Lisa Barnes Lainer, Ph.D.

09/14/2022

I’ve been MIA here on my page for a long time! What have I been doing you asked…well, a lot of parenting and working AND preparing to take the Psychologist Jurisprudence Exams for licensure in Nevada and Oregon. It has been a long time since I have sat for an exam and I will confess to being anxious.

Each of these tests was given remotely and were “open note” exams which meant that I could use the study materials provided for me. Those notes included various statutes and codes dictating each particular state’s laws related to the practice of psychology. Also provided were the American Psychological Association's official Code of Ethics as well as any ethical additions each state wanted to add. Each exam was a series of multiple choice questions. When I took the exam I had to agree that I would not use any other material while I took the exam, I would not consult any other professionals for help, and I would not share any of the exam questions with anyone else.

Open book/note tests seem like they would be easier, and sometimes that is true. There were some questions where I could look to the statutes and determine what each state's laws were regarding a particular issue. However, most of the questions were not nearly that clear. Most questions involved short vignettes about a client and some issue that has developed in the course of treatment, and the question asked which of the four answers provided the best answer as it relates to one or more ethical issues.

Let me tell you that these tests were not very easy. Each took me over two and a half hours to complete, and while I was pretty confident that I had passed, I worked hard to think carefully about what issue was presented in each question and what was the best legal or ethical principle that needed to be applied.

I am very proud to announce that I am now fully licensed to practice psychology in both Nevada and Oregon (as well as in California)! I provided therapy through a HIPAA compliant online portal. I welcome your referrals.

08/12/2021

How do you organize your schedule? Do you carry around a paper and pencil calendar (I used to LOVE my Filofax)? Do you use a whiteboard calendar? An online calendar?

Years ago my husband and I began using Google Calendar, with different color coded calendars set up for him, myself, each of the kids, and family activities. It was a game changer...When one of us needs to schedule something (for ourselves or as a couple or family) we can see who is and isn't free and make thoughtful decisions about scheduling.

As we head towards the beginning of the school year, I encourage everyone to work on calendering skills with their kids, regardless of their ages. Free printable calendar pages are available on line, and each child can have their own copy with their activities, parties and school events and assignments can be added. Learning to look forward and plan an entire week, knowing where the windows of time are to focus on school work, when to plan playdates and hangouts, can help your children feel more in control of their lives.

05/26/2021

So many of my clients, children and adults alike, with anxiety are struggling with the reality of the world starting to open up as the Covid vaccine becomes widely available here in the United States. The unintended consequences of the lockdown of businesses and the closure of in-person school for those with social anxiety has been profound. Adults are scared to leave their homes, allow their fully vaccinated friends and family into their homes. They are out of practice in a social world and are reluctant to re-engage. They are fearful of this virus even when they have been fully vaccinated.

Children and teens found safety and comfort in schooling from home because it took away the necessity of face-to-face interactions with their peers. School expectations were lowered during the pandemic and some are struggling to relearn how to put real effort into their academic pursuits. The children and teens who would have been out and about hanging out with friends have lost some of those skills.

It is very important that we recognize the very real emotional consequences of such a severe lockdown.

05/04/2021

What is ADHD?

ADHD is perhaps the most common childhood mental health diagnosis. It is sometimes thrown around in jest or used derogatorily and, alternatively, denied that it actually exists. There is some controversy around causes of ADHD and the various treatment approaches available. In this post I will touch on the hallmark symptoms of ADHD as well as the most common treatment(s) that are recommended. Where there is notable controversy or concern I will try to address that as well.

ADHD is a neurodevelopmental disorder that is most often diagnosed in children, but which can persist into adulthood. It is characterized by difficulty paying attention, hyperactivity or restlessness, difficulty taking turns, impulsivity, and difficulty getting along with peers.

There are three “types” of ADHD each of which is characterized by one prominant feature, but that does not mean that none of the other features of the disorder are absent. Primarily Inattentive type is characterised by distractibility, difficulty completing tasks, day dreaming or difficulty following multi-step tasks. Predominantly Hyperactive-Impulsive type is characterized by restlessness, fidgeting, near constant movement, and impulsivity that can lead to frequent accidents and injuries. And, Combined Presentation type, which as described is a good mixture of all of the symptoms listed above.

The cause(s) of ADHD appear to be primarily genetic although no one single gene has been identified. Other causes such as prenatal environmental exposure to lead or alcohol, and brain injury have been hypothesized but not yet found to be responsible. The belief that excess sugar consumption, too much television watching, etc. causes ADHD has not been supported although any of those factors may affect already existing ADHD.

Diagnosis of ADHD is made by a mental health professional through a series of evaluations of the child’s behavior in a range of different settings. Interviews and paper and pencil measures are administered to the child, parents and teachers. There is no blood test or other genetic test that determines an ADHD diagnosis. The DSM V (The Diagnostic and Statistical Manual used for diagnosing individuals) provides a series of symptoms that must be present in two different settings to receive an ADHD diagnosis. Those symptoms must be present for a certain duration of time and must interfere with everyday functioning.

Children as young as 4 can be diagnosed with ADHD, but in those cases there are often serious behavior issues seen in preschool and daycare,including major tantrums and some physical aggression. Often diagnosis is not made until the child is school aged, when the ability to sit still in class and attend to teachers becomes the expectation and the student struggles to do so.

Treatment of ADHD is often multifaceted. A combination of medication and therapy is often what is most effective. There are different categories of medications prescribed for ADHD including stimulants that have a paradoxical effect on individuals with ADHD, and nonstimulants. Stimulants are more often prescribed and tend to be faster acting. Non Stimulants take longer to go into effect but their effect can last longer. A medical doctor must prescribe these medications, and individuals must be monitored for decreased appetite and sleep difficulties. With either class of medication it can take some time to find the correct medication and the correct dosage.

Therapy, both for the child as well as for the parents is often very important. Children with ADHD sometimes struggle with self-esteem issues and social issues due to their disruptive behavior. Where there are issues related to executive functioning (the ability to plan and organize school work) educational therapy can be very helpful and creates external scaffolding to support students.

Parent support and parent training therapy is also an important part of treatment for ADHD in children. Parents need support in understanding the diagnosis and range of treatment options. Parents often also benefit from developing new skills to help their child and to redirect difficult behaviors.

If your child is diagnosed with ADHD it can feel overwhelming. Finding a good child psychiatrist with who you feel comfortable is very important. While pediatricians CAN write the prescriptions for the medications, it is better to see a child psychiatrist who can better decide what medications might be best for your child. Seek out some parenting support as well so that you have someplace to go to deal with your own emotions and to develop ways to better support your child.

04/18/2021

https://www.wsj.com/articles/jory-fleming-sees-the-neurotypical-world-from-an-outsiders-perspective-11618588476?reflink=desktopwebshare_permalink

Autism looks like so many different things. For so long when we heard the term "autistic" what came to mind was someone who had completely withdrawn from the world and was unreachable. Our understanding of this disorder as truly representing a spectrum of abilities and functioning is very important. I can't wait to read his book!

An author and Rhodes Scholar challenges misguided assumptions about people with autism.

04/12/2021

https://www.wsj.com/articles/when-the-pandemics-end-means-the-return-of-anxiety-11617299927?reflink=desktopwebshare_permalink

This article makes a brief mention of the moral high ground those who carry around with them high levels of Covid Anxiety. I have found this to be very true in my practice. Those clients who have struggled the most with anxiety related to exposure to this virus, and who have locked down most heavily are also the most judgemental of their friends and family who have made different choices, or made issues other than medical concerns their priority. In these cases friendships have been severely strained, sometimes to their breaking point.

For people who were already anxious before Covid-19, the limitations of the pandemic offer a sense of control that they are reluctant to let go.

04/05/2021

I am often asked about the differences between psychiatrists and psychologists, and all of the various mental health practitioners that we encounter in the search for the right therapist. There are differences in licensure, the amount of schooling, the focus of that schooling and the amount of clinical experience required during the training and after training, and the scope of expertise.

I will try to help clarify the differences between some of the various mental health practitioners for you. Keep in mind that this is not an exhaustive list of mental health practitioners and that for each degree and license there are differences in requirements that vary state by state. The information here is for your general information.

A psychiatrist is a medical doctor (MD) who has completed four years of college (and have received a baccalaureate degree) and then four years of medical school and passed the licensing exam to practice medicine. This license must be renewed regularly and continuing education is required for renewal. He or she then completes a 4 year residency in psychiatry where the focus is on psychiatric diagnosis, treatment and medication. To be a psychiatrist one must also obtain certification from the American Board of Psychiatry and Neurology. Psychiatrists are the only mental health professionals who are able to prescribe psychiatric medication. Within the world of mental health some psychiatrists focus on medication management while others also work as ‘talk therapists’.

A psychologist has completed four years of college (and have received a baccalaureate degree) and then four years of a graduate program and, upon completion, has been awarded a Ph.D. or a Psy.D. During that schooling he or she will have completed 1600 hours of supervised clinical work in various internships. Once the degree is completed a psychologist must complete an additional 1600 hours of supervised clinical work. They cannot practice independently (without clinical supervision) until they have passed their state licensing exam. This license must be renewed regularly and continuing education is required for renewal. Psychologists are the only mental health specialists who are trained and authorized to complete psychological and neuropsychological testing.

A social worker has completed four years of college (and has received a baccalaureate degree) and then three years of a graduate program and upon completion has been awarded a MSW. During that schooling, he or she will have completed 3600 hours of supervised clinical work. The exam required for a social worker to see clients independently (without supervision) changes the degree to LCSW. This license must be renewed regularly and continuing education is required for renewal. Social work is a practiced based profession that focuses on the well being of the individual within their community with an emphasis on human development and behavior and the social and economic forces that impact those individuals. Social workers practice in a private setting as a therapist, and also work within institutions such as hospitals and clinics.

A marriage and family therapist has completed four years of college (and has received a baccalaureate degree) and then two years of a graduate program and received an MA in marriage and family therapy, mental health counseling or a similar field. After that schooling he or she will then complete the required number of supervised clinical hours (the number of hours required vary from state to state) after which they can sit for the licensing exam and become a licensed marriage and family therapist (LMFT). This license must be renewed regularly and continuing education is required for renewal. LMFT’s work in private practice settings as well as in clinics.

Ultimately, it is important to be sure that whomever you trust your mental health to is licensed in their state and that their license is in good standing. You may need or want to choose someone with a particular license or speciality to best address your needs. Remember too that finding someone who you feel confident and comfortable with is also very important.

03/31/2021

Somebody once said:
"Gratitude turns what we have into enough".
We all have struggles, some of them big and some of them small, but if we can take the time to find gratitude in the little things, it change our mindset, if only for a short time. It is so very important to recognize the things that we do have and not only lament the things that we don't.

03/22/2021

If you have never been to therapy before you might be wondering what it's like. What happens before I have my first appointment? What do I actually do in therapy? Do I have to lay on a couch?

Everybody's therapy practice is a little different, but there are a few common experiences I can share with you. First, you will likely speak with your therapist on the phone prior to actually meeting face-to-face. That meeting gives you a chance to tell the therapist what is bringing you to therapy right now and to ask any questions you might have of the therapist both in terms of what to expect specifically in their practice and his or her experience. It is also a time for the therapist to determine if what brings you to therapy is something they believe they can help you with. It is important that each of you feel like you are a good fit.

Once you have both agreed that you are a good fit for one another you will make an appointment. When you arrive at the therapist office you may find a clipboard with forms to complete while you sit in the waiting room. You will also likely find a list of therapists names with a switch or button right next to the name. When you hit that switch or button it will light up on your end, and it will light up in the therapist's office. That will let him or her know you are there.

When it is time, you will be welcomed into the therapist's office and invited to sit on a chair or couch. There is no requirement that you do anything at all beyond that. Your first session will likely involve your explaining in much more detail the issues that have brought you to therapy, and the therapist may ask you a lot of clarifying questions. Don't worry if you are a little bit nervous or uncomfortable telling the therapist every little detail. It takes some time to build a trusting relationship with a therapist.

Before the session is over you will confirm your next appointment. Payment will likely be expected before you leave the office unless a different arrangement has been made. Most therapy session are 50 minutes, and when the session is over you will be shown to the exit. Sometimes you will exit out the same door you entered back into the waiting room. In other offices you will be shown to a private exit that exits directly into the hallway.

I hope this general overview is helpful. Please leave any thoughts or questions in the comments.