Category Archives: Psychology

August 19, 2014 · 12:10 pm

Why Oppressed People May Not Jump At Chance For Freedom


Ever wonder why those who experience systematic abuse and violence don’t jump when they get a chance for freedom? Consider the abused teen choosing not to reveal the abuse to an inquiring teacher but rather stays in the abusive home in silence. Consider the victim who refuses the help of a friend in order to leave a domestically violent spouse. What is the psychology that supports these responses to oppression?

Brilliant Mhlanga has written a short memoir of his experience of being from an oppressed people group in Zimbabwe. Under the guise of “independence” his people and his family suffered tremendous violence. Family members were raped and murdered in grisly fashion. He labels what happens a genocide (from 1980-1987).

Here’s how he describes the impact of this systematic oppression (emphasis mine, British spellings his)

The psychology of oppression, then, becomes a phenomenon derived from the state where the oppressed, given their existential experience, adopt the attitude of ‘adhesion’ to the oppressor (ibid: 45). Freire adds that under these circumstances the oppressed cannot consider their situation clearly and objectively in a bid to discover themselves outside the spectacles of their oppressor. As discussed earlier, the oppressed rationalise and internalise their suffering. Their state of mental warping makes them appear as walking symbols of conformity. Such conformity makes them reject their enlightened brethren whom they tend to perceive as ‘trouble makers’. To them anyone who advocates change of their state of being is likely to bring them more trouble, as they cannot know the likely outcome. They fear change. This is the state of people who have lost a sense of hope in their full potential without the help of the oppressor.

Notice some of the features of the oppressed:

  • Identity tied to oppressor
  • Belief that one cannot exist outside this relationship (fear of being in relationship, fear of not being in relationship)
  • Internalize suffering (blame self)
  • See those who would fight for their freedom as dangerous (the devil you know may be better than the one you don’t know)
  • Reject change as dangerous

Now these features are not found in everyone who is abused but they are worth noting. Those who would want to help the oppressed must consider these challenges and develop interventions that do not automatically trigger the fear reactions. This might include,

  • Identifying self-blame and raising doubts
  • Giving freedom to control response to oppressor (not coercing leaving oppressor)
  • Identifying possible future
  • Validate change as scary

Quote: Mhlanga, B. (2009) On the psychology of oppression: Blame me on history! Critical Arts, 23:1,106 — 112

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August 12, 2014 · 12:11 pm

Brooks on journaling about emotions


Friend Jeff McMullen pointed out a recent David Brooks op ed in the New York Times. (Read it here). While I’m not sure I agree fully with his journaling/not journaling point he says something very important about the timing of writing one’s emotions after a traumatic event. He says,

When people examine themselves from too close, they often end up ruminating or oversimplifying. Rumination is like that middle-of-the-night thinking — when the rest of the world is hidden by darkness and the mind descends into a spiral of endless reaction to itself. People have repetitive thoughts, but don’t take action. Depressed ruminators end up making themselves more depressed.

Then later, this important distinction between immediate processing of emotions and later processing,

We are better self-perceivers if we can create distance and see the general contours of our emergent system selves — rather than trying to unpack constituent parts. This can be done in several ways.

First, you can distance yourself by time. A program called Critical Incident Stress Debriefing had victims of trauma write down their emotions right after the event. (The idea was they shouldn’t bottle up their feelings.) But people who did so suffered more post-traumatic stress and were more depressed in the ensuing weeks. Their intimate reflections impeded healing and froze the pain. But people who write about trauma later on can place a broader perspective on things. Their lives are improved by the exercise.

David points to some research that exists that suggest CISD is unhelpful for some participants. Some are made worse. Yet, narrating one’s trauma in the broader context of a life tend to see a reduction of symptoms. The difference seems to be whether the focus in on life or mostly on the trauma. Trauma in perspective is the goal. Just reviewing trauma may in fact strengthen the traumatic reaction rather than weaken it.

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June 28, 2014 · 5:15 am

Military trauma and traumatic brain injury: Challenges and Opportunities


Colleague and veteran Steve Smith has let me know about this web article regarding the state of PTSD/TBI injury among active duty military personnel. The essay points to some very startling numbers:

  • 59% report no improvement or worsened symptoms after undergoing treatment for PTSD and TBI
  • 30% dropped out before treatment was complete
  • A large portion of patients are on up to 10 meds at a time

The news item goes on to summarize presentations made a few days ago at the American Legion symposium on care for TBI and PTSD veterans. What makes this worth reading is that the actual slides from the presentations are provided in links at the end of the piece. I encourage you to go and read up. You can see what is being done using complementary treatments, the numbers of veterans with head injuries (interestingly, 80% are NOT received during combat) and/or PTSD, what services are available and what recommendations are made to DoD and the VA system to improve patient care.

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May 16, 2014 · 8:41 am

Traumatic Nightmares? Two Treatment Possibilities


Many who suffer from PTSD or other traumatic reactions also experience chronic nightmares. It is bad enough to have to deal with intrusive memories and triggers during the day but being robbed of peaceful sleep can send you over the edge, both in terms of physical and emotional health. Christian counselors may be tempted to ignore these nightmares (how can you stop something you have little control over?) or overly spiritualize the content of the dream.

But we ought not neglect the problem of nightmares. It is well-known that reductions in quality of sleep make all mental illnesses worse. Nightmare sufferers understandably avoid sleep but of course this creates a vicious cycle of insomnia, anxiety, and increased avoidance strategies.

There are two intervention options (among many) that appear to have fairly robust positive data indicating helpfulness. (For detailed descriptions of these two and others including the analyses of value, see this pdf): Prazosin (medication) and Imagery Rehearsal Therapy (IRT).

Prazosin is an anti-hypertensive (alpha blocker) that may work on the problem of too much norepinephrine in PTSD patients. It seems to improve sleep length and REM time. Interestingly, beta blockers have been found to increase nightmares rather than reduce them. I am no physician and so cannot evaluate the value of this medication for clients but would encourage clients with chronic, severe and re-occurring nightmares to talk with their doctor about whether Prazosin might work for them. The studies I have reviewed primarily examined the value of this medication for veterans with extreme nightmare problems. The most significant downside to medication treatment is that it only works when the medication is taken. Stop the medication, the nightmares may come back. However, some relief may be beneficial and thus the medication then has value.

Imagery Rehearsal Therapy (IRT) is a short-term therapy that does not work on the actual content of the traumatic experience or attempt to treat PTSD. Instead, it treats nightmares as a primary sleep disorder problem. There are variations on IRT but most versions last between 4 and 6 sessions and may be delivered in individual or group formats. Sessions include education about the nature of nightmares, sleep hygiene protocols, and the imagery replacement protocol. While some of the IR protocols are done imaginally, others ask nightmare sufferers to (a) write down the details of the distressing nightmare, and (b) write a new ending to the nightmare. As Bret Moore and Barry Krakow describe, the therapist does not dictate the new outcome of the revised dream but encourage the sufferer to “change the nightmare anyway you wish” (Psychological Trauma, v. 2, 2010). The nightmare sufferer then rehearses (multiple times) the new ending and is instructed to ignore the old nightmare.

Sound goofy? How is it that a person can just decide to have a different dream? However, the evidence that this therapy works is quite robust. Numerous studies with veterans and civilians indicates it is effective in reducing unwanted nightmares. Most treatment protocols suggest starting with nightmares with content unrelated to actual traumatic events.

Thus, Christian counselors ought to review these two treatments and consider learning the IRT protocol to bring relief to chronic nightmare sufferers.

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May 12, 2014 · 12:58 pm

Counselors talking about themselves? Additional thoughts


Last week I described some research supporting counselor self-disclosures, research that suggests clients appreciate disclosures revealing (a) similarities between counselor and client, and (b) vulnerabilities or personal emotions. While this research flies in the face of conventional wisdom in most counselor training programs, I cautioned counselors to ask some questions first before talking too much about self. With this post, I would like to press the caution just a bit more.

Why do counselors talk about themselves?

Why do counselors talk about their personal life with clients? Read the following numbered list to see some of the main reasons (and the sub-points in italics as illustrations of that reason). Then, consider the bracketed sub point as an alternative to self-disclosure.

  1. We want to put clients at ease and we think knowing something about ourselves might help
    • I can see you are anxious about whether taking antidepressants is appropriate for faithful Christians. I take them and it has only helped my faith.
      • [You’re not alone with that question so let’s explore the pros and cons to taking an antidepressant. Why don’t you start by telling me the reasons you’ve heard or thought about for not taking Prozac?]
  2. We believe our personal history will help a client understand, accept, or challenge something about their struggle
    • I know this treatment for panic disorder is difficult for you but I can tell you it works. It worked for me.
  3. We want to please an inquiring client
    • Yes, I am married and I have 2 children.
      • [Sure, I don’t mind telling you who is in my family, but could you first tell me why that is an important question for you?]
  4. We want to earn their respect and believe that our history will help
    • Well, for starters, I want you to read my book. It is now in its second edition and has been translated into 4 languages. I think you will find it very helpful for your problem.
      • [I’d like for you to start reading about your problem. There are a couple of books out there that I think you might find helpful, including one I wrote. But, feel free to look these over on Amazon and choose the one that seems right for you.]
  5. We like talking about ourselves; our personal stories seem difficult to avoid
    • You and I have a lot in common. My wife has the same problems as your husband. So, I know how lonely you must feel. We’ve tried…
      • [Though you are not saying so, I wonder if you feel lonely in your marriage.]
  6. We see the relationship more like a friendship with mutual sharing
    • I’m so glad to see you today. You are a bright light in a dull day. I look forward to our stimulating conversations. Just yesterday I was thinking about you and wishing to have coffee with you to discuss your career future. 
  7. We want to be seen as human rather than just professional
    • Yes, it has been a stressful day. I could use a back rub after all these sessions today.
      • [You know, some days are harder than others, but I’m curious why you asked this today?]
  8. We want the client to help us in some way
    • I was thinking about your need to work and my need to have someone edit my website. Or, I’m headed out on a mission trip next month. Well, I am if I can get enough donations. I’m about $1000 short thus far but I know God will come through.
      • [neither of these need to be said!]

Is it necessary? Is it helpful?

While self-disclosures may improve client perceptions of counselors, I suspect that empathic, client-centered therapists evoke these same feelings by asking good questions making observant reflections yet still minimizing disclosures, especially those where we initiate them and those that force the conversation to our personal history. There are some disclosures that are in response to client questions (e.g., have you ever struggled with addictions? Are you married? Do you believe in medications? Are you angry with me?) that warrant an answer. When giving this answer, work hard at keeping it brief and returning to the client’s story.

Don’t forget about social media self-disclosures

Clients sometimes “hear” our disclosures through social media. Imagine a client reading, “Well, that was a difficult session, glad I’m done for the day” having been that counselor’s last appointment! Blogs (like this!), Twitter, Facebook, and Instagram can be forms of self-disclosure. Be wary of these. Conventional wisdom says to avoid social media contacts with most clients so as to avoid harm to the counseling relationship. While we need not require an outright ban of these connections, a thoughtful counselor will review connections via social media for potential harm.

Be human

Despite these efforts to avoid letting our selves intrude too far into the session, sometimes life gets in the way. A counselor has a health or a family crisis. Clients have ways of finding this out and often want to ask how things are going. Here it is appropriate to say something brief, thank them for their concern and then start the session. In other situations a client discovers a shared passion for food, a sporting team, a connection through mutual friends. Enjoy these connections, acknowledge them, but be sure not to linger there during the session proper. We are, after all human. Don’t be surprised when counselor and client humanness come into contact.

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May 9, 2014 · 10:36 am

Should therapists talk about themselves to clients? Surprising information


How do you feel when your counselor begins to self-disclose during a session? When they do, is it helpful or a lapse in their judgment?

This is a common conversation in counselor training programs. Generally, most models of counseling and therapy discourage counselor-self-disclosure; some models do so more than others. The reasons for discouraging counselor self-disclosure vary from breaking the unconscious projection (analytic) to just confusing clients because we change the subject from client to counselor.

But a recent article in the April 2014 Journal of Counseling Psychology, suggests that self-disclosure might actually help more than we think. Henretty, Currier, Berman, and Levitt completed a meta-analytic review of 53 studies examining counselor self-disclosure versus non disclosure. And “overall” they found that clients have favorable perceptions of disclosing counselors.

Why? It appears that when a client perceives great affinity/similarity with a counselor, they rate that counselor higher. Also, when a counselor reveals something difficult or painful (a vulnerability?), it makes them more human to their clients. Some examples of this negative valence might include, “when you said that, I felt really sad.” Or, “Let’s talk about your anxiety, having suffering with it some years ago, I suspect you…”

Not so fast!

So revealing similarities with clients and being human make clients feel more similar and possibly more understood. This makes sense. Client/Counselor matching seems to correlate with better outcomes. However, before counselors go talking about themselves they ought to consider a few things.

  1. Why am I doing this? Is what I have to say for them or really for me? (Too often, we speak to talk about self)
  2. Is what I say really going to keep my clients focused on themselves or distract them to my story?
  3. Am I sure that what I say will show similarity? The truth is that we *think* we have a similar story but the times we are sure we know what our clients are feeling we are most likely to stop listening and then miss the client.
  4. How often do I do it?

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May 5, 2014 · 9:49 am

Does yoga decrease PTSD symptoms?


The lead article in the most recent issue of Journal of Traumatic Stress (27:2, 2014) presents a small randomized control trial pitting yoga interventions (12 sessions) against “assessment control” (i.e. assessment plus no treatment). The authors suggest this is the first randomized control trial for yoga interventions, something needed since there is significant anecdotal and quasi-research evidence that yoga reduces trauma symptoms. It is purported to work for several reasons: improved breath-control, improved mind-body awareness/mindfulness, and improved stress resiliency.

What did they find?

The answer to the title question: yes, but not more than controls. Some improvement is noted in the Yoga intervention group: reduction of re-experiencing symptoms and reduction of hyperarousal symptoms. However, the same reductions are also noted in the assessment control group. You might wonder why. The authors suggest that the control group found benefit in tracking their symptoms each week. Thus, self-monitoring may help improve well-being, especially if the person also is accepting and normalizing symptom expression of PTSD. Thus, both groups may have received the same intervention: self-awareness, self-monitoring, and self-acceptance.

Now, this trial was rather small, just 38 in total. With a larger study, researchers might find more power to their intervention. Why keep trying? Yoga is (a) low-cost, (b) not particularly taxing from an emotional standpoint (thus few drop-outs when compared to something like Prolonged Exposure), and (c) something that helps sufferers stay attuned to their body.

 

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April 29, 2014 · 12:39 pm

Urban trauma or bad kids?


Psychiatrist Michael Lyles gives an excellent presentation on the nature of urban trauma at the 2014 ABS Community of Practice. He points out how much of what gets labeled as uncaring violence is better seen through the lens of urban trauma reactions. In addition, he discusses the response of the church. Not to be missed!

Michael Lyles – COP 2014 from American Bible Society on Vimeo.

After his presentation, Police chaplain and urban pastor Rev. Luis Centano gave this response regarding trauma in the city of Philadelphia.

Rev. Luis Centeno – COP 2014 from American Bible Society on Vimeo.

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April 16, 2014 · 1:10 pm

New Pennsylvania Mandated Reporting Bills Signed Into Law


My local newspaper informs me that Governor Corbett signed into law HB 431 436 and SB 21 and 33 into law today. The paper reports what this means:

“Senate Bill 21 ensures that virtually anyone who works with children in a professional or volunteer capacity, including school personnel, personnel at colleges and universities, youth sports coaches, child care providers, religious leaders, physicians and other health care workers, social services workers, law enforcement officers, librarians, emergency medical service providers and employees and independent contractors for each of those entities are required to report suspected child abuse.

“House Bill 436,” Stephens continued, “adds attorneys for organizations caring for children to this list of reporters, while preserving the attorney client privilege, bringing Pennsylvania in line with a majority of states across the U.S.”

So, anyone who works with or volunteers with children is now considered a mandatory reporter. Attorneys who work for those organizations who serve children cannot keep quiet when child abuse is reported to them. Mental health and other health professionals continue to be mandated reporters when potentially abused children present to them or their colleagues.

Besides expanding who is mandated to report suspected child abuse, HB431 also now requires evidence of 3 hours of training on child abuse recognition and reporting for all seeking PA licenses AND evidence of 2 hours of continuing education on the same subject for all who seek to renew their PA licenses. 30 CE hours are still the minimum required per licensing period, but now 2 of those 30 must be about child abuse recognition and reporting. Not sure if that means the existing mandate to take at least 3 hours in ethics will be on top of the 2 for child abuse reporting or if the 2 for child abuse reporting will count towards the 3 in ethics.

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March 19, 2014 · 10:11 am

Mapping urban domestic trauma


Our community of practice continues with a presentation by Michael Lyles, MD who presented on the problem of trauma in urban settings. [Watch his talk here] He pointed out how we often think about violence and the connection with trauma in international settings but fail to connect the two in American urban settings. We see angry young men and women who seem calloused and do not value life. Yet, often what is happening is that we have hypervigilant individuals who choose to manage their trauma reactions by being alert and on edge and ready to attack before being attacked. When you bring together poverty, violence and a traumatized population, you develop a chronically traumatized person, meeting most criteria for PTSD but never getting diagnosed.

One study mentioned a few statistics about violence prevalence. 55% of urban children have experienced sexual abuse (compare that to about 15% of US population); 39% have witnessed domestic violence. 27% experienced physical abuse.

To highlight the problem he pointed out a 2o12 Philly Magazine report on trauma in our city. Between 2001 and 2012, more than 18,000 people were shot. During that time some 3800 murders. He noted that suicide rates run about 20% and that number goes even higher when you include “academic suicide”–dropping out of life. In addition, he pointed to the connections between trauma and adrenal overload, hypertension, diabetes, and other physical illness. He also pointed to the scarring that takes place in the amygdala.

He noted a good book to consider: John Rich, MD (Drexel University) Wrong Place, Wrong Time: Trauma and Violence in Lives of Young Black Men.

He ended his presentation considering the role of “Chief Musician” as found in the Psalms. These are folks who listen to the story, don’t debate it, set it to words/music that are appropriate.

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