Treatment Plan: Psychoeducation Lesson Summaries

Psychoeducation involves providing clients with information about their specific concerns, diagnoses, or psychological processes. It helps clients gain knowledge and understanding of their difficulties, enabling them to make informed decisions and participate actively in their treatment. Psychoeducation may include teaching coping skills, stress management techniques, or providing resources for self-help.

Parts Work Theory

An overview of “parts” of your subconscious and conscious mind, showing up as physical sensations, emotions, thoughts, perceptions, and behaviors.

Parts work is a therapeutic approach that views the mind as a system of interrelated parts, each with its own unique perspective, role, and function. These parts can be divided into three main categories: Exiles are parts that hold painful emotions, memories, and experiences that have been rejected or disowned by the conscious mind. Managers are parts that try to protect the system from further pain by controlling, suppressing, or avoiding difficult emotions and experiences. Firefighters are parts that try to reduce tension and anxiety by engaging in impulsive or destructive behaviors.
Internal family systems (IFS) is a specific type of parts work that was developed by Richard Schwartz. IFS therapy focuses on helping people to develop a compassionate relationship with their parts, so that they can be integrated into a healthy and functional system.

The subconscious and conscious mind are both made up of parts. Some of these parts are more visible than others, but they all play a role in our thoughts, feelings, and behaviors. Subconscious parts are often hidden from our awareness, but they can still have a powerful influence on our lives. These parts may be formed in response to trauma or difficult experiences, and they may hold negative beliefs about ourselves or the world. Conscious parts are the parts of ourselves that we are aware of. These parts may include our thoughts, feelings, sensations, and behaviors. It is important to remember that all of our parts have a positive intention. Even the parts that seem “negative” are trying to protect us in some way. The goal of parts work is to help us to understand and accept all of our parts, so that we can live a more balanced and fulfilling life.

Homework: Watch all the videos relating to IFS (From: Lucas Forstmeyer)

Parts Work Self

An overview of “self” (pure innate consciousness): with strengths of compassion, connection, calmness, clarity, courage, confidence, curiosity, creativity, patience, presence, playfulness, perspective, and persistence.

The self is the natural leader of our internal system or “Psyche,” the part of us that is our pure innate consciousness. It is the part of us that is aware, present, and connected to the world around us. It is the part of us that is compassionate, connected, calm, clear, courageous, confident, curious, creative, patient, present, playful, perspectived, and persistent. The self is often hidden from our awareness, but it is always there, waiting to be discovered. When we connect with our self, we feel a sense of peace, joy, and well-being. We feel connected to our inner wisdom and our higher power. We feel confident and capable. We feel creative and alive. The self is the source of our true power. When we connect with our self, we can access our full potential. We can achieve our goals. We can live our lives with meaning and purpose. We can make a difference in the world.

Following are the character strengths and virtues that are associated with the self and how it relates to parts. Compassion is the ability to understand and share the feelings of our parts and other people, and experience empathy and appreciation for them. Connection is the feeling of being connected to the parts and other people, and to something larger than ourselves. Calmness is the ability to remain peaceful and centered in the face of stress or challenges. Clarity is the ability to see things clearly and to make wise decisions. Courage is the ability to face our fears and to do what is right, even when it is difficult. Confidence is the belief in our own abilities and worth, that self has the capacity to lead the system. Curiosity is the open-minded and inquisitive attitude that leads to learning and growth. Creativity is the ability to come up with new and original ideas and solve problems that have solutions.

Patience is the ability to wait calmly and without complaint and just experience the moment. Presence is the ability to be fully aware of the present moment without distraction, criticism, or judgments. Playfulness is the ability to experience awe and wonder, enjoy life, and to see the world in a lighthearted way. Perspective is the ability to see things from different angles and to understand the big picture. Persistence is the ability to keep going even when things are tough.

These are just some of the many character strengths and virtues that are associated with the self. When we connect with our self, we can access these qualities and live our lives to the fullest.

Homework: Watch all the videos relating to IFS (From: Lucas Forstmeyer)

Parts Work Concepts

An overview of concepts: polarized parts, allied parts, trailheads, blended parts, unblending, blending, burdened parts, unburdening, concerned parts, blocking, asking permission, gratitude and appreciation for your protectors. Polarized parts are two or more parts that are in conflict with each other. For example, a person might have a part that is afraid of public speaking and another part that wants to be a public speaker. These two parts are polarized because they have opposing goals. Allied parts are two or more parts that work together in harmony. For example, a person might have a part that is responsible for planning and organizing and another part that is creative and imaginative. These two parts are allied because they share the same goal of achieving success.

Trailheads are the daily experiences and one time events in life that cause physical sensations, emotions, thoughts, perceptions, and behaviors that can be used to access different parts of the self. For example, if a person feels a tightness in their stomach when they think about public speaking, this might be a trailhead to the part that is afraid of public speaking.

Blended parts are parts that have become so fused with self that they seem to be self. For example, a person might have a part that is afraid of public speaking and another part that tries to control their anxiety by becoming very rigid and controlling. These parts can take control of our thoughts, emotions, reactions, decisions, actions, and behaviors.

Unblending parts is the process of separating self and the parts that have taken over. This can be done by identifying the different trailheads to each part and then working with each part separately. There are multiple ways to unblend, ask them to separate, or distancing self are just two examples. Consciously blending your parts is the process of bringing different parts and the self together in a way that is healthy and productive. This can be done by understanding the different parts and their needs, and then finding ways to work together in harmony. We can then work with the parts through direct access.

Burdened parts are parts that are carrying around difficult emotions or experiences. These parts can feel heavy, stuck, or overwhelmed. Unburdening your parts is the process of helping burdened parts to release the difficult emotions or experiences that they are carrying. This can be done by listening to the part, validating its feelings, and then helping it to find a way to let go of the burden. Concerned parts are parts that are worried about the well-being of other parts. These parts might try to protect other parts from feeling pain or from being hurt by blocking access. Blocking access to exiles is the process of preventing exiled parts from coming into awareness. This can be done by avoiding situations or memories that might trigger the exiled parts.

Asking permission to work with exiles is the process of asking exiled parts for permission to work with them. This can help to build trust and rapport with the exiled parts, and it can make it easier to help them to heal. Gratitude and appreciation for your protectors is the process of expressing gratitude and appreciation for the parts that have been protecting you. This can help to build trust and rapport with the protectors, and it can make it easier to work with them to heal. These are just some of the many concepts that are associated with parts work. When we understand these concepts, we can better understand ourselves and our inner world. This can help us to heal from trauma, to resolve conflict, and to live more fulfilling lives.

Homework: Watch all the videos relating to IFS (From: Lucas Forstmeyer)

Parts Work Concepts

A summary overview of parts work concepts; choosing a target part, find the part through access or trailheads, focus on the parts, flesh out the part, ask what the part feels about self, and how you feel toward the part, become friends with the part, what is the part’s job or role, find out what the part fears would happen if it wasn’t doing this job, what would it like to do for a job, witness the exiled part, retrieve the exiled part, holding space for the part, reparent the exiled inner child, unburden the exile by sharing the pain and letting go of the pain, integrate the exile and other associated parts back into the system in a more healthy way. Parts work is a complex and challenging process, but it can be very rewarding. When parts work is successful, it can help people to heal from trauma, to resolve conflict, and to live more fulfilling lives. Some additional tips for doing parts work follows. Be patient and gentle with yourself. Parts work can be a challenging process, so it is important to be patient and gentle with yourself. Be curious and open-minded. Parts work can be an eye-opening experience, so it is important to be curious and open-minded about what you might discover. Find a therapist who is experienced in parts work. If you are serious about doing parts work, it is important to find a therapist who is experienced in this type of therapy.

Homework: Watch all the videos relating to IFS (From: Lucas Forstmeyer)

Physical Interventions

These interventions focus on the body, aiming to promote awareness, relaxation, and regulation of bodily sensations. Examples include deep breathing exercises, progressive muscle relaxation, yoga, massage therapy, and biofeedback. Techniques such as grounding exercises, breathwork, and self-soothing strategies can help regulate the nervous system and promote a sense of safety and calm. These interventions can be used to help people to become more aware of their physical sensations, to reduce stress and anxiety, and to improve their overall well-being. Somatic interventions can be a helpful addition to psychotherapy for a variety of mental health conditions. Somatic interventions can help to reduce anxiety symptoms, such as racing thoughts, muscle tension, and heart palpitations. Somatic interventions can help to improve mood, reduce stress, and increase energy levels. Somatic interventions can help to process traumatic memories and reduce the symptoms of post-traumatic stress disorder (PTSD).

We will discuss the following topics related to somatic interventions: benefits of somatic interventions; how somatic interventions work; different types of somatic interventions; how to practice somatic interventions at home; potential risks and side effects of somatic interventions. I will also provide you with a list of resources, such as books, websites, and videos, that provide more information about somatic interventions.

Meditation and Mindfulness for People Who Say They Can’t

Meditation and mindfulness have become increasingly popular in recent years, as people have come to realize the many benefits they can offer. However, there are still many people who say they can’t meditate or practice mindfulness. They may make excuses like “I’m too busy” or “I can’t sit still.” If you find yourself in this camp, don’t worry. You’re not alone. There are many ways to overcome these barriers and start a meditation or mindfulness practice.

Start small. Don’t try to meditate for 30 minutes right off the bat. Start with just a few minutes each day, and gradually increase the amount of time you spend meditating as you get more comfortable. Find a method that works for you. There are many different types of meditation, so experiment until you find one that you enjoy and that fits your lifestyle. Make it a habit. Schedule a time each day to meditate, and stick to it as much as possible. Even if you can only meditate for a few minutes, it’s better than nothing. Be patient. It takes time to develop a meditation or mindfulness practice. Don’t get discouraged if you don’t see results immediately. Just keep practicing, and you will eventually reap the benefits.

There are some people who will have ambivalence and resistance to meditation. People use excuses, but also have real barriers they experience in implementing a new spiritual practice:. I’m too busy is a common excuse, but it’s not a valid one. You can always find a few minutes each day to meditate or practice mindfulness. Even if it’s just 5 minutes, it’s worth it. I can’t sit still, or I am autistic, or I have ADHD, or I have a TBI. If you have trouble sitting still, try a different type of meditation, such as walking meditation or yoga. There are also many guided meditations available online that can help you focus your attention. Other reasons people give includes: I don’t believe in it, or my religious beliefs discourage it. Even if you don’t believe in meditation or mindfulness, you can still reap the benefits of these practices. Meditation has been shown to have a number of physical and mental health benefits, regardless of your beliefs.

Mindfulness and meditation are two techniques that have been shown to be effective in improving ADHD symptoms. Mindfulness is the practice of paying attention to the present moment without judgment, while meditation is a more structured form of mindfulness that involves focusing on the breath or a particular object. There is a growing body of research that suggests that mindfulness and meditation can help people with ADHD in a number of ways. Meditation may improve your attention and focus. When people with ADHD practice mindfulness, they learn to focus their attention on the present moment and to let go of distracting thoughts. This can help them to stay focused on tasks and to avoid distractions. Meditation may reduce impulsive behavior. Mindfulness can help people with ADHD to become more aware of their thoughts and feelings, which can help them to make more mindful choices and to avoid acting impulsively. Mindfulness may improve your ability to regulate your emotions. Mindfulness can help people with ADHD to become more aware of their emotions and to learn how to manage them in a healthy way. This can help them to reduce anxiety, anger, and frustration.

A number of studies have shown that mindfulness and meditation can be effective in improving ADHD symptoms. For example, a study published in the journal Attention in 2010 found that mindfulness meditation was effective in reducing symptoms of ADHD in adults. The study participants who practiced mindfulness meditation showed significant improvements in their attention, focus, and impulse control. Another study, published in the journal Child and Adolescent Mental Health in 2014, found that mindfulness-based cognitive therapy (MBCT) was effective in reducing ADHD symptoms in children. The study participants who received MBCT showed significant improvements in their attention, focus, and impulse control. While mindfulness and meditation can be helpful for people with ADHD, it is important to note that they are not a cure. However, they can be an effective complementary therapy to medication and other treatments.

There are a number of different ways that people with ADHD can learn how to meditate and be more mindful. There are many books and websites that offer instructions on how to meditate, and there are also many mindfulness-based programs that are specifically designed for people with ADHD. It is important to find a meditation practice that works for you and to be patient with yourself as you learn. Meditation can be challenging at first, but with practice, it can become easier and more rewarding.

The following tips can help you meditate, whether you have ADHD or have trouble meditating. Use guided meditations. Guided meditations can be helpful for people with ADHD and Autism because they provide structure and focus. There are many guided meditations available online and in app form. Use visualization. Visualization can be a helpful way for people with ADHD and Autism to focus their attention. For example, you could visualize yourself sitting in a peaceful place, such as a forest or a beach. Make it fun. If you’re not enjoying your meditation practice, you’re less likely to stick with it. Try to find ways to make meditation fun for you, such as listening to calming music or using essential oils. Start with short meditations. Even a few minutes of meditation can be beneficial. Find a quiet place where you won’t be interrupted. Sit in a comfortable position. Close your eyes and focus on your breath. If your mind wanders, gently bring it back to your breath. Don’t judge yourself if your mind wanders. Just keep bringing it back to your breath. Be patient and consistent with your practice.

With practice, you will learn to focus your attention and to let go of distracting thoughts. This can help you to improve your attention, focus, and impulse control. It can also help you to reduce anxiety, anger, and frustration.

Disorders of Executive Functioning

Attention Deficit Hyperactivity Disorder History Lesson

Attention Deficit Hyperactivity Disorder and The DSM 5

Attention Deficit Hyperactivity Disorder is included in the Diagnostic Statistical Manual of Mental Disorders 5th Edition, Text Revision because it is considered a Neurodevelopmental Disorder beginning in childhood and continuing throughout the lifespan. It is a disorder because it is a harmful dysfunction. Jerome Wakefield defines mental disorders as: dysfunction(s) in one or more evolved psychological adaptations (abilities) that are universal to the species (part of human design) and that lead to harm to the individual, including increased mortality, morbidity, and impairment (ineffective functioning in major life activities). ADHD easily meets both criteria; so it is a disorder. If the dysfunction is on a continuum and not categorical, at
what point does it become a disorder? The answer; when it causes harm – adverse consequences – for the individual (the environment kicks back). A useful distinction emerges here: symptoms are the cognitive and behavioral expressions or manifestations of the disorder; and impairments are the adverse consequences arising from them.

Early conceptualizations of ADHD focused on inattention, impulsive behavior, and excessive activity, as well as defective moral control of behavior. Proponents of these views recognized that ADHD-like behavior could arise from brain injuries yet might also develop from flawed social environments. Later views emphasized ADHD’s association with brain damage, particularly to the frontal lobes, followed by an emphasis on brain dysfunction, then hyperactivity. Current views of the etiologies of ADHD now emphasize its neurodevelopmental nature and the prominent roles played by genetic, as well as nongenetic, neurological factors.

Advances in developing diagnostic criteria have resulted in more precise specification of symptoms, along with two symptom lists; an emphasis on childhood or early-adolescent onset of the disorder in most cases; and a requirement for both cross-setting pervasiveness of symptoms and evidence of impairment in one or more major life activities. More recent theories of ADHD have viewed deficits in self-regulation as central to the disorder, while also suggesting that deficits in executive functioning and biologically based motivational difficulties that undergird self-regulation are likely to account for most or all of the symptoms associated with the disorder.

Efforts at subtyping ADHD, such as in the DSM-IV, did not prove successful. But a subset of inattentive children manifesting SCT or CDD, along with social passivity and other distinguishing clinical features, may yet come to be recognized as a second attention disorder that is distinct from yet partially overlaps ADHD. Research using neuroimaging techniques has served to isolate particular brain regions (especially the frontal–striatal–cerebellar network, and possibly other regions) as underlying the disorder, and particularly as involved in the difficulties with inhibition and executive functioning.

Increasing research on heredity and genetics has clearly shown a striking hereditary basis to ADHD, along with the identification of numerous candidate genes or chromosomal locations that hold some promise in explaining the disorder. Research into the neuropsychology of ADHD has also increased substantially in the past decade; it supports the view that ADHD is not only an inhibitory disorder but also one associated with deficits in the major executive functions that underlie self-regulation. Further research, especially on prenatal neurological hazards and postnatal injuries and environmental toxins, suggests that some cases of ADHD may arise from brain injury rather than, or in interaction with, genetic mechanisms.

When I am discussing an ADHD diagnosis with a client, I am starting with the foundational criteria from the DSM 5 TR, and explore the newest research in etiology, symptomology, and impairments, and the newest evidence based approaches to treatment. If you would like to explore the information further, please click the link. 

Diagnosing ADHD with the Most Current Research Available

Attention Deficit Hyperactivity Disorder Impairments

Health Domain

• More enuresis/encopresis as a child
• Poorer general health
• Poorer nutrition & more obesity
• More eating pathology & binging
• More risk for Type II diabetes
• Less exercise for health maintenance
• Poor dental hygiene and health
• More allergies
• Greater substance use/abuse
• More comorbid mental health conditions
• Greater risk for seizure disorders
• More sleep problems
• Greater risk of Internet addiction (including porn)
• Greater accidental injuries
• Risky sexual behavior, more STDs
• More likely to have teen pregnancy
• Higher risk for coronary heart disease
• Greater risk of early mortality
• Shortened total life expectancy
• Greater economic burden

Social Domain

• Disrupted family functioning
• Poorer peer relationships
• Impaired friendships
• Poorer intimate/cohabiting
• relations/disrupted parenting
• Deficient reciprocity & cooperation
• More risk for victimization
• More antisocial activities
• More arrests/likely to be jailed

Daily Living

• Difficulty managing time
• Difficulty making decisions
• Problems with organization
• Working memory (forgetfulness)
• Difficulty with planning and problem solving

Financial

• Poor money management
• Less annual income & savings
• More total indebtedness
• Excessive impulse buying
• Lower credit ratings
• Missed utility and debt payments
• More likely living with parents
• Receive more support from others

Occupational Domain

• Enter workforce earlier
• More part-time work
• Less skilled work level
• Less progress in career
• More job changes
• More often fired/dismissed
• Lower annual salary
• Less life-time earnings
• Impaired work performance
• Poorer coworker relations
• More unexcused absences
• Greater use of sick days
• More episodes of unemployment
• More accidents at work
• More likely to be out on disability

Education

• Poorer school performance
• Under-productivity in work
• Underachievement for intelligence
• Risk for specific learning disabilities
• More disruptive class behavior
• Higher risk for grade repetition
• More suspensions/expulsion
• More special educational services
• Less educational attainment
• Lower high school graduation rate ?
• Less college attendance
• Less likely to graduate college
• Less use of adult education

Driving

• More driving prior to licensing
• Poorer steering/vehicle coordination
• More distracted driving
• More variable reaction times
• Excessive speeding & risk taking
• More road rage episodes
• More traffic citations
• More crashes and at-faults
• More severe crashes
• More license suspensions

Sources:

Russell A. Barkley, Ph.D. Clinical Professor of Psychiatry, Virginia Commonwealth University, School of Medicine. Richmond, VA 

Prompt for (AI-LLM) Google Bard: Criteria, List of Impairments associated with ADHD.

Introduction to Cognitive Distortions

Introduction to Cognitive Biases

Introduction to Logical Fallacies

Introduction to Stress, Worry, Anxiety, Panic

Calming & Relaxation Skills

Emotion Regulation Skills