The Effect of Parental Behavior on Trauma Recovery

In a study in Poland:

"Parental overprotectiveness moderated the effect of trauma, thus augmenting the impact of stress experienced during the disaster on the level of PTSD symptoms.

The findings suggest that excessive parental control and infantilization of children for a long time after a disaster are harmful for adolescents' health and could be an obstacle in the recovery process.

Parental overprotectiveness could be conceptualized as another manifestation of liabilities of parental social support because it involves excessive and unnecessary parental protection that is uncalled for given the child's developmental age.  In a review of the literature, Holmbeck et al., (2002) characterized parental overprotectiveness as a tendency for infantilization, toward excessive physical and social contact with a child, extreme fear associated with the fulfilling of parental functions, unwarranted control, intrusiveness, and continuous attempts at impeding the child's independence."

"An additional family factor that might moderate the relationship between trauma exposure and PTSD symtomatology may be the level of conflict within the family.  A home atmosphere with arguments and conflicts may be perceived by adolescents, who are disaster victims, as an indication of lack of family support.  Research on negative responses of support providers, such as engaging in arguments, blaming or showing disinterest responses at times referred to as 'negative social support,' strongly documented their potential to impede recovery from all traumas."

Bokszczanin, A. (2008).  Parental support, family conflict, and overprotectiveness:  Predicting PTSD symptom levels of adolescents 28 months after a natural disaster.  Anxiety, Stress & Coping, 21(4), 325-335.

Infantilizing anyone, besides an infant, is disempowering - not good.

Dr. Pennebaker's Writing Assignment

Dr. Pennebaker did research on the health and mental health effects of writing and journaling.  Here is what he learned:

"People who engage in expressive writing report feeling happier and less negative than before writing.  Similarly, reports of depressive symptoms, rumination, and general anxiety tend to drop in the weeks and months after writing about emotional upheavals."

--From "Writing to Heal" by James W. Pennebaker

He found that college students who wrote coherent, organized and detailed accounts of traumatic events (big T and little T events) - for just 20 minutes over four days - were less likely to go to the student health center six months later as compared to the other writing groups.

Dr. Pennebaker's Basic Writing Assignment:

"Over the next four days, write about your deepest emotions and thoughts about the emotional upheaval that has been influencing your life the most.  In your writing, really let go and explore the event and how it has affected you.  You might tie this experience to your childhood, your relationship with your parents, people you have loved or love now, or even your career.  Write continuously for 20 minutes."

Recently, I heard a colleague talk about The Recovery Model in Mental Health.  I always take notes and ask for copies of PowerPoints from excellent speakers.  Here are a few points he made...

• Everyone has, is or will be in Recovery for some type of illness, grief, or crisis
• Anyone can Recover
• Not everyone does Recover
• We can't predict who will or won't Recover...No really, we can't
• Recovery is highly individualized
• Success in Recovery seems to include:
• Skills
• Supports
• Resources

Person First

“It is more important to know what sort of person has a disease than to know what sort of disease a person has.”

Hippocrates

The Learners

The following gem came to me courtesy of a colleague. Being a lover of learning, it's nice to know that I'll never be done - I never have to leave the party.

“In a time of drastic change it is the learners who inherit the future.
The learned usually find themselves equipped to live in a world that no longer exists.”

--Eric Hoffer

Sweat Lodge

I reconnected with a cousin on my father's side of the family - the side we both walked away from because we decided to be open and honest about the family secrets.

She's now a medicine woman at an Indian High School and she is a sweat leader.

I participated in my first sweat last night.  I have always been interested in doing a sweat and was waiting for an invitation.  When you are ready, the teacher will come.

It was a co-ed group - there were male and female high school students.  The singing and drumming was beautiful.  The prayers were strong and heartfelt.  There was a lot of pain to release.

Being my first time, she'd check in on me after every round,  "how are you doing, Ale?"  I was doing great.

The ritual starts outside by picking a tobacco leaf and offering it to the fire with a prayer.  Then you are smudged (passed over with a sprig of smoking sage) - front and back.  You ask permission to enter the lodge and crawl in on hands and knees through the small opening.  This is symbolic for the males and females.  Men should always ask permission to enter when dealing with Mother Earth and women.  It also symbolizes crawling back to the womb and an opportunity for rebirth.

The floor is dirt and with each round of steam and heat becomes slightly muddy.  The coolest spot in the lodge is the earth.

It is pitch black inside and you may see visions.  After each round, the person tending the fire brings more hot rocks to the sweat leader.  The assistant picks up the rocks using deer antlers and ritualistically places them in a dirt hole dug out in the middle of the lodge.  The sweat leader sprinkles a potpourri of medicinal herbs on the hot rocks and it smells amazing.

In the first round we introduced ourselves - name, tribe and place of origin - and prayed for ourselves.  The young people were Lakota, Apache, Navajo, and other smaller tribes I don't remember now.  All I could say was my name and place of origin - I don't yet know what my tribe is.  My cousin said it smelled like copal because there was a Mexican Indian in the lodge.  I'll take that moniker for now.

In the second round, we prayed for mothers, grandmothers and women kin - the heat blazed in this round.  In the third round, we prayed for our fathers - only one person in the lodge was still closely connected to his father, a medicine man.  I realized in this round that one of my earliest wounds was not being claimed by my father and the resulting vulnerability that created.

I'm 43 now and claim myself.  I am committed to looking out for myself now.  I am committed to loving myself now and all the joy that brings.

A reader told me recently:  Apapachate tu misma.  Vive para ti, aprovecha.  Vive la vida, tienes derecho.  Amate tu y busca todo lo mejor para ti.  Quierete todos los dias.  Yo, yo, yo, fijate en ti.  Tienes que ver por tu vida.  Tienes que ser egoista. Abrete. Piensa en ti. Piensa en ti.  (Essentially, "put yourself first, self-care, self-love" and all that jazz.)

Especially for social workers, groomed and paid to care for the needs of others,  paying attention to our own needs as well requires a paradigm shift and new neuronal grooves and pathways in our self-sacrificing brain. A win-win solution is always possible if we look for it.  It is worth it for ourselves and all our relationships, including clients.  We can't teach, model or expect self-love and self-care from our clients if we haven't really experienced it for ourselves.  Practicing self-love and self-care is good for those around us.  If we are okay, they will be okay too - we are all connected and that's how systems work - we influence each other.

In every round there was singing.  The leader belted some songs and at the end she taught us a simple song about wishing us tranquility.  The boys, especially the son of a medicine man, also belted songs in their language.  It was sweet, beautiful, powerful and moving.

The sweat leader had a message about the importance of self-love and how the lack of it is why people cheat and get drunk and start wars.  At the end of the first round, she encouraged us to say, "I love myself."

Everybody had a story.  Everybody had some pain.  Everybody had a reason to be there.  Everybody had a really good sweat.

Lose Yourself

Chills, I tell ya, chills...

Look, if you had one shot, or one opportunity
To seize everything you ever wanted in one moment
Would you capture it or just let it slip?
Yo

His palms are sweaty, knees weak, arms are heavy
There's vomit on his sweater already, mom's spaghetti
He's nervous, but on the surface he looks calm and ready to drop bombs,
but he keeps on forgetting what he wrote down,
the whole crowd goes so loud
He opens his mouth, but the words won't come out
He's choking how, everybody's joking now
The clock's run out, time's up over, bloah!
Snap back to reality, Oh there goes gravity
Oh, there goes Rabbit, he choked
He's so mad, but he won't give up that
Easy, no
He won't have it, he knows his whole back's to these ropes
It don't matter, he's dope
He knows that, but he's broke
He's so stagnant he knows
When he goes back to his mobile home, that's when it's
Back to the lab again, yo
This whole rhapsody
He better go capture this moment and hope it don't pass him

You better lose yourself in the music, the moment
You own it, you better never let it go
You only get one shot, do not miss your chance to blow
This opportunity comes once in a lifetime yo
(You better)

The soul's escaping, through this hole that is gaping
This world is mine for the taking
Make me king, as we move toward a new world order
A normal life is boring, but superstardom's close to post mortem
It only grows harder, only grows hotter
He blows us all over these hoes is all on him
Coast to coast shows, he's known as the globetrotter
Lonely roads, God only knows
He's grown farther from home, he's no father
He goes home and barely knows his own daughter
But hold your nose 'cause here goes the cold water
His hoes don't want him no more, he's cold product
They moved on to the next schmoe who flows
He nose dove and sold nada
So the soap opera is told and unfolds
I suppose it's old partner but the beat goes on
Da da dum da dum da da

You better lose yourself in the music, the moment
You own it, you better never let it go
You only get one shot, do not miss your chance to blow
This opportunity comes once in a lifetime yo
(You better)

No more games, I'ma change what you call rage
Tear this motherfucking roof off like 2 dogs caged
I was playing in the beginning, the mood all changed
I've been chewed up and spit out and booed off stage
But I kept rhyming and stepped right into the next cypher
Best believe somebody's paying the pied piper
All the pain inside amplified by the fact
That I can't get by with my 9 to 5
And I can't provide the right type of life for my family
Cause man, these goddamn food stamps don't buy diapers
And it's no movie, there's no Mekhi Phifer, this is my life
And these times are so hard, and it's getting even harder
Trying to feed and water my seed, plus
Teeter totter caught up between being a father and a prima donna
Baby mama drama's screaming on and
Too much for me to wanna
Stay in one spot, another day of monotony
Has gotten me to the point, I'm like a snail
I've got to formulate a plot or I end up in jail or shot
Success is my only motherfucking option, failure's not
Mom, I love you, but this trailer's got to go
I cannot grow old in Salem's lot
So here I go it's my shot.
Feet fail me not, this may be the only opportunity that I got

You better lose yourself in the music, the moment
You own it, you better never let it go
You only get one shot, do not miss your chance to blow
This opportunity comes once in a lifetime yo
(You better)

You can do anything you set your mind to, man

--Eminem

Open Communication

Big Sur, California

In really good family therapy, family members are encouraged to practice open communication - to use their own voice and to speak for themselves - to go through the eye of the storm, if you will.

Most of the time, most of us, avoid the storm. 

It's ballsy to head straight for the eye of the storm.  It is scary, uncomfortable, nerve-wracking, and our deepest fear is that we won't survive.

Avoiding the storm may feel safer temporarily, but what price do we pay in the long run?

Okay, enough with the metaphor.  What am I really talking about?  Any painful or "unacceptable" thought, feeling, jealousy, insecurity, memory, experience, need, desire, want, etc. can swirl and churn into a storm.

In family therapy, open communication is facilitated so that family members can talk about it - whatever it is.  And families overcome their deepest fears to face the pain and suffering head on - out of pure love and trust and because they want relief, freedom and the safety, bond and connection that comes with intimacy and belonging.

Sometimes we avoid difficult conversations because we don't want to offend, hurt or drive away those we care about.  We want to protect our loved ones.  Sometimes we avoid opening up and sharing our dark secrets because we want to protect ourselves from the shame that we feel.  We fear being abandoned or rejected.

Too many filters and there is too much distance.

Open communication is connection.

I have been through the eye of the storm with my own family members - both family of origin and current nuclear family.  I have helped other families traverse the eye of the storm. The outcomes may be surprising, unexpected and initially, even undesired.  But they are always worth it.  I can tell you that no matter how scary or uncomfortable, there is beauty and peace on the other side.

There is something clean and fresh and uncomplicated about telling the truth, about living your truth.  After many such storm crossings, I would not live it any other way.

I Am Poems by Resilient Students

Two years ago, I ran therapy groups with my colleagues for immigrant teens exposed to traumatic or stressful events.  After completing the 10-session group, we asked them to write I Am poems to express to family members and friends what they had been through and what they had learned. Here is what a couple of  students wrote:

I am someone who was born in a small town.
I am someone who, as a child, played on the streets with his friends.
I am a person who has always had the support of his parents.
I am from a place where narcotics are ruining the people.
I am a person who tries and tries, until he obtains what he wants.
I am someone who is always willing to help a friend.
I am a person who knows what he wants, and what I want is to become a doctor.
I am someone who is very friendly and breaks the ice.
I am the son of two divorced parents.
I am someone who had to defend his mother when his father tried to harm her.
I am from a home where spirituality is very important.
I am someone who dislikes hypocrisy.
I am a person who has had to endure family loss.
I am a person who has had to leave all his friends behind and move forward with his life.
I am someone who followed his mother to the United States.
I am a person who found a way to express myself through theatre and dance.
I am a person who successfully met the challenge of learning English, so that I could attend a university.
I am someone who even though I left my friends behind, I have made more friends.
I will be a doctor and a fighter.
I am Juan Luis and even though I have been through a lot, I know what I want and will fight for what I want and those I love.

--15 years old
Guatemala

I am from the thumb of America.
I am a person with thousands of friends to support me.
I am Salvadoreña and Guanaca.
I am a person who is proud of my homeland.
I am from a humble and hard working family.
I am a person with a good sense of humor.
I am a person who helps those in need.
I am one who expects a future full of triumphs.
I am a person who dreams of being an athlete.
I am a person who wants peace in my family.
I am a person who does not give up.
I am from a neighborhood filled with crime.
I am from a family of strawberries and watermelon.
I am a person filled with dreams yet to come true.
I am a person who loves all those around me.
I am a person who always smiles.
I am a person who helps you to smile when you are sad.
I am from romantic music and “punta” music.
I am a person who loves stuffed animals.
I am the person you do not imagine that I am!
And I am someone, who with all my own efforts will accomplish my dreams and goals.

--15 years old
El Salvador

El Que Dirán

Perceived stigma about receiving mental health services SUCKS.

Perceived stigma is the belief that most people will devalue and discriminate against individuals who use mental health services and/or have a mental illness.

In a study about the effect of perceived stigma and dropping out of treatment for depression, the authors found that although younger patients reported perceiving more stigma than older patients, stigma predicted treatment discontinuation only among the older patients.

The study concluded that patients’ perceptions of stigma at the start of treatment influence their subsequent treatment behavior.  Stigma is an appropriate target for intervention aimed at improving treatment adherence and outcomes.

Sirey, J.A. et al, (2001). Perceived Stigma as a Predictor of Treatment Discontinuation in Young and Older Outpatients With Depression, Am J Psychiatry 2001, 158, 479–481.

Talking about fears of discrimination at the beginning of therapy may go a long way to keeping people in treatment.  It's sucks that other people's bull$&!* can serve to hold us back from participating in treatment that benefits us.  Being depressed is neurotoxic (bad for our brain) and bad for your heart (depression is a predictor of heart disease).  Caring for your mind-body or caring about other people's perceptions of what is normal - it's sad that people feel faced with such an ultimatum.  Healing, in all its forms, could be fashionable and the new black.  Becoming integrated, whole and balanced is sexy.

Social Support!

In two landmark studies on resilience (Werner & Smith, 2001; Cederblad et al., 1994), the significance of social support in promoting and sustaining resilience was highlighted.

Werner & Smith (2001) noted:

The men and women in this cohort consistently ranked mental health professionals (whether psychiatrists, psychologists, or social workers) much lower than counsel and advice given by spouses, friends, members of the extended family, teachers, mentors, coworkers, members of church groups, or ministers.  Their low opinion of the effectiveness of professional help did not improve from the second to the third and fourth decade of life.  This finding taught us a lesson in humility! (p. 169).

Almedom, A., & Glandon, D. (2007). Resilience is not the Absence of PTSD any More than Health is the Absence of Disease, Journal of Loss and Trauma, 12(2), 127-143. 

When I read this, I think that influencing the opinion and advice given by the social support network of urban youth and their families will go a long way to influencing their resilient behavior.  Social marketing approaches (vs. individual therapy approaches) seem better equipped to do this and seem more likely to shape social norms.

When I read this, I also think back to my decision to cut out time with friends and family in order to juggle work, school and mothering.  Silly girl.  Lesson learned:  When beginning a rigorously challenging undertaking, you need more support and resources, not less.   Next time, I'll cut down my unrealistic expectations instead.

A Definition of Mental Health

"Mental health is the state of balance that individuals establish within themselves and between themselves and their social and physical environment."

Almedom, A., & Glandon, D. (2007). Resilience is not the Absence of PTSD any More than Health is the Absence of Disease, Journal of Loss and Trauma, 12(2), 127-143.

More on the Definition of Resilience

Resilience:

• A process
• An outcome
• A dynamic steady state in the face of adversity
• A defiance of risk & vulnerability
• More than just the absence of PTSD
• A multidimensional and multifaceted construct
• To recoil, rebound, resume shape and size after stretching or compression
• To have or show elasticity or buoyancy or recuperative power
• Readily recovering from depression
• In one study, the Sense of Coherence (SOC) scale is used as both the definition and measurement for resilience.  By combining quantitative data (SOC-13 scores) and qualitative data in tandem, the study examined resilience in its multidimensional context, factoring in sociocultural, psychological, historical, economic, political, and ecological differentials.
• The complexity of resilience - a dynamic steady state that cannot be measured in isolation from its context of generalized resistance resources, including social support.  Meaning making is an integral part of human nature and the capacity to overcome adversity - only the SOC accounts for it in quantitative terms.
• The evidence of two studies, from Western and non-Western multi-ethnic study samples, find that resilience to crisis events and experiences is more normal than previously acknowledged.

From:
Almedom, A., & Glandon, D. (2007). Resilience is not the Absence of PTSD any More than Health is the Absence of Disease, Journal of Loss and Trauma, 12(2), 127-143.

My Trip to France

My blog stats indicate 19 page views from France today and 60 in the last month (woohoo!)

Seeing how that is one of my favorite countries, I wonder what sort of content appeals to my countrywomen and men?

I am not above pandering for a trip to France.

Dite-moi, s'il vous plaît, ce que tu veut lire ici et je l'ecrit.  Je voudrais voyage a la France pour visiter et conférence. J'aime l'art et la cuisine et la culture du pays. Pardon-moi, j'ai etudier francais dans l'ecole mais je ne le parle plus.

I believe in visions and dreams so I like to play the wishing game with my friends.  This is where I ask them quite simply, "What do you want?"  I love to hear their responses because passion is contagious.  I believe in thinking about and talking about our passions - eventually this seems to make them real.  I am so grateful for every aspect of my life right now, but there are still some dreams yet to be made manifest.  I visited Paris in May, 2005 and I have been jonesing to return ever since...

Families, Trauma & Storytelling

From Bernardon, S. and Pernice-Duca, F. (2010). A Family Sytems Perspective to Recovery From Posttraumatic Stress in Children.  The Family Journal, 18, 349-357:

"The participation of the family in the treatment process following a traumatic event or stressor is considered key to recovery." 

"...the promotion of recovery for children requires the active participation of the family within the therapeutic environment, allowing family members to develop a narrative on the trauma experienced and co-constructing healthy ways to cope.  This joint commitment serves to enhance communication between all family members, increase understanding of the trauma and subsequent symptom expression, as well as alleviate the family's tendency to rely on rigid or ineffective ways of coping." 

"Recovery approaches that emphasize deconstructing the fragmented traumatic memories and reorganizing them into a coherent, meaningful narrative have been associated with reduced PTSD severity." 

Researchers reported "community violence as equally affecting both parents and children, which then resulted in higher mental health issues across the life span." 

Researchers also reported "...parental mental health as being strongly related to adolescent's PTSD symptomotology.  Parents suffering from PTSD may model PTSD symptoms such as avoidance or hyperarousal behavior.  In addition, they may overlook their children's anxieties or symptoms because they are preoccupied..." 

Researchers "suggested that family and interpersonal relationships are closely linked to the development, maintenance, and improvement of PTSD, and thus concluded that significant others should be either formally, through intervention involvement, or informally, through psychoeducation, included in the treatment plan."

From Gidron, Y. (2001). Translating Research Findings to PTSD Prevention:  Results of a Randomized-Controlled Pilot Study.  Journal of Traumatic Stress, 14(4):

Researchers showed that "an increasingly organized description of their trauma was associated with a better prognosis"

Getting the Word Out on the Streets

Plastic hands attached to street grates

Social Marketing?  Advocacy?  Performance Art?  Street Performance?  Guerrilla Marketing?  All of the Above!

Marketing for the Greater Good

 

Marketing products with true functionality.  Love it.

Simple

 

Who said social marketing budgets had to be astronomical?  I like the creativity of keeping it cheap and real.

The Possibilities are Endless...

There are so many channels for social marketing now!  Having fun imagining all the possibilities and combinations. . .

Ideas that Stick

Using the UNEXPECTED in communicating your ideas makes them stick...

Person in Environment

"I made up my mind... that I would never try to reform man [sic]— that’s much too difficult. What I would do was to try to modify the environment in such a way as to get man [sic] moving in preferred directions."

R. Buckminster Fuller, 1966

Guerrilla Marketing

Healing

"Healing may not be so much about getting better, as about letting go of everything that isn't you - all of the expectations, all of the beliefs - and becoming who you are."


~ Rachel Naomi Remen

UCLA, Department of Social Welfare

Feeling proud of my little school

Competent & Loved, Part 3

Beloveds, y'all are fu#$en awesome - flaws and all.  

That's the honest-to-goodness Truth.

Competent & Loved, Part 2

You can do it!  You can figure it out.  Stick to it.  Never say die.

You matter - no matter what.

Notes on Parenting . . .

Is it possible to socialize a child without breaking their spirit?
YES!!!

Is there a dark place in every parent that makes us capable of killing or abandoning our own offspring?
YES!!

It is a miracle to me that more parents don't kill their children.  Yes, I mean that sincerely.  Noted psychiatrist, Walt Brackelmanns said, "We are all fu@%ed up (all of us), it's amazing we get anything done."

When I work with parents and they ask me, "do you have kids?" I know what they really want to know is, "have you ever felt overwhelmed/exhausted/helpless/powerless as a parent?  have you ever experienced the urge to kill or abandon your own child but managed to contain yourself somehow?"
YES!!

Do you understand the vulnerability that parenting creates?  Do you understand that it is like ripping your chest open with your bare hands and pulling out your very own heart to send to school, child care and into the world everyday?
YES!!

"Will you work with me and not judge me for the dark place, pain and ambivalence that exists in all parents?"
YES!!

"Will you support and empathize with me as a parent and not just feel sorry for my child?"
YES!!

If we love kids, then we need to love their parents.  I mean, REALLY love them - nurture, guide, listen, understand deeply, offer genuine praise, provide a meal when they are too tired or dis-spirited to cook, respite child care, and so on.   This is true for any parent, but especially critical for a parent with a mental illness.  We all need help sometimes.  All of us.  There is no shame in that.  That is what community is for - for thousands of years this has been so.  We need more loving, supportive, and connected communities. Amen.

Competent and Loved

Our insecurities may make us mean.

If we walk around with a deep belief that we are incompetent (don't know something/anything and cannot learn), then anyone who is confident and competent will be threatening and we will try to emulate them or simply take them down.

If we walk around with a deep belief that we are unloved or un-loveable (a lie we believed very early on), then we may fall prey to sycophants and be easily manipulated. 

If we walk around with both erroneous beliefs (incompetent and unloved), then watch out world because we will be Super Mean (anti-hero wearing a cape).

I worked with a 2-fer.  She felt incompetent (semi-competent at best) and unloved.  Feeling confident and competent myself, without any compulsion to ki$$ a$$ (I naively thought my work would speak for itself), she hated me.  What's worse, she was my boss.

I went into work telling myself, "it's okay to be who I am, it's okay to be who I am" to counter the bad vibes I got from her daily.  I tried to impress her, make her look good, do an excellent job, etc.  That only made her more pi$$ed off.

A few years after I stopped working for Super Mean, a friend/mentor assured me that it was not about me.  Another friend/"F" mentor offered, "you are not the jerk whisperer" (that's "F" for "feelings," people!).

I am grateful that it has been a long time since I have worked for her, although I learned a valuable lesson.  When dealing with a Super Mean boss, be competent and ki$$ a$$, otherwise, find yourself a boss that is competent and feels loved.  I have worked for the latter and I prefer it.

Water seeks its own level.  Be confident and believe that you matter to attract the same.

I first heard that quote about water seeking its own level from another friend/mentor. I collect mentors because I still have a lot of growing up to do.  My friends/mentors remind me that I am competent and loved despite my occasional immaturity and numerous mistakes, God bless them.

Feeling competent and loved is our birthright.  If we don't feel that way now, what gets in our way and what would make us feel more confident? What makes us continue to believe the lies we learned (like good students) so early on?  We have a right to outgrow limiting beliefs and learn some new stories - we can do it.