1. Crisis Management
2. Comprehensive Assessment and Diagnosis
3. Psychotherapy
   • Alliance Building
   • Psychologically Based Mentoring, Coaching, Advising
   • Stages of Psychotherapy
4. Parent Guidance
5. Consultation Services for other professionals:
   • Medical, educational, psychological

Crisis Management

1. Making an Accurate Diagnosis
   • Depression and anxiety are a part of many psychiatric syndromes and are expressed differently in each individual.
   • These symptoms may also occur in gifted individuals in crisis who have no psychiatric disorder.
   • Understanding the differences is important so that an accurate diagnosis can be made.
2. The Use of Psychotropic Medication
   • Psychotropic medication is often used during crises to prevent further psychological deterioration and to restore self control.
   • Choosing between the different types of mood stabilizers, antidepressants and major or minor tranquilizers can be a complex process and requires clinical judgement that comes with experience.
   • Once a solid therapeutic alliance is established, psychotherapy can proceed and the use of psychotropic medication often becomes unnecessary.
3. Restoring Self-Regulation
   • Active stress management techniques are suggested.
   • Programs are outlined for Healthy
     • Nutrition
     • Sleep
     • Time Management
     • Work Schedules
   • Plans are discussed for elimination of
     • Substance Abuse
     • Self-Destructive Behavior

Beyond Diagnosis: The Comprehensive Assessment

A complete assessment allows us to understand all aspects of a gifted person’s personal experience as well as his/her problems and symptoms.

Steps in the Assessment Process

1. Collecting Historical Data
   • Parents are asked to provide the different parts of their child’s history. This includes
     • Developmental
     • Medical
     • Social
     • Education
   • Gifted adults provide their own histories.
   • History of giftedness
     • A detailed description of the child’s giftedness is reviewed.
     • Dramatic successes and failures are noted.
   • Each parent’s personal history is reviewed.
   • The circumstances and history of their marriage are explored.
   • The nature of parent child interactions are examined.
   • Areas of strength and vulnerability are established for each family member.
   • School reports, previous workups, testing results and evaluations are all reviewed.
   • School teachers, counselor, and psychologists are consulted where appropriate.
2. Formulating the Problem
   • The formulation identifies each of the internal and external forces in a gifted person’s life that contribute to their problems.
   • A “Hierarchy of Causality”
     • The formulation establishes an order of importance for the different stressors and makes a concise statement of how they individually and in interaction with each other cause the symptoms and maladaptive behavior.
   • The Psychodynamic Component
     • This aspect of the formulation helps explain how unresolved unconscious and conscious conflicts and anxieties develop into a “Central Dynamic Conflict.” A diagnosis describes what a person has, a formulation describes who a person is and how he/she got to be this way.
     • It helps explain how repetitive maladaptive efforts to resolve emotional conflicts contribute to problems with peers, family, school.
     • It helps avoid misdiagnoses. A gifted person in crisis can be mistaken for one with a true psychiatric disorder. The most common misdiagnoses are
       • Bipolar Disorder
       • Mood Disorders
       • Anxiety Disorders
       • Personality Disorders
     • Making an accurate diagnosis is never a simple procedure. It requires clinical judgement that comes with experience.
3. Special Applications of the Psychodynamic Formulation
   • The “Inner Experience” of giftedness
     • The psychodynamic formulation helps separate the conflicts and anxieties a gifted individual feels about his/her very personal “inner experience” of giftedness from conflicts and anxieties that he/she has with school, peers and parents.
   • Family Dynamics
     • The psychodynamic formulation helps clarify if a gifted child’s underachievement, self-destructive behavior or psychological symptoms are an acting out of family dynamics. For instance, a family’s ambivalence about having an exceptional child or the child’s way of holding a marriage together.
   • Evaluating the Twice Exceptional Child – A Gifted Child with Learning Disabilities
     • Gifted children may have coexisting learning disabilities for three different reasons.
       1. A neurologically-based learning disability
       2. Emotional conflicts that inhibit learning but originate in a family’s conflicts and dynamics.
       3. Self-imposed learning disabilities: irrational beliefs that learning issues or learning inhibitions are actual learning deficits. These self-imposed “learning deficits” are unconcious psychological mechanisms for restricting expression of brilliance.
     • A thorough psychodynamic evaluation can help distinguish between these three causes or clarify their relationship to each other when they coexist.
   • Existential Depression
     • Gifted individuals may become resigned to living in physical or emotional isolation feeling that no one understands them and that they are unlovable. The cause is often thought to be a set of unlucky circumstances. However, existential depression may result from an inability to find ways to be adaptable and flexible without compromising gifted integrity. A psychodynamic evaluation can help clarify whether conflicts in this arena exist.
   • Distinguishing a gifted polymath from a person with an Attention Deficit Disorder.
     • Under extreme stress a gifted polymath’s ability to multi-task may unravel. The resultant erratic, behavior and distractibility may mimic a person with Attention Deficit Disorder.

The Comprehensive Treatment Plan

Once the formulation has been established it acts as a guide for

• School Interventions
• Family Interventions – especially parent guidance
• Suggestions for Learning Disability Interventions
• Psychotherapy

Psychotherapy

The Therapeutic Alliance

• Developing a therapeutic alliance with a gifted individual may be difficult. Feeling relieved once their crisis has been resolved may stimulate them to end therapy prematurely. This almost always insures a return of symptoms. Gifted individuals may also abbreviate psychotherapy because they believe that therapists do not “get” giftedness. As part of crisis intervention, addressing their inner experience of giftedness can convey that psychotherapy has more to offer than symptom relief.

Early Stage

• In this stage of psychotherapy we frequently act as psychologically informed mentors, coaches and advisors. The first task is to help establish more effective strategies for managing the real world. Once this is accomplished we help gifted individuals establish or reconnect with a vision for their giftedness. Addressing embarrassment and guilt about being exceptional helps a unified and coherent vision to emerge. We help validate, clarify and explore this vision. Suggestions are made for finding the appropriate venues for full expression of their gifted potential.

Middle Stage

• In this stage our patients come to understand
  • That efforts to avoid conflict about being gifted by disavowing it through underachievement and self-destructive behavior are the leading causes of depression, anxiety and other psychological symptoms.
  • The basic concepts of psychodynamic psychology
  • The universal nature of psychological conflict
  • That psychological conflict is not a sign of mental weakness or mental illness
  • The differences between conscious and unconscious conflict
  • The origins and long-term effects of unresolved early normal and gifted developmental conflicts and how they intersect with each other.
  • The value of tolerating, examining and exploring conflict and anxiety instead of acting impulsively to avoid or deny them.
  • Healthier ways of resolving psychological conflicts

Late Stage

• In this stage more complex aspects of psychodynamic psychology are introduced and explained.
  • The ubiquitous nature of transference in all relationships
  • The nature of psychological resistance to change.
  • The nature of adaptive and maladaptive psychological defense mechanisms
  • The working through process
• Conflicts within the “inner experience” of giftedness are explained and examined.
• The extra cognitive aspects of gifted endowment are explained and examined.
  • Facilitating the synergy of intuition, imagination, clairvoyance, curiousity, aesthetic, and physical sensativities, helps creative work become more productive.
• Obsessionalism, procrastination, oppositionalism, and impatience are explored in more depth.
• Warning how to handle phases of creativity that are explosive is just as important as learning how to handle phases of creativity that seem stagnant.
• Psychotherapy becomes a model for collaboration in all relationships.

Parent Guidance

The Family in Crisis

• When a gifted child, adolescent or young adult develops a psychological crisis, the entire family unit may also go into crisis.
• How do we manage this?

The Elements of Parent Guidance

• Education
  • Explaining the differences between normal and gifted development.
  • Using the formulation to differentiate circumstantial conflicts from developmental conflicts.
  • Using the psychodynamic parts of the formulation to distinguish between conscious and unconscious conflicts.
  • Exploring conflicts about the “inner experience” of giftedness.
• Information about these issues can be reassuring to parents as they begin to understand different aspects of their child’s problems.
• This knowledge provides a foundation for a parenting approach that goes beyond simple behavior management.

Improving Communication

• Establishing ground rules for respectful communication and interaction between both parents as well as between parents and child.
• All opinions and feelings – negative and positive – are legitimized.
• Discussions about difficult topics are limited until trust is restored.

Developing a Plan for Encouraging and Supporting Gifted Development and Limiting Destructive Regressions.

• We help parents become familiar with each of their reactions to their child’s giftedness.
• Individual sessions help each parent learn more about their own values, strengths, weaknesses and unresolved conflicts about their own family of origin.
• In individual sessions, each parent discusses their view of their marriage. Confidentiality promotes a discussion of more sensitive issues.
• We learn whether or not each parent is gifted, how they feel about it and what they have or have not done with it.

Discussion about Differences

• We encourage an open and honest discussion about differences parents have with each other.
  • How and in what way do each of them feel about supporting gifted development?

  How much do they feel gifted development should be limited?

  How much sacrifice should be made as well as other possible differences unique to their situation?

• Becoming a Team
  • The process of parent guidance then becomes a combination of education, support, exploration as well as coaching and advising. Invariably, parents discover they cannot completely resolve their differences yet have to become a team in order to successfully help their child.

Consultation

Open Communication Always Takes Place with Other Involved Professionals

• Educating other professionals about the psychological aspects of giftedness.
• Using each individual’s formulation to explain difficult or strange behavior.
• Building alliances with other professionals so that effective collaboration actually occurs.
• Acting as a liaison between parents and other professionals so that parents can be effective advocates and misunderstandings can be prevented.
• Helping translate psychological needs of gifted children into sensible recommendations for curriculum changes.