Month: November 2015

My Favorite “Non-Therapeutic” Games… Perfection

Perfection game photoPlaying games in therapy is one of my most favorite things to do in my profession as a therapist.  Children especially enjoy game play, as they also like having a willing opponent in which to play games.  In my practice, I use specialty therapeutic games, which are games that are specifically created and designed to address particular mental health issues and challenges (e.g., impulse control, positive thinking, etc.), as well as traditional board and card games that you can purchase at a department store (e.g., UNO, CandyLand, etc.).  I call this latter group of games “non-therapeutic” because they were not specifically designed to be used as therapeutic techniques in mental health.  The truth is that regardless of whether a game is specifically designed with a therapeutic purpose in mind or not, ANY game can be made to have therapeutic value in my playroom.

I’ve explored various techniques that I use with the games Jenga, Find It, and Sorry! in previous posts.  In this post I’m going to show you the therapeutic value of the classic game Perfection with children who have difficulty with focus, attention, and concentration and those who need to develop more effective problem-solving skills and appropriate coping strategies.  Perfection is an excellent game to help with all these things!

How to Play Perfection

The object of the game Perfection is to fit all the shapes into their matching holes in the game tray.  Pictured in this post is the travel edition of Perfection, which includes 16 shapes, but the original game actually has 25 shapes that you have to fit.

To set the game up, the player spreads the shape pieces next to the game tray so that he or she can easily access the pieces.  It helps if all of the handles are facing up, though if you’re looking for the added challenge, leave the shapes as they are.  Then the player sets the timer (on the game tray) so that they have 60 seconds of time to complete their task (for the travel edition of this game, the timer will be set to 30 seconds as there are fewer shape pieces).

Next the player simply presses down on the game unit’s pop-up tray and starts the timer.  The player then has to quickly fit the shapes into their matching holes.  If he or she finishes before the timer runs out, they should quickly turn the timer off; their turn is over and they have successfully completed their task (they win!).  If he or she DOES NOT finish before the timer runs out, the tray will pop up and scatter the shapes all over (and nearly scare you both to death in the process!).

How to  Make Perfection Therapeutic

Perfection is played no differently in therapy than how it is played regularly.  When I first introduce the game to a child, I teach them how to play and let them play two or three times without any intervention from me.  During this independent game play, I observe the child’s behaviors:  Does the child become easily frustrated?  How does the child handle the stress and frustration of trying to beat the timer?  Is this method effective for them?  How well are they able to concentrate and focus?  Are they easily distracted?  More likely than not, you will find that most kids get in such a hurry to beat the timer that they actually decrease their efficiency of successfully completing the task due to their inability to remain calm and focus on the task itself.

After the observation phase, I discuss my observations with the child.  I then prompt him or her to brainstorm ways to improve, offering suggestions such as slowing down, remaining calm, using deep breathing techniques, and staying focused.  I then role play these new techniques with the child while they play the game again (and sometimes, again and again).

Soon you (and the child) will see visible improvement in their efficiency in completing the game’s task.  The goal, whether achieved that day or a few sessions down the road, is for the child to be able to utilize effective and appropriate coping and problem solving skills during game play, as well as in real life situations that he or she may encounter.  For this reason, it is important to process and even role play these new skills and how they can be utilized in various life situations, such as when taking a test in school.  It’s remarkable how easily kids will remember their new skills all because they played the game Perfection!


Book Review: “How to be Comfortable in Your Own Feathers”

How to Be Comfortable In Your Own Feathers photoI’m very picky about things like books, movies, and television shows.  Something has to be really good for me to like it.  When I first ordered How to be Comfortable in Your Own Feathers by Julia Cook, I admit that I was very excited.

I like Julia Cook’s children’s books because they always teach a valuable lesson for children while keeping it fun, like how to keep from blurting out in class, maintaining self-control, and the difference in tattling and keeping yourself or your friends safe.  Julia Cook, who has authored more than 50 books for children and teachers, is a former teacher and school counselor with a master’s degree in Elementary School Counseling.  She writes books for children that keep them laughing while learning to solve their own problems, use better behavior, and develop healthy relationships.

In the book’s Foreward, it states, “How to be Comfortable in Your Own Feathers uses a creative approach to speak to children who may be currently struggling with body-image concerns.  Due to the sensitive nature of this topic, it is important that adults understand how to use this book effectively.  This story is written in a manner that gives children an opportunity to apply the characters’ experiences to their own lives.  It also demonstrates appropriate adult responses that encourage the development of healthy eating habits.”

Bluebird, who is the main character in this story, wants to flutter like the most popular bird in class, Hummingbird.  Bluebird, Chicken, and Owl all try so very hard to flutter like the hummingbird, but each of them just aren’t able to do it.  Hummingbird tells Bluebird that the reason she isn’t able to flutter like her is because her body is “too frumpy,” her wing span’s too wide, and her feathers look “lumpy.”  Hummingbird even advises Bluebird to go on a diet and work out at the gym so her body could be thin.

So Bluebird goes on a strict diet where she barely eats, and she works out, just like the hummingbird told her.  Eventually, Bluebird begins losing her feathers and not feeling so well.  Her mom finds out about what she has been doing and teaches her about balance and having a healthy “Food Voice.”  Bluebird begins to learn how to find balance and even finds out that she isn’t supposed to flutter like a hummingbird because she is a bluebird, and bluebirds are meant to soar. Near the ending of the book, Bluebird is seen talking to a counselor and is beginning to feel better about herself, though some days are still harder than others.

What I Thought About the Book

Just as I have liked several other books authored by Julia Cook, I felt this one was a winner as well.  It is beautifully illustrated by Anita Dufalla, which makes the book even more appealing to readers.  I felt the book’s message about body image, good self-esteem, and healthy eating was definitely one that many children of today need to hear.  The book is recommended for third graders and older, but I think a more appropriate age recommendation would be fourth grade to sixth grade.  I’m not sure I can see a child in middle school not thinking that the book is too young for him or her.

I do think the book started out really strong and quite engrossing and then began to slack off as soon as Bluebird’s mother learned of her body image issues.  Then it seemed the book was quick to rush to the end.  I’m not sure I liked the last few pages where Bluebird is seen talking to her counselor, and I am a counselor.  Maybe it was the way things were worded, but it just seemed kind of hokey, not that seeing a counselor isn’t an excellent idea for someone having problems with their body image.  After I read the book, I looked back at the reviews that others had written and apparently there were others who felt the same way too.

Although the ending seemed kind of abrupt and rushed, I still felt that this was a good book, particularly for the children in which it was written for – those with body image issues.  Children with low self-esteem could also benefit from the book, though it may not be appropriate for everyone.  Body image can be a sensitive topic, but that doesn’t make it any less important.  Children in elementary grades are now dieting excessively and trying to lose weight, and most of them, even if a weight issue exists, have little idea as to how to eat and exercise healthily and with appropriate balance.  It’s certainly a topic that should be addressed.




Seasonal Affective Disorder: More Than Sad

Seasonal Affective DisorderEvery fall around the months of September and October, thousands of Americans begin showing signs of constant agitation and anxiety, irritability, crying spells, overeating, fatigue, lowered sex drive, difficulty sleeping, and depression.  Their energy begins to drop noticeably, their arms or legs feel heavier, and they have such intense feelings of hopelessness that it leads some to begin thinking about suicide.  They may even begin to become hypersensitive to social rejection, that is, if they’re not avoiding social situations altogether.  All of these symptoms generally continue for six long months.  Six.  Long.  Months.

Six long months until spring arrives and the sun begins to shine more.  Six long months until Daylight Savings Time, when the days finally start lasting longer.  Six long months until as many as six out of every 100 people in the United States begin to feel some sense of normalcy again.  Six long months of struggling with Seasonal Affective Disorder, or SAD.

Most of us tend to experience some physiological and emotional changes when the weather hits.  We generally eat more, sleep more, and even experience more up and downs during the shorter days.  We are often disappointed that the summer has ended and that the weather is colder.  But those who suffer from SAD experience all of these things and much more at a level of intensity that is equivalent to those who suffer from clinical depression (Major Depressive Disorder).

Who Suffers with Seasonal Affective Disorder (SAD)?

Although we know that as many as six out of every 100 people in the U.S. struggle with SAD, it is estimated that there’s a probable 10-20% who experience a milder form.  The diagnosis affects both men and women similarly, but it is significantly more prevalent in women.  In fact, 80% of SAD sufferers are women ages 18-45.  And we must remember that none of these numbers even include the number of people that suffer in silence, those who know that something is “off,” but they fail to seek treatment for one reason or another.

As is true worldwide, Seasonal Affective Disorder is significantly more prevalent in Northern regions than in regions closer to the equator, meaning that those who live farther from the equator are more likely to develop SAD.  You can see this if you compare SAD rates in Fairbanks Alaska, in which 9.2% of the population suffers from the illness, and Sarasota, Florida, where 1.4% of the population is affected.  The change in latitude is a common cause of light deprivation.

SAD also has an inherent vulnerability, as it tends to run in families.  Most patients with the illness have at least one close relative with a history of depression (often SAD).  The disease also tends to first appear in one’s 20s, and its symptoms then generally return year after year once the weather begins turning colder.

What Causes SAD?

The jury’s still out on exactly what causes Seasonal Affective Disorder.  Its likeliest cause may be attributed to reduced exposure to sunlight during the shorter days of the year.  This lack of sunlight affects how serotonin and melatonin work in our brains, affecting mood, sleep, and appetite.  It is also thought that stressful events may contribute to feelings of depression in the winter.  Stress tends to be harder to deal with in the winter for a variety of reasons, including the season’s holidays, weather, etc.

Seasonal Affective Disorder

Symptoms of Seasonal Affective Disorder

Symptoms of SAD are very much similar to those experienced by those who suffer with Major Depressive Disorder, or clinical depression.  To be classified as Seasonal Affective Disorder, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) states that there is evidence of “a regular temporal relationship between the onset of major depressive episodes in major depressive disorder and a particular time of the year.”  Two major depressive episodes that show this relationship must occur within the last two years.

As with a clinical diagnosis of Major Depressive Disorder, SAD must meet five or more of the following symptoms that have been present during the same 2-week time period and represent a change from previous functioning.  At least one symptom must be either (1) depressed mood or (2) loss of interest or pleasure.

  • Depressed mood most of the day (In children and adolescents, this may be irritable mood)
  • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
  • Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day
  • Insomnia or hypersomnia nearly every day
  • Psychomotor agitation or retardation nearly every day
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day
  • Diminished ability to think or concentrate, or indecisiveness, nearly every day
  • Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
The symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning, and the episode cannot be attributed to the physiological effects of a substance or to another medical condition (source:  “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition”).
Light Therapy

Treatments for SAD

There are different noted treatments to help people suffering with Seasonal Affective Disorder.  Probably the most popular treatment and piece of advice from doctors and mental health providers is to get some light, whether it be in the form of natural sunlight or usage of a “SAD lamp,” light therapy appears to be the treatment of choice for SAD.

If able, the most affordable and desired choice of the two would be to get out in the sunlight.  Even though it’s cold outside, the sunlight is extremely beneficial to those affected.  It is recommended that you get out in the morning sunlight if possible, but if you have a job like so many where the sun still hasn’t come up by the time you leave for work in the morning, the next best thing is the noon sunlight.  Try taking a lunch break outdoors and find a sunny spot.

If you’re unable to soak in the natural sunlight, or if you’re not able to get enough sun, SAD lamps may be something to look into.  SAD lamps, or light therapy, stimulate natural daylight and is highly recommended to sufferers of SAD.  Patients generally begin with 30-45 minutes of daily treatment in front of the special bright lights and then gradually reduce this duration on a weekly basis.  The intensity of light is equivalent to being about the same that you might see when looking out the window on a sunny day.  People have reported great relief from this type of treatment.

Other treatments that one might find beneficial to help alleviate the symptoms of Seasonal Affective Disorder include the following:

  • Antidepressants. – Talk to your physician about your symptoms, and see if taking an antidepressant may benefit you.
  • Exercise. – Getting your heart rate up and breaking a sweat increases serotonin and endorphin levels.
  • Cut back on stimulants like caffeine, alcohol, and carbohydrates. – These can lead to mood swings that can worsen your depression.
  • Eat foods containing tryptophan. – Many who suffer from SAD experience reduced levels of serotonin, the brain’s neurotransmitter.  Tryptophan is an amino acid that is a precursor of serotonin; eating foods that contain this may increase your body’s production of serotonin and help you feel better.
  • Check your diet. – Make sure your diet is healthy, nutritious, and balanced.
  • Fill your home with light. – Open up those blinds!
  • Wear warm colors and surround yourself by them too. – The colors yellow, orange, and red can stimulate your mood greatly.
  • Laugh. – Watch your favorite television show or a funny movie. Let yourself laugh out loud.  Laughter stimulates endorphins much like exercise.

If you believe you may be suffering from Seasonal Affective Disorder (SAD) or clinical depression, it’s important that you get treatment.  Don’t suffer in silence!  Contact your physician and get evaluated.  Visit a qualified mental health provider with experience in treating depressive disorders.  There’s help out there.




How to Beat Seasonal Affective Disorder and the Winter Blues

10+ Tips to Combat Seasonal Affective Disorder

10 Home Remedies for Seasonal Affective Disorder

The Symptoms of Seasonal Affective Disorder

Seasonal Affective Disorder: Dangers of Severe Depression

I Spend Half the Year Hating Myself and Wanting to Die: How SAD Affects Women

“Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition” (American Psychiatric Association)

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