Paying Attention to Suicide

suicide-prevention

Statistically speaking, 50% to 90% of those who commit suicide suffer from a depressive disorder (Stolberg, Clark & Bognar, 2002; van Praag, 2005 as cited by Butcher, Menika, & Hooley, 2010) . However, those suffering from schizophrenia, substance use disorders, and personality and anxiety disorders also experience suicide ideation (Oquendo, Baca-García, Mann, Giner, 2008). Still others with no diagnoses at all succumb to feelings of hopelessness and sadness to the point of suicide. Suicide is the third leading cause of death among persons aged 10-14 and the second among persons aged 15-34 years. In the year 2013, over 41,140 people lost their lives by suicide in the United States (Centers for Disease Control and Prevention, 2015). Understanding the signs and symptoms of depression and suicide ideation can be a preventative measure to combat such a horrific and permanent solution to a temporary problem.

Those in the mental health field must be ever vigilant in picking up on subtle cues, symptoms, and signs of suicide ideation and actions associated with such behavior. One way to look for symptoms and signs of suicide and assess client stability is to conduct a Mental Status Exam (MSE) and a risk assessment (RA).  If a counselor can gather enough information to assess such a risk, then he or she may be able to help save a life. A MSE is a useful checklist to guide a counselor in verifying a client’s diagnosis. By noting items such as appearance (is grooming acceptable?), manners and behaviors (is eye contact suitable for cultural and ethnic background?), thought processes (is he or she aware of the day of the week, the month?), and mood (are they abnormally anxious or sad?), a counselor can begin to get a better picture of the client, his or her presenting issues, and the history and managing skills he or she brings to the table.

An assessment such as the RA proposed by O’Conner, Warby, Raphael, and Vassallo (2004) helps to “improve detection and increase referral” of suicide while also helping to find an “appropriate plan of management” (p. 352-353). By knowing certain triggers a client may possess, along with understanding specific demographics, such as if the client belongs to a special risk group, has a past or present situation of concern or alcohol or drug abuse, homelessness issues, legal problems, and/or a prison record, a counselor may be able to detect other pressure points of instability guided by the RA. This also includes checking for at risk mental states, such as agitation, anger, guilt, and depression (O’Conner, et al., 2004). If there is any question as to the possibility of suicide, it must be addressed immediately.

O’Connor, et al., (2004) indicated that over 40% of people who commit suicide had seen a health professional prior to their death. Still others will never be a “client” or even see a doctor. Clients may not even realize they are at the point of acting on their suicidal thoughts until it actually occurs. Treating suicide ideation and the possibility of suicide under the guise of another disorder, intervening in a crisis situation, and working with groups at high risk are the only true preventions those in the field have at their disposal at this time and even then, it is not a guarantee. When labeled with another disorder, clients can be treated for depression associated with suicide through cognitive and psychotherapy interventions and medication (Butcher, et al., 2010). Crisis intervention may also occur through a suicide hotline in which the person at risk has someone to talk to during times of distress. Crisis intervention may be even in the hands of a loved one. Emergency treatment and referrals for inpatient care and involuntary hospitalization can possibly occur if someone else is involved and concerned about the person at risk.

Suicide is a serious epidemic. Being aware is the first step to prevention. Common warning signs of suicide that should not be ignored are threats of hurting oneself, preoccupation with death, changes in eating or sleeping habits, loss of interest in activities that were once important, marked changes in personality, persistent feelings of gloom and helplessness, and the action of giving away valued possessions (Cavanaugh & Kail, 2007).

If you are having these symptoms yourself or are worried about a loved one who may be exhibiting these behaviors, please call the Suicide Prevention Hotline at 1-800-273-8255, call 911, or for non-emergency situations, please call a medical profession or counselor for help.

References:

American Psychiatric Association (APA). (2000). Diagnostic statistical manual of mental disorders – text revision. Washington, DC: Author.

Butcher, J. N., Mineka, S., & Hooley, J. M. (2010). Abnormal psychology (14th ed.). Boston, MA: Allyn & Bacon

Centers for Disease Control and Prevention. (2015). Retrieved from   http://www.cdc.gov/Features/PreventingSuicide/

Cavanaugh, J.C. and Kail, R.V. (2007). Human Development: A Life-Span View (4th Ed.). Belmont, CA: Thomson Higher Education.

María A. Oquendo, M.A., Baca-García, E. Mann, J.J. & Giner, J. (2008). Issues for DSM-V: Suicidal Behavior as a Separate Diagnosis on a Separate Axis. Am J Psychiatry 165:1383-1384. doi: 10.1176/appi.ajp.2008.08020281

O’Connor, N., Warby, M., Raphael, B., & Vassallo, T. (2004). Changeability, confidence, common sense and corroboration: Comprehensive suicide risk assessment. Australasian Psychiatry, 12(4), 352–360.

 

Group Therapy for Kids: What Both Counselors and Parents Need to Know

group

Working with children and teens definitely takes a special kind of person. A child or teen group leader has to know the rules and laws (both national and state) and understand the nuances of confidentiality and ethics when it comes to working with kids. Understanding laws regarding abuse and the chain of command in reporting anything suspect needs to be understood before ever beginning a children’s group. Being properly trained to work with children such as understanding the psychological and biological growth of children in general is incredibly helpful and, in most situations, required (Corey, Corey, & Corey, 2010). Being educated in Piaget’s Cognitive Theory and the ideas regarding symbolic function and egocentricism will truly come in handy when understanding children’s viewpoints versus teens and adults. Understanding important roles in each age and stage is important as well. For example, accepting that caregivers are incredibly important to young children while social networking is more important to teens will help gear the goals, exercises, and directed activities in a group.

And let’s face it. A group leader also has to be a pretty darn good salesperson – one has to sell his or her self to the kids as well as the parents/legal guardians/caregivers and the school system (if working in such a capacity). Certainly having the caregivers on board is going to make a world of difference. Collaboration is key. One suggestion is to have an ongoing group for the caregivers that coincides with the kid’s group. If at all possible, this would benefit everyone involved. The families could come together –  the children would be getting the support they need from both those who brought them and the group while the caregivers have an hour to themselves to discuss their own concerns and find support as well (Corey, et al., 2010). However, as Marianne Corey (2010) explains, the child’s welfare is of the upmost importance and if that means not involving the caregiver, than that is perfectly acceptable as well.

Everything from the proper name (the word “club” works much better than “group,” for example, per Karen Kram Laudenslager, as cited by Corey, et al., 2010) to explaining confidentiality must be geared toward a child in hopes that he or she will want to interact and be involved. Certain considerations have to be looked at such as the group’s purpose, the age of the children and even the physical size and grades of participants. The more cohesive you can make the group on the outside before it gets started, the better off it will be on the inside. Setting is important as well – large rooms that are adequate for screaming and yelling and just having fun are the best choice. Activities that are both structured and purposely unstructured are always a must (Corey, et al., 2010).

Once the group is established, then the real work begins – being the best group counselor and leader one can be by building rapport, trust, and cohesion in the group. Children are the toughest crowd – they can see right through the charade and will call a person out with no problem. So, honesty is crucial. Many of the suggestions that Corey, Corey, and Corey (2010) use to explain working with kids and teens in groups are very much like working with any adult group. Being neutral, paying attention to both nonverbal and verbal cues in the members, and preparing group for termination a few weeks before the end are things that should be done regardless of the age of group members.  A bit of tweaking, of course, will be needed with younger groups. Acknowledging that the leader is a different adult than the adult in the child’s life is a strong tactic, such as if a member is looking for an alley or someone to tattle to, or is worried about trusting or abuse or deceit. Using more time, empathy, and examples to help kids understand how confidentiality works is another. Having a graduation of sorts – even a party- for termination is another way to make it more child specific (Corey, et al., 2010).

A lot of nondirective play therapy should be involved when working exclusively with children. Corey, et al., explained that “play is the natural language that children most readily speak” (p. 295) and helps the childrens’ processing of what is learned in group. Of course with any members, you need to gear the goals in a direction in which they gain a sense of identity and self esteem and work toward a connection with others. As Aronson explained, “In addition to a very healthy sense of humor, the ability to provide consistency, stability, constancy in the face of provocation, an even aggression is critical [in a adolescent group therapist]” (p. 162).

Regardless of what age group one works with, the main goal should be to give the group members a sense of self in which they can make decisions, feel confident and able, and understand that they are important. Group leaders must be the one thing that a member can rely on to help them grow and expand and realize their potential.

References:

Aronson, S. M. (2004). Where the wild things are: The power and challenge of    adolescent group work. Mount Sinai Journal of Medicine, 71(3), 174– 180. Retrieved November 2, 2010, from the Academic Search Premier database.             (AN 13126160)

Corey, M. S., Corey, G., & Corey, C. (2010). Groups: Process and practice (8th ed.). Belmont, CA: Brooks/Cole.

What Did You Say?

 

language

In order to understand culture and how it affects language and communication, one must understand what language is universally. Chomsky theorized that language is innate (Gardiner & Kosmitzki, 2005; Santrock, 2009). This idea can be upheld simply by looking at the brain – a normal brain has parts dedicated to language, such as Wernicke’s and Broca’s areas, that are hardwired to help with motor development and processing of language. When these areas are destroyed, we lose the ability to understand, relay, process, and perform language, regardless of experience and environment.

 

Timing, structure, and the stages in which we learn language all seems to be quite similar (Santrock, 2009). We all start out babbling – testing things out – whether it be with our gestures in the form of sign language, in our facial expressions and motions in mimicking others, or in forming sounds with our tongues and jaw. Studies by Kuhl (as cited by Santrock, 2009) have shown that all children, even as early as a few days, can pick up on every phoneme of every language – that when born, we all have the ability to understand and recognize a variety of nuances of blending sounds across cultures and nations. As we grow, we lose this ability simply because we do not use it – the fine distinctions of sounds in certain languages are not practiced and simply are pruned from our brain. However, language is much more complicated than just sounds.

 

Language is part of communication. For many of us, we learn this communication from our environment and caregivers. We “talk to learn” as Vygotsky explained (as cited in Gardiner & Kosmitzki, 2005) and someone responds in kind to reinforce it. For instance, when we point with a finger to something that interested us, joint attention usually occurs (Cavanaugh and Kail, 2007), meaning someone notices us pointing, clarifies what we are seeing, and maybe will point at something else for us to engage in communication even further. If no one is there to teach or respond, these abilities to “learn” language are lessened. Language and the practice of language come from the influence of our environment. The nuances of unknown cultural protocols and other environmental influences can skew these things, however.

 

Hello, social media.

 

One area of communication that is incredibly important to all cultures is the art of negotiations. Just perusing facebook can give you a bird’s eye view of how well that can go. But, even when face to face, it can still be awkward when you don’t know the rules of communication in regards to culture.

 

For instance, Graham (1993, as cited in Smith, 2001) noted the vast differences between American and Japanese buyers and sellers in regards to language, both verbal and body, and negotiations. They found that those of the Japanese culture did not like direct rejection, interruptions, or initiative in a lower status individual. Americans were confused by the head nods and whether that was a positive gesture and were unclear when final negotiations were complete in Japanese transactions (Smith, 2001). Solutions to understanding hierarchies in response to talking out of turn, gestures and body language, and the art of different cultures is incredibly important. Kaplan and Cunninghan (2010) recommend that you know both your fellow communicator as well as yourself. They indicated that understanding how directness and subtlety are used is crucial. Also something as simple as “knowing who is in the room” can keep respect at the center of the conversation (Kaplan & Cunningham, 2010, para. 14).

 

In the classes I teach and the people I encounter in private practice, I have the priviledge of working with a very diverse population. I learn something new from every student and client I encounter. Admitting that I don’t know something about a student or client and his or her culture is the only way to learn. For instance, my class structure is open discussion and conversations can stall when a reference, gesture, or slang is made or used that one culture or group may understand while another does not. If not addressed, it makes for a very awkward class and can cause a separation in the class body. The best thing to do in that situation is simply ask. The person who is unaware (sometimes me!) learns and understands a nuance of a culture other than his or her own while also empowering the person who made mention of the information to explain it from their viewpoint and feel understood. It is a win-win situation. It empowers everyone involved when we attempt to understand each other in this respect.

 

Language and understanding is a two way street. Make it a smooth ride.

 

References:

Cavanaugh, J.C. and Kail, R.V. (2007). Human Development: A Life-Span View (4th Ed.). Belmont, CA: Thomson Higher Education.

Gardiner, H. W., & Kosmitzki, C. (2005). Lives across cultures: Cross-cultural human development (3rd ed., pp. 101–116). Pearson/Allyn & Bacon.

Santrock, J. W. (2009). A topical approach to life-span development (custom ed.). New York: McGraw-Hill.

Smith, P.B. (2001). Cross – cultural studies of social influence. In D. Matsumoto (Ed.), The handbook of culture and psychology (pp. 361-374). New York, NY: Oxford University Press.

How to Help a Child: Theories of Development

childhelpingmom

 

Developmental theories abound regarding the role the mind, body, culture, and society play in growth and learning. Two defining theorists that paved the way are Jean Paiget, the famous Swiss psychologist, and Lev Vygotsky, the Russian psychologist.

 

Piaget was very definitive in his four stages of cognitive development. These included  sensorimotor, preoperational, concrete operational, and formal operational (Gardiner, 2001). Piaget theorized that these stages were universal and that every child began at the sensorimotor stage and moved through every stage thereafter in a uniformed pattern of adding schemes (Cavanaugh & Kail, 2007). Schemes, he determined, were mental concepts and images that one files away in personal memory banks. A child begins these schemes very early in life and adds to them as he or she grows. When a child adds to a scheme or memory, by way of learning, Piaget called this assimilation (Santrock, 2009). When a child adds a new scheme or memory and must rework an already determined scheme, Piaget called this accommodation. Piaget believed that, as a child learns and adds to his or her learning, he or she is continually searching for equilibrium (Cavanaugh & Kail, 2007). Often, one is in disequilibrium and it is a constant battle to try and work things out in one’s head – to place those schemes in particular files in order to stay balanced. According to Piaget, such disequilibrium and the continuous search for equilibrium is truly an individualistic and natural process. Piaget’s ideas about cognition relied on the idea that all children find solutions for themselves (Santrock, 2009). Throughout his theory, Piaget rarely referenced the role of culture or society (Gardiner, 2001).

 

Vygotsky felt quite different about this idea as his sociocultural theory suggested the role of culture and social structures. For instance, zone of proximal development (ZPD) is a term he coined to explain the interaction of an authoritative figure and a child working together to learn (Cavanaugh & Kail, 2007). Vygotsky believed that the interaction – that assistance of an accomplished adult guiding a child – was pertinent to a child’s learning curve. Figuring out what a child could do on his or her own and then picking up and joining in at that particular point in order to instruct and guide for further learning is the defining feature in building learning concepts, according to Vygotsky (Cavanaugh & Kail, 2007; Gardiner, 2001). Scaffolding, a term to explain such teaching, is used throughout a child’s life – from learning how to get dressed to learning how to ride a bike.  Throughout these endeavors, a child and teacher use language. By using language with others, a child learns how to think and process, and in turn, eventually uses that language privately. This becomes “private speech” (Santrock, 2009) or what many adults simply call “thought.” Vygotsky (1978) states: “Every function in the child’s cultural development appears twice: first, on the social level, and later, on the individual level; first, between people (interpsychological) and then inside the child (intrapsychological)” (p 57). By engaging in private speech that is initiated through interactions with more experienced mentors, a child can exercise the process of more difficult tasks and understand his or her mistakes (Berk, 1994 as cited by Santrock, 2009). Communication is thus learned outwardly and then turned inward (Santrock), solidifying the role society and culture plays in learning.

 

Both Piaget and Vygotsky were interested in the role of the mind of the child in the process of development and both theories are constructivist in nature (Santrock, 2009). Both theories play a pivotal role in understanding how children process, learn, and engage in the world around them. Education is key in both theories as well. However, how that education happens is where the theories lose similarity. Piaget believed a child learns through individual discovery. Piaget (1962) believed in a “child’s spontaneous mental development” (para. 19) whereby Vygotsky insisted that instruction and mentoring was significant in learning processes. Piaget’s very defined stages left little room for variance and have been criticized as such through results of replicated studies within different ethnicities and cultures (Santrock, 2009).  Vygotsky’s ideas about cognition were not as well defined as Piaget’s and did not follow a set of stages. Language and private speech are dominant in Vygotsky’s theory, whereby Piaget believed them to play a nominal role.

 

Though the two theorists both brought incredible key ideas to understanding the nuances of development and the inner and outer working of early growth, the two contradicted each other’s work in many areas. However, their respect for one another was evident even in their dissention. Vygotsky wrote in a preface to one of Piaget’s translated books: “[Piaget’s] clinical method proves a truly invaluable tool for studying the complex structural wholes of child thought in its evolutional transformations. It unifies his diverse investigations and gives us coherent, detailed, real-life pictures of child thinking” (1934, para. 6). Piaget, after Vygotsky’s death, wrote “[O]n certain points I find myself more in agreement with Vygotsky than I would have been [earlier in my career]” (1962, para. 2). He went on to say: “I regret [our disagreement] profoundly, for we could have come to an understanding on a number of points” (1962, para. 1).

 

So, what does all this really mean? When a child is in your life, watch and observe. Is he or she handling things well? Then let it ride and let them know you notice how well they are handling things. Are they struggling and need a bit of guidance? Then, by all means help them and let them know it is okay to ask for help. Finding that balance can be the tricky part, though. But what’s really important in both psychological theories is simply this: be there for them. Give them your undivided attention when they want your guidance. Let them grow at their own pace and help them make it to that next step if you see things going a different direction. Support them. They will be fine, but with you supporting them, they will be even better.

 

References:

 

Cavanaugh, J.C. and Kail, R.V. (2007). Human Development: A Life-Span View (4th Ed.). Belmont, CA: Thomson Higher Education.

 

Gardiner, H.W. (2001). Culture, context, and development. In D. Matsumoto, D. (Ed.),The handbook of culture and psychology (pp.11-34). New York, NY: Oxford University Press.

 

Piaget, J. (1962). Comments on Vygotsky’s critical remarks concerning The Language and Thought of the Child and Judgment and Reasoning in the Child. Retrieved from http://www.marxists.org/archive/vygotsky/works/comment/piaget.htm

 

 

Santrock, J. W. (2009). A topical approach to life-span development (custom ed.). New York: McGraw-Hill.

 

 

Vygotsky, L.S. (1978). Mind in Society. Cambridge, MA: Harvard University Press.

 

Vygotsy, L. S. (1934). Thought and Language. Retrieved from

http://www.marxists.org/archive/vygotsky/works/words/ch02.htm

Thinking about Teaching? Here’s Some Things to Consider

teaching

I work as an adjunct teacher, work with many clients who are adjunct teachers, and have had the pleasure of knowing many friends and family who are in academia and have also been in adjunct positions. I have never known a teacher to do it for the money, but simply the love of teaching. I decided to explore how such a profession adds up in the career field as far as pay structure, security, and values.

The results?

For those who have had a college teacher they loved, give them a shout out. I assure you they are not doing it for the money, the security, or the insurance – most of these things never happen. They are doing it to help pass the torch of knowledge – to you.

According to data released in 2010, there are over 10,000 institutions of higher learning in the United States (US Department of Education, 2012). This number, of course, is growing every year. According to the American Federation of Teachers (AFT, 2012a), adjunct teachers are becoming more concerned about their working conditions, lack of job security, and the inability for job growth. Adjuncts now make up more than 75% of the teachers in higher education. Less than 40% of those have insurance or retirement benefits offered through their employers (AFT, 2012a). Nearly 60% are being paid less than their counterparts (AFT, 2012a). For those who teach in adjunct positions, it is not unusual to not know if one has a job from one semester to the next. Employers have no obligation in assuring a job position and they can chose to not renew a contract with no reason given. Raises do not happen and the pay for a 3 credit class is significantly lower than the salary of a full time teacher. It is not unusual to not know what classes an adjunct teacher will be given when they will be, or if they are guaranteed to take place at all, sometimes waiting until the day the class begins to know for sure. Often times, classes an adjunct thought they could count on get cancelled at the last minute. Whether teaching online or in brick and mortars, adjuncts are expected to hold office hours, tutor students, answer emails, stay late if a student needs guidance, grade papers and various assignments, and attend office functions and meetings.

The impact this has on adjunct teachers, students, and the institution is complex. Often, adjunct teachers’ morale is low and the insecurity in the job can create undue stress.  Many teachers scramble to find work at three to four different colleges each semester or teach in concordance with another job to secure a steady paycheck (AFT, 2010). A survey completed by the Center for the Future of Higher Education (AFT, 2012b) indicated that 94% of adjunct teachers have little institutional support from department heads, very little access to office materials such as copy machines and teaching materials, and often have very little preparation time for new classes. This, in turn, affects the students’ learning environment.

In understanding the complexity of the issue, one must be sure to understand the hierarchy of events and the obscurity of such a bias viewpoint (Cooper, 2012). Certainly, there are other areas to consider when looking at the institutional as a whole. To define the problem of adjunct teachers so narrowly is irresponsible. In fact, out of 500 interviewed, 70% indicated they were satisfied with the support they received from their institutions (AFT, 2010). However, when money was investigated, over 45% indicated they made less than $15,000 per year and only 28% had access to health insurance (AFT, 2010). Most hoped to make it a full time job in which those things might improve. They hoped for this becasue they loved the job itself – interacting with students, sharing knowledge, and using their degrees as a way to give back. In fact, 57% of adjunct teachers indicated they teach simply for the love of teaching.

So, give a shout out to those who teach. And when considering going into teaching yourself, know that you will do it for the true love of teaching and not much more than that. You won’t get rich in dollar signs, but you will get rich in knowing you are making a difference.

References:

American Teachers Association (AFT). (2010). A national survey of part-time/adjunct faculty. American Academic, 2, http://www.aft.org/pdfs/highered/aa_partimefaculty0310.pdf

American Teachers Association (AFT). (2012a). New report blasts conditions of adjunct faculty. Retrieved from http://www.aft.org/newspubs/news/2012/082412adjuncts.cfm

American Teachers Association (AFT). (2012b). AFT Survey Looks at Part-Time and Adjunct Faculty Issues. Retrieved from http://www.aft.org/newspubs/news/2010/032210ameracad.cfm

Cooper, T. (2012). The Responsible Administrator. San Francisco: John Wiley & Sons.

United Nations. (1998). Fiftieth Anniversary of the Universal Declaration of Human Rights. Retrieved from http://www.un.org/rights/50/decla.htm

To Disclose or Not Disclose?

Be quiet, my friend. You can't tell my secrets.

Kennedy and Charles (1997) discussed how important it is for therapists to “employ the instrument of their own personality” (p. 53) when counseling others. Furthermore, Corey (1996) explained how valuable it is for therapists simply be ourselves in the therapeutic process. It is incredibly vital for each therapist, as an individual, to find their own style when working with clients. What works for one will not work for another. Disclosure – or sharing information about him or herself with clients – works along the same guidelines.

Disclosure can be incredibly helpful in the therapeutic process but it can also be detrimental. Yalom (1995) declared that therapists should not freely express their feelings. He stated, “A therapist must model responsibility and appropriate restraint as well as honesty” (p 115). He encouraged spontaneity but cautioned therapists to always keep in mind the need of their clients. A therapist must always decide why he or she is choosing to disclose personal information and it must necessitate benefitting the client (Corey, 1996). It is a constant ego check.  Therapists must always ensure that disclosure is not for selfish reasons – to impress a client, to demonstrate worthiness to a client, or to confirm to a client that they are also human (Corey, 1996).

Some therpists are reluctant to disclose – they may want to avoid emotional involvement, maintain focus on the client, and/or keep over-identification to a minimum (Kennedy & Charles, 1997).  Balsam and Balsam (1984) explained that disclosure is a way for a therapist to show a client they care. They felt that this “caring” could just as well be shown in other forms that may be much more effective to some clients – by listening assiduously, being present in the moment, being emotionally available, and being on time (Balsam & Balsam, 1984).

Another pitfall of therapist disclosure is creating a friend vs. therapist situation.  In order to have a good working relationship with a client, it is important that the client feels accepted and understood. In doing this, some therapists make the mistake of becoming buddies with their client and lose the common treatment goal that was set forth in the beginning. Guidelines must be set and adhered to, ensuring this does not happen.  Being a friend is nice, but is neither productive nor helpful in a therapist/client relationship.

On the flip side, when disclosure does not occur at all or in very small, unproductive ways, a therapist may be conceived by a client as passive or uncaring. Some clients might be incredibly disturbed if reciprocal disclosure is not involved in therapy (Yalom, 1995). It can also create a distorted view of a therapist as some superhuman being. Farber (2003) stated that therapist disclosure especially in cognitive-behavioral therapy (CBT) enhances positive client expectations and strengthens the therapist/client relationship. By not disclosing, open dialogue can be lost and can stunt real growth (Corey, 1996). Proper self disclosure can model to a client that this is the way therapy is, thus paving the way for many  productive sessions. By modeling disclosure in a therapy session, it replicates appropriate interpersonal functioning (Farber, 2003).

Corey (1996 recommended that a therapist must disclose persistent feelings that are directly related to the present transaction. If an idea or thought is constantly coming up that nags at a therapist in session, most likely it is something that needs to be disclosed. Corey also suggested distinguishing between disclosure that is related history and disclosure that is an unrehearsed expression of the present experience.  Rehearsed disclosure can seem forced and inappropriate. However, when used to confirm or express understanding of a client’s current incident, it can be extremely helpful.

Disclosure is a balancing act, as are all facets of the therapist/client relationship.

So, what is the point here? Another buyer beware, if you will. If you are a client and your therapist talks way too much about themselves, think about why that is. Is it helpful to you? Or is it stifling your own growth and treatment goals? Or on the flip side, does your therapist not say enough? If you ask a direct question that relates to the topic and the therapist shrugs it off as not important, does that leave you feeling rejected? Self disclosure is a balancing act and there is no right way to do it. But, if you feel comfortable with your therapist, most likely, there is just the right amount for your needs. If you don’t, then it may be time to think about what you need from your therapist. Talk to your therapist about it and see if you can find the balance. If not, do find a therapist who understands your needs – and puts your disclosure, not theirs, first.

References:

Balsam, R.M. & Balsam, A. (1984). Becoming a psychotherapist: A clinical primer. Chicago: The Univerity Chicago Press.

Corey, G. (1996). Theory and practice of counseling and psychotherapy. (5th ed.) Pacific Grove, CA: Brooks/Cole Publishing Co.

Farber, B. (2003). Self-Disclosure in psychotherapy practice and supervision: An introduction. Journal of Clinical Psychology. 59(5), 525-528. Retrieved Sept 6, 2005 from Academic Search Premier.

Kennedy, E. & Charles, S. C. (1997). On becoming a counselor. New York: Cross Road Publishing.

Yalom, I. (1995). The theory and practice of group psychotherapy. (4th ed.) New York: BasicBooks.

What We Do as Therapists that Others Do Not: Postmodern Approaches

counselors

I have been doing a lot of reading lately about those who call themselves “life coaches.” Now, not all life coaches are bad. In fact, some are quite good. But one in particular has ruffled my feathers, to say the least. One woman, who will remain nameless as I just simply can’t inspire others to look for her, has written a book indicating that counselors should be killed – that they are not doing any couple or individual any good. I still can’t decide if she is saying this to be funny or not. She claims that all that is really needed is for people to take her advice, as she has been married for twenty plus years and her experience is all you need. She claims that all you have to do is take her advice based on her experience and you will live a wonderful life in a wonderful marriage. She writes about numerous couples who have taken her advice and lo and behold, it simply works. What’s interesting is she uses no evidence based practices, has had no academia or field training except of her own volition, and uses no scientific backup for her claims and technique whatsoever.

So, kill me and use her marriage as your catch all for you and all other couples and individuals everywhere and we’ll all be good.

This kind of thinking makes me cringe and, if truth be told, makes me angry.

She is a writer, and tours constantly as a motivational speaker, and has more money than I can even imagine thinking about having.

Good grief.

Some may call jealousy. A little. Sure. I’m not a saint.

But, what really irks me is how she is derailing the work that therapists do as a whole. I am also concerned about what the heck she’s selling and how she’s bamboozling clients who trust her.

I use techniques that have proven to work under scientific scrutiny that experts in the field have studied and revamped and made available for all sorts of diverse couples and individuals. The techniques I use are upheld by multiple associations, doctors, and scientists that have worked with hundred upon thousands of people to make sure we, as a field, are doing no harm. I went to school for two Masters degrees and am getting my PhD to be able to make sure I am doing no harm. I have had over 1700 hours of training.

Did I mention she made her technique up with no studies to show for it? Or that she has no degree? Or is not held accountable by any governing bodies? I could go on and on.

I worry that she is doing harm.

I worry that she does not understand constructivist narrative perspectives or what those in the field call CNP. This is when a therapist and client focus on the stories that clients tell about themselves and others about significant events in their lives. By knowing these stories, clients appreciate how they construct their realities and how they author their own lives. The client, not the therapist, is the expert and the interaction of dialogue between the two is used to elicit perspective, resources, and unique client experiences. I worry that this life coach does not understand the role of questions that therapists are taught to ask that empower clients to speak and express their diverse positions. The therapy based on such evidence based practices supplies optimism and support in the process. The goal is to generate new meaning in the lives of clients and co-develop, together, solutions that are unique to the situation while also enhancing awareness of the impact of various aspects of the dominant culture on the individual.

Such a therapeutic technique helps people develop alternative ways of being, acting, knowing, and living. The key concepts of this narrative perspective derive from a social constructionism theory in which the assumption is that there are multiple truths and that reality is subjective and based on the use of language. Such an approach is considered postmodern as it strives for a collaborative and consultative stance. Does this life coach know this?

There are so many theories that I would gather to think this life coach does not utilize. She only talks at people, making her solution all encompassing, making each couple and individual the same. Therapists realize this is not the case. This is never the case.

For instance, does she know that solution-focused brief therapy is grounded on a positive orientation whereby people are considered healthy and competent? That the past is downplayed, while the present and future are highlighted? This therapy is concerned with looking for what is working and the therapist assists clients in finding exceptions to their problems. There is a shift from problem-orientation to solution-focus and emphasis is on constructing solutions rather than problem solving. There is the assumption that people can create their own solutions and that small changes lead to large changes. Here, the client is again the expert on his or her own life and the therapist merely collaborates. Questions from the therapist allow clients to utilize their resources while focusing attention on solutions. Questions are geared to create change that can be useful and help clients to take note when things were and are better – it helps them pay attention to what they are doing and open up possibilities to do something different.

There are three kinds of relationships in solution-focused therapy. There is the customer-type relationship whereby a client and therapist jointly identify a problem and a solution to work toward. There is also the complainant relationship in which a client describes a problem, but is not able or willing to take an active role in constructing a solution. Lastly, there is what is called “visitors” – the clients who come to therapy because someone else thinks they have a problem. There are many techniques/questions used in these relationships depending on so many variables. There is no one way to do it all. A therapist has to consider everything from the type of questions to ask to how much to ask. There are pre-therapy change questions whereby a therapist may ask “What have you done since you made your appointment that has made a difference in your problem?”  There are also exception questions such as when the therapist directs clients to times in their lives when the problem did not exist. There is also my favorite – the miracle question. This is the one by which a therapist asks “If a miracle happened and the problem you have was solved while you were asleep, what would be different in your life?” Therapists may also ask scaling questions – “On a scale of zero to 10, where zero is the worst you have been and 10 represents the problem being solved, where are you with respect to the issue now?” Does someone who had not studied these therapies and theories and more along with the rigorous tests behind them know truly how to help someone that will create lasting change and do no harm?

Narrative Therapy is another postmodern approach in which the therapist listens to clients with an open mind while encouraging them to share their stories with curiosity and persistence. How does that happen when you are lecturing someone and making everyone the same? The truth is, you simply can’t. The focus of narrative therapy is that the person is not the problem, the problem is the problem. The therapeutic process in narrative therapy involves collaborating with the client in identifying and naming the problem, separating the person from his or her problem, and investigating how the problem has been disrupting or dominating the person. Then, there is a search for exceptions to the problem. Therapists may ask clients to speculate about what kind of future they could expect from the competent person that is emerging. The functions of a therapist in narrative therapy is to become an active facilitator and demonstrate care, interest, openness, empathy, contact, and fascination. A therapist must adopt a not-knowing position – image that! This allows for the client to guide by his or her story, helping them to own their story and their life. This helps clients construct a preferred story line and creates a collaborative relationship between the therapist and the client. The client is the senior partner – they are in charge.

Questions in narrative therapy are used as a way to generate experience rather than to gather information and they are always asked from a position of respect and curiosity. By asking questions, therapists assist clients in exploring dimensions of their life situations which can lead to taking apart problem-saturated stories. The focus is to relate to problems in life but not be fused with them, a process call externalization. Externalization is a process of separating and freeing the client from identifying with the problem. Externalizing conversations can lead clients to recognizing times when they have dealt successfully with the problems in other ways. This can occur through deconstruction and creating alternative stories. New and alternate stories that are co-created indicate that clients can continually and actively re-author their lives. Questions that explore possibilities enable clients to focus on their new life and the way they want it to be.

You simply can’t get that kind of collaboration, that kind of care, that kind of respect from a step by step guide book from a woman whose only claim is she has been married for 20 odd years. And you certainly won’t get it from someone who touts that her way is the only way.

So, my point? Please, buyer beware. When looking for help, when looking for someone to walk with you through your life, make sure they know what they are doing. Make sure they are there for you – not simply to make a buck or a book. A good therapist – even a good life coach – will not tell you their story and give you a one solution for all gimmick. They will ask for your story. Then, you will work on it together, with your story leading the way.

Two Theories: One Ideal

control

Alfred Adler (1870-1937), the founder of Individual Psychology, created the Society for Individual Psychology in 1912. He was notorious for being a showman, often working with clients in front of large audiences. Alder believed that the requisite for a good life rested on a sense of superiority and control. Adler believed that we have five goals that needed to be addressed in a life, which he labeled life tasks: love, work, friendship, self, and spirituality. Adler indicated that these needs were based on our role in the community and upheld the notion that people need to engage with others to feel fully at peace and to fulfill these needs. His work became so popular that by 1952, the Adler Institute in Chicago was founded.

In 1965, William Glasser wrote his first book entitled Reality Therapy and opened his first institute under his own name three years later. Glasser was influenced by the ideas of Adler and theories related to internal control and motivation. Today, reality therapy is now called choice theory or choice therapy. Choice theory’s foundation centers on basic needs that we all desire: survival, love, belonging, power, freedom, and fun. Glasser indicated that love and belonging were primary. According to Glasser, each person is responsibility for fulfilling these needs in his or her own life.

While Adler and Glasser disagreed on how to actually get these needs met, they did agree that we must lose the idea that things “happen” to us. Rather we needed to begin to think that we happen to things – that we have control and choices over our lives, not the other way around. We are responsible for our own choices. We are responsible for getting our own needs met.

Glasser believed all responsibility of choice lay within the individual, whereas Adler acknowledged that, sometimes, options can feel, and actually can be quite, limited (Petersen, 2005). Sometimes, it is hard to see the choices, but they are there. One thing we simply cannot do is blame others for those choices. Both Adler and Glasser claimed that the notion of passing off blame just simply didn’t help.

Mental illness is seen by both Adlerian and Choice theories as simply behaviors of inferiority and unsatisfied needs. Wary of any sort of actual labeling, both Adler and Glasser considered mental illness a choice by the client, whether subconscious or conscious, that actually benefited the client. Such illnesses are used as a tool to get whatever we need or want at the time.  In this respect, such things as anxiety, depression, and mania are purposeful and needed. Yet, they are also ineffective and tend to cause more harm than good. Very controversial theories, indeed. But they raise some interesting thoughts.

At the time of Adler’s newfound theory, not much was known about abnormal behavior – it was considered simply a neurosis. Today, so much more is known about the genetic and hereditary links to abnormal behaviors, yet Glasser holds fast to the idea that it is still a choice of sorts, insisting that medicinal interventions are not needed (Corey, 2005).

Glasser’s choice therapy works toward treatment goals that teach clients to make substantial choices in order to satisfy their needs and relationships in a productive manner.  Adler’s theory does the same but with a much larger stress on social interactions. Both theories tout the need for defining relationships and working toward understanding our own specific needs. By recognizing what our needs and life tasks are and then working toward fulfilling them, both theorists believed that mental illness could be eliminated. Encouragement and education are seen as important parts of the process, as well as focusing on what the client needs in order to be well.

So, can we eradicate mental illness by focusing on life tasks and fulfilling our own needs? Adler and Glasser seemed to think so.

My thoughts?

I have seen clients work hard to find their way back from depression, anxiety, trauma, and all sorts of illnesses, mental and physical. Some take medication and some do not. Does it eradicate the symptoms, the illness, the reason that they come seeking help in the first place? I cannot say with all certainly that it happens this way every time. People are different and to assume that they will all manage their symptoms the same way and that they all stem from the same place is not quite fair.

What I do know with all certainty is this: Adler and Glasser were on to something. When a client comes to see me, they often are overwhelmed, exhausted, unsure, and want to change something.

Because something doesn’t feel right, doesn’t seem right, doesn’t look right.

Something is off.

How we discover what that is is by focusing on those needs that are unfulfilled, those life tasks that have gone unmet, the thoughts and choices that they are making now as well as then and how they have affected their past, their present, their future. Often, the real work is figuring out what a client needs. Some clients have never given themselves an opportunity to consider this.

Once that work begins – discovering their needs, taking choice into their own hands, finding out what needs to happen, and how to get it – well, that is when and where symptoms start to drop away.

A wonderful thing begins to happen. They find that life is not happening to them, they are happening to life.

References:

Corey, G. (2005). Theory and practice of counseling and psychotherapy. (7th ed.) Pacific Grove, CA: Brooks/Cole Publishing Co.

Petersen, S. (2005). Reality therapy and individual or adlerian psychology: A comparison. International Journal of Reality Therapy. 14(2), 11-14.

The Path to the Self

winding-path-drawing-wallpaper-1

I realize whatever concept or theory I write about today may just as easily change tomorrow. Throughout my college and professional career, the ideas and concepts have continued to transform and grow, ultimately shaping the science of psychology as well as my own practice. I also know that whatever I ultimately focus on based on the theories and constructs I honor, may work one day and not the next, based on the path my client and I are walking. I will continually go back to the drawing board based on that path, time and time again. I expect to never stop learning and studying, and because of this, I am sure my approaches and ideals will change as time goes on, as they have in the past.

I am very fond of Adlerian theory, as well as feminist theory, and I also appreciate the very convoluted and intense teachings of Freud and psychotherapy. I love behaviorism and how we are in a dance with our environment. I love cognitive psychology and how we are destined to be driven by our own thoughts. And how fun is Gestalt? Working with the “in the moment” process brings about a playfulness and awareness that no other therapy can manage as effectively. There are so many wonderful theories and ideas to choose from. For me, it’s like candy. I want to try them all. My students make fun of me when I teach psychological theories. When I introduce a new one, I say, “This one is awesome, it’s my favorite!”

Adler discussed the idea that we all have feelings of inferiority – we all want to become something, to be important in our own lives. Feminist theory really tells us the same thing but in a different context – that we are worthy to rise above whatever social constraints there are to be the important people that we truly are meant to be. Freudian theory is awesome too – the time taken to delve into dreams and the self? What a wonderful gift to the self. The very thought of sitting on a couch, away from the world, and just talking to find out where it leads. To let the mind be free enough and open enough to explore? What a powerful thing! Few of us let ourselves do that.

Therapy based on the science of psychology is a way to appreciate the self for what one is, what one has been, and what one can be. I think we owe it to ourselves to take the time to do that, whatever theory or science guides us. While each theory is unique, they do have one thing in common – a simple respect for the journey.

Science respects the journey.

Thus, the thing to remember?

You are on a journey. Respect the journey and yourself as you walk along it.

And will the journey takes twists and turns and change and grow?

Damn straight it will. Keep walking. A discovery is on the horizon.

Unhealthy Anger and Violent Aggression: Break the Silence

Grudges-holding-on-to-hot-coal

I have been studying unhealthy aggression in males and females and the need for preventative anger management within families for a long time. What I’ve discovered is there are differences between the sexes and throughout different cultures in regards to anger (Fischer & Evers, 2011). The way men and women not only handle unhealthy anger but keep it secret creates a wall of silence and prevents us from truly talking about and finding ways to stop it.

Our approach to men and women in terms of unhealthy anger is based on societal expectations and rules. Men who are angry are often forgiven for their anger as it is often seen as a type of machismo. They lash out. Men are allowed – even expected – to get angry until it hurts someone or creates some sort of visible damage (Copenhaver, Lash, & Eisler, 2000). For women, anger is simply not acceptable. Women are allowed to cry, to show fear, to become upset – yes. However, true anger displayed in a woman is seen as something entirely different than it is in a male (Blincoes & Harris, 2011). Women lash in. Carol Tarvis, author of Anger: The Misunderstood Emotion explained that women learn very early in their lives to internalize their anger, which often displays as depression.

This isn’t just American culture, either.

For instance, Egyptian women are taught to conform in the face of patriarchal violence – the lash out but only toward other females (Yount, 2010). They often blame other females for any abuse in a relationship. When interviewed, female family members of women who are victims of male lashing out indicated that the woman “deserved” the abuse (Yount, 2010, p. 48). It is not uncommon to be physically struck for being lax with wifely duties, talking behind a partner’s back, or confiding in a mother or sister. In order to evade mistreatment, Eygptian women must avoid or prevent the aggression, keep it secret, and remain obedient (Yount, 2010). This is not much different from the United States. We just tend to have a bit more shame about actually believing this is okay (Jakupcak, Tull, Roemer, 2005).

Regardless of being female or male or the culture in which we are raised, there is a taboo and an anxiety in talking about such things as domestic violence, unhappiness in the family, or uncontrollable unhealthy anger. Shame, fear, and feeling like we are the only ones keep us silent. But, the silence is deafening.

Studies indicate over 40% of partners slap and hit each other on a regular basis (Santrock, 2009). Over 1 million women per year are victims of physical assault by intimate partners (National Coalition against Domestic Violence, 2012). Although much smaller in numbers, men are part of these statistics as well. Over 4% of men have been injured as a result of intimate partner violence (IPV) that included rape, physical violence, and/or stalking by an intimate partner and 1 in 7 men have been the victim of severe physical violence by an intimate partner.

These are only the men and women we know about, not the men and women that remain hidden and silenced.

Unfortunately, social policies in regard to damaging anger are not prominent in the United States and there are very few preventative measures in place. They are even more lax and often nonexistent in other parts of the world. Hafkin (2004) indicated that the ideals of one’s home life, such as the want and need for privacy, thoughts on parental and spousal rights, and the desire for what is often a false sense of family stability prevent many social policies from becoming reality.

The secrets remain.

If you are a part of this secret, please speak out.

In the U.S. and Canada: Call The National Domestic Violence Hotline at 1-888-799-7233.

In the U.S.: Call Gay Men’s Domestic Violence Project at 1-800-832-1901.

References:

Blincoes, S., & Harris, M.J. (2011). Status and inclusion, anger, and sadness: Gendered responses to disrespect. European Journal of Social Psychology, 41(4), 508-517. doi: 10.1002/ejsp.811

Copenhaver, M.M., Lash, S.J., & Eisler, R.M. (2000). Masculine gender-role stress, anger, and male intimate abusiveness: Implications for men’s relationships. Sex Roles, 42(5-6), 405-414. doi: 10.1023/A: 100705030538

Fischer, A.H. & Evers, C. (2011). The social costs and benefits of anger as a function of gender and relationship context. Sex Roles 65(1-2), 23-34. doi: 10.1007/s11199-9956-x

Yount, K.M., & Li, L. (2010). Domestic violence against women in Egypt. Sex Roles, 63(5), 332-347. Doi: 10/1007/s11199-010-9793-3

Jakupcak, M., Tull, M.T., & Roemer, L. (2005). Masculinity, shame, and fear of emotions as predictors of men’s expressions of anger and hostility. Psychology of Men & Masculinity, 6(4), 275-284. Doi: 10.1037/15249220.6.4.275