manage coping with cravings and these are essential along with avoiding high-risk situations.

  • Talk it through. Talk to friends or family members about craving when it occurs. Talking about cravings and urges can be very helpful in pinpointing the source of the craving. Also, talking about craving often helps to discharge and relieve the feeling and will help restore honesty in your relationship. Craving is nothing to feel bad about.
  • Urge surf. Many people try to cope with their urges by gritting their teeth and toughing it out. But some are just too strong to ignore. When this happens, it can be useful to stay with the urge until it passes. This technique is called urge surfing. Imagine yourself as a surfer who will ride the wave of your drug craving, staying on top of it until it crests, breaks, and turns into less powerful, foamy surf.
  • Challenge and change your thoughts. When experiencing a craving, many people have a tendency to remember only the positive effects of the drug and forget the negative consequences. Therefore, you may find it helpful to remind yourself that you really won’t feel better if you use and that you stand to lose a lot. Sometimes it is helpful to have these benefits and consequences listed on a small card that you keep with you.

10) Relapses are abusing one's drug or addiction throughout the process of recovery. These are very common and there are a variety of reasons for this, such as testing personal control (“I can have just one drink”) or giving in to cravings however patients MUST realise these are common part of the recovery process. They are discouraging and frustrating, understandably but after going through one they can learn from their mistake and immediately after having a relapse they should start the recovery again, not give up or something like that - they need to talk with friends and their psychologist again and gain support. 

In 5 years time after recovery relapses are close to impossible!


Psychology Hold

Something that we took about a lot here if you're part of the Psychology Unit, a CITY psychologist or part-time psychologist. I'll explain what it means.

When is a "Psychology Hold" done?

Psychology holds are done for high-risk patients and are done before a session. If your patient immediately appears to be a red rating and has a medium-high chance of committing chance that will harm themselves or perhaps others in a short span of time then they need a psychology hold. They are always done for 72 hours.

Why is it done?

A psychology hold is done to simply diagnose someone straight away and intensely, instead of having one psychologist do a diagnosis that could take multiple-sessions, we have a team dedicated to doing it. We can determine the severity the patient poses from a psychology hold and can decide the best form of treatment for the patient from one psychology hold.

It can be done for various reasons: suicidal person, someone who inflicts harm upon themselves; someone who's being constantly arrested and seems mentally unstable; someone constantly beating up others/their own family and seems mentally unstable. Much more then this small list though.

How do I do it?

Conducting a psychology hold is simple. You need to take the patient to the upper floor of the Crisis Centre and then transfer the patient over to the team of psychologists that work there - NPCs.

Note: we don't actually RP the full 72 hours. That would be incredibly boring unless the other party wants to do it and there will RP for them. You skip the 72 hours and it is NPCed. See the example if you don't understand.

For example - this is pretty much the simplest way of roleplaying a psychology hold if you just want to ask what disorders/issues a patient has:

Quote

// A team of psychologists approach Jim and take him to a bed where they begin an intense psychological diagnosis period on him for 72 hours, with breaks. He's provided food, water and other drinks under strict moderation of what he is doing via the CCTV present.

 // What mental health disorders or mental health issues does Jim have?

 // Jim has anger problems that is linked with clinical depression.

The aftermath: if a patient was required to go into psychology hold, they need a session straight afterwards.

Suicidal patient

If you're still treating your patient that has been suicidal/under another severe risk where releasing them to the public would not do the city a favour/cause havoc/cause another suicide attempt/more harm etcetera you can leave them in a psychology hold indefinitely until the next session at your discretion until the point where you deem the patient fit for society and under minimal risk as possible.

Subject: Obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder (OCD) is described as an anxiety disorder. The condition has two main parts: obsessions and compulsions.

Obsessions are unwelcome thoughts, images, urges or doubts that repeatedly appear in your mind; for example, thinking that you have been contaminated by dirt and germs, or experiencing a sudden urge to hurt someone.

These obsessions are often frightening or seem so horrible that you can’t share them with others. The obsession interrupts your other thoughts and makes you feel very anxious.

Compulsions are repetitive activities that you feel you have to do. This could be something like repeatedly checking a door to make sure it is locked or repeating a specific phrase in your head to prevent harm coming to a loved one.

Causes

It's not clear exactly what causes OCD, although a number of factors have been suggested.

In some cases the condition may run in families, and may be linked to certain inherited genes that affect the brain's development.

Brain imaging studies have shown the brains of some people with OCD can be different from the brains of people who do not have the condition.

For example, there may be increased activity in certain areas of the brain, particularly those that deal with strong emotions and the responses to them.

Studies have also shown people with OCD have an imbalance of serotonin in their brain. Serotonin is a chemical the brain uses to transmit information from one brain cell to another.

Diagnosis

Just because you have obsessive thoughts or perform compulsive behaviours does NOT mean that you have obsessive-compulsive disorder. With OCD, these thoughts and behaviours cause tremendous distress, take up a lot of time, and interfere with your daily life and relationships.

The compulsive behaviour of hoarding—collecting and keeping things with little or no use or value—is a common symptom of people with OCD, even if the problem may not be severe. However, people with hoarding symptoms are more likely to also be suffering from other disorders, such as depression, PTSD, a specific phobia, skin picking, kleptomania, ADHD, tic disorders, or compulsive buying.

OCD signs and symptoms: Obsessive thoughts

Common thoughts:

  • Fear of being contaminated by germs or dirt or contaminating others.
  • Superstitions; excessive attention to something considered lucky or unlucky.
  • Order and symmetry: the idea that everything must line up “just right.”
  • Excessive focus on religious or moral ideas.
  • Fear of causing harm to yourself or others.

OCD signs and symptoms: Compulsive behaviours

Common behaviours:

  • Excessive double-checking of things, such as locks, appliances, and switches.
  • Repeatedly checking in on loved ones to make sure they’re safe.
  • Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety.
  • Spending a lot of time washing or cleaning.
  • Praying excessively or engaging in rituals triggered by religious fear.
  • Accumulating “junk” such as old newspapers or empty food containers.

Treatment

1) The four steps of treating OCD.

Psychiatrist Jeffrey Schwartz, author of Brain Lock: Free Yourself from Obsessive-Compulsive Behavior, offers the following four steps for dealing with OCD:

RELABEL – Recognize that the intrusive obsessive thoughts and urges are the result of OCD. For example, train yourself to say, "I don't think or feel that my hands are dirty. I'm having an obsession that my hands are dirty." Or, "I don't feel that I have the need to wash my hands. I'm having a compulsive urge to perform the compulsion of washing my hands."

REATTRIBUTE – Realize that the intensity and intrusiveness of the thought or urge is caused by OCD; it is probably related to a biochemical imbalance in the brain. Tell yourself, "It's not me—it’s my OCD," to remind you that OCD thoughts and urges are not meaningful, but are false messages from the brain.

REFOCUS – Work around the OCD thoughts by focusing your attention on something else, at least for a few minutes. Do another behavior. Say to yourself, "I'm experiencing a symptom of OCD. I need to do another behavior."

REVALUE – Do not take the OCD thought at face value. It is not significant in itself. Tell yourself, "That's just my stupid obsession. It has no meaning. That's just my brain. There's no need to pay attention to it." Remember: You can't make the thought go away, but neither do you need to pay attention to it. You can learn to go on to the next behavior.

(more can be found at helpguide1 2

1b) If patient has a certain fear - e.g. only has compulsions of washing their hands as they believe they're dirty, something like exposure therapy can also be deployed.

Exposure therapy, as the name suggests, exposes you to the situations or objects you fear. The idea is that through repeated exposures, you’ll feel an increasing sense of control over the situation and your anxiety will diminish. The exposure is done in one of two ways: Your therapist may ask you to imagine the scary situation, or you may confront it in real life. Exposure therapy may be used alone, or it may be conducted as part of cognitive behavioural therapy.

2) Relaxation techniques can help with anxiety. (not necessary)

3) Healthy life habits. Physical activity relieves tension and anxiety, so make time for regular exercise. Don’t use alcohol and drugs to cope with your symptoms, and try to avoid stimulants such as caffeine and nicotine, which can make anxiety worse.

4) Learn about anxiety. In order to overcome anxiety, it’s important to understand the problem. That’s where education comes in. Education alone won’t cure an anxiety disorder, but it will help you get the most out of therapy. Assign your patient homework for this education, Google is simply amazing.

5) Reduce day to day life stress. Examine your life for stress, and look for ways to minimize it. Avoid people who make you anxious, say no to extra responsibilities, and make time for fun and relaxation in your daily schedule.

6) Cultivate connections with other people. Loneliness and isolation set the stage for anxiety. Decrease your vulnerability by reaching out to others. Make it a point to see friends; join a self-help or support group; share your worries and concerns with a trusted loved one.

7) Write down obsessive thoughts/worries. When you begin to obsess, write down all your thoughts or compulsions.

  • Keep writing as the OCD urges continue, aiming to record exactly what you're thinking, even if you’re repeating the same phrases or the same urges over and over.
  • Writing it all down will help you see just how repetitive your obsessions are.
  • Writing down the same phrase or urge hundreds of times will help it lose its power.
  • Writing thoughts down is much harder work than simply thinking them, so your obsessive thoughts are likely to disappear sooner.

8) Get enough sleep. Not only can anxiety and worry cause insomnia, but a lack of sleep can also exacerbate anxious thoughts and feelings. When you’re well rested, it’s much easier to keep your emotional balance, a key factor in coping with anxiety disorders such as OCD.


Post Traumatic Stress Disorder

Post Traumatic Stress Disorder, most commonly referred to as PTSD is an anxiety disorder caused by very stressful, frightening or distressing events. PTSD can develop immediately after someone experiences a disturbing event or it can occur weeks, months or even years later. PTSD is estimated to affect about 1 in every 3 people who have a traumatic experience, but it's not clear exactly why some people develop the condition and others don't. It was officially diagnosed during the Vietnamese War, but of course this has lasted much longer. It is very important to note PTSD comes and goes.

Another important note is that general traumatic events DO show at least some signs for PTSD for almost everyone, and these are normal reactions. What makes PTSD what it is, is it being long-lasting and not just for a few days following the event. It can only be diagnosed one month after the traumatic event.

Causes

The types of events that cause PTSD include:

  • serious road accidents
  • violent personal assaults, such as sexual assault, mugging or robbery
  • prolonged sexual abuse (including rape), violence or severe neglect
  • witnessing violent deaths
  • military combat
  • terrorist attacks
  • being held hostage
  • natural disasters, such as severe floods, earthquakes or tsunamis
  • losing someone close to you in disturbing circumstances.
  • a traumatic childbirth, either as a mother or a partner witnessing a traumatic birth
  • extreme violence or war

The events can happen a while (years) before the PTSD symptoms begin showing.

Symptoms

The symptoms shown from PTSD are highlighted normally at the place(s) of the event, or anything that can trigger memories of the event, from objects to vehicles. After you think PTSD has haltered for the time being (it is a chronic disorder), one test can be simply checking the before and after response to the triggers.

Some of the symptoms that people suffering from Post Traumatic Stress Disorder include (bare in mind, PTSD can only be diagnosed a month after the traumatic event occurred):

  • a lack of or disturbed sleep (insomnia included)
  • vivid flashbacks (feeling that the trauma is happening all over again)
  • intrusive thoughts and images
  • nightmares
  • intense distress at real or symbolic reminders of the trauma
  • physical sensations, such as pain, sweating, nausea or trembling.
  • extreme alertness
  • lack of concentration
  • self-destructive behaviour or recklessness.
  • irritability and aggressive behaviour

They may also develop other mental health problems, such as:

  • severe anxiety
  • a phobia
  • depression
  • a dissociative disorder
  • suicidal feelings.

“I feel like I’m straddling a timeline where the past is pulling me in one direction and the present another. I see flashes of images and noises burst through, fear comes out of nowhere… my heart races and my breathing is loud and I no longer know where I am.”

Treatment plan:

0) Identify their triggers and check the before and after response to these triggers (this will be done at the end of all sessions that focus on the treatment itself, it's to monitor progress). Triggers can be places, objects and events that remind them of their traumatic experiences and often times their symptoms are highlighted and can be monitored through their triggers and any progress.

1) Has the event or symptoms just recently occurred? If so, use the technique of watchful waiting, to see if their symptoms improve without treatment.

2) Trauma-focused cognitive-behavioral therapy. The CBT approach for PTSD and trauma involves carefully and gradually “exposing” the patient to thoughts, feelings, and situations that remind them of the trauma. Therapy also involves identifying upsetting thoughts about the traumatic event–particularly thoughts that are distorted and irrational—and replacing them with more balanced picture. You can also use exposure therapy to get them to imagine situations and gradually build up from things that only effect the triggers in a minor way and work control from there to imagining the highest level of something impacting the triggers and such. It can be done with imagination or drama (roleplay basically). If you can, you can also expose them in a practical way by actually taking them to their triggers and build up on how the patient will control themselves from there - not suitable or allowed in some cases though, especially at the start.

-

Good resource on CBT, different to above.

3) Family therapy. Since PTSD affects both you and those close to you, family therapy can be especially productive. Family therapy can help your loved ones understand what you’re going through. It can also help everyone in the family communicate better and work through relationship problems caused by PTSD symptoms.

4) Avoid alcohol and drugs including caffeine. These are obviously used as self-medication with only short-term benefits but long-term negatives including emotional numbing, social isolation, anger, and depression.

5) Be both patient and understanding. A person with PTSD may need to talk about the traumatic event over and over again. This is part of the healing process, so avoid the temptation to tell your loved one to stop rehashing the past and move on. It is very difficult for people with PTSD to talk about their traumatic experiences. For some, it can even make things worse. Let them know you're available to talk to, though.

6) Group sessions and meeting with other people with PTSD helps your patient greatly.

7) Enjoying nature works quite well for some to aid them.

8) Medication - used as a last resort. Can be used if a patient is clinically depressed, having sleeping issues, does not feel ready to talk or willing to. Paroxetine works well. Antidepressants such as Mirtazapine, amitriptyline and phenelzine have also been found to be effective and are sometimes recommended as well. While antidepressants may help them feel less sad, worried, or on edge, they do not treat the causes of PTSD.

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Buddy    1066

oh my god this is the biggest wall of text that ive ever seen here!! it looks really good, im gonna grab me some popcorn while i sit and read this..

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JimRP    171

Question typesWhen in a session, it's important to ask the right kind of question depending on what response you want.

Open questions: i.e. " can you tell me how sad are you feeling right now?". Open questions allow people to express what they think in their own words. They are for more descriptive answers (qualitative data), however they are harder to analyse and draw comparisons and conclusions from. If in-depth answers are wanted and they are used for complex questions that cannot be answered in a few simple categories but require more detail and discussion you should use open questions.

Closed questions: i.e."Are you feeling either happy or sad?" -  Closed questions structure the answer by allowing only answers which fit into categories that have been decided in advanced. In this case it'd either probably be "happy", "sad" or "neither". The responses are often restricted, therefore these are good for quantitative data meaning we can count how many yes' or no's answers that are received.

Coping with Grief and Loss

Grief and loss is something that the majority of human beings, no matter how privileged must unfortunately face through their life. Whether this be a divorce, death of a loved one or a friend, loss of health or a job, retirement or miscarriage. While there are no right or wrong ways to grieve, there are healthy ways to help one cope when they clearly can not move on for a long duration.

The basics

What are the sort of things that cause grief:

  • Death of a close one or loved one.
  • Death of a friend.
  • Loss of health - e.g. being diagnosed with a certain death.
  • Losing a job.
  • Losing financial security.
  • Retirement.
  • Miscarriage.
  • Loss of friendship/relationship
  • And many more...

Grief isn't the same for everyone:

Grieving is a personal and highly individual experience. How you grieve depends on many factors, including your personality and coping style, your life experience, your faith, and the nature of the loss. The grieving process takes time that varies for everybody. It's not a reaction that can be forced or sped up.  It can happen in days or weeks, for some it can take years - as stated before, it's highly an individual process.

Myths:

Grief normally only takes around a few months, up to one year.

Well nope - grief doesn't have a timetable and there are many factors that affect how long this takes, as long as the receiver's attitude to it.

Without crying, you don't really care about your loss.

Again, as this is a myth the response is no. Crying is one response of sadness, some people simply cry more then others or have it as a primary response. There are people who feel more grief then some and do not cry.

You must be strong during grief. You need to be brave and help your family.

Hiding your feelings will not help. Feeling sad, unhappy, lonely and scared are normal responses to grief. Don't put on masks, if you show your true feelings you will gain support for your loss.

Just ignore it and it'll all be fine!

Again I'm afraid this isn't the answer. Ignoring it will mean you have not actually dealt with it, if you want it to go away you must deal with it.

Five stages of grief:

There are the five stages of the grief that are very popular out in the media, on television and whatnot. But, what you don't learn from TV is that you DO NOT need to go through each stage to heal grief. You don't even need to go through any of these stages. If your patient does go through them, it probably won't be in any order - but if they do then they can know that they relate to millions of other people.

The five stages of grief as defined in 1969's author has stated that "“They were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grieving is as individual as our lives.” She didn't want them to be some sort of framework or must-do list.

Regardless, here are the stages:

  • Denial.
  • Anger.
  • Bargaining (i.e. patient will request for something to or to not happen, and in return they will do something/not do something.
  • Depression.
  • Acceptance.

Symptoms

  • Feeling scared/frightened.
  • Anger.
  • Blaming people/themselves, when they aren't really the ones who caused the grief.
  • Guilt of past events/events or actions that did not happen.
  • Shock and disbelief.
  • Fatigue.
  • Weight loss/gain.
  • Aches/pains.
  • Insomnia.
  • Nausea and other physical symptoms.

Treatment

Determine if you're really needed: Some people feel like that they may need a psychologist straight after a death of a loved one or anything similar - however this sometimes is just done out of the heat of the moment. There are times where you should help immediately, such cases are:

  • Feel like life isn’t worth living
  • Wish they had died with your family member/friend.
  • Blame themselves for the loss or for failing to prevent it.
  • Feel numb and disconnected from others for more than a few weeks.
  • Are unable to perform their normal daily activities.
  • Are having difficulty trusting others since their loss.

It’s normal to feel sad, numb, or angry following a loss. But as time passes, these emotions should become less intense as they accept the loss and start to move forward. If they aren’t feeling better over time, or they grief is getting worse, it may be a sign that your grief has developed into a more serious problem, such as complicated grief or major depression and this is where we play a huge role.

Complicated grief, is where your patient has been grieving for a long time - while grief never goes away, it should not remain how difficult it was when it started.  If the pain of the loss is so constant and severe that it keeps them from resuming their life, they may be suffering from a condition known as complicated grief . Complicated grief is like being stuck in an intense state of mourning. They may have trouble accepting the death long after it has occurred or be so preoccupied with the person who died that it disrupts their daily routine and undermines their other relationships.

Symptoms of this include:

  • Intense longing and yearning for the deceased
  • Denial of the death or sense of disbelief
  • Imagining that your family member/friend is alive
  • Searching for the person in familiar places
  • Feeling extremely angry.
  • Feeling that life is empty or meaningless
  • Avoiding things and places that remind them of their family member/friend or grief point.

Distinguish between grief and depression: Grief and depression, have many of the same symptoms on paper. It's important to know that grief is like a rollercoaster, one hour one can be feeling good, moved on and the next hour they could be locked in their room.

With depression on the other hand, the feeling of sadness, despair and anything else is always constant and doesn't go away. Those are the best of distinguishing between the two, however there are other symptoms that suggest depression and not just grief:

  • Intense, pervasive sense of guilt
  • Thoughts of suicide or a preoccupation with dying
  • Feelings of hopelessness or worthlessness
  • Slow speech and body movements
  • Inability to function at work, home, and/or school
  • Seeing or hearing things that aren’t there


Once you've determined whether they need your help or not, you can put things into full play.

0) Firstly, educate them on the concepts of grief. They should know what they feel is normal and grief is a rollercoaster, and you need to busts some myths for them so they understand themselves better due to it.

1) If you have 3+ patients in the same situation or another psychologist has patients suffering from the same problem, with Command+ authorisation a group session can be ran and must be documented in the correct section. This is due to it being proven time and time again that sharing stories help people tremendously!

2) Make your patient ACCEPT their feelings. Many people mask their feelings which keep it going longer then it should.Sadness, anger, frustration and even exhaustion are all normal and many more.

3) Make sure your patient DOES NOT deny the grief. Make sure your patient does not deny their friend/family member has passed away, or they will easily become isolated.

4) Talking about the death with a loved one/friend. You can ask them to do this on their own time, or you can bring their friends/family for a portion of the suggestion. In case of no close friends/family please act as one for them!

5) Helping others cope with loss can help, i.e. if they reach out or share their story to someone so they can get help in the future or something works - even if they just introduce themselves to a stranger and reach out, try to help them and share what has worked for them - you can take PSY-1 out for this and monitor them - they may be able to trade tactics on this and develop friendships!

6) Remember and celebrate, if they have lost something, they should remember this and celebrate. If they have lost a family member, they can make a photo album or decorate their family member's grave with hand-picked flowers. If they have lost their job, they should reflect on how lucky they were to have the job and work on getting a new one. They can also make a journal about their loss, you can provide a complimentary one for them along with a pen.

7) Make sure they take care of themselves and their family, and do not abandon what is deemed as necessary. Eating well, exercising and getting plenty of rest help us get through each day and move forward.

8) Make sure your patient is feeling what they want to feel, not telling anyone, including themselves telling them how to feel. No one is allowed to them to how to feel, their grief is their own - they shouldn't feel pressurised into "moving on" or "letting go". It's perfectly fine to cry, be angry or even laugh, finding moments of happiness and joy and replaying those treasured memories in their head![/b]

Medication

As a general rule, normal grief does not warrant the use of antidepressants. While medication may relieve some of the symptoms of grief, it cannot treat the cause, which is the loss itself. Furthermore, by numbing the pain that must be worked through eventually, antidepressants delay the mourning process.

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Castiel    1124

Holy walls of text. I'll read through this all later Jim, looks good though!

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Ramon    360

I need some time to read all the text, but at first sight it looks good.

But can I ask how did you get the information?

Also the Medication part. Is that finished already?

And I don't agree that part to be honest.

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JimRP    171

I need some time to read all the text, but at first sight it looks good.

But can I ask how did you get the information?

Also the Medication part. Is that finished already?

And I don't agree that part to be honest.

Says how on top!

Medication part is not finished yet.

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PaulB    1

*brain blown* too much intens. Great job!

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Raptor    175

Yo JimRP, this really is the biggest wall of text ever holy damn. I'll add it to my reading list ;)

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Roman    0

Holy crap...will this give me a college degree if I read it all?

Did you write this by yourself?

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