Dr. Gosney Featured in SDVoyager Magazine!

Dr. Clarissa Gosney, Licensed Psychologist and Founder of Pinnacle Counseling and Testing Center, was interviewed by SDVoyager Magazine and has been featured in their “San Diego’s Most Inspiring Stories” column!

By referral from a client’s mother, Dr. Gosney was sought out by SDVoyager Magazine to highlight the amazing work that she and her other clinicians at Pinnacle Counseling and Testing Center are doing to help children, adolescents, and adults reduce their anxiety through Evidence-Based Treatment. In the interview, Dr. Gosney talks about one of Pinnacle’s specialized treatments, PCIT-SM, CBT, and Exposure Therapy with clients with Selective Mutism and the positive impact the treatment has not only on the clients, but on the clients’ families as well!

The article also highlights VERY exciting news about a new program that Pinnacle Counseling and Testing Center will begin this summer! Read the article to learn more. You won’t want to miss it! Climb on.

Doubt and Dysfunction in OCD

Johns Hopkins Medicine recently highlighted Gerald Nestadt, Psychiatrist, who has studied and treated patients with OCD for the past 30 years. He has found strong evidence for a biological basis for OCD, while he acknowledges that one’s environment also plays a role. Recently, Gerald Nestadt has been studying the role of doubt in OCD. He has found that the more self-doubt one has, the more dysfunctional their OCD tends to be. For instance, one does not simply act on an obsessive thought (compulsion) for the sake of performing the act, but out of their own self-doubt that they had performed the act correctly or thoroughly enough.

We know that with OCD, the behaviors (compulsions) are performed in an effort to reduce one’s own anxiety. This may work for the short-term, but anxiety is not decreased overall unless the person is able to resist acting out on their compulsions. At Pinnacle CTC, we guide clients through this process by using Exposure with Response Prevention (ERP). ERP is not only effective in the treatment of OCD, but for many anxiety disorders as well.

Learn more about the Conditions We Treat and other information on the Evidence-Based Treatment modalities we offer at both our San Diego and Murrieta, CA offices.

Read the full article.

Save the Date!

"Anxiety is the work of a strong, healthy brain that’s a little overprotective" - Karen Young

I recently came across a really great article about anxiety in Kids and Teens that aligns very closely with our first blog post, which you can read here.

"Anxiety is the work of a strong, healthy brain that’s a little overprotective" - Karen Young

In this article, found on the website 'Hey Sigmund,' Karen Young does a great job of explaining what parts of the brain are involved in anxiety, and what kids, teens, and parents can do to help.  It is a must-read for parents of anxious children or teens, and can also be used as an excellent psycho-education tool for therapists working with children and adolescents.  

Often times, kids and teens don't know that they are anxious... They just know that they feel really bad.  They may think they are sick.  They may think nobody likes them or wants to be their friend.  They may feel like they can't do anything (or many things) right.  It may be easy for them to give up, or to avoid the risk of failure by not even trying.

For parents of anxious children or teens, they may not know how to handle the refusal, the avoidance, the tantrums or arguments, and the pleading to stay home from school.

There are very important skills that children, teens, and parents can learn in therapy to help manage anxiety.  Still, if a child or teen spends 1 hour a week in counseling, that's 167 hours spent in other environments throughout the week.  It's no wonder why practicing skills outside of session is so important for success in managing anxiety!  This is why the role of parents and schools is so important in creating successful treatment outcomes.  At Pinnacle Counseling and Testing Center, we believe the role of parents, teachers, and other mentors is crucial.  Therefore, not only are anxiety-management skills learned and practiced in session with the child or teen, but these skills are then are taught to parents (and teachers and other mentors, where applicable) so that progress can continue to be made between sessions.

If you believe that you, or your child or teen may have anxiety, and you are looking for skills and support, please contact us here for your free consultation.

Selective Mutism: What it is and What it is NOT

You may have opened up this blog post thinking “What on earth is Selective Mutism?”  Before we get started, I want you to imagine the following:

You are a child, lively and creative.  You have a good sense of humor, you are playful, and you love to learn.  At home with family, you feel completely free to be who you are without reservation.  When you meet a stranger, however, you find yourself frozen.  Unable to speak.  The stranger says, “What’s your name?” and you freeze further.  The stranger then says “Oh, you’re a shy one, aren’t you?” and further tries to coax you into conversation.  Panic alarms are going off inside your mind and all you want to do is escape, but you are frozen.  You look to your parents as a plea for help… a rescuing.  The stranger moves along, and your anxiety slowly starts to decrease in their absence.

I encourage you to keep the above scenario in mind as you read the following.

What is Selective Mutism?

Selective Mutism (SM) is an anxiety disorder that begins early in a child’s life, where the child consistently feels unable to speak to certain people or in certain situations in which speaking is expected (such as at school or in the community), while speaking freely in other settings (such as at home). 

What is the risk?

Asking for help is often one of the biggest challenges for someone with Selective Mutism.  As a result, these children may wet their pants because they are afraid to ask to use the restroom and may not tell anyone about this accident.  Someone with SM may also be unable to ask for help when lost.  With greater SM impairment, there is often a higher risk for danger, such as a child that may break his or her arm and not tell anyone.

What Selective Mutism is NOT: Debunking the Myths

SM is NOT shyness or social anxiety.  If you were to watch a video of a classroom with the volume muted, a child with SM would often look just like the other children—engaging in play and following classroom routine.  It is only when the volume is up that the child with SM stands out.  A shy child or a child with social anxiety, however, may be seen on the video playing alone or being behaviorally and socially timid with peers or teachers.  While often mislabeled as “shy,” many parents of children with SM would say just the opposite because at home, children with SM seem just like every other kid—playful and talkative.  Many times, children with SM are rambunctious or hyperactive in the home because they have pent up energy from not speaking for much of their day.  This can be especially true for children who are unable to speak in school.

SM is NOT Oppositional or Defiant Behavior.  Sometimes children with SM are viewed as “defiant” or “oppositional” due to a perceived refusal to speak.  Because these children may not look anxious, but may stare blankly and look “frozen” when expected to speak, they may then get in trouble for their “refusal.”  This, of course, further increases their anxiety.

SM is NOT a result of trauma.  It is common to hear a story about a child who had a bad experience in preschool or kindergarten, and that was the first time the child stopped speaking to others.  While it may be true that this child had a bad experience, how do we explain the other children who shared this same experience but did not develop Selective Mutism?  This tells us that there is a genetic component to SM.  After all, Selective Mutism is an anxiety disorder and anxiety tends to runs in families.

SM is NOT Autism.  In response to their lack of verbalization in certain settings, many children with Selective Mutism are misdiagnosed as being on the Autism Spectrum.  One of the differences between Selective Mutism and an Autism Spectrum Disorder is that the perceived social deficits in the person with SM seem to “disappear” when the child is at home.  This is why it is very important for anyone diagnosing SM to ask to see a video of the child in their home environment so they can get an idea of the child’s communication abilities when anxiety is not a limiting factor.

SM is NOT a result of a Speech and Language Disorder or difficulty in understanding a second language.  Children with SM often score lower in classes and on academic testing in which verbalization is required.  Unless a learning disorder or developmental delay is also present, these low scores tend to be a result of their anxious inability to speak in certain settings.  The evidence here, once again, is in the child’s performance when in a safe and relaxed environment (such as the home), where we would see developmentally appropriate speech.  SM is not limited to a certain language.  Therefore, if the child speaks freely in various settings in his native language, but not in his second language, this is not SM.

SM is NOT something the child will simply “outgrow.”  While I refer to children throughout this post, let it not be assumed that adults do not struggle with SM.  While some are able to overcome their SM over time, it is not without much hard work.  As with other anxiety disorders, the more time the person spends avoiding their anxiety, the greater the anxiety often becomes.  This is also true for SM, especially when friends and family have made habit of speaking for the person.

What to keep in mind when diagnosing Selective Mutism

In order to make an accurate diagnosis of Selective Mutism, it is best practice for the assessing professional to ask to see a video of the child with SM speaking freely in a comfortable environment, in addition to performing a face-to-face evaluation with the child and family.

Although SM is a consistent failure to speak in social situations where speaking is expected, these situations may look different for each child.  For example, many children with SM have difficulty speaking in school, though this is not the case for all.  Some children with SM feel comfortable speaking in school but “freeze” when speaking with extended family members or people in the community.  Though each person with SM may have a different presentation, the failure to speak must interfere with social communication, or with educational or occupational achievement.

In order to reach a diagnosis of Selective Mutism, the consistent failure to speak must be ongoing for at least one month.  That being said, Selective Mutism cannot be diagnosed within the first month of school because that is a sensitive period where many children are slow to warm up and speak in class.  After the first month of school, however, if a child is still not speaking to teachers and/or peers, an evaluation should be considered.

Selective Mutism cannot be diagnosed if the child’s failure to speak is a result of difficulty using or understanding the language, so one must be careful in diagnosing SM In a child who speaks a second language.  In the same light, a diagnosis of SM would not be appropriate if the failure to speak could be explained by a communication disorder.  Last, SM does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder.

If you or someone you know has Selective Mutism, Pinnacle Counseling and Testing Center can help.  We not only provide treatment with the individual diagnosed with SM, but also with the families, schools, and other important people in the person’s life.  This is because at Pinnacle, we know that treatment doesn’t just happen in session.  The best outcomes stem from collaboration and implementation of skills across all settings.

 - Clarissa Gosney, PsyD, Licensed Psychologist (PSY 29633)

Click HERE to schedule an appointment or to inquire more about our services.

Could your child have anxiety? How anxious children are often mislabeled and lost in the mix.

There is no age limit on stress and anxiety.  While some parents have always seen their child as a “worrier,” some families are noticing the effects of stress on their child for the first time.  Still, some children may only have experienced anxiety after a trauma or other high-stress event.

The truth: anxiety looks different in kids!  Children who are affected by anxiety and stress are often mislabeled and misdiagnosed.

HOW ANXIETY, TRAUMA, OR STRESS MAY LOOK IN A CHILD

An anxious child may be seen as:

THE COOL KID

Damian is the “cool kid” in class.  His teacher reports that he refuses to complete school work and spends much of class time socializing with his friends.  When his teacher talks to him after class, he is like a completely different student: compliant, friendly, apologetic, and perhaps a bit embarrassed.  While on the outside Damian may seem like a student who doesn’t care about school, his fear of criticism from his peers takes precedence.  He fears that his friends will tease him if he gets good grades.

THE PERFECTIONIST

Sarah is a good student who follows the rules of the classroom.  While she gets excellent grades on her assignments, you won’t find her raising her hand when the teacher asks for a volunteer.  Sarah fears humiliation at the risk of saying or doing something wrong.  As a result, she refuses to try things unless she can be certain of success.  Maria can also be found spending much more time than is expected to complete various school assignments, often resulting in staying up late.  In the morning, Sarah finds it difficult to get moving because she is so tired, and may even miss school that day.

THE SHY ONE

At school or in the community, Anthony finds himself frozen; unable to speak.  Feeling the need to protect her child from discomfort, and not wanting to make others feel uncomfortable when he stares blankly or hides in response to their greetings, Anthony’s mother often explains that he is “shy.”  However, he is very talkative and even a bit high-energy when at home with his family or with close friends.

THE TUMMY TROUBLED

Maria has a few close friends at school, but they aren’t in many of her classes.  In her eyes, everyone in her math class is surrounded by their friends and she feels completely left out.  Whenever her teacher announces that it’s time to work with a partner or in groups, Maria feels sick to her stomach and asks to go to the nurse’s office.  Maria’s tummy troubles increase throughout the school year and, despite being seen by a number of different medical specialists, there is no medical explanation for her pain and discomfort.  On the weekends, her symptoms improve.  When Monday morning comes, however, Maria’s symptoms reappear and she pleads with her parents to let her stay home. Her school has expressed concern over the number of absences she has had.

How We Can Help

At Pinnacle Counseling and Testing Center, we take the time to complete a comprehensive evaluation of each client so that we can provide accurate and effective treatment to help children manage their symptoms so that they can get back to school, and back to being a kid!  We also understand the value of family, so parents will always have involvement in our therapeutic work together.  This way treatment can continue at home, increasing the likelihood for lasting results with symptom reduction, helping your child reach peak mental health performance.  Climb on.

If you think your child might be experiencing anxiety or stress, click HERE to schedule a comprehensive intake session.

- Clare Gosney, PsyD, Pinnacle Counseling and Testing Center