Areas of Focus — Pica & Associates Psychological Services

Areas of Focus

Areas of Focus

Adjustment Disorders

Adjustment disorders are considered the most benign of the psychological diagnoses. Anyone can be diagnosed with an adjustment disorder at a given point in life. Essentially, individuals diagnosed with an adjustment disorder experience mild to moderate forms of transient anxiety and depression related to the occurrence of a significant life stressor such as the loss of a job, divorce, death of a loved one, etc.

Anger Management

Individuals with anger management issues have trouble processing and expressing their vulnerable feeling states in a healthy and appropriate manner. Anger, for these folks, functions to suppress more difficult emotional states. Individuals with anger problems are often raised in homes that modeled violent and aggressive ways of negotiating conflict. Treatment for anger management often involves training in emotional awareness, problem solving training, role-play, relaxation exercises, and developing an understanding of the cues that trigger aggressive episodes.

Anxiety Disorders

Anxiety is a common emotion that anyone has either experienced (e.g., flush cheeks and racing heart before giving a speech) or can relate. Individuals diagnosed with anxiety disorders, however, experience an ongoing or heightened level of anxiety (e.g., tension, restlessness, accelerated heart rate, panic) that interferes with their daily functioning at home, school, work, or within the context of their marriage or relationships. In some cases the individual becomes so panic stricken that he or she becomes immobilized to the point that one cannot leave the house, refuses to drive, or in the case of social anxiety develops various types of phobias (irrational fear of an object or situation).

Aspergers/Autism Spectrum Disorders

Asperger's is an Autism Spectrum Disorder which when one focuses in on the word "spectrum" it means that there are a variety of ways symptomatology can manifest. Overall, the diagnosis is characterized with difficulties in social interaction and preoccupation with particular interests or behaviors. Therapy focuses in on social skills training and helping the individual with understanding people and the world outside of his / her own world.

ADHD (Attention-Deficit/Hyperactivity Disorder)

Individuals diagnosed with Attention-Deficit / Hyperactivity Disorder typically have difficulties with attention, hyperactivity, and / or impulsiveness. The diagnosis includes three different types: Predominantly Inattentive Types, Predominantly Hyperactive-Impulsive Type, and Combined Type. The differences between the types are that individuals with Inattentive Type typically have difficulties with attention, focus, and following through on instructions, while individuals with Hyperactive-Impulsive Type show more symptoms of fidgeting, being "on the go" often, blurting comments out, and interrupting others. Combined Type is a diagnosis given to an individual who has symptoms of both the above types mentioned. Symptoms of any type of ADHD must have been present before the age of seven.

Attachment Issues

Attachment issues is a fairly broad term used to describe individual's difficulties to form healthy attachments to their primary caregivers while in childhood. Being neglected, abused, separated, overly indulged by a primary caregiver can affect a child's ability to emotionally regulate himself / herself and affect how a child interacts with others. Attachment issues can play a huge role in how individuals understand relationships and how they form relationships with others in adulthood.

Bipolar Disorders

Bipolar Disorder is a difficult disorder to manage and treat given that individuals diagnosed with bipolar disorder are often resistant to treatment. As a result, bipolar disorder, if left untreated, can have a devastating impact on both the individual and family system. Bipolar disorder can present as Type I or Type II. In Type II, the individual experiences hypomanic (less than manic) states marked by agitation, impulsivity, sleep disturbance, etc., never becoming delusional or psychotic in nature. Bipolar Type I characterizes those individuals who enter full blown manic episodes marked by impulsivity, flight of ideas, sleep disturbance, delusional and / or persecutory thinking resulting in psychiatric hospitalization. Treatment generally consists of psycho-education, family therapy, and psychotropic treatment managed by a psychiatrist in the community.

Conduct Disorders

Conduct disorder describes children and adolescents who show a blatant disregard for basic social norms and expectations. Behaviors that characterize conduct disorder include a symptom picture or combination of physical aggression, use of weapons, thievery, fire setting, lying, truancy, bullying, and cruelty to animals. This is a diagnosis that must be made before the age of eighteen.

Depression

As with anxiety, depression is a common human experience. We all get down or experience the blues from time to time. However, with depressive disorders, the frequency and / or intensity of the depressed mood (e.g., sadness, tearfulness, hopelessness, loss of pleasure, insomnia, loss of concentration, loss of appetite, and difficulty making decisions) becomes so pervasive that it causes a significant disruption in daily living. In the most extreme case, one may begin to question whether life is worth living resulting in suicidal ideation.

Eating Disorders

The area of Eating Disorders includes Anorexia Nervosa and Bulimia Nervosa. Individuals with Anorexia focus in on keeping their weight below a minimal normal level though control of food intake and over exercise. Individuals with Bulimia, typically control body weight by binging and then purging or using diet pills / laxatives. Eating disorders are not just a body image issue. Many eating disorders are a manifestation of family system issues that need to be worked though. Also, eating disorders often center around the individual needing a sense of control in a life they feel is chaotic and out of their control. Therapy focuses in on helping bring a more healthy sense of control back to the individual as well as family therapy.

Family Therapy

Family therapy is a primary component of working with children and adolescents. It is often an adjunct to individual treatment and can entail various family members. It is important to remember that each member plays a functional and dysfunctional role in the family system. Families often function to maintain balance, even if the balance is dysfunctional. Quite often, the problematic patient is often the symptom bearer of the family system. As a therapist it is important to recognize these roles and shift the system so as to make for healthier equilibrium.

Learning Disorders

A learning disorder can be diagnosed when an individual demonstrates abilities below a level that is expected given their age and grade level in school. Specific types of learning disorders include, Mathematic Disorder, Reading Disorder, and Disorder of Written Expression. These diagnoses are made through assessments typically via the school and / or outside psychologist.

Marital Therapy/Couples Therapy

Pica & Associates sees couples experiencing various levels of conflict from mild to severe. Most often, they encounter couples who have evolved into alienated roommates, who lost their spontaneity, and are fighting over parenting, financial, or family of origin issues. Therapy is focused on rebuilding intimacy and communication in addition to introducing spontaneity into the relationship. Couples with children and adolescents are encouraged to work as an allied team so as to prevent splitting behaviors in the home.

Men's Issues

In terms of Men's issues, Pica & Associates frequently works with men who may be encountering developmental or relational crises. This might include marital issues, career options, raising teens, and/or redefining one's identity as he moves through the lifespan.

OCD (Obsessive Compulsive Disorder)

OCD is considered an anxiety disorder. Its symptoms include repetitive or persistent thoughts (obsessions) or behaviors (compulsions). Though an individual is aware that the thoughts / behaviors are inappropriate or excessive, they have major difficulties and experience distress if they attempt to not engage in these behaviors. Therapy includes helping then individual understand the emotions that underlay the obsessive behaviors and compulsions, as well as restructuring the cognitive distortions that maintain the behaviors.

ODD (Oppositional Defiant Disorder)

Unlike conduct disorder, children and adolescents diagnosed with ODD do not show the blatant disregard for social norms and expectations. Their symptom picture includes argumentative, defiant, and verbally aggressive behavior aimed at parents and authority figures. Such individuals are often easily annoyed, deliberately annoying, angry, resentful, vindictive, and blaming of others for their own mistakes and misbehaviors. In such cases, parents need to work as a unified team and set and maintain appropriate boundaries.

Pain Management

In relationship with a chiropractic and physical therapy group, Pica & Associates works with individuals struggling with back, leg, knee, and shoulder pain; sports related and from accidents. Techniques for dealing with pain include guided imagery, breathing exercises, and progressive muscle relaxation in addition to processing how pain and physical limitations have affected the individual's sense of identity. For instance, what do I do since I can no longer function as a competitive skier?

Panic Disorders

Panic disorders are diagnosed when an individual experiences episodes of heightened anxiety marked by a combination of heart palpitations, trembling, chest pain, shortness of breath, hot flashes, feeling dizzy, feeling like one is going "crazy," and / or choking. The attacks can be quite frightening, often leaving one uneasy and in fear of the episode reoccurring. This can result in an avoidance behavior termed agoraphobia in which the individual becomes restricted to the home and frightened at the prospect of leaving the house. Treatment focuses on exposure, systematic desensitization, normalizing and providing context for the fear, and connecting with the underlying feelings driving the behavior.

Personality Disorders

The two major personality disorders that present for treatment pertain to borderline and narcissistic personality disorders. Borderline personality disorder characterizes those individuals with an ill defined sense of self, who have issues with abandonment, gravitate toward volatile relationships, see things in terms of black and white, with tendencies to overvalue or debase those in their lives, experience episodic bouts of aggression, and fleeting episodes of suicidal ideation. Narcissistic individuals are emotionally fragile sorts who overcompensate by putting on an air of bravado, see others as objects to manipulate, lack the capacity to self reflect, distort reality to justify their behavior, fail to learn from their mistakes, and project anger onto others.

PTSD (Post Traumatic Stress Disorder)

PTSD stems from an individual being exposed to a traumatic event (e.g., death or abuse). After the exposure, the individual experiences anxiety, may re-experience the event, and avoid people, situations, or settings that may remind him / her of the event. A person with PTSD can present with difficulties in sleep, anger outbursts, hypervigillance, and being easily startled. Therapy centers around helping the individual get control of themselves and the past situation.

Self Injury

Individuals who engage in self-injurious behavior typically intentionally direct harm on their body (e.g., via cutting, burning, scratching, etc.). These behaviors can be seen as "parasuicidal" and can be connected at times to actual suicidal behavior. Individuals who self-harm express their feelings through injurious behaviors. Self-injurious behavior can be included as symptoms of other disorders (e.g., Borderline Personality Disorder). Therapy focuses in on helping bring awareness to the individual of their dysfunctional behaviors and guiding them to more functional ways of expressing difficulties.

Sensory Integration Dysfunction

Individuals with sensory integration dysfunction have difficulties organizing sensory information as it comes through the senses (e.g., smell, touch, vision, auditory, taste, etc.). Therapy is focused on helping the child's sensory issues not be the main focus of difficulties. Some individuals can work through in therapy sensory issues so as to open up more options in their more rigid world. However, with many individuals, therapy focuses in on helping educate family members of individual’s difficulties, as well as work on behavioral intervention plans so as to widen the area of sensory acceptance. With Sensory Integration Dysfunction, Pica & Associates typically work with an outside occupational therapist to help with these issues.

Social anxiety describes a symptom picture in which the individual develops an excessive and unreasonable fear of being in public. A major theme relates to the fear that he or she is going to humiliate him or herself or be embarrassed and exposed to the scrutiny of others. The primary mode for such treatment is exposure with response prevention.

Substance Abuse / Dependence

Substance abuse refers to a condition in which the use of a substance, alcohol, or drugs results in significant problems with family, marriage, law, or job to name a few. For instance, substance use that results in a DUI, blackouts, missing work, or marital issues are all examples of how substance use can affect an individual’s life. Substance dependence refers to a condition in which the individual is using regularly, spending a significant amount of time in situations that perpetuate use, a tolerance has been developed, and withdrawal has become an issue for concern. Pica & Associates have extensive experience working with adolescent and adult substance issues as both have been employed by and trained under the models of Gateway Foundation, a leader in the treatment of substance abuse / dependence.

Women's Issues

The area of women's issues can include the following: domestic violence, postpartum depression, eating disorders, gender issues, marital issues, etc. Therapy focuses on helping an individual grasp a sense of control as well as empowerment in a word that can be very chaotic.