On Saturday, in celebration of Resurrection Sunday, I resurrected my greenhouse. Around this time last March we had an ice storm that crushed the metal frame of my greenhouse. With my father’s ingenuity we rebuilt the frame and on Saturday I put it back together. I couldn’t find my thermometer but the temp inside was pushing 85-90 degrees.
Will I grow something inside? Maybe. Right now it has a lawnchair so I can read the paper in comfort.
Filed under gardening
While few outpatient, private practice therapists deal much with those diagnosed with schizophrenia, there are things therapists can do to ease the suffering of both client and family. Kim Mueser, a professor at Dartmouth Medical School has published a number of helpful research and popular writings designed to increase social and cognitive functioning and decrease family distress in people with schizophrenia. Click here for an Amazon.com list of his writings. His Complete Family Guide (#1 on the list) is probably the best though several other texts may be just as useful depending on the reader’s focus. And while medications are important in the treatment of schizophrenia, it is quite clear that when families and client learn to minimize family distress and conflict, they also reduce active psychotic episodes
—–
There are a number of interesting research angles on the pathways of Schizophrenia. One such hypothesis is that the croticostriatal loops do not work correctly in such patients. In lay terms this means that information doesn’t flow normally from the frontal lobe of the brain to some of the mid-brain structures and then back again. This seems to be part of the cause of apathy and lack of volition and/or planning. One wonders whether the longer time it takes for information to flow properly in order to make a decision or interpretation increases the likelihood of making random assumptions about the world. I know that when my children get stuck in a math problem, they are more likely to begin wild guessing to complete the task.
Grading papers from class and one student illustrated her point by including this quotation from The American President. Not a movie I’ve seen but like this little piece:
President’s Aid (Michael J. Fox): People want leadership, Mr. President, and in the absence of genuine leadership, they’ll listen to anyone who steps up to the microphone. They want leadership. They’re so thirsty for it they’ll crawl through the desert toward a mirage, and when they discover there’s no water, they’ll drink the sand.
President: …People don’t drink the sand because they’re thirsty. They drink the sand because they don’t know the difference.
Sounds just about right.
Filed under Great Quotes
In the last chapter the authors theorized about our propensity to live out of socially constructed schemas. Now in chapter 9 of Integrative Psychotherapy, McMinn and Campbell apply schema-focused interventions (domain 2–dipping beneath symptoms to core issues) to the problem of depression. But before they get to that task, they make these 2 points:
1. It’s “incorrect and potentially dangerous” (p. 278) to assume one does symptom focused interventions with anxiety problems and deeper level interventions for depression. Instead, the therapist ought to move seamlessly between them as needed. They remind the reader that their chapters are illustrations and not manuals.
2. There are useful symptom based interventions for the problem of depression that should not be overlooked: (a) medications (they explore fallacies that keep people of faith from using them and point out that meds are sometimes better than counseling alone), (b) behavioral techniques (keeping an activity schedule, assertiveness training), and (c) cognitive restructuring (keeping a dysfunctional thought and challenge record).
At this point the authors begin to illustrate their version of schema-based interventions. Unlike classic interventions (diagnosing the underlying schema and then correcting it), they describe recursive schema activation which is designed to “give clients many opportunities, session after session, to decenter [see life from another perspective] from the deep, persistent themes of their lives that can never be fully obliterated” (p. 288-9). The main difference between the IP model and the classic model is their humility in seeing schemas as understood and managed rather than corrected. Also, they desire to activate and experience schemas as much as talk about them.
The goal of this part of IP is to stand apart from one’s schema so as to see it and choose to deactivate it where it is not helpful. In the case of depression, it means standing back from “depressogenic thoughts” using mindfulness and spiritual disciplines. The client doesn’t challenge thoughts so much as he or she activates the schema in counseling over and over in a manner that allows distance and the possible formation of a new schema or identity.
Just how does this work in therapy? McMinn and Campbell suggest these strategies:
1. Taking a life history to identify re-occurring themes that might signify the presence of maladaptive schematics (e.g., long history of feeling rejected by others). In taking the history, the client not only tells but re-experiences the schema with the counselor
2. Schema inventories. They mention one in particular: www.schematherapy.com. These are used to get the client thinking about schemas that contribute to their problems.
3. Discussion of faith. The therapist explores how the client’s view of God fits in their view of self. The assumption is that a maladaptive schema likely contains distortions of the character of God. The goal is to understand at this point, not correct.
4. Moving from specific to general. Clients often describe recent painful events (and thoughts and feelings). The therapist encourages the client to explore how these thoughts and feelings fit their general conclusions in life (e.g., people always leave me).
5. Looking for themes. The counselor looks to articulate and activate themes and creates space for the client to do the same.
6. Evoking emotions. The counselor needs to move from an intellectual discussion to the emotions attache to the schema. Often-times, this means using the here-and-now to explore emotions. Otherwise clients only report on feelings in a disconnected manner. If so, they remain disconnected from the insights they gather.
7. Guided discovery (vs. just telling the client the interpretations). The authors present a good illustration of the difference between telling and collaboration on p. 298.
8. Imagery and meditation. The goal here is to use these techniques to activate and deactivate schemas. Why? They suggest these techniques support safety (to limit overwhelming oneself). They do note that while prayer may help in schema alteration its primary purpose is to connect with God and shouldn’t be thought of as some technique apart from its main purpose.
Finally, in the last 13 pages the authors take up how recursive schema activation is a bridge-building exercise. It bridges cognitive processes (logic, analysis) and emotional and relational processes; unconscious and conscious processes; past and present; events and meanings that we give them; schema activation and deactivation. They conclude that not every person has the psychological resources to deactivate schemas once activated and point the reader to the next two chapters where relationship interventions will need to be used.
MY THOUGHTS: This is a good chapter that describes what I think is core to therapy: self-observation in a safe environment that happens as much through experience as it does through logical analysis. The reality is that our schemas shape our sense of self and the world as much as our 5 senses do. We think we merely ascertain what is happening to us but in fact we are prepping our critical thinking with assumptions. Here’s my question. Is the schema something that can be changed. I hear the authors saying that they aren’t all that optimistic about it but just maybe we can control it, decide not to listen to it. In part I agree. And yet I don’t want to underestimate just how much a person can change their outlook on life and self. Where I think the biggest challenge lies is helping clients feel safe enough to accept that they make these assumptions. In couples counseling I find many/most couples unwilling to consider the possibility that their assumptions about their no-good spouse were formed before the ever met their spouse. They come wanting to fix the marriage and part of my job is to help them see that before they can fix the marriage they need to understand how their responses tell a lot about themselves and maybe less about their spouse than they think. This is hard for counselees to accept because it sounds to them that they are responsible for their spouse’s bad behavior. Helping a client not live in all/nothing thinking is my challenge. Further, I must make sure not to fall into “telling” mode when helping someone come to this realization. Sometimes I want to speed up the process and thereby lose the client.
MSNBC provides this transcript of Obama’s speech today. As you likely know he is under fire for comments his pastor, Jeremiah Wright, made in sermons over the years. This speech is quite masterful as it rejects Wright’s characterizations but recognizes the reality that is behind his angry judgments about American politics, racism, injustice, and place in the world. He shows the parallel with white anger for being held accountable for the sins of our early fathers. In both cases, impolite speech is understandable but not helpful. He says,
Just as black anger often proved counterproductive, so have these white resentments distracted attention from the real culprits of the middle class squeeze
What should we do? He tells us to take responsibility for our lives, reject victim mentalities, insisting on justice for all, acknowledging the legacy of discrimination, rejecting cynicism, working together as opposed to for our own good alone.
He’s right. When we see hyperbole, we must acknowledge the truth at the center. Fact: we have been arrogant snobs in dealings with other countries. It shouldn’t surprise us that if we kick the dog, the dog bites back. Fact: The country wants equality as long as it doesn’t cost anything. We keep complaining, but until we all agree that my neighbor’s struggle is my own, we won’t see much change.
He’s wrong. Trying harder and being truthful about racial reconciliation progress is good, but it is not enough. Without the work of the Holy Spirit, the breaking of our pride, the demand that our individual identities take precedence over that of God’s humble servants, we’re not likely to make much more progress. Legislation helps curb our sin, but it does not stop the seed of racialization. Only the Cross does that. Isaiah’s prophecy is that God is going to discipline his people so that cannot put their trust in man–whether he is bad (e.g., Ahaz) or good (Hezekiah). He lays us bare then He brings us into Zion so that we know that it is His power and holiness that makes us his people.
One final note from his speech. See how he explains why he doesn’t reject a friend who has said stupid things. In my mind this is how we ought to talk about each other instead of throwing them under the bus in order to get what we want:
I can no more disown him than I can disown the black community. I can no more disown him than I can my white grandmother – a woman who helped raise me, a woman who sacrificed again and again for me, a woman who loves me as much as she loves anything in this world, but a woman who once confessed her fear of black men who passed by her on the street, and who on more than one occasion has uttered racial or ethnic stereotypes that made me cringe.
One year ago, we had an ice storm that crushed my greenhouse. I’m itching to rebuild it (already made the skeleton of it out of PVC with my father). But I’m going to wait up bit longer. Until then, I’m looking for the signs of Spring, such as…
Meanwhile, my parents still have this (or most of this…) to contend with:
Filed under gardening
Unfortunately, many people experience violent or near death experiences. Some of those folks go on to have symptoms fitting the diagnosis of Posttraumatic Stress Disorder (PTSD): intrusive memories/flashbacks cause them to reexperience the event coupled with attempts to numb themselves in some way and yet still finding themselves in a heightened state of vigilance all of the time.
Since the Vietnam War, we’ve learned a lot about this set of problems. The primary forms of treatment touted now are controlled and imaginal exposure to the traumatic event(s) coupled with relaxation, distraction, and cognitive reframes. And we continue to learn about the presence of PTSD in violent family dynamics as mentioned last Monday (3/10/08).
But here are two articles pointing to somethings I hadn’t thought much about:
1. Perpetrators of violent crimes sometimes experience PTSD from their crimes. A group of English researchers did a study of 105 prisoners who had committed intentional violent crimes. 46% experienced distressing intrusive memories (one aspect of PTSD) and 6% met criteria for PTSD. The more antisocial the criminal before the crime, the less likely they would actually experience distressing intrusive memories. So, those who are most uncaring don’t really struggle with these problems. Here’s a question: should you try to help perpetrators with their distressing, intrusive memories? Does having them lead them to be less likely to re-victimize? Or do they make them more distressed, more hypervigilant and therefore more likely to attack?
Biblio: Evans et al. (2007). Intrusive memories in perpetrators of violent crimes: Emotions and cognitions. Journal of Consulting and Clinical Psychology, 75, 134-144.
2. Why is it that attachment literature and adult PTSD from child abuse literatures have been separate? Stovall-McClough & Cloitre of NYU ask this very question and review the literatures from each area. Attachment literatures come out of developmental theories while PTSD research tends to be CBT based. But the two are quite connected. Consider the authors points:
Biblio: Stovall-McClough & Cloitre (2006). Unresolved attachment, PTSD, and dissociation in women with childhood abuse histories. Journal of Consulting Psychology, 74, 219-228.
Filed under Abuse, Anxiety, Post-Traumatic Stress Disorder
Several of the folks at HarvestUSA (see my sidebar for their site) have written pieces for the Philadelphia Daily News. My friend John’s piece was published most recently so click the link and read and rejoice in God’s redemptive power.
Filed under Christianity: Leaders and Leadership, Relationships, Sex
Counselors have vastly differing styles of counseling. Some choose to be directive, others are remain passive even when the client wants them to give advice. We are different because of our varying theories and personalities. But I always assumed that most counselors do not take notes during sessions unless needing to record very specific details (say taking a family genogram or collecting details for a psychological report). But after having conversations in several different locations I learn that many write during the session. They write down key client phrases and other things that they wish to come back to and explore at a later date.
I’m curious about your experiences–either as a counselor or counselee. Was there note-taking going on during the session and was it helpful (for both)? Did it cause problems?
I don’t take notes in session so that I can stay engaged in good dialogue with my clientele. I don’t want to miss subtle details and I don’t want to break up the work by taking a note. It seems to me that if I take a note during the session, the client waits for me to do so and then they move out of an experience to only describing an experience–and so distance themselves from their feelings and thus any insight or intervention is also distant.
What do you think?
Its easy to do…here’s a man who knows all the ins and outs of money laundering tactics since he used them to prosecute many criminals in his previous job. He’s also taken down several prostitution rings. He has daughters and ought to think about how he would feel if they engaged in this behavior. He has a long marriage and ought to think about she has been so violated.
He knows better and yet he spent thousands of dollars over a long period of time pursuing sex with prostitutes. And we are tempted to think judgmental thoughts. How could he… Serves him right…
But Jesus says that if you have engaged in desiring and lusting after someone not your spouse, you are just as guilty as Spitzer. That’s a hard teaching. We know secret thoughts don’t have the same consequences as actions and yet everyone starts down the path from the same place.
What his tragic story should encourage us to do is to be sober about our own deceptive thoughts and desires, pray for his family, thank God for the cross and the offer of forgiveness, and endeavor to say no to sin and yes to love of others.
Filed under News and politics, self-deception, Sex, sin
Musings on Faith and Psychology 