Copyright 2008 | Privacy Policy psychotherapyservicesforthegifted.com	1. Crisis Management 2. Comprehensive Assessment: Avoiding Misdiagnosis 3. Establishing a therapeutic alliance 4. Psychotherapy; mentoring; coaching; advising 5. Parent Guidance 6. Consultation with other professionals CRISIS MANAGEMENT When education and other therapeutic approaches fail to alleviate problems, gifted individuals and their families often come to us in crisis.  What are the elements of successful crisis management? A.  Accurate Symptom Identification Depression and anxiety are expressed differently in each individual.  Recognition of the many manifestations of these serious psychiatric symptoms is necessary before an accurate diagnosis can be made and psychotropic medications can be appropriately prescribed.  For younger children, differentiating a gifted child in crisis from one with an Asperger’s disorder, a spectrum disorder, Attention Deficit Disorder or a developmental fixation is important. B. Psychotropic Medication During crisis intervention it is often necessary to use psychotropic medication. It’s proper use can prevent further psychological deterioration and restore a sense of self control. Once a solid, therapeutic relationship is established other aspects of the psychotherapy can proceed and the use of psychiatric medication often becomes unnecessary. C. Restoring Self-regulation Once the more troublesome symptoms are alleviated, we are very active in suggesting stress management techniques: for example establishing healthy nutrition, sleep and work schedules help eliminate substance abuse and acts of self-destructiveness. THE COMPREHENSIVE ASSESSMENT Our assessment process goes beyond the standard psychological/educational protocols and provides a dynamic formulation for the gifted individual’s problems. How do we accomplish this? By adding a complete personal history to testing results, previous workups and evaluations, all parts of the gifted individual’s personal experiences can be thoroughly examined.  Once problem areas are identified their relationship to each other is explored.  Understanding how these areas - individually and in interaction with each other - cause psychological symptoms, under-achievement and self-destructive behavior helps us arrive at a Psychodynamic Formulation. This formulation is a concise explanation for how the  internal and external forces in a gifted person’s life - individually and together - cause problems.  The psychodynamic formulation accomplishes several other things: 1. It helps to avoid diagnostic mistakes a.  It helps distinguish a person with a true psychiatric disorder (bipolar, mood disorders, anxiety disorders, personality disorders are the most common misdiagnoses) from an individual in a gifted adjustment crisis. b. It helps  distinguish a gifted child with a true learning disability - the “twice exceptional child” - from a gifted child with a self-imposed learning deficit - a “pseudo learning disability”. c. It helps distinguish a  gifted polymath - a person with exceptional knowledge and abilities in many domains- from a person with Attention Deficit Disorder. Under extreme stress the gifted polymath’s ability to multi-task, unravels. The resultant distractibility may appear to be similar to the symptoms of Attention Deficit Disorder. 2. It distinguishes between conflicts and anxieties within the inner experience of giftedness from conflicts and anxieties the gifted person has with his parents, peers, work or school. 3. The formulation establishes an order of importance for the forces acting on or within the gifted individual. 4. It is a starting point from which a comprehensive treatment plan is established. 5. It helps guide the psychotherapy through its different phases. ESTABLISHING A THERAPEUTIC ALLIANCE Building a therapeutic alliance with a gifted individual may be a difficult task.  Although they may feel grateful once their crisis has abated, symptom relief may reawaken a gifted person’s need for autonomy.  Their  fears of collaborating with others may compel them to leave therapy prematurely. Another reason gifted individuals abbreviate their therapeutic experience is their belief that therapists don’t ‘get’ giftedness. By addressing their inner experience of giftedness as part of crisis intervention we can convey that psychotherapy has more to offer than symptom relief. PSYCHOTHERAPY A.    Early Stage In this phase we frequently act like psychologically informed mentors, coaches and advisors helping our gifted patients  establish their vision of giftedness.  Removing emotional roadblocks allows a unified and coherent vision to emerge. We validate, clarify and explore this vision.  We help find appropriate venues for the full expression of this vision of giftedness and suggest strategies for getting there. B. Middle Stage In this stage we help our patients: Recognize the universal nature of psychological conflict and help them learn about the origins and mechanisms of their particular conflicts Understand that psychological conflict is not a sign of mental weakness Learn the difference between conscious and unconscious conflict Learn how unresolved aspects of early experiences influence current feelings, thinking and behavior and how these interfere with the effective use of their gifted endowment. Learn to examine and explore confict and anxiety before acting impulsively to avoid or eliminate them Learn how underachievement and self destructive behavior are attempts to eliminate conflict and anxiety Arrive at better ways of resolving psychological conflicts: learning the adaptive mechanisms of  ‘positive psychology’ C. Late Stage In this stage there is a greater emphasis on the psychodynamic aspects of the inner world of giftedness and less on the practical, cognitive-behavioral problem solving techniques that were so useful in the early stages.  Our patients learn that the inner experience of giftedness has areas of conflict that are independent of external circumstance or previous relationships. The elements of gifted endowment can now be seen as separate independent forces that may work in synergy with one another - to allow for explosive accomplishments - or conflict with one another to inhibit productivity Exploring these dynamic relationships  helps resolve problems with procrastination, obessional indecision, and perfectionism Psychotherapy now resembles a process of mutual discovery and serves as a model for collaboration in other relationships. PARENT GUIDANCE One of our first goals is to help parents reconnect emotionally and intellectually with their gifted child. In guidance sessions we explain: The important differences between normal and gifted development How their child’s particular psychological symptoms may be caused by specific unresolved conscious as well as unconscious conflicts The causes of underachievement, self destructive and provocative behavior and suggest strategies for changing them. Guidance sessions also provide parents with  emotional support and a forum for conflict resolution: parents rarely agree on how to respond to and manage the challenges having a gifted child. Differences can be aired and discussed in a safe environment CONSULTATION 1.    In each case there is open consultation and communication with the other involved professionals. 2.    Consultation is available to other therapists who may want advice about their cases.	Jerald Grobman M.D. 1044 Madison Avenue New York,N.Y., 10075 212-249-7351 Madelon Sann L.C.S.W. 1044 Madison Avenue New York,N.Y. 10075 212-737-6508 163 Engle Street Englewood, NJ07631 201-569-3887