Wednesday, June 30, 2010

Celebrating!

I am celebrating nearly 200 posts. My New Year's Resolution for many years has been to write more. Finally, I am.

I successfully completed the first year of a doctoral program at UCLA. Another goal/impossible dream of mine. I just heard that I passed the comprehensive exam. Sweet relief.

The blog has logged over 4,300 page views with nearly 1,200 unique visitors.

After all that work, comes play.

Happy, happy, summer to friends and visitors.

And Thank You, Yesus.

Gabor Mate on Attachment

"My mother and I barely survived our months in the Budapest ghetto. For a few weeks she had to part from me as the only way of saving me from sure death by starvation or disease. No great powers of imagination are required to understand that in her state of mind, and under the inhuman stresses she was facing daily, my mother was rarely up to the tender smiles and undivided attention a developing infant requires to imprint a sense of security and unconditional love in his mind. My mother, in fact, told me that on many days her despair was such that only the need to care for me motivated her to get up from bed. I learned early that I had to work for attention, to burden my mother as little as possible and that my anxiety and pain were best suppressed.

In healthy mother-infant interactions, the mother is able to nourish without the infant's having in any way to work for what he receives. My mother was unable to provide that unconditional nourishing for me - and since she was neither saintly nor perfect, quite likely she would not have completely succeeded in doing so, even without the horrors that beset our family.

It was under these circumstances that I became my mother's protector - protecting her in the first instance against awareness of my own pain. What began as the automatic defensive coping of the infant soon hardened into a fixed personality pattern that, fifty-one years later, still caused me to hide even my slightest physical discomfort in front of my mother.

Thus, in writing this book, I describe not only what I have learned from others or from professional journals but also what I have observed in myself. The dynamics of repression operate in all of us. We are all self-deniers and self-betrayers to one extent or another, most often in ways we are no more aware of than I was conscious of while 'deciding' to disguise my limp" (from my elderly mother).

From "When The Body Says No: The Cost of Hidden Stress," Chapter 1


I see in his narrative the dynamics and interaction between a depressed mother and her infant. How both cope and adapt. How this impacts attachment and trust, especially then but also later.

Attachment informs me about how are we taught and trained to matter. As women, or as social workers, or as helping professionals, or as sons/daughters, or as partners/significant others. The (mostly unconscious) responses, messages, interactions, from the people that we care about the most, tell us that we are important - that our voice will make a difference, that we were important from the day we were born, that we are separate and belong, that we can trust our own minds and bodies and that we can trust those charged with the care of our minds and bodies.

Summer Reading

I invite you to read "When the Body Says No: The Cost of Hidden Stress" by Gabor Mate, MD. We can have an on-line book club with back and forth comments posing as discussion.

Right off the bat, in "A Note to the Reader," Gabor Mate writes, "...mind and body are not separable" and that one of the purposes of his book is "...to hold up a mirror to our stress-driven society so that we may recognize how, in myriad unconscious ways, we help generate the illnesses that plague us." He clarifies the difference between blame and responsibility in this regard, to avoid being misunderstood: "While all of us dread being blamed, we all wish to be more responsible - that is, to have the ability to respond with awareness to the circumstances of our lives rather than just reacting. We want to be the authoritative person in our own lives: in charge, able to make authentic decisions that affect us. There is no true responsibility without awareness...the more we can learn about ourselves, the less prone we are to become passive victims."

Okay, hardly light summer reading but it is important and then he gives us, "...transformation brings forth the healing - the coming to integrity, to wholeness - of what is already there. While advice and prescriptions may be useful, even more valuable to us is insight into ourselves and the workings of our minds and bodies. Insight, when inspired by the quest for truth, can promote transformation."

He quotes physiologist, Walter Cannon, who suggested "there is wisdom in our bodies."

I hear friends saying, "life is a journey," and I'm curious about the examined life - with respect for and awareness of the wisdom and power of the mind and body. What is that journey like and where will it lead?

Wednesday, June 23, 2010

Summer Theme

Since reading and studying inspires writing, I am not sure how much blogging I will do this summer. In addition to summer fiction reading, I will probably read articles about resilience and attachment. Reading, learning and talking about resilience makes me feel good (happy, hopeful and wise) which is good for summer reading. And everything begins and ends with attachment theory.

To start things off...

"Social learning theories posit that the earliest and most salient influence on children is the home environment because family management skills, discipline techniques, and monitoring strategies are crucial factors impacting youth development."

"Research has demonstrated that parenting behaviors and family relationships are strongly related to student engagement, which appears to be a consistent finding across ethnic and socioeconomic groups"

"In terms of parenting behaviors, the authoritative parenting style is positively related to multiple dimensions of student engagement. Longitudinal research demonstrates that authoritative parenting leads to student engagement, as indicated by improvements in school engagement (i.e., classroom engagement, school orientation, bonding to teachers, school conduct) over a 1-year period in children with authoritative parents compared to children with nonauthoritative parents. Thus, parents who combine high levels of acceptance, supervision, consistent discipline, and democracy promote student engagement compared to those who do not exhibit these parenting behaviors."

From Relations among School Assets, Individual Resilience, and Student Engagement for Youth Grouped by Level of Family Functioning, Jill Sharkey, Sukkyung You, and Katrina Schnoebelen, Psychology in the Schools, 2008.

Friday, June 18, 2010

Smiling

We did it. The first year is over!! It was humbling and exhilirating. Every time a kind soul asked about school, it was hard to acknowledge that the program was beating me up. But I made it. Passed all my classes and finished the comprehensive exams. Survived. Learned a lot about research and evaluation and policy and attachment and secondary traumatic stress and...

Cork pops, I cheer, dramatic collapse.

Can't help but smile all the time now. I guess there's always a reason to smile. With all the pressure off, now it seems easier. I want to remember to keep smiling all year.

Cheers to everyone showing up even though the goal seems so out of reach.

I can't seem to locate the reference now, but I remember hearing a long time ago that a study interviewed octogenarians and septuagenarians and one of the questions asked was about regrets. What they said most often was that they wished they had taken more risks.

"Those who persist in threatening situations and master the experience gain efficacy reinforcement, whereas those who choose to avoid threatening situations or cease their activities early reinforce negative efficacy expectations."

I am glad I took the risk. My romanticized notions of going back to school are what motivated me to show up so I am glad I didn't realize beforehand just how hard it would be. The 80 year-old in me is also smiling.

Wednesday, June 16, 2010

Reflection

"...psychology is not observing external objects at a distance but observing our involved lived experience."

"Much of our activity in daily life occurs without a great deal of self-conscious reflection or questioning...It is only when we encounter an obstacle to what we are attempting to do that we become self-consciously concerned and reflective, such as if we were unexpectedly to find the door locked and required a key to open it."

"From birth, we are 'thrown' into worlds not of our own choosing, and our individual being as human agents is shaped with others in the sociocultural contexts in which we find ourselves."

From Toward an Alternative Psychology (Chapter 12), Jeff Sugarman and Jack Martin.

Therapist, know thyself. Know the social norms, gender role stereotypes, and other expectations that have shaped you. Decide whether you want them to continue to define you, oppress you, or confine you. Upon reflection, you can choose to break free. Who are you? What do you want? What do you believe? Say it softly and quietly to yourself first. Write it down so you remember. Then make it public. Do or say something authentically. It is your birthright.

Imagination has Changed Our World

"The founders of social movements, the Protestant reformers, the founders of the trades unions, Mary Wollstonecraft, people who suggested that we could do it differently, are heroes...People who suggested a new self image for women and gays. People picked it up and ran with it, but it didn't emerge from anything participatory. It was an achievement on the part of the people with more powerful imaginations than most..."

"...thinking about justice and democracy must be based not on arguing from appearances to some grand theory, but by imaginative articulation of 'still only dimly imagined future practice': we need to tell imaginative stories of new possibilities rather than build political theories."

From Pragmatist Philosophy and Action Research: Readings and Conversation with Richard Rorty, Peter Reason, Action Research, 2003.

Sunday, June 13, 2010

Trying to laugh all the way to Comprehensive Exams...

"Laughter does not cure any illness but is a coping mechanism for people under stress. Laughter reduces stress, tension, and pain. It is a form of emotional support for patients."

"The Bible states that A merry heart does good like a medicine (Proverbs 17:22) and makes a cheerful countenance (Ibid 15:13). The Talmud (Berachot 61b) suggests that the spleen produces laughter."

"In the past two thousand years, humor and laughter have been used therapeutically in a variety of medical and other situations. Randomized controlled clinical trials have not been conducted validating the therapeutic efficacy of laughter. However, benefits have been reported in geriatrics, oncology, critical care, psychiatry, rehabilitation, rheumatology, home care, palliative care, hospice care, terminal care, and general patient care."

"Humor does not make problems disappear but it makes them easier to bear. Humor and laughter are good for the body and good for the spirit. The following seems to be good advice for patients and caregivers alike: 'laugh regularly, smile often, and help others to laugh and smile.' In this era of complementary therapies, it seems appropriate that humor and laughter take their place of honor as a supplementary form of the treatment of illness, together with prayer and chicken soup."

"Laughter may help to control pain by distracting attention, by reducing tension, by changing expectations, and by increasing the production of endogenous endorphins."

Endogenous endorphins are the pain-killing, morphine-like chemical substances that are produced by our own bodies. Interesting that morphine injected right after trauma prevents PTSD. It's no wonder what laughter in the face of stress can do. Interesting that mirror neurons make me smile when you're smiling. Let's start a smiling and laughing wave and see how good that feels. ;) ;) :0) ;) :) ;0)- ;) ;) ;) ;)

"...humor and laughter serve as 'the body’s instinctive, cognitive, and biologic mechanism for restoring homeostasis and equilibrium.' Laughter restores balance and equilibrium. It dissipates tension, fear, frustration, and other stress such as 'burnout', perhaps by producing biochemical changes in the body such as decreases in serum growth hormone, cortisol, dopac, and epinephrine levels. Doctors and nurses are increasingly recognizing the importance of humor in reducing stress and promoting feelings of well being of both patients and themselves as care givers. Laughter is an often neglected resource in managing personal and professional stress."

From Therapeutic Efficacy of Laughter in Medicine, Fred Rosner, M.D., F.A.C.P., Cancer Investigation, 20(3), 434–436 (2002).

I am ready for all of it, laughter, massage, aesthetic pampering, prayer, and some chicken mole (I am beyond the need for soup). Comprehensive exams may not be an illness, but they are stressful. It's a lot to remember and write in six timed essays - 24+ pages in eight hours spread over two days, especially if you're not exactly sure what the questions are. Boy, will there be some celebrating when this is all over! Cheers!

Greetings, Blog Visitors!

I started this blog in the Fall of 2009.  I am in awe to know that our words and ideas can spread globally.  It should be no surprise.  We are all connected.  The red circles on the maps below represent blog visitors from all over the world.  Welcome and greetings.













Thursday, June 10, 2010

Self-Worth

"Coopersmith described four components of self-worth:

(1) power, or the ability to influence people and events important to the person

(2) significance, or a sense of being accepted and valued by others

(3) competence, or the ability to reach goals

(4) virtue, or behaving consistently with one's moral values and beliefs.

" 'Self-esteem' is the most common term given to self-evaluative behavior, attitudes, beliefs, or perceptions. Global self-esteem, according to Rosenberg, is the most important aspect of the self-concept and involves a person's feelings regarding adequacy and worth, health, appearance, skills, and sexuality. Miller aserted that self-esteem is an important variable in developing hopelessness or maintaining hope, in that individuals need to feel good about themselves, their value, and their worth before they can invest in improving their situations."

From: A theory-based nursing intervention to instill hope in homeless veterans, Tollett, Jane; PhD, RN; Thomas, Sandra; PhD, RN in Advances in Nursing Science, 18(2):76-90, December 1995.

Self-efficacy!

"Personal control or power contributes to psychological adjustment and physical health.

According to Bandura, the concept of self-efficacy is basic to the issue of personal control.

Self-efficacy is a belief in one's capabilities to execute required behaviors.

Self-efficacy theory asserts that expectations of personal mastery are the primary determinants of changes in behavior.

Expectations of self-efficacy determine the initial decision to perform a behavior and the amount of effort to expend in the behavior, as well as the amount of persistence in the face of adversity.

Self-efficacy has a direct influence on the choice of activities; people avoid situations that they believe they cannot cope with and become involved in activities they feel capable of handling.

The stronger the perceived efficacy, the more effort is expended in an activity.

Those who persist in threatening situations and master the experience gain efficacy reinforcement, whereas those who choose to avoid threatening situations or cease their activities early reinforce negative efficacy expectations."

From: A theory-based nursing intervention to instill hope in homeless veterans, Tollett, Jane; PhD, RN; Thomas, Sandra; PhD, RN in Advances in Nursing Science, 18(2):76-90, December 1995.

What do you believe?
What do you expect?
How much effort are you willing to expend?
How long are you willing to keep trying until you figure it out?

Hope, Optimism, Resilience

"People without hope see themselves as failures and have no expectation that anything or anyone can help them out of their present situation. This hopelessness creates a sense of powerlessness that Miller described as the perception that one lacks the ability or capacity to affect an outcome. The powerlessness concept closely relates to others, including learned helplessness. In learned helplessness research with animals, lack of control over aversive stimuli resulted in later interference with learning. However, we know little about what produces helplessness in humans. Recently, Seligman, who has done the seminal work on helplessness, has promoted the notion of 'learned optimism' as an antidote for helplessness in humans. He maintained that individuals can choose the way they think; that thoughts are not only reactions to events, but also actually change what ensues; and that resilience in the face of defeat can be acquired. Further, Seligman believed that the key to the process of acquiring resilience in the face of defeat is hope."

From: A theory-based nursing intervention to instill hope in homeless veterans, Tollett, Jane; PhD, RN; Thomas, Sandra; PhD, RN in Advances in Nursing Science, 18(2):76-90, December 1995.

Hope, the Construct

"Miller explored the nature and etymology of hope and based her instrument development on a definition of hope that is characterized by...
...an anticipation for a continued good state
...an improved state or a release from a perceived entrapment.

The anticipation may or may not be founded on concrete, real world evidence.

Hope is an anticipation of a future which is good and is based upon mutuality (relationships with others), a sense of personal competence, coping ability, psychological well-being, purpose and meaning in life, as well as a sense of "the possible."


Cited in: A theory-based nursing intervention to instill hope in homeless veterans, Tollett, Jane; PhD, RN; Thomas, Sandra; PhD, RN in Advances in Nursing Science, 18(2):76-90, December 1995.

Power

"Miller proposed that power is a resource for living that is present in all individuals and is 'the ability to influence what happens to oneself.' "

"...maximizing the patient's power resources facilitates the patient's ability to cope."

"When powerlessness is not contained, hopelessness can result."

"...'powerlessness leads to depression and low self-esteem, causing hopelessness that in turn immobilizes the individual.' "

Cited in: A theory-based nursing intervention to instill hope in homeless veterans, Tollett, Jane; PhD, RN; Thomas, Sandra; PhD, RN in Advances in Nursing Science, 18(2):76-90, December 1995.

Hope, Again

"Hope is a vital life force in humans. One function of hope is to defend against despair. Expectation is a key attribute of hope and is, of course, directed toward the future-not the past. This expectation can be directed toward relief from a difficult situation, but people must have a basic sense of control over their environment and a belief that there is a "way out" to be able to hope for relief from present difficulties. A sense of entrapment, multiple losses, illness, impoverishment and life-threatening situations leads to a loss of hope or an inability to hope. When hope is lost, there is no reason to act, to set goals, or to work toward freedom from adverse situations because there is no way out."


Cited in: A theory-based nursing intervention to instill hope in homeless veterans, Tollett, Jane; PhD, RN; Thomas, Sandra; PhD, RN in Advances in Nursing Science, 18(2):76-90, December 1995.

Hope

Hope is the thing with feathers
that perches in the soul,
And sings the tune without the words,
And never stops at all.

--Emily Dickinson

Cited in: A theory-based nursing intervention to instill hope in homeless veterans, Tollett, Jane; PhD, RN; Thomas, Sandra; PhD, RN in Advances in Nursing Science, 18(2):76-90, December 1995.

We Can Problem-Solve, We Can Set Goals, We Can Take Action

Figure 2: Where is the exit in this ugly loop? Problem-solve, set a goal, take an action, hope (with audacity), speak up (be presumptuous), use your power, ask for help, move - do something different, dare, whatever it takes, whatever works for you.

Cited in: A theory-based nursing intervention to instill hope in homeless veterans, Tollett, Jane; PhD, RN; Thomas, Sandra; PhD, RN in Advances in Nursing Science, 18(2):76-90, December 1995.

Figure 2 . Miller's Theory of the Powerlessness-Hopelessness Cycle. Coping with Chronic Illness: Overcoming Powerlessness. 2nd ed. Philadelphia, Penn: FA Davis; 1992. Copyright (C) 1992, FA Davis, Philadelphia, Penn.

Overcoming Powerlessness

Figure 1:
"...intervening in the cycle at the belief system by instilling hope will aid in restoring the perception of power (self-efficacy), raise self-esteem, and lessen depression..."

It is all about beliefs. What are we believing these days? How long have we been carrying those beliefs? Do they still serve our best interests?

There is also mindbodyspirit - all connected, just like we are.

Cited in: A theory-based nursing intervention to instill hope in homeless veterans, Tollett, Jane; PhD, RN; Thomas, Sandra; PhD, RN in Advances in Nursing Science, 18(2):76-90, December 1995.

Figure 1 . Miller's Patient Power Resources Model. Coping with Chronic Illness: Overcoming Powerlessness. 2nd ed. Philadelphia, Penn: FA Davis; 1992. Copyright (C) 1992, FA Davis.

Wednesday, June 9, 2010

Charter Schools

“A recent study by Stanford University’s Center for Research on Education Outcomes shows that just 17% of the nation’s charter schools provide education superior to that of traditional public schools. Duncan calls on states to enforce more rigorous standards of accountability and to shutter charters that chronically fail.”

“Because of small classes and excellent teachers who give students as much personal attention as they need, Green Dot students’ scores on state assessments are nearly 19% greater than their local public school peers. Green Dot’s founder Steve Barr visited L.A.’s best private schools and worst public schools and quickly realized that small schools that are filled with motivated, engaging teachers make a difference for students no matter their level of shyness, their command of English, or their skin color.”

“We didn’t get rid of the knuckleheads and the gangbangers – we figured out a way to teach them all.” Locke Family of Schools’ Athletic Director.

MLK high school graduate: “Before we even stepped onto campus, we knew that the bar was set pretty high, and there was no way to overcome it except through time and effort.”

From 2010 issue of US News & World Report on School Reform

Lessons Learned - Do We Dare Change?

“Lessons No. 1 from NCLB: Accountability is a powerful tool and is working to improve learning.

Lesson No. 2: Accountability makes people uncomfortable. We no longer are able to hide from the facts, which is that only half our minority students stand a chance of graduating from high school on time.

Lesson No. 3: The reauthorization should encourage continuous improvement in our classrooms, give educators the credit they deserve for the most challenging work, and provide parents and students more customizable options. Parents deserve even more information and better options that customize schools to meet the needs of their children. We need more charters, more school choice, more customized technology, and more real-time feedback to catch educational problems, intervene immediately, and better address the needs of our student population.”

From 2010 issue of US News & World Report on School Reform

National Board Certification Helps Students

“The bonuses helped lure dozens of nationally certified teachers into long-troubled schools. And many of those schools are turning around. More important than the money, Sharon Stewart, a Sulphur Springs teacher says, was the way the training and self-analysis required for national certification made her a better teacher.”

From 2010 issue of US News & World Report on School Reform

Social-Emotional Learning First

"To understand the challenges Aldine (Independent School District’s high schools) students face in the classroom, Eisenhower 9th grade School Principal Ike McGowan says it’s important to first understand their home lives. Some students come from dysfunctional, single-parent homes or families with one or more members incarcerated. These circumstances cause some students to come to school angry and apathetic toward learning. Oftentimes, we have a lot to do with kids emotionally before we can start teaching them content, and this reality is one of our biggest battles.”

From 2010 issue of US News & World Report on School Reform

Recruit, Train, Mentor, Nurture & Support the Best and the Brightest

“Working collaboratively does not always come naturally to teachers, who have long been trained to teach behind closed doors. That tradition of isolated teaching has meant that kids are very dependent on which teacher they get: A good teacher means a good year of learning; a weak teacher means a bad year. For the most part, middle-class students with strong academic support systems in their families can survive a weak teacher or two in their lives. But for low-income students, even one weak teacher can set them back for years. A recent long-term study commissioned by the National Institutes of Child Health and Human Development found that low-income students have only a 10% chance of consistently being assigned a good teacher.”

from 2010 issue of US News & World Report on School Reform

Figure It Out - No Magic Bullet

“Why don’t all schools succeed? How did these schools turn challenges into triumphs? Probably the most common thing heard from educators in these schools is: there is no magic bullet. Rather, they have all developed complex approaches to the complicated task of educating all students. But there is one thing they do share: the deeply rooted belief that all their students not only can learn but will learn – and it is up to the adults in the building to figure out how to make sure of that.”

From 2010 issue of US News & World Report on School Reform

Nexus of Crisis and Opportunity

“Never waste a good crisis. Sometimes the nexus of crisis and opportunity leads to dramatic reforms that we need, that frankly are more difficult to accomplish when things aren’t so tough. Some people will be paralyzed by the challenges they are facing, and others will see this as a chance to fundamentally break through and challenge the status quo. And those are the leaders that we will invest in.

The economy makes it more difficult, but what’s the alternative? Sit back for a couple of years and accept the status quo? Accept incremental change? You can’t do that. You have to push as hard as you can and look those challenges square in the eye and do the best you can in a tough environment. Look at this tough environment not just as a huge challenge but also a time of opportunity."

from 2010 issue of US News & World Report on School Reform

More Fun & Joy

"Look for the funny side of life. Enjoy what you do. Create an atmosphere of caring, support, and fun in your work. When you are having fun you work more effectively and efficiently"

--Author and therapist Catherine Fenwick, known for conducting humor seminars around the world and running an online laughter therapy center

Secondary Traumatic Stress & Professional Resilience

Gentry, Baranowsky, and Dunning (2002) note that all professional caregivers will at some point in their professional lives be forced to confront secondary traumatic stress and burnout. Working with traumatized clients indisputably has negative effects upon the mental health professional, including social workers (Ting, 2005).

The effects of secondary traumatic stress are believed to impair the ability of clinicians to effectively help those seeking their services (Figley, 1999). Professionals experiencing secondary traumatization are believed to be at higher risk to make poor professional judgements such as misdiagnosis, poor treatment planning, or abuse of clients than those not experiencing secondary traumatization (Rudolph, Stamm, & Stamm, 1997).

Ascher (1992) referred to urban school studies that focused on working conditions as a key to retaining good teachers. Such conditions are associated with better teacher attendance, more effort, higher morale and a greater sense of efficacy in the classroom. These conditions involve:

• Strong, supportive principal leadership
• Good physical working conditions
• High levels of staff collegiality
• High levels of teacher influence on school decisions
• High levels of teacher control over curriculum and instruction (Hammond, 1996)

Questions

What is the relationship between practice wisdom/knowledge and research?

What is and what is possible?

Is there inherent conflict that is insurmountable or is integration possible?

Tuesday, June 8, 2010

Post-Positivist Epistemology

“Scientists are in the business of providing reasonable justifications for their assertions, but nothing can make assertions absolutely safe from criticisms and potential overthrow" (Phillips, 1990).

Sunday, June 6, 2010

How are we worse for the wear? What can be done about it?

"Constructivist self-development theory is interactive in that it view's the therapist's unique responses to client material as shaped by both characteristics of the situation and the therapist's unique psychological needs and cognitive schemas."

"The effects on therapists are pervasive, that is, potentially affecting all realms of the therapist's life; cumulative, in that each client's story can reinforce the therapists gradually changing schemas; and likely permanent, even if worked through completely."

In 1966, Carl Jung "originally conceived that an 'unconscious infection' may result from working with the mentally ill."

In 1976, English described this process: "As the emotional needs and distresses of people in difficulty were presented to me, I not only felt them through the process of empathy, but I also found I tended to absorb them within myself as well."

In 1978, Chessick hypothesized that "conditions of depression and despair in one's clients (which he calls 'soul sadness') can be contagious."

In 1985, Farber cited "evidence that the client can transfer his or her pathology to the therapist."

In 1987, Guy cited "research which supports the notion that doing psychotherapy can be dangerous to the psyche of the therapist."

In 1990, McCann presents her "notion of vicarious traumatization...implies that much of the therapist's cognitive world will be altered by hearing traumatic client material."


In 1999, Figley described secondary traumatic stress and compassion fatigue as "a reaction from indirect exposure to a traumatic event...as a result of the therapist's own empathy towards a traumatized client in addition to the therapist's own secondary experience fo the traumatic material."


In 2007, Hernandez formulates "a new concept: vicarious resilience. It addresses the question of how psychotherapists who work with survivors of political violence or kidnapping are affected by their clients' stories of resilience. It focuses on the psychotherapists' interpretations of their clients' stories and how they make sense of the impact that these stories have had on their lives."

In 2007, Radey and Figley, coin the construct "compassion satisfaction" in the "broader context of positive social work...a paradigm shift towards identifying the factors that lead clinical social workers toward human flourishing in their field...compassions satisfaction or feelings of fulfillment with clients, rooted in positive psychology and expanded to incorporate the social work perspective. The model suggests that affect, work resources, and self-care influence clinicians' positivity-negativity ratio, which in turn can result in compassion satisfaction. To maximize compassion satisfaction, research, education, and training should consider how classroom instruction and workplace policies can promote the most success among clinical social workers."

There is energy exchange between client and therapist. What do we know about this exchange and how can we manage it in the best interest of both parties?

I frequently get massages for health maintenance and self-care. I forego other treats in favor of this one. I have had massages by practitioners up and down the State of California. On a few occassions, I walked in congested and by the end of the hour, walked out breathing easy. On both occassions, I heard my masseuse walking out with those sniffles. I wondered if there had been an exchange of energy and wondered how it had been transfered. After this experience, I asked two different practitioners about what they were taught and how they deal with their clients' release of toxins and energy. They both said that they set their intention at the outset of the massage to release the energy that no longer serves the client, but not take it on.

What are mental health professionals taught about this? We are taught about setting limits and boundaries. Understanding where we begin and end. Empathizing but not becoming responsible for our clients problems. But it appears that empathizing is both a vehicle for the clients' healing and a potential risk hazard for the therapist.

I remember working in South Los Angeles as a beginning social worker and feeling overwhelmed by the sense of hopelessness and despair that is "in the air." I remember thinking that it tapped into my own experience growing up in East Los Angeles and the air of hopelessness that can linger there. I remember wondering if this pre-existing vulnerability made it difficult for me to work in this environment and with this population. That is when the concept of resiliency saved my life. It reminded me of the other side of the story. The truth that despite the risks, most of my classmates were indeed living, loving and working well in adulthood. There is hope, despite the risks.

Early on in my career as a school social worker, I used to get weekly massages for $40. That gifted healer taught me that rather than release the energy accumulated at work throughout the week (my massages were on Friday evening), I could notice the energy coming towards me and shunt or redirect it away from me and not allow it to enter and be processed by my own body. She was like that. She spoke metaphysically and I usually only half-understood. But over time, I practiced this somehow. The visual metaphor helped to give meaning or grounding to the experience - like a guided visualization.

Because of neuroscience research, we now know about mirror neurons and how two people can sync up, right-brainwise, that is. Reevah called this, in the tradition of psychodynamic psychotherapy, knowing a lot about a person by how they make you feel when you are with them for five minutes. In Eastern medicine, this might be called energy or chi/qi. If this is happening between us, it would seem beneficial to explore this further, for all our sakes.

I am fascinated by what we can learn about this transfer of energy, how to manage it and what purpose it serves.

References:
Radey & Figley. (2007). The Social Psychology of Compassion,
Hernandez, Gangsei, & Engstrom. (2007). Vicarious Resilience: A New Concept in Work With Those Who Survive Trauma
McCann & Pearlman. (1990). Vicarious Traumatization: A Framework for Understanding the Psychological Effects of Working with Victims.

Saturday, June 5, 2010

Does the impression a provider has about a patient affect treatment decisions?

Abstract:

The goals of this study were to define the psychological and personality characteristics that physicians attribute to their patients and to determine whether these attributions affect treatment decisions. A Physician Attribution Survey was developed to achieve the first goal, and demonstrated that likeability and competence were salient features of the physician-patient relationship. Videotapes were then created demonstrating patients with three different combinations of likeability and competence: likeable-competent (L-C), unlikeable-competent (U-C) and likeable-incompetent (L-I). After being pre-tested with several samples of health professional students, the tapes were shown to 93 primary care physicians. These physicians then completed both a Physician Attribution Survey and a Patient Management Problem describing their proposed treatment.

There were significant differences in treatment on five of nine treatment dimensions, depending upon the characteristics of the patient.

First, the Likeable-Competent patient would be encouraged significantly more often to telephone and to return more frequently for follow-up than would the Likeable-Incompetent or Unlikeable-Competent patient.

Second, the staff would educate the likeable patients significantly more often than they would the unlikeable patients.

Third, the physician would offer significantly more patient education to incompetent patients than to competent ones.

Fourth, the unlikeable patient would receive significantly more interviewing regarding the psychological aspects of care than would the likeable patients.

Fifth, the Likeable-Competent patient would receive augmented medication more frequently than either the Unlikeable-Competent patient or the Likeable-Incompetent patient.

There were no differences in the use of the physical examination, referral to staff, frequency of return or hospitalization based on the personal characteristics of the patient, although some of these variables were significantly affected by the attributed disease. There were no interactions between patient characteristics and disease as determinants of management.

These findings have implications for medical education, studies of medical decision-making, and assessments of physicians' quality of care of patients. The methods developed provide a basis for more extensive and detailed studies of the explicit and implicit theories physicians have regarding the relationship between the personality characteristics of their patients and treatment decisions.

Reference:
Perceived likeability and competence of simulated patients: Influence on physicians' management plans, Barbara Gerbert, Social Science & Medicine, Volume 18, Issue 12, 1984, Pages 1053-1059.

Double Standards that Suck for Women

Abstract: Social-role theory suggests that women are likely to be penalized for acting assertively (or in other ways that are counter to stereotypical expectations). Using a sample of 76 supervisor–subordinate dyads, this research investigates the reactions of supervisors to the use of intimidation strategies by men and women working in a law enforcement agency. The findings suggest that, among female employees, the use of intimidation tactics of impression management is negatively related to supervisor ratings of likeability. In contrast, among males, the use of intimidation is unrelated to supervisor ratings of likeability. In addition, for females, the use of intimidation is unrelated to performance ratings; among male employees, though, the relationship between intimidation and performance evaluations is positive. The implications of this study for management practice and future research are also discussed.

So do you play the game and conform with expected norms (stereotypical expectations) or do you strive to use your voice, ask for what you need or want, and be authentic at work despite the risks and costs?
I get it that charm goes a long way, I appreciate it as much as the next person. But isn't that how our country got G.W. Bush, when Karl Rove, with considerably less charm and a definite agenda, ran the show? Don't sociopaths and con artists use charm to their advantage (and our disadvantage)? Isn't charm how we get hoodwinked?
I understand that my desire for a more direct/honest form of communication will never take hold, at least half of us or probably more on most days, just don't want to hear it or don't want to risk being the one to say it. But can we expect at least an inching toward relationships, interactions and decision-making with our eyes open?
Reference: Counternormative impression management,likeability, and performance ratings: the use of intimidation in an organizational setting
MARK C. BOLINO AND WILLIAM H. TURNLEY(2003)
Journal of Organizational Behavior, 24, 237–250