Monday, April 25, 2011

Becoming Your Own Shaman

"Albert Schweitzer reportedly once observed, 'The witch doctor succeeds for the same reason all the rest of us [doctors] succeed.  Each patient carries his own doctor inside him.  They come to us not knowing this truth.  We are at our best when we give the doctor who resides within each patient a chance to go to work.' "

From The Way of the Shaman by Michael Harner

Saturday, April 16, 2011

Minuchin's Rule

"In this room, I have only one rule.  It is a small rule, but apparently very difficult for this family to follow.  It is that no person should talk for another person, or tell another person how this person feels or thinks.  People should tell their own story and own their own memory."

From Minuchin, S. & Fishman, H.C. (1981). Family Therapy Techniques. Harvard University Press. Cambridge, MA.

Thursday, April 14, 2011

Intervention Statements for Parents

The following are Structural Family Therapy intervention statements (cognitive constructs) Minuchin might make while working with families having difficulty with a young child's disruptive behavior.

"This support of the parental subsystem aims at increasing both the psychological distance between the mother and child and the proximity between spouses, giving them a common task as parents."

"When a four-year-old is taller than her mother, maybe she is sitting on the shoulders of her father."

"A four-year-old is no match for her parents if they pull together."

"If you cannot handle a young kid, maybe you are pulling in different directions."

"You must be doing something wrong.  I don't know what it could be, but I am sure if you think together, you will find out what it is, and moreover, you will find a solution."

"As things go, you are defeating each other, and in some way you are hurting and exploiting a child that both of you love very much, so we will need to find a way in which you help each other so you can help your child."


From Minuchin, S. & Fishman, H.C. (1981). Family Therapy Techniques. Harvard University Press. Cambridge, MA.

Minuchin's Cognitive Constructs

"These are idiosyncratic phrases of Minuchin's who likes concrete metaphors. If a therapist borrows them, he must make them personal or, better, select his own phrases to highlight intrusion into psychological space, indicating and separating overinvolved dyads."

When sister answers for brother:  "You're helpful, aren't you? You take his memory."

"You take his voice."

"If she answers for you, you don't have to talk."

"You are the ventriloquist and she is the puppet."

"Your hallucinated voices are not even yours; your father's voice is talking inside of you."

"If your father does things for you, you will always have ten thumbs."

"If your parents know when you need insulin, then you don't know your own body."

From Minuchin, S. & Fishman, H.C. (1981). Family Therapy Techniques. Harvard University Press. Cambridge, MA.

The Parent Is In Charge

"Throughout the course of therapy the children and especially the mother invite the therapist to intervene and set limits.  The pressure is tremendous for the therapist to activate and 'help this family into shape.'


The therapeutic goal remains, however, to get the mother to assume the role of the leader for her family.  For the therapist to assume this job would only allow the mother to continue as a helpless person.


The correct intervention for the therapist in this situation consists of resisting the induction into the role of 'helper' for the family.  Otherwise, he will only contribute to the mother's displacement from an executive role."

From Minuchin, S. & Fishman, H.C. (1981). Family Therapy Techniques. Harvard University Press. Cambridge, MA.

Own Voice

Minuchin:  So you are acting, really, in strange ways, Gina.  You're acting as if you are six, and you're acting as if you are over 60, like your grandma.  
And both of your parents accept that, so it's not your fault.  It's absolutely your fault if you are running this household.  
But, Gina, you are caught because you are saying to your father the kinds of things that you think your mother wants to tell your dad, so you ampify Mother's voice.  
You are saying to your mommy the kind of things that you know your grandma and your father say to your mother.  
So you are just the voice of everybody in this family.  You don't have your own voice.  You are the puppet of the ventriloquist...

From Minuchin, S. & Fishman, H.C. (1981). Family Therapy Techniques. Harvard University Press. Cambridge, MA.

Voice, Mind and Body

Sometimes family members speak on behalf of other family members in a family therapy session.  Here is Minuchin's intervention to a family with an 11 year old daughter who is asthmatic:
Minuchin: ...Okay, I am talking about Pauline having a voice and a mind and then having a body. If Pauline has a voice and a mind, then she will control her body."

From Minuchin, S. & Fishman, H.C. (1981). Family Therapy Techniques. Harvard University Press. Cambridge, MA.

The Therapist Challenges Family Homeostasis

"As she (the therapist) accommodates to the family and selects data, she may be seduced into selecting precisely the data that the family feels comfortable presenting.  The therapist's job is to help the family change, not to keep them comfortable."
From Minuchin, S. & Fishman, H.C. (1981). Family Therapy Techniques.  Harvard University Press.  Cambridge, MA.

Politeness as Collusion

"Even when therapists recognize the ineffectiveness of their interventions and want to change them by increasing their intensity, they may at times be handicapped by rules of courtesy.  Therapists, like their clients, have been trained since childhood in the appropriate response to people:  respect and acceptance of their idiosyncrasies.  Besides, therapists and family members belong to the same culture.  They respond to the implicit rules of how to behave in situations in which people transact with other people.  Therefore, when family members show in a session that they have reached the limit of what is emotionally acceptable and signal that it would be appropriate to lower the level of affective intensity, the therapist must learn to be able not to respond to that request, despite a lifetime of training in the opposite direction."

Minuchin, S. & Fishman, H.C. (1981). Family Therapy Techniques. Harvard University Press. Cambridge, MA, p. 117-118.

Helping Others Be Incompetent/Competent

In a family therapy session, Minuchin is talking to a 19 year old son about his relationship with his helpful father.  Minuchin challenges the idea that helping is helpful.  The 19 year old son had been in an inpatient psychiatric center for 6 months:
Minuchin (to son):  Well, if you don't help him (father) to change, you will not be able to use your hands.  You will always have ten thumbs - you will always have two left hands - you will always be incompetent because he is doing things for you.  He is paralyzing you.  Talk with him about that, because I think that's very dangerous what your father did just now.
(Father had picked up the lapel microphone wire that was draped over the chair and moved it for son).

Later in the session, after son gets interrupted by family members as he is trying to "help Dad,"  Minuchin offers:
Minuchin (to son):  I am a stranger, you see, and I can't help because I don't know you two.  If you need some help, you can ask someone in the family to come and join you, but if you don't need to, I want you to try first by yourself.

Empowering Voice in Family Therapy

Salvador Minuchin is the creator of Structural Family Therapy. In the book, Family Therapy Techniques, he presents excerpts from his family therapy sessions.  The following is his intervention as statement to a mother who has difficulty managing the behavior of her 5 year old daughter:
Minuchin:  She needs to hear that voice.  This voice is necessary.  You are afraid of your stern voice, but this voice is good.  At times it's soft and loving and at times it's strong, and she needs to hear both ranges.  She needs to dance to your music.

Wednesday, April 6, 2011

Stress and Disease

"Exposure to chronic stress markedly increases vulnerability to adverse medical outcomes. This holds true across a wide variety of mental and physical conditions.  For example, persons facing chronic stress are more likely to develop an episode of clinical depression, experience symptoms of an upper respiratory infection following viral exposure, suffer from a flare up of an existing allergic or autoimmune condition, and show accelerated progression of chronic diseases such as acquired immunodeficiency syndrome and coronary heart disease...This phenomenon is apparent across the entire lifespan. From early in childhood to late in adulthood, chronic stress is accompanied by worse health and the magnitude of this effect is substantial: In some cases, exposure to chronic stress triples or quadruples the chances of an adverse medical outcome."

Miller, G.E.,  Chen, E. & Zhou, E.S. (2007).  If It Goes Up, Must It Come Down? Chronic Stress and the Hypothalamic-Pituitary-Adrenocortical Axis in Humans.  Psychological Bulletin, 133 (1), 25–45.

Sunday, April 3, 2011

Characteristics of a Shaman/Shamaness

"And there, as they assert, they cut his head open, take out the brains, wash and restore them, to give him a clear mind to penetrate into the mysteries of evil spirits, and the intricacies of disease; they insert gold dust into his eyes to give him keenness and strength of sight powerful enough to see the soul wherever it may have wandered; they plant barbed hooks on the tips of his fingers to enable him to seize the soul and hold it fast; and lastly they pierce his heart with an arrow to make him tender-hearted, and full of sympathy with the sick and suffering."

--Shamanism:  Archaic Techniques of Ecstasy by Mircea Eliade
Poets, writers, artists, musicians and scientists venture beyond the conventional limits to tap into the fountain of inspiration and bring back knowledge that benefits the whole tribe of humanity.

Saturday, April 2, 2011

The Shaman

". . . the shaman was neither the madman nor a charlatan, as other scholars had regarded him, but a gifted (if, indeed, often unwell or mentally unstable) individual who entered into a trance in which he climbed up to the world of the gods and the animals, and brought back knowledge that was useful to his whole tribe."

--Shamanism: Archaic Techniques of Ecstasy by Mircea Eliade

Coherence

“I want to be a witness to my delirium. That’s why I write, I must find coherence in this mad journey.” 
 --18-year-old Ekiwah Adler-Bel�ndez a “literary prodigy and cerebral palsy and scoliosis survivor.”

Check out the full article on narrative medicine and poetry's power to heal at "Mary Oliver Saved My Life" by Greg Cook.

There is something about coherence, making sense of things and developing understanding, that seems to be powerful, organizing and healing in the face of attachment disruption, trauma and illness.  Whether you write, talk, sing about it or act it out in a play - we strive to contain it, to put it into the form of a story with details - events and associated feelings - with a beginning, middle, and end.  It is a holy and powerful formula.  It is self-expression.  It works.  What's your story?  Come on, everyone has got a voice.  What do you want to say?