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Tag: Jacqui Manning

Why students are packing Prozac in their lunch boxes

This post was first published by RendezView, 31/1/16

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Laptop? Check. Lunch box? Check. Prozac? Check.

For more and more young people, the preparation for back to school this year will include making sure they have their anti-depressants close at hand.

Australia has one of the highest rates of use of these medications in the world and a recent University of Sydney study found that there has been a particularly marked increase in the use of these drugs in children and adolescents.

In fact, over the four-year period from 2009-2012, researchers found that the largest increase in use was amongst children aged between 10-14 years.

Dr Emily Karanges, now a research fellow in the Medicines Policy Unit at the University of NSW and lead author of the paper based on the study’s findings, suspects the rates of usage would be even higher amongst those who are school-aged today: “There is no reason to think this trend would have reversed. Given the steep upward trajectory in the rate of antidepressant use at the time of our research, especially among young people, I’d expect the figures now would be significantly higher again.”

Yet the therapeutic guidelines from the US, UK and Australia recommend that psychological therapies rather than medication be used to manage depression and anxiety of a mild or moderate severity, and that anti-depressants should only be used for severe disorders or when all other treatments have first proved ineffective. This is because these drugs are often less effective in depressed children and adolescents than in adults, and come with increased risk of self-harm and suicidal thinking.

Karanges also advocates for caution as: “The brain is still developing up to the age of 25 and antidepressants are a pretty blunt instrument. We know very little about how they might be changing the development of the brain and whether they might have long-term effects into adulthood.”

So what is driving this eagerness to medicate kids who need support?

Although counsellors and psychologists can’t prescribe medication, many are quick to suggest young people visit a GP to access these (it is not uncommon for this to be suggested as a solution even during an introductory counselling session). Concerned parents may then go to their GP specifically requesting drugs.

And many time-poor GPs report feeling ill equipped to treat mental health issues; according to the Black Dog Institute, in Australia GPs don’t have to have any specific training in mental health to practice.

Karanges points out that these types of medications are also heavily marketed to the medical community: “It is perhaps no coincidence that the anti-depressants that were most rapidly increasing in use were also the newest ones and the ones most likely to be advertised to doctors.”

GP’s may also have the misguided view these types of medications are relatively safe. A Danish study published in The British Medical Journey this week found that the harms reported in antidepressant trials were often seriously misrepresented and underreported, this included suicide attempts and suicidal idealation being coded in reports by pharmaceutical companies as “emotional lability” or “worsening depression”.

Reports issued by drug companies were, the authors said, “even more unreliable than we previously suspected”. The study concluded by recommending “minimal use of antidepressants in children, adolescents, and young adults, as the serious harms seem to be greater, and as their effect seems to be below what is clinically relevant”.

Instead, treatments such as psychotherapy and exercise were suggested.

It may also be that culturally, we are not always comfortable with the full spectrum of human emotions and are too eager to seek a quick fix.

Psychologist Jacqui Manning says she would be reluctant to suggest medication, particularly with a young person, until a range of other strategies had been tried first.

“I may see teens during highly stressful life events like the HSC exams or a breakdown or death in the family,” she said.

“Sometimes parents will say, ‘my child isn’t coping — do you think they need meds?’ I’ll respond that there are many things we can try first and that their son or daughter’s feelings are a normal human response to an extremely stressful situation.”

Whilst it is important not to stigmatise or alienate those young people who do genuinely need medication, Iain McGregor, Professor of Psychopharmacology at the University of Sydney, has called for time out on making medication our default response when supporting children and teens in crisis.

“We need to have a national debate about what is driving this phenomenon,” he said.

“Why are we so reliant on pills for the mental wellbeing of our young people?”

And what is happening that is making our kids feel so desperately sad in the first place?

What to look for when choosing a counsellor or psychologist

The following guest post is shared with permission from the author, the wonderful Matt Glover from MGA Counselling Services. Matt wrote this following a discussion I had with him and two other professionals I admire, Sarah McMahon from BodyMatters and Jacqui Manning, The Friendly Psychologist. Sarah has also put together an excellent resource on how to select a therapist for eating disorders which may be viewed here.

Recently I was having a discussion with Dannielle Miller from Enlighten Education about what to look for when choosing a counsellor or psychologist.  In Australia, we still live in a culture that places some stigma on seeing a mental health professional, and so we are hesitant to ‘ask around’ like we do when looking for a plumber or dentist. If you’re wrestling with a mental health issues, a relationship problem, a personal issue, or just feel plain stuck, make sure you check the following before booking a session with a counsellor or psychologist.

1. Check the qualifications. While Psychology and Social Work are regulated industries, Counselling is not. Anybody can set themselves up as a counsellor and charge a premium without even a single hour of training. Online certificates and diploma’s abound in counselling, but these are little better than nothing at all. Many of them do not require any sort of supervised placement and barely scratch the surface of best practice when it comes to the different models of therapy. For counsellors, I would suggest sticking with those that have a Bachelor degree or above, from a reputable university. When you ring to make a booking, ask where the therapist did their training.

2. Check the accreditation. Make sure the counsellor you see is accredited at more than student level with one of the professional bodies. The professional bodies maintain a code of ethics for the industry and ensure that individual therapists are engaged in ongoing professional development and supervision. As a counsellor, I’m accredited through the Australian Counselling Association, but there are equivalent associations for Psychologists and Social Workers.

3. Check the experience. Regardless of your heart for helping people, it takes a while to become really proficient in the helping industries. I say to aspiring counsellors to try and get work with a larger agency before thinking about  private work or opening your own practice. I worked for 14 years for other organisations before opening MGA. When you ring a therapist, ask them how long they’ve been practicing. If they say “two weeks”, wish them well for their career, hang up, and call the next person on your list.

4. Check the specialty. Most of us have a field that we specialize in, based on our own interests and history. In my practice, we focus on sexuality, spirituality, and mental health, with individual therapists at MGA having more focused areas like relationships, eating disorders and the like. If you’re after some help with depression, for instance, make sure your therapist has experience working in that area. Associated with this point is the model of therapy. There’s lots of different ‘therapies’ – some will suit you and others won’t. CBT has been popular in the past but seems to be going out of fashion in recent years. Gestalt is still popular, as is person centered therapy. Acceptance and Commitment Therapy (ACT) is the model we use at MGA, but each client is treated according to their needs, not pushed through a conveyor belt.

5. Check the “fit.” If you find you don’t really click with your therapist, find somebody else. I don’t have any research to back this up at all, but my feeling is that at least 50% of a good outcome in counselling depends on how well you get along with your counsellor. If you have a counsellor that is rude, irritating, talks about themselves all the time, seems uninterested, hurries you along, doesn’t listen or even smells funny, then you won’t get the most out of your time together. You may even miss some important, helpful suggestions because you really just don’t like them very much. Sometimes a good outcome does take time, but you want to take that journey with somebody who you connect with well.

6. Check the reputation. This is a little harder to do, but ask around to see what sort of reputation a therapist has. Personal recommendations are not a rock solid guarantee (you have to get along well with them remember) but it’s nice to know that there is some good reports about the person you are seeing.

7. Check the responsibility. By this I mean, check that you have responsibility for where the sessions go and what it is you cover. I do a lot of work with the transgender community and I’ve lost count how many times clients say to me that their previous counsellor talked about nothing but their gender transition, despite the client wanting to see them for an entirely different reason. (Eg, bullying at work) In sessions, make sure you talk about what YOU want to talk about. As things unfold, you may uncover other things that you need to work on – a skilled therapist will help you do this. But if your counsellor insists on making you talk about things that seem irrelevant and they won’t give you a reason why, think about whether you should continue with them.

8. Check the practical stuff. Ask how long the sessions are, what the fees are, whether it has disability access, whether it is close to public transport, is there parking available, what are the opening hours and so on. Whatever practical things are important to you, ask about them. Also check to see if your therapist has any long holidays planned – sometimes a break in momentum can set you back, so if they’re going to be away for six months, ask for somebody else.

The lovely Jacqui and I on the set of channel 9's Mornings show.
The lovely Jacqui and I on the set of channel 9’s Mornings show.

Jacqui offered a few final thoughts in addition to these I thought worth sharing here too: “Also, I’d say that if the work feels confronting, that’s OK, therapy is meant to make shifts and sometimes these can feel uncomfortable but it shouldn’t stay that way for long. The therapist should be skilled at going at your pace, but if they’re not, it’s perfectly acceptable to ask them to slow down. And if you don’t click with one therapist? Don’t give up on the process. It’s like finding a good hairdresser, it can take time to find the right person to trust, but you don’t stop getting your hair done if you have had one bad haircut.”

At what age should girls start dating?

My writing buddy Nina Funnell and I have spent a busy week doing media for our new book Loveability – An Empowered Girl’s Guide to Dating and Relationships. A highlight for me was speaking to the exceptional Natasha Mitchell on ABC’s Life Matters – you may listen to the interview here. 

Interestingly, the majority of the interviews we did seemed focused on determining at what age parents should allow their children to date. Case in point – this segment on channel 9’s Mornings:

 

The facts? Whether we like it or not, as I state in the interview above ( and teen Jordie confirms) young people are forming relationships at a younger and younger age and trying to ban these only contributes to secrecy. Further, young people spend an inordinate amount of time thinking and talking about relationships so we must ensure warm, wise, realistic and accessible advice is offered early.

Nina recently explained why setting blanket bans and stigmatising all relationships as being potentially dangerous is unhelpful:

“Instead of treating the sexuality of children as something to be either feared or controlled, we need to encourage open conversations about intimacy and relationships. It is also important not to demonise young people’s sexuality or interest in these topics, as this can create stigma, anxiety and shame.

It is deeply unhelpful (for example) to teach young people that the only reason why a girl might seek out intimacy or connection is due to low self esteem and a lack of self worth. This view totally disregards the desires and natural sexual urges of young women as well as the legitimate and positive experiences they may draw from relationships.”

So – how to handle this question in a positive, realistic way?

Again, I called on Nina for she answered this question for girls in the Q&A section of our book (with a little help from our go-to psychologist Jacqui Manning)  I think they nailed it:

Q. My parents think I’m too young to start dating. How young is too young?

A. Knowing the right time to start dating isn’t so much about waiting till you turn a specific age. It’s about ‘taking the time to do it right’, according to psychologist Jacqui Manning. ‘Your early relationships can really set the scene for your love future, so having good experiences now will set you up with positive expectations from your partners forever.’

Ask your parents why they think you’re too young. Ask for their advice, and ask whether they’re comfortable to share their own experiences with you. Although some girls find it uncomfortable to talk about relationships with their parents, you can get some good tips by having an honest chat with them.

Relationships can be difficult to manage when you’re still busy learning about yourself, so don’t rush into it just because it’s what other people are doing, says Jacqui. ‘The important thing to remember is to not get swept up in another person’s idea of how the relationship should be, but to establish your own values and boundaries around what’s important to you — before you enter into a relationship. That way, you’ll have a better idea of when something doesn’t feel right.’

Before dating, think about the following questions: what kind of person do I like and what sort of qualities am I looking for in a person? What are my dating boundaries and deal breakers? What would a good relationship look and feel like to me? If, after you have put some effort into thinking about what you want, you feel self-assured enough to set boundaries in your relationships, then you may well be ready to get out there.

Nina and I have also developed a series of shareable images we have been using on Facebook and on Instagram to encourage girls into thinking more about their Relationship Deal Breakers and their Relationship Must-Haves. Feel free to download these and use them too! 

Let’s open up dialogue – not shut it down.

RRPicMonkey Collage

 

 

 

“To all my Facebook Friends: promise never, ever to assault women.”

The news that the body of Melbourne woman Jill Meagher has been found has left many of us distressed, and searching for answers. And, driven by this fear, we are at risk of offering misguided and potentially harmful advice to our young women. Case in point, a friend posted this as her Facebook status today: “To all my female FBFs: promise never, ever to walk home alone. RIP Jill Meagher.”

My aim in pointing out why this status is so unhelpful and misguided is certainly not to embarrass this Facebooker, but I do want to draw attention to how problematic this type of discourse is as I have seen and heard many similar comments in the past 48 hours. In fact, following on from an excellent piece about the dangers in victim shaming written by Clementine Ford this week, I was asked to caution against dialogue that assumes those who are harmed must have been doing something wrong on channel 9’s Mornings program yesterday.

So, what are the uncomfortable truths?

Firstly, Ms Meagher lived 700 metres from her home –  it is highly unlikely a cab would have taken her such a short distance and even getting a cab home wouldn’t necessarily have guaranteed her safety: there are a significant number of assaults on women in taxis. In Western Australia alone, ten drivers were convicted of sexual assaulting passengers  in the period from January  through to August 2012, whilst the WA Transport Department  received 52 complaints about sexually inappropriate behaviour during this same time frame.

Secondly, even if women did remain forever vigilant and never left the house unless escorted, they are not guaranteed safety. The vast majority of episodes of violence against  women occur with someone the woman knew, and trusted; many women are not safe even in their own homes. One in three Australian women will experience violence in an intimate relationship.

Finally, let’s ask ourselves the following questions. Is it fair and reasonable to expect women to live in a state of perpetual fear? Where would we draw the line; do we expect all girls and women to only walk to and from their workplaces and schools if they are escorted? After all, violence does not only happen after dark. And, is a world in which women no longer have personal freedom, one we want to be promoting?

Wouldn’t better advice be: “To all my FBF’s promise never, ever to assault women”?

The uncomfortable truth is that there is no quick, easy fix. Violence against women will not be stopped simply be increasing female fear (besides, ask any woman – there is plenty of fear there already). Violence will not be stopped by only ever walking in company, or by refusing to go out at night, or by demanding women keep themselves safer.

This week, in an attempt to make some sense of the senseless, and initiate more nuanced discussions, I am sharing a post by Psychologist Jacqui Manning.

NB: this blog talks about the traumatic effects of sexual assault – if you feel this will be painful for you to read, please pause here and/or get support before you do – LifeLine are 24/7 on 13 1114.

Jill Meagher and the problem with our men

As with many people across Australia I am writing with a heavy heart as the body of Jill Meagher was discovered this morning. I haven’t been able to stop thinking about her and think this is probably because I have done what she did a thousand times before. Why wouldn’t it be OK for her to walk a short distance home from where she was?

By all accounts she was smart, independent, savvy and familiar with her surroundings, all protective factors however the unthinkable happened to her.

The focus has been on women keeping themselves safe after dark, however it really should be on the men committing these heinous crimes and how we as a culture can make changes so this kind of crime diminishes over time.

Random brutal violence can happen to both men and women as we saw with the death of Thomas Kelly in Kings Cross, however while it does happen, the majority of attacks on men don’t involve sexual assault.

The ramifications of sexual assault are life-long. Even 20 years later those who experience this most horrible crime can suffer with the traumatic effects.

These can include:
* nightmares
* physical reactions of trauma and anxiety – heart palpitations, racing thoughts, sweats
* not wanting to get into a relationship
* not wanting intimacy with a trusted partner
* not being able to have children (fear of being examined/the whole process)
* not feeling safe in their own home – whether or not the assault took place there
* destroyed self-worth

I work with my clients to try and heal, re-build, learn strategies to alleviate the very real physical aspects of their trauma, and it does work over time. I remember many years ago one of my lovely clients who had just completed an emotional session with me regarding her sexual assault, walked out of my room beaming and saying “I never thought I could feel so light and free about this”.

But wouldn’t it be wonderful if the therapy came as an early intervention for our men, rather than as a tool to mop up the mess? Wouldn’t it be great if by one man seeking help for his problems, this prevented the downward spiral that leads to committing the crime of sexual assault (and murder) which affects not only the victim but their families and loved ones?

In our culture men are taught (from a very young age) to toughen up, don’t cry, deal with it, ‘don’t be a girl’ if they are feeling sad/down/upset. So what are men supposed to do with their very real feelings?
In Australia they are ‘allowed’ to drink heavily, get angry, be sullen, perhaps even get violent, that is all just a part of ‘boys being boys’.

Meanwhile:
* They are not being taught constructive outlets for their feelings
* They are not being shown how to communicate anger/sadness/grief in a positive way
* They are not being shown at a cultural level that drinking is not the answer to everything (I struggle every year to buy a fathers day card without it referring to beer).
* They are told to ‘man up’ if they have a reaction to difficult situations (relationship breakdown, losing their job etc).

I know absolutely nothing about the man who raped and killed Jill Meagher and I don’t know if anything could or would have prevented him from inflicting such horror.

I do know however that we can try to do better and rather than constantly laying the responsibility at the feet of women to keep themselves safe, we need to shift that responsibility where it belongs – to the perpetrators and to a society that hasn’t taught their men better ways.

Please call LifeLine if this article has been difficult for you to read and/or seek help from a trusted professional. Lifeline 13 1114

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