Saturday, December 29, 2012

Predictors of Resiliency

Based on a generation of research studies, here is the short-list of correlates and predictors of resilience:
  • One or more effective parents
  • Connections to other caring, competent adults
  • Cognitive, attention, and problem-solving skills
  • Effective emotion and behavior regulation
  • Positive self-perceptions; self-efficacy; self-worth
  • Beliefs that life has meaning; hopefulness
  • Religious faith and affiliations
  • Aptitudes and characteristics valued by society (for example, talent, attractiveness)
  • Prosocial friends 
  • Socioeconomic advantages
  • Effective school, a sense of connectedness to school
  • Effective community (for example, safe, with emergency services, recreation centers, options for young people)
Resnick & Taliaferro, 2011

Personal Change

Is it possible for people to change?  Yes, we can!

Do most people change?  Sadly, no.

Personal change is supremely difficult, even if we really, really wanna change.  It's a death of sorts and therefore super scary. 

Most of us prefer the devil we know over the devil we don't know.

But if we have faith, hope or optimism that we can create a new reality that is better than the fix that we're in - then it seems scarier to stay the same than to change.

If the door that we're scared to open - the one that leads into the darkened unformed room of our future - seems dangerous, then would it give us courage to know that we are the architects and decorators that can wield power and imagination over the space?

What would you do with the new, open space?

Wishing you an auspicious and transformed 2013 of your own creation.

Wednesday, December 26, 2012

Dissertation Proposal Checklist

I am working on the dissertation proposal - full throttle.  Actually, I have been working on it for the last two and a half years - it is taking that long to digest the reading, concepts and theories and bring the vision down to size (I keep telling myself that it's an exercise and not a life project).  In truth, the thinking behind most dissertations are a lifetime of cumulative thoughts, feelings and experiences.

Once I was done with coursework and left to my own devices, the writing process could be quite unstructured.  Fortunately, at this level, most students are neurotic enough to find the discipline and structure internally to bang it out.

There are tricks I employ to help me get it done, like:

  • postering my walls with notes and references for each section of the proposal
  • studying with other PhD students (misery loves company or as my friend, Jenna, said: if you see your friend reading and writing - you feel competitively compelled to follow suit)
  • scheduling daily time in my planner to sit on my butt and write (and actually following through despite all tempting distractions)

The truth is, for me the greatest motivator is my own passion for reading and writing about my topic and population.  I feel lucky to get to do this - to have the time and space to think about these things and to use my imagination, my spirit and soul in this way.

Checklist toward Proposal Defense:
Abstract

Introduction
  • Statement of Problem
  • Research Questions
  • Significance of the Study
  • Assumptions
  • Limitations
  • Definitions of Key Terms
A Review of the Literature
  • Theories to Guide the Study
Methodology (draft sumbitted to adviser - check)
  • Research Design
  • Research Questions
  • Participants & Sites
  • Research Variables
  • Data Collection Procedures
  • Measures
  • Data Analysis Plan
Timeline

Also, I need a committee of four like-minded scholars that get along. And I need to request IRB approval to conduct the study.  Plugging away a little at a time, every day, I know I can do this.  I wanna defend by May.  This means I enjoy summer break with my daughter, preferably in Hawaii AND be eligible for employment as an Assistant Professor next Fall.  Most of the social work programs in Los Angeles are hiring now.

This is the longest journey.  Had I known, I may not have started.  On the other hand, what else would I be doing?  Watching TV and complaining about my life?  Sometimes there is beauty in the difficult - like being purified and polished by fire.  Ironically, as hard as this is, my life has never been more balanced.  When you focus, really focus, on what you want - you get down to the essentials like work, love and play - all in moderation.  Compared to my previous workaholic lifestyle, this pace seems like semi-retirement.  I could get used to this - a life of passion and balance.  Thank you, Yesus. Amen.

Parenting and Adolescent Behavior

"Externalizing problems were much better predicted by familial and extrafamilial factors than by the individual characteristics of the adolescent."

"The quality of attachment to parents is strongly related to adolescent's well-being and depression.  Because parents provide support for conventional behavior and sanctions against conduct problems, positive bonding to parents seems to function as a protection against antisocial behavior and delinquency.  In addition to parental bonding, parental ability to supervise their child and parental monitoring of the child's daily activities increases the likelihood that the adolescent will be deterred from problem behaviors.  Parental monitoring decreases unsupervised time and narrows the range of negative social influences."

Dekovic, 1999

Saturday, December 22, 2012

The Burden of Not Talking About It

To inhibit ongoing thoughts, feelings or behaviors is associated with physiological work...If active inhibitory processes are maintained over an extended period of time, they serve as a long-term cumulative stressor that increases the probability of stress-related diseases.  A particularly insidious form of inhibition occurs when individuals have experienced a traumatic event that they are unable to discuss with others.

Disclosure of Trauma and Health Among Holocaust Survivors
James W. Pennebaker, Steven D. Barger, and John Tiebut (1989)
Psychosomatic Medicine, 51, 577-589

Transparency

Jourard was a visionary who argued that openness in at least one significant relationship was a prerequisite for a healthy personality.

Self Disclosure in Personal Relationships by Kathryn Greene, Valerian J. Derlega, Alicia Mathews

Friday, December 21, 2012

The Physiological Cost of Not Talking About It

Abstract
Results from a series of studies are summarized in support of a general theory of inhibition and psychosomatics.

According to this view, to inhibit thoughts, feelings, or behaviors is associated with physiological work.

In the short term, inhibition results in increased autonomic nervous system activity. Over time, inhibition serves as a cumulative stressor that increases the probability of psychosomatic disease.

Actively avoiding thoughts and feelings surrounding a trauma and/or not discussing a trauma is a particularly insidious form of inhibition.

The results from recent surveys and experiments indicate:
  • (a) childhood traumatic experiences, particularly those never discussed, are highly correlated with current health problems;  
  • (b) recent traumas that are not discussed are linked with increased health problems and ruminations about the traumas;  
  • (c) requiring individuals to confront earlier traumas in writing improves health and immune system functioning;  
  • (d) actively talking about upsetting experiences is associated with immediate reductions in selected autonomic activity. Implications of these findings for our understanding of disclosure, trauma, and disease are discussed.
...trauma may cause slight anxiety and cause us to think...If we were molested as children, fired from our jobs, or mugged, far more physiological and cognitive activity would ensue.

A fundamental psychological question concerns how we come to find meaning in traumatic experiences.
In this paper, we present the results from several studies that indicate that talking about---or in some way confronting--traumatic experiences is psychologically and physically beneficial.  

DISCLOSURE OF TRAUMAS AND PSYCHOSOMATIC PROCESSES
By JAMES W. PENNEBAKER and JOAN R. SUSMAN
Soc. Sci. Med. Vol. 26, No. 3, pp. 327-332, 1988

Thursday, December 20, 2012

Internalizing our Parents

When our children internalize our negotiable rules and loving structure, then they often make decisions based on these beliefs:
"It's okay for me to grow up and still be dependent at times.  I can think things through and get help doing that.  I continually expand my ability to be responsible and competent."

When we provide structure and enforce non-negotiable rules consistently, then children often make decisions based on these beliefs:
"There are some rules I have to follow.  I can learn from my mistakes.  I am a good person.  I'm lovable and capable.  They care about me and take care of me."

If parenting relies on criticism, then children believe:
"I have to know what I don't know.  I will try harder, be strong, be perfect.  If I don't do things right, I am a bad person.  I can't be good enough.  I am hopeless.  Why bother?"

If parenting consists of freedom without responsibility (marshmallow parenting), then children learn to believe:
"I must take care of other people's feelings and needs or I don't need to care about anyone but me.  I am not capable of learning how to value and take care of myself.  If help is offered, mistrust it or at least expect to pay a price for it but don't expect helpful structure from others."

If parenting lacked rules, protection or contact, then children begin to believe:
"Don't ask for or expect help.  No one cares.  If I am to survive I will have to do it by myself.  If help is offered, mistrust it.  Help and trust are a joke."

If parenting is characterized by rigidity, which springs from fear, then children will often make decisions based on the following beliefs:
"I am not wanted.  Parents don't care about me.  Rules are more important than my needs.  I will let others think for me.  I will comply, rebel or withdraw.  I will blame myself."

Growing Up Again:  Parenting ourselves, parenting our children by Jean I. Clarke and Connie Dawson

Supportive Care in Parenting

"I love you, you are loveable.  You are capable.  I am willing to care for you.  Ask for what you need.  Your welfare is important to me.  I am separate from you.  I trust you to think and make judgments in your own best interests."

Growing Up Again:  Parenting ourselves, parenting our children by Jean I. Clarke and Connie Dawson

Love

Care and support are based on unconditional love.  If, as children, we didn't feel loved unconditionally, it may be hard to recognize and accept unconditional love when others offer it to us.  If our being loved hinged on how we were useful to our families, we may hold our breath and wait for the other shoe to drop when someone says, "I love you."  We wonder, What will I have to do to deserve this? or What is this going to cost me?

If we had to accept long ago that adult needs came ahead of ours, we questioned love and support to ensure our survival.  Now we will have to learn to believe in unconditional love and that may take awhile.  But we can do it and the better we learn to accept unconditional love for ourselves, the better we will be able to offer it to our children.

"I am loved, I am lovable, I am loving."  These are the unconditional love decisions.  Here are some personal rules that flow from these decisions:
  • I accept love freely.
  • There is an infinite supply of love.
  • I give love freely.
  • I surround myself with loving people.
  • I protect myself from unloving people.

Growing Up Again:  Parenting ourselves, parenting our children by Jean I. Clarke and Connie Dawson

Grieving

Usually  I write about what is on my mind - what I'm curious about and what I've been mulling over - in an effort to organize it, detail it, digest it, make sense of it until it is coherent and I feel calm.

Lately, I have been doing a lot of grieving and letting go.  I could post those thoughts but they seem so personal, even for me.

What I can say that is pretty universal about grieving is that sooner or later, we all experience loss so we have to learn how to grieve.

Sometimes we're stoic about it.  Sometimes we dive right in.  Sometimes we alternate between stoicism and hysteria.

We tell the story to our friends.  When they can't hear it anymore (God bless them for their patience), then we make more friends and regale them with the same stories.  The bigger the loss, the greater the need to tell the story over and over again.

Sometimes there are tears, lots of tears - ready to burst out of your eyes but have to wait till you get to the car or until your daughter goes to sleep.

Sometimes there are so many questions and doubts that you gotta write them down in excruciating detail in journals, planners, post-its, the nearest scratch paper (the back of junk mail envelopes, for example), or the margins on the page of the book or article you are reading.

Unfortunately, all this digesting doesn't make the story any smoother, cleaner or more "in a nutshell"-like when you talk about it over lunch with friends.  There are soo many drafts of the story before it is ready to be put to rest.

Like a good novel, there are many layers of meaning.  And grieving a current loss can't help but remind you of every loss that has preceded it - that's when the story feels infinite.

What I've learned is to feel all my feelings.  Better out than in.  The feelings will pass unless I stifle them and allow them to get stuck.  The work of grieving is like an homage, a memorial and a clearing.  Sweeping the house for a new day.  There are moments of peace.  There are moments of pain.  There is lots of love and support available.  There is always a new day.


Monday, December 10, 2012

A definition of codependency

Codependency:  an excessive preoccupation with the lives, feelings, and problems of others.

Yikes, isn't that called altruism in social work?  My hypothesis is that social workers were groomed by families of origin to take care of others.  When we realized we could get paid for doing what we do best, we applied to an MSW program.  Hopefully, in the process, we also learned that helping could look vastly different in our relationship with our clients as compared to what it looked like in our families.

The antidote to codependency is self-love, self-care and self-worth.  Cheers to all this good stuff in the New Year!  As it turns out, taking care of ourselves is good for others too.

Psycho-education for PTSD


Niles et al., (2012) summarizes the purpose of psychoeducation for PTSD clients is “to increase one’s understanding of stress reactions, readjustment difficulties, and recovery, as well as to normalize experiences, and assist in the early identification of symptoms that my reflect the development or exacerbation of a mental disorder (p. 540).”

Thrive with Self-Love


Four major factors appear to contribute to compassion fatigue: 
  • poor self-care
  • previous unresolved trauma
  • inability or refusal to control work
  • stressors and a lack of satisfaction for the work.”
Positive affect can increase and be increased by physical, intellectual, and social resources.  Fredrickson (1998) recognized the importance of individual resource in promoting health and well-being.  Positive emotions facilitate and are facilitated by resource building.  Resource building revolved around one’s ‘compassionate core’ grounded in altruism.  This core consists of an individual’s inner resources and capacities (i.e., thriving and resilience) and accumulated wisdom derived from life experiences.”

From the article, The Social Psychology of Compassion

Fear & Resilience


"In an analysis of facial fear expressions of female assault victims with PTSD undergoing prolonged exposure for PTSD, fear expressions during the first reliving of rape memories were highly correlated with improvement at posttreatment."
 From the article:  Influence of Emotional Engagement and Habituation on Exposure Therapy for PTSD


Don't be afraid to face the fear - it actually means something better is on the other side.



The ordinariness of resilience


“Expectations that special qualities were required to overcome adversity may have been influenced by prevailing deficit models of psychopathology that the early resilience investigators set out to overturn.  In other words, expecting extraordinary qualities in resilient individuals implied that ordinary adaptive resources and systems were not enough.”

From the article:  Ordinary Magic, Resilience Processes in Development

Challenge the Family Structures


“Family therapy is not social change, and it is hardly self-evident that changes in the power relations between men and women can be bought for the price of a therapist’s fee.  Male privilege and female masochism are structured into the psyche and into the social arrangements of everyday life.  A challenge to these structures requires no less than a momentous social upheaval, and that is now in progress.”

From article, "Feminism and Family Therapy"

Families as Systems


“The more satisfying their experience of growing up has been, the more likely are people to choose a partner who provides them with a sense of continuity of that experience.  Whatever the nature of the early family life, everyone has a profound need to maintain a sense of identity developed in the early year; invariably, there are close links between the old family and the new mate” (p. 222).

“Clinicians also become much more aware of the family.  Some therapist discovered the family system by being bruised by it…working with an individual and being totally defeated by the family’s power over the patient…”

The major problem we see in the individual approaches is that it fails to take account of the powerful interdependence between family members…it is very difficult for individuals to change, maintain that change, if the family does not change too…it doesn’t matter who has the presenting problem or what the problem is – whether it’s a child who wets the bed, an alcoholic husband, a couple considering divorce, a wife who is depressed, a runaway adolescent, or a capable student who is failing in school.  The ‘symptom’ is merely a front for the family’s larger stress (p. 271).”

Ideally, we would like to start with the larger system we are able to assemblewe want to relate to the most global system first, then move on to the smaller subsystems…we may work for some time with the couple…we can then work with individuals…individual therapy should be like the Ph.D. – the last stage in the training (p.273).”


From "The Family Crucible"

Disclosure is Powerful

“The mere act of disclosure is a powerful therapeutic agent that may account for a substantial percentage of the variance in the healing process” (Pennebaker, 1997, p.162)
Writing about emotional experiences as therapeutic process, Psychological Science, 8(3), 162-166.

MBSR for Urban Youth

"The data suggest that MBSR instruction for urban youth may have a positive effect in domains related to hostility, interpersonal relationships, school achievement, and physical health” (Sibinga, Kerrigan, Stewart, Magyari & Ellen, 2011, p.213). 

Mindfulness-Based Stress Reduction for Urban Youth The Journal of Alternative and Complementary Medicine, 17(3), p.213-218

Choosing to be Lovable

"I am loved, I am loveable, I am loving."

These are the unconditional love decisions.  Here are some personal rules that flow from these decisions:

  • I accept love freely.
  • There is an infinite supply of love.
  • I give love freely.
  • I surround myself with loving people.
  • I protect myself from unloving people.


From "Growing Up Again" by Jean I. Clarke & Connie Dawson

Self-Determination

I am not a good girl or a bad girl. No self-judgments.

I am a Woman who chooses and accepts the consequences of my choices.

Unashamed and whole.

Who are you?

Monday, November 26, 2012

Have Courage to Be True

"This is tense work indeed, but it is better than having the powerful drama take place covertly."

The Family Crucible by Napier & Whitaker

Writing Thoughts & Feelings for Good Health

"The results of the experiment demonstrate that the mere act of writing about basic thoughts and feelings about coming to college reduces the number of health center illness visits for college freshmen over the following 4-5 months relative to students who write about superficial topics.  Equally important, the lack of any meaningful wave effects indicates that whenever individuals confront their thoughts and feelings about college, positive health effects follow (p. 535)."

Accelerating the Coping Process by J.W. Pennebaker, M. Colder & L.K. Sharp

Organizing the Trauma Memory

"In individuals with PTSD, worst moments contained more unfinished thoughts and fewer words indicating cognitive processing than the remainder of the narrative, which was not the case for individuals without PTSD.  A number of theorists have argued that the disorganization of the trauma memory is involved in the development of PTSD, especially intrusive memories moments of PTSD participants (p.684)."

Jelineck, L., Stockbauer, C., Randjbar, S., Kellner, M., Ehring, T., & Mortiz, S. (2010).  Characteristics and organization of the worst moment of trauma memories in posttraumatic stress disorder.  Behavior Research and Therapy, 48, 680-685.

Women in Families, Therapy & Society

"Women have always been buried in families, and as long as gender remains an invisible category in our clinical work, they will remain submerged.  But if therapy is about confronting what is unspoken, we must ask ourselves how we can get people to talk about issues so fundamental and so inflammatory that they threaten the structure not only of the family as we know it but of the whole society as well (p. 9)."

Feminism and Family Therapy

Humor Saves Family Therapy


"...and the humor.  Families in difficult situations are likely to become very grim, morbidly dedicated to their issues and positions (p.112)." 
"Humor is one means the therapist can use to try to break this grim mood, hoping to wake the family out of the hypnotic trance where all is desperation and struggle...We can encourage them to change their mood by getting them to begin to laugh at themselves - just a little, anyway."

The Family Crucible by Napier & Whitaker

Therapy Honeymoon

"It's a honeymoon. When people decide to go into therapy, things are usually better off for a while.  I was just warning you so you wouldn't be surprised when it didn't last."

The Family Crucible by Napier & Whitaker

Disclose It and Heal

"College students and adults who reported having experienced one of several types of childhood traumatic events (e.g., sexual or physical abuse, death or divorce of parents) were more likely to report current health problems if they had not disclosed the trauma to others than if they had divulged it."

Confronting a Traumatic Event:  Towards an Understanding of Inhibition and Disease by J.W. Pennebaker

The Caregiver is Key - No Matter What

"...a fundamental assumption of Multi-System Therapy (MST) is that the youth's family or caregiver is the key to favorable long-term outcomes, even if that caregiver presents serious clinical challenges."

Engaging multi-problem families in treatment:  Lessons learned throughout the development of Multisystem Therapy by Cunningham & Henggeler (1999) in Family Proc

Writing About It - Short-Term Pain & Long-Term Gain

"Writing about earlier traumatic experience was associated with both short-term increases in physiological arousal and long-term decreases in health problems."

Confronting a Traumatic Event:  Toward an Understanding of Inhibition and Disease by J.W. Pennebaker
"The members of the family had to learn to talk about themselves and their own feelings rather than to engage in a critical attack on someone else (p.140-1)."

The Family Crucible by Napier & Whitaker

Okay to be Human

"...asked her to try to make allowance for the human side of her therapist.  'We make mistakes, too' (p. 187).

The Family Crucible by Napier & Whitaker

You are under no obligation to tolerate it

"These rationalizations, upon exploration, usually reveal a sense of obligation in the parents which leads them to tolerate behavior they don't like in their children...Energy is misspent in shifting and denying blame rather than focusing on what can be done to change the situation..."

Foster's Technique:  A systematic approach to family therapy by Reevah Lesoff

Disclosing and Feeling Better

"...these data offer support that confiding about traumatic experience, although depressing in the short run, appears to have positive physical and psychological effects in the long run.  At this point, we have demonstrated that disclosing early and recent traumas has positive physiological effects (p. 330)."

Disclosure of Traumas and Psychosomatic Processes by J.W. Pennebaker and J.R. Susman


Writing is Valuable

"The writing paradigm is exceptionally powerful, participants - from children to the elderly, from honor students to maximum security prisoners - disclose a remarkable range and depth of traumatic experiences.  Lost loves, deaths, incidents of sexual and physical abuse, and tragic failures are common themes in all of the studies.  If nothing else, the paradigm demonstrates that when individuals are given the opportunity to disclose deeply personal aspects of their lives, they readily do so.  Even though a large number of participants report crying or being deeply upset by the experience, the overwhelming majority report that the writing experience was valuable and meaningful in their lives (p. 162).

Writing about emotional experiences as a therapeutic process by J.W. Pennebaker

Stages of Change & SFBT

"The processes of change associated with the move from precontemplation to contemplation are consciousness raising, dramatic relief, and environmental reevaluation.

If the client is identified in the precontemplative stage of change then using the SFBT techniques of co-creating a problem with the client, the use of the miracle question and using exceptions can lead the client from precontemplation to contemplation.

Similarly, if a particular client is in the contemplative stage of change, self-reevaluation is the process of change that will lead this client from contemplation to preparation and the use of scaling questions and emphasizing second-order change can result in dramatic self-reevaluation, thereby leading the client into the preparation stage of change (p. 186).

Incorporating the stages of change model in solution focused brief therapy with non-substance abusing families by Kelch & Demmit (2012) in The Family Journal:  Counseling and Therapy for Couples and Families

Going it Alone

"They cannot expose their problems until they have achieved enough sense of security to think that they may be able to survive going it alone (p. 157)."

The Family Crucible by Napier & Whitaker

Real, Direct & Alive

"...though there is a contract in which the family agrees that they need to change and will allow the therapist to help, the family knows they will resist change (p. 81)."

"We avoid getting caught in the trap of becoming the permanent advocate of one person or one position.  We work as the agent of the family as a whole, and we can't afford to get locked into a particular relationship (p. 92)."

"If we want the family to...become...more real, more direct, more alive, then we have to be real, and direct, and alive ourselves (p. 93)."

The Family Crucible by Napier & Whitaker

Change is Possible if We are Stuck

"The use of such purposeful and goal-oriented questions in group practice convey to all its participants a meaning of being 'stuck' and not 'sick,' and the likelihood of 'change' instead of 'stagnation' (p. 337)."

SFBT Groupwork with at-risk junior high school students by Newsome (2004).


Purposeful Silence

"The longer the silence endured, the more tension it generated.  I could feel my chest tightening slightly and waited.  I was tired of waiting, and I was seized by a strong need to say something, anything, that would bridge my sense of aloneness (p. 63)."

The Family Crucible by Napier & Whitaker

The Power of Systems

"Generally, the larger, more complex systems tend to exert control over the smaller and less complex systems.  But influence moves up and down the entire chain, and if we are to understand human behavior, we must integrate knowledge from different levels. (p.50)"

The Family Crucible by Whitaker & Napier

Changing our Perceptions and Responses

"Solutions are changes in perceptions and interactions, which are not to be solved by the practitioner but rather co-constructed with the client."

Examining the Effectiveness of Solution Focused Brief Therapy:  A Meta-Analysis by J. Kim

Universal Magic

"This approach, in turn, has led to the argument that resiliency is a universal and ordinary phenomenon, rather than the providence of only a few lucky or special children.  Masten (2001) calls such resiliency 'ordinary magic' and argues that it is a common phenomenon that arises from ordinary adaptive processes."

Sources of resiliency among successful foster youth by Hass & Graydon (2009) in Children and Youth Services Review

Therapeutic Alliance as Leverage for Change

"The central hypothesis of this group was that the client's impressions of the therapist as expert, trustworthy, and attractive provides the helper with leverage (social influence) to promote change."

The Role of the Therapeutic Alliance in Psychotherapy by Horvath & Luborsky (1993).

Understanding Resistance

"Resistance [is] defined as stemming from a number of forces, including a system's natural efforts to maintain stability, most people's somewhat irrational fear to change, and their reluctance to give up control over their lives."

Anderson (1983)

Hope & Self-Confidence

"The client possesses resources and competencies that can be drawn on...as a result, hope and self-confidence can be rebuilt."

From Solution Focused Brief Therapy in the Journal of Contemporary Psychotherapy by F.P. Bannick (2007).

Fight, Struggle, Push & Try

"If we had continued in the same vein before - questioning, probing, interpreting - we would have set a dangerous precedent by implying that we were assuming the responsibility for pushing for change...they had to know, early in the process, that their initiative, their will to fight and struggle and push and try, was essential to a successful outcome..."

The Family Crucible by Napier & Whitaker

Creating our Environment

"...one if the most important principles of groups is that the group is a miniature world - whatever environment we create in the group reflects the way we have chosen to live..."

Love's Executioner by Irvin Yalom

Stages of Change & SFBT

"...clients can actually be in any stage of change when presenting for counseling and still be stuck.  Using specific techniques employed in the SFBT model, therapists can assist the client through the processes of change which will ultimately result in them entering the next stage of change."

Pre-contemplation, Preparation & Action Stages:  Talk therapy has been found to be more effective (such as the Miracle Question of SFBT)

Action Stage:  Behavioral techniques such as compliments, cluing and stimulus control are encouraged.

From Solution Focused Brief Therapy by B.P. Kelch & A. Demmit

what's going on in the family?

"But for Claudia, the experience was different.  Since we have moved away from her and her problems, she looked different:  more alert, more curious, and relieved.  She was quickly composing herself and hearing every word." 
"I'm pretty clear on what's going on with Claudia and I'd like to get away from her for a while.  Can you talk about the family as a whole?"

(Claudia is the teenage daughter in a family therapy session with greats Whitaker and Napier)

From the Family Crucible

Essential Relationship Factors

Rogers asserted that the therapist ability to be empathic and congruent and to accept the clients unconditionally were not only essential but sufficient conditions for therapeutic gains.

From The role of the therapeutic alliance in psychotherapy in Journal of Consulting and Clinical Psychology by A.Q. Horvath & L. Luborsky (1993).

Wednesday, November 7, 2012

Our Childhood Story and Attachment to Our Children

As a result of interviewing the mothers of the children in the study, Main found a strong correlation between how a mother describes her relationships with her parents during her childhood and the pattern of attachment her child now has with her.  Whereas the mother of a secure infant is able to talk freely and with feeling about her childhood, the mother of an insecure infant is not. 
In this part of the study an interviewer asks the mother for a description of her early relationships and attachment-related events and for her sense of the way these relationships and events affected her personality.  In considering results, as much or more attention is paid to the way a mother tells her story and deals with probing questions about it as to the historical material she describes.   
At the simplest level, it was found that a mother of a secure infant is likely to report having had a reasonably happy childhood and to show herself able to talk about it readily and in detail, giving due place to such unhappy events as may have occurred as well as to the happy ones.   
By contrast, a mother of an insecure infant is likely to respond to the enquiry in one of two different ways.  One, shown by mothers of anxious resistant children, is to describe a difficult unhappy relationship with her own mother about which she is still clearly disturbed and in which she is still entangled mentally, and, should her mother be still alive, it is evident that she is entangled with her in reality as well.  The other, shown by mothers of anxious avoidant children, is to claim in a generalized matter-of-fact way that she had a happy childhood, but not only is she unable to give any supporting detail but may refer to episodes pointing in an opposite direction.  Frequently such a mother will insist that she can remember nothing about her childhood nor how she was treated.  Thus the strong impression of clinicians, that a mother who had a happy childhood is likely to have a child who shows a secure attachment to her, and that an unhappy childhood, more or less cloaked by an inability to recall, makes for difficulties, is clearly supported. 
Nevertheless a second finding, no less interesting and one of especial relevance here, arises from a study of the exceptions to the rule.  These are the mothers who describe having had a very unhappy childhood but who nonetheless have children showing secure attachment to them.  A characteristic of each of these mothers, which distinguishes them from mothers of insecure infants, is that despite describing much rejection and unhappiness during childhood, and perhaps tearful whilst doing so, each is able to tell her story in a fluent and coherent way, in which such positive aspects of her experiences as there were are given a due place and appear to have been integrated with all the negative ones.  In their capacity for balance they resemble the other mothers of secure infants.  It seemed to the interviewers and those assessing the transcripts that these exceptional mothers had thought much about their unhappy earlier experiences and how it had affected them in the long term, and also about why their parents might have treated them as they had.  In fact, they seemed to have come to terms with their experience. 
By contrast, the mothers of children whose pattern of attachment to them was insecure and who also described an unhappy childhood did so with neither fluency nor coherence: contradictions abounded and went unnoticed.  Moreover, it was a mother who claimed an inability to recall her childhood and who did so both repeatedly and strongly who was a mother whose child was insecure in his relation to her.  In further examination of the data it has been found that all these correlations also hold true for fathers. 
In light of these findings Main and her colleagues conclude that free access to, and the coherent organization of information relevant to attachment play a determining role in the development of a secure personality in adult life.  For someone who had a happy childhood no obstacles are likely to prevent free access to both the emotional and the cognitive aspects of such information.  For someone who suffered much unhappiness or whose parents forbade him or her to notice or to remember adverse events, access is painful and difficult, and without help may indeed be impossible.  Nevertheless, however she may accomplish it, when a woman manages either to retain or to regain access to such unhappy memories and reprocess them in such a way that she can come to terms with them, she is found to be no less able to respond to her child's attachment behaviour so that he develops a secure attachment to her than a woman whose childhood was a happy one.  This is a finding to give great encouragement to the many therapists who for long have sought to help mothers in just this kind of way.

A Secure Base:  Parent-Child Attachment and Healthy Human Development by John Bowlby


Ahhh! the implications...

Monday, November 5, 2012

Narrative Exposure Therapy (NET)

Working in South Los Angeles where most students are exposed to multiple traumatic events and half endorse traumatic stress, depressive and anxiety symptoms in the clinical range, I wondered what is done in war-torn countries to treat trauma?  Because addressing this through individual or small group (6-8 students) interventions by mental health professionals seems burdensome and unfeasible.

Apparently, TEN years ago a short-term intervention to reduce PTSD symptoms among civilians living in low-income and war-torn countries was developed and shows very positive and sustained outcomes among adults AND children.  

Further, "both mental health professionals and lay counsellors can deliver NET....[a] study demonstrated how lay counsellors recruited from the local area and trained to deliver NET had results equivalent in efficacy to trials in which NET was delivered by mental health professionals...The lay counsellors who provided both types of therapy were recruited from the local community and were trained for six weeks." 

As if all that were not interesting enough, NET aims to create an autobiographical account of a traumatized persons life - with details, coherence, organization, order, the good and bad - which may not only be effective in reducing PTSD symptoms.  Given what we know about the nature of a parents narrative of their childhood being a good predictor of the quality of attachment security with their children, NET may also prove to be effective in increasing attachment security between traumatized parents and children (which we know is a mediator and moderator of PTSD development) - that will be my next research question...

Attached is an abstract and excerpt from an article that describes the research evidence and steps in conducting Narrative Exposure Therapy (NET).

ABSTRACT

Individuals who have experienced multiple traumatic events over long periods as a result of war, conflict and organised violence, may represent a unique group amongst PTSD patients in terms of psychological and neurobiological sequelae. 

Narrative Exposure Therapy (NET) is a short-term therapy for individuals who have PTSD symptoms as a result of these types of traumatic experiences. 

Originally developed for use in low income countries, it has since been used to treat asylum seekers and refugees in high-income settings. 

The treatment involves emotional exposure to the memories of traumatic events and the reorganisation of these memories into a coherent chronological narrative. 

This review of all the currently available literature investigates the effectiveness of NET in treatment trials of adults and also of KIDNET, an adapted version for children. Results from treatment trials in adults have demonstrated the superiority of NET in reducing PTSD symptoms compared with other therapeutic approaches. 

Most trials demonstrated that further improvements had been made at follow-up suggesting sustained change. 

Treatment trials of KIDNET have shown its effectiveness in reducing PTSD amongst children. 

Emerging evidence suggests that NET is an effective treatment for PTSD in individuals who have been traumatised by conflict and organised violence, even in settings that remain volatile and insecure.

Conducting NET

NET is a manualised treatment. The patient first undergoes psychoeducation in which the theoretical underpinnings of PTSD and the process of NET and rationale for treatment are explained. Psychoeducation about how avoidance of reminders of traumatic events is a key feature of PTSD, and the impact of this on inhibiting treatment, is provided. Once informed consent has been obtained, the therapy can begin. Sessions are usually 60–120 min in length and ideally occur in close succession preferably with one or more sessions per week and a maximum of a fortnight between sessions.

In the first session the patient constructs the ‘lifeline’. This is a physical representation of their life using a rope, beginning at birth and ending at the present day, with a section of the rope left uncoiled representing the future. The patient then briefly goes through their life, in chronological order, placing a symbol (e.g. flowers of different shapes and sizes) on the line to represent happy events and a different symbol (e.g. stones) for sad or frightening events. The therapist's role is to ensure the correct chronology of these events. The lifeline is useful in establishing the therapeutic relationship and in providing an indication of the number of sessions that may be necessary to address all traumatic events (although some events may only be disclosed later in therapy).

Following this session, subsequent sessions are dedicated to the narration of the person's life, in chronological order, with particular focus on and attention to the traumatic events. Periods between events are described in brief to contextualise the traumatic events within the individual's life and produce a coherent narrative. On approaching a traumatic incident, the focus is on contextual information, firstly establishing what life was generally like at that time (where was the person living, what were they doing, what was a typical day) and then narrowing this down as precisely as possible to what happened when the event occurred. The traumatic events are then narrated in great detail, gently resisting the patient's attempt to hurry through or avoid emotional engagement with the memory

The patient then slowly narrates their traumatic experience in chronological order, as they experienced it at the time. They are encouraged to describe all sensory modalities along with their thoughts and feelings. The aim of NET is to connect the hot memories into the corresponding information held within the cold memory for the event and so the patient must be emotionally involved in the narration but must also put these experiences into words, constantly integrating the contextual information. At the same time as the narration of the traumatic event progresses, the patient's current physical, emotional and cognitive reactions are observed and verbalised. The therapist continually guides the patient back and forth between what is happening for the patient at the time of the narration (present time) and what occurred at the time of the event.  One of the aims of the therapy is for the person to be emotionally exposed to the memory of the event for sufficient time that habituation occurs and their emotional response to the memory is diminished over the course of therapy. However, this is unlikely to occur within a single session. The session ends at a safe point in the narrative, at the end of a traumatic event, once the therapist has ensured that the patient's arousal has diminished and that their emotional state is improved. The events in the period after the traumatic incident are narrated to help the patient place the episode in context.

The narrative as described in the session is written up by the therapist between sessions, this provides an opportunity for the therapist to ensure they have fully understood the details and chronology of the events described and therefore highlights areas in the story which do not seem as coherent and possibly need further exploration at the next session.

At the beginning of the next session the narrative from the previous session is read to the patient to ensure accuracy, once again expose the patient to memories of the event, elicit further information and promote integration of the hot and cold memories. Usually the patient notices a reduced physiological and affective reaction from the first session, although several sessions may be necessary for habituation to occur for severely traumatic events. 

At the end of the re-reading of the narrative, the period between this event and the next traumatic event is briefly narrated, before moving forward to the next traumatic episode, which is again narrated in intricate detail. This process continues until all stressful events have been narrated and the affective responses to the memories have reduced. At this point, the patient and therapist will have created a testimony of the person's life from birth to the present day, with a detailed narration of the traumatic events

At the end of the therapy some time is spent discussing hopes and aspirations for the future, following which all parties who have been involved in the therapy (including the patient, therapist and interpreter) sign the completed testimony. The patient receives a copy of this for their own private records and the authors report that it is common to find patients sharing their testimonies with others including lawyers and human rights organizations.




Thursday, November 1, 2012

Pearls from The Family Crucible

Because a family comes into the therapy with such a sense of failure, it is important to show that they are unconsciously 'up to something' that is basically constructive.

Napier & Whitaker, 1978, p. 32

We try to keep the right balance of pushing and waiting, and sometimes we err in one direction or another.  

Napier & Whitaker, 1978, p. 99

Good old transferences...we therapists being stupid about it, flattering ourselves that the patient is really reacting in the beginning to us...but we are deluding ourselves if we think that the patient isn't always struggling with subtle and largely invisible ghosts and images out of the past.

Napier & Whitaker, 1978, p. 107

She felt pressured by her parents, and the [individual] therapy felt like more pressure.

Napier & Whitaker, 1978

There is another maxim:  the therapist will project his own family system onto the family he is treating.

Napier & Whitaker, 1978, p. 183

We gotta do our own family of origin work.  We gotta address the tendency toward co-dependence in our field.  The opposite of co-dependence is self-care.  We can find a happier medium between being other-centered and being self-centered - in extremes either is problematic, in balance - well that's called living well.

Tuesday, October 30, 2012

Fuck, Stories Can Be Beautiful

I'm crying in the cafe after reading that excerpt.  Fuck, stories can be beautiful. 

It reminds me that my daughter, at age 11, still wants to be tucked in and hear stories. 

It used to mean I read Cinderella to her ad nauseum

Then I turned her on to children's bible stories (I enjoyed reading them over and over too). 

Now she just wants stories about my childhood and life - my past Halloween costumes, things I did with my mom, embarrassing crushes I had on boys, etc. 

Anything that will help her to understand her thoughts, feelings and experiences. 

Any story that will bring meaning to all the changes and newness of life. 

Connection, integration, meaning, making sense of it, digesting, learning, growing, acceptance, belonging, soothing, understanding, seeing - fuck, stories can be beautiful.

Storytelling (Fucken) Heals (Duh!)

The evaluations that day indicated that people were pleased with the workshop, felt understood for the first time since 9/11, and wanted to continue meeting in the large group. In that setting, they asked to continue working with the therapist assigned to them.

Teenagers and children could join if they wished, but were clearly listening even as they did artwork. They always moved in when stories were being told about their lost parent. The kids seemed hungry for such stories. 

One of the interactions in the multiple family meetings that was most poignant occurred when a worker spoke up. An operating engineer we shall call Bill (not his real name) had survived, but was injured, bumed, and traumatized. On the recommendation of his therapist, he and his wife attended the meeting with his fellow workers’ families that day. He wanted to connect with the families of his missing coworkers, but was afraid the wives would ask him about their suffering in the inferno just before he was miraculously blown out. What happened instead was that Bill told a story. After being quiet all day, he shifted in his chair, leaned over toward a young girl who was crying, and said:

Honey, I want you to know that your Daddy led out a thousand people. He knew the building, and it was complicated. He led them out-and then he went back in, but that’s what we do. That’s our job. He was going in for more people, but he didn’t make it out that time. The next time you go to a ball game, I want you to look at the crowd and see what a thousand people looks like and know that your Daddy saved that many people. 

For centuries, storytelling has helped heal trauma and loss by providing access to meaning. Nothing a therapist could have done that day would have equaled the healing power of Bill’s story for the little girl, her mother, and for himself and his wife. Brothers and sisters in the union family were connecting by breaking their isolation, sharing stories, painful as it was. Everyone, including therapists cried, but with a new and more positive meaning about the tragedy.

HEALING LOSS, AMBIGUITY, AND TRAUMA: A COMMUNITY‐BASED INTERVENTION WITH FAMILIES OF UNION WORKERS MISSING AFTER THE 9/11 ATTACK IN NEW YORK CITY
Pauline Bossl, Lorraine Beaulieu, Elizabeth Wieling, William Turner, Shulaika LaCruz
Journal of Marital and Family Therapy, Volume 29, Issue 4, pages 455–467, October 2003

How We (People of Color) Grieve

There is a cultural chasm dividing European American families and families of color, especially immigrant families, around issues of death, loss, grief, and ambiguity. For the European Americans, there is often the seemingly impersonal and bounded culture-keeping a stiff upper lip and the avoidance of public displays of emotion. Get over it; move on. For African Americans and Latinos, among others, there is often a more direct, intimate, and expressive tradition around death, as well as with ambiguous loss. The cultural differences existed in therapists, too.
HEALING LOSS, AMBIGUITY, AND TRAUMA: A COMMUNITY‐BASED INTERVENTION WITH FAMILIES OF UNION WORKERS MISSING AFTER THE 9/11 ATTACK IN NEW YORK CITY 
Pauline Bossl, Lorraine Beaulieu, Elizabeth Wieling, William Turner, Shulaika LaCruz 
Journal of Marital and Family Therapy, Volume 29, Issue 4, pages 455–467, October 2003

Families - where it's at

The New York therapists who volunteered to help us with these meetings were an eclectic group. Those who felt most successful working with families in a community setting, regardless of their original training, could approach multiple generations flexibly and systemically. Therapists accustomed to quiet professional offices were challenged, because typically, families were large, including parents, children (newborns to teenagers), grandparents, aunts, uncles, friends, and even clergy. The Union Hall was alive with sound and activity, but this was not the case at the first meeting. That was eerily quiet-at first.
HEALING LOSS, AMBIGUITY, AND TRAUMA: A COMMUNITY‐BASED INTERVENTION WITH FAMILIES OF UNION WORKERS MISSING AFTER THE 9/11 ATTACK IN NEW YORK CITY 
Pauline Bossl, Lorraine Beaulieu, Elizabeth Wieling, William Turner, Shulaika LaCruz 
Journal of Marital and Family Therapy, Volume 29, Issue 4, pages 455–467, October 2003

Monday, October 29, 2012

Meditation and the Brain (and the Body)

Scientists have found that Tibetan lamas who do something called "loving-kindness meditation" have thicker-than-average neuron development in parts of the brain associated with happiness.  Meditation has also been shown to lessen heart disease, high blood pressure, infectious illness, and many other indicators of both health and aging.

Steering by Starlight
Martha Beck

Friday, October 26, 2012

Dating Psychology

PRAT, to pretend rejection to increase desire
Pimp
by Iceberg Slim

Do you - like a fish - prefer a lure that's moving away from you?
Do you like it when someone heaps on the praise and attention that you feel you never got from ______ or ________?
Or do you like it when someone is direct about what they want or like about you (and it resonates with your own desires and self-concept)?

When someone feigns disinterest to lure me in, I get turned off instead.  
First, it's disingenuous.   
Second and simply, I want someone who sees me and gets me and thusly wants me (duh).

This PRAT game sounds like it goes over well between two insecures.  I know who I am and what I want.  No games necessary.  I either like you or I don't.  You either like me or you don't.  The next part is the really fun part (more fun than disingenuous games).

Thursday, October 25, 2012

Balance

All work and no play can lead to writer's block, breakdowns, or divorce.

Complete Your Dissertation or Thesis in Two Semesters or Less
Evelyn Hunt Ogden

Monday, October 22, 2012

Rigor & Relevance

Balancing rigor and relevance is one of the tensions inherent in social work research...the two are not mutually exclusive.  It is important in a dissertation to carry out rigorous systematic research underpinned by an appropriate epistemology or theory.  This does not mean that your dissertation cannot address a practical problem.  It does mean that you have to have to have a theoretical framework to explain your theory of change.

All questions have behind them theoretical foundations without the exploration of which the questions are impossible to answer...the purpose of research as theory building and testing.

The Dissertation: From Beginning to End
Peter Lyons & Howard J. Douek

Dissertations & Theory

Theories have several basic functions; they are used to describe, to explain, and to predict. 
The role of theory in your dissertation is to provide an organizing framework through which you conduct your study. 
In addition, your dissertation research can make a contribution to the confidence we have in a particular theory or to our understanding of the conditions under which the theory coheres.
The basic purpose of scientific research is theory.
A research question is of little consequence without a theoretical framework to help conceptualize why this should be so.
One of the contexts that your review of the literature provides for your research is the theoretical connection between variables of interest.  This connection allows you to make tentative predictions and test how robust the theory may be.


The Dissertation:  From Beginning to End
Peter Lyons & Howard J. Douek


Combining Open and Closed

In social study, you open your eyes and look, in diagnosis, you close them and think.

Mary Richmond, 1917

Friday, October 19, 2012

Family Therapy Notes...

If people are really going to get deeply into therapy, they need to know that they can escape easily. So at the end of every hour we implicitly give the family the option of not making another appointment.
If the family situation is very difficult, it may even be necessary for the therapists to grow personally in order to respond adequately to the crisis.
Confrontation can lead to disaster in relationships, as well as to renewed caring, with so much of the balance held by the unconscious intent of the people involved.
The Family Crucible
Napier & Whitaker, 1978

Fathers in Family Therapy

Fathers usually are the outsiders in the modern family, and often they find coming into family therapy very uncomfortable.

The Family Crucible
Napier & Whitaker, 1978

Believe

For God has not given us a spirit of fear but the power of love and of a sound mind.
2 Timothy 1:7


Thursday, October 18, 2012

Individual vs. Family Therapy

"Claudia...was very sensitive to pressure from adults.  She felt pressured by her parents, and the therapy felt like more pressure.  She began to see the therapist as a special kind of policeman who had been hired by her parents to 'shape her up.'"

"By trying to treat her in isolation from the real source of her problems, the psychiatrist was unknowingly collaborating with the scapegoating process in the family."

The Family Crucible
Napier & Whitaker

Integrated Assessments

The framework considers the balance of risk (forces contributing to a problem condition) and protective (internal and external resources for the protection against risk) factors that interact to determine an individual's ability to function adaptively despite stressful life events.
Risk and Resilience Ecological Framework for Assessment and Goal Formation.
Corcoran, J. & Nichols-Casebolt, A.

Spirit, Growth and Healing

"Rogers acknowledges another characteristic of person-centered therapy increases effectiveness for the client - that is simply the presence of the counselor is releasing and helpful.  He feels that the inner spirit of the client, producing the potential for profound growth and healing energy."

Client-Centered Counseling


Person and Environment

"The ecological perspective provides a useful guide for the assessment process.  It deals with life situations and with the interface between the child and the important subsystems in which the child must function.  According to this perspective, there are neither inadequate persons nor inadequate environments; rather, the fit between person and environment is in relative accord or discord.  The ecological perspective further assumes that the attributes of the person and the situation need to be internally consistent, coherent, and positively complementary (p.105)."

Assessing Behavior Disorders in Children:  An Eclectic Approach
Paula Allen-Meares

Therapeutic Alliance Bests Treatment Method

The results also showed a significant relationship between total therapeutic alliance ratings and treatment outcome across modalities, with more of the variance in outcome attributed to alliance than to treatment method.

Krupnick et al., 1996
"It fails [marriage] for a complex set of reasons, most of which we will deal with later, but the major reason is that the protagonists get very scared that they are each going to lose their identities in the dependency, in the same way they lost them in the families in which they grew up.  The marriage begins to feel like a trap, a replication of the old family of origin.  So the couple begins to back away from each other, mistrusting."

The Family Crucible:  The Intense Experience of Family Therapy
Augustus Y. Napier with Carl Whitaker

"our failure to know joy is a direct reflection of our inability to forgive"

52 Quotes and Weekly Mindfulness Practice
Jack Kornfield

In the spirit of forgiving the inevitable failings of others and our own, here's to lots of love, joy, and peace, peeps :)

Thursday, October 11, 2012

Cold Memory & Hot Memory

Cold memory contains contextualised information about one's life at different levels of organisation, with increasingly specific information at each stage.  The first and most accessible stage contains information relating to 'lifetime periods'...The next stage contains information about 'general events'...Event specific knowledge is the next stage...In addition to the contextual information stored, sensory and perceptual information (referred to as 'hot memory') is also linked to this event specific knowledge.
'Hot' memory includes detailed sensory information as well as cognitive and emotional perceptions and physiological and motor responses, all of which are intertwined.  Unlike with cold memories, there is evidence that the limbic structures associated with emotion are heavily involved in sensory perceptual representations of events.  For traumatic events, these sensory perceptual representations are known as 'fear networks' or 'fear structures.'

Robjant & Fazel, 2010 (p.1032)

Tuesday, October 9, 2012

Dissertation Proposal Title

Love, Culture, Stories & Resilience:  The relationship between open family communication about traumatic memories and posttraumatic resilience

Love = The only reason you would withstand the pain of talking about it

Culture = What our grandmothers and ancestors taught us to do in order to heal

Stories = An organizing narrative takes the fragments of our trauma memories and puts them into a whole, coherent story

Resilience = Not only reduced PTSD, anxiety, and depressive symptoms, but also Hope, Trust, Love and Growth.

PTSD

Robjant, K. & Fazel, M. (2010).  The emerging evidence for Narrative Exposure Therapy:  A review.  Clinical Psychology Review, 30, 1030-1039.
"The three core symptoms of PTSD are:
  • Firstly the re-experiencing of intrusive vivid memories of traumatic events both during sleep and in the day, when the individual often has a sense they are re-living the event.
  • Secondly, the active avoidance of anything that may trigger these memories, with associated emotional numbing, derealisation and depersonalisation.
  • The final symptom is persistent hyperarousal and an exaggerated startle response, reflecting the readiness of the body's fight or flight response."


Not a Pimp, Not a Ho

Everyone seems to call dating and relationships a game.

Being an inveterate dork, I was advised to read the urban classic, Pimp by Iceberg Slim.  Amazon is shipping it as I write.

In the meantime, I watched the documentary, American Pimp by the Hughes brothers.  I took five pages of notes (soo dorky, right?).

One definition of naive is "lacking information or experience."  Imma tackle this nonsense with the same rigor and intensity that I bring to everything.

At first blush, a pimp is a classic con artist - a sociopath, a narcissist.  And a ho is a classic borderline (personality disorder).  Both survivors of trauma, abuse and attachment problems.  Ironically, in (non-business) romantic relationships, narcissists and borderlines seem to gravitate to each other too.

I wanna write the book, Not a Pimp, Not a Ho:  the How & What of Healthy Relationships.  Everybody has got a bit of pimp and a bit of ho in 'em.  I wanna learn all I can so as not to be so dorky and naive and then I wanna share the wealth of info - I want it to be a classic best-seller.  Not a pimp, not a ho, but wise to the game.  Not cynical or bitter, but wiser.

Send me your Pimp/Ho stories, you know you got 'em.  Write the coherent narrative (it's healing) and then send it to me.  I'll look for the patterns and report back.  Taking one for the team.

Monday, October 8, 2012

ABD

I am nearly ABD (All But Dissertation).  I have completed all required coursework and passed all comprehensive and written exams.  Now, I am assembling the dissertation proposal for defense.

My adviser said that you don't get a PhD by taking classes - you get it by completing the dissertation.

Wikipedia says:
Indeed, in most scholarly fields, the dissertation is the most important part of the doctoral degree, because successful completion and defense demonstrates that the candidate has sufficient expertise, self-discipline, and originality to advance the field of inquiry.
I like that story :)

Letter of Application

The time has come.

I began this journey in the Fall of 2009 (but really, it began long before that even).

Now I am submitting my letter of application for an Assistant Professor position.

I am so glad that my leap of faith back then and there has lead me to where I am in the here and now.

Here is my first draft of the letter:

October 8, 2012
Dear Dr. Weaver:
I am writing to apply for the position of Assistant Professor, Tenure Track in the School of Social Work. I am a doctoral student at UCLA working on a dissertation proposal under the direction of Dr. Stuart Kirk. I am currently assembling the proposal in preparation for defense by December. I expect to complete all work for the Ph.D. by June of 2012. I believe that my teaching experience combined with my course work and research background make me a strong candidate for the position outlined in your notice.
As my curriculum vitae shows, I have had excellent opportunities to teach a variety of social work courses, including Social Work in the Schools, Child Welfare, Women’s Issues in Social Work, Human Behavior and the Social Environment, Empowerment and Recovery in Mental Health and the Advanced Practice series for the Children, Youth, Women and Families concentration. Among the most satisfying experiences for me as a teacher has been working as a field instructor for undergraduate and graduate students, earning several awards.
My work in the schools has provided me with the inspiration as well as a kind of laboratory for my dissertation research. My project, Families, Stories, Love & Resilience: The Relationship between Family Communication and Post-Traumatic Resilience, examines the association between the nature of family communication about traumatic memories – as a form of narrative exposure therapy – and variability of PTSD development among low income urban families. I hypothesize that families that engage in open communication about traumatic events and memories are more likely to exhibit posttraumatic resilience than families who tend to engage in avoidant coping. The purpose of this study is to lay the foundation for a social marketing campaign as mental health intervention among low-income urban families with chronic exposure to multiple traumatic events, an underserved and vulnerable population. Ultimately, I am interested in bridging the divide between research and practice in my own practice, research and teaching.
In my career as a profession social worker and in the health and human services field in general, I have worked at all levels of practice – micro, meso and macro – primarily with diverse children, youth, women and families. This clinical experience informs my teaching practices. I am able to integrate the current literature with numerous case examples and experiences, which I believe bring theories and concepts to life, making them easier to understand and remember. I am interested in employment at CSULA based on my satisfying teaching experience here since 2001. One of the strengths of CSULA is the diversity of the student body. My impression is that the best students from the surrounding urban neighborhoods come to CSULA. It is also my impression that strong students who are interested in an affordable quality education are also drawn to CSULA. This mix translates into rigorous and rich classroom discussions. I am also a product of the surrounding urban neighborhoods and most of my career has been working with the same. It is truly an honor to prepare the best and the brightest students from my old neighborhoods to give back to the same neighborhoods and contribute to their progress and well being.
Sincerely,

Alejandra Acuña, LCSW, PhD Candidate

Friday, October 5, 2012

The Coherent Story of the Memory Heals

ABSTRACT of what I like to call a "mother-effin smoking gun" article:
Individuals who have experienced multiple traumatic events over long periods as a result of war, conflict and organised violence, may represent a unique group amongst PTSD patients (sic) in terms of psychological and neurobiological sequelae.  
Narrative Exposure Therapy (NET) is a short-term therapy for individuals who have PTSD symptoms as a result of these types of traumatic experiences.  
Originally developed for use in low-income countries, it has since been used to treat asylum seekers and refugees in high-income settings.  
The treatment involves emotional exposure to the memories of traumatic events and the reorganisation of these memories into a coherent chronological narrative.
This review of all the currently available literature investigates the effectiveness of NET in treatment trials of adults and also of KIDNET, an adapted version for children.
Results from treatment trials in adults have demonstrated the superiority of NET in reducing PTSD symptoms compared to other therapeutic approaches.
Most trials demonstrated that further improvements had been made at follow-up suggesting sustained change.
Treatment trials of KIDNET have shown its effectiveness in reducing PTSD amongst children.  
Emerging evidence suggests NET is an effective treatment for PTSD in individuals who have been traumatised by conflict and organised violence, even in settings that remain volatile and insecure.
BAM!

Robjant, K. & Fazel, M. (2010).  The emerging evidence for Narrative Exposure Therapy:  A review.  Clinical Psychology Review, 30, 1030-1039.

Secrets, Truth & Freedom

Iyanla Vanzant is back on Oprah - thank God for reconciliations and reunions.  I recommend her book, In The Meantime, to all single folks wondering what to do (self-work) while we are between love partners.

I watched one of her show's last night about family secrets and it resonated with my research interest on open family communication.  Here are highlights of some of the insights:
  • No family secret is worth the shame, sadness & energy it brings into the world.
  • I had a hard time telling my family my secret because it caused so much pain for me and I didn't know how to tell them.
  • Family, please forgive me for believing you couldn't handle the truth.
  • Family, please forgive me for withholding the truth.  I didn't know how to heal myself.
  • By keeping my secret, I betrayed their trust.  
  • Sometimes, parents teach their children how to lie by hiding what they believe is shameful - which is what makes it so shameful.
  • Secrecy and lies create a crazy-making and toxic environment.
  • It is time to be free!
  • Release the secret and be free!
  • Come clean.
  • Make a behavior change request of your loved one with a consequence and then move forward.
  • Tell the truth - step out into the unknown and dare to be loved as we are.  Don't be more concerned about how they will respond initially.  Principled speaking means we tell the truth despite the cost and trust that the truth will win out.

Amen and Thank You, Yesus.  All this truth-telling at the risk of ostracism and shunning is already paying off.  All I gotta be is myself. sigh.

Are we human or are we dancer?
--The Killers

Thursday, September 27, 2012

Feel

I operate from the assumption (hard-won lesson) that all feelings are normal and natural.  They deserve to be noticed, not judged.

When I share my thoughts and feelings, lay myself bare, I just wanna be heard, understood and accepted (feel felt).

It means I have the ovaries to be real - no pretense, not trying to be cool (because I am cool - got nothing to prove).

I don't wanna be judged, questioned/interrogated, fixed, dismissed, minimized, pathologized, told that I'm wrong, lectured, etc.

Feelings are ephemeral, they too shall pass.  So I acknowledge them.

When we don't acknowledge our feelings or the feelings of others, it signals to me that somewhere, somehow we learned to stuff, deny, ignore, intellectualize them, see them as weak, steamroll over them.

I've worked really hard to stop doing that.  I wanna be seen, understood and accepted.  I start by doing this for myself.

Rumi's poem the The Guest House says it all...

This being human is a guest house.
Every morning a new arrival.

A joy, a depression, a meanness,
some momentary awareness comes
as an unexpected visitor.

Welcome and entertain them all!
Even if they're a crowd of sorrows,
who violently sweep your house
empty of its furniture,
still, treat each guest honorably.
He may be clearing you out
for some new delight.

The dark thought, the shame, the malice,
meet them at the door laughing,
and invite them in.

Be grateful for whatever comes,
because each has been sent
as a guide from beyond.

Care & Let Go

It's not that I don't care, it's that I have no control over it, so I let it go.

Tuesday, September 25, 2012

The Relationship between Maternal Acceptance, Community Violence & Child Outcomes

Increasing levels of community violence victimization were significantly associated with PTSD symptoms, and even after controlling for being a victim of violence, simply witnessing community violence was significantly related to stress symptoms.

Additionally, as hypothesized, the relations between community violence exposure and mother's report of internalizing and externalizing problems were moderated by the child's perception of maternal acceptance.

Moderate and high levels of maternal acceptance acted as a buffer, protecting children exposed to community violence from developing emotional and behavioral problems.

Bailey, B.N., Hannigan, J.H., Delaney-Black, V., Covington, C, Sokol, R.J. (2006).  The Role of Maternal Acceptance in the Relation Between Community Violence Exposure and Child Functioning.  Journal of Abnormal Child Psychology, 34(1), 57-70.


Monday, September 24, 2012

De-escalating a Fight in Family Therapy

Mother and daughter clearly wanted to fight, but it would have been a mistake to allow them to.  Carl extended his hand toward them, as if to block the current between them.  His voice was firm.  "Let me stop you two.  Because I really do want to wait for Don."  They looked away from each other, and the moment passed.


From The Family Crucible: The Intense Experience of Family Therapy by Augustus Y. Napier with Carl Whitaker

A Moment of Conflict in Family Therapy

"What we are talking about is the prospect of the family as a whole changing.  And to start that process with one fifth of the family absent would be unfair to Don (sibling) and I think unfair to you.  He's part of the family, and we need him here if the family as a whole is going to change." There was an edge of toughness in my voice. 
Mrs. Brice didn't give in easily.  "But Don isn't the problem.  The problem has to do with Claudia."  Her voice was chilly, too.  We were definitely having a fight. 
Nor was I giving in.  "But you see, that's your initial definition of the problem.  We assume that the problem is much more complex and much more extensive than Claudia.  And the whole family just has to be involved."  I hesitated, gazing with level intensity at the mother.  I realized that pushing the family might mean losing them, but I knew that it had to be done.  "Now, maybe you guys aren't up to this kind of major job that we're talking about.  We really can't decide that for you.  But it's clear that we need the whole family."  A very large and imposing silence.


From The Family Crucible: The Intense Experience of Family Therapy by Augustus Y. Napier with Carl Whitaker

Moments in Family Therapy

"Claudia (teenage identified patient in family therapy) seems pretty alive to me," I said.  "I like the fact that she's angry and fighting with her parents rather than taking the anger out on herself.  I feel that Claudia is very stressed, but that suicide right now is an option that she keeps open rather than an obsession.  As a fantasy, it seems very much a part of her battle with her parents."  I summarized.  "She doesn't feel suicidal to me."  Claudia seemed to brighten with the words.
From The Family Crucible:  The Intense Experience of Family Therapy by Augustus Y. Napier with Carl Whitaker

Sunday, September 23, 2012

What if?

What if my study yields no significant findings or my hypotheses are not supported? 
I will still have learned the research process and completed my final requirement for the doctorate.

What if no man will ever love and cherish me again?
I will love and cherish myself.

What if people judge me for my choices?   
Ni modo (Fuck it).

What if people find out about my missteps?
I proudly own all my experiences.

What if people think I'm too this or too that? 
Not my problem.

What if people try to punish me (by shunning me) for not being a "good girl," in other words, not doing what they want me to do? 
Fuck it, it's not my problem.  They lose more than me in that shunning thing.  Thanks for walking out, meanies.

Who the fuck do you think you are playing against type, busting through glass ceilings, bending traditional gender roles, breaking with tradition, doing what you want, being happy, having fun?
Exactly.

What do they call the doctoral student with the lowest gpa at graduation?
Dr.

Risky

When I was younger, I took a lot of risks because I didn't know enough to be scared.

Now that I'm older, I take even more risks because my faith has grown bigger than my fears.

Where are you on the continuum and where do you wanna be?


Friday, September 14, 2012

Assembling a Dissertation Proposal



I'm not a great cook, but I can assemble a great salad.

Writing, on the other hand, is totally my thing.  However, writing a dissertation proposal (about 75 pages) was starting to get unwieldy and overwhelming, especially with the naive ambition of my ideas.

So I have decided to change the way I think about it and bank on my strengths.  Now, I am in the process of assembling my dissertation proposal.

The proposal has the following sections:  Introduction, Statement of Problem, Literature Review, Theoretical Framework, Research Questions and Hypotheses, Methodology, Abstract and Timeline.

I have butcher paper representing each section gracing every bare wall space in my dining room (my art work is resting temporarily on the ground).  I will post pics soon - it's quite lovely in a colorful, creative and organized way.

As I read through articles (from the sweet spot of my venn diagram - the intersection between low-income urban families, parent-child communication and posttraumatic resilience), I am posting ideas about research questions and methods that are recommended in the discussion section of these articles.  I am also posting information for the lit review.  Index cards, post-it notes and sharpie pens (in lots of cool colors) are my best friend right now.

Also, I had to completely re-write the discussion section of my publishable paper - I didn't really know what I was doing the first time and tried to fake it.  I decided to learn how to write it by doing what painters do - copy the experts.  So I literally wrote out - sentence by sentence - the discussion section of about a dozen articles (the very ones I am using for my dissertation proposal - a two-fer) to crack the code and find the pattern:  (1) study finding, (2) how it is consistent or contradicts with existing research, and (3) interpretation(s) of finding, (4) repeat as necessary.


Surprisingly, it meant I could read and internalize what I was reading no matter where I was reading (cafe with great music, cafe with cute men everywhere, on the couch with the TV tuned to So You Think You Can Dance or Top Chef or Project Runway, etc., or 11pm at my dining room table).  Now I can skim through those sentences - and the inevitable stars and notes I wrote in response - in order to post them on a corresponding butcher paper.  I am actually EXCITED about going through all the articles to mine them for ideas for my proposal.  I am a nerd and I like it. 

Who said research can't be creative and fun?  That's precisely why I do it.