East Bay CAMFT Newsletter Archives

President's Statement with EBCAMFT President, Kelly Sharp, LMFT

Admin EBCAMFT — Wed, 30 Oct 2013 13:05:55 GMT

Happy Fall!

We are heading into a particularly busy time for the Chapter with elections around the corner and planning for annual General Membership meeting.

This year we will have several open positions on the Board and I welcome your interest in participating on the Board for 2014. We have Member at Large positions open as well as the Secretary position. With all that has been going on at the State level, we are in great need of passionate members to assist the Chapter in advocating for the needs of MFT's. Please contact me for more information. Election ballots will be sent out in mid November.

We are currently in the process of putting together the results from our recent survey about the CAMFT bylaw changes. We will share results ASAP and appreciate all those who participated. EBCAMFT will continue to utilize surveys to gain clarification around our Chapters’ needs and ways to best serve our community.

As many of you already know, State CAMFT voted at their most recent Board meeting to repeal the new bylaws and reinstate the former bylaws pending a membership vote. This action is a step in the right direction and would not have been possible without the hard work from many dedicated members who gave their time and energy to advocating to the State Board. In an effort to show support for the cause and the efforts of those who have generously donated their time and energy, the Board of EBCAMFT recently made a donation to Laura Strom, MFT and Heather Blesssing, Intern MFT. These two women have worked tirelessly for the cause to reinstate the old bylaws and we wanted to show our appreciation by helping to offset the costs of their work.

I am including a very important write up from Jason Saffer, MFT about the upcoming membership vote to repeal the new bylaws. Please read carefully and be on the lookout for your ballots to arrive. Feel free to contact me at any time with comments or suggestions and please consider joining us on the Board for 2014. kellymsharp@gmail.com

Please read carefully (Thanks to Jason Saffer, MFT for allowing us to share this):

STATE CAMFT BOARD OF DIRECTORS
APPROVES REPEAL OF NEW BYLAWS!
YOUR VOICE HAS BEEN HEARD! -
AND YOUR VOTE IS STILL NEEDED!

Dear Colleagues,

Due to the immense outcry from the CAMFT membership, the CAMFT Board has decided to repeal the 2013 Bylaws, subject to voter approval.

Your vote is needed by Nov. 30th!

The CAMFT Board of Directors met in Santa Barbara September 21-22, 2013 and deliberated for 12+ hours over the many communications they received with regard to the bylaws changes. In addition, fourteen CAMFT members from across the state attended the meeting and twelve gave passionate testimony about the bylaws changes that helped the Board make their decision.

Ultimately the Board approved the following two motions:

1. "To approve the repeal of the current bylaws approved in July 2013 and reinstate the bylaws adopted in January 2009. The Board's approval is subject to voting members' approval by ballot."

2. "To send the vote to the membership, regarding the bylaws, per the motion approved on September 21, 2013, for a December 4, 2013 election date. December 5th and 6th to be designated ballot-counting days."

What does this mean? CAMFT's future depends on your level of involvement! Please vote on or beforeNovember 30th, 2013 to ensure your vote arrives by the Dec. 4th deadline in the CAMFT office. Ballots will be sent out in late October or early November 2013.

YES Vote = You agree with the CAMFT Board to repeal the recently passed July 2013 State Bylaws and revert back to the 2009 Bylaws. (CAMFT will revert to representing just MFTs and MFTIs).

NO Vote = You do not agree with the CAMFT Board to repeal the most recent Bylaws and therefore want the 2013 Bylaws to stay in place. (CAMFT will stay on its path of opening to all other masters level and above license types including psychologists, social workers, psychiatrists, professional counselors and educational psychologists as a broad based mental health organization).

PLEASE KEEP AN EYE OUT FOR YOUR BALLOT IN THE MAIL.
(Per the advice of their counsel, MFT Interns will not be allowed to vote since they did not vote on the original bylaws ballot in May 2013).

It is important to remember that "re-setting" back to the 2009 Bylaws is a first step in a longer dialogue process about the direction CAMFT members want our association to go.

- Kelly Sharp, LMFT
President, EB CAMFT

Challenges and Rewards of Treating Longer-term Eating Disorders By Johanna Marie McShane, PhD, CEDS

Admin EBCAMFT — Tue, 15 Oct 2013 13:04:05 GMT

Treatment of eating disorders has historically been conceived as rather monolithic or as a bit “one size fits all.” Until recently, little attention has been paid to variables such as the age at which the illness developed or the duration of the illness. Fortunately, clinicians are beginning to recognize the impact of these variables on the course of the disorder and on treatment.

Briefer-term eating disorders, have been studied and written about to some degree, and a specific treatment model exists. Longer-term eating disorders need similar attention.

Longer-term eating disorders benefit from treatment modalities tailored specifically to the complexities unique to those types of illnesses. These include a deep and wide-ranging dependence upon the symptoms/behaviors of the disorder; the sufferer’s belief that he/she “is” the illness as opposed to a person who "suffers from" the illness; an entrenched world view based on the eating disorder that leads to profound difficulty envisioning life without the disorder and an inability to believe in the possibility of surviving without the “assistance” of the illness; diminished experience in relationships other than with the illness, and the sufferer's consequent fear of incompetence in his/her ability to cultivate and maintain fulfilling connections.

In addition to psychological issues, medical and nutritional matters need to be considered within the context of the longer-standing nature of the illness. Serious physiological consequences can occur in any eating disorder; however longer-term eating disorders carry with them particular risks, not the least of which is higher mortality.

Treatment for longer-term eating disorders must navigate all these complexities, balancing attempts to reduce/resolve symptoms with the reality that the sufferer is intensely attached to and dependent upon those very symptoms.

In keeping with this, longer-term eating disorders need and deserve their own treatment models.

From a psychological standpoint, some approaches to treating eating disorders view the sufferer as engaged in a “war” with his or her disorder, the objective being to “win” the war by “conquering” (destroying) the disorder. Adversarial stances can provoke unintended consequences, particularly in longer-term illnesses: escalation of symptoms, intrapsychic disconnection and antipathy, antagonistic relationships between clients and clinicians.

Specifically designed for longer-term eating disorders, The Mediation Model holds that the sufferer and his or her disorder are not enemies. The goal of treatment is not to “kill off” the eating disorder, but to understand and then resolve what have seemed inexorable “conflicts between the sufferer and the illness.” As resolution of these “conflicts” occurs, symptoms of the eating disorder diminish.

Treatment of longer-term eating disorders brings myriad challenges. It also offers innumerable rewards for the sufferer and his or her family, and for clinicians. Treating these illnesses should be considered a specialty in its own right, with specific training for clinicians who wish to work with these types of sufferers. Longer-term eating disorders have often been considered “recalcitrant” or “treatment resistant” or “too chronic to treat,” or worse yet, “hopeless.”

This shouldn’t and needn’t be the case if we improve and expand our understanding of this subsection of eating disorders, and if we advance our ability to address these illnesses.

Dr. Johanna Marie McShane has been working in the field of eating disorders treatment for twenty-two years. After beginning her career as a therapist in an inpatient/residential eating disorders program, she went into private practice in 1994, working with adolescents and adults who suffer from all types of eating disorders. She has a passion for helping sufferers, their families and other loved ones understand these illnesses, as well as for guiding them through the process of recovery.

Johanna Marie McShane, PhD, CEDS
Licensed Psychologist,
Certified Eating Disorder Specialist
925.998.7153
jmmcshane@sbcglobal.net
drjmcshane@sbcglobal.net
www.johannamcshanephd.com

A Kinder Divorce By Sara Bisikirski, LCSW

Admin EBCAMFT — Mon, 14 Oct 2013 13:01:29 GMT

Every day individuals and couples seek therapy for support around relationship difficulties. As therapists we know that frequently this work does not result in more satisfied partnerships, but instead a decision to separate and therapy then becomes a place to problem solve how to do so most effectively.

Therapists are often asked for guidance in this area, however we might have as many questions about the divorce process as our clients do. In attending A Kinder Divorce you will receive information about the ins and outs of the different pathways (i.e. litigation, mediation, collaborative practice, do it yourself) available to obtain a divorce or legal separation as a way to best inform and support your clients. We will also discuss:

-the pros and cons of the different divorce processes
-options for making adjustments to court orders
-community resources available to support divorcing families
-the legal, financial & emotional issues surrounding divorce.

Also because this particular A Kinder Divorce workshop is being geared toward therapists, rather than its usual audience (individuals who are facing divorce or separation) we will also discuss diagnostic and other therapeutic considerations to make in assessing what divorce process could perhaps be most appropriate for a particular client. Please feel welcome to bring questions that could benefit from consultation of this type.

Having trained initially as a child and family therapist Sara Bisikirski, LCSW has worked with clients from the ages of 4 to 80, providing individual, couples, family and group therapy. In addition to her role as the co-founder and therapist half of the attorney-therapist mediation team of CA Family Mediation Services, most recently Sara has worked as a therapist and clinical supervisor within the Department of Psychiatry at Alameda County Medical Center and the MindTherapy Clinic of Corte Madera and San Francisco. Licensed to practice in California since 2006, Sara received her B.A. from Oberlin College and Master of Social Work from the University of Michigan. She was certified as a mediator through the Northern California Mediation Center.
With a background in psychotherapy first, Sara’s career choices have been driven by a passion for trauma prevention and treatment. In this way she views mediation as a natural progression of her clinical work: an opportunity to help families resolve divorce or other family law issues in a way that minimizes the traumatizing impacts that traditional family court battles can have.

Sara Bisikirski, LCSW
CA Family Mediation Services
510.469.1313
www.camediate.com

President's Statement with EBCAMFT President, Kelly Sharp, LMFT

Admin EBCAMFT — Sun, 22 Sep 2013 21:03:23 GMT

Fall is upon us and the Board of EB CAMFT is preparing for a busy few months. The next EB CAMFT Board meeting will be held on Friday, September 20th from 4-6. Immediately following the meeting we will be hosting our Summer Social at the Epworth United Methodist Church in Berkeley. We welcome you to attend both the meeting and the social.

Our Mentoring Program has really taken flight and we appreciate all the participation and feedback about this budding program. We still have a few Mentees looking for Mentors so please let us know if you are interested in participating as a Mentor. Recently our Program Chair, Laura Friedeberg, hosted a didactic training called Finding Inner Courage, presented by Ilene Wolfe, MFT. Laura is already planning future trainings, please check the calendar of events for upcoming trainings and other Mentoring Program events. If you are interested in learning more or participating in the program, contact Laura at lfriedeberg@yahoo.com.

Stay tuned for details about our upcoming General Membership meeting. EB CAMFT is looking to host this annual meeting in October. We are firming up dates and securing our guest speaker. With much to discuss with our members regarding the current state of CAMFT, we are hoping for a large turnout and rich discussion.

Please pay attention to your inbox as we have sent out a Survey Monkey link asking for your participation in a quick survey about your experience and input regarding the CAMFT bylaws. The information gathered from this survey will have great implications for how the Board of EB CAMFT moves forward in supporting our members. The survey results will be disseminated to our members so we can all be informed where our Chapter stands on these important issues.

Thanks again for all the support, comments and feedback during this very active time for our Chapter. I look forward to the continued dialogue. Please feel free to email me kellymsharp@gmail.com with further ideas and comments or to RSVP to the Summer Social.

Munchausen By Internet By Shalini Dayal, LMFT

Admin EBCAMFT — Sun, 22 Sep 2013 20:42:23 GMT

Munchausen and Origins:

Munchausen is a severe form of Factitious Disorder where the person feigns or produces symptoms of illness designed to garner sympathy and attention. (Feldman & Ford, 1995). In Munchausen, for example, the person may travel and may endure invasive, sometimes dangerous procedures to gain attention and sympathy. The sufferers often take on other personas and invent extensive fabrications to support their claims and gain sympathy.

The word Munchausen comes from Baron Karl Friederich Heironymous Freiherr von Munchausen (1720-1797), a German nobleman and cavalryman, who is said to have regaled his friends and associates with fantastic and often outlandish stories of his exploits.

In 1953, Richard Asher, reported on people feigning illness and named this disorder after Baron Munchausen. Dr. Asher was a British endocrinologist and haematologist. He worked in the mental observation ward at the Central Middlesex Hospital and described Munchausen Syndrome in an article in 1951 (The Lancet, 1951).

Munchausen differing from other disorders:

In her profiling journey, Pat Brown, talks of volunteering in hospitals to learn and observe people’s behaviors and often seeing how some willingly create and act out symptoms to get attention and sympathy and to control others around them, often unaware and uncaring of the toll it takes on others.(Pat Brown, The Profiler: My Life Hunting Serial Killers and Psychopaths, 2010).

Munchausen is also commonly recognized as Munchausen by Proxy, where a primary caregiver fakes or exaggerates illnesses or symptoms in a dependent, usually a child. This illness is extremely difficult to diagnose since the caregiver is often very attentive and caring and puts on a good show. The caregiver is often familiar with the medical illnesses and carefully plans the exaggeration of symptoms, at times, putting the child at grave risk.

Munchausen differs from Malingering which has external incentives, while attention and emotional gains are the driving motives for Munchausen. Malingering is the purposeful production of falsely or grossly exaggerated complaints with the goal of receiving a benefit or reward, such as money, insurance settlement, drugs, avoidance of work or military duty or some other kind of responsibility (Psychology Today, 2010)

In Somatoform disorders, the symptoms are not voluntarily produced. The somatoform disorders are a group of psychiatric disorders in which patients present with a myriad of clinically significant but unexplained physical symptoms. They include somatization disorder, undifferentiated somatoform disorder, hypochondriasis, conversion disorder, pain disorder, body dysmorphic disorder, and somatoform disorder not otherwise specified.1 These disorders often cause significant emotional distress for patients and are a challenge to family physicians. (American Family Physician, 2007)

Conversion disorder, also known as Hysterical Neurosis, is a mental health condition in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation. Sufferers are not making up the symptoms and usually are afflicted because of an underlying emotional or psychological conflict/stress or trauma (A.D.A.M. Medical Encyclopedia., Nov 17, 2012)

Munchausen by Internet:

With the advent of the internet and the resources it offers, Munchausen has developed in a new way. As we all know and utilize, and often direct clients to, there is an abundance of online support groups, chat rooms, newsgroups, social media, etc. Often, the ones using these groups, see them as an invaluable resource where they receive and offer support to others like them, sharing their hopes, fears and information. However, at times, some of the members are not there because they too have suffered as the because of an underlying emotional or psychological conflict/stress or trauma (A.D.A.M. Medical Encyclopedia., Nov 17, 2012)

Recent Events:

There have been several recent events reported in the news media about people claiming to be someone they are not, while inserting themselves in people’s lives to gain sympathy and emotional support, like Mandy Wilson and Manti Te’o. The behaviors demonstrated by the Mandy Wilson and T’eo’s relative are surprisingly similar along with the motive of gaining love and sympathy.

Mandy Wilson from Australia, posted her plight to an online support group attended by people from around the world, about her struggle with cancer as a single mother. Her Facebook page showed postings from her friends regarding her condition, which all turned out to be falsely created to get the emotional support and sympathy of the support group members. It all came to light when a 42 year old Canadian, Dawn Mitchell, who was closely involved with Mandy Wilson, grew suspicious after seeing pictures of Mandy after chemotherapy. Mandy had hair growing out quickly, something that doesn’t happen after hair loss due to chemotherapy. Dawn searched for obituaries of Mandy’s friends who had supposedly died and was unable to find any news on their deaths. Dawn was instrumental in exposing Mandy to the other group members. Mandy Wilson disappeared and has probably joined other online support groups under a different persona with a new set of online community supporters She left behind many who were disillusioned and jaded with the online group and hurt at the time and emotional investment they had put forth.

Manti T’eo, a Notre Dame football player, got involved with a woman online in 2011. He never met her in person, but carried on a 2 year online relationship. He went on to dedicate a game to his girlfriend, who he believed to have died because of cancer. When people questioned T’eo about meeting this girl, he claimed to have met her because he did not want to be ridiculed for having a purely online relationship and not questioning the identity of that person. It was eventually revealed that the online persona was created by a family friend who was in love with Te’o. To save face, T’eo frequently changed his story, at one point claiming he had met the woman in person. Te’o, like numerous others, was embarrassed for his gullibility in falling for this deceit.

Unfortunately, as news stories reveal, Te’o was not initially believed and many a sports writers had a field day making fun of him. The person who defrauded Te’o came up with an elaborate explanation for his actions. He calls himself confused and in recovery from homosexuality.

In the following case, the progression of events are very apparent with how the stage was set, how convincing the story was, how it evolved to fit the needs of the person, and how it hooked those close to her to fill her deep need for attention.

Setting The Stage: Paints a pitiful picture
In the beginning of 2007 after a painful breakup, Liz reconnected with her first cousin, Karen who lived in Toronto. Karen was 14 years younger, told Liz of a difficult childhood, including sexual abuse by a babysitter’s husband and physical abuse by her parents. Karen quickly inserted herself into Liz’s life, often calling and texting her, telling her about her (Karen’s) medical problems and unsupportive family. Karen told Liz about a horrible gang rape in high school and her first boyfriend dying tragically a few years previous. Karen’s current boyfriend contacted Liz about Karen’s health, showing great concern. Shortly thereafter, Karen accused her boyfriend of raping her and cut off contact with him. Her counselor, in Toronto also contacted Liz, via email and text about Karen’s depression. When Liz expressed concern about Karen’s health, Karen’s cardiologist contacted Liz about Karen’s heart problems. From 2007 onwards Karen began visiting Liz regularly: Karen often insisted on being introduced as Liz’s oldest daughter.

The Plot Thicken; Hooking The Prey:
In 2007, when Liz signed on to Chemistry.com, Karen’s counselor in Toronto introduced Liz to her close friend, Tony. This online relationship developed quickly. However, they never talked on the phone and he was reluctant to visit. Karen quickly put any doubts on Liz’s part, to rest, telling Liz she was friends with Tony’s now deceased daughter, confirming he suffered from PTSD so could not talk on the phone. Karen often assured Liz that Tony would someday visit Liz in the Bay Area.

More Drama
In 2009, Karen told Liz that she had begun a new relationship with her best friend’s ex-boyfriend. She asked for Liz’s help and support as she was afraid of being ostracized by her best friend. Karen’s health problems had escalated and she had now been diagnosed with Lupus. Tragically, Karen’s new boyfriend died suddenly of massive heart failure at the age of 30 in London, England. Tony was instrumental in helping Liz connect with Karen’s new boyfriend during his hospitalization, through some of his good friends who were physicians in England. Along with these physicians there were several minor players introduced, too many to mention here.

The Unraveling
Liz became increasingly exasperated with Tony and his reluctance to meet her. Her relationship with Karen also began faltering in 2012. Liz cut off contact with Tony, and lost touch with some of the people in Karen’s life, her counselor and cardiologist, who had been regularly contacting her until that time. . Karen’s counselor had sent some bizarre accusatory messages to Liz regarding Karen’s care, so Liz cut off contact with the counselor. Liz finally broke off with Karen herself when Karen became increasingly needy and self- centered, all her conversations focusing on herself, her needs and her successes.

The Truth
In the early part of 2013, at the urgings of a friend, Liz began to search for Tony, Karen’s therapist and Karen’s cardiologist. She called other family members to confirm Karen’s illnesses and the people involved in her life. She discovered that none of them existed. In all, Liz found that Karen had created over 12 online personas who had contacted Liz at various points in the past 5 years, to create a concerned and supportive network for Karen. All them were email entities only, all the emails originating from proxy servers and from one single server based in the Bay Area. Some were modeled after real people in Karen’s friend’s lives, but no one in the whole story except Karen was real.

Symptoms or Ways to Recognize Munchausen by Internet: So what do you do when you suspect someone you know online is not being honest? It is important to note, these people are very intelligent and should really be script writers in Hollywood instead of creating elaborate schemes to hook their supporters. Some of the red flags are:

Working knowledge of symptoms of diseases and illnesses, some descriptions match posts and explanations on websites.
Symptoms escalate if doubts are brought up or focus shifts to others.
Miraculous recovery or dissipation of symptoms.
Contradictory statements with no relevant explanations.
Online postings, emails, phone calls,(?) texts etc. by people around the person such as friends, family, etc. who support the individual, often similar wording and patterns. These people never appear in the flesh.
Elaborate stories and events, one more fantastic then the other like dying or moving away, etc.

Some technical ways to verify people and emails: You can find anyone, anywhere, if you know how. I learned a lot and I can find anyone, as long as they exist. Once someone sends an email, they have created an un-erasable path or signature.

Questioning and verifying addresses, if possible, to verify authencity of the user.
Similar methods of communication: same messenger, like Yahoo, or Gmail, which send texts directly to phone numbers.
Find people online using people search engines like People Search, Zaba Search, White Pages.
Use reverse email look up to see originating point of emails. Usually there may be a common originating IP address and/or Proxy servers. Looking for people through home ownership records and other services which are public.

Treatment for the Victims and those diagnosed with Factitious disorder
The victims of people with Factitious Disorder or Munchausen By Internet, often need extensive help and support through their recovery. Their faith and trust in people and the group process is usually shattered. They are deeply ashamed and embarrassed at falling for lies. They need a safe, non-judgmental place to regain that faith and trust again, through individual and ironically, through group therapy. Dr. Feldman recommends an online group therapy to rebuild the broken trust and faith in the power and healing of the group process.

Treatment for those diagnosed with Factitious Disorder, can include several modalities though primarily depends on the
individual’s commitment to change their behaviors. There are no known statistics on successful treatment for Munchausen by Internet.

Some treatment options include but are not limited to:
Traditional talk psychotherapy for the people who commit these frauds is recommended. Treatment includes transparency in their relationships, working in individual and family therapy, on issues of ownership and responsibility. Family therapy increases the chances of recovery, and/or some suppression of some behaviors, like tall tales.

Friends and families can help confront the person and keep them on track. As a word of caution, those involved should be prepared for histrionics and further manipulation. Treating any co-occurring or underlying issues of depression, anxiety or OCD behaviors. Evaluation and treatment for addictions and other maladaptive behaviors.

Those diagnosed with Factitious Disorder, do not take responsibility quickly and easily. They lack empathy for the people hurt by their lies and actions, and often show no remorse for others. Most of the persons who commit such acts usually disappear when confronted. They often manipulate others to generate sympathy for themselves and not their victims.

The Internet can give us a thousand identities and the power to change them as needed. In the end, it is our responsibility to be vigilant of our online communications and interactions, to follow our gut instinct, check and recheck when possible. Remember, if someone feels too good to be true, and you have never seen them, they probably are just that, Too Good To Be True.

______________________________________
I am in full time private practice in Fremont, for the past 7 years. Prior to that, my background includes working for the City of Fremont Youth & Family Services, the Fremont Police Department, Shelter for Violent Environment, the New Haven Unified School District and the Alameda County Sheriff's Office. During the course of the past few years, I have worked with kids, teens, families, individuals and families on a variety of topics. I have dealt with Domestic Violence, Child and Adolescent behavior issues, depression, ADD & ADHD. I work extensively with children, adolescents, individuals, couples and families with emphasis on cross cultural and gender issues, sexuality, assimilation, expectations and communication, using non-verbal methods like play and art therapy with young kids. I am also trained and certified in EMDR.

Op-Ed: Petition to Governor Jerry Brown Regarding the Intern Hours Verification Process Jenny Kepler, MFT Registered Intern

Admin EBCAMFT — Sun, 22 Sep 2013 20:35:55 GMT

Editor: A few weeks ago I received an email from a colleague containing a link for a petition related to the amount of time it took for the BBS to review interns' hours, allowing them to take the licensing exams. I contacted the petition's author, Jenny Kepler for information on her motivation and hope behind the petition. Here's her response:

Jenny Kepler: I want to convey how unfair it is that after the years of school, training and interning we do (the 3000 usually takes 3 years to attain), the BBS makes us wait at times up to 8 months to approve us to sit for the exam. We put in so much time and energy, working for nothing or very low wages (I have 2 kids, I could never support them on intern wages on my own) despite our professional level of education. During the time it takes the BBS to approve our hours, we continue to work for free or low wages, pay for supervision and be denied access to the professional status we have earned - even though we have completed our training. We work in agencies, seeing really hard clients. We do the jobs that people further along in their professional paths often opt out of. We do this because we are passionate about our work and its value to society. We deserve to be valued for our commitment, not punished. We deserve a license as soon as possible.

The application itself says that approval should take 4-6 weeks. While the hours approval is very important, there are many ways that the BBS could streamline it for us. Since I started this petition I have heard so many horror stories about people who've waited all this time just to be told they are missing a signature or a class. They could have taken care of those issues while they waited for their hours to be approved. Now how much longer must these folks wait? Surely, the State of California has the technology and the funds to make this process more efficient.

I hear that many interns drop off the licensing track since they can't afford to work for such low pay without family support, independent wealth or a second or third job for so long. I wonder how this impacts the socio-economic range of diversity of the licensed population.

It's not just interns that suffer because of this archaic system. Clients suffer too, as agencies often can't hire therapists without licenses, clients must wait in line. As ObamaCare rolls out and more people will be able to access mental health services I imagine this will only get worse. Unless the BBS makes a change.

_______________________________
I received my bachelor's degree in modern literature from UCSC in 1995 and master's degree from CIIS in 2011. I have worked in the food, wine and travel industries, and more recently have been a doula and a therapist. I have been with Through the Looking Glass in Berkeley providing parent/infant therapy with their Early Head Start program since 2012.

Notes:

To access and sign the petition, please visit:
http://petitions.moveon.org/sign/governor-jerry-brown-6? source=s.icn.em.mt&r_by=8554288

The full text of the petition:

Petition Statement

We are dedicated and have worked hard to prepare ourselves to serve California’s growing mental health needs. MFT interns should be able to take the licensing exam within a reasonable amount of time so we can get to work providing these much needed services.

Petition Background

It takes Marriage and Family Therapist interns like me years to complete our licensing requirements, including our 3000 supervised clinical hours. After we’ve met these requirements, the Board of Behavioral Sciences currently takes 7+ months to verify our hours, simply because they are understaffed. Hiring just one more employee at the BBS would make an enormous difference in the lives of interns who are forced to wait almost a whole year despite being basically license-ready.

To check on important updates from the BBS, please check their site regularly: http://www.bbs.ca.gov/. It appears that they are in the process of switching to online license and renewal applications, however it isn't clear whether they are including the hours verification process in this new system. You can read more about BreEZe here: http://www.dca.ca.gov/about_dca/breeze/index.shtml

The site currently states: IMPORTANT MESSAGE FOR RENEWING LICENSE APPLICANTS:
Please complete your applications prior to September 15, 2013 in order to avoid delays.

The Department of Consumer Affairs will be transitioning to the new BreEZe online licensing and enforcement system in early October. During this transition, there will be temporary disruptions in cashiering and other services.

If your license renewal date is anytime in September or October, these disruptions could affect you.

Please renew your license early! Do not wait and risk a late renewal!

Examination candidates whose test eligibility expires late September and early October may also be affected. Please submit your application prior to September 10, 2013 to avoid delays.

President's Statement with EBCAMFT President, Kelly Sharp, LMFT

Admin EBCAMFT — Mon, 02 Sep 2013 20:29:57 GMT

Hope everyone is enjoying this beautiful summer.   A lot has happened over the past month and EB CAMFT has busily been trying to keep up and remain active with the recent State CAMFT Bylaw changes. We have heard from several Chapter members who have emailed, attended Board meetings and/or made personal calls informing us of their concerns and questions regarding the bylaws. We appreciate your voice and continue to solicit your input so that we can serve you best and stay informed about the needs of our Chapter. Most recently the Board sent a letter to Jill Epstein and the State Board reinstating our position about nullifying the recent vote and beginning the process over to include more dialogue and input from members. On July 27th there was a great turnout in Marin for the meeting with Jill and 2 other State Board members. If you were unable to attend the meeting, you are able to watch a video of the meeting on YouTube. http://youtu.be/Z8KginNfcDk

Fall is around the corner and the Board has begun conversations about upcoming elections. Now is a great time to consider ways you can become more active in EB CAMFT and participate in creating changes that are in line with our members’ needs. We will have several positions open and welcome your application to serve as a Board member. Feel free to email me at kellymsharp@gmail.com if you are interested or have questions about the details.

The next EB CAMFT Board meeting is Friday, August 16th from 4-6pm. We will continue discussions of the bylaw changes, revisit hosting another social and begin strategizing for building a strong Chapter Board in the next year. We welcome your input and attendance.

                         Kelly M. Sharp, LMFT
                         President, EB CAMFT

Treating Mood Disorders With Nutrition Teray Garchitorena, ND

Admin EBCAMFT — Mon, 02 Sep 2013 19:44:42 GMT

The food you eat can be the most powerful form of medicine, or the slowest form of poison.      ~ Ann Wigmore

The CDC reports that 11% of all Americans over 12 years old are currently prescribed antidepressants. This is a staggering 400% increase since 1988. Among women aged 40 to 59, one in four women are on these medications.

At the same time, concerns about the efficacy and safety of psychotropic drugs are the on the rise. Clinical trials show mixed benefit, with a study famously showing superior results from placebo. Because of this, more patients and providers are looking to natural medicine for solutions.

Supporting patients with mood disorders using diet usually involves one or more of the following strategies:
                      1.Blood Sugar Regulation
                      2.Providing Nutritional Building Blocks and Precursors
                      3.Modulating Inflammation
                      4.Healing the Gut

Blood Sugar and Mood
For the majority of people suffering from anxiety and fatigue, skipping meals is an aggravating factor.
To assess whether blood sugar is an issue, I ask my patient if she feels lightheaded or jittery between meals, tired after meals, or feels much better after a meal. I also ask if she craves sweets. Her answers let me know if I need to work on stabilizing her energy input via food, or whether I need to investigate insulin resistance.
Insulin resistance can also show up as difficulty losing weight, a belly that is wider than the hips, or a tendency to gain weight under stress.

Why is insulin resistance, or pre-diabetes, important in mood issues?
Glucose is the primary fuel source of the brain. Without a steady supply of fuel, synapses don’t work efficiently, neurons
degenerate, and this manifests in suboptimal mood and thought coherence. Insulin resistance is a phenomenon that develops over time, due to a combination of genetics and constant, excessive influx of sugar from the diet.

The natural function of insulin is to trigger glucose absorption into cells. The more glucose is in the bloodstream, the more
insulin is pumped out by the pancreas. Over time, insulin receptors on cells become resistant to the insulin signal. It’s a little bit like starting to tune someone out, if all they do is yell at you all day. Cells naturally become less sensitive to insulin (e.g insulin resistant) when they get too much, too often.

Unfortunately, insulin resistance takes place in the brain as well. Which means brain cells resist the signal from insulin, and don’t absorb their vital fuel, glucose. It’s no wonder that people with diabetes are more likely to suffer from depression – their brains are starving for glucose! But the solution is not to give them more sugar – that’s what got them in trouble in the first place. The solution is to re-set their insulin receptors so that they start to respond to insulin again.

Reversing Insulin Resistance
Have you ever heard the term “so quiet, you could hear a pin drop”? When there is no sound, our ears seem to be extra sensitive even to small noises. It’s the same for receptors. If you lower the volume of insulin, over time, the receptors start to pay attention and follow the signals to absorb glucose again. Note – this only applies to people who are not insulin-dependent!

How do you lower the volume of insulin? By lowering the volume of glucose in the blood. This is done via low-glycemic diet – low sugar, low refined carbohydrates, mostly whole foods. When done right, a low glycemic diet also provides all the nutrients needed for healthy mood and brain function.

Delivering the Raw Ingredients
The physiology of mood is dependent on several players – neurotransmitters, hormones and enzyme co-factors, to name a few. When treating mood disorders with diet, I need to ensure that patients are getting all the raw materials they need. Most neurotransmitters are made up of amino acids. The body gets about 70% of amino acid needs met through the food we eat – specifically, from protein.

The first order of business is usually to eat a palm-size worth of protein three times a day – especially breakfast. Most people skip this meal or power up with coffee and a pastry, setting off a mood and energy rollercoaster. Protein in the morning stabilizes blood sugar, and usually reduces cravings.

It is also important to ensure that they are getting enough fat. Every cell in the body is wrapped in fat, and many vitamins need fat for absorption. Good fats like olive oil, avocados, nuts seeds and fatty fish provide satiety, reduce overeating and provide for proper cell signaling and hormone production.

The fish-sourced EPA and DHA are crucial for mood. DHA in particular makes up a significant portion of the fat in the brain. It is EPA, however, that appears to be more important in treating depression. This may have a lot to do with the fact the EPA is a potent anti-inflammatory.

What is the relationship of inflammation and mood?
Inflammation is a major focus of almost every field of medicine. It a process that appears to underlie all of chronic disease – heart disease, cancer, autoimmunity to name a few. Inflammation is closely related to oxidative free-radical damage, a process implicated in degenerative diseases.

The central nervous system is in constant communication with the periphery –inflammation on one side of the blood-brain-barrier will affect the other. Depressed people are more likely to have inflammatory markers evident in blood tests, compared to non-depressed cohorts. EPA and DHA, powerful anti-inflammatory fats, have been shown to help in the treatment of depression.

The Power of Plants
Plant foods, particularly vegetables and fruit, are undisputed nutritional powerhouses. They are high in anti-inflammatory and anti-oxidant compounds. They contain the vitamin and mineral co-factors needed for the conversion of neurotransmitters. A British study showed that eating seven servings of fruit and vegetables was associated with greater mental well-being.

In addition to their incredible nutrient content, whole plant foods are high in soluble and insoluble fiber, making them essential for gut health. Which, you guessed it, plays a major role in the regulation of mood.

The Gut-Brain Connection
The gastrointestinal tract is also known as the “second brain”; it contains more neurons than the spinal cord or the peripheral nervous system. It contains 95% of our serotonin, as well as a large part of our immune system. The immune system, in turn, regulates inflammation.

The gut has the complicated task of absorbing nutrients, while keeping out microbes and other undesirable elements. This crucial process is disrupted in the medical phenomenon known as “leaky gut” – nutrients are poorly absorbed, and inflammatory particles enter the blood stream, causing immune reactions that can affect the brain. Leaky gut has been associated with depression and alcohol addiction.

Dietary fiber from plant foods helps correct leaky gut by nourishing GI cells with short-chain fatty acids. This is done with the help of beneficial bacteria, also known as probiotics. Research into the relationship between gut microflora and neurological issues is growing, as are findings that link the status of the “microbiome” with inflammation.

For the patient with a combination of mood problems as well as digestive problems, normalizing the GI is essential in the
restoration of balance and can have profound benefits. By stabilizing blood sugar, supplying the raw materials for
neurotransmission, controlling inflammation and healing the gut, it is possible for many individuals to avoid or minimize their need for medication.

The process does require education, commitment and patience. It also has the potential not just to treat mood disorders, but also prevent other disease, making it an incredibly efficient use of time and effort on the part of the clinician and the patient.

Dr. Teray Garchitorena has been practicing naturopathic medicine in Berkeley for five years, and is co-founder of the Berkeley Naturopathic Medical Group. Her programs provide integrative solutions for depression, anxiety, autoimmunity and fatigue.

510.856.8600
2615 Ashby Avenue, Berkeley CA
www.berkeleynaturopathic.com
info@berkeleynaturopathic.com

Working with Women Sex and Love Addicts By Joan Gold, MA, MFT

Admin EBCAMFT — Mon, 02 Sep 2013 18:58:47 GMT

They come from all walks of life: doctors and hairdressers, personal trainers and stay-at-home moms, law-breakers and law enforcement. They are upper class, working class, adult children of alcoholics, daughters of porn addicts, clergy, or both.   Many of them have concurrent eating disorders and/or alcohol or drug problems. They span all ages, and while a number fit the cultural stereotype for “attractive,” many others can and do go unnoticed in a crowd.

I have been working with women who are sexually and romantically compulsive/impulsive for five years now in my role as Director of Women’s Programs at Impulse Treatment Center (ITC). ITC currently runs 11 groups a week for male Sex Addicts and four groups per week for Partners. However, having even one women’s group for Sex and Love Addicts has been difficult to establish on an ongoing basis.

A major reason that Sex Addiction was not added to the recent DSM-5 was the lack of women in treatment for Sex Addiction.   Sex Addiction in women may be relatively rare while Love and/or Relationship Addiction appears to be more common. As noted in the proposed DSM-5 criteria, no single sexual or romantic behavior gives rise to a diagnosis of Sex and Love Addiction. To be termed “Sex and Love Addiction,” a clear destructive sexual/romantic pattern must be evidenced that disturbs relationships, careers, physical and/or emotional health.

In Ready to Heal, author and therapist Kelly McDaniel delineates the four cultural beliefs that underlie the development of Sex and Love Addiction (as known as Sex/Love/Relationship Addiction or SLRA) in women:
    I must be “good” in order to be worthy of love
    If I am sexual, I am “bad”
    I am not really a women unless someone desires me sexually and/or romantically
    I must be sexual to be loveable

The obvious impossibility of navigating these diametrically opposed beliefs is hard to miss. Throw in some childhood trauma, attachment issues, lack of boundaries or lack of modeling of healthy intimacy, and it is remarkable that more women aren’t struggling with SLRA. Or perhaps they are.

After several years of running groups for Partners of Sex Addicts I began to notice a curious phenomenon. While most Partners evidenced the classic signs of codependence – focusing on others rather than focusing on self – many others were clearly focused on their own needs to the exclusion of all else. They felt entitled to an available partner, insisting on their fantasy version of the addict as sexual/romantic object of choice despite all evidence to the contrary. It was the insistence on the fantasy that got me curious. Was it possible that a number of women in my Partners of Sex Addicts groups were also Sex/Love/Relationship addicted themselves?

I’ve never been big on labels and use the various terms primarily as a guide to treatment, so my first thought was to deal with the women together on a continuum, treating the lack of worthiness that both the Partners and the Addicts bring to their self-in-relation. This lack of worthiness comes from many different sources; for some Partners it may result from living in too close proximity to addiction for too many years, while in other Partners or the Addicts it may go back a lot farther, all the way to childhood. And there can be distinctly different ways of acting out these issues (which gave pause to my idea of treating them together in a group).

Both nature, nurture, and the current sexualized cultural climate contribute to women’s addiction and codependency patterns. Neither role ultimately satisfies the need for self-esteem and empowerment which accounts for the cyclical shift from addiction back to codependency back to addiction. (Kasl, 1989).

According to the Society for Advancement of Sexual Health (SASH), sexually addictive behavior patterns in women may include: Prostitution, excessive flirting, dancing, or personal grooming to be seductive; wearing provocative clothing whenever possible; changing one’s appearance via excessive dieting, excessive exercise, and/or reconstructive surgery to be seductive; exposing oneself in a window or car; making sexual advances to younger siblings, clients, or others in subordinate power positions; seeking sexual partners in high-risk locations; multiple extramarital affairs; disregard of appropriate sexual boundaries, e.g. considering a married person, one’s boss, or one’s personal physician as appropriate objects of romantic involvement; trading sex for drugs, help, affection, money, social access, or power; having sex with someone they just met at a party, bar or on the internet (forms of anonymous sex); compulsive masturbation; and exchanging sex for pain or pain for sex.

Again, it is important to note that no one sexual/romantic behavior qualifies for a diagnosis of Sex Addiction; diagnosis is not about judging anyone's sexual expression or behavior, but rather an evaluation of an overall pattern and history of behavior that results in legal, financial, medical, emotional and/or relational consequences.

Women who seek treatment for Sex and Love Addiction (including sexual anorexia, the other end of the acting-out continuum) usually do so because of some crisis; either confrontation or fear of confrontation by family or friends, or the legal, financial, medical, emotional and/or relational consequences themselves. The ageing process itself can also present a window for change.

There are a lot of challenges to working with women who have both an overwhelming longing for and fear of connection. Early research (and the approximately 40 women we have seen at ITC to date) shows that women SLRAs have more trauma then male sex addicts. Many women SLRAs have difficulty trusting other women; a women’s group is overwhelming just by definition. Attachment issues in general make it difficult for women to form a safe connection with a therapist or group members.

Initial contact by phone is extremely important. A number of women call to talk, but can’t actually come in for treatment
because, unlike the male sex addicts, they often do not have their own money or transportation or both. At Impulse Treatment Center, a large portion of the men we work with are still in relationship with wives/partners who are willing to support their treatment process. Women SLRAs do not generally find the same willingness on behalf of their partners; dependency, both financial and otherwise, is a key barrier to seeking treatment.

Despite these barriers, as anyone who works with addicts of any description knows, recovery is possible. Until my work in
establishing a solid group for women SLRAs is achieved, I rely on 12-Step programs, including Sex and Love Addicts Anonymous (www.slaafws.org) and Sex Addicts Anonymous (www.sexaa.org) to provide the ongoing community so necessary to support the Addict’s vulnerable self that emerges in early sobriety. And in the meantime, I look forward to the day that a female celebrity, a la Tiger Woods, will come out of hiding and open the door to a greater cultural understanding of the truth behind Sex and Love Addiction as it impacts women.
____________________________________
Charlotte Kasl, Ph.D., Women Sex and Addiction (New York: Harper and Row, 1989) 46.
Kelly McDaniel, Ready to Heal: Women Facing Love, Sex and Relationship Addiction (Gentle Path Press, 2008) 35. Society for the Advancement of Sexual Health (SASH) www.sash.net

Joan Gold is a licensed Marriage & Family Therapist and the Director of Women’s Programs at Impulse Treatment Center in Walnut Creek, the oldest and largest comprehensive Sex Addiction Treatment Program in Northern California (www.sexaddicttreatment.net).

She also has a private practice focusing on general addiction and codependency treatment as well as issues of ageing and creativity in Berkeley, CA (www.eastbayholistictherapy.com). Joan can be reached directly at 510.418.2387

The Core of Grief: What Every Therapist Needs to Know About “Ooey-Gooey Guilt”, Powerlessness and “The Grief Closet” Ninette Larson, LMFT

Admin EBCAMFT — Mon, 02 Sep 2013 18:55:25 GMT

My son died almost 30 years ago. It brought me face-to-face with this “crazy” thing called “grief”. “What was this powerful thing that can knock you down, take your identity away and explode your life as you know it?” How do you maneuver through the maze of intense feelings of despair, anger, longing, fear and the biggest ones of Guilt and Powerlessness without getting stuck?

Grief is two things: Feelings and Changes. Getting though it requires movement and connection.
Everyone grieves differently, but when we know what tasks we need to accomplish to be able to move through it, and when we know the warning signs and guide posts so we don’t get stuck or lost, we can heal. We can even grow and transform on the journey though healthy grief.

Grief walks into our offices in a huge variety of ways, some of which are: death in the family, divorce, life-threatening or life-limiting illness, the end of a meaningful relationship, change in career direction, fertility issues, empty nest, or a major move. Profound Grief is a multi-layered, complex process that can impact every corner of our and our client’s lives. Unprocessed, it can get stuck and become chronic depression, anxiety, anger, substance abuse, family dysfunction, or it can be projected onto future generations.

For the past 25 years I have been exploring Grief, learning from clients, students and my own experience. I built my work on the foundation of a Master’s degree with a Clinical Specialization in Grief Therapy. I have added my own experience and insights gained from working with thousands of children and adults while running a Children’s and Family Grief Program at a local hospice for 8 years, teaching classes on Grief at JFKU, and doing more than a hundred presentations on Grief for Conferences, interns, doctors, churches, health care providers and schools, as well as working with clients in my own private practice.

Over the years many therapists have expressed to me how valuable my concept of “The Grief Closet” has been to them. Grief doesn’t go anywhere unless we have a chance to process it. It just gets stuffed into our “grief closet”. Then, when we have new losses, the “grief closet” door swings open and all the old grief tumbles down on top of us and we feel overwhelmed. Entering a new developmental stage also opens the closet door. Children’s Grief and “National Grief” (Sandy Hook trauma, etc.) can also trigger our old grief that we haven’t had an opportunity to process.

The “stickiest” feeling in Grief is Guilt. Clients can go through layers of guilt throughout the grieving process, often ending with feeling guilty about finishing their acute grief. We most commonly know about survivors guilt, and the “woulda, shoulda, coulda” built on hind-sight. Children find amazing, creative ways to feel guilty. Why? It took me many years of asking myself this question to realize that it was because of “powerlessness”. At least if we’re guilty it means we were powerful enough to cause the death (or other grief), if it’s my fault, then I’m not powerless. But we are powerless over some things, and in death it’s an existential crisis since we weren’t given total control over life and death. The Serenity Prayer is our way out of this dilemma: to figure out what we can and what we can’t do, and the wisdom to know the difference. Then we can take our power and not get trapped (or like one kid said “I beat my head against the wall”) in those places where we don’t have power.

Copyright 6/30/2013
“Grief Closet” copyright 1998
Ninette Larson MFT / Ninettelarson@att.net / Ninettelarson.com

President's Statement with EBCAMFT President, Kelly Sharp, LMFT

Admin EBCAMFT — Sat, 13 Jul 2013 03:11:52 GMT

Happy Independence Day to all! This has been a very busy time with all the energy surrounding the CAMFT bylaw
changes. The Board of EB CAMFT continues to dialogue about ways to best support and advocate for our members around the upcoming changes. At this point we are still unclear of the implications of these changes. We have just
learned that Jill Epstein and 2 CAMFT Board members will be attending a Town Hall meeting in Marin County on Sat,
July 27th. Please spread the word about this very important opportunity to learn more about what is to come of
CAMFT. I am not clear on the agenda but am hopeful that we can voice our concerns and learn more about CAMFT’s
intentions. The meeting will be held in San Rafael at The Four Points Sheraton located at 1010 Northgate Drive.

The meeting will run from 1-3 and RSVP’s are requested. Please send your RSVP to admin@marincamft.org. Much
appreciation to MARIN CAMFT for organizing this meeting. EB CAMFT will send out an overview of the meeting for all
those who are unable to attend. We encourage you to forward along this invitation.

As a local chapter of CAMFT, EB CAMFT needs to hear from you. We are in the position of needing to sign our Chapter
Agreements which keeps us current as a CAMFT Chapter. With the uncertainty of the future of CAMFT, we especially
need to hear your voice about what you want from your local chapter. Please consider attending an upcoming Board
meeting or emailing us with your ideas, thoughts and concerns. The next meeting is scheduled for Friday, July 19th
from 4-6. Email us for the address. It is critically important that we make decisions based on our members’ needs;
please help us do this by participating in these discussions as they arise. We will continue to inquire about your
needs and concerns as we gain more information and will make our decisions with as much transparency as possible.

The BBS has sent out an update to all those MFT’s awaiting the GAP exam for LPCC licensure. As of July 1, 2013 the
GAP exam will be available, the clock is now ticking, so please be sure to look into any deadlines that may apply to
you.

Thanks to all of you that have reached out to become volunteers with EB CAMFT. We are in the process of putting
together volunteer opportunities and if we have not yet responded to your inquiry, please be on the look out for an
email from us with more information.

Have a lovely summer and as always, please feel free to contact me with any questions or comments at kellymsharp@gmail.com.

News From the EB CAMFT Mentorship Program Laura Friedeberg, LMFT, Mentoring Program Chair

Admin EBCAMFT — Sat, 13 Jul 2013 03:05:35 GMT

“I considered Nat King Cole to be a friend and, in many ways, a mentor. He always had words of profound advice”-
                                                                             ~Diahann Carroll

As the Mentoring Program Chair, I am pleased to report the successful launch of our initial cohort of mentors and mentees. We currently have twenty-three mentorships that began, with the goal of sharing expertise, in May 2013!
The commitment and energy around this new program has been dynamic! All involved have contributed generously to the program’s initial success and the “pay it forward” movement. Collaboratively, with this interconnectedness, we are
creating a more compassionate organization where inclusion is encouraged and rewarded.

In May 2013, I attended a thought provoking conference on Cultivating Compassionate Organizations, which incidentally, was held in Louisville, Kentucky. I had the opportunity to meet and speak with the Mayor of
Louisville, Greg Fischer. Louisville is considered a “compassionate city”. Fischer signed on to the Charter for
Compassion which requires a 10 year commitment of practicing action-based compassion in the community on a daily
basis. Fischer’s mission is to fuel connectedness and inclusion, meaning having empathy and a deeper understanding
of all people, in order to create greater opportunities, social justice, and a better environment, all which helps
with resilience, happiness, and the best opportunities for people in the community to flourish. Without the ability
to be compassionate, we are vulnerable to illness/disease, increased depression, poor attachment, and lack of
meaning in life.

For those contemplating membership in this program, imagine the following:
                * A therapeutic community with a credible organization, where members not only feel comfortable
                   discussing controversial matters, but are perceived as well respected in the community.
                * A therapeutic community in which these mentorships are values and protected
                * A therapeutic community that gives back by sharing knowledge, and that sensitively addresses issues

This is an invitation for involvement in such a community. The Mentoring Program is currently enrolling new mentors
and mentees for our second cohort. A time commitment of one hour per month for at least one year is required.
Licensed therapists are encouraged to mentor students/interns or newly licensed therapists. A mentor is someone
willing to give back by sharing expertise and guiding the professional and personal development of another. A
mentee is a “learner”, who is motivated to seek valuable advice in order to grow. Please contact me at
lfriedeberg@yahoo.com for more information or to enroll.

Laura Friedeberg completed her Master's degree in Counseling Psychology from John F. Kennedy University. She
supports adults, teens, graduate students, law enforcement, and groups, suffering from losing a loved one by
disability, transition, divorce, affairs, addiction, or death. She uses evidence-based practices, framed to re-
structure "stuck" thinking. Her approach addresses compassion and social substance as a method of finding meaning
in times of profound pain.

Laura's new practice will open in September 2013!

Laura Friedeberg,
Licensed Marriage Family Therapist, Unriddling Relationship Loss with Compassion: The foundation for Emotional
Freedom, Mentoring Program Chair EB CAMFT
1676 Solano Avenue, Berkeley, CA 94707 * 510-984-6544 * lfriedeberg@yahoo.com * www.laurafriedeberg.com

Positive is An Attitude Holism, Empowerment and Joy on the Ride to End Aids Ruth Cohn, LMFT

Admin EBCAMFT — Sat, 13 Jul 2013 00:38:12 GMT

It is hot at the lunch stop. I am sitting in the shade eating a very good sandwich. A woman with a red Medical Staff T-shirt comes up to me and says “Your eyes look red and irritated. Come by the medical tent when you get in to camp and we will take care of you”.

Where else on Earth does medical care come to you?

Many of us are old enough to remember the days when the scourge of AIDS seemed to hover everywhere. By the 1980’s and early 90’s the previously colorful and lively Castro District had become a veritable hospice, and too often a morgue. All of us knew someone who was dying an agonizing death or had lost someone to the disease. My best friend from seventh grade, who had grown up to become a glamorous fashion model, was the first person whose ravaged body I saw. It was with him that I had my first conversations about what it was like to be dying.

After Donny died at the age of 33, I went on to work with the Volunteer Therapists AIDS Project, an organization that provided free psychotherapy to people with AIDS. It was sobering and sad, sharing in individuals’ and couples’ fear and grief as life was cut short way too soon.

Since the advent of life-extending AIDS medications, the place that the illness holds in the public eye has of course changed dramatically. Still, while life on today’s meds is very different from the short and miserable life trajectory of earlier AIDS sufferers, it is still far from easy. I now have only one client who has AIDS, a nurse infected on the job by a needle stick in the middle 1990’s. The early drugs had a side effect of nearly unbearable depression. The meds she has been on over the last four years that I have known her, have a complex constellation of other side effects, from relentless, gnawing muscle ache, to immobilizing fatigue, memory slippage, crumbling teeth and hearing loss. We are constantly sorting symptoms of the illness from the side effects of the meds, the psychological from the physical, while simultaneously navigating the state’s draconian Workers Compensation system. Even now, she says that “living with AIDS is a full time job. “

Almost since its inception, the San Francisco AIDS Foundation (SFAF) has largely been funded by the California AIDS Ride, now called AIDS LifeCycle. This seven-day, 545 mile fund raising bicycle trek from San Francisco to Los Angeles, enables SFAF to provide vital AIDS support and education services all completely free of charge. After thinking about it for some time, I first decided to do the ride in 1999. I bought a jade green Bianchi Eros (yes, a bike called Eros!) for the venture. At the time I thought I’d be doing a very good deed. I proceeded to have one of the great experiences of my life. My Eros and I recently returned from our fifth AIDS Ride.

Long before becoming a therapist, I was fascinated and mystified by the interplay between body, mind and spirit. I was compelled by issues such as eating disorders, addictions, trauma and sexuality, all of which took place at the interface between psychological and physiological. The study of the brain seemed to be an avenue to tie it all together. Yet I have never experienced a world so holistically integrative, that seamlessly embodies all of these dimensions in the warm context of community, as the world of the AIDS LifeCycle.

Riding a bicycle 545 miles in seven days is a feat of considerable bodily strength and endurance. On most days we cover between 80 and 110 miles. Many riders are non-athletes who started riding a bike specifically to do this ride. We are bodies of every size and shape, color, age (this year’s oldest rider was 83!) and of course sexual orientation, out there pedaling together.

This year we were 2,200 riders strong, supported by 500 “roadies” (volunteers who do everything from serving food to bike parking, gear trucking controlling traffic, etc.) Always among us are the “Positive Pedalers,” a contingent of HIV-positive riders who are the undisputed heroes of the Ride.

We begin training at least six months before the ride. My husband and I are training ride leaders- not unlike being a therapist on wheels! For this year’s June 2nd departure, we led our first training ride on Thanksgiving Day. For more than half the year we work hard together, helping riders to build strength and endurance while also making sure they learn the crucial basics of balancing food, hydration, exertion and rest/recovery.

During the week of the Ride we share not only the road, but also all of our meals, port-a-potties, shower trucks, and sleeping quarters on massive campgrounds. As our traveling village makes its way down the coast, we inhabit a different tent city each night, accompanied by a volunteer medical staff, that includes not only doctors and nurses, but also physical therapists, chiropractors and massage therapists. On every level we are profoundly involved in a shared bodily experience. And every camp has a staff of volunteer professional bike mechanics attending to the physical life of our vehicles. Bike shops across the Bay Area have been important allies of the Ride for years, not only lending us their best staff, but offering discounts in their stores throughout the training year.

The range of emotions we experience is hard to describe. There is not only the elation and empowerment of being able to achieve previously unknown physical heights, (bathed in those delicious brain chemicals that come with vigorous physical activity,) but also the thrill of being part of a large organism of others who have devoted a phenomenal proportion of their year to this cause. During our six months of training, all of us spend at least half of every weekend on the road.

We also meet the challenge- and the pride- of being involved in a massive fundraising effort. While each rider must raise a minimum of $3,000, many participants manage to raise $5,000, $10,000, even $20,000 and more. This year’s ride amassed over $14.2 million with more funds still rolling in. I am proud to say the vast majority of the money raised goes directly where it is supposed to go- for AIDS services and education. Even now, I am regularly overcome with awe and love for this community and how we work together for a cause; that matters deeply to each one of us.

This is the spiritual dimension of the Ride. It evolves out of a connection to something larger than ourselves, and united by the common commitment to the cause of health and justice for people facing AIDS. As we pump our way southward, we are often greeted by the outpouring of support from communities along the route. Inhabitants of small farm towns, rural enclaves and larger cities too, stand on the side of the road with signs or bells, cheering, encouraging and thanking us. Little kids wave, school children hand us licorice vines or strawberries. For eleven consecutive years, one small town has set up a stand that distributes ice cream and home made cookies to our riders. A café in Santa Cruz annually posts a sign in front that announces: “Everything free to AIDS Riders.”

This sense of spirituality deepens at each campsite, all of which have a meditation tent to memorialize the many who have left us. At the same time, it amazes me that such a tragic and somber cause is regularly and respectfully transformed into a hotbed of humor and fun, wacky costumes and unending laughter- a world so imminently positive.

Limitations of space prevent me from saying all I would like to about the AIDS LifeCycle. You can learn more by logging in to AIDSLifecycle.org. Of course you can contact me directly for an earful. Perhaps you’d like to join us! For me, this year’s slogan “You Belong Here” aptly captures the essence of the Ride- this year and every year. Although I am an HIV negative, heterosexual, middle aged married lady, I have never felt so much a part of something in my entire life.

Ruth Cohn, MFT and AASECT Certified Sex Therapist, is in private practice in Oakland. She specializes in work with adults with histories of childhood trauma and neglect and their intimate partners and families. She is the author of Coming Home to Passion: Restoring Loving Sexuality in Couples with Histories of Childhood Trauma and Neglect . She can be reached at cohnruth@aol.com or www.cominghometopassion.com.

I’m an MFT. Why Should I Care About Dissociative Identity Disorder? Gil Shepard, LMFT

Admin EBCAMFT — Sat, 13 Jul 2013 00:34:14 GMT

Because you have most likely been working with clients afflicted with Dissociative Identity Disorder (DID) in your caseload without recognizing it!

Spitzer et alia (2006) note that i “The prevalence of pathological dissociation [pathological dissociation refers to DID] in the general population of North America was estimated to range between 2 and 3.3%.” ii Vedat Sar (2011) notes that “overall, the prevalence of dissociative disorders in inpatient and outpatient psychiatric settings seems to be around 10%, while approximately half of them (5%) has DID.” iii Sar further states that these rates jump dramatically for special populations such as alcohol dependency (9.0%), chemical dependency between 15% and 39% and exotic dancers and women in sex work (no statistic given). iv Practically speaking the percentages are really much higher because DSM-IV defines DID very strictly and excludes many who in terms of presentation and treatment are DID.

What are common presentations in an MFT office?
A couple came in for pre-marriage evaluation. It seems they went to a party where an ex was present and Sue (identifying characteristics have been changed) left her current boyfriend behind. She woke up the following morning in the ex’s bed not knowing how she got there. Easy diagnosis revealed she lost things, lost time and people come up to her calling her a different name than she knew. I had seen Bill for about a year for individual work when he brought in his wife. I understood the problem better when I found he had an alter that totally closed down and shut her out when she got upset with him. Bill knew nothing about this alter who needed to be worked with along with Bill to help resolve relationship issues.

Jacqueline, a woman in her 70’s presented with a history of therapy going back to her 20’s that included LSD therapy and other dramatic kinds of therapy that did not help. In the initial interview I asked if she heard anything inside her. She began to cry and said, “Yes, I hear a baby crying.”

The next session I used EMDR to release the baby’s experience of being molested and integrated the infant. “I feel more complete now,” Jacqueline said. She had other alters that we worked with using different approaches ways until they were integrated, with her traumatic feelings gone. After about a year she was vibrant and bursting with energy!

In the first session with Sabrina she suddenly froze with her tongue stuck out of the side of her mouth. I could not contact her and I suddenly felt like someone had drawn the blood out of my veins. Desperately I pulled myself out of the sudden deep hole I was in and asked her to pull her legs up to her chest. Slowly she began to do this but sitting on a chair made that difficult. I suggested it might be easier for her to sit on the floor and coached her to continue and hold her arms around her legs hard. She did this, came back and I could breathe again. What had happened? Sabrina had abreacted a child part frozen in time in a traumatic experience of the past. I had her concentrate on her body by curling into a tight ball and that brought her back to her adult self. She had first split into parts as an effect of sexual abuse when an infant by her mother. Later we found her mother also had DID.

DID covers a wide spectrum of presentations and I am only touching on a few in this article. While DID usually begins before 8 years old and sexual abuse is most commonly present, the DID can be caused by other overwhelming events. Bill, mentioned above, grew up with major abandonment in a war torn country. John was extremely brutalized both physically and emotionally by a raging alcoholic father. Carol was isolated as an infant and also grew up with a violent alcoholic father without early sexual abuse. Of course people who are gay or lesbian may also have DID. Sometimes the violence from a father increases if a child appears gay.

Here is a caveat. If someone wants to have a sex change operation, check very carefully to see if he or she has DID. Sometimes one part may take over who is a different sex than the body but all the other parts have the body’s sexual orientation. The sex change operation can create irreparable damage. Such conflicts within the “system” is common with DID.

When I get a client with a history of trauma, either from abandonment, sexual abuse, violence or severe attachment breaches, or with diagnoses such as bipolar, schizoid, borderline, schizoaffective, or somatic disorders I almost automatically expect DID. DID alters may present with almost the entire DSM’s diagnoses. It is estimated that it usually takes from six to eight years in the mental health system (that includes MFT’s) before an accurate diagnosis of DID is made.

Sabrina, mentioned above, had all of the above diagnoses and more from 25 years in the mental health system beginning in a hospitalization with her mother! before I diagnosed her with what was then called Multiple Personality Disorder. Needless to say, hospitalization with a perpetrator of abuse is NOT ideal.

I have learned the hard way that to be effective I need to be always aware that a given client could be DID. But how can you tell?

Switches between alters can be clear with head rolling or a suddenly different appearance. Sometimes a client will appear to be a child or even much older in a minute. But it can also be very subtle. Even the client may not be aware of the switch. Sometimes a client may have a mask-like face – that often indicates another part is taking a peep to see who you are.

DID is not always present even with extensive trauma. However trauma itself is often hidden from the client. DID, by its very nature, is almost always hidden from the client. Clients with DID generally don’t have a clue they have it. I strongly recommend taking the training provided by the International Society for the Study of Trauma and Dissociation. Go to ISST-D.org and look under “Training and Conferences.” I would also recommend training in EMDR (Eye Movement Desensitization and Reprocessing) and (EFT) Emotional Freedom Technique, as each of these are useful in treating trauma and the traumatic memories found in DID.

Gil Shepard LMFT has been licensed over 35 years and specializes in treating individuals with severe trauma issues, PTSD, and especially Dissociative Identity Disorder (DID). He has specialized in treating DID for the last 12 years. He is trained in and uses EMDR (Eye Movement Desensitization Reprocessing,) EFT (Emotional Freedom Technique,) and Hypnosis and has found that combinations of these speed up healing. He is also trained in Breema and Ortho-Bionomy, two forms of bodywork that provide a strong somatic base for his work. His office is in Walnut Creek (very close to Hwy 24 and to Hwy 680) and can be reached at 925-937-3337 or at gilshep@pacbell.net. He is listed on TherapyNext.com, SmarterYellowPages.com and articles he has written can be found by searching his name.

President's Statement with EBCAMFT President, Kelly Sharp, LMFT

Admin EBCAMFT — Thu, 13 Jun 2013 03:26:08 GMT

Many of our members have expressed great concern about the recent proposed bylaw changes initiated by CAMFT. The Board of EB CAMFT has been vocal about our concerns regarding the lack of transparency about these proposed changes and sent a letter to Jill Epstein formally addressing these concerns. Thank you to the many members who have passionately gotten involved and shared their strategies for getting our voices heard. The tone of conversations on the Etree has been respectful and allowed those with differing or undecided opinions to consider strong points in a professional and open manner. The Board of EB CAMFT strives to support our members’ concerns in thoughtful and strategic ways. Your input, participation and ideas are welcome and heard. Thank You!

We have gotten a great response to the launch of our Mentoring Program and welcome more applications, particularly from Mentors. We have a waiting list of Mentees who would love the opportunity to learn from you, please consider signing up if you have not. More information can be found on the website, or you can contact Laura Friedeberg, the Program Chair at mentorship@eastbaytherapist.org.

The next EB CAMFT social is getting planned as we speak. We are teasing out the details and will keep you posted. We are considering a Sunday, coffee/Tea social and have a couple of ideas in the works. If you have particular suggestions or places in mind please feel free to let us know. This next social will most likely be held East of the Caldecott.

As always, your feedback, thoughts and comments are welcome and greatly appreciated. Contact me any time at kellymsharp@gmail.com.

Have a great June!

When A Client Needs Psychotherapy But is Too Ill To Leave the Home Rosalee Benelli, M.A., MFT

Admin EBCAMFT — Thu, 13 Jun 2013 03:23:33 GMT

Can you imagine what it might be like to be so ill, especially with a chronic condition, and your relationships suffer? What do you do if you can’t leave the home for the therapy you need?

I facilitated support groups for people with life-challenging, chronic illnesses both on the Peninsula and in the East Bay for 12 years. In these groups, I helped members find their own best answers on how to deal with their condition(s) and relationship issues, how best to communicate with their doctors and other health practitioners, work on setting good boundaries for self-care, saying "no" without guilt, and develop a better relationship with themselves.

I know firsthand the challenges these people face. Although I no longer run these groups, I now am putting in the time to assist individuals, couples and families in dealing with the various issues that arise when one or more family members suffer from chronic illness. I do this by telephone and can, possibly, include Skype.

Many divorces occur when a mate becomes chronically ill, the children don’t understand and struggle to deal with a health-challenged parent, older parents worry about what will happen to their adult offspring when they, the parent, passes away. Being a parent with a chronic illness poses multiple challenges and resulting emotions from the inability to be who you used to be and the parent you want to be and know you could be if not for poor health.   Other family members feel burdened and resentful when caring for a chronically ill person. The ill person can feel isolated, abandoned, fearful and hopeless. All may suffer from feelings of denial, anger, resentment, guilt, fear and more. Now, maybe more than any other time in life, a chronically ill person needs help with managing their own life better and restoring and healing ailing relationships.

Too, the healthy people who deal with the chronically ill also need a place to vent, share their side of the story without the shame and judgment involved.   They need validation for their enduring hardships as well.

Frustrations with the medical community are also a factor for many a chronically ill person.   Assessing even if an ill person can even get to a doctor’s appointment can be a stressor for all involved. Impatience on both sides is not uncommon when dealing with caregivers, drivers, doctors, nurses and so on.

For those who can work, there can be misunderstandings with co-workers and bosses who expect them to meet their job requirements when they can't, need to go in late or leave early, and take more days off than is considered acceptable. In addition there is the stress of lost wages from not being able to work.

Some people have to go through the process of getting on a disability plan either private or Social Security or both and this process can be cumbersome and confusing. One can go through numerous feelings of disbelief about their health and where they are in life, disbelief from those in their support network or no support at all. With all major difficult changes in life most deal with the grief process of denial, anger, bargaining, depression and acceptance.

Additionally, many have been put on psychotropic medications to, hopefully, cope better with their lives but have discovered later on that the medications themselves are causing other health issues. For those individuals who want to or are tapering off psychiatric medications under their physicians supervision, I can offer support and guidance on learning new coping skills to deal with the feelings that surface or resurface so that one doesn't become overwhelmed by them and want to give up. The process can be lengthy and considerably uncomfortable at times but with the right skills and understanding about the process, one can achieve the goal of safely coming off their medications and build more self-confidence and internal control over their own lives so they don't need to resort to chemical treatment for their issues.   Just to be clear, I do not advise a client to come off medications or on anything relating to what medications are available and what they are for as that is not within my scope of practice.

It is during these difficult times when we could immensely benefit from an experienced person to help guide and lead the way to a more fulfilling and rewarding life. I am here for them.

Rosalee Benelli is a licensed Marriage and Family Therapist (MFT) in the state of California. She was born in Sebastopol, California in 1948. She did her undergraduate work at San Francisco State University and received her Bachelor of Arts degree in Health Science in 1983. While working on her B.A. degree, she was married, raising two sons and working at College of San Mateo as Secretary to the English Division Chairman. In 1989, she became very ill with an incurable physical illness and is still health-challenged today. During her early years with her health challenges, she worked at Stanford University as Secretary to the Chairmen of Petroleum Engineering. While working at Stanford University, she worked on her Master of Arts degree in Counseling Psychology which she received in 1994, then acquired her MFT license in 2003.

She chose this work as she knows first-hand the value of psychotherapy in dealing with relationship issues in regard to chronic illness and dealing with illness itself as well life’s challenges in general. Following a divorce in 1987 she continued to co-raise her sons with her former husband and has an amicable relationship with him now although there were difficult years in-between. For 12 years she facilitated support groups for people with life-challenging, chronic illness both in San Mateo and then in Hayward where she lives and works now. Her scope is still in relational work with the specialty of managing the additional stress of chronic illness and offering help to those who are home-bound.

510 909 7950
rosaleebenellimft.com
Hayward, CA

Psychotherapy and the Twelve Steps: Addressing Some of the Unique Concerns of Clients in 12-Step Recovery: By Peter Carpentieri, MA, LMFT

Admin EBCAMFT — Fri, 17 May 2013 14:23:22 GMT

Overview: The purpose of this article is to share some ideas and experience regarding psychotherapy and the Twelve Steps and working with clients in Twelve Step Recovery, offer some guidelines and suggestions for working with recovering clients, and invite dialogue and conversation within our community to better serve this population.

There is a fair amount of ambivalence, if not outright distrust or disdain, in both communities, regarding the value and effectiveness of the other. Many a joke is cracked and a good hearty laugh had at the expense of psychotherapy during the course of Twelve Step meetings around the world, where therapy is often regarded as a total waste of time and money. At the same time, I have noticed an equal ambivalence or doubt, if not ignorance, among therapists, regarding the value and effectiveness of the Twelve Step Recovery experience for those who rely on it.

While there is some truth to both of these points of view – psychotherapy is not useful for all addicts in all situations and some addicts do use the Twelve Step programs as another escape from the deeper and more challenging issues they face - for the most part, my experience has been that psychotherapy and the Twelve Steps, when used together to complement each other and practiced in the spirit of cooperation, are a powerful force for healing and transformation which can mean the difference between true happiness in recovery and continued relapse and suffering. Furthermore I've found that the Twelve Steps and psychotherapy are not only compatible but are, in a sense, merely different approaches to, and contexts for, the same process: discovering and bringing to light that which blocks or obstructs our capacity for joy and aliveness, and cultivating a more balanced, fulfilling and joyful way of life; one that is sustainable over the long haul.

The Twelve Steps invite us to look closely at our thoughts, feelings, motives, beliefs, attitudes, dreams, fantasies, and conduct, and to discuss these with another human being, in the interest of freeing ourselves from the bonds of suffering, and living happy and productive lives.These elements comprise a process of becoming more aware of how we actually live, moment by moment, and finding a fuller and freer way of living; an invitation to deeper awareness and connection. Psychotherapy is, in my view, a similar and, in some instances, nearly identical process. The containers and interventions may differ but, ultimately, the goal and the essence are the same.

Particular concerns:

Many people in Twelve Step programs arrive at a point in their recovery where therapy becomes an key part of the process. For many, this is a troubling and challenging dilemma. The prospect of trusting someone who may not be in recovery with intimate, shameful, painful feelings and experiences, may feel risky at best and life-threatening at worst; particularly after one establishes trust, sometimes exclusively, with sponsor(s) and friends in recovery.

Many, if not most addicts - and by addicts, I mean all types of addicts: food addicts, sex and love addicts, debt and spending addicts, gambling addicts, drug addicts, alcoholics, relationship addicts, codependents, come into recovery realizing their lives are in serious, even perilous danger. The realization and acceptance of this fact, is, ideally, the foundation of recovery. It's what makes one willing, as the book “Alcoholics Anonymous” (aka “the Big Book”) says, “to go to any length,” (p. 58) to recover. If our life is on the line, we are more likely to try things that our fears, defenses, and habitual patterns would have us resist or outright refuse to try. For many addicts, anything that feels like it may topple the apple cart of recovery, or “sobriety,” in the largest sense of the word, feels life-threatening. Therapy may very well fall into this category.

For many addicts, keeping things simple and routine is extremely valuable in avoiding slips and lapses that can prove Psychotherapy and the Twelve Steps: Addressing Some of the Unique Concerns of Clients in 12-Step Recovery cont'd.

quite dangerous. Entering therapy to work on issues that have long plagued them, even in sobriety, can feel like walking a tight rope with death on either side. “What if my therapist and my sponsor don't agree? What if my therapist suggests I do something that the program would discourage? What if I get triggered by something my therapist says and relapse? How can I trust a therapist anda sponsor and a Higher Power? I don't want to upset the apple cart; I've been sober – or abstinent – too long.” A well-informed, aware therapist can offer a quality of aid and

support that can make this journey less treacherous – both literallyand emotionally – for a client in recovery. A firm knowledge and understanding of the Twelve Steps and the Twelve Step recovery process as it is commonly practiced can provide the therapist with a greater ability to support the client's recovery, while doing the therapeutic work that can foster the growth and development the client so desperately needs.

Some practical suggestions:

Here are some practical suggestions for improving your effectiveness when working with clients in 12-Step Recovery:

Attend open 12-Step meetings, particularly in the fellowships to which your clients belong.

Read AA literature and literature from other fellowships; specifically:

    Alcoholics Anonymous ('the Big Book')

    The Twelve Steps and Twelve Traditions (AA)

    The Twelve Steps of Overeaters Anonymous

    Co-Dependents Anonymous (the CODA 'Big Book' )

    How Al-Anon Works

    Sex and Love Addicts Anonymous (S.L.A.A. 'Basic Text').

Ask how many meetings your client is attending. Ask if that's enough. Ask how long it's been since they spoke with their sponsor and how often they speak. Take an interest in their relationship with their sponsor and the others they attend meetings with.

Take an interest in their recovery and how it's going for them. Ask them what step they are on and how they are progressing. Inquire about their relationship with God or Spirituality or a Higher Power; this is an essential element of the recovery process and one that often poses difficulties along the way.

Familiarize yourself with the Twelve Steps so that you can relate directly to your clients' experience and understand what they are talking about.

In many ways, working with clients in Twelve Step Recovery is like working with any other cultural difference: the more we can learn about it - from our clients, our own research, consultation and immersion - the better equipped we are to help them.

Reference cited:

Alcoholics Anonymous. (2002). Alcoholics Anonymous Big Book, 4th Edition. New York, NY: Alcoholics Anonymous World Services.

Al-Anon Family Groups. (2008). How Al-Anon Works. New York, NY: Al-Anon Family Groups.

Alcoholics Anonymous. (1981). The Twelve Steps and Twelve Traditions. New York, NY: Alcoholics Anonymous World Services.

Anonymous. (2012). Co-Dependents Anonymous, 1st Edition. New York, NY: CoDA Resource Publishing.

Anonymous. (1993). The Twelve Steps of Overeaters Anonymous, 1st Edition. Rio Rancho, NM: Overeaters Anonymous, Incorporated.

Augustine Fellowship. (1986). Sex and Love Addicts Anonymous: The Basic Text for the Augustine Fellowship. San Antonio, TX: The Augustine Fellowship.

Peter received his Masters Degree in Counseling Psychology, with a Transpersonal Focus and a Specialization in Child and Adolescent Therapy, from John F. Kennedy University. He is also Certified by the Kripalu Yoga Institute in Lenox, MA as a Holistic Health Counselor / Educator. He was originally trained in the Humanistic Client-Centered and Gestalt methods, gradually incorporating a myriad of other methods and approaches, 25 years of Zen Buddhist practice, and his training in Holistic Health Counseling and Education into his practice as a Psychotherapist. He also completed 12 units of Early Childhood Education at Merritt College and taught preschool for three years. Peter specializes in working with people in 12-Step Recovery, those who have survived the suicide of a loved one, adolescents and their families, and spiritual and existential dilemmas. He lives by the lake in Oakland and has an office in South Central Berkeley.

peterc.mft@gmail.com

President's Statement with EBCAMFT President, Kelly Sharp, LMFT

Admin EBCAMFT — Fri, 10 May 2013 13:48:27 GMT

Happy May! The Board is excited to announce that we have brought back the EB CAMFT Mentoring Program. Laura Friedeberg has taken on the role of Program Chair and will be happy to provide information to anyone interested in participating as a Mentor or Mentee. We are excited to facilitate more support for our pre-licensed and newly licensed members, and to provide the opportunity for our more seasoned members to share their wisdom and knowledge as they give back to the profession. The Board is also hoping to host another Chapter Social in June and would like to provide a venue, east of the Caldecott Tunnel. Please contact us if you have any ideas of a suitable place for us to mingle. As we have been discussing over the past few months, the Board is focusing on ways to enhance our CEU program. Sandy McQuillin has fought hard to keep this program afloat and has dedicated much time and energy into the Wednesday and Saturday functions. Sandy has decided to step away from the program starting in June and we want voice our great appreciation for all her hard work and dedication to the program. As we prepare for the transition, we are seeking Chapter volunteers who would be interested in stepping in and helping us manage the Wednesday and Saturday CEU presentations. Please contact us if you are interested. As part of our ongoing efforts to provide more chapter meetings, socials and gatherings, we are offering free memberships to those who sign up through our Volunteer Program. The details will continue to unfold and will mostly likely require a commitment to 3 events per calendar year. Participating in the Volunteer Program will grant full membership benefits for those who might be unable to make the financial commitment of joining our Chapter. Thanks so much for the ongoing comments and feedback, please continue to reach out to us so we can better serve our members. Drop me a line anytime at kellymsharp@gmail.com.

Mentoring Success Through Compassion Laura Friedeberg, LMFT, Mentoring Program Chair

Admin EBCAMFT — Fri, 10 May 2013 13:47:04 GMT

“In every art, beginners start with models of those who have practiced the same art before them. And it is not only a matter of looking at the drawings, paintings, musical compositions, and poems that have been and are being created; it is a matter of being drawn into the individual work of art, of realizing that it has been made by a real human being, and trying to discover the secret of its creation.”
-Ruth Whitman

My ambition in re-introducing this meaningful program is to advance connection between folks who believe that community and engaging in social responsibility is transforming and cultivates a more compassionate organization. Additionally, this mindset offers multiple benefits to the participants.

In the process of developing the relationship, both mentor and mentee are also practicing authenticity, an invaluable therapeutic skill that will invite both parties to feel comfortable with vulnerability and thus, increased confidence. My hope is that this newly found confidence carries over into intimate relationships, friendships, work relationships and ultimately therapeutic relationships. Authentic connectedness is the key to healthier relationships, better health, and the reduction of burdening symptoms and disease.

This unique professional relationship can further self-compassion which assists in increased meaning and purpose for both.

In Victor Frankl M.D., Man's Search for Meaning, he discusses his experience as an Auschwitz concentration camp inmate. In an attempt to find meaning in this horror, he developed Logotherapy which focuses on meaning as the catalyst for powerful change.

Just as Frankl’s focus in his circumstance helped him survive, finding meaning in your relationships and lives can help you get through difficult times. Bringing in science, your choices can promote neural changes. Being happier will strengthen your Amygdala and increase Oxytocin associated with trust and safety.

While considering involvement in this opportunity, ask yourself the following questions:

-What really matters to you in life?

-How can I role model/participate in a meaningful relationship?

-How does being a trainee/intern/licensed psychotherapist create meaning for you?

-How do you currently impact purpose?

-How can we cultivate leaders?

In my professional mentoring roles, having experienced suffering and not always “fitting in”, has contributed to my ability to have compassion for others. I am less judgemental, have less fear, and over time, have developed a greater sense of identity. Had I been mentored as a pre-licensed or newly licensed clinician, I believe it would have nurtured my personal and professional development in profound ways. It would have likely impacted my involvement in my community sooner, allowed me to discover talents while staying true to self, receive valuable feedback and resources, and the opportunity to practice skills relevant to professional and personal goals.

In mentor roles, I have benefited from mentees by giving to others which in turn, gives me pleasure. It allows me to honor boundaries, and most importantly, build valuable relationships and connectedness.

Reminder: Mentoring is not providing coaching or clinical supervision to mentees.

I invite you to get involved in this program not only for yourself and your match but to challenge the culture of East Bay CAMFT.

Laura Friedeberg, LMFT, Mentoring Program Chair

Unriddling Relationship Loss with Compassion: The Foundation for Emotional Freedom

Laura Friedeberg completed her Masters’s Degree in Counseling Psychology from John F. Kennedy University. She currently works with the criminal justice culture and provides clinical supervision to MFT trainees and interns. Additionally, she has marked experience working with adolescents and in private practice. Look for Laura’s new practice in Albany (where she resides with her partner) toward the latter part of 2013. She specializes in working with adults, adolescents, graduate students, and groups who have experienced profound loss in relationships. Compassion and mindfulness underlie her work. lfriedeberg@yahoo.com

Interview With Newly Licensed Therapist, Sean Holcomb, LMFT

Admin EBCAMFT — Fri, 10 May 2013 13:46:23 GMT

Q: Please tell us about your preferred theoretical stance and any particular population with whom you enjoy working.

After getting licensed I spent some time at the Mental Research Institute to focus more on strategic family therapy. I found in my intern work with children and adolescents that my clients had far better outcomes if I had access to as many people as possible within the family system. I also work to address symptoms that each member of the family is struggling with, and get each individual’s unique perspective on what is the family’s current difficulties.

In my private practice I work with children and adolescents through family therapy. I do not see children or adolescents individually; I require the family’s participation in every session. I am also a home based family therapist, in which I travel to my client’s homes and provide therapy in the comfort of their own environment. This method provides multiple benefits. One, it allows me to observe the family in a normal and familiar environment. With young children this means that I am getting closer to baseline behaviors than if they were to be in a foreign or new environment, which may cause hesitation or lack of acting out. There were many times in my agency based work that I heard mother’s tell me, “They don’t act like this at home. I wish you could see them there!”

Second, it takes away one stress and barrier to therapy. Sometimes it is difficult to make and attend therapy, particularly if there are many children in the family. I also found that when I was operating an office through agency based work, it was difficult to get a paternal figure into therapy. Traveling to the home has given me access to many members of a system that I may not have access to on a regular basis.

Q: Where did you complete your internships and traineeship? Where did you attend graduate school for Psychology?
I graduated from Pepperdine University in Los Angeles in 2008. I was a trainee for Jewish Family Services in their school based program in Malibu, working with middle and high school students. After graduation I began working at an outpatient DMH clinic in south Los Angeles, providing therapy to children and families. I also worked with Green Dot Public Schools, providing school based therapy to underserved populations throughout Los Angeles. When my family moved back to the Bay Area I returned to work at Seneca Center in their school based intensive day treatment program as a classroom therapist.

Q: What work experience outside of therapy do you feel informs your work as a clinician?
Before I went to graduate school, I worked for several years as a classroom counselor in a non public school for children with severe emotional disorders. I primarily used behavior modification techniques, but also worked to develop relationships with the students to affect change though positive and healthy interactions. I think back to my time often when working with particularly young children, helping parents contain behaviors but also working with them to foster a loving relationship with their kids.

Q: How would you like to collaborate with other clinicians?
Since I don’t see client’s individually, I like having access to clinicians to refer family members that may be in need of more individual work to compliment the family work I do. Also, sometimes an individual will enter therapy, and it becomes apparent that some family work might be of benefit. Family therapy is an excellent compliment to the insight that comes from individual work. Working with school counselors, pre-school teachers, and other members of a child’s system has been invaluable in providing the necessary collateral work to paint a larger picture and give context to behavior.

Q: Are you focused on developing or maintaining a private practice; or do you prefer agency-based work?
I am focused right now on developing my private practice and am actively accepting referrals for families that might benefit from therapy. I have also had the privilege of apprenticing with Dr. Bruce Linton in Berkeley and his long standing Father’s Forum program. I am now facilitating a men’s group for new dads with children ages 0-1. The group meets in North Berkeley, and is currently accepting new members.

I can be found on the web at:
www.seanholcombetherapy.com
510-859-3098
sean@seanholcombetherapy.com

Information on the Father’s Forum can be found at:
http://www.fathersforum.com

Identifying Dissociative Disorders in Subclinical Populations: Treating DID Elizabeth Schenk, PhD, LCSW

Admin EBCAMFT — Fri, 10 May 2013 13:45:43 GMT

Dissociative Identity Disorder (DID), long considered a rare condition, in actuality has a prevalence rate of 1-3% of the general population. The vast majority of DID patients do not make their dissociative disorder obvious to others, nor is it obvious to themselves. There are windows of diagnosibility (Kluft, 1991, Lowenstein, 1991) which allows for the appropriate diagnosis of DID. Though supportive therapies provide a helpful foundation for DID patients, it is only after the correct diagnosis is made that adequate healing can occur. DID, a condition that originates in childhood, is typically not diagnosed until patients are well into adulthood, if diagnosed at all. The average patient is in psychotherapy for 7 years prior to the correct diagnosis of DID.

Because DID patients rarely volunteer information about dissociative symptoms, nor recognize their own dissociative tendencies, the absence of focused inquiry about dissociative processes prevents the actual diagnosis from being made. The reasons patients may present for treatment may be varied, often wit random and vague physical and psychological symptomatology. Patients may present with complaints of impaired memory and concentration, but may report no significant history of trauma. Frequently, individuals with DID present as academically and professionally successful with strong interpersonal relationships. Patients may not be able to give a clear picture about why they are seeking therapy. They may remain in therapy, devoted to their therapist for many years, but without getting substantially better.

The 6% of the DID population that presents with overt symptoms are readily diagnosed, and may present in crisis or in hospital settings, for either psychological or physical reasons, as there is considerable overlap with this population. The professional challenge in diagnosing DID requires not only a thorough history, but focused questioning on the presence of DID symptoms, as well as the use of well designed assessment tools.

I have diagnosed, treated, and consulted about dozens of DID patients in over 20 years of practice. With the exception of a few, all were diagnosed in their 30’s, 40’s or 50’s. All had been in treatmenta with one or multiple therapists, frequently for a number of years; few presented with overt DID symptoms,. As with many seasoned DID clinicians, I identified a couple of patients who were in my practice for a number of months or years before I recognized their dissociative disorder.

Dr. Elizabeth (Betsy) Schenk is a licensed psychotherapist with orientations in both Clinical Social Work and Clinical Psychology. Dr. Schenk maintains a full-time private psychotherapy office on Lake Merrit in Oakland She is Faculty emeritus SFSU School of Social Work. She has worked a behavioral health administator for adult and pediatric hospitals, and currently works extensively with survivors of trauma, specializing in the treatment of dissociative disorders and vicarious trauma. Dr. Schenk is a recognized immigration forensic psychological expert and has prepared psychosocial assessments and courtroom testimony for over 15 years. She has lectured and provided organizational consulting to hospitals, child welfare agencies, legal agencies and health and mental health clinics. She has been providing clinical consultation and supervision for over 20 years. Email: drelizabethschenk@gmail.com; 525 Bellevue Avenue #319 Oakland 510-208-3450

President's Message

Admin EBCAMFT — Sat, 06 Apr 2013 16:05:01 GMT

Happy Spring!

Thank you to all who attended our social at Urban Legend Cellars last month. There were about 35 people in attendance and it proved to be a successful event for networking, reconnecting with old friends and unwinding after a long week. We look forward to hosting more socials throughout the year.

The Board of EB CAMFT has been busily planning and prioritizing as we launch into spring. Peter Carpentieri, our current Treasurer, has volunteered to initiate the Intern and Trainee support group. We will soon be offering ongoing groups for our Intern and Trainee members and welcome your participation and/or thoughts or ideas about ways to further offer support you. Please contact Peter directly at peterc.mft@gmail.com for more information.

The Board is also in the processes of re-launching our Mentoring Program. Several members at the social expressed interest in becoming mentors and we would love to hear from you if you would like to participate as a Mentor or Mentee. State CAMFT recently announced they will no longer be providing a mentoring program, so we will attempt to fill the gap by providing local mentorship to our newly licensed and pre-licensed members.

At our most recent Board meeting, EB CAMFT member Lynn Marie Lumiere provided us an overview of the legal consultation she has been receiving in regards to negotiating with insurance companies and anti-trust laws. The Board shares many of our members’ concerns around the relationship with insurance companies and reimbursements. We will continue to dialogue with CAMFT about their efforts to protect us, and will continue to seek outside legal consultation about potential options. Stay tuned for updates and please contact us with your ideas, thoughts or comments around this very pressing matter. Feel free to contact me at kellymsharp@gmail.com.

Countertransference to the Hegemonic Critic in Complex Post Traumatic Stress Disorder

Admin EBCAMFT — Sat, 06 Apr 2013 16:04:06 GMT

Unless one is actually afflicted with Cptsd, it is hard to comprehend the totalitarianism and viciousness of the client’s critic. When a child is raised by parents who thwart her attempts to bond, her superego grows into an outsized critic as she desperately strives for safety and belonging.

Constant negative attention and a dearth of positive attention are typical of Cptsd-genic parents. Such parents use contempt …intimidation melded with disgust…to frighten and shame the child into total submission. The child’s two most fundamental developmental needs, safety and attachment, are constantly frustrated. Her superego morphs into a toxic critic, goading her to be perfect and self-deprecating in order to gain acceptance and to avoid punishment and abandonment.

Eventually, the critic forces the child to identify with her aggressors so thoroughly that she perpetrates their contempt and abandonment against herself. This is especially true of the “gifted child” [a la Alice Miller], who embraces perfectionism as a strategy to make her parents at least safer if not more engaging. She hopes that if she is smart, helpful, pretty, and flawless enough, that her parents will finally care for her.

But as John Bradshaw points out, continued failure at winning their regard forces her to conclude that she is fatally flawed - loveless not because of her mistakes, but because she is a mistake. She can only see what is wrong with or missing in her. Anything she does, says, thinks, imagines or feels has the potential to spiral her down into a depressed abyss of toxic shame and abject fear. Her superego fledges into a full-blown, trauma-inducing critic, which now keeps trauma alive throughout the day by attacking her for every minor foible…by filling her psyche with stories and visions of catastrophe… moment to endless moment during emotional flashbacks.

Cognition in the Cptsd survivor is a maze of perfectionism and endangerment programs. [My article “Shrinking the Inner Critic in Cptsd” identifies 14 of these poisonous processes When the survivor is triggered, she perseverates about everything that has gone or will go wrong, obsessing all the while about triaging her imagined disasters. Hurrying, worrying, drasticizing and hypochondriasizing are ubiquitous cul-de-sacs of the critic’s negative focusing. Consciousness devolves into a process of negative-noticing – incessantly preoccupied with defects and hazards. Small potato miscues and peccadilloes trigger her into a full blown fight/flight response, which upon adrenalin exhaustion, collapses her into a depressed sense of helplessness and hopelessness.

The Outer Critic
The typical traumatized child also develops an Outer Critic, which projects his rejecting parent[s] on everyone around him. He is plagued by intense social anxiety fueled by the belief that people abhor him as much as his parents did. People are just too dangerous and too flawed to trust. Social interactions are routinely avoided or minimized.

The outer critic also commonly projects perfectionism in another way. It focuses on people’s flaws to justify avoiding them. It constructs expectations that no other human being can match. Drasticizing about a minor faux pas, the critic decides that the other is too untrustworthy for further relationship. Endless repetitions of this dynamic leave the survivor stuck in the legacy of his family’s original abandonment. Most of my Cptsd clients initially have no one in their lives who they can relate to other than superficially.

Many survivors also experience relating as a highly stressful process of vacillating between outer and inner critic. Their negative-noticing oscillates between their own dangerous defectiveness and the deal-breaking defects of others. And some, of course, via repetition compulsion periodically plunge into dangerous attachments with others who replicate their parents’ patterns of abandonment and abuse.

Countertransference and the Critic
In the early phases of therapy, I sometimes feel hopelessly impotent and frustrated with the task of helping the client to deconstruct her critic. Sometimes, it seems as if the critic is the self, not some bothersome superegoic deformity or powerfully entrenched internalization. Standard tools, such as interpretation, psychoeducation, and mindfulness fail to even loosen a screw.

After numerous futile attempts to loosen up any real resistance to the critic in the client, the urge to give up deconstruction efforts feels irresistible. Early in my career, I would think: “This critic stuff is so Psych 101. I have addressed the client’s critic issues so often that we’re both clearly sick of it. If I don’t back off soon, she’s going to leave. She’s just not going to get it. Her critic’s just too big for her to see. It’s a forest of perfectionism and endangerment blurred by her narrow focus on this particular moment’s catastrophizations.”

Thankfully, I eventually learned that nothing would change for this type of client, until we shrunk the critic enough to eke out some psychic space for self-observation – for cultivating the developmentally arrested need of self-support. I now rely a great deal in early therapy upon psychoeducation and family of origin exploration. Out of an ongoing elicitation of the client’s childhood trauma, we weave an accurate narrative of how she was inculcated with a vicious and relentless critic. I help her see how she was innocent and blameless, unlike the “care”-givers, who brainwashed her into routinely hating, shaming and abandoning herself.

Psychoeducative interpretation about the genesis of the toxic critic is, in my opinion, a step that cannot be bypassed, and I do it as much as the client can tolerate. Sometimes, I derive motivation to persist with this very slow, repetitive process by garnering the energy of other countertransferrential feelings that I have. I now typically feel guilty and neglectful when I let the critic get away with abusing the client. At such times, I feel derelict in my human and professional duty to bring attention to how he is hoisting himself on his parents’ petard.

I find now that I can no longer passively collude with the inner critic by failing to actively notice it, as various adults typically did while he was growing up. When an adult does not protest a child being attacked with destructive criticism, s/he tacitly approves it. The child is forced to assume contempt is normal and acceptable, and the witnessing adult forsakes his tribal responsibility to protect children from other adults who perpetrate child abuse.

When I label the traumatizing behavior of the client’s parents as egregious, I begin the awakening of her developmentally arrested need for self-protection. I model to her that she should have been protected, and that she can now resist mimicking their abuse in her own psyche. This eventually encourages disidentification with the aggressor and weakens the internalization of the attacking parent as the locus of the critic. Ptsd expert, Harvey Peskin, adamantly proffers that witnessing and validating the criminality of traumatizing behavior is essential to ameliorating ptsd.

In my own case, I felt loved by my grandmother who lived with my family, but she never helped me see that my parents’ vitriolic rages were wrong and not my fault. In retrospect, I believe that her neglect crystallized my belief that I totally deserved their abuse. The stage was then set for me to morph their contempt into self-loathing…chapter and verse for nearly two decades. I have also noted a marked difference in the ferocity of the critic in clients who had one influential adult in their childhood who helped them see that the destructive behavior of a caregiver was wrong and not their fault. In fact, some have survived horrible parental abuse without developing full blown Cptsd.

To close I would like to encourage you to become the first person in the Cptsd client’s life who helps him see how horribly and unfairly he was indoctrinated against himself when he was too young and impressionable to resist. Let me paraphrase Milton Erickson’s challenge to us all: we must remain resolute, brave and creative about repetitively confronting key deeply imbedded patterns that do not easily resolve from our attempts to treat them.
I believe it is crucial to apply this advice to deconstructing the critic- patterns that block the client’s psyche from becoming user-friendly.

[In my two articles on Shrinking the Critic, available for downloading at www.pete-walker.com, I offer an expanded perspective on deconstructing the influence of the hegemonic critic.]

Pete Walker, M.A., is in private practice in Lafayette. He has been working as a mental health professional for thirty-five years. He is also the author of The Tao of Fully Feeling: Harvesting Forgiveness Out Of Blame. His various published writings on working with Complex Post Traumatic Stress Disorder and adults traumatized as children can be viewed and downloaded from his website: www.pete-walker.com. He can also be reached at 925.283.4575.

Practicing Mindfulness and Compassion Conference

Admin EBCAMFT — Sat, 06 Apr 2013 16:03:03 GMT

Greetings friends and colleagues,

On Friday March 8, as a representative of EBCAMFT, I attended the “Practicing Mindfulness and Compassion” conference (The Science of a Meaningful Life) at the Craneway Conference Center on South Harbor Way in Richmond. The conference was envisioned and organized by The Greater Good Science Center at UC Berkeley and Mindful Magazine, a brand new print magazine for fostering mindfulness and its benefits for the general public, and co-sponsored by numerous other groups and organizations, including EBCAMFT. The “headliners” at the conference were Jon Kabat-Zinn, Kristin Neff, Paul Gilbert and Shauna Shapiro, but their were numerous other inspiring speakers and presenters.

From the outside, the conference center looks like a huge warehouse or factory and, come to find out, that's exactly what it is. Apparently the site was formerly a Ford Motor Company manufacturing plant where Model-T's were produced in the early part of the 20th Century. Also interesting to note is that Henry Ford III is apparently a proponent of mindfulness practices. Not sure if that had anything to do with the conference being held at this location.

For me the conference was a wonderful, warm, inspiring, refreshing and enlightening experience which reinvigorated both my mindfulness practice and my self-compassion practice. These were the two primary focuses of the conference and we had many opportunities throughout the day to explore various ways of cultivating these two practices and understand their relationship to one another. Some of the presenters emphasized the pivotal place in our planet's evolution that we now occupy and the importance of widespread Mindfulness practice and Compassion for the survival and continued evolution of the species.

Roughly 500 people turned out for the conference, most of whom were not therapists or mental health clinicians. We were all treated to a wonderful blend of direct experience, inspiration and information throughout the day with each of the contributors providing an essential piece of the overall picture. EBCAMFT had a small table set up, along with many other groups, where people browsed and networked before, during and after the event. We provided postcard brochures, newsletter samples and membership applications to anyone who wanted them.

Jon Kabat-Zinn was the first speaker and mixed humor, warmth, Buddhist teaching, practical exercises and anecdotes, providing a lovely overview of Mindfulness practice and it's place in modern society. Kristin Neff focused exclusively on Self-compassion as an essential aspect of Mindfulness practice and shared research findings and more practical exercises on the subject to give us a taste of where self-compassion fits in to the grand scheme of things and how important it is, especially in healing work. Shauna Shapiro focused on the health benefits of mindfulness practices as well as their importance in helping therapists and other professionals to be more compassionate and empathetic with their clients. Paul Gilbert, a British therapist, led us in a variety of therapeutic exercises based on warmth, empathy, compassion and mindfulness for integrating and healing conflicting aspects of the personality. He shared many clinical examples, answered many questions and entertained us throughout with his uniquely British brand of humor.

Lastly, a panel of four presenters spoke about their work using Mindfulness practices “in the field” with prenatal care and birthing, school children, lawyers, and seniors and provided moving anecdotes and answered questions from the audience. Dacher Keltner, co-founder of the Greater Good Science Center, moderated the event.

All in all, I came away from the conference with a deep appreciation for the Greater Good Science Center at UC Berkeley and a deeper commitment to Mindfulness practice in my own life and work as a means for helping our species and planet move in a direction that will foster peace, cooperation and harmony for the future. Definitely time well spent and I look forward to many more such conferences as I continue on my personal and professional journey.

Thank you to EBCAMFT and the Greater Good Science Center for offering me this rich opportunity.

Peter received his Masters Degree in Counseling Psychology, with a Transpersonal Focus and a Specialization in Child and Adolescent Therapy, from John F. Kennedy University. He is also Certified by the Kripalu Yoga Institute in Lenox, MA as a Holistic Health Counselor / Educator. He was originally trained in the Humanistic Client-Centered and Gestalt methods, gradually incorporating a myriad of other methods and approaches, 25 years of Zen Buddhist practice, and his training in Holistic Health Counseling and Education into his practice as a Psychotherapist. He also completed 12 units of Early Childhood Education at Merritt College and taught preschool for three years. Peter specializes in working with people in 12-Step Recovery, those who have survived the suicide of a loved one, adolescents and their families, and spiritual and existential dilemmas. He lives by the lake in Oakland and has an office in South Central Berkeley.

Peter Carpentieri, MFT

peterc.mft@gmail.com
510-463-1150
Comments and inquiries welcome.

SOCE Update with Jim Walker, LMFT

Admin EBCAMFT — Wed, 13 Feb 2013 06:17:44 GMT

You might have heard that in 2012 California enacted legislation to protect youth aged 17 and younger from methods to change their sexual minority orientation and/nonconforming gender expression. Governor Brown signed ban into law calling the practices "psychoquackery."

Originally CAMFT was opposed to the bill unless amended. CAMFT changed to neutrality on it before the legislature approved it. Meanwhile many state organizations like the California Psychological Association, National Association of Social Workers of California, the BBS and others supported it.

The new law applies to a collection of practices referred to by the acronym SOCE, which stands for sexual orientation change efforts. SOCE goes by a variety of other names: "reorientation therapy," "ex-gay therapy," "conversion therapy," or "reparative therapy." The new law applies not only to sexual orientation change efforts. It also applies to methods used to influence or coerce children to be more gender conforming. The law does not apply to providers who help youth affirm their same-sex attractions or therapists who help youth understand their true gender identity, should they be feeling that it is different than the gender identity assigned to them at birth. The new law applies to prelicensed and licensed health providers, not to unlicensed counselors or clergy.

I'm a MFT ten years post licensed and I have a private practice in San Francisco and Oakland where I work with adults and couples. I have a very deep and abiding interest in helping people realize that being LGBT is good and that reducing the myths against us is needed not only for our mental health but for our physical well-being and sometimes for protecting our very lives. That led me to volunteering to help get the new law passed. It was my first experience with seeing how a law becomes enacted. It was done with the support of untold numbers of people. I plan to keep supporting this new law through all it's legal challenges and into implementation.

The stakeholders who created the law did so to reduce the stigmatizing, dangerous outcomes from those practices, and to increase the a child's chances of getting affirming therapy. In creating the law, they drew not only from the participation of organizations such as CAMFT and the American Association of Marriage and Family Therapy in the process. They also drew from decades of solid research and clinical experiences about what is best for youth.

The new law will impact only a very small percentage of licensed therapists performing child and family therapy. It is aimed at stopping--if any law can--the practices of a small number of SOCE practitioners. The new law was to take effect Jan. 1, 2013. However, it has been delayed by legal challenges. The latest case is called Pickup v. Brown and is brought by David Pickup, MFT, among others. Mr. Pickup has been a CAMFT member and perhaps currently is still a member. The 9th Circuit Court of Appeals reports that they will act quickly on the case.

What does the law say? The first section of the law is a list of policies from major medical associations against SOCE. A typical portion of that section reads this way:

"(c) The American Psychological Association issued a resolution on Appropriate Affirmative Responses to Sexual Orientation Distress and Change Efforts in 2009, which states: "T[he American Psychological Association] advises parents, guardians, young people, and their families to avoid sexual orientation change efforts that portray homosexuality as a mental illness or developmental disorder and to seek psychotherapy, social support, and educational services that provide accurate information on sexual orientation and sexuality, increase family and school support, and reduce rejection of sexual minority youth."
(d) The American Psychiatric Association published a position statement in March of 2000 in which it stated: "Psychotherapeutic modalities to convert or 'repair' homosexuality are based on developmental theories whose scientific validity is questionable. Furthermore, anecdotal reports of 'cures' are counterbalanced by anecdotal claims of psychological harm. In the last four decades, 'reparative' therapists have not produced any rigorous scientific research to substantiate their claims of cure. Until there is such research available, the American Psychiatric Association] recommends that ethical practitioners refrain from attempts to change individuals' sexual orientation, keeping in mind the medical dictum to first, do no harm.
The potential risks of reparative therapy are great, including depression, anxiety and self-destructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by the patient. Many patients who have undergone reparative therapy relate that they were inaccurately told that homosexuals are lonely, unhappy individuals who never achieve acceptance or satisfaction. The possibility that the person might achieve happiness and satisfying interpersonal relationships as a gay man or lesbian is not presented, nor are alternative approaches to dealing with the effects of societal stigmatization discussed.
Therefore, the American Psychiatric Association opposes any psychiatric treatment such as reparative or conversion therapy which is based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that a patient should change his/her sexual homosexual orientation."

What is does the law define as illegal? The section defining what is illegal reads:

"Article 15. Sexual Orientation Change Efforts
865. For the purposes of this [law], the following terms shall have the following meanings:
(a) "Mental health provider" means a physician and surgeon specializing in the practice of psychiatry, a psychologist, a psychological assistant, intern, or trainee, a licensed marriage and family therapist, a registered marriage and family therapist, intern, or trainee, a licensed educational psychologist, a credentialed school psychologist, a licensed clinical social worker, an associate clinical social worker, a licensed professional clinical counselor, a registered clinical counselor, intern, or trainee, or any other person designated as a mental health professional under California law or regulation.
(b) (1) "Sexual orientation change efforts" means any practices by mental health providers that seek to change an individual's sexual orientation. This includes efforts to change behaviors or gender expressions, or to eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same sex.
(2) "Sexual orientation change efforts" does not include psychotherapies that: (A) provide acceptance, support, and understanding of clients or the facilitation of clients' coping, social support, and identity exploration and development, including sexual orientation-neutral interventions to prevent or address unlawful conduct or unsafe sexual practices; and (B) do not seek to change sexual orientation.
865.1. Under no circumstances shall a mental health provider engage in sexual orientation change efforts with a patient under 18 years of age.
865.2. Any sexual orientation change efforts attempted on a patient under 18 years of age by a mental health provider shall be
considered unprofessional conduct and shall subject a mental health provider to discipline by the licensing entity for that mental health provider."
That is the full description of what the law entails. What does the law mean for CAMFT members? CAMFT members who continue to use standard affirmative practices for healthy same-sex attractions in youth and to use standard treatment approaches for youth working through gender identity changes will not be in violation of the new law. Therapists who support the child's development through connectedness and caring as the child affirms for himself or herself his or her true sexual orientation and gender identity are in compliance with the law.

The new law complements a policy about SOCE issued by CAMFT last year. That policy states that CAMFT "is concerned about children and youth, who are especially vulnerable to harm and who lack adequate legal protection from involuntary or coercive treatment and whose parents and guardians may not have accurate information to make informed decisions regarding the child’s development and well-being." CAMFT's policy was developed to specifically support children--as this new law does--from attempts to change their attraction to their own sex. You can read CAMFT's position at their web site.

Clinical research and experience has shown that when stigma and discrimination are proactively managed there are healthier outcomes than when the person is left with the option of trying to conform to societal norms to relieve distress. One body of research that substantiates this comes from Dr. Caitlin Ryan. Dr. Ryan heads the Family Acceptance Project at San Francisco State University. During the past decade Dr. Ryan has trained more than 30,000 health and mental health providers on the mental health care of LGBT adolescents. Dr. Ryan has earned awards such as the National Social Worker of the Year and many others. Dr. Ryan actively supports California's new law banning SOCE.

Dr. Ryan and her collaborators have used a new evidence-based family intervention model based on their extensive peer-reviewed research over decades. That research has identified 106 specific accepting and rejecting behaviors that parents engage in to respond to their LGBT children. Dr. Ryan reports "these accepting behaviors include advocating for their children when others mistreat or discriminate against them because of their LGBT identity or connecting them with positive adult LGBT role models."

Their research has found there are "significant major health risks when parents insist on rejecting behaviors such as sending them to a therapist or clergy to change their sexual orientation, preventing them from learning about their LGBT identity, or making them pray and attend religious services to change their sexual orientation." She reports that they "found that these specific parental and caregiver rejecting behaviors were related to health risks for the LGBT youth in young adulthood, including attempted suicide, suicidal ideation, depression, illegal drug use and risk for HIV infection." (Ryan, Huebner, Diaz, & Sanchez, 2009). Their research also found that family accepting behaviors help protect LGBT youth against these major risks and promote well-being including higher levels of self-esteem and social support in young adulthood. (Ryan, Russell, Huebner, Diaz, & Sanchez, 2010).

Researchers found that lesbian, gay or bisexual young adults who reported high levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression (at the cut off point for medication), 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse – compared with peers from families that reported no or low levels of these family rejecting behaviors (Ryan, Huebner, Diaz, & Sanchez, 2009).

"Specifically," Dr. Ryan explains, "young adults whose parents sent them to a therapist or religious leader to attempt to cure, treat or change their sexual orientation during adolescence were far more likely to consider suicide and to attempt suicide than peers who were not sent to undergo SOCE. They also were far more likely to report clinical depression and to report levels of depressive symptoms that reached or exceeded the threshold for medication." (Russell, Ryan, Toomey, Sanchez, & Diaz, in preparation).

Sexual and gender minority youth who are not affirmed for their attractions may miss out on important developmental milestones. At a time when heterosexual adolescents are learning to socialize about romantic and sexual attractions, sexual and gender minority youth who undergo SOCE may be disadvantaged. They will be conflicted about dating those of their own gender when dating them will subject them to stigma, and they will be conflicted about dating those they do not romantically or erotically prefer (Hetrick & Martin, 1987; Lasser & Gottlieb, 2004; Ream & Savin-Williams, 2005). The American Psychological Association's Practice Guidelines for Lesbian, Gay and Bisexual clients (2012) indicate that these attempts to mask or deny sexual identity put sexual and gender minority youth at risk for unwanted pregnancy, unsafe sex, interpersonal violence, substance abuse, and suicide attempts.

Minors are in the initial stages of exploring and acquiring information to enhance their understanding and skills associated with their sexuality and choices. The problem with offering SOCE to minors is that youth may not realize their long-term needs and may overestimate their ability to cope in the long-term with denying their deeper same-sex attractions. If youth are overfocused on meeting the religious needs of their parents and the heterosexual norms of society, youth may not realize that not acting on their authentic same-sex romantic and sexual desires will create deep conflicts and emotional pain for them later in life, if not sooner.

The Mormon church has long disallowed same-sex attractions and relationships. In a recent major shift, church elders abandoned their former practice of encouraging members with same-sex attractions to marry members of the opposite sex. Too much emotional pain came out of that practice when spouses discovered they could not remain married without distress and pain coming from forcing themselves to deny or hide their attractions to their sex in order to be married to a person of the other sex. In 2012 the church leaders reversed their position after coping with decades of broken marriages and family pain resulting from encouraging young people to marry despite their same-sex romantic or sexual orientation. See http://gayandlesbianmormons.org

Healthy sexuality depends on developing an integrated awareness and acceptance of one’s needs and values, which can provide meaning, authenticity, wholeness, and satisfaction as it orients the individual toward intimacy, love, and companionship. Sexual development therefore requires periods of exploration without bias. It requires learning how to live positively with one’s attractions, regardless of one’s sexual identity and life choices. Although some SOCE youth clients may feel supported by their SOCE provider, at its core, SOCE reinforces a message that their sexual/romantic desires are wrong. They are something to extinguish. The new law reinforces that adolescent development is supported by therapeutic interventions that affirm living positively with one's same-sex attractions.

For extensive, expert information about how to affirm LGBT and questioning youth, reliable information is available online at the following sites: http://leadwithlovefilm.com, http://www.genderspectrum.org,http://familyproject.sfsu.edu

For more updates about the new law, watch the news this spring.

Jim Walker, MFT
510-684-4508 cell
Offices in Oakland and San Francisco
http://mindbodytherapyservices.com
http://lgbtcounseling.com

Eating Disorders and Mild Multiplicity By Shoshana Kobrin, LMFT

Admin EBCAMFT — Wed, 13 Feb 2013 06:14:26 GMT

Judy Lightstone, clinician and researcher on eating disorders in the San Francisco Bay Area states, "The therapist must be aware of the role of dissociation in eating disorders." 1 I, too, believe the symptoms of eating disorders are a form of Dissociative Identity Disorder where the self splits into parts for emotional survival. People with eating disorders invariably have experienced significantly difficult or traumatic childhoods and teens.

I coined the term "Mild Multiplicity" to describe dissociation in eating disorders.3 "Mild" indicates that this type of dissociation is a less severe form of the condition.

Mild Multiplicity
Normally, we all have different parts of the self acting somewhat independently, depending on the situation. We dress, act, and feel differently at home and at work, with relatives or with strangers. The extreme form of Dissociative Identity Disorder is defined in the DSM IV: "Each personality state may be experienced as if it has a distinct personal history, self-image, and identity…”.4

Mild Multiplicity falls in between the bounds of normalcy and extreme dissociative disorder. On a scale from one to ten, a normal level of compartmentalization is a one. The DSM definition is a ten. Mild Multiplicity is from a six to an eight on the continuum.

With Mild Multiplicity, the dissociation is generally restricted to eating disorder behaviors; the person is unable to stop the parts of the self acting out by yo-yo dieting, fasting, bingeing, compulsive overeating, or purging. Apart from the eating disorder beliefs and behaviors, an executive-self provides continuity of personality, behavior, and emotion, managing life’s tasks fairly well. Relationships are usually problematic.

Freud and Eric Berne
The idea of separate aspects of the self is not new. Freud, in his formulation of Id, Ego, and Superego, established that the human psyche is multi-faceted. Erik Berne’s theory of Transactional Analysis adapted Freud's divisions of personality.5 The Id becomes the Inner Child, (Natural and Adapted) Ego is the Adult, and Superego is the Parent (Good or Critical). These systems of thought, feeling, and behavior are warring factions in the unconscious, especially in eating disorder patients.

The Parts in Mild Multiplicity
Although sometimes criticized as simplistic, Berne's formulation of the introjected Child, Adult and Parent Parts is a useful and easily accessible theoretical base to describe dissociation in eating disorders. This is incorporated into my definition of Mild Multiplicity.

Child Parts in Mild Multiplicity
With an eating disorder, the Natural Child, expressive and joyful, hides away while the Adapted Child acts out with dysfunctional eating behaviors and negativity towards the body (Body Dysmorphic Disorder).

Adult Part in Mild Multiplicity
This is usually highly developed and extremely functional. People with eating disorders are typically intelligent and resourceful, and have unconsciously chosen the route of dissociation for survival. Injunctions from doctors and diet organizations are ineffectual long-term, however, since the well-disciplined and rational Adult has vanished, replaced by the emotionally hungry Adapted Child who rejects each diet.

Parent Parts in Mild Multiplicity
The Critical Parent is a harshly negative self-concept. Self-hatred is projected onto the body. "Fat, fat, FAT! You're nothing but a fat pig," one patient constantly said to herself, even though she was no more than fifteen pounds above the norm for her height.

The Good Parent and Natural Child are undeveloped – often non-existent – in Mild Multiplicity
The Hidden Ones
In working with eating disorders, I found far more hidden, unconscious Parts than the five Berne describes. They reflect:
   Roles in the family of origin
   A difficult or traumatic childhood
   Unconscious ideas and beliefs
   Patterns of thought and behavior, especially around food and the body
   The emotional state at a certain age
   Reactions to experiences or people
   Various emotions, states of mind, or moods

The Parts are divided into the Challenging and the Affirmative Parts. Unfortunately, people suffering from eating disorders are governed by the Challenging Parts. The rational, nurturing, joyous, and creative Affirmative Parts can restore balance and health.

Naming a Part gives a handle to grab onto when it pops up unexpectedly and is followed by plunging into the knee-jerk, negative activity with food. Naming is the first step in allowing the disassociated Parts to emerge to conscious awareness.

Here are examples of named Parts that my patients and I have discovered and personalized over the years: the Challenging Parts that cause dysfunctional eating, and the healing, encouraging Affirmative Parts.

Challenging Parts
Conditioned Children:Hungry Baby, Black Hole, War Zone Child, Goody Two Shoes, Pirate, Rebel, E.T., Child in the Well
Critical Parents: Slave Driver, Helpless Heap, Mad Monkey Mind, Daggers
Monsters: Binge Monster, Two-headed Green Dragon

Affirmative Parts
Adults: Rationalist, Mover and Shaker, Ms. Competence, Problem-solver, Natural Children, Explorer, Cuddles, Happy-go-lucky, Good Parents, Earth Mother, Wounded Healer, Warrior Knight, Higher Beings Angel Michaela, Yoda, White Light

The steps in managing the Parts are naming, accepting, and feeling compassion for them, dialoguing with them, strengthening the Affirmative Parts, and finally, integrating all the Parts.

Bringing the Parts to consciousness remedies the dissociation. This heals the alienation and inner hunger of an eating disorder, promoting a connection with passion, joy, and meaning in life.

Notes

1. Lightstone, Judy. (2005) Healing Intractable Eating Disorders. Home study course, p.23.

2. Something Fishy (2006) Website on eating disorders: Exploring the Role that Abuse Plays in the Development of an Eating Disorder.

3. Kobrin, Shoshana. (2012) The Satisfied Soul: Transforming your Food and Weight Worries. Bloomington, IA: AuthorHouse.

4. American Psychiatric Association. (1994) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, page 484. Washington D.C.

5. Berne, Erik. (1964) Games people play: The Basic Handbook of Transactional Analysis. New York: Ballantine Books.

Shoshana Kobrin LMFT, has a psychotherapy practice in Walnut Creek, specializing in eating disorders. She gives workshops, presentations, and trainings for professionals and the community. She’s the author of The Satisfied Soul GuideBook: Your Path to Transformation and The Satisfied Soul: Transforming Your Food and Weight Worries
To contact her: (925) 256-8503 shoshanakobrin@sbcglobal.net
www.shoshanakobrin.net www.kobrinkreations.com

Shoshana will present a CEU Presentation with EBCAMFT on March 9 at Epworth United Methodist Church in Berkeley. Please check our Events section for more details.

Mysterious Skin Film Review By Merle Yost, LMFT

Admin EBCAMFT — Sat, 08 Dec 2012 09:43:14 GMT

This has been one of the most difficult reviews that I have ever had to write, because the subject is very close to my heart. I had to give myself some distance to really look at the film, which also speaks to its power.
I think that this is a great movie, incredibly accurate in its depiction of men who were sexually abused as children, and I encourage you to see it. I feel that it is particularly important for those men who are childhood sexual abuse survivors, and the people who love them and work with them, to see Mysterious Skin.

There is little suspense in the film; it is all well laid out. The journey is in watching the characters grow up and begin to deal with the pain and horror of their childhoods and the impact that had on their adulthood. The two central characters, both their adult selves and the boys portraying them as eight-year-olds, are great. The story is about two boys, both sexually abused by the same man, the local baseball coach. The meat of the film is about impact of the abuse on them as they grow up and the influence on their choices and their lives.

The pedophile played by Bill Sage is well represented as a caring man who pays a lot of attention to the boys. It is not violence but subtle manipulation that seduces the boys. Often the boys who are yearning for a man’s attention are the most vulnerable, and this character gives the boys something they are desperately seeking.
Our main character, Neil, played by Joseph Gordon-Levitt as the adult and Chase Ellison as the eight-year-old, was emotionally incested by his mother, so additionally being sexualized by his coach seemed only natural to him. He saw it as one of the great experiences of his life. He romanticized it and constantly tried to recreate the experience. This is called a “repetition compulsion” and is often mislabeled as sexual addiction. The sexual experiences with the coach were the most intense pleasure that he had ever received, and at eight years of age, he had neither the emotional nor physically ability to process the sensations. It is normal and common for a male in this situation to attempt to recreate the experience, to try and work through the feelings, to no longer freeze emotionally. Unfortunately, this method rarely works.

The other main character, played by Brady Corbet as the adult and George Webster at age eight, was great. Webster, in particular, did an extraordinary job of showing the dissociation that often happens to a child being sexually abused. He literally went blank which continued into adulthood, and was unable to remember what happened, so he created a screen memory to explain the feelings that he has. As he is forced to relive the real experience, he regressed into the eight-year-old boy’s experience and begins to process in his adult body those feelings that were too much as a child. Corbet also showed the other side of sexual abuse: survivors who become sexually anorexic as a way to stay away from the experience that so traumatized them.

Is he gay, when he rejects the advances of a girl and his new best friend is a gay young adult male? Who knows? He would probably not be able to figure that out until he continues to develop psychosexually after working through the trauma of the abuse where he has been frozen in time as an eight-year-old.

There are three great scenes in the film. The first scene is where Brian (Corbet) confronts his father (Chris Mulkey) for not protecting him and missing that something awful happened to him. The second is the rape of Neil by his last trick. Males sexually abused as children are much more likely to be raped as adults. The third scene is the last 9 minutes of the film where the characters unite to reclaim their memories and feelings about what had happen to them. The emotion ripped across the screen, and we felt their pain. That is great filmmaking and acting.
I feel like I am writing a paper on sexual abuse and attending this film for me was like watching parts of my own life as well as my work. I am a psychotherapist who is both a sexual abuse survivor and a specialist in the treatment of men who were sexually abused as adults and or as children.

The performances were uniformly good and the direction was right on. It is the first Gregg Araki film that I enjoyed. It is his first mainstream film and is certainly deserving of all the attention and praise that it is getting. The women who played Neil’s and Brian’s mothers gave dead on performances. Elisabeth Shue as the incestuous mother was real in showing her caring, boundary-crossing, inappropriate behavior. Lisa Long was so funny as the Martha Stewart of backwoods Kansas, I would laugh every time she came on the scene. Her protectiveness was evident, and we loved her for it.

My only real complaint is that I did not feel much emotion from the film. It is very detached and intellectual. You see horrible things but you never get the emotional kick except in the three scenes that I mentioned above. If the point was to see it from the emotional perspective of the two lead characters, it succeeded brilliantly. If Spielberg had directed this it would have been so over the top in feelings that I suspect it would have been unwatchable. I have to compare it to the play from the same material and to the best movie on sexual abuse of boys that I have ever seen, The Boys of St. Vincent. Both of these other vehicles showed both the horror of the abuse as well as hit-you-below-the-belt emotions.

I highly recommend the film. I hope that theatre companies everywhere produce the Mysterious Skin play. This message about the abuse of boys must be told over and over if we are to save another generation from this life sentence of pain. The film is great and honest material. When I do my workshop, Shedding Light on the Sexual Abuse of Boys and the Men They Become, I strongly encourage participants to watch the film before the workshop.
It is particularly important for therapists to see this film. It will help them see in very graphic terms the abuse and impact on males and how it can look different than with females. Just getting a male to admit that he was abused is generally the first step and this film will help many in taking the first steps toward healing. It will also give the therapist and client a point of reference outside of the clients experience that can may it easier to examine what abuse looks like and how it compares to their own.

The movie Mysterious Skin is based on the novel of the same name by Scott Heim.

Merle Yost is a 1991 graduate of the JFK Transpersonal Program. His has had a practice in Oakland for close to 20 years. He is graduate of the SF Gestalt Institute, an Approved EMDR Consultant and a specialist in PTSD and traumatic childhoods. www.myost.com

As a Military Family Life Consultant he spent 30 days in Germany working with solders and their families.

Merle has published 5 books, and is a leading authority on men with gynecomastia and expert on working with men that were sexually abused as children.

He has been a supervisor for many years at the Pacific Center in Berkeley.

Official Site: http://www.mysteriousskinthemovie.com
A film by Gregg Araki, Director, Writer and Producer
NC17, Starring Brady Corbet, Joseph Gordon-Levitt, Michelle Trachtenberg, Jeff Licon, Bill Sage, Mary Lynn Rajskub and Elisabeth Shue
Film still taken from www.rottentomatoes.com

Girl Bullying: What Do We Do About It? By Tess Brigham, LMFT

Admin EBCAMFT — Sat, 08 Dec 2012 09:41:57 GMT

As therapists we are used to working in the “shades of gray” but one thing we know is that boys and girls are different. When a parent comes to us it is vital that we understand the distinction between how boys and how girls bully each other.

Bullying is an issue that triggers emotional reactions in us because most of us have been bullied at some time. Girl bullying is an important segment of the larger issue of female self-esteem and female friendships.

When parents come with issues of bullying, this presents the opportunity for you to help parents, to not only navigate this difficult situation, but also to give them education and tools to strengthen their daughter’s sense of self. This will enable their daughters to grow into strong and confident young women.

Complicating this issue is that we are working with a generation of kids that are “digital natives” and use technology on a level that we will never fully understand. The anonymity and availability of Smartphones, Facebook and Twitter can make bullying a 24/7 problem.

When a parent comes to you saying their daughter is being bullied, certain techniques can be helpful:
Educate them on what happens biologically and developmentally during the pre-teen and teen years.
Inform them of what they can do at home before, and during, their daughter’s middle school years.
Develop a plan of action when their daughter is being bullied. Incorporate tools they can use on a daily basis to continue to strengthen their daughter’s self-esteem.

Biologically girls bond and build trust with people through relationships. Dr. Louann Brizendine in her book “The Female Brain” has discovered that a girl’s behavior is not a direct result of socialization. We are not born with a “unisex” brain, girls are already wired as girls and boys are wired as boys. Brizendine writes, “girls arrive (in) the world better at reading faces and hearing human vocal tones. A girl is born with a highly tuned machine for reading faces, hearing emotional tones in voices and responding to unspoken cues in others.”

When a girl enters puberty, according to Brizendine, “this is the first time a girl’s brain will be marinated with high levels of estrogen. These hormonal surges assure that all of her female specific brain circuits will become even more sensitive to emotional nuance, such as approval and disapproval, acceptance and rejection.”

Girls will be strong and confident one moment; miserable and sad the next. Biologically girls are predisposed to react strongly to relationship problems. Developmentally girls need to be liked and connected, while socially they are expected not to show too much anger or aggression. These juxtaposing forces create a conundrum. If a girl wants to express negative feelings toward a friend, she has to use subtle tools. She will spread a rumor anonymously because she needs to remain socially connected. She must avoid being perceived as mean or aggressive by the group.

Parents can have tremendous influence over their daughter’s viewpoint of other females thus they must look at their own attitudes towards women. Do they judge women on appearance in front of their daughters? How do the females in the house speak of themselves? Are they constantly criticizing their appearance and speak negatively of themselves? Are the accomplishments of women being celebrated? Our culture has so many unrealistic ideals for women. Parents demonstrate through their praise the qualities they value. This is the foundation for their daughter’s view of women and thus herself.

If a parent comes to you because their daughter is being bullied tell them to do nothing. Parents want to jump in and solve the problem, but their daughter has come to them because she needs to be listened to and heard. If they react with panic or worry, this will make her shut down completely. Let her vent the entire story. Do Not Blame--all parties’, the aggressors, the victims, and the bystanders, are hurt by bullying. Validate her feelings and normalize her stress.

Ask her what she wants to do about the situation. Find out what she thinks would be the best way to resolve this issue. Hold your advice. If it happens once let her speak to the bully directly. If the problem persists or gets extreme, take action and make sure to involve your child in the process.

Help your daughter learn how to deflect and ignore the insults. Your daughter needs to develop resilience against the bullying. Help her develop self-esteem outside of her school relationships. Get her involved in athletics or a hobby. If she can feel a sense of accomplishment in another aspect of her life, it will improve her overall view of herself.

Parents can work on helping develop and improve their daughter’s self-esteem. They can create rituals with their daughter by finding time each day, maybe 10 minutes before bedtime or at breakfast, to connect with their daughter. No phones, computers, or talk of homework, this time needs to be focused on their daughter so she can really talk. The small things that parents do everyday add up and can have tremendous influence. It may not be apparent today, but it will payoff in the future.

It is imperative that we give parents information about what is going on in their daughter’s brain and how it affects behavior. This knowledge can help parent’s change how the family reacts to bullying as well as help them develop an atmosphere of positive female imagery. Therapists can suggest ways to incorporate bonding activities that can become life long patterns. Girls may always struggle with female relationships and with being able to express their negative feelings. We need to have empathy, listen attentively and help them develop ways to resolve conflicts in order lessen the impact of girl bullying.

Tess Brigham is a family therapist specializing in working with pre-adolescent and adolescent girls, helping navigate the complexities of being a teenager in the 21st century as well as helping parents find the ìrightî moments to build stronger connections with their daughters. Tess offers practical interventions parents can use to establish trust and open communication with their daughters. She currently works at Coyote Coast Youth and Family Services in Orinda and at Kaiser Permanente. She has a private practice in Oakland and lives in Berkeley with her husband and young son.

www.tessbrigham.com

Highlight on Bay Area Psychotherapy Training Institute (BAPTI) Marie Hopper, LMFT, Clinical Director BAPTI

Admin EBCAMFT — Sat, 08 Dec 2012 09:40:15 GMT

Next year, in April 2013 the Bay Area Psychotherapy Training Institute (or BAPTI) will be celebrating 20 years as a counseling and training center. BAPTI was founded in 1993 with the intent of providing moderate fee counseling services to the Lamorinda and greater Contra Costa County community while also educating and mentoring mental health professionals interested in starting a private practice. This mission for BAPTI has not changed over the years, and we are excited to be celebrating its accomplishments while also preparing for its next 20 years.

In the fall of 1992 Dr. Robert Marino began discussing his vision for BAPTI with a colleague, Margaret de Petra. The ideas that developed--gathering top notch clinicians in various specialities and establishing a training program for MFT interns and Ph.D post doctorial students, soon came together, and in April 1993 the first offices were opened in Lafayette. Within a few months, a local psychologist, Dr. Beth Ferree, joined Margaret and Bob as a partner and immediately joined in the implementation of the intern training component. Margaret and Beth served as BAPTI’s first directors and Bob became Board President. But BAPTI has been much more than just a counseling center. It is, and has been a collective of private practice clinicians who have taken to heart the idea that if they support each other, and share their skills they could both enjoy their work more deeply and serve their clients more effectively. This larger group of licensed clinicians came to be known as ‘MDF’ (for Marino, dePetra & Ferree)

The community grew quickly. Many interns who completed the BAPTI program elected to remain involved after they became licensed by becoming members of the board of directors, supervisors in the program, or by offering training or other skills to the newest class of interns. BAPTI and the clinicians associated with it have gone from four offices in one suite 20 years ago, to four suites shared by over 30 clinicians today.

Currently, BAPTI interns collectively see between 50 and 60 clients a week with a client population ranging from children to adults in individual, couples or family sessions. Some interns work from a CBT perspective, some from a psychodynamic perspective. Others are developing specializations in trauma and EMDR. Working with couples from an attachment perspective is a growing interest for many, as is mindfulness and using ACT. This holiday season BAPTI is offering a ‘Holiday Support Group’ on Thursday nights for clients that need extra support during the holiday, and to help provide coverage for therapists on vacation. Interns come into the program with a variety of previous experiences, but all share the interest of becoming strong licensed clinicians who can survive in the private practice sector.

Over the years a wealth of diverse perspectives have developed among the BAPTI and MDF clinicians. By having seasoned MFT’s, Psychologists and LCSW’s with a variety of specializations involved in supporting BAPTI, the interns have the ability to consult on a wide range of topics whenever they like. All of the MDF clinicians offer consultation to the interns, so interns are able to more easily educate themselves on a given topic whenever necessary for a specific case. In building this supportive and skilled resource for the interns, they are able to provide clients needing a sliding scale a good option for mental health services.

Clients come from many sections of Contra Costa and Alameda counties for services, and have enjoyed the ability to continue working with their clinician after he or she has become licensed. One of the unique aspects of the BAPTI training program is that it also allows interns to build their client base while in the program, and then take clients when they leave. This has been a critical piece for many newly licensed clinicians graduating from BAPTI so that once they are on their own they have the clients necessary to open their private practice. Services for the client are therefore uninterrupted by the licensing process.

As BAPTI enters the new year we are reflecting on what has been our history, and what we hope will be our future. In this complex era, when mental health services are needed more and more, but are unaffordable to many, we hope to continue to provide an alternative solution. We know we share the goal of excellent patient care with those of you who also work in the mental health field. And, in the spirit of supporting everyone in this larger community of care providers, we wish you all a very happy new year.

BAPTI's intake line is 925-284-2298. BAPTI is located at 3468 Mt. Diablo Blvd #B201, Lafayette, CA 94549. Marie Hopper can be reached at 510-919-1110.

Marie Hopper, LMFT is the clinical director for BAPTI. In addition to working at BAPTI, Marie has a private practice with offices in Lafayette and in El Cerrito. She specializes in working with couples, parenting issues, and young adults. She also enjoys running women's support groups.

Seeking Safety Treatment Manual: Accessible Tools for Work with Trauma by Lisette Lahana, LCSW

Admin EBCAMFT — Mon, 19 Nov 2012 00:43:28 GMT

“You yourself, as much as anybody in the entire universe, deserve your love and affection.” -Buddha

According to Judith Herman (1992), the first stage of recovery from trauma is that of “Safety.” This key stage can include skill building in order to prepare for the work of “remembrance and mourning,” which may involve exposure therapies. With the best of intentions, we sometimes rush toward interventions that trigger Post Traumatic Stress Disorder symptoms which can cause people to fall apart in our office or when they return home. I’ll admit that I’ve had the experience of being shocked by what I heard during an intake in response to the routine question “Have you ever experienced any abuse as a child?”   I’ve listened, paralyzed, as the gory details of a rape tumbled into the room. It can be difficult to stop a client mid story but sometimes that is exactly what we must do, gently, in order to prevent destabilization. Early on I assess what skills clients already possess for self-regulation when they are having overwhelming feelings. Slowing down before entering into trauma work helps us assess where a client fits into this stage model for trauma, their symptom picture and their expectations of therapy.

When working on the stage of “Safety” with clients, we encourage them to spend time in therapy learning day-to-day coping skills. That may mean helping clients decrease or stop using substances, self-harm or other compulsions. We focus on helping clients gain a sense of control or understanding of their symptoms. Later we may move to help them establish safe environments and relationships with healthy boundaries.   At the core of this stage of recovery is that our clients become skilled at developing a safe relationship with themselves and others. This is where Seeking Safety: A Treatment Manual for PTSD and Substance Abuse (2002) by Lisa Najavits, can become a trusted companion.

The Seeking Safety Program, designed by Najavits, comes in the form of a manual with 25 different topics for clients who have Post Traumatic Stress Disorder and also applies to those with a co-occurring Substance Abuse diagnosis.   Multiple studies have found there is a strong link between PTSD and substance abuse. In one recent study, between 44% and 56% of women seeking treatment for substance use disorder had a lifetime history of PTSD (Covington, 2010).   The Seeking Safety model has been used in a variety of settings and has been found effective at reducing symptoms of PTSD. After fifteen years of different therapies, one of my clients, “Sharisa” noted that the program finally helped her to understand the connection between her history of incest and her abuse of alcohol.

Seeking Safety is primarily geared toward adults and can be used individually, in groups, with all genders, and without any special training. Training materials and videos are available on Najavits’s website for those who want additional preparation. It has been tested with a wide variety of populations, from veterans to incarcerated women. A therapist who has knowledge (but not necessarily a specialization) in trauma and substance abuse will have all they need to use these materials successfully. Abstinence as well as harm reduction principles are promoted in the materials.

The manual provides 25 topics that combine cognitive behavioral therapy, interpersonal skill training and psychoeducation. I appreciate that the program materials address how trauma informs a person’s core values and ways of making meaning of the world.   The topics can be presented to clients in any order. I often provide clients with a topic list and they can then choose which topics they want to focus on. For some clients, I have presented only one or two handouts in the entire course of individual treatment. Others take part in my six-month group therapy program. Clients may work on topics such as “Asking for Help,” “Compassion,” or “Healing from Anger.”

I routinely use these materials with clients who have no substance use issues as the program seems equally effective for them. When we reach one of the rare sections of the handouts whose focus is primarily on drugs or alcohol, I ask clients who don’t relate to think of things that they do that may be harmful, in order to cope. Most trauma survivors I’ve worked with relate to the idea of having unhealthy compulsions or coping tools such as gambling, smoking, isolation or overeating.

In a group setting, using Seeking Safety handouts, we begin by listening to a quote, like the one above, about self-compassion by Buddha. During every check-in period we ask about positive and negative attempts to cope over the week. For example, last week one client talked about the self-harming behaviors she uses to cope, that of picking at her skin when stressed. I applauded her honesty and helped her analyze the impact of the behaviors. We brainstormed other ways to manage her distress next week, such as returning to her weekly yoga practice. All this was approached with curiosity, avoidance of shame and respect for her resilience.

In Seeking Safety, each topic comes with a chapter to prepare therapists and includes handouts for clients. Chapters, which I like to think of as my cliff notes, give background on the topic as well as tips on how to initiate dialogue and build insight. One of my most cherished handouts is on “Detaching for Emotional Pain (Grounding)” which helps clients “…shift attention toward the external world, away from negative feelings.” (p. 125) The therapist gets a step-by-step ten-minute script to walk clients through physical, mental and soothing grounding skills. These tools help clients reduce their reactivity and move away from their fight or flight response. For example, to mentally ground, clients are encouraged to “play a categories game with yourself” and name as many cities or types of dogs as they can. Or “count to 10 or say the alphabet very s…l…o…w…l…y.” Then they get to take home a trusty handout to practice the three types of grounding in their weekly commitment (homework).

I love leading Seeking Safety Groups because my clients, most of who have complex PTSD, actually notice feeling more stable and using healthier coping skills after six weeks of the program.   However, sometimes giving up the familiar negative coping can lead to an upsurge in trauma symptoms. Seeking Safety gives therapists and clients a foundation of tools to draw upon as the work challenges and deepens over time. I encouraged clinicians to take a look at the materials and bring in a model that helps clients, who are often stuck, move toward healing.

Licensed since 1999, Lisette Lahana, LCSW is CAMFT member in private practice in Oakland, CA and has run Seeking Safety Groups since 2008. She has openings in her current Seeking Safety group in Lake Merritt/Oakland.   LisetteLahana.com. Learn more about Seeking Safety, the topics, the empirical research behind it and how to purchase the manual on SeekingSafety.org.

The Women's Cancer Resource Center's Free Therapy Progam By Ali Vogt, LMFT

Admin EBCAMFT — Wed, 10 Oct 2012 04:23:34 GMT

Bernice is a 48-year old African American woman who was diagnosed with stage-four lung cancer in August. Unfortunately the diagnosis came in the midst of an extended depressive episode. She has no support system and her husband has recently become physically abusive. She is desperate for someone to talk to and help her work things out.

Maggie had Hodgkin’s Lymphoma at age 16 and then breast cancer at age 34 and recently had a bilateral mastectomy. She is unable to work due to the neuropathy in her hands and feels directionless in her life.

Anna’s relationship with her husband has always been difficult but now with her recent stage two breast cancer diagnosis, things have gotten worse. She and her husband want couples counseling with a Spanish-speaking therapist.

These three women are typical clients in the Women’s Cancer Resource Center’s Free Therapy Program. Their issues are “every day” in some respects and yet dire with the added challenge of cancer. Being a therapist in this program is a privilege because the issues these women face are literally life and death.

As most of us know, there is a great need for therapy services in low-income and uninsured communities. The American Cancer Society issued a compelling Report to the Nation, which found that poor Americans were receiving substandard health care. As mortality rates for cancers have improved for certain populations, African American and Latino women continue to present with late stage diagnoses and die from this disease. This is especially of concern in Alameda County, one of the most racially and ethnically diverse regions in the nation and where 11.5% of the population lives below federal poverty level resulting in disparities in disease, disability, and healthcare. As a result of the economic downturn, resources for therapy, cancer screening, diagnosis, and treatment continue to diminish. Barriers such as limited English proficiency and illiteracy, and patient-health provider communication difficulties due to cultural beliefs, and myths and fears about cancer often delay treatment resulting in a more advanced cancer presentation at the time of diagnosis.

The Women’s Cancer Resource Center (WCRC) is at the forefront of providing services to all women with any cancer, from all backgrounds, economic abilities, and ethnicities. Our clients include women with new diagnoses, in remission/survivorship, living with metastatic disease, and receiving end-of-life care. We provide an array of programs designed to help our clients cope with the physical and emotional changes caused by diagnosis, treatment, and the challenges of caring for someone with cancer. The Free Therapy Program, offers 12 free psychotherapy sessions to low-income and/or uninsured individuals and couples that desire a safe place to discuss any issue related to their cancer diagnosis.

Who does the therapy? Therapists and interns just like you who are in a private practice and want to volunteer in a meaningful way. Therapy can take place in the therapist’s office – which makes it a convenient volunteer opportunity - or in a private space at WCRC. The therapists are the newest intern to the most seasoned Psyd’s, PhD’s, MFT’s and LCSW’s. We have therapists from all cultural backgrounds and three that speak Spanish fluently.

The Free Therapy Program volunteers offer 12 free fifty-minute sessions after which the client can become the therapist’s client if a fee can be agreed upon. Volunteering can lead to practice building. The therapist also receives clinical training on end-of-life issues, and cancer, through bi-monthly seminars held at WCRC. These trainings are enriching networking and community building events.

This program is only one of the many that the Women’s Cancer Resource Center (WCRC) provides for our community. We provide information on prevention and early detection and do outreach to underserved communities throughout the East Bay. Core programs are led by staff and volunteers and include: information and referral to community resources, support groups, in-home support, psychotherapy, emergency financial assistance, cancer and wellness workshops, and navigation through an often complex and overwhelming health care system to ensure appropriate care and treatment.

Though the majority of our clients are diagnosed with breast cancer, WCRC serves all women with any cancer and all programs and services are FREE of charge.

As with all our programs at WCRC, volunteers are the heart of the Free Therapy Program. Currently the program has 30 therapists actively seeing clients. We are consistently recruiting a diverse group of therapists to meet the needs of our clients. We are hoping to attract therapists in the East Bay and San Francisco. We are especially interested in therapists who identify as African American and who speak Spanish fluently.

For more information, contact Ali Vogt, MFT at ali@wcrc.org 13a42d64d98a45a1__GoBack. To learn more about WCRC please see www.wcrc.org.

Ali Vogt, MFT, is the Clinical Manager of WCRC’s Psychotherapy Programs. She also has a private practice in San Francisco and Oakland where she works with adult individuals and adolescent girls.

The Body Never Lies by Dr. Nicky Silver

Admin EBCAMFT — Tue, 18 Sep 2012 04:57:07 GMT

When I was in my early 20s I went to a bioengergietc therapist. She watched me walk and told me specific accurate info about myself. That experience blew me away. Now I teach this.

What seemed mysterious to me at that time is actually a learnable skill once we start to look for the somatic signs.

For example, we generally unconsciously feel drawn to someone who approaches us with an open posture and a buoyant walk. Conversely we may unconsciously shy away from people who carry “heavy energy” as illustrated by their posture, their facial expression, their walk and their demeanor.

These same reactions affect us in our role as therapists when we are working with our clients. As therapists, our task is to make the unconscious conscious. When we fail to pay attention to these subtle and not so subtle somatic cues in our clients, we are not only missing an essential diagnostic tool but we are also relinquishing the opportunity to present the client with an irrefutable truth.

The body never lies. As we know, we can all verbally deny. But our bodies never lie.

For example, a woman came to see me for complaining of right hip pain that she had since the birth of her child some 15 years ago. I watched her walk and saw that her gait was compromised such that the optimal rotational mechanism of a healthy joint was altered. During treatment I worked to balance her imbalanced musculoskeletal system using chirppractic skills, craniosacral therapy and mind body awareness. Therefore, while I was working with her, I continually explored her responses to the treatment, both physically as well as emotionally. During the third session, as I loosened some very tight muscles in her hip, she burst into tears as she remembered the origin of her injury.

During the birth of her daughter 15 years prior, she was delivering in a teaching hospital. While under spinal anesthesia, a resident doctor innocently and inadvertently pressed on her left thigh pushing it beyond its normal range of motion, causing the pain that she had suffered for all these years.

What a huge and surprising discovery. The rest of our session focused on her rage at this pain that she suffered from for so long as well as the corresponding cost to her sexual pleasure. .She admitted that she and her husband have had significant sexual issues that began after the birth of her daughter and finally now it made sense that it stemmed from this hip injury.

As a psychotherapist, you might meet this woman in couples counseling. The sexual issues may have become elaborated into believes about either her or her husbands inadequacies, loss of self esteem, and/or verification for shutting down in the relationship. .

But if you looked at her gait, it would become obvious that her two hips were not moving synergistically. Her left leg was rotated outward while her right seemed normal.

While you may not diagnosis the source of her gait, a relevant question might be to ask if she has pain in her leg. And if so, how long has it been going on?

The point of all this is to encourage therapists to begin to see their clients and look for meaning not just in the words they say but also in their physical actions.

Here are some simple guidelines to look for:

How does someone walk in to your office?

How does someone sit down?

How do they hold their head?

How do they hold their chest,?

What are the position of their shoulders?

What story is their posture saying?

Just this little awareness can make a big difference in the way you see your clients and can significantly open the lens through which you can see this person. By doing so, a greater potential exists to incorporate the integration of the mind and the body in your treatment.

Dr Nicky Silver will be offering a presentation to The East Bay Therapists Association on Wednesday October 3^rdfrom 10 AM -12 PM. at St Mark’s Methodist Church at 415 Maraga Way in Oriinda, CA

Dr Nicky Silver has been a practicing chiropractor for over 30 years. She has studied extensively with The Center for MindBody Medicine with Dr. James Gordon as well as with holistic health pioneers, including Dr. Bernie Siegel, Dr. Carl Simonton and Dr. Elisabeth Kubler Ross

Dr Silver uses gentle chiropractic care, craniosacral therapy and creative processes to support her patients in living a life with less pain and more vitality. A main focus of her work is teaching skills for self care. Her office is located in Oakland. Website is drnickysilver.com

Old Dog New Tricks: Enter Neurofeedback by Ruth Cohn

Admin EBCAMFT — Tue, 18 Sep 2012 04:52:45 GMT

Attachment is the fundamental drive in human beings. It is a drive that brings aggression and sexuality to its defense and to its enhancement, and it is the precursor to human love. It is gained through the delicate interplay of vocal tone and facial expression, through body to body communication, through the dyadic system of care that develops when the mother attunes to her baby. When attachment fails through the significant interruption or destruction of this system, the infant suffers not only what appears to be irreparable emotional harm but significant brain damage. Sebern Fisher (1)

Just as I began to hope I might soon settle down into the tranquility and wisdom of middle age, I find myself running around the country to trainings, poring over brain twisting books, spending all my money on consultation and scrambling up a wall-steep learning curve. It all began at the annual Boston trauma conference last June. I've been attending it religiously over twenty years, it is where I have often first learned of what would next inform or revolutionize my practice. It was there that I first heard Bessel van der Kolk talk about the traumatized brain; it was there that I first heard Allan Schore speak about attachment neuroscience; Pat Ogden and Peter Levine talk about trauma and the body; and Francine Shapiro's discovery of EMDR. But over the last few years there has not been much there that was new to me. I figured the trauma field had begun to plateau. This year I thought I was just going to see my friends.

I was surprised to find something new to me being showcased there; neurofeedback. In particular a practitioner named Sebern Fisher presented cases and described work with complex PTSD and Dissociative Disorders, showing video clips of clients saying such things as "What we achieved in a year and a half with neurofeedback, would have taken me a whole lifetime of any other kind of psychotherapy. “ I was intrigued. I had never even heard of this.

Admittedly I have never been able to make peace with how long it takes to heal trauma, or for that matter how long psychotherapy takes. It seems profoundly unjust that people must not only suffer horrors, indignities and injuries in childhood or whenever during their lives, and continue paying for years for what they never asked for. The quest for a methodology to expedite this has always motivated me to learn more and better methods. I listened to Sebern and others. A number of presenters who work with children talked about ADD, ADHD and Autism spectrum disorders, and seeing remarkable results in ten or twenty weeks of twice a week 30-minute sessions. Only because it was this conference, organized by someone as highly esteemed, brilliant and research based as van der Kolk, could I consider believing what I was hearing.

I promptly came home, and after signing up for the training, went out in pursuit of a neurofeedback practitioner. I always insist on experiencing first hand, any methodology I intend to practice. I was surprised to find few neurofeedback therapists in the Bay Area. I ended up with a woman in Palo Alto and began my ritual schlep down to the Peninsula every week.

After about the second session, I was amazed to find myself feeling astonishingly calmer and happier, and things just didn't bother me. I continued the sessions for a total of about 20, over about 6 months. I was repeatedly amazed at the changes I observed in myself. Always right on the edge of being OCD, I observed my character loosening and becoming more flexible. Things I had chronically been anxious or even scared about seemed to spontaneously fall away, my husband with his jaw on the floor observed me rather effortlessly making decisions that would have been unthinkable for me before. Clearly my brain was changing, and so differently from how I had ever before experienced myself changing through psychotherapy. It was not by will, effort or intention, but simply showing up for the sessions and submitting to a truly effortless process. The only effort really was the schlep to Palo Alto. So I have embarked on a journey, attempting to make sense out of this. I took the training, and have begun to practice and observe what happens with clients in this most remarkable process.

Peak Performance for Every Brain

So what then is this neurofeedback? It emerged in the 1960's out of biofeedback. In effect it is operant conditioning, not unlike dog training. As I explain to clients, when the puppy pees outside you give her a cookie. Every time she successfully pees outside you praise her and give her a cookie. After a while, you don't have to give her a cookie anymore. She just knows to pee outside. Neurofeedback works according to the same principle.

The underlying theory is that in effect, all mental disorder (and many physical disorders too,) are dysregulations of arousal. In the world of trauma we have known this for some time. The traumatized person, with an overactive amygdala, swings between hyperarousal and hypoarousal, with the gravest of his or her difficulties being the inability to self regulate, or calm down.

We also know from attachment neuroscience that the infant's brain develops in resonance with the brain of the good enough care giver. When the caregiver is dysregulated, dysregulating, or absent, the infant's brain development is destabilized or stalled. And the capacity for self regulating affect and experiencing essential calm and joy, is elusive at best.

Where the notion of dysregulated arousal was easy to integrate into my previous thinking. What I had never realized or thought about before, is the specifics of arousal, the actual firing of the brain. Neurons fire at different frequencies. When too many neurons fire at too high of a frequency, we experience hyperarousal, perhaps anxiety or rage. When too many neurons fire at too low a frequency, we might experience depression, numbing or dissociation.

Of course different brain areas will have optimal ranges of firing frequencies. For example the prefrontal, executive functioning area of the brain optimally fires at a moderately high frequency required to sustain focus, concentration and mental energy. If frequencies are too low in the front of the brain, one might suffer diffuse attention; lack of motivation and follow through; or flat affect.

In the brainstem area, resides the function of calming the nervous system and body. If the back of the brain is firing too high, we are unable to calm down or sleep well. That is when the individual might be prone to substance abuse, overeating, compulsive behavior, or some activity pursued in the service of calming down. So in every brain, in each site of the brain, there are optimal frequencies, optimal levels of neuronal firing, and of course optimal ranges for desired function. We want the front of the brain to slow down in order to relax and sleep, we want it to perk up for driving or taking an exam. What neurofeedback does is train the brain to fire in its optimal range at any given site. It is peak performance training for any brain.

Mirroring and Validating

First attachment theory and later interpersonal neurobiology, have taught us that the brain develops in resonance. Through the experience of being mirrored and validated, through a consistent empathic response that comprehends and attends to her communication, the infant self emerges. The caregiver sees and communicates, “I see you, yes!” As Alan Schore (2) and Daniel Siegel (3) have taught us, through an interplay of right hemisphere to right hemisphere “contingent communication” the organ of the self, the brain grows, and with it the capacity to self regulate. Our offices are filled with young and old who lack or long for these experiences due to trauma, neglect, or some other loss or disruption. Their worst suffering is in the realm of relationship, which really is the most important thing there is.

That is what brought me to relationship work. The agony and loneliness of dysregulated relationship for many is unbearable. Besides psychotherapy, I learned one way to repair both the missing experience of mirroring and validation, and to heal the injury of relationship, to be in couple’s work that incorporates a communication style that is all about mirroring, validating and empathy (4.) It works powerfully, and is probably the most difficult work I know from the client’s perspective. Often it takes time. Many of the injured are not so fortunate as to have a relationship within which to do such work, or are too troubled to tolerate its pain or duration. For some, their partners lack the stamina.

I believe that neurofeedback replicates the dynamic of mirroring and validating. Ironically the computer with its graphics or mechanized beeping reflects the rhythms of the brain waves back to the brain, indicating “Yes! That’s it! That’s good! Do that some more.” Hard wired for positive re-enfocement, the brain complies. Neurofeedback research with other mammals shows the same result. This makes intuitive sense to me. John Gottman the marriage researcher translated it to science 20 years ago, demonstrating that relationship stability requires a 5:1 ratio of positive to negative. (4)

Timing is Everything

So how does this stuff work? After a painstaking assessment process, the therapist determines which are the brain areas most central to the symptomatology. Of course in the case of trauma and many other attachment injuries, we know the amygdala is the key site. Electrodes are located on the scalp to be in contact with the site in question, and the computer is set to the optimal range of neuronal firing for that site. The complex science of brain wave rhythms is beyond the scope of this article. Suffice it to say, part of why the learning curve has been so steep for me, is that the therapist must become fluent at knowing about both anatomy and the electrical functioning of the brain. Where I was familiar with biochemistry and even a bit about cerebral blood flow as per neuroimaging spect technology, electrical firing was a whole new world to me. I have come to learn that timing is everything and has tremendous impact on neurochemistry and blood flow. The rate per second or per cycle at which neurons fire, as measured in hertz, is in effect they key to mental health, or so believe the practitioners and researchers of neurofeedback. When the timing of the brain’s firing is optimal symptoms disappear, even symptoms of which we were not aware.

The computer is set such as to monitor the rhythm of firing of the various brain waves. When they are firing in the optimal range for that wave, the computer emits a signal communicating “That’s good! That’s good!” It might be a beep or a gong or a picture on the computer screen. The positive feedback, like the puppy’s cookie, trains the brain to keep it up. And the brain does just that. Outside of its owner’s awareness, the brain continues the dance of firing in resonance with the computer and over time comes to prefer the rewarded rhythm. Like the puppy, over time, the reward is no longer required and the brain leaves its training wheels and keeps going that way. The computer does not add anything. It simply measures and reflects, mirrors and validates.

The client does not have to remember heinous scenes, feel painful emotions, does not even have to talk. The process goes on outside of the client’s awareness. For those jaded by years of therapy, sick to death of their own tired horror story, it is a dream come true. They can have healing essentially just by showing up. They can even fall asleep during the session and the brain keeps working and benefitting. Imagine being able to snooze and win!

It does sound too good to be true, I know. And yet my experience continues to be astonishing. One woman, Rhonda, was referred to me recently by her psychodynamic therapist. After many years of good therapy she had a traumatic athletic accident, not only terrifying but disfiguring. Even a year out from the trauma her symptoms would not abate. Both she and her therapist were frantic as her flashbacks and emotional activations began to jeopardize her employment. She was desperate enough to try anything.

Assessment revealed that Rhonda had a whole childhood of chronic abuse that exacerbated the adult trauma. After her first session of amygdala training she began to calm down. She felt hopeful, although she considered the possibility that it might be placebo, or the prospect of something different. But by the fourth session when both she and her therapist were amazed at her resilience and rapidly growing stability, in addition to the increasing calm and confidence, she already began referring her friends to me for neurofeedback. Even the physical pain of her injury was abating. This is only one of many examples of the wonders I have seen even in the short time I have been practicing. Of course it sounds like snake oil. It would have to me too if I had heard about it from anyone but van der Kolk. Seeing is believing.

So I am studying neuroanatomy and physiology (and a fair amount of arithmetic!) like a madwoman so inspired to learn this. It seems to be what I have long been searching for: a way to move people quickly through trauma, and really most any other affliction. I am increasingly coming to believe, it is dysregulation of arousal, most often rooted in disordered attachment that underlies most if not all symptomatology and pathology. To me it makes sense.

Of course there are transference issues. I now touch my clients, pasting the electrodes on their head and ears. I am actively messing up my clients’ hair! And as Fisher points out (6) the attachment disordered might relate to the computer like a rivalrous sibling, apparently compelling the therapist’s attention and interest. I too have had these experiences. Yet as the brain gets trained, either the stability becomes available to work with the transference issue, or the symptom just simply vanishes.

Neurofeedback is not a substitute for relationship work or the depth work of psychotherapy. Rather, like medication it may provide the stability requisite to making progress possible at all. Speaking of medication, many clients find that as the brain finds its peak performance zone, their medication dosage initially begin to feel like an overdose, and even eventually become superfluous. Another perk. The intrigued, curious or skeptical who wish to read more might have a look at www.eegspectrum.comwhich recommends readings and has archives of articles on many subjects. Or give me a call. Maybe I’ll hook you up!

The perennial question is, why doesn’t anyone know about this? First I would say is the old koan about research money: it takes large scale research to gain validity in today’s world. In order to get research grants a certain amount of validity is required, to warrant the investment; and of course the way to the validity is the large scale research... The deep pockets for research money are with the government and the pharmaceutical companies. So people like van der Kolk fight for grant money from the National Institute of Health. Fortunately he is intrepid and tireless. As for the pharmaceutical companies, why would they consider funding research for a methodology that promptly gets large numbers of people off their meds?

Additionally touchy feely and/or deeply feeling therapists, not unlike myself, might balk at a methodology with a beeping computer as its medium, likening it to the monkey baby’s wire mother. My 20 year old niece, now an undergraduate studying for a career in psychology recently said to me, “This works so quickly, aren’t you worried that everyone will get better so fast that you won’t have any clients?”

1. Fisher, Sebern F. Neurofeedback: A Treatment for Reactive Attachment

Disorder From the web site of EEG Spectrum International .

2. Schore, Allan, Affect Regulation and the Origin of the Self: The Neurobiology

of Emotional Development. New York. Lawrence Erlbaum Associates Inc.

1994.

3. Siegel, Daniel, The Developing Mind: Toward a Neurobiology of

Interpersonal Experience. Guilford Press. New York. 1999.

4. Hendrix, Harville, Getting the Love You Want, A Guide for Couples.

Henry Holt and Company. New York. 1988.

5. Gottman, John, Why Marriages Succeed or Fail: And How You Can

Make Yours Last. Simon and Schuster. New York. 1995.

6. Fisher, Sebern F., On Becoming a Neurofeedback Therapist: Thoughts on the

Integration of Psychotherapy and Neurofeedback. From the web site of EEG

Spectrum International.

Ruth Cohn, MFT and AASECT Certified Sex Therapist, is in private practice in Oakland. Also certified in EMDR and Sensorimotor Psychotherapy, she specializes in work with adults with histories of childhood trauma and neglect and their intimate partners and families. She is currently preparing for certification in EEG Neurofeedback. She can be reached at cohnruth@aol.comor www.cominghometopassion.com.

Update to SB1172 and SOCE in California by Jim Walker, LMFT

Admin EBCAMFT — Mon, 10 Sep 2012 22:09:08 GMT

CAMFT and California Senate Bill 1172 (Risks of SOCE)

EB CAMFT was the first CAMFT chapter supporting SB 1172. This historic bill could be the first in the nation that would ban sexual orientation change efforts--SOCE--for minors. Other terms for SOCE are "reparative therapy," "ex-gay therapy" or "conversion therapy."

SB 1172 passed the legislature in August and is now waiting for the Governor's signature.

The bill is needed to protect queer and questioning youth from approaches that claim to reduce or stop the development of their same-gender erotic attractions, behaviors and identities. Years ago the major national psychological organizations affirmed how risky and unhealthy SOCE is, yet the damaging practices have not stopped.

The bill is needed because decades of trying to affirm being LGBTQ or questioning has not stopped the psychological damage from a small group of practitioners of "reparative" methods. Survivors of receiving "ex-gay" practices when they were teens report having lasting psychological damage from what was done to them as youth.

The state board of CAMFT has opposed Senate Bill 1172. While they were working with a coalition of organizations to change the bill, EB CAMFT, SF CAMFT and LA CAMFT became supporters, along with AAMFT of California, NASW of California and many other organizations.

CAMFT was in a coalition with other organizations opposing the bill until mid-August when the California Psychological Association broke with the coalition and moved to supporting the bill. Santa Clara Valley CAMFT followed them in becoming supporters. The California Latino Psychological Association recently also became a supporter along with many other organizations.

This photo shows therapists from Gaylesta, the LGBTQ Psychotherapy Association of the SF Bay Area, with staff from Equality California, delivering petitions for SB 1172 to Governor Brown's office. Over 50,000 signatures supporting SB 1172 were collected from around California and outside the state. Equality California is a sponsor of the bill and works with the legislature to further LGBTQ rights and improve queer health through legislation.

The BBS is a supporter of SB 1172.

The Pan American Health Organization, recently called for national legislation against SOCE. "These practices are unjustifiable and should be denounced and subject to sanctions and penalties under national legislation," said Dr. Roses, director of PAHO. Dr. Roses went on to say, "These supposed conversion therapies constitute a violation of the ethical principles of health care and violate human rights that are protected by international and regional agreements. http://www.dayagainsthomophobia.org/Media-Release-World-Health,1557.

There will certainly be more news about SB 1172 soon. Please sign Gaylesta's petition and distribute it freely. You can also call the Governor's office and express your support as a licensed, or prelicensed, mental health provider: 916-445-2841.

Gaylesta's petition is at: http://www.change.org/petitions/protect-youth-from-being-forced-into-ex-gay-therapy-sb1172

A bill similar to SB 1172 is expected to be introduced to the New Jersey legislature before the end of September 2012.

Jim Walker, MFT
510-684-4508 cell

Prevent Therapist Burnout: Take a Career Break By Fran Wickner, Ph.D., MFT

Admin EBCAMFT — Mon, 10 Sep 2012 22:06:41 GMT

As a psychotherapist in private practice since 1984, one of my specialties is helping clients manage stress in their lives. Those of us in the helping professions are especially susceptible to stress. This article is about a relatively new way to help with stress and work burnout: taking a career break.

For the past few years I was entertaining the idea of taking what I was calling “an adult gap year”. I found many articles on high school/college aged teens/young adults taking a gap year, but nothing on adults doing this. Then I read an article in the New York Times on Meet Plan Go and Sherry Ott, introducing me to the term I had been looking for: “career break”. I attended the conference they were having in San Francisco in October 2011 and took my career break the following spring.

A career break is simply time away from your job. There is no “right” way to take a career break, only that if it is less than a month it’s more of a vacation. The word sabbatical is often used and is the same concept.

There are many benefits to taking a career break and traveling. For a profession like ours most reasons are obvious such as returning from traveling refreshed, replenished, gaining new perspectives and having time to not think about your clients. People who take career breaks often return with a more positive outlook on their job and life in general.

But there are other benefits as well that have been substantiated through research.

Psychologist Lile Jia at Indiana University published an article in the Journal of Experimental Social Psychologythat says distance can make you more creative. The implications of his research show that traveling to faraway places and communicating with people dissimilar to us can help increase creativity and lead to considering novel alternatives.

A study from the Kellogg School of Management in Chicago also supported the research that living abroad boosts creativity. This study showed that the experience of another culture endows us with a valuable open-mindedness, making it easier to realize that a single thing can have multiple meanings. People who travel are more willing to realize that there are different ways of interpreting the world.

Jia’s work and the study at Kellogg showed that traveling not only helps your creativity but also improves your problem solving abilities, skills that are imperative in our field.

If you do decide take a career break, be prepared for internal and external blocks. Society’s norm is to work until you get old (or sick) before you can take your break, so when deciding to take a career break, encountering mental and social hurdles are common. You will have to explain yourself to family and friends, because right now taking a break when you are healthy and younger than retirement age is the exception. Sometimes using the word “sabbatical”, a term people know, will help explain what you are doing, but you will still find many family and friends doubting your decision.

Maybe you have told yourself this same narrative, i.e. I will work and work until I retire. But in our field, there usually isn’t a set age to retire, and if you are in private practice, no one is “retiring” you. Just like with any big change in your life, if you take all this in and tell yourself “I can’t do this”, you never will.

Logistically, therapists often are worried about what will happen to their clients. Those in private practice might also be worried what will happen to their business. You need to treat this the way you do other planned (or unplanned) absences such as maternity leave, caring for a sick family member or leaving your agency job. Regarding your clients, you give adequate notice, find back-ups when needed and arrange for a return date. As with other absences, you share as much or as little as you want based on your theoretical perspective and the particular client’s needs. As far as your business, you need a plan to have it back up and running upon your return. Before leaving could be a good time to use a practice building consultant so you can return to a thriving practice.

Future articles will give specifics on how to therapists can plan for a career break including dispelling the myths of why you can’t do it (too expensive, it will ruin my career, I can’t go with my family, I can’t go alone, it’s too dangerous, this isn’t the right time, etc.), practical planning tips and how to manage your private practice or job before and after your career break.

Thousands of people are now taking career breaks. It is possible. You will return with new motivation and renewed energy for the wonderful work we do. Consider taking a career break because you deserve it. And the best reason isn’t deep or clinical or psychological or particularly introspective; do it because it will add to your happiness.

REFERENCES

Jai, Lile, Hirt, Edward & Karpen, Samuel. Lessons from a Faraway land: The effect of spatial distance on creative cognition. Journal of Experimental Social Psychology. 45(5), September 2009, 1127-1131.

Lehrer, Jonah. Why We Travel. The Observer. (3/14/10).

Maddux, William W. & Galinsky, Adam D. Cultural borders and mental barriers: The relationship between living abroad and creativity. Journal of Personality and Social Psychology. 96(5), May 2009, 1047-1061.

Stellin, Susan. Practical Traveler: Making the Dream Trip a Reality. New York Times. (10/17/10).

ON-LINE CAREER BREAK RESOURCES

http://meetplango.com/ (extensive links, meetings, tools for taking a career break)

http://meetplango.com/san-francisco/ (Information about the 10/16/12 S.F. conference)

http://franwickner.com/?page_id=7 (practice building workshops, consultations and on-line e-books on the business side of your practice.)

Fran Wickner, Ph.D., MFT has been a licensed MFT since 1983. She has a private practice in Albany, CA, serving individuals, couples, families and teens. For over 25 years Dr. Wickner has also been helping clinicians grow their private practice both with and without managed care. Her website, www.franwickner.com has information about her practice and her consulting business including practice building workshops, consultations and downloadable practice building packets.

On October 16, 2012, Dr. Wickner will be a speaker at the MEET PLAN GO! Conference in San Francisco, CA http://meetplango.com/san-francisco/ .

You can contact her at franwickner@hotmail.com or 510-527-4011.

Transpersonal Hypnotherapy by Holly Holmes-Meredith, D. Min, MFT, CCHT

Admin EBCAMFT — Mon, 10 Sep 2012 22:04:29 GMT

The practice of Hypnotherapy is interactive and directly engages the client’s unconscious resources through verbal and non-verbal communication while the client is in the hypnotic state. Therapy done in this expanded state is greatly enhanced and supported because the client is able to access information, healing, creativity, memories and insight that is not normally available when in the waking conscious state.

By engaging a transpersonal or spiritual form of hypnotherapy, the client’s personal transformation can be supported even further. Invoking client’s higher Self (or higher power, or the Christ with in, or Buddha wisdom, or the Divine Self, called by many names) aligns clients in accessing profound states of consciousness similar to those experienced in deep meditation or in profound states of presence: states when the egoic or self- involved consciousness is transcended or simply out of the way. Healing and profound change can take place, often fairly effortlessly, through these transpersonal states of consciousness. Clients report that these expanded states of consciousness change them in lasting positive ways. Clients realize that, for instance, they have sadness, but are not the sadness. They can potentially experience themselves as spiritual in essence: as a spiritual being having a human experience.

In traditional talk therapy, the client works from the conscious egoic level most of the time, and in many ways she keeps reinforcing the stories, identifications and negative patterns around her difficulties by focusing on them and taking about them over and over again on a conscious level. In talking about the problems and feelings there is the hope that the client will have a spontaneous breakthrough of insight and change. In contrast, by dialoguing with the higher Self directly in a trance state, the hypnotherapist and client can elicit direction from the higher Self as to what focus and issues need to be addressed and guidance as to techniques and approaches to take. For instance, if a client comes into hypnotherapy wanting to release a symptom of claustrophobia, the therapist and client can, in trance, ask the higher Self what would be most effective focus and hypnotic approach in the session: inner child/inner family work, skill rehearsal, a childhood or past life regression, or processed that release anxiety. The session, therefore, is directly guided by the part of the client that already knows the cause of the fear and what the client needs to release it. The client’s wisest part is directing the therapy and helping both the client and hypnotherapist to give structure to the session and to support the step by step unfolding of the hypnosis process. The hypnotherapist helps the client to access her higher Self and supports her in cultivating ways to communicate and form an inner relationship with the higher Self so that it becomes a trusted and readily available resource not only in a hypnotic state, but in also daily life.

How will the client know when she has accessed this higher Self? The higher Self is loving, supportive, non-judgmental, offers gentle nudging, has the perspective of the big picture, is compassionate, and is focused on the good of all concerned. The higher Self may come in a visual form as an archetype, deity, symbol, or a representation as a self-actualized self. It could be perceived as an inner voice or telepathic communication. It could communicate through a knowing or body sensation. Every client has a unique experience of it. The higher Self is a direct link to an intuitive experience of the highest good and connection to the divine.

Working with a transpersonal form of hypnotherapy is often a mystical and spiritual practice for the client. She can learn to access and utilize expanded states of consciousness directly, at will, and for a variety of personal goals and purposes. The process of being in an expanded state is just as healing and significant in supporting change as is directing the state of consciousness towards a therapeutic personal goal or outcome. For the client in the hypnotic state, accessing awareness of the higher Self becomes a profound teacher of how our consciousness works to create our realities. These hypnotic states become vehicles through which we can re-create our realities. The practice of this form of hypnotherapy is a form of spiritual practice that puts us directly in touch with our spiritual nature and how our consciousness creates the forms and structures of our lives.

In hypnotically accessed transcendent states, you begin to have a new sense of self and a new way of relating to the challenges in your life. Through higher Self awareness and presence, you become dis-identified from your stories, negative patterns, and symptoms.

If you are interested in engaging in this transpersonal and spiritually focused form of hypnotherapy, interview a potential hypnotherapist to discover if the hypnotherapist invokes and works directly with the client’s higher Self as a co-therapist, resource, and inner guide for the client in the session. If so, you can be assured that the content of the focus of the hypnotherapy session will have absolute integrity and authenticity that comes from this wise and loving aspect of Self.

Holly Holmes-Meredith:
Doctor of Ministry, MA, Clinical Director,
Licensed Marriage Family Therapist, Certified Clinical Hypnotherapist,
Board Certified Regression Therapist

Holly's teaching and therapy is grounded in a solid twenty-five year background in education, psychology, hypnotherapy and metaphysics. She teaches with an engaging expertise, ease and competence that builds professional skill and confidence in her students. Holly integrates a psycho-spiritual perspective in her teaching, models client empowerment and practices hypnotherapy as an art. In the last ten years she began studying and adding hands on healing and energy therapies to her work including Reiki and EFT.

Holly has a private psychotherapy and hypnotherapy practice on site at HCH at the Transformational Therapy Center which she founded in 1986. She is especially skilled in regression therapy, pain management, working with phobias, anxiety, and spiritual issues.

Holly is an examiner and a founding member on the Board of Directors for the International Board of Regression Therapy.

She was awarded her Doctorate in Ministry degree in 2007. Holly's dissertation on Hypnotherapy as a Spiritual Practice is in the process of being re-written as a Hypnotherapy text.

Originally published at http://hollyholmes-meredith.blogspot.com on March 26, 2010

Update to SB1172 and SOCE in California

Admin EBCAMFT — Sat, 09 Jun 2012 23:50:57 GMT

By Jim Walker, LMFT

The EB CAMFT board gave their support to SB 1172 at their May board meeting. Senate Bill 1172 would regulate sexual orientation change efforts--SOCE--otherwise known as "reparative therapy," "conversion therapy," or "ex-gay therapy." The latest version of the bill may be found here http://www.leginfo.ca.gov/bilinfo.html by searching for SB 1172.

The bill would ban attempting SOCE on minors, and it would require an informed consent for SOCE on adults. The informed consent would notify the client that SOCE is found to be potentially harmful by such organizations as the American Psychological Association and other national mental health organizations.

Earlier this year, statewide CAMFT announced their SOCE policy--asking mental health professionals who provide therapy to those seeking sexual orientation change "to do so by utilizing affirmative multiculturally competent and client-centered approaches that recognize the negative impact of social stigma on sexual minorities." http://www.camft.org/Content/NavigationMenu/ResourceCenter/SOCE/default.htm

Organizations that have supported SB 1172 are the Pacific Center in Berkeley, the Women's Therapy Center of El Cerrito, Gaylesta [the LGBTQ Therapists' Association of the SF Bay Area], the Lesbian and Gay Psychotherapy Association of Southern California and the California Division of the National Association of Social Workers.

SB 1172 was authored by Senator Ted Lieu (D-Fullerton) with support from two LGBT rights organizations, the National Center for Lesbian Rights and Equality California http://www.eqca.org/site/apps/nlnet/content2.aspx?c=kuLRJ9MRKrH&b=5609563&ct=11722129&notoc=1 Equality California and the National Center for Lesbian Rights are known for their courageous work protecting queer people and their families.

So-called "conversion therapy" has been in the news lately. The eminent psychologist who claimed in his 2003 study there appeared to be change in sexual orientation "in very rare cases" recently revoked his study. He apologized to the gay community.

The Pan American Health Organization, the oldest health organization in the world and part of the World Health organization, has called for national legislation against SOCE. "These practices are unjustifiable and should be denounced and subject to sanctions and penalties under national legislation," said Dr. Roses [director of PAHO]. "These supposed conversion therapies constitute a violation of the ethical principles of health care and violate human rights that are protected by international and regional agreements." http://www.dayagainsthomophobia.org/Media-Release-World-Health,1557

Most recently the Southern Poverty Law Center filed an ethics complaint to the American Psychological Association and the Oregon Psychiatric Association on behalf of an Oregon man who alleges he was subjected to SOCE. http://www.washingtonpost.com/national/oregon-man-says-psychiatrist-tried-gay-to-straight-conversion-therapy-against-his-wishes/2012/05/23/gJQA3MMJlU_story.html?wpisrc=emailtoafriend

It is very noteworthy that these major organizations consider supposed conversion therapy as a violation of clinical ethics.

Senate Bill 1172 will come to a vote before the whole Senate before or by June 1, 2012. In addition to the support of CA-NASW, one of the largest mental health organizations in California, the bill's authors have been seeking support from smaller organizations such as the California Psychological Association and AAMFT-California. Statewide CAMFT and other organizations have been negotiating for amendments to the bill before supporting it.

________________________________________________________________________________________________

Jim Walker, MFT, is in private practice in SF and Oakland where he specializes in working with couples and with healing from trauma. Among his many activities, he's volunteering with the Pacific Center on starting their continuing education program this fall.

Jim Walker, LMFT
510-684-4508 cell
Offices in Oakland and San Francisco
http://mindbodytherapyservices.com
http://lgbtcounseling.com

Psychotherapy and the Twelve Steps: Addressing Some of the Unique Concerns of Clients in 12-Step Recovery

Admin EBCAMFT — Sat, 09 Jun 2012 23:08:08 GMT

By: Peter Carpintieri, MA, LMFT

Overview:

The purpose of this article is to share some ideas and experience regarding psychotherapy and the Twelve Steps and working with clients in Twelve Step Recovery, offer some guidelines and suggestions for working with recovering clients, and invite dialogue and conversation within our community to better serve this population.

There is a fair amount of ambivalence, if not outright distrust or disdain, in both communities, regarding the value and effectiveness of the other. Many a joke is cracked and a good hearty laugh had at the expense of psychotherapy during the course of Twelve Step meetings around the world, where therapy is often regarded as a total waste of time and money. At the same time, I have noticed an equal ambivalence or doubt, if not ignorance, among therapists, regarding the value and effectiveness of the Twelve Step Recovery experience for those who rely on it.

While there is some truth to both of these points of view – psychotherapy is not useful for all addicts in all situations and some addicts do use the Twelve Step programs as another escape from the deeper and more challenging issues they face - for the most part, my experience has been that psychotherapy and the Twelve Steps, when used together to complement each other and practiced in the spirit of cooperation, are a powerful force for healing and transformation which can mean the difference between true happiness in recovery and continued relapse and suffering. Furthermore I've found that the Twelve Steps and psychotherapy are not only compatible but are, in a sense, merely different approaches to, and contexts for, the same process: discovering and bringing to light that which blocks or obstructs our capacity for joy and aliveness, and cultivating a more balanced, fulfilling and joyful way of life; one that is sustainable over the long haul.

The Twelve Steps invite us to look closely at our thoughts, feelings, motives, beliefs, attitudes, dreams, fantasies, and conduct, and to discuss these with another human being, in the interest of freeing ourselves from the bonds of suffering, and living happy and productive lives. These elements comprise a process of becoming more aware of how we actually live, moment by moment, and finding a fuller and freer way of living; an invitation to deeper awareness and connection. Psychotherapy is, in my view, a similar and, in some instances, nearly identical process. The containers and interventions may differ but, ultimately, the goal and the essence are the same.

Particular concerns:

Many people in Twelve Step programs arrive at a point in their recovery where therapy becomes an key part of the process. For many, this is a troubling and challenging dilemma. The prospect of trusting someone who may not be in recovery with intimate, shameful, painful feelings and experiences, may feel risky at best and life-threatening at worst; particularly after one establishes trust, sometimes exclusively, with sponsor(s) and friends in recovery.

Many, if not most addicts - and by addicts, I mean all types of addicts: food addicts, sex and love addicts, debt and spending addicts, gambling addicts, drug addicts, alcoholics, relationship addicts, codependents, come into recovery realizing their lives are in serious, even perilous danger. The realization and acceptance of this fact, is, ideally, the foundation of recovery. It's what makes one willing, as the book “Alcoholics Anonymous” (aka “the Big Book”) says, “to go to any length,” (p. 58) to recover. If our life is on the line, we are more likely to try things that our fears, defenses, and habitual patterns would have us resist or outright refuse to try. For many addicts, anything that feels like it may topple the apple cart of recovery, or “sobriety,” in the largest sense of the word, feels life-threatening. Therapy may very well fall into this category.

For many addicts, keeping things simple and routine is extremely valuable in avoiding slips and lapses that can prove quite dangerous. Entering therapy to work on issues that have long plagued them, even in sobriety, can feel like walking a tight rope with death on either side. “What if my therapist and my sponsor don't agree? What if my therapist suggests I do something that the program would discourage? What if I get triggered by something my therapist says and relapse? How can I trust a therapist anda sponsor and a Higher Power? I don't want to upset the apple cart; I've been sober – or abstinent – too long.” A well-informed, aware therapist can offer a quality of aid and support that can make this journey less treacherous – both literallyand emotionally – for a client in recovery. A firm knowledge and understanding of the Twelve Steps and the Twelve Step recovery process as it is commonly practiced can provide the therapist with a greater ability to support the client's recovery, while doing the therapeutic work that can foster the growth and development the client so desperately needs.

Some practical suggestions:

Here are some practical suggestions for improving your effectiveness when working with clients in 12-Step Recovery:

Attend open 12-Step meetings, particularly in the fellowships to which your clients belong.

Read AA literature and literature from other fellowships; specifically:

Alcoholics Anonymous ('the Big Book')
The Twelve Steps and Twelve Traditions (AA)
The Twelve Steps of Overeaters Anonymous
Co-Dependents Anonymous (the CODA 'Big Book' )
How Al-Anon Works
Sex and Love Addicts Anonymous (S.L.A.A. 'Basic Text').

Ask how many meetings your client is attending. Ask if that's enough. Ask how long it's been since they spoke with their sponsor and how often they speak. Take an interest in their relationship with their sponsor and the others they attend meetings with.

Take an interest in their recovery and how it's going for them. Ask them what step they are on and how they are progressing. Inquire about their relationship with God or Spirituality or a Higher Power; this is an essential element of the recovery process and one that often poses difficulties along the way.

Familiarize yourself with the Twelve Steps so that you can relate directly to your clients' experience and understand what they are talking about.

In many ways, working with clients in Twelve Step Recovery is like working with any other cultural difference: the more we can learn about it - from our clients, our own research, consultation and immersion - the better equipped we are to help them.

Reference cited:

Alcoholics Anonymous. (2002). Alcoholics Anonymous Big Book, 4th Edition. New York, NY: Alcoholics Anonymous World Services.

Al-Anon Family Groups. (2008). How Al-Anon Works. New York, NY: Al-Anon Family Groups.

Alcoholics Anonymous. (1981). The Twelve Steps and Twelve Traditions. New York, NY: Alcoholics Anonymous World Services.

Anonymous. (2012). Co-Dependents Anonymous, 1st Edition. New York, NY: CoDA Resource Publishing.

Anonymous. (1993). The Twelve Steps of Overeaters Anonymous, 1st Edition. Rio Rancho, NM: Overeaters Anonymous, Incorporated.

Augustine Fellowship. (1986). Sex and Love Addicts Anonymous: The Basic Text for the Augustine Fellowship. San Antonio, TX: The Augustine Fellowship.

_________________________________________________________________________________________________

Peter received his Masters Degree in Counseling Psychology, with a Transpersonal Focus and a Specialization in Child and Adolescent Therapy, from John F. Kennedy University. He is also Certified by the Kripalu Yoga Institute in Lenox, MA as a Holistic Health Counselor / Educator. He was originally trained in the Humanistic Client-Centered and Gestalt methods, gradually incorporating a myriad of other methods and approaches, 25 years of Zen Buddhist practice, and his training in Holistic Health Counseling and Education into his practice as a Psychotherapist. He also completed 12 units of Early Childhood Education at Merritt College and taught preschool for three years. Peter specializes in working with people in 12-Step Recovery, those who have survived the suicide of a loved one, adolescents and their families, and spiritual and existential dilemmas. He lives by the lake in Oakland and has an office in South Central Berkeley.

Peter Carpentieri, MFT

peterc.mft@gmail.com

510-338-8042

Comments and inquiries welcome.

Weighty Issues in Therapy

Admin EBCAMFT — Sun, 06 May 2012 19:12:55 GMT

By Jacqueline Holmes, M.Ed., MFT

In our popular culture there is a focus on being thin and controlling one's weight and food through dieting. As a result of the dieting mentality we clinicians are seeing increasing numbers of clients struggling with Binge Eating Disorder (BED). An estimated 3% of women and 2% of men are suffering from BED nationally according to a study done by NEDA (National Eating Disorders Association). That is more then all the people struggling with Anorexia Nervosa and Bulimia combined. Binge eating is a natural response to dieting, since the client is often starving while dieting and this can set the body up to crave more food. This type of eating pattern can also interrupt the normal response to hunger and satiety. When you add the emotional drivers and stress of the behaviors, you create a binge eater. Many therapists miss the signs that this is a serious problem for their client and that if it is an untreated behavior it can become a more chronic issue.

The binge eater frequently can feel invisible or even discounted since they aren’t starving or purging, so they wonder if they even have an eating disorder. In January of 2012, Binge Eating Disorder was added to the DSM-IV adding some validity to the symptoms and behaviors with which these clients are struggling. The client may report that they can’t stop eating and then they continue to fixate on how to control their weight as it fluctuates with the binge episodes. To cope, they may restrict their food intake or over-exercise. As with all eating disorders the binge eating is also related to psychological issues like low self-esteem, stress, depression, anxiety and trauma. Over eating has become a popular coping mechanism to avoid more difficult feelings and situations.

Often the habit of turning to food for comfort, control or self-pleasuring can create new problems like increased depression, isolation, medical complications from poor nutrition and weight gain. My clients often say that it “doesn’t matter what the feeling is the answer is food!” “If I’m sad I eat. If I’m mad I eat. If I’m bored I eat. If I feel lonely I eat, and so on.” Food isn’t the answer to a feeling and we have to learn the difference between feeling hunger and these other feelings. If there are other feelings present then we need help the client to find ways to experience them and to decrease the self harming behaviors.

Breaking free from binge eating isn’t only about managing a food plan and increasing exercise, though those techniques can be helpful. It's also important to explore the triggers and underlying psychological drivers that take us to food for comfort.

There is an answer to anger, sadness, boredom and loneliness and that is finding ways to feel them and to learn about how to manage them in daily life. Identifying the situations and triggers for the binge can be helpful in developing other strategies for coping, rather than turning to food. Some helpful tools are: Keeping a “feelings journal” and becoming curious about the desire for food. Developing compassionate self-dialog around the following questions: When do I binge? What do I choose to binge eat? How am I feeling before, during and after the binge episode? Is food going to help or hurt me right now? The goal is to develop awareness and decrease the shame and judgment about the behaviors.

Helping the client to begin to ask themselves, “What else could I do?” is an empowering technique. It can be very helpful to assist the client to develop other forms of self nurturing and self comforting. “What other activities do you have that make you feel good?” Something like reading, taking a walk, calling a friend, playing an instrument, doing a hobbyundefinedknitting, painting, craft work or just tinkering and completing a chore.

I also feel it is vital to break the isolation of binge eating. You can recommend the client seek out a support group with other people who are seeking recovery. OA (Over Eaters Anonymous)and ANAD (National Association of Anorexia Nervosa and Associated Eating Disorders, Inc.) groups as well as recovery groups for people coping with eating disorders can be very helpful. The important thing is to allow the client to talk and not feel shamed or judged.

Working with eating disorders can also give us an opportunity to look at our own beliefs and habits around our own bodies. Our attitudes and comments are closely watched by the client. When we express appreciation and care for our own bodies we become a role model for health and body acceptance.

Jackie Holmes, M.Ed., MFT has been working with Eating Disorders for over 30 years. She offers individual, couple and family therapy in her private practice at the Concord Therapy Center. She has worked all levels of care: Inpatient, Partial, Intensive Outpatient and Outpatient settings, working specifically with Eating Disorders.

She is on the adjunct facility at John F. Kennedy University and UC Berkeley where she teaches continuing education classes in the Eating Disorders Certificate programs. She frequently is a guest speaker at conferences and schools where she speaks on a variety of topics related to recovery and healing from these deadly diseases.

casaserenaedp.com

Progress with CAMFT on SOCE

Admin EBCAMFT — Sun, 06 May 2012 18:02:32 GMT

By Jim Walker, MFT

On March 9, 2012, CAMFT's state board approved a policy about SOCE and posted it to CAMFT's web site. To inform EB CAMFT membership about this, I was asked to submit this article because of my efforts with part of CAMFT's process with developing a position on SOCE.

SOCE is an umbrella term for sexual orientation change efforts. Methods that are purported to be therapy such as ex-gay therapy, reparative therapy and conversion therapy are examples of SOCE. Many people who have survived SOCE report being very psychologically and spiritually scarred as a result of this so-called therapy. The spiritual abuse happens when the sexual orientation change efforts come within a religious counseling context, particularly when the so-called therapy happens through what is called "Christ-centered relational healing."

CAMFT has seen intense struggles during the past four years about taking positions on mental health and family health not coming from heteronormative values. Years ago other mental health organizations such as the American Psychological Association and the National Association of Social Workers issued supportive policies for same-gender loving people's health and for supporting nontraditional gender identity development. The appeals coming from CAMFT members during the last four years for CAMFT to follow suit have deeply threatened some CAMFT members and leaders.

The history behind CAMFT's SOCE policy development started more than two years ago. After a LGBTQ advocacy group called California Therapists for Marriage Equality (CTME) advocated and won a policy statement from state CAMFT for marriage equality in 2009, and after CTME convinced CAMFT, the Gottman Institute, the Women's Therapy Institute and other organizations to join an amicus brief against Prop 8 in February 2010. In March 2010, a much smaller group of us organized ourselves to appeal to CAMFT to issue a statement on SOCE.

By June 2010 a proposal had been created by Lisa Maurel, Bruce Weitzman, James Guay, Jurgen Braungarten, Sheila Smith, LaDonna Silva and myself. Where hundreds of therapists had been involved in urging CAMFT to make a statement about marriage equality, only a couple dozen, if that many, were interested in starting to advocate for a statement about the harms of SOCE.

We submitted our proposal to Mary Riemersma (CAMFT's former executive director) to give to the board. She wanted the proposal to go first to the ethics committee. It went to the committee, which did not advance the proposal. Bruce Weitzman from the board of SF CAMFT then took up the efforts of advancing a proposal to the state Board. The original proposal would have been lost if it were not for members and state leaders advocating continually throughout the years for a statement specifically about SOCE.

The statement released by CAMFT about SOCE earlier this year is a very, very different statement than the one proposed in 2010. In the circle of contacts I have from CTME and from the original CAMFT listserv from the CAMFT community forum, the announcement drew lots of attention. I don't know how to gauge what attention it drew in the larger membership. The therapists who've been waiting for almost 2 years had mixed opinions about how worthy a policy it was.

It really matters when mental health advocates speak up about the health issues of those who are stigmatized and struggling in our society. The American Psychological Association has done an incredible effort in this regard. Although not a expert on the APA, I believe the APA has done it for the most part through the volunteer efforts of their members. Those policies and guidelines have made their way into proposals for legislation and court decisions. What the eminent American sociologist Jane Addams said long ago is so true, "Progress is not automatic; the world grows better because people wish that it should, and take the right steps to make it better."

In the next article I write I want to report on how CAMFT could be impacting the development of a California bill that would ban SOCE from being practiced on minors. That bill is SB 1172, authored by Senator Ted Lieu (D - Fullerton) and supported by Equality California and the National Center for Lesbian Rights.

Jim Walker, MFT, is in private practice in SF and Oakland where he specializes in working with couples and with healing from trauma. Among his many activities, he's volunteering with the Pacific Center on starting their continuing education program this fall. He thanks Caiti Crum for her help with this article.
==========================================================

Jim Walker, MFT
510-684-4508 cell
Offices in Oakland and San Francisco
http://mindbodytherapyservices.com
http://lgbtcounseling.com

How Dangerous is My Client?

(Past member) — Sat, 03 Mar 2012 23:00:20 GMT

By Ronald Mah

The following e-mail arrived in my Inbox in late April 2007.

"I have a young Korean-American client who is a college graduate student in literature. He's a writer. I'll call him Jim. His initial presenting issues were dealing with a sense of isolation and his long-term resentment and anger from being misunderstood and bullied throughout his school career. This young man felt very alone and angry when he was younger. Jim wanted to work on this because he was concerned it might eventually affect his relationships and career. He is clearly exceptionally intelligent, and perhaps even brilliant in his work. He has been recognized for his writing and received awards since high school. He has been involved in an internship with one of his instructors, an editor for a literary magazine. He finds that very stimulating although he is doing somewhat menial work as a "gofer."

He talked about working on a graphic novel where the protagonist is dealing with anger over rejection, "and being invisible" with the themes of justice, compassion, violence, suffering, victimization and bullying, and redemption. It is very clear, that the novel is semi-autobiographical and that he identifies with the main character. The plot of the novel culminates with an intense massive act of vengeance upon the main character's abusers. I don't want to be simplistic, and really don't want to be stereotypical or even worse, racist, so I need to be more clear if there is potential for violence with him. The conversation was disturbing to me after the recent violence at Virginia Tech. To be more blunt, my question is, how dangerous is my client?" (Details have been altered to protect the confidentiality of the client.)

Less than two weeks earlier, at Virginia Tech on April 16, 2007, on the campus in Blacksburg, Virginia, a student, Seung-Hui Cho killed 32 people and wounded many more, before committing suicide. This was the deadliest school shooting in U.S. history. Only eight years before on April 20, 1999 at Columbine High School, two students, Eric Harris and Dylan Klebold, killed 12 students and a teacher, as well as wounding 24 others. They also committed suicide before they could be captured. Seung-Hui Cho was of Korean ancestry having moved here as a young child. Cho left behind angry and vengeful writings and videotapes chronicling a long history of mistreatment by others. His intense resentment seemed to motivate his homicidal actions. After the fact, laypeople and professionals have struggled to figure out the cause and origins of his violence, as was done after the killings at Columbine High. For some, this is to understand the tragedy. For others, it is also to understand, anticipate, and hopefully prevent similar explosions in the future. Unfortunately, examining prior episodes of violence by others such as the Columbine killers did not prevent Cho's outburst. "With his sadistic creative writing, contempt for snotty rich kids, militaristic posing, and heavily plotted revenge fantasy, Virginia Tech killer Cho Seung-Hui has eerily reminded many Americans of Columbine murderers Eric Harris and Dylan Klebold. Cho apparently saw Klebold and Harris as kindred martyrs, giving the boys two separate shout-outs in his suicide manifesto" (Cullen). None of us as therapists wish to be similarly reminded of Cho, Harris, or Klebold as we may fail to recognize a client's potential for violence.

The e-mail I received shortly after the shootings, posted a question that was not hypothetical nor academic. Television and other media analysts (the Today Show, NBC Nightly News with Larry King among others) have argued as to whether Cho was an angry depressive, a psychopath, a schizophrenic, or a psychotic among other diagnoses. Several resources, including Time (Veale) quoted family members saying that he had been diagnosed with autism when very young. This brought a quick response from AutismLink and Autism Center of Pittsburgh Director Cindy Waeltermann that it was "unfair to blame Cho's actions on autism." As mental health clinicians, it is hard not to speculate on the evolution and causes of Cho's violence. Speculation however can be beneficial if it serves us to assess other individuals, such as our clients or our clients' intimate relationships for the potential of violence. The therapist who wrote the e-mail was concerned because there were elements in her client that were similar to Cho and his history. However, there were also distinct elements once identified that allowed her to have confidence that her client was unlikely to erupt into violence. These elements also help direct the therapeutic process.

Here are fifteen criteria or elements to aid determination of the violence potential of children and teens. The concepts should also be applicable to adults. Eight of the fifteen criteria are highly compelling for an individual such as Seung-Hui Cho. These are

    •    Self-Righteousness Attitude
    •    Entitlement
    •    Ego-syntonic Perception
    •    Intense Emotional Arousal
    •    Resentment
    •    Characterlogical Nature
    •    Isolation/Avoidance Behavior
    •    Lack of Remorse

Taking into consideration, that I have not, and in all probability, you have not undertaken an intensive formal evaluation of Cho's developmental, psychological, social, academic histories, these issues are highly suggestive from the media information that has been available. He had an intensive sense of self-righteousness that fed into deep resentment from his years of being ostracized and bullied throughout his school career. The self-righteousness and resentment translated into an intense entitlement to have vengeance, which created a complete lack of remorse for actions to be taken. It is clear that he deeply believed that his victims or targets deserved to be killed. He was also living up to the powerful and vengeful persona that he believed in. There was no conflict within himself regarding who he was and his eventual violent behavior; his violence was ego-syntonic. His issues and emotional state were not transitory, but rather seemed to be deeply embedded into his personality. His perception and relationship to others and the world appears characterlogical. His inability and difficulty in social relationships led to deep isolation and a lack of relationships or community to give him any kind of feedback or reality check or testing of his perceptions. While his lack of remorse would seem to suggest being a sociopath, his writings and his videos demonstrate intense emotional arousal unlike that of sociopath. In addition, it appeared that he intended to commit suicide or go down in a blaze of glory. Sociopaths are highly manipulative and can be extremely dangerous, but they also normally fully intend to survive their behavior. In other words, they do not want to go down in a blaze of glory, but to survive and to do it again in some other form to some other people. My best guess diagnosis from afar, is that Cho had paranoid personality disorder or some other issue that results in significant paranoia. Gregory Lester, Ph.D., trainer and therapist who specializes working with personality disorders identified the Columbine killers as having paranoid personality disorders.

In my clinical experience with young children, pre-teens, and a few adults with high functioning autism or Asperger's Syndrome, I have seen a developmental progression that can lead in some cases to a paranoid personality disorder. This is by no means, the normal or only outcome. With early intervention and skillful education and care, children with Asperger's Syndrome or other high functioning autism can be highly successful in all aspects of life. Dr. Temple Grandin is one example of a very respected author with autism. She is an expert on cattle handling, and has written and spoken often from her experiences and insights as an autistic individual, including many television appearances. Unfortunately, with inadequate caregiving and/or highly negative social experiences, there can be extremely problematic outcomes for some individuals. Autism or Asperger's Syndrome does not cause violence. However, one of the major challenges for individuals within the autistic spectrum is the difficulty in reading social cues, especially nonverbal cues. Individuals within the autistic spectrum are also often more sensitive to environmental stimulation. These combine to make social interactions often extremely challenging for such a child. In communities such as classrooms or the playground, other children often identify such children as being different, and subsequently a target for teasing and victimization. The childhood history of Cho reports that he was brutally teased and bullied in school. Depending on the individual temperament or personality of the child, as well as the environmental and interventions support (or lack of) from caregivers such as teachers, children with these issues respond differently. It seems that Cho did not get the appropriate support or intervention, and with his intense personality suffered greatly and became ever more resentful. Another person with more positive support, with a similar intense personality may become a very attractive passionate individual. Because of the difficulty in understanding social cues, Cho may not have understood how he was perceived, or why others treated him so badly. This may have exacerbated his growing isolation, emotional trauma, and increasing resentment. Unable to identify why others were so abusive to him for seemingly no logical reason, a hypervigilance and hypersensitivity leading to paranoia may have resulted. Over the years, a paranoid personality disorder may have developed. Waeltermann is alluding to such destructive dynamics, when she says, "This is a wake-up call that stresses the importance of early intervention, research, and appropriate treatment strategies.... research has consistently shown that when children receive the help that they need early on they are more likely to become more adept at social and communication skills." Cho did not receive this intervention or treatment. It appears that his challenging dynamics (which I believe may have been undiagnosed Asperger's Syndrome or other autistic spectrum issue), while observed, were never accurately diagnosed and most importantly, never treated appropriately. The consequence to him was his lonely enduring deep dark world of anger and resentment that subsequently erupted to darken the lives of so many others.

Consensus may never be reached regarding Cho's diagnosis. Interestingly the paranoid personality disorder diagnosis has not been mentioned in my reading of the media literature. Whether or not, others agree with this diagnosis, does not serve Cho or the many victims at Virginia Tech. However, the criteria or elements that were compelling and led me to this diagnosis can be useful in assessing the violence or danger potential of others, hopefully before violence occurs or so that intervention can be made. If you consider the eight criteria or elements and apply them to the client, Jim that the therapist was concerned about in the e-mail, you find that there are important distinctions. In addition, if you consider other criteria or elements (the other seven I have found to be important), you can gain even greater clarity for diagnosis. Some of the criteria or elements give clear indication of a more stable and less violently prone individual. Others guide the therapist in clinical inquiry. The first major difference between Jim and the shooter at Virginia Tech is that Jim sought out therapy. Cho was a social isolate and unable to maintain social relationships. He had difficulty maintaining even formal relationships with teachers. He internalized his process and did not have any social context for reality check. Jim uses therapy for this process, and he is successful socially. He seeks out social contact and interaction. Also, Jim was not comfortable with his own anger and resentment. It was ego-dystonic for him, because he could see how it would harm his relationships. Jim is not deeply resentful, although he could have cause for resentment in being a gofer for his instructor at the internship. Instead he appreciated the opportunity to experience the work despite his menial responsibilities. The judgment regarding the other criteria and elements were not clear to the therapist for Jim, but can be pursued through the therapeutic process. The following are questions I suggested that the therapist explore to get more information and clarity. Some are specific for Jim, while others would be useful in general to examine other individuals.

Are there any aspects of paranoid personality disorder or other paranoid thinking? This can also be from paranoid schizophrenia or stimulant drug abuse (cocaine, crack, crank, methamphetamine). It is also imperative to assess that these symptoms aren't affiliated with a medical condition, other chronic substance use, or chronic symptoms attributed to the development of physical handicaps. Is there a long held resentment and self-righteousness for past wrongs done to him? Or, is the upset or anger transitory? Intense feelings that are released through cathartic processes are less likely to erupt into violence.
Does he/she have mechanisms to self-soothe distress or other negative emotions (other than with drugs and alcohol or other dysfunctional behavior)? Does he/she activate them effectively or readily? Individuals, who can self-soothe to any significant degree, are more likely to keep bitterness and resentment under the threshold that ignites destructive behavior.
Is there any underlying Asperger's disorder (high functioning autism) that may be indicative of missing social cues? Does Jim give appropriate non-verbal social cues in the therapeutic interaction? Not only do many individuals in the autistic spectrum not recognize social cues, they may also not give appropriate social cues.
Does he/she present as "odd"? Mismatch between emotional content and non-verbal cues (eye contact, facial expressions, body movements, voice tone, etc.) may indicate autistic issues, or may indicate disconnection due to intense uncomfortable emotions. In addition, any individual perceived as different is more prone to being targeted for victimization by bullies.
Is his/her presentation that of a "normal neurotic?" "Normal neurotics" may have an intense presentation at the high or low end of the normal spectrum of emotions. However, they tend to be available to processing their emotions in therapy.
What is the energy of the movie for Jim? The movie Jim is doing may be cathartic and serves to mollify his resentment. It may keep him from possibly exploding violently into reality.
How does Jim feel about his recognition? Does he feel them deserved? Appreciation is the normal reaction to recognition. High fragile self-esteem or entitlement would be characteristic of narcissist individuals. Failure to get recognition can result in narcissistic rage and transitory aggression.
Does Jim feel that despite the awards, that others still don't understand or value him? That he has got recognition and awards from others from his work would seem indicative of gaining positive social validation. Thus, he would be less likely to be dangerous. If he thought that the recognition and awards come from stupid people that he feels superior to... that getting the awards are just signs of their ignorance, stupidity, perverted values, that he's fooling them, then there should be more concern.
Does he/she feel understood by anyone? By you? Individuals often seek validation from their therapist, after many life experiences of invalidation. They normally appreciate and respond positively to the validation. If the client cannot feel understood or appreciated, or dismisses validation, it would be of concern.
Does he/she feel that he can be understood by anyone? Who? Cho felt he understood the Columbine killers. Determine with whom the client identifies. Who he/she understands. Are they positive models or dangerous models?
How does he/she see his/her own anger and what does he/she do with it or in reaction to it? Even when many individuals feel their anger is justifiable, they also understand it can be dysfunctional for them. Of greater alarm, is when an individual sees the anger and the aggressive behavior that harms others, as both justifiable.
What is the ending of the novel? Is there personal redemption or just vengeance? Does the protagonist die (is doomed) or move on to "happily ever after?" Does the character have hope? Is it a transformative process for the character? For example, from doing poorly to doing well, from being alone to having positive relationships? A transformative story is a self-prophecy of hope as opposed to a story of doom.
What generation is Jim? Foreign-born, first American born with immigrant parents, second generation, or third generation or beyond? The less Americanized or closer to immigration generationally, the more likely an individual may have difficulty fitting in. What are his/her parents like? This is a basic psychodynamic exploration- an examination of the family of origin, attachment relationships, validation, nurturing, etc.
Does he/she feel rejected now? Are these feelings transitory or ongoing? Transitory feelings come and go and are not likely to cause distractive behavior, unless he/she is highly impulsive.
Was he/she referred or mandated to therapy? Is he/she self-referred? Self-referral is an act of hope and less likely to be indicative of desperation, and thus he/she is probably less likely to be dangerous.
Are there class issues that may also apply? Class is an often forgotten discriminatory issue.
How does Jim identify? As American? As Korean? Internalized self-hatred can have ethnic or cultural origins. Internalized self-hatred can externalize into aggression against others.
Does he/she identify as normal? As special? As different? Misunderstood, etc.? How does he/she identify relative to others, such as victim to bully, or superior to inferior? The role dynamics can predict behavior at or to others.
You could ask Jim directly about the shooter at Virginia Tech. How much does he empathize versus identifies with Cho?

Empathy might be indicative of understanding Cho's pain, while identification may be indicative of seeing himself in that role.
There are lots of questions that can get greater information and insight. What do your instincts say? Versus your fears? In the short message from the therapist, there were indications that were not consistent with Jim being a danger to others. However, this therapist, just as you are, is the only one in the room to make a final judgment and to do the interventions or therapy. The therapist was able to take these questions and interact purposefully with Jim. I later received this wonderful note from the therapist,

"From the questions you prompted me with, even before seeing him again, I was able to gather that my client was most probably needing affirmation and that his attitude is more hopeful. It is clear that he was reaching out for some support and that his work most probably is cathartic. I feel empowered and will move forward in the therapy. I will use the questions to further assess him, and whether my current sense of his low or non-propensity to violence is correct." About four months later, I received an additional communication from the therapist regarding her client. "My former Korean-American client is doing a lot better. He's starting a paid post-graduate internship at the literary magazine this fall. He won an award for one of his short stories that included a financial prize. He has had a lot of support from his former instructors and myself. Although I haven't heard from him in a while, he usually contacts me for a few sessions when a crisis or he needs to work through something stressful."

The larger list of criteria or elements to use for assessment for violence or danger potential is:

    1.    Specific Triggering Event
    2.    Opportunistic Behavior
    3.    Sense of Entitlement
    4.    Self-Righteous Attitude
    5.    Ego-syntonic Perception
    6.    Self-Esteem Gain or Loss
    7.    Intense Emotional Arousal
    8.    Pleasure
    9.    Resentment
    10.    Functional Reinforcement (Positive or Negative)
    11.    Characterlogical Behavior or Perceptions
    12.    Transitory Behavior or Perceptions
    13.    Isolation/Avoidance Behavior
    14.    Social
    15.    Presence or Lack of Remorse

In addition, nine types or origins of violent or aggressive behavior may be characterized:

    1.    frustration
    2.    cultural issues
    3.    bullying
    4.    borderline behavior
    5.    narcissistic behavior
    6.    paranoid behavior
    7.    sociopathic behavior
    8.    psychotic violence
    9.    substance abuse ignited aggression

Which and how the fifteen criteria or elements manifest indicate the core etiology of the nine types of violent or aggressive behaviors. Each of the nine types of violent or aggressive behavior has a distinctive profile of the fifteen criteria or elements. Explaining how each of the fifteen criteria or elements applies to these nine types of violent or aggressive behaviors is beyond the capacity of this article. In addition, opinions may differ on the relevance of or how to apply these criteria or elements. As you examine a client for danger potential, including suicide, domestic violence, or child abuse, using this process should conceptually confirm much of your clinical instincts. I believe that clinicians often do very good work based on instincts. However, if it is good work, it also is conceptually sound work. As you understand the conceptual foundations to your instincts, you go from good to often, great work. In addition, instinctive work is largely reactive, but with conceptual clarity you can be proactive. This becomes especially important when there is a potential for violence by or to our clients. The first responsibility of a therapist is the safety of the client and the safety of others in the greater community. The threat of harm to others, suicide, child abuse, and domestic violence constitute fundamental legal and ethical requirements for all mental health professionals. The first assessment of violence or danger potential serves the choice of action to that first responsibility. The subsequent assessment serves our therapeutic responsibility to address the client's emotional and psychology process. Whether or not you operate clinically using DSM terminology and diagnoses, assessing for and addressing relevant criteria or elements from the following list can serve therapy:

    •    dealing with specific triggering events,
    •    likelihood of engaging in opportunistic behavior,
    •    sense of entitlement,
    •    origins and the consequences of a self-righteous attitude,
    •    development and consequences of ego-syntonic perception,
    •    how self-esteem is gained or lost with the behavior,
    •    dealing with intense emotional arousal that affects the behavior,
    •    pleasure versus displeasure of the negative behavior,
    •    development of and intensity of resentment,
    •    degree of functional reinforcement from the behavior (positive or negative),
    •    how established or characterlogical is the behavior or perceptions,
    •    whether the behavior or perceptions are transitory, and how to get past them successfully if they are transitory,
    •    degree of isolation/avoidance behavior,
    •    need for and success at social relationships and interactions,
    •    presence or lack of remorse

For example, the violence potential of one adolescent gangbanger versus another gangbanger can be differentiated in seeing how one individual's potential aggression may come from the cultural framework of the gang, while the other's significantly greater potential for violence and danger to individuals and society may come from a sociopathic energy within the cultural framework of the gang. Differentiating criteria or elements for the sociopath would be

    •    lack of remorse,
    •    pleasure in the violent behavior,
    •    absence of intense emotional arousal,
    •    ego-syntonic nature of the behavior,
    •    lack of resentment fueling the behavior,
    •    opportunistic nature of getting away with the behavior,
    •    disinterest in social sanctions,
    •    characterlogical nature of the behavior

Given the psychological profile of the sociopath, emphasizing or creating significant negative consequences for the violent behavior would be the most effective approach for change. Appealing to remorse would be completely ineffective, among many other approaches. For the gangbanger who may be asked to or does engage in aggressive behavior primarily because of the culture of the gang, the differentiating criteria or elements would be

    •    potential functional gain in self-esteem and social status within the gang for the high risk behavior,
    •    need to arouse intense anger in order to be violent,
    •    lack of motivating resentment against a target,
    •    displeasure in the act,
    •    ego-dystonic experience
    •    remorse for harming someone.

For this gangbanger, challenging the cruelty of the act, the dystonic identity of being a violent person, the gangbanger's remorse from harming someone, while also addressing and offering alternatives to gain self-esteem and status would be more effective therapeutically. This approach would have little or no effect on the sociopathic gangbanger. Can we absolutely be sure about a client's potential for violence? Probably not, but we are nevertheless responsible to do the best that we can. Applying these criteria or elements to other clients could provide diagnoses, assessment for violence potential, and direct treatment differentially. And, give us greater confidence for our clinical judgments.
I have been contemplating, developing, using, and sharing this conceptualization with other therapists and human services professionals for the past three years. It has developed and grown with input from others, and has proved to be a useful tool in clinical work. I invite you to participate in the conceptualization and use of this process. Your feedback, commentary, and ideas would be very welcome. You can contact me by e-mail at Ronald@RonaldMah.com or through my website www.RonaldMah.com.

References:

AutismLink Reacts to Diagnosis of Autism in Virginia Tech Shooter, AutismLink, PR Newswire Association LLC, www.prnewswire.com/cgi-bin/stories.pl.

Professor: Shooter's writing dripped with anger, 2007 Cable News Network, CNN.usnews/2007/US/04/17/vetch.shhting/index.html.

"The Ones Who Make You Mad and Drive You Crazy: Personality Disorders For The Marriage and Family Therapist," presentation by Gregory Lester, Ph.D. at the 2004 CAMFT 40th Annual Conference in Los Angeles, May 2, 2004.

Psychopath? Depressive? Schizophrenic? Was Cho Seung-Hui really like the Columbine killers?, Dave Cullen, April 20, 2007, Slate Medical Examiner, Washingtonpost.Newsweek Interactive Co. LLC, www.slate.com/id/2164757.

A Family's Shame in Korea, Jennifer Veale/Seoul, Time in Partnership with CNN, www.time.com/time/worls/article/0,8599,1613417,00.html.

http://www.templegrandin.com, website of Temple Grandin, Ph.D.

Ronald Mah, M.A., L.M.F.T. has a private practice in San Leandro, CA. He consults and trains for many human services agencies, therapists, and educators. He's on the Board of Directors of the California Kindergarten Association, and also on the Board of the California Association of Marriage & Family Therapists (CAMFT). He's the author of "Difficult Children in Early Childhood, Positive Discipline for Pre-K Classrooms and Beyond," Corwin Press, 2006, and "The One-Minute Temper Tantrum Solution," Corwin Press, 2008, and has another book in development for Corwin Press on social emotional issues including victimization for children with Asperger's Syndrome, Learning Disabilities, or ADHD, and gifted children; has dvds on child behavior, discipline, and development with FixedEarthFilms.com. He's written online courses for the National Association of Social Workers- California Chapter. He also teaches MFT trainees at the Western Institute for Social Research in Berkeley. He also is a credentialed elementary and secondary school teacher; and has owned and directed his own child development center. His website is www.RonaldMah.com which includes articles and resources for parents, educators, and therapists. E-mail is Ronald@RonaldMah.com.

Walt Whitman's Vision of Same-Sex Marriage and the Call of MFT's

(Past member) — Sat, 03 Mar 2012 22:18:50 GMT

By Steven Herrmann

In my 2010 book Walt Whitman: Shamanism, Spiritual Democracy, and the World Soul, I examined in-depth the poetry and prose of Walt Whitman. From a contemporary, analytical psychological point of view, I demonstrated how Whitman speaks to age-old sociopolitical and religious questions that are highly relevant to our world today. My book discusses topics including:

 1) Whitman's emergence as a world-liberating figure;
2) Three stages of American democracy: the political, economic, and spiritual;
3) The awakening across the globe of the archetype of bi-erotic marriage;
4) Whitman's religious vision; and
5) Spiritual Democracy: the oneness of all religions.

I showed in my book how Whitman tapped into the archetype of Spiritual Democracy, which has indigenous roots in North America, and I attempt to clarify how he tried to universalize it, by announcing a new religious attitude that is nondiscriminatory, feminist, and LGBT affirming. I feel moved to share ideas from my book with East Bay CAMFT members because the notion of marriage equality is pivotal today, particularly with the focus in the world being centered right now on democracy. The breakdown of organized religions and need for new unifying myths to give coherence to changes that are taking place in the world presents us with an urgent psychological task.

Whitman not only tapped into the archetype of same-sex marriage, he may have predicted its emergence in a prospective way as an institution in the American polis and the world; he places images of same-sex marriage at the foundation of his democracy along with the rights of the well-married man and wife; his democratic visions appear to anticipate the movement currently afoot commemorating the political and legal recognition of same-sex marriage, now ratified in seven States across the US (Connecticut, Iowa, Massachusetts, New Hampshire, Vermont, New York, Washington, plus Washington D. C., and the Coquille, Suquamish Indian Tribe in Oregon). All seven of these States have legalized same-sex marriage. Why CAMFT has lagged behind these States and remained "neutral" by not taking a position on the issue of marriage, when all other national mental heath organizations (the American Psychological Association or APA, the California Psychological Association or CPA, the American Psychiatric Association or APA, the National Association of Social Workers or NASW, and the California Association of Social Workers or CASW) are all in support of marriage equality, is puzzling to me.

My hope is that my workshop will be of particular interest to MFT's today in light of current debates at the State and local chapter levels regarding marriage equality/inequality. In my view it is important to raise not only practical and clinical issues of how to effectively treat LGBT patients, following Proposition 8, but to question where we stand as an organization, and examine the impact of our various positions on clinical treatment and the ethics of our profession. I am not taking a personal position on what CAMFT's position has been or should be, but I do want to question it. In this workshop we will also take a brief look at what is happening globally, to widen our knowledge base.

Workshop Description

My workshop will cover a notion brought forth in my 2010 book Walt Whitman: Shamanism, Spiritual Democracy, and the World Soul, namely the archetype of bi-etoric marriage as a new guiding myth for our times. I am delighted to share this Workshop with EBCAMFT members because I feel the notion of marriage equality is pivotal in our work today, particularly with focus in the world being centered right now on democracy on all three levels, which Whitman identified for us in 1871: 1) political, 2) economic, and 3) spiritual. The breakdown of organized religions in many parts of the world, the reactionary trend towards fundamentalism in Islam and the West including America's religious right, and the need for new unifying myths, to give coherence to political, economic, and spiritual changes taking place across our diverse world, presents us with an urgent psychological task as Marriage and Family Therapist's or MFT's: a call to vocation. We are each called today to take a stand on an important issue of either enlightening our public about the need for same-sex equality for all people, on all three levels--political, economic, and spiritual--or not. Personally, I am in support of same-sex marriage. What the California Association for Marriage and Family Therapy's or CAMFT's position on marriage equality/inequality is or is not is up to CAMFT. I will address the controversial religious dimensions of this sacred domain by presenting a new myth. My workshop will address therefore the controversial religious dimension of the sacred institution of marriage and will present a new myth that provides a foundation in the collectivity to lend support for the movement afoot towards the institutionalization of same-sex marriage. This again is my personal view I will be sharing, so I have no intention of converting anyone to adopt either Whitman's, or my point of view. That is a matter of personal conscience and we each must decide for ourselves, or remain neutral about it. With some of my friends and colleagues at EBCAMFT, I feel a professional duty to speak out about this matter. I hope you will join this important discussion.

A Brief Biography of the Author

Steven B. Herrmann, PhD, MFT received his Bachelor's Degree in "Depth-Psychology and Religion" from the University of California at Santa Cruz in 1982, where he worked as a Teaching Assistant for the poet William Everson. He received his Master's and Doctoral Degree in clinical psychology and has over twenty five years of clinical experience working with children, adolescents, adults and couples. He has taught at John F. Kennedy University and has published numerous essays, lectured nationally and internationally, and written two books, including Walt Whitman: Shamanism, Spiritual Democracy, and the World Soul (2010) Published by Eloquent Books: Durham, Connecticut. ISBN: 978-1-60911-699-6. Steven is in private practice with offices in Montclair, Oakland and San Francisco. Steven is especially interested in the interface of analytical psychology, world religion, and American poetry.

Walt Whitman: Shamanism, Spiritual Democracy, and the World Soul (2010) Published by Eloquent Books: Durham, Connecticut. $28.95 ISBN: 978-1-60911-699-6 Available at Amazon.com By Steven B. Herrmann. PhD, MFT (EBCAMFT Member).

The Exciting Life of a CEU Coordinator

(Past member) — Sat, 03 Mar 2012 21:22:37 GMT

By Sandy McQuillin, LMFT

I was innocently sitting in an East Bay CAMFT Board meeting about a year and a half ago, when the question of "who would take over the CEU Coordinator position arose?" Since I loved going to the presentations I thought "Why not me?" That's when my life became so interesting and chaotic.

First of all I had no idea what the position did, so I had some quick learning by attending a presentation with the outgoing coordinator. That was it! I did a fast learning of the paperwork, how to make coffee (I don't drink it so big problem for attendees) and how to line up great speakers. Then I was off and running to do the job.

Over this past year and half I've learned that the fun part is getting to know all the talented members in our chapter. One of the secret benefits is I have been able to gain so many CEU's. I have also enjoyed the advantage of learning from all these presentations and to be able it use this it in my work with clients. The knowledge and experience from all the wonderful talent we have in this Chapter is truly a benefit I see, from being involved.

Last October of 2011 our coordinator for the intimate Wednesday presentation in Orinda had to step aside and guess who said she would take it on for awhile? Yes I can't help myself and just stepped right up. I love this cozy comfortable group of seasoned, pre- and newly-licensed members that, meet on the first Wednesday of every month. What a great opportunity for this close knit group to support me and all the presenters.

But I am fast realizing that it is such a great big job I need some members to take advantage of having an involvement opportunity to help me. I love telling you how these first rate presentations work, so maybe some of you will see an opportunity for your involvement.

On the second Saturday of each month the presentations are two hours and one can receive two CEU's. The meeting starts at 9:30 for bagels, coffee, tea and an opportunity to mingle and get to know other members. The presenter starts at 10:00 and ends at 11:55 so that we can do a quick introduction and fill out the evaluations. These meetings are alternated between Epworth Methodist Church in Berkeley and St. Mark's Methodist Church in Orinda. There are no presentations in the months of July and December.

As mentioned above we have a presentation on the first Wednesday of the month worth one CEU and lasts one hour. This meeting starts at 10:00 for coffee, tea, bagels and mingling. The speaker starts at 10:30 and stops at 11:30. At this time we all introduce ourselves and pass out business cards or workshop information. After the evaluations are collected and certifications are passed out we finish at noon. We do not meet in AUGUST OR DECEMBER.

These are a great opportunities to really get to know other therapist in the area for consultation or referrals. I realized after attending the CAMFT leadership Conference last week-end how much I would like to have one meeting a month for the lower ( Hayward, Castro Valley, San Leandro, ) East Bay members. I am open for any suggestions on how to go about having presentations in that area. I will leave this involvement opportunity to all therapists who relish getting to know all our Chapter members.

Strength in Numbers: Being a Member in Group Consultation

(Past member) — Sat, 04 Feb 2012 17:46:10 GMT

By Don Mack

A hallmark of owning a Private Psychotherapy Practice is isolation. Regardless of how many years we've been doing this work as Therapists, or even how well we're doing professionally, it can be tough to navigate the legal, ethical or personal questions that arise in each of us. When we connect with our clients about their concerns and questions, sometimes we're left feeling drained and uncertain about things we hear. We might also be unclear how to proceed with difficult therapy challenges. This is when a group consultation meeting can provide guidance and clarity.

I've been involved with a monthly Therapist consultation group for about eight years and it has consistently been a great source of clarity, knowledge, connection and validation for my clinical work. I began the group by inviting a few colleagues and posting an online invitation. Each participant came with their own clinical experiences, concerns and expectations for the group. Some Therapists that responded were a natural fit, others weren't.

As one might imagine with the varying personalities of Therapists and our differing clinical orientations, assembling a new work group met with some small challenges.

Since it was the first group I had organized, I was unsure what to look for when interviewing potential members. While most participants had an open approach regarding how the group would evolve over the first few months, others had a clear, commanding presence early on. One participant seemed to overshadow the collaborative intent that I had envisioned for the group, and eventually opted out. One thing that became clear for me was that bringing together a group of unique professionals with an intention of forming a strong, creative, trusted bond required commitment, patience and time.

During the first few meetings of the group we primarily discussed the desired structure and goals to be met. Our group agreed on a fairly loose structure, but there would be several key components that would take place in every session. We decided a two hour meeting was a good amount of time to tackle issues without being cumbersome in its longevity. The meeting begins with each member briefly "checking in", both personally and with psychotherapy practice concerns. While every session is unique, ongoing themes have emerged in each of our meetings. Common topics include insurance and paperwork questions, efficient marketing ideas, case presentation and designing our private practices to best match the clinician's ideal goals.

As time has gone on the group has evolved into a trusted entity which functions both as a professional network and has led to trusted friendships. Not surprisingly, as we learn about each member's therapeutic specialties, the relationships also have evolved into a consistent referral source. Being a member of a monthly therapy consultation group has had an immeasurably positive affect on both my therapy practice and my life. While admittedly I occasionally have had reservations about attending one of our meetings because of a full schedule or other obligations, I've never left one of our sessions feeling disappointed. I always end our meeting with some clearer insight, new clinical information or more focused motivation for my practice.

So if you're looking to add focus and inspiration to your therapy practice, consider joining a consultation group. You might also think about starting your own, with any specific focus you'd like. When I posted that invitation 8 years ago I knew that I wouldn't regret it.

Don Mack, LMFT is a licensed Marriage and Family Therapist and a Clinical Hypnotherapist. He specializes in working with people struggling with addictive behaviors, as well as assisting others in finding the motivation to express themselves creatively. With offices in both San Francisco & Berkeley he can be reached for consultation at contact@donmack.net or phone 415.820.9620.

Dyadic Developmental Psychology Workshop

(Past member) — Fri, 03 Feb 2012 17:47:58 GMT

A Dan Hughes attachment and intersubjective model for working with foster, adoptive children and families

Presented by Mervin Maier, MFT

Whether an intern or therapist, you have all been presented at sometime or another with a child or teen that has been exposed to intrafamilial abuse, neglect, inadequate or unpredictable parenting, separation or loss of a primary caregiver. Many of these young people exhibit oppositional-defiant behaviors, have difficulty trusting adults, have problems controlling their emotions, and frequently try to control people and events in their lives. Most children that demonstrate this profile will not meet the criteria for Reactive Attachment Disorder (RAD). They demonstrate what Dan Hughes, PhD and founder of Dyadic Developmental Psychology (DDP) calls an "attachment disturbance". Whether RAD or not at the core of these children's sense of self is shame. Their belief is that they are "bad" and "unlovable".

Probably most of you, like me, were trained to work with these young people by providing individual therapy. Play therapy with a child and talk therapy with a teen, with the occasional family or parenting session thrown in just for good measure. Utilizing this approach I struggled with children who cleverly controlled our therapy sessions. The impetus for them to do so was perfectly understandable. They were trying to avoid any contact with their personal histories that would get them in touch with their pain and suffering, lack of self worth, and of course shame. I felt frustrated, ineffective and believed that I rarely made a lasting connection with them. Unfortunately for those young people I hadn't yet happened upon a model that would help to provide them with a "safe harbor" to explore themselves.

DDP is a model of treatment that is consistent with the theories of attachment and intersubjectivity which creates a safe setting to explore, resolve, and integrate a wide range of memories and emotions. Through non-verbal and verbal attunement, reflective nonjudgmental dialogue, empathy, and plenty of reassurance the child/young person can join with the therapist and caretakers (that are in session) to co-regulate affect, as well as co-construct meaning to their lives. Through this work the child's level of trust grows, their level of attachment with their caregivers expands; their shame diminishes as do their behavioral problems. Parents/caregivers feel more connected and effective.

Mervin Maier, MA, MFT has been training with Dan Hughes since 2004 and is a "Certified Dyadic Developmental Psychotherapy ® Therapist". In his practice Mervin serves children, teens, adults, and couples. He is currently working on certification in EFT for couples. In addition to attachment issues Mervin has specific expertise in trauma, anxiety, depression, ADHD, learning difficulties, anger management and spectrum disorders. Contact Mervin at mmaiermft@att.net.

Assessing Partner Abuse In Couples Therapy

(Past member) — Sat, 07 Jan 2012 17:55:56 GMT

By Albert Dytch

Many therapists, including those of us with extensive clinical experience, frequently plunge into doing therapy before we have adequately assessed whom and what we are treating. It is in the nature of the therapist-client relationship that we cannot know the whole story from the outset. Our clients may be lost, confused, withholding, or in denial. They aren't ready to divulge everything at a first session (and if they were, we would probably wonder why). In the cause of establishing a working alliance, we leave avenues of assessment unexplored until a more opportune moment. Assessment and treatment necessarily walk hand-in-hand as the ongoing process of discovery and healing unfolds.

However, none of this relieves us of the ethical and professional obligation to carefully assess factors that may undermine treatment. Sometimes we collude with our clients' denial systems, deliver services that are misdirected or even harmful, and allow problems to get worse, under the guise of providing treatment. Meanwhile, our clients continue to believe they are getting help, and we continue to collect our fees. Whether the undiagnosed problem is addiction, bipolar illness, domestic violence, or some other weighty issue, part of our job is to make educated guesses and follow up on them.

The purpose of this article is to address one specific error I encounter with troubling frequency: the failure of couples therapists to assess adequately for partner abuse. By partner abuse, I mean the use of force, intimidation, or manipulation--or the threat to use any of those methods--to control, hurt, or frighten an intimate partner. Note that the definition can be met even if no physical violence is involved. Verbal and psychological tactics are more common; frequently they are also more effective, and they can be more emotionally damaging in the long run.

I have met with couples in treatment for several years with seasoned therapists who missed the extent and severity of the physical and emotional abuse taking place at home. While it is true that clients bear some responsibility for staying silent on the issue (whether out of fear, or outright denial), the obligation to assess rests firmly on our shoulders. For example, an abused partner may feel unsafe to bring up abuse in the presence of the other because of likely retaliation, yet many therapists have a policy of never meeting with separately with one member of a couple they are treating jointly.

Regardless of the reason for the assessment failure, the tragic result can be months or years of continued abuse. "Suffering" is a pallid word to describe the soul-damaging, spirit-deadening impact of ongoing abuse on the abused partner and the children who live with it. The corrosive nature of some abuse leads to an erosion of the self that can be extremely difficult to reverse. The effects are cumulative and must stop before healing can begin. Additionally, abuse generally grows worse without intervention. Meanwhile clients incur a sizeable expenditure of time and money, and the therapist (and, by extension, our profession) loses credibility.

COMMON MISCONCEPTIONS

Several common misconceptions hamper or prevent an adequate assessment of partner abuse.

"The couple reports that they yell at each other, so they both contribute to the problem." Loud arguments should always suggest the possibility of partner abuse. Most abusive relationships involve some angry behavior by both parties; some involve mutually abusive behavior as well, although the degree of fear is generally much greater for one partner than the other. While both partners are responsible for their own behavior, they probably contribute disproportionately to the abuse.

"I spoke to them about partner abuse and they deny it is going on." As therapists, we know better than to accept a client's analysis of their difficulties and to probe more deeply. If an angry client reports that he believes in firm discipline but would never abuse his children, do we simply take his word for it?

"It is my policy never to meet individually with clients I see in couples therapy." Adequate assessment cannot be accomplished with both partners in the room. Asking directly about abuse in a couples session puts the abused partner in a no-win position: to disclose and risk reprisal, or to deny and thereby avoid getting needed assistance.

"I have a 'no secrets' policy, so clients know that anything they share with me individually will be brought into the couples session." In my view, such a policy is designed to relieve the therapist's anxiety and hinders rather than helps the client. As therapists, we often learn things we cannot or choose not to divulge. Holding some information in confidence is a small price to pay if it allows us to leverage our clients into the right form of treatment.

"Even if there is undiagnosed partner abuse, I'm helping them resolve the underlying relationship dynamic." By its very nature, abusive behavior prevents the resolution of other issues. Abuse skews the relationship dynamic and leaves most of the power and control in one partner's hands.

"I can teach them better communication skills until they trust me enough to disclose the issues they are withholding." Communication skills are easily subverted at home by abusive partners. "I statements" are meaningless if the intent is to hurt, control, or manipulate.

"I'm not taking a stand on the issue because I'm afraid the abusive partner will bolt from treatment." Again, the delusion here is that some treatment is better than none. What is needed is a referral to appropriate treatment, rather than maintaining the fiction that the couple is getting help while the abuse continues.

INDICATORS OF PARTNER ABUSE

Clients in abusive relationships present with typical complaints: "We don't know how to communicate with each other." "We've been arguing a lot." "We're both under a lot of stress." "We've needed counseling for a long time and he/she finally agreed." "We disagree about disciplining the children." Their level of intimacy usually has declined.

More telling indicators are embedded in the relational dynamic that emerges in the consulting room. There may be unexplained tension in the room; certain topics appear to be off limits. There may be a marked difference in the way and the degree to which each partner participates in the session. The abusive partner may always start the session or alternatively always make the abused partner begin. One partner may be highly critical and judgmental, or exercise control through silence, intimidation, and manipulation. The other may speak hesitantly and haltingly--or, alternatively, may be hostile, resentful, and angry, seemingly out of proportion to the subject under discussion.

They may disagree on basic facts and have widely divergent views of the same events. Frequently both partners are highly defensive and misconstrue what the other says, as though looking for an opportunity to act angry or hurt. They report or exhibit destructive communication patterns, such as escalation, invalidation, or a demanding/withdrawing dynamic. Impulse control may be poor. Problem-solving and conflict resolution skills are lacking.

Any of these symptoms are sufficient to raise suspicions of partner abuse. Alternatively, many abusive relationships present as typical relationships with occasional heated arguments that both parties have come to see as the necessary though undesirable price of an intimate partnership.

ASSESSMENT PROTOCOL

When a couple comes to see me specifically because of my expertise in treating partner abuse, I typically employ a four-session protocol. I meet once with the couple, once separately with each partner, and then once more with the couple (or twice, if I need to gather further information or test hypotheses) to deliver my recommendations.

Alternatively, a couple may come to see me because they're having difficulties and have decided to try therapy. I might not begin to suspect partner abuse until they have seen me a few times. At that point, I might say something like:

"During the last several sessions, I've been able to observe how you interact with each other. As part of my work and to get to know you a little better, I'd like to schedule an individual appointment with each of you. That will give me a chance to get to know you better, find out more about you, your childhood, family history--that sort of thing."

I wait until the individual session to address the issue of confidentiality and "secrets." I typically begin that session with:

"This is kind of a rare opportunity to get together with you, and I'm wondering if there's anything you'd like me to know that you're not comfortable saying with your partner in the room? If it's something you want to tell me in confidence, I can keep it to myself. If it's something I think would be helpful to discuss in a joint session, I'll let you know that today, but I won't disclose anything you don't want me to."

I also tell the client that I would like to ask a series of questions about the kinds of behaviors that happen in relationships. I use an Abuse Behavior Inventory I developed after several years of working in the domestic violence field. (A slightly abridged version is included at the end of this article.) These specific questions can be supplemented by inquiring about the first, last, and worst conflicts that have occurred.

The individual interview allows me to uncover whether a pattern of abusive or controlling behaviors exists. This is accomplished best in the context of a clinical interview, for two principal reasons. First, clients provide much more information--factual, psychological, and emotional--than they would with a self-administered questionnaire. Second, clients may be so disturbed by their answers that they need an opportunity to process their reactions.

Comparing their answers side by side is an exceptionally useful diagnostic tool. Couples who corroborate each other's answers generally exhibit greater awareness of problems in their relationship and are more often motivated to do something about them.

RECOMMENDATIONS FOR TREATMENT

If the individual sessions reveal a pattern of partner abuse, my recommendations to the couple might go something like this:

"I have some thoughts about your therapy and where we go from here. We've discussed the issues and difficulties you experience together (name them), and I think it's clear to all of us that the two of you need couples therapy. But I think it's premature at this point. It's really just a matter of timing. You're going to be spinning your wheels until you both have a chance to address your own issues. Then you'll be able to take advantage of what couples therapy has to offer."

In the typical abusive heterosexual relationship, I generally refer the man to one of my men's groups with a focus on partner abuse; I refer the woman to a colleague who offers groups for women in abusive relationships. Other options include individual therapy with a therapist who has experience treating partner abuse and group therapy for abusive women. I generally refer men who are being abused to individual therapy, since groups for this population are rare.

In recommending separate treatment, there is a risk that the abusive partner will accuse the abused partner of having disclosed sensitive or confidential information that led to the recommendation. To minimize that risk, I base my recommendation primarily or solely on what the abusive partner told me and what I observed in meeting with the two of them together.

There is not sufficient room here to address the arguments for and against conjoint treatment in cases of partner abuse. Before I will consider treating an abusive couple together, they must meet several conditions.

Their answers to the Abusive Behavior Inventory match closely.
Past abuse was moderate to mild; currently, abuse is mild or absent.
The couple can adhere to a contract of no further abuse.
The abused partner is safe, unafraid, and able to mobilize resources if needed.
Both partners are motivated for treatment out of a sincere desire to grow and change.
Both partners are willing to be accountable for their behavior, without blaming the other.
The couple can use basic communication skills in a non-manipulative manner.

In short, couples therapy is appropriate when the dynamics of the relationship, not the abuse, is the proper focus of treatment.

RESOURCES

Treating partner abuse is a specialized field. Trainings in recognizing and treating partner abuse are helpful, but the only way to develop expertise is through direct experience. Practice administering the Abusive Behavior Inventory with colleagues. The next time you suspect partner abuse, assess for it. Consult with colleagues, a supervisor, or an expert. If you discover your suspicions are groundless, you can breathe a sigh of relief. If your suspicions are confirmed, refer the couple immediately for further assessment, if necessary, and appropriate treatment. The hazard of proving your suspicions incorrect is small compared to leaving partner abuse undiagnosed and untreated.

Abusive Behavior Inventory. Click here to download this form in PDF format (85Kb).

Albert J. Dytch, Licensed Marriage and Family Therapist, has been treating partner abuse and domestic violence since 1984. He has worked at Men Overcoming Violence and STAND! Against Domestic Violence and was co-founder of The Center for NonAbusive Relationships. He currently leads four men's anger management/partner abuse groups in his private practice in Oakland, where he also sees individuals, couples, and families. Albert has been a frequent presenter on the topic of partner abuse and consults with other therapists on their difficult or dangerous cases. He can be reached at 510-452-6243 or on the web at www.mensangermanagement.com.

Oral Character Style and Postpartum Suffering

(Past member) — Mon, 05 Dec 2011 17:58:52 GMT

By Jessica Sorci, MA

I remember nursing my newborn daughter and feeling an overwhelming physical thirst of emergency intensity nearly every nursing session. It felt as if I would die from not having liquid and my entire being was clamoring for more, more, more. I could drink 32 ounces and my thirst was still unquenched; I kept a large bottle of liquid at my side everywhere I went and I became anxious when it was more than half gone.

The sensation of that thirst brought up a keen awareness of NEED in me, mixed with panic that I wasn't going to be able to get the need met. It was as though the infant part of me that hadn't gotten "enough" was reawakened every time I attempted to meet that particular need of my daughter's. I experienced the need and the panic behind it as an indication that I was lacking something vital in myself.

I think now that I was glimpsing the psychological world of my own internal infant self, and that she had been left very thirsty, or the emotional equivalent of very thirsty in a way that had been terrifying and all consuming.

For most new mothers, the days, weeks and months following the birth of a baby are challenging and exhausting. And for some new moms the postpartum experience actually results in a crisis and a total or near complete collapse of self. I believe this subsection of new mothers who suffer so intensely in the postpartum period might be more deeply understood and more successfully treated if we consider them through the lens of character style, and in this case, specifically the oral character style. (Johnson, 1994).

During the symbiotic phase of development, "there is no conscious differentiation between oneself and one's caretaker" (Johnson, 1994). The infant experiences the mother as its self, and the mother too, has a sense of sharing her infant's experience. This symbiosis is critical to survival in that it forces the mother's attention to be always on her newborn in a way that helps ensure proximity and acute awareness of the newborn's needs. If we accept the idea that mothers are in a sort of psychological lockstep with their babies, we can imagine that parents continue to experience the part of their self that is developmentally congruent with their child, simultaneous to the child experiencing that particular stage. Mothers of newborns are then thrust back into re-experiencing their own newborn infant self that has essentially been dormant in the unconscious prior to the birth of this new baby.

Our earliest psychological developmental task is embodying the capacity for attachment and bonding (Johnson, 1994); failures in this period result in schizoid and oral adaptations in the fundamental structure of the infant and later the adult. For mothers who suffer greatly in the months following birth, I believe it is often the case that their own early infancy was fraught with either harsh, aversive parenting (leading to a schizoid character style, typified by withdrawal) or deprivation and unreliability (leading to an oral character style typified by premature, exaggerated independence). It's almost as though the birth of the baby forces the mother back in time to when she herself was an infant. If the mother was well cared for by an attuned, consistent, responsive other, that newborn part of her will likely be well resourced and able to draw from her own full tank to meet the needs of her young infant. But a mother who did not herself receive the kind of warm, attuned and empathic responses that a newborn requires for optimal development will find herself overdrawn and out of gas as she tries to nurture her own new baby. The meaning that she makes of her struggle and the way in which she responds to the crisis also tend to fall in line with her established character style. Mothers who encountered developmental blocks after their early infancy will be challenged in other predictable ways as their children's development progresses and pulls forth those characterological facets. Here I am focusing on the oral character style, as I have noticed the prevalence of "oral" traits in the new mothers I've worked with whose struggle to adjust to their new role is particularly painful. My hypothesis is that as clinicians working with PPD, we can be of immense help to our clients by supporting them in making the difficult leap into owning their own "neediness" and allowing their dependence to move to center stage.

The central theme of the oral character's life is denial of her own needs. "Orality will develop where the infant is essentially wanted and an attachment is initially or weakly formed but where nurturing becomes erratic, producing repeated emotional abandonment, or where the primary attachment figure is literally lost and never replaced" (Johnson, 1994). "Essentially the oral character develops when the longing for the mother is denied before the oral needs are satisfied" (Johnson, 1994) and the child in effect has to grow up too soon. As an adult, the oral character suffers from "the inability to identify needs, the inability to express them, disapproval of one's own neediness, inability to reach out to others, ask for help or indulge the self. The individual tends to meet the needs of others at the expense of the self, to overextend and to identify with other dependent people" (Johnson, 1994), effectively denying and projecting her own needs onto others. Her false self appears to be nurturing and helpful, but in truth she is desperate (perhaps unconsciously) for the kind of sustained care and love she did not receive. This false self is her "compensated" self -- that part of her self that has learned how best to function in a world where her own needs could not be met, by being helpful to others and not acknowledging her own immense needs. She also has a "collapsed" self that emerges when the compensation fails, such as in the postpartum period. There is an ongoing fluctuation between compensated (sometimes grandiose and even manic) and collapsed (depressed) states that can appear cyclothymic (Johnson, 1994) in oral characters.

New mothers who fall into this oral category tend to describe themselves as having been "Type A", controlling, and/or particularly independent, having identified with this compensated part of their selves. Sometimes it is the case that these women have histories of appearing to be highly functional, and prior to their postpartum period were superficially quite well adjusted, though they often report having lived with low grade depression throughout their lives. Metaphorically, it's as though they've built a reasonably solid looking house on a very weak, incomplete foundation. Having a baby is the crisis that shakes the house so hard it completely collapses and reveals the jury-rigged structure beneath.

The postpartum period is a time when mother and infant need an extraordinary amount of external support. Oral characters tend to find themselves in family and social contexts that are consistent with their own style, meaning there generally aren't supportive systems in place nor is there access to many helping hands, either because the mother is unable to relinquish control, reach out and trust others to help and/or because there actually aren't helpful others available. Consequently, as the new mother is coming into a psychological reexperiencing of her old injuries from her early infancy (namely her sense of lack and of being a burden), mixed with absolute need for support in the present time, she is simultaneously re-injured in the same manner that caused her orality. Feelings of helplessness, terror and futile longing set in, all while she is "burdened" with the task of caring for another similarly helpless, terrified little being who continually echoes and reminds her of her own unmet need for soothing.

The therapeutic aim in working with new mothers who have PPD (or the like) and have had developmental arrests in their own infancies is to assist them in identifying resources and mobilizing adequate support as quickly as possible. This can be quite challenging when working with women who fundamentally don't know how to ask for what they need and don't feel entitled to receive what is offered. In my experience, helping a new mother to get over the initial hump of asking for and receiving, regardless of the discomfort she will feel, can make a profound difference in the emotional health of the entire family and in the outcome of PPD. The fact that she appears for treatment is a promising sign, indicative of receptivity. The window for attachment and bonding with a baby is finite (though generous), and I see it as imperative that mom begins to accept nurturance and sustenance for her self in the postpartum period so that she can genuinely nurture and sustain her baby. Without adequate sustenance for herself, she will undoubtedly though not deliberately, perpetuate the oral style in her child.

In her collapsed state, mom must be encouraged to go ahead and need, to go ahead and ask for and take in some of what she has always longed for and what she has secretly been enraged about never having received. It's as though she has to transform her entire internal world and operating system to be one where it's permissible to have needs, to speak up, to take in, all while learning to feed and care for and understand a newborn -- and quite probably with little sleep! In therapeutic terms, what might be a prolonged, gentle and gradual approach in a non-postpartum period is by necessity a crash course in self-care in the wake of PPD. Although it flies in the face of my psychodynamic/analytic training, I find it necessary to bluntly state and firmly repeat a sort of mantra to these new mothers attesting to the naturalness of their immense needs in the postpartum period, the idea that mom is of little use to baby when mom is undernourished on any level, along with an ongoing, exhaustive review of all of her potential resources. As the crisis eases, we have the luxury of slowing the process down and understanding and exploring the nuances and particulars of her personal story.

In the postpartum period, many mothers with an oral character style have access to incredible feelings of need and longing in a way that is unfamiliar and overwhelming to them. Allowing those feelings to emerge, to be named, felt and then grieved is the beginning of a transformative healing process whereby they can begin to restructure their very character. We are gifted as mothers with an opportunity to readdress our early attachment wounds through the process of bonding with our own babies. But as adults we now have the power to bring words and consciousness to the experience, so that we can affect the outcome in ways that are consistent with our deepest values. A mother's experience of postpartum suffering can be the undoing of her oral character style and also an opening for incredible developmental and characterological growth.

Jessica Sorci is a Marriage and Family Therapist Intern who received Master of Arts Degree from Antioch University in 2009. She is in private practice in Campbell and Los Gatos, CA, specializing in postpartum and parenthood transitions as well as relational and attachment challenges. She facilitates a Postpartum Adjustment Group for new mothers and draws from her training in psychodynamic, somatic, attachment and mindfulness-based theories.

References
Johnson, Stephen M. (1994). Character styles. W. W. Norton & Company.

EMDR: A Fast and Effective Trauma Treatment for Children

(Past member) — Thu, 03 Nov 2011 17:02:30 GMT

By Alexandra Phillippe

There are many types of traumas that effect children and adolescents, and there is a great deal of variation in what different people find upsetting. What is a trauma for one might not upset another person at all. Traumas can range from the dramatic (such as witnessing violent death, or being sexually assaulted) to the subtle (experiencing an incident of emotional abuse, or being bullied) and everything in between. I find it is important not to judge whether or not a child "should" be upset by an experience. If a memory is disturbing him or her, trauma treatment may help.

Children who are suffering from disturbing memories or a full diagnosis of PTSD may exhibit different symptoms than adults. These symptoms may be confusing to the parents or caregiver, and might include:

Post-traumatic play. Children use pretend play or toys to recreate and act out their upsetting memories. They play looks very serious or frightening to the child, and may scare other children.
Post-traumatic reenactment. A child may do to others what has been done to them, or encourage others to do the upsetting thing again. For example when a sexually abused child initiates sex acts with others, or a child who has been frightened by a fire plays with matches or engages in arson.
Frequent frightening nightmares, or difficulty sleeping. May begin trying to sleep in parent's bed.
Appear to "zone out" or freeze up suddenly.
The child may do well (or even improve) at school and when busy, but act disturbed at home or when given free or quiet time.
Sudden clinginess.
New anxiety or fears.
Sudden jumpiness or exaggerated startle response.
Refusal to participate in previously enjoyed activities, including a sudden hatred for school.
Phobias.
Make negative statements about one's self ("It was my fault", "I'm bad", "I'm not safe", "I am ugly/stupid/worthless").

EMDR stands for Eye Movement Desensitization and Reprocessing. It is a scientifically proven treatment that cures problems caused by trauma quickly and effectively. EMDR is particularly efficient at treating trauma in children and teenagers. The young brain is constantly growing and changing which enables children to use EMDR extremely successfully and unbelievably quickly. Whereas an adult will usually take 2 hours to process a traumatic incident, a child will process in 5-15 minutes, and a teen 30-40 minutes. I often see dramatic symptom reduction immediately after the first EMDR processing session.

Children (ages 18 months-12 years) follow a special EMDR protocol that looks quite different from the adult procedures, but covers the same basic elements of desensitization and reprocessing. The therapist makes a game out of the bi-lateral stimulation and tells the child the story of the trauma beginning with the child being safe, and ending safe having learned something. An individualized story is used because children do not desensitize or reprocess on their own as adults usually do. When the child's trauma story is known to the parent/guardian/caretaker, the adult(s) are seen alone for 1-3 sessions for the therapist to gather history and information, and explain the procedures. Then the child and parents are seen together for one session of introduction and preparation. One or 2 EMDR treatment sessions per trauma are needed, usually with the parent present, followed by one follow-up/goodbye session. This direct EMDR method works well for both adjunct therapy work and short term treatment.

When the adult(s) do not know the trauma story, are extremely low functioning, perpetrated the trauma, or are new to the child (i.e. foster parent) the therapist may find play therapy to be safer and more effective for the child in building rapport and determining the trauma story(ies). EMDR techniques can then be incorporated into the play. The play therapy/EMDR hybrid approach takes significantly longer, but has been equally effective in my experience. The hybrid approach is possible as an adjunct therapy, but can be more complicated and difficult. I have found that it works best when the long term therapist has witnessed extensive post-traumatic play or the child has told the therapist the trauma story, and the long-term therapist can describe the trauma story to the EMDR therapist. In these instances the long-term therapist fulfills the role of the parent and the EMDR treatment progresses more similarly to the direct EMDR method.

In some cases the parent or caretaker has been traumatized as well. It may be a multigenerational type trauma, such as abuse, or an incident that impacted multiple family members, such as a robbery. In these circumstances I have found that when the parent completes EMDR treatment first, they are more able and willing to provide the necessary safe-base and an accurate and clear EMDR story for the child. The old metaphor applies of putting on one's own oxygen mask before helping a child.

Adolescents (ages 13-21) follow the same protocol as adults, moving through 8 phases of treatment, and are typically seen without the parents. However, while teens desensitize very rapidly, they do not usually reprocess on their own. The therapist can assist the teen in logically thinking about the event, and preparing for the future. Teens can expect a minimum of 3 preparation sessions and approximately one session per trauma, plus one follow-up/goodbye session.

What parents have said about their children:

"She is sleeping in her own bed now, with no nightmares. It's a miracle!"
"He doesn't talk about the bad man anymore. He is happy--normal, he can play again."
"She has not gotten in trouble at school since the EMDR session. I didn't think she was paying attention, but it worked, she has stopped all of those behaviors" (from the parent of a child who had been sexually acting out at school).

For more information about EMDR, check out the EMDR International Association website www.emdria.org. There are many excellent books on using EMDR with children. I most enjoyed reading Small Wonders: Healing Childhood Trauma with EMDR by Joan Lovett, M.D.

About the Author

Alexandra Phillippe, MFT has 18 years of experience caring for and working with children. She has 7 years experience as an art and play therapist and has been practicing EMDR with children for 5 years. Alexandra is fully trained in EMDR and child EMDR and is working toward her EMDRIA certification. Alexandra has a private practice in Oakland and is currently accepting clients with approved Victim Compensation claims, Blue Shield insurance, or private pay. Alexandra is also experienced at providing adjunct EMDR treatment for children, adolescents and adults who are in long term therapy or groups elsewhere.

The Four Levels of Trauma Defenses

(Past member) — Mon, 03 Oct 2011 17:04:34 GMT

By Steven Kessler

Any journey is easier if you have a map that shows you where you are and how to get to your destination. This is especially true on the journey of psychological healing, since some of the territory you must navigate is buried in the unconscious. Whether you are healing yourself or guiding someone else, having a good map is often essential to your success.

For complete psychological healing, we must heal not only the original core wounds, but also all the defense mechanisms that the person has created to protect themselves from feeling those core wounds. The defense mechanisms can be quite complicated. They are often organized in layers, with each layer imperfectly solving the problems created by the layer just beneath it and leaving problems to be solved by the layer above it, or not solved at all.

It is those remaining problems, the ones not solved at all, that show at the surface. Those are what people are typically aware of when they come to therapy or buy a self help book. They think that all they need to do is solve the surface problem. When that doesn't work, they often feel disappointed. But if you have a map, you can tell by looking at the surface problem where to dig for the core wounds and what types of defense layers you may encounter along the way.

I have created a simple map that shows how the various layers of defense mechanisms are laid down, each one on top of the layer before it. Starting with the simplest at the bottom and building up to the most complex, the layering looks like this:

4. trauma + self-negation --> self-defeating behavior

3. trauma + numbing habit --> addiction

2. big or repeated hurts --> defense is ego syntonic --> trauma

1. an isolated hurt --> defense is ego dystonic --> phobia

I hasten to point out that in real life the different layers are not always so distinct, and one level may blur into another. The map is simplified so that what's important stands out, but real life is rarely so simple. The map is useful, but the map is not the territory. Keeping that in mind, let's go through the layers one at a time and unpack each one.
The 1st Level -- Phobias

The simplest kind of wound is a single, isolated hurt. Up to that time, the person's life has been basically okay, at least in the area of this latest hurt. So the problem that the client presents is relatively small and simple, within the context of an otherwise functional life.

For instance, suppose the client is an adult who used to do all the usual adult things, including driving her car on bridges. But then something happened. Since then, she becomes anxious every time she drives over a bridge. She begins to sweat; her hands shake. She tells herself there is no reason to feel this way, this is childish, it's 'not me'. But it continues. To avoid feeling this way, she now avoids bridges.

She has developed a phobia, a fear of a particular situation. She can feel the fear and name the situation that arouses it. She knows what she does to avoid the feeling, and she considers the feeling to be uncharacteristic of her. In psychological jargon, the feeling is 'ego dystonic'. She has not identified with this feeling or the avoidance behavior and they have not become part of her personality or identity. She will say things like "I know I shouldn't feel this way" or "This just isn't me."

This is the simplest kind of wounding. The hurt and the attempts to avoid it are close to the surface. The person experiences little or no secondary gain from the feelings or behaviors, so ending them brings uncomplicated relief.

Because phobias are structurally so simple, they can be fairly easy to heal, if you have a tool such as EFT (emotional freedom technique) to dissolve the trauma. It was in healing phobias that EFT got it's reputation for "one minute wonders". Using EFT, all you need to do is find the core incident that created the phobia and collapse it, testing your work thoroughly to make sure you've cleared all of its aspects. When there is only one core incident, this is usually easy to do.
The 2nd Level -- Trauma

The next, more complicated level is what we typically call trauma. Here the wounding incidents are so big and/or repeated that they have re-organized the person's relationship with the world. The person's whole life may now be organized around making sure 'that' never happens again. And they feel justified in feeling the way they do; the feeling is 'ego syntonic'. If they have been coping with this wound for a long time, it usually has become an identity structure, so that now they identify themselves by referring to it, as in "I'm an incest survivor" or "I'm an adult child of an alcoholic."

A deep healing of the core wounding incidents will usually dissolve that identity structure, leading to a spontaneous shift in how the person identifies them self. For instance, a client who had been repeatedly molested by her father and who had believed since childhood that she must have been bad to have deserved such treatment, paused during an EFT session to reflect on it all and then stated, "You know, this had nothing to do with me. I was a wonderful little girl. He was a sick man." Her whole psyche had just spontaneously re-organized itself.

What differentiates this second level from the first level is the relative size of the trauma and it's defense and the extent of identification with it. In the first level, the trauma and defense are smaller than the rest of the person's life, which is free of this feeling and behavior. In most of their life, they are okay, but in certain situations, they "have a feeling." In the second level, the feeling has them. The feeling and defense are so large that they color and organize the person's entire life, becoming part of their identity and causing them to say things like "That's just who I am."
The 3rd Level -- Addiction

At the third level, the level of addiction, we have all the trauma and defenses of the second level, but they are now buried under an additional layer of defense, an habitual behavior that serves to numb the person to the pain and anxiety of the core trauma. Here, the person's solution to the underlying problem has itself become a problem. Usually, people come for help with stopping the addictive behavior, completely unaware that it is their medicine for a deeper wound, and that we must heal that deeper wound to really cure the addiction.

The numbing agent may be anything. Some of the favorites are alcohol, drugs, food, sex, work, money, success, and popularity, but any substance or activity can be used, as long as it works well enough to dull the feelings from the trauma. However, all addictive behavior is ultimately unsuccessful because "You can never get enough of what you don't really want." If what you really want is to feel loved, there is no substitute that will give you that feeling. If what you really want is healing for the original hurt, there is no amount of anesthesia that will work. Sooner or later, the numbness wears off and the hurt returns.

This extra layer of defenses makes the healing process that much more complicated. In addition to healing the original core wound and the feelings, beliefs and identity arising from it, the addictive behavior itself must be addressed. Typically the addictive behavior has several components, including the craving for the drug of choice, the situations that trigger the craving, the habit of self-medication for the craving, and chronic psychological reversal (this is a term from energy psychology, referring to a situation in which the healthy flow of energy in the body is so disrupted that perception gets confused. In this state, what is bad for the body can actually feel good.) All of these parts of the addiction are interwoven and mutually re-enforcing, which makes them that much harder to untangle and dissolve.
The 4th Level -- Self-Defeating Behavior

The 4th level is the deepest and most difficult to change, because here a deeper and more effective numbing process has been added to the usual layers of trauma defenses (and there may be active addiction, as well.) This additional layer of defense is an unconscious, automatic habit of self-negation.

Self-negation is a much deeper and more damaging habit than addiction, because while addiction tries to bury the pain, self-negation tries to bury the self. It does this by stifling all the expressions of the self and assertions of personal will, such as initiating actions and having preferences and desires.

Why would anyone adopt a habit of negating their own impulses, of preventing their own self-expression? Like all defense mechanisms, it was the best solution the child could find for the problems it faced. In this case, the problem was a parent who could not tolerate the child's developing sense of separateness, autonomy and will. To prevent this development, the parent set out to break the child's will by actively punishing the child's expressions of his own separateness, autonomy and will.

Today, such actions may seem unusual or even bizarre, but during the 1800's and early 1900's, this practice was the norm. Most books on child-rearing from that era state that a child is a wild animal and it is the parents' duty to break the child's will in order to civilize it. Although the instructions in child-rearing manuals have changed, there are still many parents who were brought up this way or who, for some reason, were not able to psychologically separate themselves and therefore cannot tolerate the development of a separate self in their child.

The core wounding usually happens something like this: around the age of two, the child naturally becomes aware of it's separateness and begins to express its will as different from the parent's. Instead of supporting the child's budding autonomy, the parent opposes it, using guilt, shame, manipulation, over-control, or outright violence. At first the child fights back, asserting his own will in opposition to the parent's. But the parent is bigger and stronger and willing to escalate the punishments as far as it takes to force the child's compliance. Time after time, the child loses the fight. Eventually, he concludes that "I can never win, and any assertion of my own will only brings more punishment."

So the child does the only thing that will stop the pain -- he turns its own will against himself and stops himself from feeling or expressing his own impulses and desires and autonomy. He learns to automatically defeat himself before the parent can defeat him. This is the habit of self-negation. This habit organizes the child's psyche so deeply that the behavior persists long after he has grown up and left home. Even as an adult, impulses and desires are derailed before they reach the surface and find expression. Projects are begun, but somehow never completed. Situations that would draw attention or praise are avoided, since those were the moments that brought humiliation. Little is desired or accomplished.

These are the clients who have a reputation for defeating their therapists by refusing to change, even though they want to change. Being successful can be terrifying, since any act of self-assertion re-awakens the old fears of punishment and humiliation. They have never gotten what they wanted before, so why expect to get it now? For them, the only way to avoid losing big is to continue losing small. And underneath the self-negation there is an ocean of pain and rage at the way they were treated. But the act of self-negation protects them from experiencing all those overwhelming feelings. It is their medicine, their drug of choice.

How, then, do we help someone who is stuck at this level? First, we need to recognize early on that self-negation is present so that we don't play into the try-and-fail pattern and end up re-enforcing it. Instead, we need to recognize the need to refuse to change and give it a voice. Within EFT, Carol Look has beautifully laid out one way to do this in her Refusal Technique. This technique is very effective, both to break the logjam and to confirm that self-negation is the issue. When it is, doing the Refusal Technique will cause the client to become more animated. In fact, they often break into peals of laughter at this permission to finally say out loud what they have felt in silence for so long. This release can continue for a long time as they vent the pressure they've been carrying inside for years. And you may need to return to the Refusal Technique repeatedly, each time the logjam re-appears.

Since these clients are profoundly psychologically reversed, I suggest also applying the EFT un-reversal technique early and often. Their system is accustomed to being reversed, and you must help it gradually re-orient to being in alignment.

As you penetrate the layer of self-negation (even temporarily), you can begin to address the underlying specific incidents (traumas) that led them to resort to self-negation in the first place. Their identification with being the loser must also be named and dissolved. If addictions are present, you will have to address them at some point as well, although this will be much easier if you can collapse the underlying traumas first.

It will likely be a long and twisting road, but if you understand the function of self-negation in their psychic economy, you will make real progress.

Looking back over these four levels of trauma defenses, we can see how they are laid down, each one on top of the one below, each layer trying to solve the problems left by the previous layer. With this map in mind, I hope you will find it much easier to understand and heal the various traumas you encounter.

Steven Kessler , LMFT has been a licensed psychotherapist for over 20 years and is the Director of the EFT Therapy Center. He has studied many different healing modalities, including Character Structure, the Enneagram, NLP, energy work, and Thought Field Therapy, the precursor of EFT. He is now credentialed as an EFT Expert practitioner.

Sex and Sociability - Therapist's Disclosures

(Past member) — Thu, 01 Sep 2011 19:38:02 GMT

by Isadora Alman, MFT

Most of the clients I see in my counseling and psychotherapy practice meet with me only a few times, sometimes only once or twice. The work I do generally and in sex therapy follows the PLISSIT Model developed by Jack Annon and his colleagues in the 1970's. Specifically, I normalize my clients feelings and behavior (give Permission), offer Limited Information, make Specific Suggestions, and finally, if warranted, do Intensive Therapy. Seldom is the latter what people want when they consult me.

If a woman comes in because she has difficulty reaching orgasm, a man because he is afraid to ask for what he wants, or a couple hoping to get along better without as many quarrels I see no need to do family of origin investigation or spend several sessions taking a detailed sexual history. They come with a specific problem. It is our job, working together, to arrive at a specific solution, or a selection of possibilities. Should the presenting issue be more complicated than the client or I originally thought, that can be explained and explored as well.

I work in 90 minute sessions. I begin the first session with "housekeeping rules" such as the bathroom location, assurances of privacy with legal exceptions, that I will give a 20 minute announcement when we near the end so that we can wrap up gracefully, the rules of discourse ("Feel free to speak directly to each other rather than through me" and "If I ask a question you do not wish to answer please say so and I will back off") and I end this with "Now, how can I be of help?".

The reason I begin with my two minute or so housekeeping spiel is only partly to convey the information. It is also for the client to become a bit more comfortable with the surroundings and with me personally -- what I look and sound like and, I hope, the warmth and lack of judgment I project. It's difficult enough for some to decide and locate a therapist, make an appointment, enlist any partners to accompany them, and to get themselves finally to my office. How much more so to launch into their most intimate concerns with a stranger.

When my daughter was little and first learning the facts of sex she would ask wide-eyed and horrified "Do you and Daddy do that?' My answer then was always "What Daddy and I do is private but most adults do it and enjoy it."

My clients are all adults, not innocent six year olds. While I am certainly entitled to keep my private life private and psychotherapists are, in fact, enjoined to do so, judicious disclosure on my part goes a long way to both normalize clients' thoughts and feelings and establish our rapport. Often I will present stories of anonymous other clients for the same effect, but I find that sharing some of the misconceptions I personally also had about female anatomy for example does just that more effectively and allows us to laugh together.

I have clients that come in periodically with new life challenges over the years. While I am flattered that many quote something I said years ago, or say when stuck they try to imagine what I might tell them, several have recalled some personal sharing of mine to be what was most helpful.

Because I encourage clients to record our sessions for their use later, I am aware that bits and pieces of my own history are out there all over the place. Yet in more than 26 years of counseling, I have yet to have this come back to haunt me in any way. To the contrary, I have been told many times how meaningful my personal disclosures have been to them. They have served not only as illustrations of coping strategies but as models of how to take risks and the value of being open with others.

Isadora Alman, MFT has a private practice in Alameda. She has authored multiple books and currently writes a blog for Psychology Today titled "Sex and Sociability" http://www.psychologytoday.com/blog/sex-sociability . Isadora will be presenting at this month's Berkeley CEU workshop titled "Honey, Let's Talk," on Sept 10th. Visit Isadora at www.askisadora.com.

This article first appeared in Psychology Today.com.

Marketing: The String Connecting - Client Pain to Your Therapy Solutions

(Past member) — Mon, 01 Aug 2011 19:39:44 GMT

by Elizabeth Doherty Thomas

The gap between your love of this field and your ability to swallow the concepts of marketing may be remarkably vast. They seem to conflict: helping others versus helping yourself. Therapy is a private, confidential relationship behind closed doors and marketing is getting out there in a big way, drawing attention to yourself. If you get a little sick to your stomach, you're normal! Let's attempt, however, to reframe marketing in a way that feels authentic and maybe even inspiring. To be completely blunt, too many people are desperate for what you can offer and the only way to help them is to market yourself.

The Social Justice Approach to Understanding Marketing

How many dollars and how many people were involved in forming you from childhood through graduate school and into your license? Even private schools get tax breaks because we believe, as a nation, that education is improving your life, which improves society. Maybe your spouse worked two jobs while you went to school, or your kids didn't get as much parental attention as you had to hit the books. Now imagine all that work for naught. The very people you so desperately know you can help aren't finding you. All the time, supervision, authors who wrote those textbooks, family that sacrificed, everyone put so much energy into helping you advance, and now you're going to hide behind your couch claiming it's selfish or wrong to market?

Systems Theory Requires Being in The "System!"

People often mistake advertising with marketing. Advertising is the passive bus stop bench, the printed ad, appearing randomly in front of a variety of people who aren't asking for your services. Marketing, however, is being, quite literally, in the marketplace, or in the "systems" your ideal client hangs out in. If you work with children, the systems you market to are schools, daycares, parent groups, maybe hospitals. Maybe you serve artists, in which case you figure out all the places they natural congregate. I like to think of your ideal client as a bee that likes to buzz around fellow bees. Where are they doing this? That is the system you need to buzz around as a professional able to help with their pains and problems. They aren't wandering office park hallways, learning what the letters LMFT mean, opening doors to see if you're sitting in a chair waiting for them.

Helping Those Who Can't Pay

We care deeply about helping people but we also have student loan debt, mortgages, and with a masters or Ph.D., deserve to afford the occasional overpriced coffee, right? A cool feature of marketing is you actually offer high quality, high value information, for FREE. You focus on getting the wisdom in your head out to people who want to hear it. The more people know, like, and trust you in your community (by way of low-cost barriers like free e-books, or talks to groups of people you serve, etc) word spreads that you are a nice, likeable, trustworthy source of help and healing. Then money leaves their wallet, you fill your practice, and all the while you don't have to feel like a greasy salesperson hawking Ginsu knives for $19.95.

There are many moving parts and pieces to marketing but the great news is therapy, by it's very nature, has an inherent draw to people. Anytime you get frustrated or question the challenges of marketing, be humbled by people who are trying to make a living selling one dollar items, requiring thousands of customers, huge inventory, lots of customer service, and convincing people of the need for the tiny widget.

Elizabeth Doherty Thomas is starting graduate school in the fall to be an MFT. Since 2005 she has been helping connect therapists with clients seeking their help online via two therapy directories and her consulting work. Visit her website for free marketing help and inspiration, www.ElizabethDohertyThomas.com.

Trauma and Restoring the Rhythm of our Nervous Systems

(Past member) — Wed, 01 Jun 2011 19:40:57 GMT

By Theresa L. Cangelosi

As a somatic psychotherapist, I have always used a body- based approach in my practice. When working with clients who have experienced trauma I have learned that a mind-body approach is crucial. Freud defined trauma as a break in the barrier that protects from over stimulation and leads to a feeling of helplessness.

When an event is too stimulating to be contained, we become overwhelmed, our lower brain structures organize our survival responses and our nervous system becomes disorganized. Our nervous systems can get stuck and we could look manic and hypervigilant, we can feel numb and vacant, or we can switch back-and forth between those extremes, which can look like bi-polar disorder.

This extreme range of symptoms is indicative of a disregulated nervous system in need of stabilization. When we experience a shock, there can be a break from earth, self, and others. In stabilization we look for re-reconnection to our natural self and our community.

The "break" that Freud mentioned could be any incident that we perceive as life threatening, such as a car accident or a rupture in attachment with our caregivers. Early developmental shock or trauma can underlie acute and chronic trauma, and be an indicator of who will develop PTSD.

Whether it is developmental or shock trauma, the approach is the same. A bodymind approach to trauma is necessary to address the disregulation in the brain regions that have been overwhelmed and are struggling to regain balance and stability. It is helpful for practitioners to understand the neuro-physiology of this disregulation, and in turn educate and empower clients to be aware of their natural ability to regain integrity.

Fortunately, most of the ways we help our fellow humans who have experienced a traumatic event comes naturally to us. We have all experienced how a hand on our back can comfort us when we are grief stricken, how speaking to someone who has been injured and letting them know we are going to stay with them can do wonders. Helping someone stay present, aware of self and eventually connected with others can be the difference in someone developing PTSD or coming out of the acute stress and recovering.

Current neuro-physiology teaches us about the sympathetic and parasympathetic nervous systems, so we don't have to wonder why what we do naturally works. Knowing how the nervous system is affected by trauma helps us to respond with an intention to stabilize. It is important to know where the nervous system is stuck, so we know what would bring it into a natural rhythm, and how the nervous system will respond.

In her course called Trauma First Aide(TM) Training, Geneie Everett, Ph.D. says, "you have to know what you're looking at, to know what you're looking for". Learning the symptoms of the sympathetic and parasympathetic nervous systems is a very helpful skill set in preventing and treating trauma.

When our life or bodily integrity is threatened, it is a normal and adaptive response to fight or flee to protect ourselves. This natural stress response allows us to use our sympathetic nervous system to respond in the most successful way possible and then to return to a normal level of functioning once the threat is gone. About 80% of the population can experience high levels of activation, acute trauma, and not develop PTSD, chronic trauma. Of course it is best to help anyone stabilize soon after a trauma, so the chances of developing the wide array of symptoms, associated with PTSD, both emotional and physiological, will be greatly diminished.

After an overwhelming event, clients could be in an acute or chronic stage of trauma and find that they are stuck in any combination of the stress responses: flight, fight or freeze. Our presence and voice engaging them can help the client become self aware and grounded . As we help the client find a place in their body where they tolerate feeling sensation, they experience the natural rhythm of their reciprocal nervous system The fragmentation can come together and give a sense of integrity. The manic energy of a fiercely wagging foot can slow down with guidance from a practitioner who knows the nervous system, and the client can experience their motion attempting regulation. Once their motion is slowed to a tolerable range of experience, they could feel the internal rhythmic rocking and then a full breath. Knowing the nervous system helps us all to listen to the body calling us back to the present where we are connected, whole and safe.

Learning about the nervous system gives both client and therapist another way to understand the language of the instinctive part of us that knows how to protect us and return us to our natural integrity and resilience. It is our sensory brain that is organized for survival during and after a traumatic experience. Since the cognitive functions of the neocortex are the areas of our brains that become disorganized by the overwhelm of trauma, we as therapists who treat traumatized clients need to know how to read the sensory messages of our lower brain structures related to breathing, circulation, digestion, reproduction, flight/fight response and unconscious control. When these life sustaining functions are stable, our nervous systems can return to their inherent wisdom and natural rhythm.

Theresa L. Cangelosi, M.A., SEP is a Somatic Psychotherapist and Somatic Experiencing ™ Therapist in private practice for 18 years in San Francisco. She was part of the team that taught Trauma First Aide ™ to first responders in New Orleans after Hurricane Katrina and currently is a teacher with Trauma First Aide Associates. Find Theresa online at www.tlcangelosi.com.

This article first appeared in the January February 2011 edition of the Newsletter of San Francisco CAMFT.

Healing Your Inner Child With Hypnotherapy

(Past member) — Fri, 20 May 2011 19:44:58 GMT

By Holly Holmes-Meredith

In order to thrive and grow into our potentials, we all have basic needs that must be met consistently. The most basic needs are for food, safety and shelter. Other important needs are for loving attention, a sense of belonging, stimulation through learning and play, structure and boundaries, age appropriate responsibilities, respect, freedom to express oneself, to be heard, and creative outlets.

As children if we do not have these needs met, or they are met erratically or inconsistently, we develop defenses and strategies to compensate. These strategies may help us cope and survive when we are young, but as we get older, these defenses, behaviors, perceptions and ways of being with ourselves and our world often become liabilities. Many common issues that clients want to work on in hypnotherapy are linked to these childhood patterns that limit.

Karen's parents divorced when she was eight years old. After her father moved out, her mother had care of three kids and took on a full time job to make ends meet. Karen lost the full time attention of her mother and her father at the same time. As the oldest child, Karen took on the responsibility of caretaking of her brother and baby sister and doing many chores around the house when her mom was at work. Even though there was the support of baby sitters and neighbors who provided after school child care, Karen became the second parent to her siblings. Her time to be a child was over.

Karen was commended by all for being so grown up and responsible. She was such a good girl for helping her mom and for taking care of her brother and sister. And she was so dependable that by the time she was thirteen, her mother allowed Karen to be the after school babysitter, prepare dinner and do the chores without much supervision.

The family maintained some stability. The basic needs were met. But Karen had many childhood needs that seemed to disappear when her father left: the need for age appropriate responsibilities and the freedom to be a kid.

At 32, Karen comes for hypnotherapy wanting to work on her symptoms of co-dependence that are the result of her childhood family dynamics. Her symptoms are burnout, compulsive dependability, an excessive need to take care of others, anger, stress, and many unsatisfying relationships where she gives and gives and still doesn't have her needs met. She yearns for change.

In Karen's hypnotherapy inner child work is the focus.

It is imperative that the client has access to a positive inner resource that can function as a inner parent before the client engages in inner child work because in a regressed state the client's inner child needs to have an appropriate and loving re-parenting experience that will restructure the past events and create new inner child responses. There are several ways to gather resources. A client can meet her higher Self in hypnosis and cultivate a relationship with this inner wisdom as a re-parenting resource, or the client may do some inner family work where the client's actual parents are transformed into more self-actualized, consistent, appropriate and resourceful "inner parents" who can support the inner child. Another option, especially for a client who has had severe childhood trauma and neglect, is to access a positive archetype of a parent. With the inner parent in place and available in these hypnotic restructuring processes the inner child finally has her needs met intrapsychically; it is as if the inner child is freed from the frozen patterns and childhood perceptions so that she can finally begin to feel whole and free again.

The state of consciousness accessed in hypnosis is elastic: there is no limitation to linear lime or space. The hypnotic re-patterning can lighten or undo the energetic patterns of childhood that are creating the present life difficulties and the hypnotic re-parenting and corrective emotional experiences can create new inner patterns and responses that are accessed in present time. And because hypnotic consciousness is holographic, with ongoing work, the new patterns and experiences eventually generalize and replace the old perceptions, patterns, and behaviors. Inner child work creates lasting change.

In Karen's inner child work she accesses her higher Self as a resource for an available, wise and responsive inner parent. She dialogues with the higher Self to build trust and a loving inner relationship prior to doing any childhood regression work. She has homework between sessions to make on-going contact with her higher Self as a way to continue to build trust and familiarity with her inner wisdom. When she feels comfortable knowing that her higher Self will be with her, responsive, and consistently available, we begin the childhood regression work to support the transformation and healing of her inner child.

Commonly the hypnotic regression back to childhood events is facilitated through a technique called the Affect Somatic Linguistic Bridge. In this technique the client chooses a specific troubling issue that is current in her life and goes into the issue through body sensations, emotions and words that represent the experience. By suggesting that these current life effects are amplified, they become the bridge back in time to the childhood events.

When using this technique, Karen feels an emptiness in her stomach and a heaviness in her shoulders. She expresses that the emotions are abandonment and feeling responsible for her siblings. Her words are, "It is up to me. I have to do it myself." She feels this huge burden and her tears begin to flow.

Karen regresses to eight years of age. She is alone in the house with her siblings after school when her newly divorced mom is at work. She is cooking popcorn for an after school snack. Smoke fills the hallway and the fire alarm goes off. She pulls the pan off the stove, grabs her baby sister and screams for her brother to get out of the house. After the smoke clears, Karen discovers that the house is safe. She scours the burnt pan and airs out the house. She doesn't tell her mother about the incident because she wants her mom to think she is responsible and a big girl. Every time her mom comes home she tells Karen what a big girl she is, how responsible she is, and how she can trust her to help with the house and the kids. This special attention from her mom feels wonderful. Karen thinks that telling her mom about the smoke and burned popcorn may not only make her mom mad, but it may also stop her mom from giving her attention and praise that fills up the empty place inside. Karen covers up her fear and the feelings of pressure to do things responsibly and correctly so she can continue to get approval from her mom. Getting approval for what she does is the main way Karen feels love from her mother. Karen's developing co-dependent patterns are reinforced each time she denies her feelings or her needs and takes care of the house or her siblings for her mother's approval. Because Karen's needs aren't met freely and directly for her efforts, she begins to resent her siblings.

In the hypnotic re-parenting of the eight year old, Karen's higher Self takes charge of the popcorn incident and gets the three kids to safety and then, as the adult, she accesses the problem and deals with it. Her higher Self talks to Karen and tells her that she is lovable for simply being who she is, not for what she does. Her higher Self attends to Karen's needs to be a child and have free time and play time. Time to be a kid. The higher Self spends time with Karen nurturing her, and being present with her. Karen begins to relax and let go of the compulsion to have to do to be worthy and lovable.

After several inner child sessions Karen notices that she is beginning to set boundaries for herself and nurture herself more. She begins to practice meeting her own needs first. And when she gives to others, she begins to give from a place of fullness rather than from a place of needing approval or acknowledgement from others. She feels more relaxed and more energy and joy. Her transformation continues as she learns how to attend to, love and support her inner child.

By accessing holographic consciousness in hypnosis and working with the inner child, we can heal places where our psychological development was arrested because of unmet needs. By accessing the beyond time and space elasticity of hypnotic consciousness, and engaging in inner child work, it is not too late to have a happy childhood.

Note: The client Karen is fictional, but an accurate representation of what a typical co-dependent client would go through in hypnotherapy focusing on inner child work.

Holly Holmes-Meredith, Doctor of Ministry, Licensed Marriage Family Therapist, Board Certified Clinical Hypnotherapist, Clinical Director, HCH An Institute for Hypnotherapy and Psychospiritual Trainings

Visit Holly Holmes-Meredith's page on East Bay Therapist

Emotional Neglect and Complex PTSD

(Past member) — Thu, 19 May 2011 19:46:25 GMT

By Pete Walker

1. Introduction

2. Denial and minimization

3. Verbal and Emotional Abuse

4. Emotional Neglect: The Core Wound in Complex PTSD

5. The Evolutionary Basis of Attachment Needs

6. Abandonment Stultifies Emotional and Relational Intelligence

7. The Neuroplasticity of the Brain

1. Introduction

This article highlights the prodigious role that emotional neglect plays in childhood trauma, and how it alone can create Complex PTSD. It begins by extensively examining the processes of denial and minimization that blunt our awareness about childhood trauma. Denial is first explored in relationship to abuse, especially verbal and emotional abuse, which then sets the stage for a more complete explication of the trauma of emotional neglect.

Denial about the deleterious effects of childhood abandonment seriously delimits our ability to recover. Continuous emotional neglect turns the child's psyche into a quagmire of emptiness, fear and shame - a quagmire that she will, as an adult, frequently flashback into until she understands and works through the wretchedness of her childhood. Without such understanding, her crucial, unmet needs for safe and comforting, human connection will continue to cause her an enormous amount of unnecessary suffering.

2. Denial and minimization

Recovery from PTSD correlates with an individual's ability to understand on deep impactful levels how derelict her parents' were in their duty to nurture and protect her. The individual needs to get that emotional flashbacks are direct messages from her child-self about how seriously her parents hurt and injured her. As denial is significantly deconstructed, the recoveree feels genuine compassion for the child she was. This in turn motivates her to engage the healing process of identifying and addressing the specific wounds of her childhood. Over time she becomes aware of her specific abandonment picture and the pattern of physical, spiritual, verbal and emotional abuse and/or neglect that she experienced. [Chapter 8 of my book, The Tao of Fully Feeling, provides guidelines for assessing your particular pattern].

Confronting denial is no small task. Children so need to believe that their parents love and care for them, that they will deny and minimize away evidence of the most egregious neglect and abuse. De-minimization is a crucial aspect of confronting denial. It is the process by which the individual deconstructs the defense of making light of his childhood trauma. The lifelong process of de-minimizing the impact of childhood trauma is like peeling a very slippery and caustic onion. The outer layer for some is the stark physical evidence of abuse, e.g., sexual abuse or excessive corporal punishment. In a perversely ironic way, my parents' physical abuse of me as a child was a blessing for it was so blatant that my attempts to suppress, rationalize, make light of and laugh it off lost their power in adolescence, and I was able to see my father for the bully that he was. [Seeing my defensively idealized mother's abusiveness came much later].

Identifying my father's behavior as abusive eventually helped me become aware of less dramatic aspects of my parents' oppression, and I subsequently discovered the verbal and emotional abuse layer of the onion of my childhood abandonment.

3. Verbal and Emotional Abuse

The fact that verbal and emotional abuse can be traumatic is lost on many childhood trauma victims. Many never learn to validate its crippling effects. They never accurately assign current time suffering to it. Attempts to acknowledge it are typically blindsided with thoughts that it was nothing compared to kids who were repeatedly beaten - who had it worse. Yet for me, and many of my clients, verbal and emotional abuse was much more injurious than our physical abuse.

Being ongoingly assaulted with critical words systematically destroys innate self-esteem and replaces it with a prevailing consciousness of toxic self-criticism. Even worse, words that are emotionally poisoned with contempt [a deadly cocktail of intimidation and disgust] infuse the child with fear and toxic shame respectively. Fear and shame condition him to refrain from asking for attention, from expressing himself in ways that draw attention, and before long from seeking any kind of help or connection at all.

Unrelenting criticism, especially when it is ground in with parental rage and scorn, is so injurious that it changes the structure of the child's brain.

Here is a theoretical model of this. Repeated messages of disdain are internalized and adopted by the child, who repeats them over and over to himself. Incessant repetitions result in the construction of thick neural pathways of self-hate and self-disgust. Over time a self-hate response attaches to more and more of the child's cognitions, feelings and behaviors. Eventually, any inclination toward authentic or vulnerable self-expression activates internal neural networks of self-loathing. The child is forced to exist in a crippling state of self-attack, which eventually becomes equivalent to a state of full-fledged self-abandonment. The ability to support or nurture himself or take his own side in anyway is decimated. With ongoing parental reinforcement, these neural pathways expand into a large complex network that becomes an Inner Critic that dominates mental activity. This critic elaborates myriad programs of self-rejecting perfectionism and paints the psyche with the endangerment scenarios that I describe in my articles on Shrinking The Critic. Until these programs are effectively deconstructed, the individual typically lives in varying degrees of emotional flashback much of the time. ¹

The verbal and emotional layer of the abuse onion has myriad sub-layers of minimization which must be confronted in the long difficult disengagement of one's identity from the toxic critic. I have heard clients jokingly repeat numerous versions of this over and over: I know I'm hard on myself, but if I don't constantly kick my own ass, I'll be more of a loser than I already am.

A childhood rife with verbal and emotional abuse often creates an identification with the critic that is so pervasive, that it is as if the critic is the whole identity. Disidentification from the critic is the fight of a lifetime, and for a long time there is a great pull to collapse back into the old habit of self-blame. Ironically this self-hate can constellate around the self-judgment that one is especially defective because she cannot simply banish the critic. [Typical toxic, all-or-none thinking from the critic]. Sadly, many survivors give up before recognizing the myriad subtle ways the critic tortures them. Yet, there is no more noble recovery battle than that which gradually frees the psyche from critic dominance. Until this happens to a significant degree, there is minimal development of the healthy, user-friendly ego.

Let us look now at how emotional neglect alone creates a psyche-dominating Critic.

4. Emotional Neglect: The Core Wound in Complex PTSD

Minimization about the debilitating consequences of a childhood rife with emotional neglect is at the core of the PTSD denial onion. Our recovery efforts are impeded until we understand how much of our suffering constellates around early emotional abandonment - around the great emptiness that springs from the dearth of parental loving interest and engagement, and around the harrowing experience of being small and powerless while growing up in a world where there is no-one who's got your back. Many survivors never get to discover and work through the wounds that correlate with this level, because they over-assign their suffering to overt abuse and never get to the core issue of emotional abandonment. As stated above, this is especially true when they dismissively compare their trauma to those who were abused more noticeably and more dramatically. [This is particularly ironic in light of the fact that some individuals can suffer a modicum of active abuse without developing PTSD, if there is one caretaker who does not emotionally neglect them].

Traumatic emotional neglect occurs when a child does not have a single parent or caretaker to whom she can turn in times of need or danger, and when she does not have anyone for an extended period of time who is a relatively consistent source of comfort and protection. Growing up emotionally neglected is like nearly dying of thirst just outside the fenced off fountain of a parent's kindness and interest. Emotional neglect makes children feel worthless, unlovable and excruciatingly empty, with a hunger that gnaws deeply at the center of their being, leaving them starving for human warmth and comfort - a hunger that often morphs over time into an insatiable appetite for substances and/or addictive processes. [I find it noteworthy that denial processes about early abandonment often morph later in life to the minimizing operations that some survivors use to rationalize their substance and process addictions. While addictions are often understandable, misplaced attempts to regulate painful emotional flashbacks, they become increasingly self-destructive when an individual is old enough to learn a healthier flashback management regimen. Accordingly, excessive eating, spending, drinking, drugging, sexing, working or dissociating, are not only desperate attempts to distract from inner pain, but also counterproductive efforts to attain an ersatz form of human comfort and soothing. And while many recoverees eventually come to see their substance or process addictions as problematic, many also minimize their deleterious effects and jokingly dismiss their need to end or reduce their reliance on them.]

5. The Evolutionary Basis of Attachment Needs

The human brain evolved during the Hunter-Gatherer era that represents 99.8% of our time on this planet. Children's vulnerability to predators caused them to evolve an intense, instinctual fear response to being left alone without protection. Fear hard-wired in the child as a healthy response to separation from a protective adult, and linked automatically to the fight response so that the infant and toddler would automatically cry angrily for attention, help, cessation of abandonment - even at the briefest loss of contact with parental figures. Beasts of prey only needed seconds to snatch away the unprotected child.

In present time dysfunctional families, many parents disdain children for needing their attention. Even the most well-intentioned can seriously neglect the child by subscribing to the egregious 20th century 'wisdom': Kids need quality time -not quantity.

When children experience long periods of being powerless to obtain needed connection with a parent, they become increasingly anxious, upset and depressed. Over time their dominant experience of self is so replete with emotional pain and so unmanageable that that they have to dissociate, act out [aggression against others] or act in [aggression against the self] to distract from it. The situation of the abandoned child further deteriorates as an extended absence of warmth and protection gives rise to the cancerous growth of the inner critic as described above. The child projects his hope for being accepted onto inner demands of self-perfection. By the time the child is becoming self-reflective, cognitions start to arise that sound like this: I'm so despicable, worthless, unlovable, ugly; maybe my parents would love me if I could make myself like those perfect kids I see on TV.

In this way, the child becomes hyperaware of imperfections and strives to become flawless. Eventually she roots out the ultimate flaw - the mortal sin of wanting or asking for her parents' time or energy. Intrinsic to this process is noticing - more and more hypervigilantly - how parents turn their back or become angry or disgusted whenever she needs anything, whether it be attention, listening, interest, or affection.

Emotional neglect, alone, causes children to abandon themselves, and to give up on the formation of a self. They do so to preserve an illusion of connection with the parent and to protect themselves from the danger of losing that tenuous connection. This typically requires a great deal of self-abdication, i.e., the forfeiture of self-esteem, self-confidence, self-care, self-interest, self-protection. Moreover, ever-developing endangerment programs proliferate in the critic as the child learns that he cannot ask the dangerous parent to protect him from outside world dangers and injustices. His only recourse is to become hyperaware and on constant look out for things that may go wrong, and the list of such possibilities becomes endless, especially when they are graphically illustrated and overemphasized on the television. Consciousness eventually becomes overwhelmed with the processes of drasticizing and catastrophizing- the processes by which the child constantly rehearses dreaded and dreadful scenarios in a vain attempt to prepare himself for the worst. This is the process by which Complex PTSD with its overdeveloped stress and toxic shame programs sets in and becomes triggerable by a plethora of normally innocuous stimuli. Most notable of these stimuli are other people, especially unknown people or people even vaguely reminiscent of the parents. Over time, the critic comes to assume that other people are dangerous and automatically triggers the fight/flight/freeze/fawn response [ See my article: The Four F's: A Trauma Typology] whenever a stranger or unproven other comes into view. This process becomes the social phobia that is frequently a symptom of complex PTSD.

6. Abandonment Stultifies Emotional and Relational Intelligence

Emotional intelligence and its cohort, relational intelligence, never get to develop, and children never learn that a relationship with a healthy person can become an irreplaceable source of comfort and enrichment. Moreover, the appropriate management of the normal emotions that recurrently arise in significant relationships is never modeled for them. Emotional intelligence about the healthy and functional aspects of anger, sadness, and fear lies fallow. Moreover the receptor sites for receiving love and caring from others often lay dormant and undeveloped. Emotionally abandoned children often devolve into experiencing all people as dangerous, no matter how benign or generous they may in fact be. Anyone can automatically trigger the grown-up child into the deeply grooved patterns of perfectionism and endangerment engendered by their parents. Love coming their way reverberates threateningly on a subliminal level. If, from their perspective, they momentarily trick someone into seeing them as loveable, they fear that this forbidden prize will surely be taken away the minute their social perfectionism fails and unmasks some normal flaw or foible.

As with physical abuse, effective work on the wounds of verbal and emotional abuse can sometimes open the door to de-minimizing the awful impact of emotional neglect. I sometimes feel the most for my clients who were only neglected, because without the hard core evidence - the remembering and de-minimizing of the impact of abuse - they find it extremely difficult to connect their non-existent self-esteem, their frequent flashbacks, and their recurring reenactments of impoverished relationships, to their childhood emotional abandonment. I repeatedly regret that I did not know what I know now about this kind of neglect when I wrote my book and over-focused on the role of abuse in childhood trauma. It is so hard to convey this to a client whose critic minimizes and shames them for their plight by comparing them unfavorably to me: I didn't have it anywhere near as bad as you. My mother never hit me!

How ironic that this typically invokes a feeling-sense in me that by far the worst thing that happened to me, by far, was growing up so emotionally abandoned. In fact, it was not until I learned to assign the pain of numerous current time emotional flashbacks to the abject loneliness of my childhood, that I was able to work effectively on the repetition compulsion that kept me vacillating between long periods of isolation and relationships that were never safe enough to reveal my whole self. It is important to emphasize here that real intimacy, and the healing comfort it alone can bestow, depends on showing up in times of vulnerability - and eventually, and most especially, in the flashbacked-times of feeling trapped in the fear, shame and depression of the abandonment melange.

In this vein, I had to painstakingly practice for years showing up in my pain and abstaining from my childhood default positions of running or hiding or camouflaging with substances whenever I was in the grips of the fear, shame or depression of the abandonment melange. How else would I ever have learned that I was loveable and acceptable in all aspects of my experience, not just in the social perfectionism of my people-pleasing codependence?

And of course, like most survivors, I was ignorant at first that I was experiencing the emotional pain of the abandonment melange; how could I help but conceal it? Yet, even after considerable de-minimization of my childhood abuse/neglect picture, I still remained convinced for a long time that everyone but my therapist [who in deep flashbacks, I also recurrently distrusted] would find me abhorrent if I presented myself authentically in such condition. Gratefully, sufficient positive experiences with my therapist eventually emboldened me to bring my authentic vulnerability to other select and gradually proven relationships, where I found the acceptance, safety and support that, previously, I would not have even known to wish for.

It is important to note the limitations of the analogy of the onion. Effective recovery does typically involve working at various levels at the same time. De-minimization is a lifetime process, and remembering a crucial instance of being abused or neglected may occasionally impact us even more deeply on subsequent remembering as we more fully apprehend the hurt of particularly destructive parental betrayals. One such occasion left me reeling with the certain knowledge that getting hit felt preferable to being abandoned for long hours outside my depressed mother's locked bedroom door. I have known about the latter for quite some time now, and yet writing about it brings up some new bittersweet tears. For me, my ongoing work with the layers of the denial onion still sometimes has a bittersweet quality to it - bitter because abandonment was the worst thing that happened to me, especially as it happened over and over again at such a young and normally needy age - and sweet because these tears validate the truth of this recollection - and sweet, in gratitude, because I do now regularly experience good enough love and safety in relationship - and now bitter again because I can still emotionally flashback to that bereft state of feeling stranded from the comfort of others, even occasionally from my wife and son and inner circle-friends - and then sweet again because, ongoingly, the frequency, duration and intensity of these flashbacks decreases as I increasingly master the use of the tools I describe in my article, Emotional Flashback Management. I am also blessed to see this same progress in various of my long term clients who work with this model.

7. The Neuroplasticity of the Brain

I am so heartened to know about all the new neuroscience research that proves the neuroplasticity of the brain, i.e., that the brain can grow and change throughout our life: old self-destructive neural pathways can be diminished and new healthier ones grown. [A General Theory of Love by Thomas Lewis inspiringly explicates this fact]. The critic can indeed literally be shrunk via long-term, frequent and dedicated use of the thought-stopping, thought-substitution and thought-correction practices I describe in my articles on the critic. This is especially true when these techniques are empowered by the grieving processes I describe in my book, The Tao of Fully Feeling, and in an article, Grieving and Complex PTSD, that I will post on my website around the end of 2010.

There is also growing evidence that recovery from Complex PTSD is reflected in the narrative a person tells about her life. The degree of recovery matches the degree to which a survivor's story is complete, coherent , emotionally congruent and told from a self-sympathetic perspective. In my experience, deep level recovery is often reflected in a narrative that places emotional neglect at the core of the understanding of what one has suffered and what one continues to deal with. It is a very empowering accomplishment to really get the profound significance of childhood emotional neglect - to realize in the moment how a flashback into bewilderment, panic, toxic shame, helplessness, and hopelessness is an emotional reliving of the dominant emotional tone of one's childhood reality. Like nothing else, this can generate self-compassion for one's child-self and one's present-time self, kick-starting the process of resolving any given flashback. This also assuages emotional neglect by providing the self with the essential missed childhood experience of receiving empathy in painful emotional states instead of contempt or abandonment. This, in turn, proves that there has been significant deconstruction of the learned, unconscious habit of pervasive self-abandonment.

¹ [In viewing Richard Davidson's research along side that of Susan Vaughan's, I have come to believe that the Critic forms in the right prefrontal cortex of the brain. Davidson's research {What does the prefrontal cortex do in affect, Biological Psychology 67, 2004, pp219-233} shows that people with a predominant negative outlook have greater pre-frontal right brain activation than those with a positive outlook whose left prefrontal cortex activation dominates; moreover Vaughan's MRIs with people in flashback [The Talking Cure] shows intense right hemisphere stimulation during flashbacks with a dearth of left hemisphere activation.]

Pete Walker, M.A., MFT, is a licensed Marriage and Family Psychotherapist with degrees in Social Work and Counseling Psychology. He has been working as a counselor, lecturer, writer and group leader for 30 years, and as a trainer, supervisor and consultant of other therapists for 15 years. He holds certificates in supervision from the California Association of Marriage and Family Therapists (CAMFT) and the Psychotherapy Institute in Berkeley.

Visit Pete Walker's page on East Bay Therapist

Closing a Practice

(Past member) — Tue, 17 May 2011 19:48:18 GMT

By Cybele Lolley

Last summer, in late July 2009, I learned that my partners employer was planning on moving the company to a new location so he could be by the ocean and surf. This move was happening in February 2010. We were instantly filled with resistance, rebellion and anger. How could he do that to us, and our comfortable happy world! We reactively went into 'quit and get another job' mode.

With the economy as it was last summer, there were few to no jobs out there, especially in her field. There also was the issues of potential LHFLO-last hired first laid off. At least with the current job position she had job security and great ongoing growth. My practice was sufficient, but not enough to sustain us both if she quit and became unemployed. Within a short period of time we knew we had to follow the company.

This decision caused much anguish. I was loosing all that I had created and used as my professional and personal foundation. I needed to leave my supervisor position, my practice, my networking pool and my support community. My social friendships, my spiritual community and my comforting outlets were not going to be as easily available. My ego identification of 'I' wasn't happy! 'I' had 6 more months to live as 'I' had been living for many years. Influenced by my years working in the hospice and grief field, I was very aware of it all ending, dying. On top of that, I felt great responsibility to do this ending with the least harm possible to my clients for they too may have many internal conflicts with this outcome.

I needed to center and prepare myself before I told my clients. I tried to do this quickly, but it took two months. Holding the news at times felt like a guilty secret eating me up. I scripted personalized wording over and over as to what I would say to each client. I took the time to find how to say the news in a least painful way, to know what I was willing to disclose, and to ready for difficult questioning and reactions. I was grateful for having this grounding time. All clients, including those I had ended with within the year, were told in early October, with only four months remaining. My decision to notify recent terminated clients was based on addressing my unavailability for future services at a non-crisis time.

When other clinicians asked about my process, I referred to this time as 'breaking up with 20 relationships at the same time, one after another, not because they weren't loved or their work was complete, but because I was moving away.' As a way to manage this great emotional difficulty, my mind would create sarcastic humor by remembering popular 'break-up' songs such as Breaking up is Hard to Do, Another One Bites the Dust, and 50 Ways to Leave Your Lover. This technique kept me open, lighter and available.

The therapeutic relationship we had developed through continual brave vulnerability, devoted repairs and tender caressing was ending, was dying. Each client had their own reactions to this painful news so attentive sensitivity and adaptability were required on my part. I had a client point out to me that I was making a 'selfish choice' repetitively and it was a great challenge to not move into justifying my position since it felt like I had little or no choice. Another client wanted to complete her therapy 'to do' list for all the issues she skirted around for years. A couple clients didn't want to be reminded of our little time left and pulled back relationally and behaviorally. One client even terminated early to take control of our situation. However, the majority of my clients stayed until the end, coming back consistently even though they knew it would be difficult. They stayed with their internal process and our relationship ending. Even though I know they were getting their own needs met with returning and staying present with their process, this choice also offered me the treasured gift of care. We could also call it affection or even love.

I worked hard at staying aware when my stuff was too much in the room. There was no way possible to not have my stuff in the room. Although this is an ideal thought, it isn't a human reality. Since we physically share the same space, I believe we are always in the room to some degree. One client, at one point, needed reassurance that my stuff wouldn't infringe on her process, which scared both of us. As a clinician who tends to utilize consistent boundaries around self-disclosure and containment, I felt horrified that I could cause such great damage, and professional failure, if this occurred. My only response was that I would try my best. My clients were aware of my own struggle with our ending. Even though I did do my very best to contain my stuff, I was more transparent then ever before. I cried with some and shared mutual anxieties about not knowing what was next with others.

This was such a beautiful time and such a painful time, each adding to the quality of the other. This was a transcending time. It reminded me of sitting with those who are aware they have limited time left alive due to illness. There's often a vivid and heightened sensory awareness during this time. I watched my clients and myself 'see' my physical office space with new eyes. I noticed myself looking deeply into my clients' faces and eyes as an attempt to imprint them into my memory. I caught myself breathing with them to share the same breath rhythm. Holding the compassionate space for my clients to feel all that they felt - angry, hurt, loved, rejected, abandoned, special, important, meaningful, etc. was both rewarding and challenging. To support my ability to stay open to their pain, I utilized my mindfulness practice and healing beliefs as grounding sources with all the grief emotions in the sessions.

Overall I was aware that I could not 'fix' the situation just as a doctor can't fix a dying patient, but I tried anyway at times as an attempt to ease my guilt around taking ultimate control of our work and leaving them. One of my most challenging clients, also deeply cherished, repetitively called out my attempts to 'fix' the situation. One time she humorously naming my referring efforts as 'passing her on to a rebound'. I was shocked and hurt by her perspective of this 'therapeutic' tool regularly used in our field as equivalent to a romantic rebound. I perceived her response as her resistance and lack of understanding of the 'benefit' in this standard. Over time, I got her point. I was attempting to pass her on to someone she could latch on to with the hope that it would ease her pain and meet her needs when I'm gone, even if it was under the temporary umbrella of 'grief counseling'. My client desired to grieve and process our relational death without professional help. I wonder if maybe her desire wasn't 'resistance', but the desire to rely on her emotional strength developed in our work as her grieving and healing foundation. I may never know, or not know for a few years.

I know that referring is good legal and ethical practice for not abandoning our clients and referrals to other professionals is an important practice. I gave thought-out, specific referring clinician information to all my clients. With that said, I appreciate how my client's perspective has broadened my perspective. It's deepened my understanding that our go-to referral intervention has limits. I'm now more aware that offering referral may not be for a client's sake, but may be for ours alone. Referring helps ease our guilt of abandoning them, which is what we are doing when we leave them. Referring may also be a way we seek continual contact with our clients as the next therapist may get a release to talk to us. Allowing these possibilities to be a true shifts the focus from the client being resistant to recognizing that I, the clinician, have consultation/support needs. The final work then focuses on honoring and supporting the clients plan to do the grief work outside of the therapy structure.

Getting consultation and support during this process was essential for me to stay present with the intensity of the experience. I continue to be so grateful for my consultation colleagues and fellow supervisors for their ability to hold space for my expressed pains, worries and doubts about doing a good-enough job facilitating these breakups. With most of my attention going outward towards packing up my home and closing up my personal and professional relationships, it was healing to have safe and comfortable spaces to grieve, to be scared and to find grounding strength through their trust for my abilities as a clinician.

I've thought of this termination experience often over these months. I've noticed my critical mind finding things I could have done better to maybe ease the mutual pain more. Then I remember a piece of wisdom share with me long ago. The degree of pain we feel is in relationship to the degree of attachment we have. Some may read this and disagree, and that's okay. From this place I know I did the best job I could with an extremely challenging task. I was deeply attached to my clients because they mattered to me. I cared about them. I loved them. My heart embraced them as they shared vulnerabilities with me, strived to improve their lives, and struggled to say good-bye.

As I prepare to close this article, my final thought is towards impermanence. This closing for me has been a symbolic practice death. I chose to use it as a holistic unfolding and releasing, using Stephen Levine's A Year To Live as a spiritual guide. At some point we all will go through this task of closing a practice, or someone close to you will need to do it for you. This may be a voluntary decision like my move or retirement, or involuntary due to illness or death. All things have a birth and a death, a beginning and an end. Currently, I'm in the groundless transitional space between endings and beginnings, the Bardo, the Great Void. I focus on the gifts in my present as I my rebirth, and reincarnation, begins- strengthening my health with beach walks, finding spiritual community & comforting outlets, and saying 'Yes' to auspicious manifestations, like writing this article.

The Problem with Process in Group Therapy

(Past member) — Mon, 16 May 2011 19:50:44 GMT

By Graeme Daniels

(This article first appeared in the July/August 2008 issue of East Bay Therapist)

A problem of misunderstanding? In some settings I've heard the term "process" used with at least three different meanings, two of which are clinical. The first meaning is administrative, and systemic, as in process of a business-model. Process as in procedure, I've observed, is what one colleague (with tongue firmly in cheek) called "a molasses-like movement of ideas or action within a hierarchical system like, say, a hospital, or an agency." That's what people mean when they refer to a "process unfolding."

The second meaning refers to the internal work of an individual's therapy, with therapeutic assistance being that of a catalyst: the client is "processing" material, drawn out by a probing facilitator. The last meaning, that which is most relevant to any discussion of a system's communication, or certainly to any discussion of group therapy, is one which carries the least shared understanding, and incurs the most resistance.

Perhaps it's an issue of application. The process of group therapy that I'm referring to is the relational information that passes between group members, versus the content–that is, the explicit words spoken, the substantive issues, and the arguments advanced (Yalom, 1995). In this context, process refers to a meta-communication between members, sometimes conveyed non-verbally.

In my role as group therapist, I am constantly on alert for these moments of multi-layered communication, and as a supervisor, I am frequently urging other therapists-in-training to observe patterns of process, and to orient their groups–in plainspoken terms -- to the value of learning from such exchanges. Reflecting upon these roles, group therapist and supervisor (of, predominantly, group therapy), I begin to notice an interesting array of resistances to the process orientation. It calls to mind an article by a Murray Bowen acolyte, Michael Kerr, entitled: "An Obstacle to 'hearing' Bowen Theory". In it, he wrote of the negative reactions of students when observing the Bowen theory in practical application. Likewise, I repeatedly observe the squirming in chairs, and the quiet sniff of distaste, when faced with the prospect of making process comments in groups.

Thinking more broadly, maybe the issue is one of assimilation into systems. When speaking of the contrast between outpatient groups with members of equal circumstances, and those wherein one member of a family is admitted to an inpatient unit and another participates on an outpatient basis, I draw attention to the relative intensity of the latter groups. They don't go home together, I succinctly conclude; there's no shared drive home in which individuals might recriminate one another for things said in the just finished group meeting. The difference is important, I assert. And so, there is a system beyond the present system to be concerned with. Group therapy, especially of a process-oriented approach, contends with this vast exterior system on a constant basis. I'm referring to social norms, family norms, the norms that state, for example, that commenting upon the manner of communication (especially of strangers), is rude, or at least disorienting.

Consider the following question, posed by a therapist to a new group with a homogeneous set of problems, composed of psychologically-minded members: "Does anyone in the group have any feedback for what's happening between John and Sarah?" (I shall deliberately exclude the content). Such a statement may be calling for group members to comment upon how the exchange illuminates the relationship, though the question's open-ended nature easily allows group members to choose a content-oriented response instead.

More than likely, members would select from the following options: a review of the information provided by the two members, giving advice or otherwise attempting to problem-solve for one or the other; offering acceptance, mirroring, or a declaration of shared experience. Even in groups of motivated members, who have been screened for group therapy, and oriented to the norms of the group process, comments upon meta-communication are often withheld, or else left to the group therapist to reveal.

"That's your job," I once heard a group member say. That terse reply suggests clues to the resistance to process, a matter expanded upon in Mathew Miles' essay, "On Naming the Here & Now". In it, he writes that "here & now" comments, those references to immediate events in a group that form the nuts and bolts of the process orientation, recall the childhood experience of being controlled and criticized. We remember being told to look at people when we're speaking to them, to stop interrupting, and to take our hands out of our pockets. If group therapy is to recreate this old experience, or even to just provide echoes of it, then it would be infantilizing. Furthermore, Miles writes, such a focus would intensify self-consciousness, and render a discussion of communication more complex, if not overwhelming.

A content focus is, therefore, safer and easier. Of course, group therapy is intended to do more than merely draw attention to, or even correct, all manner of verbal and non-verbal behaviors. What distinguishes the here & now focus from this disconcerting social template, is what Yalom refers to as the second tier of the here & now focus, that of process illumination. This is the dimension that provides examination, and understanding. Ultimately, it calls on members to follow the track of their exchanges, reflect upon them, and draw a non-judgmental learning experience as to how they relate to others.

All of which becomes more fascinating when thinking of groups with adolescents, or groups with so-called "low functioning" populations. Consider some of the terms or ideas already used or referenced in this article: hierarchy, self-consciousness, infantilizing, problem-solving, group safety. The reader can begin to gain an idea as to why certain populations would resist process-orientation, or else why mental health professionals would resist it on their behalf.

Recall Wilfed Bion's three basic assumptions of group life. The first basic assumption is one he called dependence. In a basic dependent group, one notices the group searching for an oracle or a deity, from which all security, nourishment, and direction come (Bion, 1961). Especially in hospitals, where little, if any, orientation is provided as to group therapy, we can imagine why adolescents would readily adhere to hierarchies and depend upon a leader, but why they might also bristle at a therapist that constantly drew attention to their mannerisms, or syntax, assuming a critical intent on the part of the therapist?

We can also understand why highly anxious individuals, accessing treatment in order, primarily, to relieve symptoms, might be disoriented by a therapeutic approach that, for example, re-directs questions away from the facilitator, but rather towards the group, and which constantly seeks to decentralize the group tasks. This approach places implicit responsibility upon the group to self-activate. This question of client/patient, or group responsibility for change versus therapist responsibility for the process (here, as in procedure) of change, is one which all therapists must address, repeatedly. The meaning of the "that's your job" rebuke is to resist shared responsibility.

And yet moments of spontaneity and individuation do occur, even if they are cast as indicators of a resistant pathology. This is particularly true in adolescent groups, and there is some irony here, as it is adult facilitators who, as often as not, resist the process orientation. Consider the following brief exchange:

Client: (upon receiving a series of facilitator questions) "I feel like you're cross-examining me!"

Therapist: "But do you see the point I was trying to make?"

Client: "I don't care. These questions are stupid."

Therapist: "Remember, this process is not about me."

The adolescent client in this instance has made, in effect, a process comment, one which the therapist has ignored. In speaking to many group therapists about this kind of exchange, I've come across a few interesting pretexts for why the therapist would choose this tact. First of all, that the group's primary task may have been that of addressing problem behaviors, with special attention to attendant defensive thinking. The process comment in the above scenario was deemed a deflection, a defensive maneuver by the group member, and so a process exploration, one that was interpretative, but not directive, would have been misguided.

Secondly, many group therapists rightfully concern themselves with group safety, and so err on the side of containment of affect. Indulging process may lead to an escalation, a stirring of high anxiety, or scapegoating, with problematic implications for the later stability of the hospital unit, or else that previously indicated ride home.

"I was concerned that the group may become overwhelmed", said one facilitator, explaining why she consistently deferred on making process interventions. She'd actually begun the group with the glib pronouncement that the group's main purpose was to explore patterns of communication, but as the group progressed, the term "communication skills" replaced 'explore", and so a more didactic intent became apparent. This was perhaps recognized by the assembled adolescents, whose largely passive participation betrayed an unconvinced air.

Perhaps it's a question of priorities, or of assessment. It's undoubtedly true that some clients are sufficiently dysfunctional (either in terms of ego boundaries, or else cognitive ability), that the process-oriented approach is too disorienting. Imagine a highly anxious group member, whose internalization of even the most carefully neutral of interpretations evokes a panicked inference of criticism, if not accusation. Although, one might argue that even this individual might benefit, ultimately, from hearing different perspectives upon communication.

Furthermore, group dynamics take place within a broader context, no matter how hard they try to create self-containment (no outside relationships as a group rule, for example). Groups in hospital settings cannot realistically contain contact outside of group meetings, they cannot eliminate the lack of cohesion borne of high turnover, or ignore that destabilizing consequences of group disorientation; and they cannot easily take neutral stances towards the varying types of self-destructive behaviors that are often the presenting reasons for therapy.

I think it's really a matter of integrating the process-oriented approach, rather than dismissing it as contrary to the priorities of, say, behavior modification, or symptom reduction. In my work with adolescents, in particular, I observe a strain of conservatism that leads to a quasi-parental dynamic between client and clinician. It's been interesting to notice that in certain modalities (art therapy, and drama therapy) some of the inhibiting qualities of regular talk therapy are diminished. Self-consciousness is often reduced, for example, if disguised in a character.

Furthermore, I've noticed the symbolic disguise of art and drama allows for a practice of process illumination that might otherwise feel too intense, too real. The explicit disclosure of true thoughts and feelings is often perceived as too threatening by adolescents. When loss of esteem, or rejection, is at stake, truth is a risk, and its disclosure requires a sensitive development of trust. Adolescents often defend against this risk by projecting the dilemma onto adults, particularly parents: "I want to gain their trust".

A more thorough depiction of group dynamics with adolescents is provided by Pressman, Kymissis, and Hauben's 2001 article: "Group Psychotherapy for Adolescents Comorbid for Substance Abuse and Psychiatric Problems: A Relational Constructionist Approach" In this description of a combined day treatment and high school program, the authors posit several observations about adolescents in treatment:

that adolescents construct acceptance and personal meaning through role-defined, non-hierarchical relations;
that conflict resolution involves the emergence of overwhelming feelings that comorbid adolescents cannot control;
that they may require extended orientation to group therapy, and may initially engage groups in a rebellious fashion;
that the primary challenge for the patients is to learn self-control and trust of others;
finally, and most crucially, that negative countertransference can be avoided when staff members do not feel intense responsibility and need for control.

The program structure and pattern of interventions reflect many of these baseline assumptions. The hierarchy of the program is decentralized, for example, de-emphasizing a "charismatic" leader, and instead implementing a multidisciplinary team. This tended to mitigate rebellious action. Empathy as a leading intervention, is emphasized, allowing space to de-pathologize patient behavior. Staff would empathize with the adolescents' resistance to treatment, rather than coaching a premature cohesiveness. Empathy with parents' distress replaced collusion with the need for punitive, rigid responses designed to influence negative behaviors.

In the article, examples are given of aggressive gestures, horseplay, sexual innuendos between patients and staff, that are met with largely interpretive response (only the example of the aggressive gesture led to a patient being removed from group); ultimately, that example, also was treated with an interpretive response, rather than a strictly directive intervention.

Above all, while not strictly identical to a process-orientation, the above-described model presents two provocative challenges that speak directly to what is, perhaps, a systemic resistance to process:

That the ability for adolescents to express angry feelings is more important than maintaining strict unit order, and
That a lack of strict adherence to subject matter of the group allows staff to keep abreast of the adolescents' thoughts and feelings.

The first time someone walked out of a group I was facilitating, I felt in my heart that I'd done something wrong. That action, combined with the group's subsequent blaming of the departed individual (I was briefly relieved, but ultimately confused), seemed to violate some ill-defined notion of leadership.

In this article, I've reviewed what I've observed as the resistance to a process-orientation, within a variety of different attention to group therapy with adolescents. I've implicitly advocated for a style of group facilitation that challenges order, hierarchy, even what some may term safety, and in doing so entered that ambiguous space wherein client/patient and therapist responsibility is negotiated. Once again.

References

Kerr, Michael E., MD (1991) "An Obstacle to 'Hearing' Bowen". Family Center Report, Volume 12, No. 4.

Pressman, Mary A., MD, Kymiss, Paul, MD, Hauben, Richard, C.A.C (2001) "Group Psychotherapy for Adolescents Comorbid for Substance Abuse and Psychiatric Problems: A Relational Constructionist Approach". International Journal of Group Psychotherapy, 51(2).

Yalom, Irvin (1995) The Theory and Practice of Group Psychotherapy. Fourth Edition. Basic books

Miles, Mathew (1970) "On Naming the Here and Now" unpublished essay, Colombia University.

The Theory and Practice of Group Psychotherapy. Fourth Edition. Basic books

Bion, Wilfred (1961) "Experiences in groups and other papers" New York: Basic books.

"Disorders of Self, New Therapeutic Horizons" (1995) Edited by James F. Masterson, MD, and Ralph Klein, MD. Brunner/Mazel, Inc.

About the Author

Graeme Daniels has been facilitating support groups and psycho-educational groups for over twelve years. He currently leads men's support groups at the Impulse Treatment Center in Lafayette, California. In collaboration with founder/owner Don Mathews, MFT, the groups address issues of sex addiction and couples' relationships. Graeme is also currently the supervisor of the intern program at Thunder Road Adolescent Treatment Center in Oakland, California, which specializes in substance abuse issues. Meanwhile, he is also in private practice in Pleasant Hill and has worked with adults, couples, adolescents, and families dealing with substance abuse as well as sex addiction.

Visit Graeme Daniels page on this Website.

Examining Distorted Beliefs Related to Substance Use, Part 3 - Intervening in the Addictive Cycle

(Past member) — Sun, 15 May 2011 19:55:33 GMT

By Graeme Daniels

This article is presented in three parts. Part 1 Part 2 Part 3

Some time ago I worked with a father and son who were struggling to communicate regarding the son's substance use. The son, Eddie, 18, had been living with his father, Mike, for two years, following his parents' divorce six years earlier. Eddie had begun using drugs (notably alcohol and marijuana) at age 14, and exhibiting defiant behaviors at home and at school. After Eddie completed a ten-week outpatient treatment intervention, father and son were referred to me for therapy.

Eddie presented as motivated to change his behavior, but was consumed with anger about his father's distrust of him. "He never believes anything I say", he'd complain, to which the father would retort, "You don't give me reason to." Both Mike and Eddie agreed that they wanted to regain mutual trust, but they were locked in a cycle of mutual blame.

Mike occasionally pretended to trust his son in order to de-escalate conflict, but ended up disillusioned whenever Eddie relapsed. Eddie ended up guilt-ridden. I asked the father and the son to each take responsibility for their own thinking, feeling, and solutions and to set a realistic foundation for the rebuilding of trust.

Eddie and I focused on identifying his problematic thinking, and redefining his ideas about risk-taking. He was aware of the risks associated with drug use: Eddie had been both arrested and suspended from school for intoxication- related offenses. When asked about the risks associated with sobriety, and the acceptance of his father's house rules, he struggled with feelings of resentment and was unable to imagine how his life might change for the better. Gradually, Eddie acknowledged the fears that lay under his resentment: abstaining from drug use might lead to loneliness and loss of friendships; accepting his father's rules meant losing his freedom and the adult image he craved.

On a deeper level, Eddie's distrust of his father stemmed from the divorce of six years earlier, when Eddie's life was thrust into turmoil, his parents' needs seemed to take priority over his own.

In reframing trust-building as a task for Eddie as well as for his father, I was able to persuade Eddie to accept a series of agreements that included (1) submitting to urinalysis testing at his father's request and (2) accepting material consequences (withholding of money, for example) whenever he relapsed. Having good intentions would not mitigate the consequences; if Eddie reached a "contact high" from someone else's use, or received a positive drug test result after unwittingly tasting a drink that was "spiked," the consequence would remain the same. When Eddie bristled: "That's not fair," I reminded him that his body and brain would respond the same to exposure to a drug regardless of his notions of fairness.

A second series of agreements presented a particular challenge to Mike. In conjoint therapy, Mike spoke of his feelings of guilt as a parent. His inconsistent parenting and controlling tendencies: name-calling, impulsive imposing of consequences, and distancing interpretations of his son's behavior ("I think you use to escape from your feelings!") masked a deep feeling that he and his ex-wife had let Eddie down. I suggested to Mike that he seemed as impulsive and conflicted as his son and that his behaviors were inadvertently reinforcing his son's negative behaviors.

I worked with Mike to focus on consistently and calmly following through on realistic limitsetting. Trust could not be based on an anxious belief in his son's latest promise, only to be followed by blame. Father and son were to commit to eliminate bargaining over the fairness of consequences of the son's drug use: the relapse of a friend, the father's controlling behavior, or other stressors, could no longer justify relapse. Further, each committed to seek out separate support systems for the processing or venting their feelings, so that they could avoid directing judgements at each other.

These agreements allowed for father and son to understand that trust is a bond that develops and evolves through ongoing attention and care, not something to be taken for granted. They allowed father and son to navigate past mutual blame, and made space for each to sit with their uncertainty and discomfort - without resorting to substance use on the part of the son, or rigidity on the part of the father.

Over the course of therapy, there were relapses on either side. Eddie often tested his father's curfews, demands for phone "check-ins," and chore assignments; he used drugs on numerous occasions, and generally manifested his contempt for Mike's parenting. Mike gave frequent voice to frustration, often characterizing his son's relapses as a form of betrayal. As time passed, the structure provided by agreements allowed father and son to explore and change their values, and challenge the beliefs that perpetuate thecycle of drug addiction.

Mike and Eddie terminated therapy after about a year. At that time, Eddie had been clean for 90 days and wanted to focus more on twelvestep work. Mike has sent me Christmas cards the last three years, and Eddie has contacted me as well. Their relationship, though not perfect, has improved. Eddie has grown to see the connection between being truthful and gaining trust and is invested in truthfulness as a value for himself. Mike is more willing to take responsibility for his feelings of guilt and inadequacy, instead of externalizing them or blaming his son. Ultimately, Eddie moved out of his father's house. Without the intensity of cohabitation, Eddie is more able to pursue the tasks of individuation, and Mike the task of letting go.

References

Gorski, T. (1989) Passages Through Recovery: An Action Plan for Preventing Relapse. Hazleton: Center City, Minnesota

Miller, M.& Bakalar, JD. "The adolescent brain: Beyond raging hormones." The Harvard Mental Health Letter, July 2005, 22(1).

About the Author

Examining Distorted Beliefs Related to Substance Use, Part 2 - The Emotional Work of Recovery

(Past member) — Sat, 14 May 2011 19:59:22 GMT

By Graeme Daniels

This article is presented in three parts. Part 1 Part 2 Part 3

"For those who self-identify as addicts, addiction (or dependency) is a state of being, and not a matter of choice."

As a result of this thinking, as well as other misconceptions, what is communicated to the struggling user is often inappropriate, if not counterproductive: misguided attempts to control use or narrow goals centered around the tangible effects (legal, medical, or occupational) of drug use. "Getting my life under control by getting my drinking under control" is a potentially dangerous fallacy. What is missing is an attention to emotional changes that distort thinking, and ultimately change relationships.

Terry Gorski, in Passages Through Recovery (1989), describes a "post acute withdrawal" phase, a time of emotional and behavioral changes that lingers twelve to eighteen months into a period of abstinence. Recovery programs refer to analogous concepts - "dry drunk" periods, or "white knuckling."

Long after the last drink has been taken, recovering addicts may have problems thinking clearly, be prone to irritability and conflict, sleep restlessly, feel vulnerable and even believe that they are going crazy.

Many addicts state that a primary goal in therapy is to regain the trust of their loved ones - parents and spouses who have become indignant towards their lying, secrecy, and manipulation. But they often become frustrated because they fail to recognize that the task of regaining trust is a reciprocal one. The mental and spiritual aspects of the disease create a negative relational cycle.

The user lies, the loved one colludes with the lie. The user pretends they are clean or blames their drug use on others; the loved one agrees to believe them. The addict says "let me handle it" or "I've got it under control" as a way of avoiding scrutiny; the loved ones back off. They subscribe to the myth that the addict can and will control their use.

This denial of reality leads users back into the cycle of use, and loved ones into despair. Provocative questions to addict clients often include: "Do you trust them enough to tell them the truth?"; "Do you trust them enough to allow for their questions?"- and especially for youth - "Do you trust them (your parents) enough to accept their limit-setting, to allow them to parent, and to allow yourself to be a kid?" The purpose is to reframe the task of regaining trust for users and their families, because the greater challenge is not that of users gaining the trust of would-be helpers, but, rather, that of helpers gaining the trust of users.

The following is a summary of important messages for substance users and families:

Mental and behavioral effects of drug use are not confined to an intoxication syndrome.
Risk-taking needs to be redefined in emotional terms; the courage to be honest and accept limitations replacing the false bravery of self-destructive behavior.
The "they like me better when I'm high" effect: When we confuse the negative effects of intoxication with those of withdrawal, we unwittingly reinforce drug use.
The development of maturity is arrested by regular drug use. This statement is not a value judgement about a person's selfhood but, rather, a truth about biological development.
The mental and emotional fallout of addiction continues long after usage stops.
The trust wound between substance users and their families is a mutual one.

Examining Distorted Beliefs Related to Substance Use, Part 1 - Distorted Beliefs about Addiction

(Past member) — Thu, 12 May 2011 20:03:19 GMT

By Graeme Daniels

This article is presented in three parts. Part 1 Part 2 Part 3

When confronting issues of substance use, professional opinions as to what constitutes use, abuse, or dependency, as well as notions of prevention, often compete with the ideas of individuals and families, and those of the culture at large.
Graeme Daniels

Recently, a client who proclaimed himself an addict looking to abstain from drugs, asserted: "I wanna quit drugs, I just wanna' drink from now on." The misconception that drugs exclude alcohol is an example of a distorted--but all too pervasive--belief. Similarly, clients often believe that the consequences of drug use are confined to the period of intoxication, and do not extend beyond that time.

As therapists working with such clients, we must confront these distorted belief systems before we can clarify treatment goals. In this article, I will discuss some important ideas pertaining to substance use, and present interventions that are substantive and practical.

Distorted Beliefs about Addiction

Inverted notions about risk-taking: Our beliefs can help us or they can mislead us. Negative beliefs about self, for example, can form the psychological fuel of an escalating substance dependency. Conversely, a positive self-image can inspire self-care. But in the inverted universe of substance abuse, definitions/ideas of positive self-image and positive self-care are turned upside down. For example, when speaking to adolescents, I often comment that an emotional and behavioral change that occurs relatively early in drug use is that of increased risk-taking and impulsivity. Drugs are dangerous, I add, not to mention illegal and largely forbidden. There is generally a respectful agreement on this point, but I also note when my clients seem unmoved. After all, I can see them thinking, risk-taking is manly, risk-taking is good.

The willingness to take risks garners esteem within a peer group and creates a false sense of heroism within the young person. This twist of thinking has significant implications; under social pressure, what we commonly think of as self-destructive risk-taking is perceived by our adolescent clients as courageous.

How can we "coopt" the positive value attached to risk-taking and turn it right side up again? I believe that the key lies in redefining risk in emotional terms: It takes courage to risk being honest with others, to stand strong in the face of peer pressure and dare to accept limitations, protect our safety, and adhere to conventional behavior.

Negative reinforcement for intoxication: Drugs are intoxicating because they promise an instant way to alter our feelings. Seconds, minutes, perhaps an hour, is all that is necessary to achieve a desired effect, and the message to our central nervous systems is clear: you do not have to wait to change how you feel. When asked what is attractive about the mood and mindaltering experience, addicts will first give some familiar responses: drugs allow for disinhibition, increase confidence or relaxation, and create a feeling of elation where there was anxiety before. But deeper exploration reveals more: As feelings change, so, too, do the user's perceptions: responses to stressors are intensified, confidence turns into entitlement, and the user, filled with false confidence, misreads social cues and perceives social approval where there is none.

Withdrawal brings with it even more distorted thinking. The absence of the intoxicating high feels punishing to the suffering addict. But what is he being punished for? For using? Or for not using? For the absence of the drug in his system, or for its presence? After all, the best way to eliminate the suffering of withdrawal is with further intoxication. The addict comes to the wrong conclusion: he believes he is being punished for not using, not for using. Onlookers may reinforce these conclusions by reacting more aversively to the negative effects of withdrawal than to the negative effects of intoxication. Consider the logic of what I might term the "they like me better when I'm high" effect: When intoxicated, a user may be relaxed, more confident, and more sociable. When not intoxicated, they may be irritable, complaining, anxious, and lethargic. Whom do we want to be around?

The "think before you act" fallacy: Science has come to understand that drug use inhibits maturity, and that addiction has more to do with biology than with character. According to a recent article in the Harvard Mental Health Newsletter: "Human brain circuitry is not mature until the early 20s. Among the last connections to be fully established are the links between the prefrontal cortex, seat of judgement and problem solving, and the emotional centers in the limbic system.

These links are critical for emotional learning and high level self-regulation." The implications of this research are that youth is particularly vulnerable to addiction. Though we may want them to "think before they act," research teaches us that the integration of thinking and feeling, that ability to distinguish between what we think is important (i.e. a craving state), and what is really important, is a matter of development and time. Teenage brains are simply not yet developed enough to make these distinctions. Drug use then further inhibits this development, because it undercuts one of the cornerstone tasks of maturation, namely, the practice of patience and the tolerance of discomfort.

Social norms are complicit with drug use. Advertising associates alcohol and tobacco use with sex, popularity and fun, and creates an environment in which immediate gratification is a commodity. Society reinforces the "life lessons" of addiction: the belief that impulsivity, intense experiences, and quick relief from bad feelings are the important goals and not dealing with, and learning from, the ups and downs of life. The sober experience of life is implicitly devalued, and not using, not being high or intense, is defined as "square."

The myth of responsible drinking: "Drink responsibly," the ads and commercials warn us. Although many can and will obey the limits, many others will struggle, fail, and suffer the consequences - legal, occupational, relational - that accompany abuse. Still others cannot even engage in the struggle. Mainstream society either misunderstands, or plainly rejects, those for whom the very term "drink responsibly" is a contradiction.

We are still a long way from grasping the notion now understood by the medical establishment, and best articulated by the twelve-step community: that for those who self-identify as addicts, addiction (or dependency) is a state of being, and not a matter of choice.

Next: Part 2, The Emotional Work of Recovery

Working with Partners and Spouses of Sex Addicts

(Past member) — Tue, 10 May 2011 20:11:09 GMT

By Joan Gold

Joan Gold As Sexual Addiction becomes more frequently recognized as a diagnostic label, sex addicts are more easily identified and referred for treatment. Addiction being a family disease, the more sex addicts referred for treatment, the more it becomes apparent that there is an entirely new group of co-addicts that urgently require attention. The partners and spouses of sex addicts, while sharing many similarities with partners/spouses of alcoholics, gamblers, et al., have many unique characteristics that significantly impact treatment failure or success.

I came to Impulse Treatment Center (ITC) in Walnut Creek, CA in March of 2008, having worked for several years as an intern with addicts and co-addicts of the more traditional variety. The ITC treatment model involves assessing the couple (frequently the initial treatment unit), then referring the partners to their own individual treatment groups. Couples therapy is usually, although not always, delayed until individual treatment has had a chance to create change.

Over the past year, I have learned a lot about the struggles my co-addict clients must overcome in order to have their pain recognized, their needs addressed, and their path towards wholeness and healing begun.

It is important to note that while sexual addiction is by no means gender-limited, at this time it is primarily heterosexual men who present for treatment at ITC. According to Carnes, the ratio of sex addicts presenting for treatment in general is the same as alcoholism and gambling, approximately three men for every one woman. (Carnes, 2002, p.13). I look forward to a time where this treatment group becomes more widely diversified; ITC has not, to date, been able to put together a group of women sex addicts. Currently I work exclusively with women as coaddicts.

Partners/spouses of sex addicts see themselves as victims and they almost always present for treatment in crisis; sexual betrayal has either recently become known, or known in a way that allows its full significance to be felt. I see a lot of hysterical, raging and/or collapsed women in my office as I assess them for appropriateness for my groups. Many of these women are in shock. For a large percentage, this is the first time they have put their outrage/loss/betrayal into words. Sometimes they don't have the words. Most of them have no support system, or they feel their support system cannot tolerate the knowledge that "the perfect husband" isn't perfect after all.

These women may have been holding into their lonely knowledge for days, months or years. Their language is halting, gutteral; their affect tearful, their bodies rigid, their attitudes careen between vindictive and confused. Upon further exploration, rarely do their stories of "the perfect marriage until the day I found the credit card receipts/the secret email account/the police report/the VD diagnosis" hold up. "What made this marriage so otherwise perfect?" I ask them. "Where did your feelings of being loved and valued come from?"

It is tempting to keep the empathy and support going forever, easy to join these women in their almost hypnotic recounting of family tragedy and virtue betrayed. If the therapy, group or individual, is to be effective however, it is crucial that the crisis be managed, and, once stabilized, that the client be helped to transition into a role where she becomes able to take an active part in identifying her piece of the addiction puzzle.

This is different than "blaming the victim" and one of the primary reasons that group therapy is the treatment of choice for co-addiction. If I have done my psycho education around sexual addiction correctly, the women will soon understand that their partners' addiction and/or recovery is neither their fault nor their responsibility. Their husbands or boyfriends did not become sex addicts because of anything the clients did or didn't do, however the reason the client was able to sustain what she thought of as an "intimate relationship" with someone not available for real intimacy is an important point of exploration.

It is noteworthy that many of the women I see at ITC have been
with their partners for two and three decades.

It is noteworthy that many of the women I see at ITC have been with their partners for two and three decades. Others report serial relationships with sex addicts, unwittingly married two and three times to different sexually impulsive men. These are my true allies in the group process, the women whose lives demonstrate that it isn't about being victims after all. They weren't "done wrong" by "bad men" through an accidental quirk of fate. What drew them into the same relationship over and over again? What felt so familiar that it overrode any sense of something not quite right? How did these women distract themselves from their loneliness, justify the lack of attention, learn to live with the sense of themselves as forever needy and unfulfilled?

It is the hardest part of my work as a therapist to develop the understanding that whether a woman decides to leave her relationship, or stay and see what can be salvaged, this "crisis" is her opportunity to look at her own role in maintaining a system of secrets and lies. This is the most challenging initial task of therapy and once navigated and the work begun, this is the most common place of ongoing resistance.

It is helpful to have my clients read Patrick Carnes' work on sexual addiction, in which he reports that sex addicts and co-addicts come from strikingly similar backgrounds: "families that are both rigid and disengaged," with "addicted or multiply addicted family members," where "relationships that are controlling and emotionally unsatisfying create comfort in that they are familiar." (Carnes, 1992, p.145-6)

Partners/spouses of sex addicts share many of the consequences of sexual addiction -- financial, health, family, career -- but most especially they share the shame. (Carnes, 1992, p. 147).

Over and over I hear women say, "If only he were an alcoholic" or "if only he were a gambler." They would prefer their husbands be addicted to cocaine rather than to call-girls, they tell me, because what cocaine offers is clear. It is not a fantasy wife or girlfriend. "Cocaine doesn't make you wonder where you fell short."

Sex addiction impacts partners at the deepest level of self. That is why an early intervention is an invitation to the women to take a look at who they are apart from the addict. Eating disorders, drug and alcohol dependence; childhood physical, emotional and/or sexual abuse figure large in many of these women's personal histories.

Again, the psycho education piece is crucial here in helping to reduce shame and suspend judgment, allowing the clients to develop empathy, first for themselves and, eventually (if the relationship is to endure) for their partner as well.

My goal in treatment is to shift the focus of the group off the sex addict and onto the woman herself. This can be an ongoing dance; if the sex addict partner is untreated, there is the ongoing impact of his projection and denial. If in treatment, the normal ups and downs of the recovery process are a constant invitation to judgment and blame. Two points I continually stress with my clients whose partners are in treatment: (1) sexual addiction, as all addiction, is a highly relapsable disorder and (2) the recovery process is a long slow journey. How are you going to take care of yourself while he is doing his work?

Most of the women I work with have some question in mind about whether they should stay in the relationship, or leave. I help them give themselves the time to really think through their options rather than end the relationship in a reactive state.

This is all complicated by centuries of cultural bias which makes it difficult to even believe in the concept of sexual addiction as a "real" diagnosis. Medical professionals, and even some therapists who have not been educated in the sex addiction model, unwittingly perpetrate the stereotype of "This is the way men are." I have worked with a number of women who have undergone years of couples therapy in which sex addiction was never named or addressed, but rather characterized as a problem of communication or temperament; one woman, for example, found herself labeled "uptight" in objecting to her husband's use of internet porn.

On the rare occasion when a group member leaves and a new member is added, each woman is asked to retell the story of what brought her into the group. Many of the women object to the retelling. They tell me how each time they repeat their story, it's like ripping the scab off a wound they desperately want to heal. I remind them that addiction flourishes in vagueness and obfuscation. True healing will only be found in the raw, unembellished truth.

Other women, who don't object to retelling the story per se, are worried that if they keep their "bad" feelings alive this way, they will never be able to arrive at forgiveness. Like the addict, they have gotten forgiving confused with forgetting. They will have the opportunity to forgive, I tell the women, down the road somewhere should they wish to do so. The job in early treatment is not forgiveness. Betrayal and loss by an intimate partner needs to be fully felt and processed before it can be forgiven. Premature attempts at forgiving/forgetting are just another form of the addict/co-addict cycle of denial.

In addition to telling and retelling the story, early group work involves psycho education around the issues of sexual addiction, co-addiction and addictive family systems; training in mindfulness in order to be able to identify and name feelings; and identification with other group members to help reduce shame and experience real intimacy.

Middle stage group work involves increasing tolerance for feelings, and learning to let feelings inform actions. Exploration of childhood loss/trauma also begin here. I have found the loss of self that results from those early woundings is what allows the women to remain in psuedo-intimate and disrespectful relationships, believing it is all they deserve.

Late stage group work includes acknowledging the changing sense of self, exploring the power and freedom afforded by being able to set boundaries, separating "kindness" from "enabling," rethinking relationship roles and rules, and building personal resources and support systems.

For more information about the Spouses/Partners of Sex Addicts Program at Impulse Treatment Center, please contact Joan Gold at (925) 2806700 or (510) 418-2387. For more information about ITC's treatment programs for sex addicts, go to www.sexaddicttreatment.net

Joan Gold is an MFT Intern supervised by Don Mathews, MFT, Director of Impulse Treatment Center. She is a 2005 graduate of JFK University, with an MA in Counseling Psychology (Transpersonal Specialization). She has completed her hours towards licensure and is currently in the process of sitting for her licensing exams.

Visit Joan Gold's page on East Bay Therapist

References

Carnes, Patrick (1982) Don't Call it Love
Carnes, Patrick (2002) Clinical Management of Sexual Addiction

Top Ten Practices in the Pursuit of Happiness

(Past member) — Sun, 08 May 2011 20:15:03 GMT

By Michelle Lane

Growing up I sensed my mom was happy in spite of many struggles. I saw that her values and appreciation of life's simple pleasures played an important part. Even so, I needed to personally experience what she modeled before I could apply her wisdom to myself and others. From a young age I observed human nature, always wondering, "What does it take for a person to feel happy?" My quest for that answer has continued.

Now, as a Marriage and Family Therapist, I have the privilege of sitting with clients every day who share with me the intimate details of their lives. Clients come to therapy in part because they want to feel happy! They come to seek solutions to regular life problems. They may need support and guidance to achieve their life goals. Whatever the case, they benefit from talking with a therapist. It is my belief that each individual is the expert on their life and ultimately the best solutions will come from within them. I also know if we can change our self-defeating thoughts, our feelings and lives will also change. Dale Carnegie said, "Remember happiness doesn't depend upon who you are or what you have; it depends solely on what you think."

Thoughts are powerful! In therapy people can develop the tools, self-awareness, outlook and confidence to transform life's challenges into a meaningful life infused with energy and optimism. As a therapist, part of my work is to listen and pose pertinent questions to help clients accomplish their goals. Sometimes the issues are more complex and many layers need to be gradually uncovered. What follows are ten healthy practices people find of benefit as they navigate the variety of challenges in their lives.

Practice #1:

TAKE CARE OF YOUR-SELF

To feel happy, it is important to pay attention to the basics---sleep eight hours a night, eat healthy foods, and exercise daily. This will sustain the energy you need to accomplish your goals. It also helps stabilize your mood. Eliminate or reduce substances such as alcohol, caffeine, sugar, marijuana or other drugs that may be draining your energy and distracting you from self-care. Repeat the mantra "Breathe, just breathe" while taking slow, deep breaths to relax your body. Other techniques such as visualization are useful as well. Think about what relaxes you, what makes you feel good and incorporate those things into your daily life. When we prioritize these basics, we take care of ourselves on a daily basis. Without self-care, other parts of life may dominate, to the detriment of our physical and mental health.

Another part of self-care is time management. Our society is fast paced and demanding of our time. When we are so busy or overwhelmed and do not take time to rejuvenate, we are likely to burn out or become less effective. In the wise words of William Wordsworth, "Rest and be thankful". List the things that drain your energy and find ways to appropriately delegate or eliminate them from your life. It is also important to ask for help when needed!

As infants, we are dependent on our caretakers, usually mom or dad. As we become independent some of us are reluctant to ask for help, thinking it a weakness. In fact, "interdependence" is necessary for success in life. As stated by Isaac Newton: "If I can see further than anyone else, it is only because I am standing on the shoulders of giants."

One thing you can do right now is make a list of the people you rely on. Then you can make use of it when you feel stressed or unhappy. Recognize that we are all social creatures who are connected and need each other. Mental health improves when we are involved with a healthy community. Do your best to distance yourself from people who are destructive or drain your energy. When you connect with supportive people and disconnect from toxic people it makes a world of difference.

Practice #2:

FIND BALANCE IN DAILY LIFE

There are many areas of life that need our attention, yet too often we focus on one thing at the expense of others. Work and children can be the squeaky wheels, but what about our physical, mental, emotional, spiritual, and relational health? Ernest Hemingway enlightens us: "I still need more healthy rest in order to work at my best. My health is the main capital I have and I want to administer it intelligently." Americans work more hours than people in other countries and are the most productive, yet all too often our health and relationships take a back seat. This contributes to illness and divorce. When you maintain balance in your life, even if you struggle in one part of it, you can feel good that the rest of your life is going well. Continuing to invest in the good parts of your life helps you feel strong and satisfied, all of which helps you deal with your difficulties.

Marital research by John Gottman suggests that to sustain a marriage, couples need a 5 to 1 ratio of positive to negative interactions. When counseling couples, I help them increase positive interactions while they are developing skills to transform the negative ones. Get a babysitter, take dance lessons, express your appreciation of each other, do things you know your partner will enjoy. If things are basically going well between you and your partner except in one or two areas, be sure to spend time together enjoying what is positive. Your worries or disappointments may diminish, and you will feel happier.

In addition to the practices that lead to happiness, developing flexibility will help you adapt to the challenges you face in life. "Extraordinary flexibility is required for successful living in all spheres of activity." (Peck, 64) Parenting tends to focus on structure, routine, and consistency. By the same token, if nothing else teaches us the need for flexibility, parenting will. When people are inflexible they get stuck in one mode all the time. Be willing to learn, grow, bend, change your perspective or even admit when you are wrong. Not only is it no fun to be around people who lack flexibility, it is not healthy. When we allow ourselves to change, we not only surprise others, we might also surprise ourselves with how enjoyable life can be.

Practice # 3:

BE PRESENT; ONE MOMENT AT A TIME

Take a look at how much you "stay and be" versus how much you "go and do." We tend to get so busy that self-care, rest, and time with friends and family may fall to the wayside. Most religions and spiritual guides talk about the value of prayer, meditation and other rituals of just being still and quiet or Being. A book I recommend on this subject is The Power of Now, by Eckhart Tolle.

Those who have not found their true wealth, which is the radiant joy of Being and the deep, unshakeable peace that comes with it, are beggars, even if they have great material wealth. They are looking outside for scraps of pleasure or fulfillment, for validation, security, or love while they have a treasure within that not only includes all those things but is infinitely greater than the world can offer. (9)

This practice of "Being" is accomplished by "staying in the moment," which is simply being in, and bringing our attention to, the present. In Taoism, there is a term called wu wei, which is usually translated as "actionless activity" or "sitting quietly doing nothing" regarded as one of the highest achievements or virtues. (Tolle, 179) When overwhelmed, we worry about all the things that might go wrong in the future. Try to surrender to the moment and determine what you need right now. More often then not meeting your current needs will lift your spirits.

Practices that may be savored in the moment include eating, drinking, sleeping, dancing, playing, painting, drawing, coloring, exercising, reading, writing, gardening, and being with other people, animals, and nature. As I write, my cats linger at my ankles, looking for attention, as the setting sun lights up the tree outside in a magnificent golden hue. In this moment I can honestly say I feel truly happy. While you seek this kind of awareness in daily life, you are not consumed with the past or future, but are present in the moment, and this is where you can find peace.

"Surrender reconnects you with the sourceenergy of Being, and if your doing is infused with Being, it becomes a joyful celebration of life energy that takes you deeply into the Now." (Tolle, 173)

In their play, children and animals teach us to celebrate the moment. Find joy in doing what you need to do today! You have the power of choice, and every moment is valuable. "Whatever you can do, or dream you can, begin it. / Boldness has genius, power, and magic in it." - Goethe

Another book that speaks to the benefit of making the most of our time and energy is The Power of Full Engagement, by Jim Loehr and Tony Schwartz. They assert that we actually become less productive if we do not take breaks or change activities every thirty to ninety minutes. Our physical and mental health are related and we must commit to taking care of both. Persistent stress actually kills neurons in the brain, and multitasking impacts memory. Therefore taking one moment at a time is part of selfcare, contributing to our overall health and happiness.

Practice # 4:

SEE THE BIG PICTURE -- VISION

Albert Einstein knew that intelligence and imagination are highly correlated: "Imagination is everything! It is the preview of life's coming attractions." Living with a vision for your life gives it meaning and purpose. Imagination connects us to our gifts and passions where we discover our love for living. A lot of research supports the power of intention and visualization. If your current situation is difficult and you are at a loss as to what you can do, remember your past strengths and imagine where you want to be in the future. This can help you realize what you can do today to get you where you want to go.

Self-discipline is accomplished when you can delay gratification, knowing your hard work will pay off in time. Sometimes we enjoy the immediate, other times we make different choices that lead to our long-term satisfaction. Learn to trust yourself when deciding what you need to balance today's pleasures with tomorrow's goals. "Every moment is a golden one for him who has the vision to recognize it as such." (Henry Miller)

Practice # 5:

APPRECIATION

When I was young, each morning as she drove me to school my mom would say, "Look at the morning glories." Tired, and still trying to wake up, I would roll my eyes and wonder why she said this every day. Later, when I moved away to college, I thought of her when I saw morning glories----finally appreciating her desire to share with me on a regular basis the beauty in nature. Now I walk as often as possible in lovely neighborhoods, by the ocean, lake or mountains, to appreciate and connect with nature to remember what a beautiful world we live in. Baby ducks or geese waddling around always lift my mood. Weekly I play fetch with a dog and daily I pet my cats and bask in their peaceful purrs.

"Do not pollute your beautiful, radiant inner Being nor the Earth with negativity. Do not give unhappiness in any form whatsoever a dwelling place inside you." (Tolle, 178) Stop and smell the roses and observe the miracle of life around you, regardless of your circumstances. Be grateful in everything. "Not what we have But what we enjoy, constitutes our abundance." Epicurus

This is one of the most powerful tools in life and relationships. Focus on the good, and more good will come. Ancient religions and modern spiritual guides will tell you the same. The Dali Lama, in The Art of Happiness describes it this way:

Happy people in contrast, are generally found to be more sociable, flexible, and creative and are able to tolerate life's daily frustrations more easily than unhappy people. And, most important, they are found to be more loving and forgiving than unhappy people. (17)

When you focus on and give voice to what you appreciate about someone, it reinforces their positive behavior and creates intimacy. No one enjoys being criticized. Find the good in others, express the positive, and you will have long lasting relationships. Jesus said, "Turn the other cheek," and promoted servant leadership, with humility and love. Compassion for your enemies is difficult but forgiveness can lead to your own sense of peace. "Peace of mind or a calm state of mind is rooted in affection and compassion. There is a very high level of sensitivity and feeling there." (Dali Lama, 26)

Others who know our strengths and weaknesses can help us view things in a more positive way. As a child I was playing outside when a bee stung me. I ran inside crying to mom. She sat me on the counter, pulled out a glass in which she began catching my tears. She held the glass up to the sunlight shining in through the window and said Look at how beautiful they are! I saw the rainbow of colors in my tears and suddenly I was laughing. There was joy and beauty even in my pain. It was one of the most valuable lessons I have learned.

Practice # 6:

ACCEPTANCE

"The pain you create now is always some form of non-acceptance, some form of unconscious resistance to what is," (Tolle, 27). The story I shared about my mom catching my tears in a glass to show me their beauty also taught me that it is okay to cry. One of my roommates told me she felt uncomfortable when I cried because she did not know what to say. I told her, "Just tell me I am beautiful when I cry!" From then on we enjoyed the experience of laughing and crying, knowing tears are a natural physical release offering relief. Now my child clients will tell their parents when they cry It's okay to cry. "It makes you feel better."

Scott Peck s A Road Less Traveled begins, Life is difficult. Once we accept this fact, we are no longer so disturbed by it. The first step in both Science of Mind and 12- Step programs is to relax, or surrender, and come to know our limitations. Sometimes this feels strange but once we do it, the steps that follow are manageable, as we realize we are a small part of a much bigger picture. It helps put things in perspective and allows us to focus on our place in the universe. For a year my mantra was Let it be, as Paul Mc- Cartney sang so eloquently. Now I frequently recite the Serenity Prayer: God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

Serenity, courage and wisdom allow me to problem solve when I feel unhappy. Therefore, unhappiness can be an indication of a need to change---if not my thoughts, then my circumstances. I figure out what I can not change, focus on what I can change and how to go about it. Problem solving gives meaning to our lives and develops courage and character. When problems are avoided, mental illnesses and destructive patterns develop, stunting our growth, rather than relieving our discontent. For more on this topic I recommend reading The Road Less Traveled (and the other books listed at the end of this article). Self-help reading is also known as biblio-therapy and can add to the tools you develop to bring about changes that you choose to make.

We make our choices, but we cannot determine the paths of others. Couples often come into counseling wanting the other person to change. They struggle with the truth that they must change themselves in order for their relationship to change. It is the same with families. If only my son would listen. Or my mom just needs to back off and leave me alone. While these certainly provide clues to relational dynamics that are not working, the key here is that they are dynamics. If you change, the dynamic changes. No longer are you at the mercy of and frustrated by someone else. Now you are empowered to do something yourself, and to know you cannot change the other person s choice, regardless of what it is.

Practice # 7:

BE PATIENT, REALISTIC AND KIND TO YOURSELF

Many people are hard on themselves and actually make themselves, and others, miserable. As the Serenity prayer reminds us, much of life is beyond our control, and what others think of us is "none of our business." People have their issues. They will sometimes try to project them on you so as to blame you for their problems. Many are neither aware of their issues nor willing to take responsibility for them.

Learn to be true and good to yourself. You are on a journey. It is perfectly normal that you will fall down sometimes. Just pick yourself up, dust yourself off, and keep walking. If you are not making mistakes, you are probably playing it too safe and may not be challenging yourself by taking risks in order to learn and grow.

You do not have to be perfect. You can be human; we are all human! It is more interesting than being perfect anyway. If you do not love and accept yourself, how can you expect anyone else to? You cannot give to others what you do not have yourself. Take responsibility for your life, and have compassion for yourself and others. Be as kind to yourself as you are to others. Recognize that even failures are accomplishments because you are taking risks, living courageously, and learning lessons.

"There are cycles of success, when things come to you and thrive, and cycles of failure, when they wither or disintegrate and you have to let them go in order to make room for new things to arise, or for transformation to happen." (Tolle, 152)

Just as nature has four seasons, in life there is a time for everything and everything has its time. We must trust we are divine creatures, a part of larger community, where not everything makes perfect sense, but in every sense we are being perfected. Like gold that goes through fire to be refined, we grow stronger as we overcome obstacles, building character and integrity. Realistically we are all sad at times, but overall we hope to have the joys in life outweigh the sorrows, and often a change in perspective can shift things dramatically. There are mountains and valleys, but within each experience, whether high or low, joy can be found.

"Honor your inner worth. Let your heart's desire breathe. Cherish your gifts. Treat yourself with tenderness, gentleness, and forgiveness. Open your heart and listen. Love is calling you to the mountain top" (Peck, 29).

Practice # 8:

PERSONAL RESPONSIBILITY

Ultimately people choose to be happy: to find the silver lining in each cloud. If you continue to wait for happiness to arrive, you will be waiting a long time and wondering why you are not happy yet. You are responsible for creating a life that makes you feel happy, accepting the life you have, and finding the joy in each moment.

"The happiness that is derived from some secondary source is never very deep. It is only a pale reflection of the joy of Being, the vibrant peace that you find within as you enter the state of nonresistance." (Tolle, 156)

Some people do not take pleasure in their time alone. However, we need to stay connected to ourselves. When we are too busy, or always around others, we may lose perspective on what is most important to us. Taking some down time allows us to focus, think things through and be more aware of our choices. I have learned that down time, time I spend alone and contemplative, restores me emotionally and spiritually, helping me stay honest with myself, and on the path that is best for me.

Self- awareness is necessary in order to "own your part" in conflict with others. It is easy to blame others for our pain, avoiding personal responsibility, yet as adults we have the power to choose who we relate to and how we relate to them. We must empower ourselves to take responsibility for our choices and let go of trying to change others. It takes courage to admit our faults and to recognize we have the ability to shape our own lives.

While limitations exist and there are things beyond our control, we can always turn things around for ourselves if we are creative and brave. When we are honest, and have the integrity to do the right thing, even when it is difficult, we discover solutions we can feel happy about. We need to challenge ourselves, stop blaming others and see what we can do to create change. Mahatma Gandhi led by example and persuades us to "Be the change you want to see in the world." This is essential to personal growth.

Practice #9:

COMMITMENT TO TRUTH -- OPENNESS, HONESTY, AND INTEGRITY

Trust is the foundation for healthy relationships. I have found tremendous healing in relationships where we have both been true to ourselves, direct, open, and honest with each other. If I am not being honest or doing the things I said I would do I feel bad about it, and I am sure the other person is not happy either. Sometimes we do not want to be around people who challenge us because we are trying to stay in our fantasy world where there is no pain or suffering.

"Insofar as the nature of the challenge is legitimate (and it usually is), lying is an attempt to circumvent legitimate suffering and hence is productive of mental illness." (Peck, 56)

I strive to be a person of integrity, dedicated to being truthful. I can also find it difficult to admit my faults and trust others with my more vulnerable feelings. I understand the desire to lie, withhold, hide, avoid or pretend to be someone you are not. What I have learned is that sooner or later the reality of those choices catches up with us and we must face the consequences. The truth always reveals itself in time.

It is difficult to assess or treat a client if the therapist does not know the reality of the client's situation. When relevant information is left out, the therapist's guidance may be ineffective or compromised in their ability to challenge a client's thoughts, feelings and behaviors. The healing of the spirit has not been completed until openness to challenge becomes a way of life. (Peck, 54) If you are not dealing honestly with your therapist about your most important and often painful issues, you might want to examine your relationships and ability to trust. It can be difficult to be vulnerable and trust the therapist with secrets, yet this is where change and growth can occur.

Addiction is well-documented as an illness where people lie to themselves and others. Justifications and deception allow a person to continue their behaviors and ignore the destructive nature of their choices. Families who keep secrets are confusing to be around because nothing is as it seems. As the therapist challenges these behaviors you are able to develop trust, honesty and integrity which will translate into your personal life. Healthier, open and direct communication will allow people to feel safer and happier.

Practice # 10:

COMMUNITY SERVICE AND GIVING TO OTHERS

Once you are grounded in joy and peace, you are ready to spread joy and peace to others. The best way to sustain happiness is to help others feel happy too. Pass it on, pay it forward. Thich Nhat Hanh reminds us, " If we are peaceful, if we are happy, we can blossom like a flower, and everyone in our family, our entire society, will benefit from our peace." (3) We are social creatures who need others, and they us. Random acts of kindness can change the course of a bad day into a good day. Simple things like smiling, treating others with respect, or offering to help can spread happiness. When I first moved to California I had the unexpected pleasure of a having my bridge toll paid by the stranger in front of me. It immediately lifted my spirits and I talked about it for several days. Often people say, "If I were rich I would give generously to others." Money is not the only thing people need. Kindness and giving of your time to another person can make a world of difference. Do what you can. Compassion for others will help you feel better, distract you from your problems and expand your perspective. We find joy in the journey, not in the destination.

I hope this article encourages you and brings you closer to feeling happy more often. Like a boat whose rudder is moved slightly to change coarse, small changes in life can lead to entirely different experiences. The more you incorporate these healthy practices, the more you will find yourself laughing and enjoying your life. Best wishes as you enjoy your journey and spread the joy to others!

Bibliography:

Burns, David D., M.D. Feeling Good. New York: Avon Books, 1980, 1999.
The Dali Lama and Howard C. Cutler, M.D. The Art of Happiness. New York: Riverhead, 1998.
Gottman, John. Why Marriages Succeed or Fail: And How You Can Make Yours Last. New York: Fireside, 1994.
Loehr, Jim, and Tony Schwartz. The Power of Full Engagement. New York: Free Press, 2003.
Moore, Thomas. Care of the Soul: A Guide for Cultivating Depth and Sacredness in Everyday Life. New York: Harper-Collins, 1994.
Nhat Hahn, Thich. Being Peace. Berkeley, CA: Parallax Press, 1987.
Peck, M. Scott, M.D. The Road Less Travelled. New York: Touchstone, 1978
Ryan, M.J. The Happiness Makeover. New York: Broadway Books, 2005.
Tolle, Eckhart. The Power of Now. Novato, CA: New World Library, 1997.

2007 Michelle Lane, Licensed Marriage and Family Therapist

If you are ready to pursue the life of your dreams, develop the tools, self-awareness, outlook and confidence to transform your challenges into a meaningful life infused with energy and optimism, get started now by going to www.michellelanemft.com

Managing Abandonment Depression in Complex PTSD

(Past member) — Fri, 06 May 2011 20:32:11 GMT

By Pete Walker

One of the most difficult features of Complex PTSD is extreme susceptibility to painful emotional flashbacks. Flashbacks are painful layers of reactions C physiological, behavioral, cognitive, and emotional - to the reemerging danger and despair of childhood abandonment. This article maps out these layered, defensive reactions and offers a treatment strategy for managing the depression that underlies them. Here is a model of the layering of an emotional flashback. Experiences of depression and abandonment trigger fear and shame, which then activates panicky Inner Critic cognitions, dedicawhich in turn launches an adrenalized fight, flight, freeze or fawn trauma response [subsequently referred to as the 4Fs which correlate respectively with narcissistic, obsessivecompulsive, dissociative or codependent defensive reactions].

Here is a common example of a flashback. A complex PTSD sufferer wakes up feeling depressed. Because childhood experience has conditioned her to believe that she is unworthy and unacceptable in this state, she feels anxious and ashamed. This in turn activates her Inner Critic to scare her with perfectionistic rants: No wonder no one likes you. Get your lazy, worthless ass going or you ll wind up a wretched bag lady on the street! Retraumatized by her own inner voice, she then launches into her most habitual 4F behavior; she either lashes out domineeringly at the nearest person [Fight/ Narcissistic] C or she launches busily into anxious productivity [Flight/ Obsessive-Compulsive] C or she flips on the TV and foggily tunes out or dozes off [Freeze/ Dissociative] C or she selfabnegatingly redirects her attention to a friend's problem [Fawn/Codependent]. Unfortunately this dynamic also commonly operates in reverse, creating perpetual motion cycles of internal trauma as the dysfunctional behaviors of 4F acting out beget new self-hating criticism, which in turn amps up fear and shame and finally compounds the abandonment depression with prolonged experiences of self-abandonment. Here is a diagram of these dynamics: Triggered ABANDONMENT DEPRESSION ← → FEAR & SHAME ← → INNER CRITIC Activation ← → 4Fs.

This article describes a treatment approach that decreases retraumatizing reactivity to the internal affects of the original abandonment depression. It describes a Mindfulness practice for somatically metabolizing feelings of depression and fear. This in turn promotes the ability to feel through abandonment experiences without launching into inner critic drasticizing and 4F acting out.

The etiology of a self-abandoning response to depression. Chronic emotional abandonment devastates a child. It naturally makes her feel and appear deadened and depressed. Functional parents respond to a child s depression with concern and comfort. Abandoning parents respond to it with anger, disgust and/or further abandonment, which in turn create the fear, shame and despair that become characteristic of the abandonment depression. A child who is never comforted when she is depressed has no model for developing a self-comforting response to her own depression. With no connection to a nurturing caretaker, depression steadily increases and sometimes devolves into the Failure to Thrive Syndrome. In my experience failure to thrive is not an all-or-none phenomenon, but rather a continuum that stretches from excessive depression to death. Many PTSD survivors thrived very poorly, and had painful bouts of lingering near the end of the continuum that feels death-like. Several of my clients commonly quipped that they feel like death warmed over when they are in a flashback.

When a child is consistently abandoned, her developing superego eventually assumes totalitarian control of her psyche and carcinogenically morphs into a toxic Inner Critic. She is then driven to desperately seek connection and acceptance through the numerous processes of perfectionism described in my article Shrinking the Inner Critic in Complex PTSD [downloadable from www.eastbaytherapist.org or www.petewalker. com]. Imitating her parent s contempt for her emotional pain, she also becomes emotionally perfectionistic and judges her dysphoric feelings as the cause of her abandonment. Over time her affects are repressed, but not without contaminating her thinking processes. Unfelt fear, shame and depression are transmuted by the inner critic into thoughts and images so endangering, humiliating and despairing that they instantly trigger escapist 4F acting out. Eventually even the mildest hint of fear or depression, no matter how functional or appropriate, instantly morphs into the danger-ridden overwhelm of the original abandonment. The capacity to selfnurturingly weather any experience of depression, no matter how mild, remains unrealized. The original experience of parental abandonment devolves into self-abandonment. The ability to stay supportively present to vital aspects of inner experience gradually disappears.

Deconstructing self-abandonment. We can gradually deconstruct the self-abandoning habit of reacting to depression with fear and shame, inner critic freak out , and 4F acting out. The processes described in this article and my paper: Managing Emotional Flashbacks in Complex PTSD [also available on the aforementioned websites] awaken the psyche s innate, developmentally arrested capacity to respond amelioratively to depression and the fear and shame that attaches to it. This is typically a long difficult journey, however, because our culture routinely humiliates any expression of fear, and depression is often seen as an unpatriotic violation of the pursuit of happiness . Taboos about depression even emanate from the psychological establishment, where some schools strip it of its status as a legitimate emotion C dismissing it simplistically as mere negative thinking, or as a dysfunctional state that results from the repression of somewhat less taboo emotions like sadness and anger.

Healing progresses when we learn to distinguish depressed thinking C which can be eliminated C from depressed feeling C which must sometimes be felt. Occasional feelings of enervation and anhedonia are normal and existential - part of the admission price to life. Moreover, depression is sometimes an invaluable harbinger of the need to slow down, to drop down internally for rest and restoration. At its healthiest, depression accesses a unique spring of intuition, such as that which informs us of the obsolescence of a once valued job or relationship.

Overreaction to depression essentially reinforces learned toxic shame. It reinforces the individual s belief that he is unworthy, defective and unlovable when depressed. Sadly this typically drives him deeper into abandonment- exacerbating isolation. Deep level recovery from childhood trauma requires a normalization of depression, a renunciation of the habit of reflexively reacting to it. Central to this is the development of self-compassionate mindfulness C the practice of staying in one s body, of staying fully present to all internal experience. Mindfulness cultivates our ability to stay acceptingly open to our emotional, visceral and somatic experience without 4F acting out.

A relational approach to healing abandonment. Most Complex PTSD clients have never had a safe enough relationship. Healing their attachment disorders requires a reparative relational experience with a therapist, partner or trusted friend who has the capacity to stay unreactively present to their own depression and the various affects that attach to it. When a therapist has this level of emotional intelligence, she can guide the client to gradually release the learned habit of automatic affectrejection and defensive reactivity. Safe and empathic eye and voice connection with an individual with good enough emotional intelligence provides a working model and a limbic resonance to help her stay unreactively present to all her affects. Daniel Siegel calls this the coregulation of affect. Moreover, as Susan Vaughan s avers in The Talking Cure, such work appears to promote the development of the inner neural circuitry necessary to healthily manage and integrate depression and its attenuated affects.

Somatic mindfulness. Therapists can guide clients to focus on and stay present to their somatic experience of abandonment fear and depression. Because depression commonly morphs instantly into fear, early work involves staying present to the kinesthetic sensations of hyperarousal and the psyche s penchant to dissociate or distract from them. Dissociation is either the classical right brain distraction of spacing out into reverie, fogginess or sleep C and/or it is the left brain, cognitive distraction of worrying and obsessing. Particularly notable here is the inner critic s dissociative transformation of fear and depression into drasticizing scenarios about the client s imperfections. Over and over, we need to guide the client to rescue himself from dissociation [left and/or right], and to gently bring his awareness back into fully feeling and experiencing the sensations of his fear and noticing his reactions to them. Mild sensations of fear are muscular tightness or tension anywhere in the body, especially the alimentary canal. More intense sensations of fear are nausea, jumpiness, wired-ness, shortness of breath, hyperventilation, electric shock and diarrhea. Although sensations of fear typically feel unbearable at first, persistent focusing with nonreactive attention ameliorates or resolves them C as if awareness itself is digesting and integrating them.

It is important to note here that this type of kinesthetic focusing often triggers memories and unworked through feelings of grief about the client s abuse and neglect in his original abandonment. This provides many invaluable opportunities to ameliorate PTSD by more fully grieving the losses of childhood. Therapists can also use the results of such explorations to foster the creation of an egosyntonic and self-compassionate narrative that deconstructs the shame and self-blame the PTSD client typically assigns to her suffering. I describe a safe, efficacious process for this type of grief work in my book, The Tao Of Fully Feeling: Harvesting Forgiveness Out of Blame.

With considerable practice, the client eventually begins to exhume from his fear, an awareness of the more elemental, underlying sensations of depression C hypoaroused sensations exceedingly subtle and barely perceptible at first. These sensations are initially as difficult to stay present to as those of fear. With guided ongoing practice however, focused attending also digests them as they are integrated into consciousness. As practice becomes more proficient, these feelings and sensations of depression can morph into a sense of peace, relaxation and ease - and sometimes open to underlying, innate core emotional experiences of clarity, confidence and belonging.

Introspective Somatic Work. Therapeutic gains in reducing self-abandonment are augmented by individual work. I was daunted in my own mindfulness work at the frequency with which my awareness yo-yo vacillated between my body and my mind C between tense sensations of fear and the myriad fear-tainted mentations of my inner critic. These catastrophizing thoughts and visualizations were my critic s misinterpretations of my fear, based on unconscious beliefs that I was still stranded in the dangerous abandonment of my childhood. My critic excoriated me incessantly to launch into flight-mode and strive for safety through productivity and perfection. In the first year of this practice I frequently had to white-knuckle the handles on my chair to stay somatically present to my feelings - to stop myself from self-medicating into excessive adrenalization. I had survived my childhood with ADHD-like busyness C with marathons of activity that kept me one step ahead of my fear- and shame-saturated depression. Gradually as I used my focused awareness to ameliorate my fear, I experientially discovered the rock bottom underlying core sensations of my abandonment depression itself. Over and over I focused on sensations of heaviness, swollenness, exhaustion, emptiness, hunger, longing, soreness, deadness. Sometimes these sensations were intense, but more often they were very subtle. With time I noticed how instantly my depression scared me and lead me to echo my parents contempt: You re bad, worthless, useless, defective, ugly, despicable . Blessedly, with ongoing practice, I gradually learned to disidentify from the toxic vocabulary of the critic. I found myself more accurately naming these revisited childhood feelings: Small, helpless, lonely, unsupported, unloved. Over time, this in turn rewarded me with a profound sense of compassion for the abandoned child I was.

Camouflaged Depression. Feelings of abandonment commonly masquerade as the physiological sensations of hunger. Hunger pain soon after a big meal is rarely truly about food, but rather about emotional hunger and the longing for safe, nurturing connection - for the satiation of abandonment. Even after a decade of practice, I still find it difficult to differentiate this type of attachment hunger from physical hunger. One, often reliable, clue is that the sensation of longing for the nourishment of attachment is usually in my small intestine, while physical hunger s locus is a little higher up in my stomach. [I believe sex and love addicts desperate pursuit of high intensity relating is also often an attempt to self-medicate deeper abandonment pain and unmet attachment needs].

Pseudo-Cyclothymia. On a parallel with false hunger, feeling tired is sometimes an emotional experience of the abandonment depression, and entirely unrelated to sleep deprivation C although over time the two can become confusingly intertwined. The emotional tiredness of not resting enough in the comfort of safe attachment and belonging, often masquerades as physiological tiredness. When our abandonment depression is unremediated, any kind of tiredness C emotional or physical - can trigger us into fear, which the inner critic then translates into endangering imperfection , which in turn triggers us into one of the 4F responses. Ironically, over-reacting to emotional tiredness eventually creates real physical exhaustion via a process I call the The Cyclothymic Two-Step. This is the dance of flight types who habitually overreact to their tiredness with workaholic or busyholic activity. Self-medicating with their own adrenalin, they run to counteract the emotional tiredness of unprocessed abandonment depression. Eventually however, many exhaust themselves physically, and become temporarily too depleted or sick to continue running. At such times, they collapse into an accumulated depression so painful, that they re-launch desperately into flight speed at the first sign of replenished adrenalin. Such clients sometimes pathologize themselves as bipolar because of their abrupt vacillations between adrenalin highs and abandonment- exacerbated lows. Also noteworthy here is the futile journey that many survivors undergo treating emotional tiredness with physiologically- based methods. The limited efficacy of such an approach however typically augments their shame: What s wrong with me. I've changed everything in my diet and in my sleep and exercise regimen. I ve seen every type of practitioner imaginable and I still wake up feeling dead tired. I believe the healthiest way out of this cul-de-sac of self-destructive and unwarranted efforting lies in cultivating selfcompassionate acceptance of the inexorability of sometimes feeling tired, bad, lonely, or depressed. In this regard, the notable AA 12 Step acronym, HALT - Hungry, Angry, Lonely, Tired C can remind us to assess whether these feelings are actually signals that our abandonment depression has been triggered and needs the quiet, internal, self-compassionate attention described above.

Conclusion. We can sometimes gain motivation for this difficult work by seeing our depressed feelings as messages from the developmentally arrested child who is flashing back to his abandonment in hopes that his adult self will respond to him in a more comforting and protective way.

Through such practice, clients can gradually achieve the healing that the Buddhists call separating necessary suffering [normal depression] from unnecessary suffering [unconscious stuckness in hopelessness, toxic shame and fear, retraumatizing inner critic acting in, and 4F acting out].

Pete Walker is director of the Lafayette Counseling Center, a sliding-scale agency that specializes in working with complex PTSD, codependency and recovery from childhood abuse and/or neglect. His website www.pete-walker.com, contains many downloadable articles on these subjects. He is also the author of The Tao of Fully Feeling: Harvesting Forgiveness Out of Blame. Information on his CEU class in Relationship Supervision is contained in the classifieds of this issue. He can be reached at (925) 283-4575.

Empowering Parents of Young Adults with Drug/Alcohol Problems: Taking the Failure out of "Failure to Launch"

(Past member) — Wed, 04 May 2011 20:36:06 GMT

By April Wise

April Wise Ned and Carla came to their first session looking like other successful 50-something couples in their upper middle class community. They were well dressed and socially appropriate. Their amiable introductions belied sadness and a sense of failure which quickly became clear as we started to talk. Their son, Eric, now 28 years old, had moved back in with them again, this time while being treated for a detox prescribed by their M.D. for withdrawal from addictive prescription drugs. As their story unfolded, I noticed the similarities of their story with others, now all too familiar.

Eric had partied in high school. Carla and Ned had worried, but saw him start into college hopeful that he'd find his way and not get any deeper into drugs and drinking. Then followed several years of not making grades, dropping out of classes, some legal skirmishes; an arrest for possession, a DUI. Each time he returned home, Carla and Ned tried to be understanding, and employed different strategies to help. In between starts and failures of school, Eric sometimes worked for short jobs which never seemed to last, and had many reasons why he couldn't commit to anything. Seeing his frequent mood swings, his worried parents decided he was depressed, and offered counseling and/or medical help. They moved him to other towns and supported him with rent on apartments. They tried not to interfere but became reluctant to leave him home alone when he was living with them because of disturbances when they were gone, and/or money and property missing or damaged when they came back. Carla described living with Eric as feeling like a hostage in my own home. At the same time, she and Ned wondered what they were doing wrong that Eric could not succeed at anything. His failures became their failures.

The crisis precipitating their call to me started when, several months prior, Eric's landlord called complaining of non-payment of rent. Suspicious and concerned since they had been sending money regularly to Eric for support, Ned decided to make a surprise visit to Eric's apartment. To his dismay, he found Eric in the apartment, clearly high on drugs, with paraphernalia cluttering the filthy room. He persuaded his son to come home, and contacted their M.D. who diagnosed opiate dependency and put him on buprenorphine and what s called an ambulatory detox. With little information about his prognosis, Ned and Carla were adrift about what to do next.

When seeing parents, whether couples like Ned and Carla or single parents, first (and throughout) I try to help them rebuild a sense of selfempowerment.

Empowering includes frankly discussing what the parents know about their child's problems with drugs/alcohol and the extent of the involvement . I recommend that they become educated on chemical dependency and treatment options. I refer them to websites such as www.SAMHSA.org and www.nida.nih.gov to give them reading lists on the subject. This also helps the parent to make clearer and less reactive decisions on how to help and when. (Example: paying rent for an apartment in another city isn't going to help just by providing a change of scenery. ) I refer them to support groups, which helps them feel less isolated with the problem.

Empowering the parents to act includes assessing what's worked and what has not. For Eric, early attempts at counseling had not helped; nor had the financial support for school, rent, car payments. Moves, advice, and threats had been equally ineffective.

Much has been written about caring for spouses who are alcoholic or drug dependent, and similarly for children who are still minors. Unique to the failure to launch family is this dilemma: the child is no longer a child; he/she is legally an adult but not living as a responsible adult. Usually the parent is living in fear that if they do not continue to support this child, he/she will end up on the street. Simply put, the child is emotionally too young to handle life's responsibilities, leaving the parent feeling obligated to continue to take care of them. This Boomer generation of parents often did drugs or alcohol themselves, grew up with enough financial security to make life relatively easy, and feel a tremendous guilt from that combination, which makes it difficult for them to say to their adult children; enough is enough.

Children who come back to Mom and Dad because they ve finished school/trade but can t afford to live on their own, or who have been self-sufficient but had some life-event that makes them dependent on a temporary basis is certainly a different story. In those cases, agreements about how long the child might be staying, and for what purpose, is usually enough to allow a healthy transition to happen. Young adults who are responsible but need a temporary hand up , will be willing to pay rent and participate in the household as equals. In most of my Failure to launch families stories, there is a continuing pattern of under-responsibility on the young person's side, superimposed by a parent/parents who are over-responsible and have bailed them out of financial, emotional, social, and sometimes legal trouble time and again.

As Ned and Carla began to understand that drug abuse was a major contributor to Eric's difficulties, they also understood that his failures weren't necessarily their own. In the following weeks I suggested and we worked on the following goals; a structured approach which I find helpful with parents of struggling young adults:

    1. Make a realistic plan about what treatment, if any, should be supported and offered. Make another plan for the eventuality that treatment is refused. Professional help is especially beneficial at this point.

    2. Reduce fear by looking at the resources their child already has. The we can t let him live on the street argument is often very far-fetched when we talk about what their son/daughter has been able to come up with on their own, when left to their own devices! At the very least, we look at what is actually available in the community that would afford shelter if the family makes a decision at some point to withdraw living at home as an option.

    3. Learn and practice emotional detachment . As Milam and Ketcham state in Under the Influence, if the alcoholic's family or friends become emotionally embroiled in these excuses and denials or believe they are somehow responsible for causing the alcoholic's unhappiness, the real problem-the physical addiction- will get sidetracked, and the psychological symptoms will be mistaken as the source of all the trouble.

    4. Refocus their time and energy on themselves. Often the marital relationship is suffering as a result of the stress. The partners, or single parent and other family members may have different opinions on what help to give, or how much money should be spent. Not uncommonly, the son or daughter becomes the confidant of one parent, and uses this to manipulate getting what he or she wants, driving a wedge between the parents. For the single parent, there is the added burden of not having support, and sometimes fear of not wanting to sever a relationship with the child, however tenuous. Parents need to look at what they are giving up in service to their child, and reconsider their own lifegoals.

    5. Understand that their credibility to encourage their child will be less if they are abusing substances or alcohol themselves. However, lapsing into guilt and accepting blame beyond honest acknowledgement will not help their child deal with his/her own issues.

    6. Get support from others, especially Al- Anon, Nar-Anon, or similar organizations. Many treatment programs offer on-going family support and free educational sessions.

Eric's parents decided, after learning about his addiction and the need for on-going intensive support after detox, to offer him 30 days to get into a residential facility or a TLC (clean and sober home for people in recovery 30 days or more). With support, they came to realize that keeping him at home longer would be reinforcing his dependence on them.

In essence, by gaining a new sense of empowerment, the parent/parents are also learning to detach in a healthy way. Jane Adams says in When Our Grown Kids Disappoint Us, Detachment demands that we rethink our priorities and shift them from our kids to ourselves. It requires us to see them for who they are, which is not us, and even if she has her mother's gift for languages or he is the spitting image of his father; we are separate individuals with separate lives on which neither has a permanent claim. Our detachment forces them to take charge of their own lives. It allows us to go on, despite the fact that our questions about why this happened to our kids-and yes, to us- will probably never be answered...

Carla and Ned continue to work on feeling empowered to make changes. Eric did decide to live in a TLC. His recovery, like most, has its ups and downs. His parents are feeling more at peace with letting him make his own decisions, and imparting that stance is allowing Eric to have more confidence in himself. Meanwhile, they have begun to take more enjoyment in their friends, activities and each other.

April Wise, MFT is a Psychotherapist, EMDR Consultant and Instructor. She has been in practice for twenty years, specializing in family relations, addictions, and co-occurring disorders. She is adjunct faculty at JFKU, and has taught for U.C. Berkeley Extension and Cal State East Bay in Addictions Studies and Treatment of Trauma. For more information about April Wise see: www.aprilwisemft.com.

Ethical Standards for Marriage & Family Therapists

(Past member) — Wed, 04 Mar 2009 00:24:09 GMT

Marriage and Family Therapists (MFTs) are dedicated to advancing the welfare of individuals and families. They respect the rights of those persons seeking their assistance, and make reasonable efforts to ensure that their services are used appropriately.

MFTs do not disclose client confidences except as required by law, or when permission has been granted by the client.

MFTs terminate or transfer a client when it is reasonably clear to the therapist that the client is not benefiting from their therapeutic relationship.

MFT's are legally and ethically prohibited from having sexual contact with clients or their spouses. For further information, the California Department of Consumer Affairs publishes a pamphlet about this entitled, "Professional Therapy Never Includes Sex." To obtain copies of this pamphlet, contact the board of Behavioral Sciences, at 400 "R" Street, Suite #3150, Sacramento, CA 95814

For the complete text of ethical standards, go to www.camft.org and click on "What Is CAMFT?"

When to Seek Help

(Past member) — Tue, 03 Mar 2009 00:22:19 GMT

All of us in the course of our lives go through a series of normal and expected challenges. These challenges have possible pitfalls, and many individuals and families need support and guidance to cope. Events such as a new baby in the family, troubled adolescent, or coping with an aging parent will affect how people function. We may also face other problems and crises such as unemployment, a sudden or chronic illness, divorce, or a death in the family.

People facing these and other such problems can often benefit from the professional services provided by MFT's.

Some signals of distress are:

Overwhelming anxiety or fear
Feelings of hopelessness
Sleep disturbances
Sexual disturbances
Unexplained fatigue
Excessive alcohol or drug use
Lack of interest in previously enjoyed activities
Excessive loss or increase in appetite
Excessive weight gain or loss

Seeking professional assistance is a courageous step and shows an awareness and a willingness to grow and change.

Looking For Help

(Past member) — Mon, 02 Mar 2009 00:16:58 GMT

Seeking a Marriage and Family Therapist or other mental health professional to assist with life's difficulties is a sign of courage and a step in the right direction to deal with the many challenges of life.

When to Seek Help

Ethical Standards for Marriage & Family Therapists

Marriage and Family Therapists (MFTs) are dedicated to advancing the welfare of individuals and families. They respect the rights of those persons seeking their assistance and make reasonable efforts to ensure that their services are used appropriately. read more

What Is a Marriage & Family Therapist?

Marriage and Family Therapists (MFTs) are relationship specialists. MFTs are trained to assess, diagnose, and treat individuals, couples, families, and groups to achieve more satisfying and productive marriage, family, and social adjustment. Our practice also includes such areas as premarital counseling, child counseling, and divorce or separation counseling.

Marriage and Family Therapists are licensed by the State of California. The requirements for licensure are a two-year master's degree or a related doctoral degree, 3000 hours of supervised experience, and passing a comprehensive written and oral examination.

A Registered Intern is a person who has an approved masters degree and is in the process of accumulating his or her hours of supervised experience. They are permitted to do counseling with clients while under the direct weekly supervision of a licensed MFT or other licensed practitioner.

The letters MFCC after a therapist's name stand for Marriage, Family, and Child Counselor. Marriage and Family Therapist (MFT) is synonymous, and can be used interchangeably.

Psychotherapy services of licensed MFTs are eligible for insurance reimbursement in most instances.