Storytelling

When I teach social work courses, I often invite social workers to speak to students.  I ask the professionals to tell their stories - talk about the client or the project that made an impression.   I ask them to cover the details - who they were and what happened, the feelings that came up, the questions and self-doubt that they struggled to overcome.

The Hero's Journey
Students want to hear the stories of the work and be inspired.  They want to learn from the experience of seasoned clinicians. Students want to see themselves in the story - cast as the capable and flawed protagonist, who faced with a challenge, struggles with external barriers and internal feelings of self-doubt, and overcomes by using time-tested and time-honored skills competently in the context of a therapeutic relationship. 

All the components of the social work process, including the theoretical framework and underlying rationale for interventions, are part of the story.

• How did you meet and how did the relationship get started? - Engagement
• What did you ask and what did they say? - Assessment
• What did you think was going on with the client and their environment?  - Diagnostic Formulation
• What did you decide to do and why?  Did the client agree? How did you explain this to the client? - Treatment Planning and Theoretical Rationale
• What did you try?  - Interventions
• How did that go? What progress did the client make?  How could you tell? Did the client accomplish their treatment goals?  Did they feel better? - Evaluation
• How did you know you were done?  How did you say goodbye? - Termination

Invariably, however, most guest speakers felt compelled to discuss their work broadly and abstractly, listing duties and components instead.  It seems that we believe the language of academia should be formal, abstract, detached.

In Methods of Discovery:  Heuristics for the Social Sciences, Abbott notes that storytelling is used as a powerful explanatory method in research because...

• ...Narration seems persuasive precisely because telling stories is how we explain most things in daily life.
• ...Narration is the syntax of everyday understanding.

If it is good for research in the social sciences, then it is good for the training of social workers.

In Writing as a Sacred Path, the author notes that in ancient Celtic cultures storytelling was considered a service to the community.  Among the Dine people (Navaho), to be told a story is a great honor.

Stories are gifts.  Write them down.  Tell the stories.  Share your insights.  Use your voice.  I bet that writing and organizing our professional stories, with details and coherence, leads to professional efficacy and resilience.  I may have stumbled on a hypothesis for testing.

Whatever way your stories come to you is the right way.  --RL LaFevers

Reading and Writing Again

Winter Quarter, 2011 has just begun and I find myself sitting again for hours at a time.  It is a reading and sitting meditation practice. Monkey mind thoughts get in the way sometimes but the lure of ideas inspired by reading draw me into a deeper focus and concentration.  Every few hours I get up for water or to move around.

Blogging is also a distraction and a release -  it is a place to put the thoughts and ideas piling up in my head while I read.  Blogging becomes a place to digest, organize, and make sense of what I am reading and flesh out the forming seed thoughts.  I see connections everywhere.  I want to build bridges between various theoretical frameworks, perspectives and approaches.

My dissertation proposal seminar is taught by Zeke, my former epistemology professor.  He is old-school in the best sense of the word.  Zeke is probably in his 70s and a Michigan alum.

• (An aside:  Michigan is the real deal, where it is too cold to do anything but study and where most grad programs are rated #1 in the country.  Dr. Brown, Director of the School of Social Work at CSULA, is also a Michigan alum and said their graduate school alumni make up the greatest percentage of graduate school deans and directors.)

Zeke is from Israel and his native accent still comes through.  He uses braces to walk because of polio disease.  He is a scholarly heavyweight and a sociologist.  I am a dork because I find myself smiling in class a lot and giving him a thumbs up while I hang on every word he speaks and take copious notes.  It is a small seminar class - 8 students total - so it's hard to be inconspicuous with my painted-on goofy smile and hand gestures.  But I don't care because he is challenging and encouraging at the same time.  He takes my questions seriously and encourages being challenging.

Some nuggets from yesterday's lecture:

• Epistemology shapes the way we think about problems and dissertations.
• By the end of Spring quarter, we will have a well-defined dissertation proposal that we are comfortable defending.
• This is a writing seminar on substance and style, so expect to write and write and write. 
• We will write the proposal piece by piece.  We will read each others work and discuss it in class.  We will write several drafts of each section of the proposal.
• We will create an environment conducive to reflection and being self-critical.
• Dissertations must be well-written, that is, everyone needs to be able to understand the language, concepts and intent.
• Dissertation Proposal:

1. Statement of the Problem (the heart of the dissertation)
2. Critical Review of the Literature
3. Own Theoretical Framework
4. Hypotheses & Research Questions
5. Methodology
6. Timeline

• If you're not passionate about your dissertation topic then you will be miserable and the work will be unbearable
• Shoot above "run of the mill" but not too far in "left field" - get creative and add something new, your own special twist to the knowledge base - frame the problem in such a way that will make it exciting and different
• In his research career, Zeke borrowed a concept from manufacturing and used it as an analogy:  "Human service organizations are like factories and people are raw materials."  Initially controversial, this new way of looking at things set him apart as a scholar.

My assignment is to write the "Statement of the Problem."  He said this is the hardest part of the proposal.  Here I go...

Research Study about Emotion Regulation in Anxiety Disorders

The goal of the Emotion Regulation study is to improve upon already efficacious therapeutic strategies for all of the anxiety disorders and evaluate ways of enhancing the long term outcomes of treatment across a broad array of measures of functioning.

The Emotion Regulation study is designed to compare two different versions of behavioral therapy for anxiety disorders.

1. The first version involves teaching methods for slowing physiological responding, changing erroneous thoughts about anxiety inducing situations, and modifying behaviors in order to learn to overcome fears of specific objects, places, or experiences, through exposure therapy. 
2. The second treatment version involves strategies designed to replace anxious physical responding and negative thinking with mindful and nonjudgmental observation, and shift behavior towards achieving life goals, again through exposure therapy.

Eligibility Criteria

Individuals who meet diagnostic criteria for any of the major anxiety disorders, Panic Disorder with or without Agoraphobia, Generalized Anxiety Disorder, Social Phobia, Obsessive Compulsive Disorder, Post-Traumatic Stress Disorder, and Specific Phobias, are eligible for the study if they are between the ages of 18 to 60, are English speaking, are not currently suffering from major medical conditions, and are either un-medicated or stabilized on medications for anxiety or depression.

Screening Procedures

• Interested participants call 310-206-9191 to complete a phone screener for initial eligibility. 
• If eligible, participants are scheduled for an in-person, no-cost, diagnostic evaluation (approximately 2-3 hours) at the UCLA Psychology Clinic. 
• Referrals are provided when the diagnostic evaluation indicates lack of eligibility for the study. 
• Eligible participants are randomly assigned to either one of the two treatment conditions.

 Treatment Procedures

Treatment is conducted one on one, over 12 weekly visits (at the UCLA Psychology Clinic) and is followed by phone calls once a month for the next 6 months. Assessments are conducted prior to beginning treatment, at completion of treatment, 6 months, and 12 months later. These assessments include diagnostic evaluations, a battery of self-report questionnaires, behavioral observation, and physiological recording in a laboratory.

Fees

• Treatment fees are on a sliding scale - based on income, for 12 sessions. 
• There are no fees for any of the assessments (prior to treatment, at completion of treatment, and 6 months after treatment). 
• Parking costs for each assessment are reimbursed upon request. 
• In addition, participants receive $25 for follow-up assessments at post treatment and 6 months, and $50 for the follow-up assessment at 12 months.

Study Personnel Contact

For further information about this project, contact Carolyn Davies at 310-206-9191. This study is conducted in collaboration with Georg Eifert, Ph.D., Chapman University, California and John Forsyth, Ph.D., State University of New York, Albany.

Principal Investigator: Michelle G. Craske, Ph.D.

Internet Skills-Based Program for Child Anxiety

If you are the mother of a 6-12 year old anxious child, you may be interested in a study being conducted by researchers at UCLA. The purpose of this study is to determine whether anxious children and their mothers can benefit from a Cognitive-Behavioral Skills-Based Program delivered over the Internet.

If you and your child are eligible for this free study, you would be randomly assigned to one of two 12-week conditions:

1. the Internet Program condition or 
2. the Waitlist condition. 

People placed in the waitlist condition will be given access to the internet program at the end of the study. You would also be asked to answer questions online and over the telephone. You do NOT need to come into the research lab. People from across the United States are welcome to join this study.

Eligibility Criteria

The following is a list of some of the eligibility criteria for this study. It is not exhaustive. In order to determine if you and your child are eligible to participate in this study, please call (310) 206-1128 and speak to the study's principal investigator, Melody Keller.

• Your child must be between the ages of 6 and 12 years old.
• In order to be in this study, you (the mother) and your child must speak English fluently.
• You (the mother) and your child must be able to read in English.
• Your child cannot be in this study if he or she has ever been diagnosed with Mental Retardation, Autism, Asperger's Disorder, or Pervasive Developmental Disorder (PDD).
• If you (the mother) and/or your child are on medication, the dose(s) must be stable.
• You (the mother) and your child cannot be in this study if either of you is currently receiving Cognitive Behavioral Therapy for any mental health problem.
• You (the mother) cannot be taking parenting classes or receiving therapy aimed at addressing parenting skills.

Study Personnel Contact

For further information about this project, contact Melody Keller at (310) 206-1128.

Principal Investigator: Melody Keller, M.A., C.Phil.

Enroll in Social Anxiety Study at UCLA

Anxious in social situations? 

Fear of public speaking?

A UCLA study offers low-cost behavioral therapy for social anxiety disorder. Please read below for more information or contact Jenny Czarlinski at 310-206-9191 or j.czarlinski@gmail.com.

The Neural Mediators of Behavior Therapy study is funded by the National Institute of Mental Health (NIMH).  The study is designed to compare two different versions of behavioral therapy for social anxiety disorder:

1. The first version involves teaching methods for slowing physiological responding, changing erroneous thoughts about anxiety inducing situations, and modifying behaviors in order to learn to overcome fears of specific objects, places, or experiences, through exposure therapy. 
2. The second treatment version involves strategies designed to replace anxious physical responding and negative thinking with mindful and nonjudgmental observation, and shift behavior towards achieving life goals, again through exposure therapy. 

Some of the participants will be assigned to a waiting period before they start one of the two behavioral treatments. The goal is to compare the neural mechanisms of each treatment approach.

Eligibility Criteria

Individuals who meet diagnostic criteria for Social Anxiety Disorder, are eligible for the study if they are between the ages of 18 to 60, are English speaking, are not currently suffering from major medical conditions, and are either un-medicated or stabilized on medications for anxiety or depression.

Screening Procedures

• Interested participants leave their contact information (i.e., name, phone number, best times to call) at (310) 206-9191 (a voice answering machine). 
• Participants are then phoned by study personnel and asked a few simple screening questions. 
• If eligible, participants are scheduled for an in-person, no-cost, diagnostic evaluation (approximately 2-3 hours) at the UCLA Psychology Clinic and also will complete an fMRI (Functional Magnetic Resonance Imaging) assessment. 
• Eligible participants are randomly assigned to either one of the two treatment conditions.

Treatment Procedures

Treatment is conducted one on one, over 12 weekly visits (at the UCLA Psychology Clinic) and is followed by phone calls once a month for the next 6 months. Assessments are conducted prior to beginning treatment, at completion of treatment and 6 months later. These assessments include diagnostic evaluations, a battery of self-report questionnaires, behavioral observation, physiological recording in a laboratory, and a repeat of the FMRI at post treatment.

Fees

There are no fees for any of the assessments (prior to treatment, at completion of treatment, and 6 months after treatment). Parking costs for each assessment are reimbursed upon request. In addition, participants are offered gift certificates in the value of $15 for follow-up assessments at post treatment, 6 months and 12 months, and $25 for follow-up assessments at 12 months and 24 months. Treatment fees are on a sliding scale - based on income, for 12 sessions.

Study Personnel Contact

For further information about this project, contact Jenny Czarlinski at 310-206-9191 or j.czarlinski@gmail.com. This study is conducted in collaboration with Matthew Lieberman, Ph.D. and Shelley Taylor, Ph.D., at UCLA.

Principal Investigator: Michelle G. Craske, Ph.D.

Talking & Laughing

In her recent documentary, Joan Rivers said the point of comedy is to face the tragedy by talking and laughing about it.  The funny lady has a serious point.

Pennebaker (1986) found that writing about emotional experiences, both the facts and the feelings, leads to improved physical health.

Bowlby (1988) told us that when mothers are able to talk about their happy or unhappy childhoods with detail, organization and coherence, bringing up the good and the bad, they were more likely to have secure attachments with their own children.

Open communication in families is linked to family resilience.  Parents talking about emotions is also related to children's social interactions and relationships with peers, and children's emotional resilience and ability to cope constructively with challenging situations.  Parents who are aware of emotions, particularly negative emotions, can talk about and accept these emotions in themselves. These parents also are aware of emotions in their children and have the ability to assist their children in understanding their emotions.

So if talking about it is so great, does timing matter?  Hobfoll (2007) writes:

• "a major reason why psychological debriefing (such as Critical Incident Stress Debriefing) has been criticized in recent years is that it serves to enhance arousal in the immediate aftermath of trauma exposure.  It has been suggested that requiring people to ventilate in the immediate aftermath of trauma can increase arousal at the very time that they are required to calm down and restore equilibrium after the traumatic experience."  

Referring to PTSD treatment, Hobfoll (2007) writes:  "Open communication and exposure therapy come later and end with a sense of relief and calm."

So what helps immediately after a traumatic event?  Studies (Holbrook, 2010; Bryant, 2009) have found that the use of morphine during trauma care may reduce the risk of developing PTSD after a serious injury. Laughter is like morphine - the body produces endorphins when we laugh that act like "natural" morphine. 

So go ahead - you have been given permission (and empirical support) to talk about it, laugh about it even.  It's not too soon to laugh about it - the sooner the better.  Cheers, to funny stories for our health in the Happy New Year - Salud!

Bryant, R.A., Creamer, M., O’Donnell, M., Silove, D., & McFarlane, A.C. (2009) A Study of the Protective Function of Acute Morphine Administration on Subsequent Posttraumatic Stress Disorder. BIOL PSYCHIATRY, 65, 438–440.

Hobfoll, S.E., Watson, P., Bell, C.C., Bryant, R.A., Brymer, M.J., Friedman, M.J., Friedman, M., Berthold, P.R., Gersons, J.T.V.M.J., Layne, C.M., Maguen, S., Neria, Y., Norwood, A.E., Pynoos, R.S., Reissman, D., Ruzek, J.I., Shalev, A.Y., Solomon, Z., Steinberg, A.M., Ursano, R.J. (2007).  Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence. Psychiatry, 70(4), 283-306.

Holbrook, T.L., Galarneau, M.R., Dye, J.L.,  Quinn, K., & Dougherty, A.L. (2010).  Morphine Use after Combat Injury in Iraq and Post-Traumatic Stress Disorder. N Engl J Med, 362, 110-117.

Attachment Quotes

I am starting to think that I should re-name this blog and put "attachment" somewhere in the title.  That would be cool with me...

"...quote from John (Bowlby), at the age of 80:

• 'My mother held the view that it was dangerous to spoil the children so her response - she was a very stable, sensible, capable person - to bids for her attention and affection were the opposite of what was required'...the only time the children could catch their mother's attention was by asking questions about nature." *

It's no wonder Bowlby became a scientist.  Kids seem to grow in the direction of what their parent(s) pay attention to - like a flower bending toward the sun.  


*From John Bowlby, His Early Life: A Biographical Journey Into the Roots of Attachment Theory by Suzan Van Dijken, New York, NY: Free Association Books, 1998.