Reaction Formation

En route to UCLA from the Eastside (on Santa Monica Blvd.)

Defense mechanism of the week:  Reaction Formation 

'The tendency of a repressed wish or feeling to be expressed at a conscious level in a contrasting form.'

Or, "The blocking of desire by its opposite." 

In other words, to say or do the opposite of what you really feel or want (because what you really feel or want is way too threatening to accept).

Like when you pulled that girl's hair in Kindergarten to show that you really liked her.

Or like when you said, "Whatever, don't come by, do whatever you want."

Or like when the Cure sings, "I won't say it if you won't.  I don't want it if you don't . . ."

Or like when Morrisey sings, "I don't mind, I don't mind if you forget me.  Having learned my lesson, I never left an impression on anyone, bye-bye . . ."

Psychological maturity is standing up for what you believe or feel, despite the costs.

My girl says, "Diversity means following your own trends, doing what you love most and being free of other people's expectations."

Wow, so proud I get to be her mama.

Family Involvement in School-Based Mental Health Services

The research clearly shows family involvement in school-based mental health services is effective in improving student academic performance.

Researchers have found family involvement is a key component to both service utilization and effectiveness.

A review of family systems approach research shows it has been equally or more effective than other therapy, produces positive change quickly (20 sessions or less) and shows a 71% improvement in children’s behavioral problems.


Engaging Families in School-Based Mental Health Treatment
Linda M. Vanderbleek, 2004

Therapist Factor

Research shows that the effectiveness of therapy does not depend on the level of training or experience of the therapist or on the type of mental health professional providing therapy.

However, the effectiveness of therapy does depend on the skill of the therapist. The most effective therapists tend to be empathic, genuine, and warm.

Therapeutic Alliance and Treatment Outcomes

A study examined the relationship of the therapeutic alliance to the treatment course and outcome of 143 patients with non-chronic schizophrenia.

Results showed that patients who formed good alliances with their therapists within the first 6 months of treatment were significantly more likely to:

• remain in psychotherapy
• comply with their prescribed medication regimens, and
• achieve better outcomes after 2 years, with less medication, than patients who did not.

Therapist-Client Relationship

"Among clients who reported a positive relationship with their therapists, 'feeling connected' was a recurring theme.

These clients used adjectives such as understanding, compassionate, warm, friendly, open, honest, and nonjudgmental to describe their therapists.

When describing how they felt in the presence of their therapists, clients made frequent references to feeling safe, relaxed, comfortable, and trusting, which facilitated vulnerability and self-disclosure and, hence, the basis for a therapist-client connection."

Laszloffy, T.A. (2000) The implications of client satisfaction feedback for beginning family therapists: Back to the basics. Journal of Marital and Family Therapy

Therapeutic Factors

40% of client improvement is due to their own strengths, talents, skills and resources.

30% is due to the client-therapist relationship (empathy, warmth, caring, genuineness, acceptance)

15% is due to positive expectations about the possibility of change (hope)

15% is due to using the right technique

(Murphy, 1999)

If we leave 40% of the questions on an exam blank, then we are likely to fail.

The difference between a C+ and an A- is 15%.

What kind of social worker do you want to be?

(from workshop by Jim Raines at SSWAA Conference in Denver)

Engagement and the Social Work Process

There is a process in social work - it is not linear, it is cyclical or spiral:

Engagement - Assessment & Mental Status Exam - Diagnostic Formulation - Goal Setting & Treatment Planning - Intervention(s) that are evidence-based (whenever possible) and culturally responsive - Evaluation & Progress Monitoring - Termination.

Every step is connected to the rest and some occur in tandem throughout the social worker-client relationship.

The social work licensing exam in California is based on this framework and yet many MSW students have never heard of it.  I didn't know about the social work process until I was five years post-masters.  It is my professional mission to change that. 

The first element in the framework is engagement.  It is critical to having a relationship.  It is often called "building rapport" but it is much deeper than that, it is "building trust and connection" and that process never ends in a relationship.  Indeed, it is not a relationship unless there is sufficient trust.

How does trust develop between two people?  Most of our cues are non-verbal - eye contact, smile, proximity, mirrored movements, and matched tones.

There is also the warmth that radiates from our heart when we open ourselves up to connect.  In an empathy workshop lead by my good friend, Karen Sorensen, she asked us to think about a person we love dearly (I imagined my daughter) and to hold their image in our mind and allow our heart to open.  I felt my heart open wide and radiate warmth.  Then she asked us to talk to the person sitting next to us with our heart open like this. We had to describe the loved one that we chose to conjure.  I was in tears talking about my girl.  Love is like that sometimes.

Since then, I have tried to open my heart whether my audience is an auditorium of teachers, a classroom of master's level students or a fourth grade boy that is shut down.

Inherently shy and analytical, I still have so much to learn about empathy, trust, feelings (my own and those of others), relationships and engagement.  Now I trust the process. It's getting better all the time.