Pinnacle's Partnership with UHS SoCal Medical Residency Program

Pinnacle Counseling and Testing Center is excited to announce our faculty partnership with Universal Health Services Southern California Medical Education Residency Consortium (UHS SoCal MEC).  This partnership offers superior graduate medical education (GME) residency programs to Riverside County, California.

Starting in September 2019, Pinnacle’s Licensed Psychologist Clarissa Gosney, Psy.D. has been serving as core faculty for the two residency programs: Family Medicine and Internal Medicine. Carissa Douglas, Psy.D. is serving as adjunct faculty.  Dr. Gosney and Dr. Douglas provide direct clinical supervision to the Family Medicine Resident Doctors at Rancho Family Medical Group’s Makena office in Temecula, CA, as well as providing training didactics for Behavioral Health integration for the two programs. Dr. Gosney and Dr. Douglas also direct the Wellness Support Team for medical residents and core faculty, ensuring that both faculty and residents maintain proper physical and emotional well-being.

This is UHS’s first year of their Internal Medicine and Family Medicine residency programs.  Chief Academic Officer and Designated Institutional Official, Dr. Michael N. Nduati, stated that “Our residency programs are integrated into the core mission of the hospitals: to provide our community superior quality care that patients recommend to family and friends and physicians prefer for their patients, while offering unique training opportunities to the next generation of healthcare providers.”

The Resident Doctors will be providing behaviorally-trained services to patients at Temecula Valley Hospital, Rancho Springs Medical Center, Inland Valley Medical Center, Corona Regional Medical Center, Palmdale Regional Medical Center, and Rancho Family Medical Group.

We are so excited to be involved in such a rewarding partnership with UHS in providing quality Behavioral Health clinical supervision and training to the medical resident doctors of Riverside County.

Read Dr. Gosney’s Family Medicine Residency Core Faculty profile.

Learn more about UHS SoCal Medical Education Residency Consortium.

Trick or...?

I will admit... I remember telling children "Say Trick-or Treat or you don't get candy" before encouraging them to say "Thank you" for the delicious treat. This was before I learned about Selective Mutism.

Selective Mutism (SM) is an anxiety disorder that causes children, teens, and adults who have it to be unable to speak in certain situations such as at school, at the store, or... you got it... while trick-or-treating.  Have you heard about the 4 F's in response to stress: flight-fight-freeze-fawn?  Perhaps you haven't heard of the latter two.  We'll talk about "fawn" another time.  But what about "freeze?"  In a stressful state, many people have a natural reaction not to fight or flee, but to feel as if they are cemented in one place.  Their minds go blank, or perhaps their minds are rushing thoughts around at a million miles a minute, yet they are frozen.  They cannot move.  Now imagine this happening to your mouth.  This is what happens to individuals with SM.  While they want to engage with others, and may be able to do so physically, they find it difficult to speak.  In elementary school, this might look like a child playing with her peers at recess but not speaking to them.  In adolescence, this might look like a teen staring blankly at his teacher when asked a question in front of the class.  In adulthood, this might look like someone who doesn’t talk to anyone at work and often doesn’t attend social gatherings.  SM isn’t shyness, though that is often how it is explained to others by those who don’t know how to explain it any other way.  SM is an anxiety disorder that causes the mouths of those who have it to “freeze,” unable to speak.

This Halloween, please keep in mind that the child or teen who extends their hand for a treat but does not verbalize anything, may be a child who wants to say “Thank you” but is frozen.  Coaxing them to speak (no matter how sweet and calm or how direct and demanding your approach) will not help but is likely to make them more anxious and thus, even less likely to speak.  Instead, flash a smile and tell them “Happy Halloween” while passing out goodies.

Thank you for making Halloween fun for everyone!

Picture this:

Heather Kormacher is the proud mother of an amazing little boy; a vibrant, full of life, introverted, book-loving good student. A mother’s pride and joy. Year after year he’s been that healthy kid, with the occasional sniffles and infection most experience from birth through ten years old. Nothing of any concern at all, medically, socially, or emotionally. Just your normal kid!

Heather wakes up one morning no doubt saying, “Where did my son Hans go, and who the heck is this?  I must be dreaming.”  You wake up from the typical dream, right?  However, she realizes that this is not a dream, but a reality which has now turned into a living nightmare.  Can you even imagine?

This precious little boy was on a downhill spiral.  He awakened that day gnawing at his tongue, agitated, in a frenzy. Within five months Hans was full of extreme rage; destruction occurred daily. These experiences impacted his life is such a horrific way that his parents found him frequently having suicidal thoughts, feeling as if ending his life was the only way to find relief.

Obsessive Compulsive Disorder (OCD).

Pediatric Autoimmune Neuropsychiatric Disorder (PANDAS), discovered by Susan Swede, a developmental pediatrician.

This combination is believed to have been Hans’ experience, a rare form of OCD associated with streptococcal infections. Hans had four times the typical levels of immune molecules that the body produces in response to a strep infection.  This was in spite of the fact that he had not actually had strep. 

It is difficult to prove a correlation between PANDAS and strep. Many questions as well as skepticism remain causing families to desperately search for answers.              

Is this a genetic predisposition?

              Is PANDAS really a separate disorder from OCD?

              Is PANDAS truly triggered by strep?

              Which brain cells are harmed?

Why do you countless children even get strep in the first place and so few develop PANDAS symptoms?

What is the biology underlying PANDAS?

How does strep actually affect the brain?

There is no definite lab test for PANDAS; however, it is possible that as many as one out of 400 children in the United States have the condition. Others argue that a patient with suspected PANDAS likely has traditional OCD or Tourette’s syndrome.

So, whatever happened to the little boy Hans? After seven months of antibiotics, which did little to improve his condition, he received IVIG (intravenous immunoglobulin). This infusion of antibiotics is stripped from the blood of thousands of healthy donors. Nearly 2 years after his initial symptoms, IVIG results were noticed within about two weeks. One morning, Hans was sitting peacefully at the dining room table eating breakfast as his mother said a passing “I love you” to her son, who responded with “I love you too,” which is something she had not heard in over a year! Hans gradually improved over the next six months and is now 15 years old and fully recovered.  The nightmare is over!   

 *NOTE:  IVIG was costly, requiring an estimated $17,000 out-of-pocket cost.  His mother was able to work with the insurance company to cover the remaining procedure costs. 

**It is important to speak with a licensed mental health professional who specializes in anxiety and OCD and is in collaboration with a medical doctor who is familiar with PANDAS if you think you or your child may be affected.

This article is a summary of an article in Science News Magazine: When Strep Plays Mind Games by Rachel Zamzow

Managing Conflict: Six Skills

In a recent article provided by The Gottman Institute, Dr. Gottman has explained to his readers that initially it takes six skills to manage something we partake in often, which is conflict. While we all fall short of perfection in the area of conflict management, luckily in Gottman’s relationship blog he provides the fundamental skills that are the formation of constructive conflict: Soften Startup, Accept Influence, Make Effective Repairs During Conflict, De-escalate, Psychological Soothing of Self and Partner, and Compromise. His research has shown that when two individuals start an argument it tends to end on the same note it began with.

Here are the skills he has provided in his research that can help lead any couple to have a meaningful and healthy relationship.

1.  Soften Startup. This is where instead of taking an aggressive and destructive approach when you initially start arguing within the first 3-minutes, you will be far happier and more stable in your relationship if you start the initial argument in a soft manner.

2.  Accept Influence or known as Complain but don’t blame. This is where no matter how wrong you think your partner is or at fault do not approach them with accusation or criticism, or it will be very fruitless.

3. Make Effective Repairs During Conflict or known as Make statements that start with “I” instead of “You.” Starting a sentence with “I” instead of “You” automatically sounds less critical and doesn’t put your partner in a position where they feel they have to defend themselves right off the bat. The key is to focus on how you’re feeling, and now how your partner is feeling.

4. De-escalate or known as Describe what is happening, but don’t evaluate or judge. This is when you describe in a mature manner what is going on in the situation instead of blaming or accusing your partner. Although you may be ready to blow fire and act out impulsively, it is always better to hold your tongue. This is more likely to lead to your partner to consider your point of view.

5. Psychological Soothing of Self and Partner or known as Be polite and appreciative. Just because you and your partner are in a tiff does not mean that your affection and respect for them has completely vanished. Adding sentimental phrases like “please” can help maintain that warm connection even during a situation that is difficult.

6. Compromise is key to a healthy relationship. We have all experienced situations where nothing is going right, and we feel overwhelmed and exhausted. This most often leads to an individual letting out all their bottled-up emotions. The best thing is to not hold onto all these issues you feel and wait for forever to finally air out your emotions, this will only lead to escalation. Generally, the issues we bring in a heated situation may sometimes not be exactly related to what we are truly trying to say where it feels like both partners are not reaching a solution. This is where compromise comes into place, come to a settlement with your partner and meet in the middle so it does not lead to any unnecessary disagreements.

My Experience as a Counselor at “Outside Voice” Selective Mutism Camp

As a recent graduate with a degree in Psychological Science and one who has been an advocate for students with special needs, working in the local unified school district for the last 4 years, I felt like I would be very qualified for the volunteer position at the Selective Mutism camp. Initially, my feelings and expectations going into camp on day 1 did not match up with what I actually experienced during the camp. After leaving camp on day 1, I felt exhausted and overwhelmed, and even a little apprehensive at the thought of returning for days 2 through day 4. It was such hard work for both the campers and I to form that connection and for me to set up an environment for them to feel comfortable enough to be able to find and use their voice. That initial apprehension drove me to feel determined to try my best and to focus on the kids, and their needs.

My goal from day 1 to day 4 was to focus on each camper that I had the opportunity to work with and to create an atmosphere that was comfortable, secure, and relaxed for them. At the beginning, I noticed some of the counselors and campers were a little nervous and anxious, but those feelings diminished as the days went on. We did many activities that I have seen in a public-school setting: birthday parties, show and tell, demonstrations on specific tasks, asking new friends questions about themselves, independent free play and playing with peers, award ceremonies, and on the last day we went on a field trip to a local children’s museum. These students were given tasks, opportunities, and prompts to overcome their anxiety and fears in new settings among unfamiliar faces and they did an absolutely amazing job! It is quite astonishing to see them overcome some of their fears right in front of our eyes. From day 1 to day 4, I noticed these campers’ skills improve drastically. I hope they will carry their new skills onto their everyday lives upon leaving camp.

It has been an amazing opportunity and pleasure to work with and witness these kids learn new skills that will help them break down their barriers of anxiety and fear. Looking back on day 1 and the lack of energy I felt to day 4 where I felt like the kids did not necessarily need me there anymore, they had become so independent and were constantly interacting with other kids using their voices. I cannot put into words the feeling I felt when I was able to witness firsthand the trials these little ones overcame and the dismay they were encouraged to face that only made them stronger. Of course, it takes baby steps to progress in any situation but what I witnessed with these campers specifically were not only baby steps, but leaps!

Anxiety in the Classroom

Your child is experiencing anxiety in the classroom. This experience can make your child feel frozen, which in turn decreases your child’s ability to learn the information being taught.  While we never want our children to experience high levels of anxiety, the classroom is one of the last places we would want our children to be anxious.  

So, how do we identify anxiety in the classroom? Unfortunately, identifying anxiety in a child at school is not always a straightforward task. Symptoms of anxiety often mimic symptoms of other difficulties, such as ADHD, learning disorders, and oppositional behavior. In order to provide the best care to a child, we need to observe behaviors closely and try to identify the root to the behaviors.

What are some behaviors to look out for that may be a result of anxiety?

Here are a few common ways that anxiety presents itself in the classroom: 

1.     Attendance problems/Trips to the nurse. Anxious kids may protest going to school due to the anxiety that arises when they are there. They also may frequently ask to go to the nurse once they are at school. Children experiencing anxiety may express that they feel sick due to experiencing stomachaches or other physical symptoms. If this is happening on a regular and consistent basis, these physical symptoms may be a result of anxiety rather than actual illness.

2.     Inattention and restlessness. While we often think of attention difficulties and restlessness as being related to ADHD, these behaviors may also be a result of anxiety. Anxious children may have difficulties attending to the lesson or sitting still when they are preoccupied with worries swarming in their heads.

3.     Not answering questions or asking for help. Children experiencing anxiety may be overly concerned with their answers being exactly right, and therefore may not share information with the rest of the class. Children experiencing social anxiety may be acutely concerned with what their peers and teachers think of them. When children are experiencing difficulties with Selective Mutism, they often “freeze” up and are unable to provide verbal responses to questions.   

4.     Unfinished work/Difficulties in certain subjects. If a child has not been completing work that was assigned, this could be a sign of anxiety. The same goes if a child is struggling in a certain subject at school and having difficulties completing the work in a specific subject. The child may either not want to turn in work that isn’t “perfect” or may be overwhelmed by intrusive, anxious thoughts that are distracting him from getting his work done.

By no means is this list exhaustive, as anxiety has many different expressions. However, if you notice your child exhibiting any of the above behaviors or others that are concerning, you might consider the possibility that the issue is stemming from anxiety. Ultimately, anxiety can be extremely disruptive in multiple areas of a child’s life, and the classroom is often one of these areas. The good news is this: if we are able to pinpoint anxiety as the root to the difficulties that our children are experiencing, we can provide the appropriate care in order to help our children conquer the anxiety that’s hindering their success. 

- By Dr. Lindsay Haig, PsyD -

The word “mindfulness” is popping up everywhere today. Maybe because I am in the field of psychology and I practice mindfulness myself, but it definitely feels as if no one can get enough of mindfulness. But how does this translate to kids and anxiety?

John Kabat-Zinn defines mindfulness as, “Paying attention in the present moment without judgment.” Fair enough, but what does this mean and how does this help kids struggling with anxiety? Mindfulness can feel simple and, at the same time, totally out of our comfort zone all at once. For kiddos (and other ages alike), mindfulness can be practiced by paying attention to the senses. When children are anxious, they are very much stuck in their thoughts and not aware of what is happening in the present moment.  By coming back to what is happening in the here-and-now (which can be extremely difficult no matter how old you are), children and adults can refocus their attention to what’s happening in the present instead of thinking about the past or future.

One exercise that I love to do in therapy is called the “5-4-3-2-1” grounding exercise. In essence, this is how it goes. Look around the room that you are currently sitting in and identify 5 things you can see (i.e. I see a cup, I see a computer), 4 things you can feel (i.e. I can feel my back on the chair, I can feel my feet on the floor), 3 things you can hear (i.e. can hear the traffic outside, I can hear my dog making silly noises), 2 things you can smell/like the smell of (i.e. I can smell mom cooking in the kitchen OR I love the smell of chocolate), 1 thing you can taste/like the taste of (i.e. toothpaste from brushing your teeth OR I love the taste of chocolate).

Why is this exercise or using mindfulness in treating kids with anxiety important? It helps them return to the here-and-now. With anxiety, it is so easy to get inside your head and be out of touch with the reality of the present moment.  Using mindfulness, we can return to what’s actually happening and leave behind those things that we think are happening. 

~ Dr. Lindsay Haig ~

We are thrilled to announce the dates for our summer camp for children with Selective Mutism, ages 3 to 9. Camp registration will be open to the public, as well as to current clients. This is the first time that Pinnacle Counseling and Testing Center will be opening its doors to offer treatment to children who are not already registered clients! Our 4-Day camp, Outside Voice, will run June 23-26 in Murrieta, California. For more details, Contact Us.

*Stay tuned for dates on our “older” kids SM camp, which will be held at the end of July!

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.

Trauma-Informed Teaching

As we approach a new school year, it is important for all teachers to look deep into the needs of each child who sits in their classroom.  Trauma is something that can scream so loudly in a voice that can be easily mistaken as oppositional, inattentive, hyperactive, and angry.  

In a recent post, Ransom for Israel painted a vivid picture of a child who has experienced trauma as a goldfish that has been mistaken as a shark.  "...our children often present with behaviors that look like the shark, but if we look below the water, we will realize they are really just scared goldfish trying to have a need met.  Their behaviors might communicate anger and hostility, but below the surface is fear and a hurting child."

School can be a fortress for the hurt and the weary.  For teachers, you have the honor of being able to "provide a safe space and help them regulate.  This might mean sinking down to eye level and saying, 'You are safe.' and then simply step away for a while.  The cure for trauma is a safe relationship and you are going to give the child space and environment to feel safe."

When you see a child who is struggling, find the need that has yet to be met.  Be their safety.

Secondary Emotions

Anger is often considered a secondary emotion because it is used as an attempt to protect ourselves against feeling or showing primary emotions such as sadness, grief, fear, and anxiety.  We may unintentionally hurt others as a form of self-protection.  Only when we decide to take off the mask of anger can we allow ourselves to begin to heal.

The next time you find yourself angry, I challenge you to look beneath the surface.  Are you feeling embarrassed?  Disrespected?  Undervalued?  Afraid?  Open yourself up to learning more about the real you, and let the healing begin.

Autism Diagnostic Assessments are Coming!!

We are VERY excited to announce that our ADOS-2 manual and kit arrived today!!! 

We are now scheduling Autism Diagnostic Assessments.  Appointments available as early as March 27th!  Click HERE to schedule your assessment.