Beth Rutkowski

Mental Health: Steps Toward Prevention

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Beth Rutkowski, PsyD, Clinical Psychologist & Psychology Team Lead, Shanghai

Beth Rutkowski, PsyD, Clinical Psychologist & Psychology Team Lead, Shanghai

It is common for people to bring their child for psychotherapy when they believe that something is wrong. If they find their child is suddenly overwhelmed, their mood has taken a turn for the worse, or difficult circumstances have arisen. Often times people will bring their daughter or son to see a psychologist as a last resort or when they feel they are out of other resources. The child may meet the criteria for a diagnosis of anxiety, depression, or post-traumatic stress disorder by the time that they walk through the door.

However, parents don’t tend to think about these types of disorders as preventable. It is common for parent to immunize their children in case they are exposed to mumps or measles. From a young age, we teach healthy eating and the importance of exercise to protect again diabetes and obesity. We don’t often talk about steps to take to prevent the development of a mood disorder.

Studies have found a variety of circumstances that both increase or decrease the likelihood of developing a mental health condition. “Risk factors” are linked with an increased probability of onset, greater severity, and longer duration of major health problems. “Protective factors” modify, improve or alter a person’s response to challenging environmental circumstances, in order to make the development of a mental illness less likely. Protective factors can be both social/environmental and individual.

As parents, we can attempt to maximize our children’s exposure to protective factors and minimize risk factors in their surroundings. Risk factors on a social level include access to drugs and alcohol, isolation, peer rejection, poverty or racial discrimination. Notably, one major environmental risk factor is displacement, which is a circumstance for many expatriate children. Therefore, the need to maximize other protective factors is even more important.

Social protective factors include empowerment, positive interpersonal interactions,
social participation, social support, and community networks. Help your child make connections within the community where you live. Take them to meet the neighbors and schedule play dates with other children. Encourage them to attend after-school activities and join groups and clubs. Allow them to make decisions, such as choosing the color of their room or where the family goes for dinner. Ensure that the majority of your interactions with them are cheerful and optimistic, both to increase their exposure to positive circumstances and to model that attitude.

Individual risk factors are also important for parents to be aware of as well. These include difficulties in school, such as academic failure, learning disorders, and poor study habits, and attention deficits. Physical concerns such as insomnia, chronic illness, and pain are risk factors as are challenges with communication skills and sensory integration. Individuals who come from families with substance use and conflict are also more likely to develop mental illnesses. So what can we do to help our children if they are dealing with any of these circumstances?

Parents can help their children develop protective factors within themselves. These include emotional resilience, positive thinking, problem-solving skills, stress management skills and feelings of mastery.

Combat learned helplessness by teaching arguments against a pessimistic outlook. People who develop mental health concerns often view the world according to the “three P’s”. When something goes wrong, they look at the situation as personal (something is wrong with me), pervasive (my entire life is going poorly), and permanent (what I’m experiencing will never get any better.) Help children view their difficulties as involving the world around them and other people as well. Have them identify the other good things in their lives when times get rough, and remind them that things will always change.

Encourage children to develop coping skills before difficult circumstances arise. These can include relaxation techniques such as visualizing a calming setting and deep breathing. They can also be taught ways to deal with strong emotions, such as expressing themselves through writing or drawing. When your child does go through a negative experience, help them think about lessons that they can take from it. Ask how it might make them stronger, who they found was a good source of support, and what they might do differently in the future- without making them feel guilty.

Help children feel proud of the things that make them special and unique. Allow them to participate in activities and teams where they can experience success. Teach your child to take care of their physical health to maintain mental health as well. These involve eating a balanced and healthy diet, exercising regularly and getting enough sleep.

It is important to realize that it is never possible to ensure your child does not face a mental health disorder. Do not put too much pressure on yourself to be perfect, and do not blame yourself if they are diagnosed. If such a situation does arise, continue supporting them in the ways identified above, to minimize the impact on their lives now and in the future.


Shanghai Psychology Team Trains on Emotion-Focused Therapy

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Dr. Leslie Greenburg recently visited Shanghai and conducted a series of trainings on Emotion-Focused Therapy (EFT). Dr. Greenburg co-founded the therapeutic approach of EFT, which is an evidence-based psychological treatment. Dr. Greenberg is presently a professor in the department of psychology at York University, where he is also director of the university’s Psychotherapy Research Center.

Three LIH Olivia’s Place Shanghai Psychology Team members – Dr. Sophie Westwood, Dr. Beth Rutkowski, and Ms. Veronica McKibben – attended his one-day workshop on Working with Shame with EFT. Ms. McKibben attended a further two weeks of training in order to develop in depth understanding and skills within the practice of Emotion-Focused Therapy.

The therapeutic techniques of EFT are based on the belief that emotions direct in the way people interact with the world. They guide our actions. They inform us of the things that we want. They help people grow and develop attachments.

The therapy focuses on regulating emotions in order to facilitate a change in behavior. Within a therapy session, an individual is assisted through the process of gaining awareness of their emotions. The therapeutic setting also allows people to experience emotions in a place that is safe and that may be challenging or even frightening to explore without support.

With training, therapists are able to help individuals identify primary and secondary emotions. An example of secondary emotion is when a person expresses anger, though she is actually masking sadness. People are then able to learn to understand, manage, and transform maladaptive emotions. This allows them the opportunity to access and utilize healthy, adaptive emotions, such as grieving the loss of a loved one or developing compassion towards a person who hurt them.

The psychological community of Shanghai was very fortunate to have the opportunity to learn these techniques from Dr. Leslie Greenburg. They will assist the LIH Olivia’s Place psychology team in their work with adolescents, families, and adults.


LIH Olivia’s Place Shanghai: Supporting Schools

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Dr. Beth Rutkowski presents on mental health at LIH Olivia's Place Shanghai

Dr. Beth Rutkowski presents on mental health at LIH Olivia’s Place Shanghai

March saw the launch of the LIH Olivia’s Place Shanghai twilight training sessions for our partners in the international schools. On Monday, 7th March we welcomed a group of 45 parents, teachers, and school nurses to our clinic. Dr. Beth Rutkowski, Clinical Psychologist, spoke with the group about Mental Health First Aid. She gave helpful advice on supporting children and also the signs of a child reaching out for support.

We are looking to our colleagues in the community to tell us what topics they would like to see covered in future training events. Health care professionals working in the community with young people suggested our first two topics. We have also had requests for workshops in handwriting, executive functioning skills, the multilingual learner, and supporting kids with ADHD in the mainstream classroom.

March also saw a new partnership with Suzhou High School. Our staff will be supporting the school’s community with a series of workshops and presentations on ‘Wellness.’ We look forward to supporting their pastoral team as they offer guidance to the young people in their care.

We have had a busy couple of months supporting the professional development programs at international schools and have been privileged to be invited to host a number of training events across the city. Members of our Occupational Therapy, Speech Therapy, Learning & Behavior Support and Psychology teams have all provided training over the last few weeks and we look forward to working more with our school partners.

Look or further information in the coming weeks about our Twilight Training Program or contact Sara Naylor, Shanghai Deputy General Manager, at san@lih-oliviasplace.com to suggest a topic or inquire about custom professional development or community information workshops for your organization. To learn more about how we provide training in Beijing, please contact Jacqueline Chen, Beijing LIH Olivia’s Place General Manager, and in Kunming, please contact George Wang, General Manager, Kunming LIH SkyCity Rehabilitation Hospital.


Childhood Obesity: How to Fight Back

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Beth Rutkowski, PsyD, Clinical Psychologist & Psychology Team Lead, Shanghai

Beth Rutkowski, PsyD, Clinical Psychologist & Psychology Team Lead, Shanghai

The increase in obesity rates in the world today is extreme and disturbing. In fact, worldwide obesity has more than doubled since 1980. Furthermore, this is starting from a young age. Over 42 million children under the age of 5 were overweight or obese in 2013. This is a scary, scary thing.

Obesity in childhood is linked to some very dangerous conditions. The facts are enough to make even the biggest milkshake fan take pause. Obese youth are more likely to have risk factors for cardiovascular disease, such as high cholesterol or high blood pressure. Obese adolescents are more likely to have prediabetes, a condition in which blood glucose levels indicate a high risk for development of diabetes. Children and adolescents who are obese are at greater risk for bone and joint problems, sleep apnea, and social and psychological problems such as stigmatization and poor self-esteem.

The risks from this childhood condition continue into adulthood. Children and adolescents who are obese are likely to be obese as adults. They are more at risk for health problems such as heart disease, type 2 diabetes, stroke, and osteoarthritis. Overweight and obesity are associated with increased risk for many types of cancer, including cancer of the breast, colon, endometrium, esophagus, kidney, pancreas, gall bladder, thyroid, ovary, cervix, and prostate, as well as multiple myeloma and Hodgkin’s lymphoma.

As frightening as these facts are, there are ways to fight back. With your help, your child can live a full, happy and healthy life without the burden of obesity and its’ disturbing consequences.

In children, exercise is the most important factor in keeping kids at a healthy weight. Adults’ weight is more highly linked to what we eat. However, exercise in children has powers that we can’t benefit from once we reach adulthood. Everyone is born with a unique set of genes that influence sensitivity to a wide range of stimuli, including food. These genes also affect how one’s body responds to food intake and fat storage. However, recent studies have shown that methylation, or adding a cluster of carbon and hydrogen atoms to genes, turns the “fat genes” off! So when children engage in aerobic exercise, it adds methyl groups to the genes that control how fat is deposited and metabolized. Exercise actually suppresses genes that make people fat. And this is a benefit that kids are privy to in a way that adults simply are not. Unfair, but good for parents to remember when their children want to play video games all day. In fact, these benefits begin to occur after a single session of aerobic exercise. As an added bonus, exercise helps kids increase bone mass.

Help your kids structure their free time better. Children actually put on more weight in the summer than during any other season. This seems counterintuitive, as the freedom of the warmer months allows them to run around outside and not be restricted to classroom seats for much of the day. In fact, this “freedom” actually leads to boredom, which is linked to increased snacking. Additionally, leisure activities for children these days are largely sedentary. Days are spent on computers, iPads, and gaming systems, all of which require minimal movement. In order to help your child minimize mindless eating and maximize activity, help them structure their free time- both during the school vacations and weekends. Find clubs they can join, schedule lessons or sporting leagues, organize play dates with friends. The more they have to do, the less they will eat.

Sleep is another factor that is hugely important in the discussion of weight. While eating well and exercise are critically important, sleep helps in a range of unique and valuable ways. When we do not get enough sleep, our bodies naturally get hungrier. This is because we need additional energy (in calorie form) to keep us awake and functioning. With less sleep, our reward centers in our brain function differently. Responses to calorie-dense foods are more intense, driving us to enjoy eating them more. Furthermore, sleep deprivation essentially turns off the forebrain, which affects judgement and moderation. This creates a perfect storm of needing food to function, desiring food that is unhealthy, and lacking the moderation to keep us from overeating. The result: uninhibited gorging on fattening foods. Helping your kids establish a regular sleep schedule is critically important, and should be maintained during weekends and vacations as well.

Some of these interventions seem obvious. Others are surprising. All of them are important. While making changes to dietary habits and favored routines is never easy, helping your child develop a healthy lifestyle and weight now will benefit them throughout their lives. If you need help addressing such a sensitive issue, a pediatrician, registered dietitian, or therapist can help broach the topic in a supportive and informative way. For more information, contact your child’s primary care physician or a pediatric clinic.

 

Dr. Beth Rutkowski is a Clinical Psychologist who and Psychology Team Lead for LIH Olivia’s Place Shanghai. If you have questions or concerns about your child’s emotional or behavioral health and habits, you are welcome to contact her directly at ber@lih-oliviasplace.com or the LIH Olivia’s Place team at (8621) 5404-0058 in Shanghai or  (010) 6461-6283 in Beijing.


Panic Attacks: What, Why, and How to Help

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Beth Rutkowski, PsyD, Clinical Psychologist, Shanghai

Beth Rutkowski, PsyD, Clinical Psychologist, Shanghai

Panic attacks can be very frightening for both the person experiencing the panic attack and anyone who witnesses it. Simply put, panic attacks are periods of intense fear where someone’s body reacts with physical symptoms and intense thoughts. These episodes usually begin very quickly and resolve themselves within ten minutes. Panic attacks are not dangerous, despite the physical symptoms, and do not cause any lasting harm. However they can be very disruptive and confusing.

Symptoms of panic attacks consist of different combinations of symptoms for everyone, and include at least four of the following:

  • Pounding or racing heart
  • Shortness of breath
  • Feelings of choking or smothering
  • Dizziness, light-headedness, or feeling faint
  • Feelings of unreality or being detached from oneself
  • Fear of losing control, dying or going crazy
  • Sweating
  • Numbness or tingling
  • Chills or hot flashes
  • Trembling and shaking
  • Chest pain
  • Abdominal pain or nausea

 

Panic attacks occur because your body is reacting as if it were in danger. Many of the symptoms would actually be very helpful if you were in a hazardous situation. If threatened, the body has evolved to go into “fight, flight, or freeze” modes. Blood is pulled away from your stomach and head to prepare your limbs to run or attack. Your breath gets heavier as you bring in more oxygen. Your extremities become sweaty and tingly as they are pumping with adrenaline. The problem is, there is no danger to be found. What has happened is that at some point, your body came to associate a certain situation with danger- even if none exists. Then it reacts with panic, even when there is no need.

If you witness your child, or any individual, experiencing the symptoms above, speak to them calmly. Let them know you can tell they are having a difficult time and that you are there to help. First, be sure it is not a medical emergency. If this is your child, you likely already know if they have a history with panic attacks or any medical conditions. If not, ask if the individual knows what is going on and look for any medical bracelets. If you are confident it is not a medical emergency, explain this to them.

In general, remain calm and speak in a reassuring but firm manner. Be patient and avoid any negative reactions to the panic- even though it is likely distressing for you to witness. Acknowledge that the terror feels very real. Remind your child that while a panic attack is frightening, it is not life threatening. Reassure them that they are safe and that the symptoms will pass. Try to maintain clear, slow speech and use short sentences.

Move the individual to a place where it is quiet and private. Stay with them throughout the duration of the attack and take cues from them as to whether they want you nearby, to keep your distance, or if physical contact is desired. If this is a situation that has happened before, behaving in a predictable manner will help your child remember that they have conquered these circumstances and will make it through once again. Help the person focus on the present by asking him or her to repeat a simple task such as raising his or her arms over the head. Help slow their breathing by breathing with them or by counting slowly to 10.

After the panic symptom subsides, comfort and reassurance are both important. Let your child know they are safe and that you are proud of them for getting through it. Help them understand what a panic attack is and why it occurs. Reassure them that effective treatments are available for panic attacks and that you will work together to find the right care.

Therapy for panic attacks is often rather brief is available through the Psychology team at LIH Olivia’s Place. For more information, contact Olivia’s Place at contact@oliviasplace.org or (010) 6461-6283 (Beijing) (8621) 5404-0058 (Shanghai). .


Preparing Children for Repatriation

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Beth Rutkowski, PsyD, Clinical Psychologist, Shanghai

Beth Rutkowski, PsyD, Clinical Psychologist, Shanghai

Repatriation can be more difficult than expatriation, especially for children. Everyone’s experiences with repatriation are different- some departures dates are locked in since arrival, others are completely unpredictable. Some people are returning to a country with family and friends, others feel they are leaving their support system behind in China. The same house, job, and school may be waiting for a family upon their return, while others are starting everything new. Logistically, the demands are many and the changes are beyond those for which we can fully be prepared.

 

The emotions that accompany repatriation are as innumerable as the experiences. There may be excitement see old friends and family or return to a school or house that they have missed. Other children may be distraught. Many children have spent more of their life living within an international culture than anywhere else. They have undergone major life transitions and accomplished great successes while living abroad. It is here that has shaped their identities and their expectations for a happy life. To these young people, home is being taken away- without a promise of return. As parents, trying to help can seem an overwhelming task.

 

As difficult as it may be, let your children know about plans to move home as soon as the information is available. The move will be a time of great uncertainty for your entire family, and beginning that process with children feeling as if they were deceived or kept in the dark will make things much more difficult for everyone involved. Encourage everyone in the family to speak openly about how they are feeling. Express your own feelings of loss or excitement, so that children know that they are able and welcome to do the same. Validate them in whatever emotions they express.

 

Often times children- and particularly teens- are very aware that their parents are undergoing a great deal of stress prior to the move. As a result, they avoid expressing their emotions or talking about their concerns in order to not add to their parents stress. Just because a child isn’t forthcoming with expressing his or her emotions does not mean they don’t have any to share. Be sure to ask them throughout the process how they are feeling and to model healthy expressions of your own emotions.

 

If children do seem fixated on negative aspects of a move home, it may be helpful to remind them of some of the positive things that will result from the move. The goal here is not to force them to change how they are feeling. Instead, it is to help them understand that the process will have both advantages and disadvantages for them. If they are returning to a country with family or old friends, remind them of the fun they have had with these individuals in the past. Talk about the aspects of the relocation you know they will enjoy- decorating a room, getting a pet, buying new things. Explain how things will be different for them than when they last lived in their home country, such as new privileges they will have or new areas worth exploring.

 

Be sure to take the time to truly say goodbye to your China life. This will allow both you and your children some degree of closure in this transition. Encourage your children to take an active role in this process. Ask them how would they like to bid farewell. Ask about favorite activities, meals, and friends they would like to invest time in. Take pictures along the way and remember to stress how these memories of such experiences will be with them forever.

 

IMG_4015Help your children get organized. Its an exhausting and confusing process for anyone relocating across oceans. Children may feel overwhelmed by all the tasks that accompany a move. Help them organize their packing process by assigning them smaller tasks for each day. If there are school assignments and exams that need to be completed, stay in touch with their teacher and remind them as tasks are due. Make sure they know you are available to help them if they need it, and that you support them as they tackle all of the tasks at hand.

 

Finally, tend to your own needs throughout this process. Repatriation is complicated and somewhat painful for everyone. As a parent, it is very easy to forget to make our own wellbeing a priority. Enjoy a massage at your favorite retreat, visit the dumpling shop you’ll miss the most, have a glass of wine with your friends. You are no help to anyone if you are sleep-deprived, anxiety-ridden, and miserable. One of the best things your can do for your child is to take care of yourself.


Clinician Profile: Beth Rutkowski, PsyD

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Beth Rutkowski, PsyD, Clinical Psychologist

Beth Rutkowski, PsyD, Clinical Psychologist

Dr. Beth Rutkowski is a Fully Licensed Psychologist from the United States. She has her Doctorate of Psychology, her Masters of Arts in Psychology, and her Doctoral Certificate of Child and Family Studies from Roosevelt University. Dr. Rutkowski obtained her Bachelors of Science in Biopsychology and Cognitive Science from the University of Michigan. She is a Certified Advanced Alcohol and Drug Counselor (CAADC), and is certified in Dialectical Behavior Therapy. Dr. Rutkowski has been a professor at both undergraduate and graduate level college settings, focusing on child and adolescent psychotherapy and basic clinical skills. Dr. Rutkowski has worked with youth, families, and adults in outpatient and inpatient settings, with a focus on utilizing evidence-based treatments. She speaks English.

 

Dr. Rutkowski provides the following services in Shanghai and Beijing:

  • Individual and family psychotherapy for children, adolescents, and parents
  • Educational and neuropsychological assessments
  • Community presentations on understanding diagnoses and crisis management

 

How long have you been in China?

I moved to Shanghai, China in August of 2015. I’m originally from Detroit, Michigan, US.

 

Why did you choose to work at LIH Olivia’s Place?

The sense of teamwork and support was what initially was so engaging about the LIH Olivia’s Place community. I also love that the mission to improve therapy services for the underserved population of youth in China is the overarching reasoning behind decisions made for the organization.

 

Why did you choose your field?

I love assisting people, parents, and families in figuring out their own skills and strengths. It is wonderful to watch them realize that they have so much good in themselves already, and it’s just a matter of letting it work for them.

 

What are some of the most rewarding experiences you have had in your chosen profession?

My favorite times are working with people when they have a “lightbulb” moment- you can tell that they are understanding something in a new and better way because of how you have helped them. This can happen in therapy sessions or when explaining the results of an assessment. It’s a reminder of why this profession exists and that it can be life-changing.

 

What’s your favorite thing about living in China and working at LIH Olivia’s Place?

My favorite thing about living in Shanghai is the fact that it will not get as cold as Michigan in the U.S., where it is often below 0 degrees. I also love the food and all the history. My favorite thing about working at LIH Olivia’s Place is the diversity of the clients we see and the learning opportunities available.

 

*What would you like to be doing in 5 years’ time?

Five years ago I would never have said I desired to live in China, but I am so happy to be here. So the most I can say is that I would like to still be having adventures!


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