Wednesday, July 19, 2017

BREAKTHROUGH CASE WORK – Dr Pradnya Ajinkya



1] Mohini's psychological, psychiatric and neurological conditions are at risk at each of these stages because even prior to conception, Mohini was genetically predisposed to mental illness.

2] Fistal's delusional, paranoid, alcoholic, manic depressive symptoms consisting with a diagnosis of bipolar II disorder or with organic effective illness.

3] Chetna's struggle with alcohol and drug abuse with psychotic symptoms and a diagnosis of schizophrenia.

4] Sayoni's life filled with chronic torture. At an early age, she learned to use glue and other substances to medicate away her emotional response to the multiple trauma to which she was subjected.

5] Kemaya's school records which provide early indication of neurological impairment. She exhibited attention problems, an inability to learn Math, signs of organic brain damage and symptoms of depression.

6] Jiten's social factors which had a prolonged effect on development and his environment prohibited his development of an emotional or cognitive ability to cope.

7] Videsh's serious memory deficits and the neurological symptom of confabulation to fill the gaps in his memory.

8] Brij is reunited with his alcoholic and abusive biologic father who provided him with a chaotic and desperate life of hunger and instability.

9] Tara who was abandoned by her biological parents and was sent to live with her grandparents. The school records document learning disabilities, and give description to severe emotional and intellectual disabilities which were never adequately addressed by the school.

10] BREAK THROUGH COUPLE ISSUES...

Commitment
Breakdown in trust
Sexual problems
Jealousy and anger
Domestic  violence and abuse
Poor communication
Power imbalances
Extra marital affairs
Divorce counselling

Sayona’s story : What we all must know -- Dr Pradnya Ajinkya



1] Nine year old Sayona feels sick almost every day. Many days she felt ill and would avoid going to school. Other times she’d throw up in school. 

2] In the counselling sessions Sayona was wailing and feeling violently ill. She cannot hide her sadness and cannot explain her fears about losing mother. 

3] The counsellor held out hope that her mother was safe but Sayona was so restless that she would get up from her chair, cry and then go back and sit on her chair and cry.

4] In one session, Sayona opened her school bag and gave a big packet with several coffee sachets to the counsellor. The counsellor was not able to describe the contents immediately. She asked the child about the sachets and the availability in her school bag. 

5] According to Sayona, a tall fair lady came along with a small girl and placed the packets in her bag. She was not able to say from where and when they came. “Please ask Krupa Uncle. He is the attendant in the school bus. Uncle is not coming since 4 days. He promised to give me a big chocolate. But I don’t want to carry these packets. When I tell that fair lady she shouts and pushes me. I am scared they will kill my mother, she cried before the counsellor. 

6] Sayona’s mother explained to the counsellor that she married Ram 12 years ago. She didn’t know what any other life is like. She lived in an illusion that she was happy in her marriage and in control of her life. 

7] Two years back her husband committed suicide. “I cannot explain how frightened I was when I saw my husband hanging on the fan. I was unable to move and desperately needed someone to come and save Ram. I crawled to the family doctor who came home within minutes. The doctor declared Ram dead. Then I literally felt nothing. I could do nothing. My brain was not functioning at any level. I could not even bring myself to talk to anyone because I had no voice. I didn’t have any words to say. I woke up each day having spent in a state of anxiety, despair and fear. I wanted to kill myself. My recovery time was lengthened by months. The world breaks everyone and afterward many are strong at the broken places,” she narrated to the counsellor.

8] “Over the past two years after her father’s death, Sayona went through a lot. She is in constant fear of losing me. But I am not able to connect the fair lady, coffee sachets and bus attendant. I can’t connect why they targeted Sayona?” spoke the aggrieved mother. 

9] The special investigation team appointed uncovered drugs in the coffee sachets.

Therapist

Sayona’s father had a tragic death. The current investigation ruled that Ram had committed suicide, but also attributed his death due to pressures from this unknown lady who was trafficking drugs.

It must have been incredibly difficult for Sayona to handle the lady, sachets and Krupa Uncle.

The fair lady must have threatened the child that her mother would also die in similar circumstances. 

Sayona is going through a double bereavement process and lot of conflicting feelings.

The lady singled out Sayona and not other children.

Q] Despite the best professional efforts at all levels why are children invariably being used for trafficking?
In the years of my working experience there have been important and time-sensitive decisions about the rise in drug abuse, trafficking and their personal safety. Many young children are becoming addicted too.

Q] Which population must be targeted as a vital part of the Prevention Strategy?
Drug addiction is a complex and pervasive health issue causing untold damage to themselves, families an
d communities. A population of age group 12-17 must be targeted for extensive education and prevention efforts along with treatment if necessary.  

Q] Effective treatment for many drug related problems?
Behavioral therapies remain the effective treatment.  In addition, a comprehensive system needs to be developed at all levels of education to improve the understanding of trafficking, drug abuse and addiction among children and adolescents.

Q] Difference in the brain activity?
The addicted brain is distinctly different from the non-addicted brain, as manifested by changes in brain metabolic activity, receptor availability, gene expression, and responsiveness to environmental cues.

Q] Role of care givers? 
Some couples even with children are at the end of their relationship (when one does and the other doesn’t) because of drug habits. Can drugs simply be a part of any relationship or family? What are families cultivating?

Case: Rising cases of drug abuse in women: A young lady explained John and I are raised in totally different environments. I am tired of his anti-drug propaganda. I cannot continue being his ‘good wife’ all the time. He has no idea what I am saying because he has not experienced. Is that my fault?

Case: Rising cases of Marijuana in schools and colleges: We are sure this rising problem is also a need of the hour. This is a tragic cycle. The corrections and treatment professionals must join in common purpose to break the cycle of drugs and crime by reducing drug consumption which will help the suffering parents and children from losing each other to a world of no return.

Tuesday, June 20, 2017

What pushes Mumbaikars to take short trips frequently Meghna Mukherjee Garvita Sharma

Jun 19 2017 : The Times of India (Mumbai)
What pushes Mumbaikars to take short trips frequently



According to a recent report, Mumbai residents love to embark on short trips at the first given opportunity.

BT finds out what makes them take these quick breaks 
When it comes to Mumbai, there is a general perception that its citizens head to international destinations for vacations. But a recent report by a travel app would have us believe otherwise. The city has emerged as being the most travel-friendly, beating rest of India (700-cities to be precise) when it comes to travelling either for work or leisure. It does not end there, Mumbaikars are also known to take frequent short trips whenever they get the opportunity, for instance long weekends and holidays. What's even more surprising is that they tend to make quick getaways to places around the city or in the country.International destinations are reserved for long vacations.
 GETTING AWAY FROM WORK
Over the years, Mumbai has strictly come to be associated with work. Given the work culture that follows a 9-to-9 cycle and a fast pace, stress levels are extremely high here compared to other metro cities in India. An actor (on condition of anonymity) put it succinctly, “Mumbai is strictly work. I travel the rest of the time to get away from here for peace.“
However, not everyone in the city can head to an international destination at the drop of a hat.
Foram Shah, a senior account manager with a digital agency , makes frequent trips away from the city. She says, “Mumbai's life is so fast and stressful, that from Monday onwards, we start thinking about Friday . We are all so preoccupied with deadlines and `what's next' that our days are planned accordingly -there is a set routine and just to do away with the monotony , we step out of the city regularly . We often go camping and trekking to places like Lonavla, Alibag, Igatpuri or Bhandardara.“

Pradnya Ajinkya, a counsellor, seconds Foram. She adds,“Travelling is a great stressbuster. But while some people travel to beat the stress of a crowded city like Mumbai, there is also the element of thrill. A lot of female travellers want to feel free and experience the thrill of travelling alone.“ HIGH ON ROAD TRIPS Road trips clearly score over other modes of transportation even with those who don't have a vehicle of their own.

Hardeep Saini, travel agent from the central suburbs, says that the monsoons witness a high demand for outstation cabs. He says, “Long vacations are also out of question with the re-opening of schools and colleges around this time of the year.So, we have people enquiring about Panchgani, Mahabaleshwar, Harihareshwar, Khopoli -places from where they can drive down to Mumbai.

BUSINESS TRIPS TOP THE LIST 

Mumbai citizens also loves to mix work with leisure. Says Abhishek Das, who frequently travels for work, “My annual trip is saved for an international destination. But during monsoon, I try and schedule my work trips over the weekend in Pune, so that I get to meet my friends and also relax. I usually book a cab from Mumbai to Pune for ` 2,000 and take a flight or train back.“

Pragya Narayan, who works in an MNC, says, “My job requires me to travel to places like Panchgani and Mahabaleshwar. So, I leave on a Friday afternoon and get back to Mumbai on Tuesday morning. I get to enjoy the scenic views as I work.“

MAY-JUNE-JULY OVERDRIVE

Vijayanti Deshpande, who runs an outstation rental cab service, adds, “While people want to travel throughout the year, bookings are heavy during the months of May-June-July . On any given weekend, more than 200 cars are booked for travel to places like Lonavla, Pune, Panchgani, Karjat and Matheran.“

Tuesday, April 18, 2017

Entering into the marriage with post traumatic stress By Dr. Pradnya Ajinkya

Abraham is having trouble sleeping for past several weeks and his mother is concerned about his health. He wakes up at irregular intervals and refuses to go to sleep at his regular bed time. As a child his mother rocked him back to sleep. The cycle has come to repeat. Abraham who is 33 years old today is completely dependent on mother to get back his sleep. Abraham's wife complains that she grew less tolerant and the two have become sensitive and argumentative.

Therapist

Several questions relating to Abraham and his family:

a] Abraham's mother is a widow who lost her husband when Abraham was 7 years old.
 
b] Abraham was the youngest of four children. 
 
c] Abraham's mother resumed college after her husband died on a part time basis and completed her education when Abraham was 12 years old.
 
d] Her plans were definite. She spends a lot of time with her children and lived in a small home and managed to make ends meet. Finances were a concern to the family. She met all the educational needs of her children through student loans and grant-in-aid and child-support-payments from various institutions. 
 
e] The description of the circumstances surrounding the development of Abraham's sleep difficulties and the factors that affected the problem started with the typical evening event and beginning with dinner progressing through the following morning.
 
f] Mother is completely overwhelmed by Abraham's current situation. She was exasperated and felt that she was able to rock him to sleep but his wife and her understanding to the situation was something she was completely unable to control.
 
g] Mother's eyes are watery and on the verge of tears. 
 
h] It became clear that Abraham's mother's mood had been sad since her husband's death. Though she encouraged herself she felt lonely and discouraged. She remembered telling Abraham how 'down in the dumps' she felt. She later cheered herself up though she cried frequently and for long periods of time. She was preoccupied by her husband's death and Abraham was the only child who was around her while she was brooding about the events that led to husband's death.
 
i] These worries interfered considerably with Abraham's ability to concentrate and seemed directly related to his sleep disorder.
 
j] Mother blamed herself for her attitude and becoming increasingly pessimistic, although she harbored considerable resentment towards her daughter-in-law.  This placed additional strain on the already problematic marital relationship citing that Abraham's wife was a poor marital partner with several examples of her misconduct, like she spends more on clothes and shares less enthusiasm on the current problem.  
 
k] According to Abraham's wife, his sleep is about his personal habit and she was annoyed by his imperfections in their relationship.  Of course, they could easily argue about the sincere efforts to work on their marital difficulties and view them as evidence of failures. They were totally out of proportion and generalized their problems from the mother's failure in her parenting to other relationships in their life.
 
l] Their future looked bleak from their current perspective, but their interest in solving Abraham's sleeping problem was an encouraging sign.
 
m] Abraham's childhood had been uneventful. Having siblings, he spent most of his time with his mother. He remembers his relationship with his mother as warm and pleasant. His father died in an accident. When he arrived home from school he heard his mother crying and saying ,” life ahead is going to be very difficult and I am overcome with grief about this young and reserved boy Abraham who will have to struggle for years through my normal schedule of activities.” Overcome with grief over her loss, Abraham feels that in retrospective, his mother attributed this lack of assertiveness to his fear that he would feel abandoned if anything happened to his mother. This thought persisted throughout school and college days and became a pattern. As time wore on, Abraham found himself brooding more and more and this worsened after his marriage. He worried his wife may leave him. The added worry about losing his wife contributed substantially to a decline in his mood and he finally decided that he would book in with a mental health counselor for:

1] Insomnia 

2] Psychomotor agitation 

3] Fatigue or loss of energy nearly every day

4] Feelings of worthlessness or excessive or inappropriate guilt

5] Diminished ability to think or concentrate, or indecisiveness, nearly every day

6] Recurrent thoughts and clearly a prominent feature of constant brooding about losing mother and wife.

EFFECTIVE COMMUNICATORS By Dr. Pradnya Ajinkya


Case 1

My 10 year old child hits other children. Other parents feel and call my child a “bad boy” or “naughty boy”. They have reinforced the negative image of my child both in my own mind and in my child’s. The first thing I feel is embarrassment and shame, followed closely by a fear that my child may have a “mean” streak. I wonder how to tell my child?
 
Therapist
Your son may be under one or many of the stress triggers that may have made him act out. Teaching instead of punishing becomes easier. For instance, instead of, “Why did you do that? I don’t understand how you can be so mean sometimes” you will be in a much better situation to say “That wasn’t the best behavior  --  we do not hit our friends”.

Case 2
 
No matter how strong I think I am, unforeseen change can leave me feeling quite vulnerable and lost. The past three days have been the most difficult. I am a part of reeling in confusion and pain. My family is experiencing the emotional roller-coaster of finding out I am pregnant at 19. I am expecting parents to restore this. I am expecting them to redeem this situation. 
 
Therapist
 
Asking these questions requires courage because, in the end, it is very likely they will not be answered. Ultimately, it isn’t about the questions.  Behind the question is a deep current of emotion threatening to overtake us. 
 
This experience can teach us about not wanting to be ignorant. You've lived this: You would have a hard time managing the powerful negative emotions that surfaced -- anger, disappointment, hurt -- while trying to keep parents and your routines on track effectively. Parents also need to handle this situation with the child that requires calm, consistent discipline. When we are already upset, we tend to discipline the kids in a way that is, uh, not calm or collected.

Case 3
 
Rupi attacks her husband: My mother-in-law asked me to do the dishes I forgot last night before I leave for work. 'I don't understand how a grown up lady can be so irresponsible and uncaring, MIL added.......... Your mother keeps criticizing me. She always uses all-or-nothing words like “always” or “never.” “What’s wrong with her?” She does not treat me as her own daughter.
 
Husband: You have a lot of pent-up-anger against my mother. You are behaving like a stranger who has a hard time adjusting herself to a family lifestyle. "What's wrong with you?'"
 
Rupi: It's usually your attempt to belittle or demean me which strongly conveys a sense of disrespect.
Husband: If there are ongoing conflicts in this marriage (eye rolling) I will prefer to quit .
 
Rupi: I have always been on the receiving end. You can't defend me. Please understand that it's not my fault, it's yours. I can never make you happy.  It’s never enough for you.
 
Husband: Looks down and refuses to discuss further and walks out the door, and says, I have a long day, I can't deal with this ANYMORE. Let us meet a therapist. We need help! Body chemistry is also not withstanding.
 
Therapist: No one is off the hook in the above scenario. Working on increasing positive interactions and enhancing the general atmosphere of our home by lowering our reliance on this form of negative communication is vital and important. The above conversations don’t necessarily mean that one's marriage is weak or doomed. The couple should be good at 'repair attempts.' The couple can send out a white flag of surrender because their marriage is important and they should want to be close to each other.

Rethinking the relationship cycle By Dr. Pradnya Ajinkya


"Please, please, please help my son," a mother whimpers.
 
The emotional battle that my son Robin has been fighting has left him a stressed man, struggling to win back from a social system trying to consume him. It was the fifth evening after my son had left his rental home, and to his surprise, while Robin in his friend's flat was looking over a new play, Sukanya came along with her friends and threatened him to return home. "It sounds very absurd. I don't agree with you," my son said, loudly. Then Sukanya and her friends threatened to punish Robin before they left.

Case conceptualization with Robin
 
"I met Sukanya in the tail end of '11.  Evidently she is a cleverer woman than what I took her for. I feel that there are deeper and more serious matters that I have suffered than the mere solution of the mystery of separation,' said Robin shutting his teeth tightly together. Robin took a deep breath and then returned with a rapid mental photograph of his bearings. "Everything seemed to be going so well from the beginning. Like not too many of us want to be thought of as a grouch of the group of friends, we too maintained a good crowd of friends and enjoyed together. She was really really nice. Everyone liked to think that we were nice together. 'Yes' slipped off our tongues before we had the chance to stop it even if we internally were shouting 'no'.  We would meet very often. Her parents lived in another city where there wasn't much in the way of work. She wanted to get independent and on her feet and she willingly invited herself to come and live with me. Then these are the few pretty blows which hit  in a few months. Sukanya would decide how we spent time together. She would insist that I cancel plans with my family and friends. She expected me to pay off her bills. She would accuse me of cheating her with friends. If I ignored she would cry and yell and stalk off for days. I always got back to Sukanya looking into the good in her, and would give her anything and cared for her. She had the strength and an advantage of getting me back each time. If I was distracted by work, she had a habit of going into severe sulking fits. She wouldn't respond to anything. I decided something was wrong, though I was in denial for a long time. It wasn't the smartest move, but I decided to move out of my rental apartment. When Sukanya realised that I was tired and out, she grabbed me by my shoulders and dropped me to the floor and spat in my face before she walked off. The pain was enough that I quickly got up and had enough presence of mind to pick up my belongings and moved out. I was so afraid to even meet a doctor. I limped for almost five days until I started getting a little better and I was confronted by Sukanya and her friends. I told them that the relationship is over and that she struck me and I was physically and mentally threatened and things dissolved into pretty much daily arguments and hence decided to spent a few days out with a folk in his house. She did try calling me but I ignored and completely cut off, then I received a ton of texts, then my friend's phone started ringing. I did not want to compromise on my safety, integrity or privacy. I really did not want to go back," said Robin wishing that the story had ended there. "She kept harassing my friends before finally leaving me. The emotional scars are definitely still there. Life for me isn't perfect, but it is the best it could be considering the path it could have taken....." he said. 'I am still in the first part, said Robin wishing that the story had ended there.  The idea that Liz, a grade V classmate loved me so much that the first time she laid her eyes on me she fell in love with me at first sight, gave me a feel between beautiful and disaster. Now finding myself feels impossible. I feel it is Liz this time. It is barely three months and she has started sending me threats via text messages, emails and calls. 'If you break up with me, I'll post those pics everywhere.' Again slowly the labels come from her to define me and out of the wreckage of the the tragic beginnings in the earlier relationship, a similarly unlikely and tragic relationship unfolds.......'
 
Therapist
 
First, let’s deal with the priorities and convictions.
 
1] Since you know the situation best, the first option you may choose might be to stand your ground and not give in to threats.
 
2] If you fear that your friend can become a threat and harm you, it might be safest to turn to some of your support systems for self care and create a safety plan. Remember to keep your parents informed.
 
3] Check out for laws against 'revenge porn'.
 
4] It is important to realise that you may need to be cautious while being careful that this is not someone you can really lead a healthy relationship with.
 
5] Be committed to write down what you need to do each day and you can look back and know how much you have accomplished.
 
6] Keeping promises to yourself is something you need to do for self help.
 
7] While you are on your difficult memories and moments, you need to weigh your answer with your convictions and priorities.
 
8] You will have to repeat the reason you gave in the first place for saying 'yes'. Example : Sukanya and I agreed that we were ready only committing to one extra level of living-in-together to know each other.  At this point, in the present moment in a new situation, you can either change the subject or say, 'If you'll excuse me, I'm not going to get there.' 
 
9] Avoid considering the request at another time. Say that it is impossible for me to consider what you are saying. I won't let myself again.
 
10] Don’t wimp out of fear and be vague with your answers to avoid hurting feelings. It raises false hope for them, makes you seem indecisive, and slows down the process of determining who is going to be helping .....
 
This raises a few questions:
 
a] Why Robin repeats over and over again the same relationship cycle of abuse?
 
b] Can his emotional availability be questioned?
 
c] Could he have acted differently?
 
d] Why it is important to choose when and whom he should love?
 
e] Deciding to continue in a safe and long term relationship?

Entertainment Quiz
 
Read the top before you scroll down...................
 
You are in a desert. You have with you the following five animals:
A lion, a cow, a horse, a sheep, and a monkey.

To escape the desert you are going to have to get rid of one of your animals.

Which one do you drop? (You can use whatever logic you like BUT  keep track of which animal is discarded when!) You have 4 animals left.
 
The desert is burning up! It goes on for miles.
Sand is everywhere. You realize, to get out, you are going to have drop another animal.
 
Which do you drop?
 
You have 3 animals left.
 
Walk, walk, walk. Hot, hot, hot.
 
Disaster! The Oasis that you were looking for is dried up!
 
You have no choice but to drop another animal.
 
You have 2 animals left.
 
Ok, it's a long hot walk. You can see the edge of the desert way on the horizon. Unfortunately, you can only leave the desert with ONE animal.
 
Which one do you drop and which one do you keep?
 
Before looking at the answers below, make sure you know which animal you dropped in what order.
 
These answers are based on Japanese Archetypes.
 
The desert represents a hardship.
 
The animals represent . . .

    Lion = Pride
    Monkey = Your children
    Sheep = Friendship
    Cow = Basic needs
    Horse = Your passion
 
So, in the face of hardship, you will sacrifice each of these things in turn. Your last animal represents that thing which you cling to at the expense of all others.

Wednesday, March 15, 2017

#Trauma -'She's alive!' By Dr. Pradnya Ajinkya




1] It is three years since my husband and three children went missing and it has not been easy.  I find myself frequently at the hospital emergency. The hospital worsens my situation. The doctors tell me to get over it and that is just what I can't do, Ma'am.

2] I heard a huge sound like the sky crashing into the earth. I could not believe my eyes, as I saw something like a huge fireball rolling down the mountain.

3] When the disaster happened, people scrambled to save their lives.

4] I saw my husband and son rushing home on the bike, but the area was covered with thick, heavy mud. That was the last time I saw them. I was screaming and screaming and screaming for help.

5] A few neighbours along with me were forcefully shifted out to a temporary camp.                  

6] My daughter Ma'am, was left behind. There are no claims that she was killed in the incident. I've been praying daily for some clue to what happened to my ten-year-old daughter who was out playing with her friends. 

7] I want to see her Ma'am. Please let me go and find out where she is. I cannot express the panic that is in my heart. I feel heartfelt sorrow. I am sure she would be found. I can't stop my tears from falling.

8] My family is expecting me to get on with my life since they have made good effort to find out about Monika. They feel it has been three years after returning home. 

9] It is getting a bit uncomfortable living with them. They do not give me my private space to think about my child's fate. 

10] I have been receiving counselling from officers of the Welfare Department to cope with the trauma following the incident. Please listen to me, Ma'am. I harbour hope. I am sure, I am traumatized by the tragedy and need psychological care. Please help me ....... please ....... to solve this mystery .......

Therapist
Th: I am listening and please be reassured that your problems and fears are being heard. 

C: Thank you Ma'am.
Th: You remember where you were during the critical incident.

C: Yes. I was at home. When I opened the door, on hearing a huge sound, I was shocked to see a huge ball of fire falling down ......
Th: What did you think at that moment?

C: I could see my husband and son being washed away. I was totally numbed. I was screaming for help. I was calling out to Monika. I felt Monika and I would be all alone.
Th: What could be worse than this?

C: I was forced to leave the place before I found my daughter.
Th: What happened to the children who were playing with Monika?

C: Rashi and Jalpa are both dead. But there is no claim about Monika.
Th: There could be a couple of people who went missing?

C: Yes. Quite some numbers. More than 500 people. Monika may be one among them. Yet, I can't forget her Ma'am. I suffer flashbacks and delusions.
Th: Take some additional help to understand  how to deal with the flashbacks and delusions. The initial counselling interventions helped you not to rebound. However, with required extended psychological care you will surely feel better and this may even alter this consistent dynamic. The mind should be given sufficient time to heal itself.

C: Yes.
Th: Taking into consideration the intensity and duration of the trauma, why don't we have a doctor come and check your stress levels regularly? They will screen you for your psychological health and train you for high-stress combat. This can avoid the panic and regular emergency landing in hospitals.

C: Yes.
Th: We will meet often at short intervals and restructure reactions to the memories of the trauma.

C: Yes.
Th: On a 0 to 10 scale how do you feel now?

C: 4. Restructuring the memories can improve the scaling?
Th: Yes. My dear Elizabeth!

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