I’m settling in for my second shift for my university’s crisis line, and my first overnight shift. It was a beautiful day, and it was difficult to drag myself into our underground lair, but here I am until 8 tomorrow morning. It’s a pretty nice little room, painted earth tones and with lots of nice nature photography framed on the walls. I have my own bathroom, TV, computer, fridge, microwave, bed, and, of course, coffee maker. I don’t plan on drinking any coffee. If no one calls, I’d like to be able to get to sleep tonight. I’m anticipating being able to sleep fine. It’s very quiet here, and the room gets very dark with the lights off. That is, unless someone calls–the phone rings very loudly. And it’s also possible that the possibility of getting a call will keep me up–I haven’t had a call yet. We’ll see!

The first thing I do is make sure the phones are working. We have two, one for crisis calls, and one backup. I have a backup colleague and two supervisors that I can call or text if I get in over my head. I can also bring them in on a three-way call, if it seems the right thing to do. I don’t anticipate that, but it’s nice to know I can. They are all very experienced at this job.

The next thing I do is look over the call sheets since my last shift. Every call gets its own sheet. It’s been pretty slow in the last week–only a few calls. It’s tempting to think that that means it’s unlikely I’ll get a call tonight, but I have no idea. I also looked back a couple months to see if there was any easily recognizable pattern for Friday shifts, but there wasn’t. Just in our current call sheet book we have calls going back about a year, and I believe that we have sheets for many years around somewhere. This line has been running for about 40 years. (And, unfortunately, the administration is shutting us down at the end of this term, for beaurocratic reasons.) I would love to enter all this info into a stats program and look for patterns! I don’t believe I would be allowed to do that, though. There would be no way to get consent from our past “research participants.” The line is totally anonymous.

The next thing I do is look at our “regular caller” book. I didn’t know this about hotlines, but there are people who use them regularly, mostly very isolated individuals, taking advantage of a free, professinal listening service to help them deal with their troubles. Pretty smart thing to do, really. It had never occurred to me. We have extensive files on these folks, sometimes going back decades. They have “contracts,” too–agreements they’ve made with us about how often and what times they can call, because they don’t tend to be in crisis, just needing some listening. The regular caller book has all the regular caller call sheets, a record of their current contracts, and a list of their calls with how much time they have left until a certain date.

Then I wait for someone in crisis to call. We define a crisis as a situation where a person’s stress overcomes their ability to cope. This can happen a lot of different ways. Our call sheets have the following categories, in addition to “other”: academic, alcohol/drugs, anxiety (popular one), bereavement/grief (another popular one), depression (popular), domestic violence, eating disorder, harassment/descrimination, homocide, information/referral, interpersonal/relationship (popular), loneliness, medical/somatic, psychosis, sexual abuse/rape, sexual concerns, sexually exploitive (this is where a caller tries to use us as a masterbation aid), sexual orientation/gender ID, and suicide (also popular).

When someone calls, I am to go through a six-step process with them. 1) Assess for immidiate danger (“Are you in a safe place to talk?”), 2) establish communication and rapport, 3) assess the problem (keep it to one–the biggest problem–and make it specific, as vague problems are almost impossible to solve), 4) assess strengths and resources, 5) formulate a short-term (tonight) and long-term (tomorrow) plan, and 6) mobilize the client, obtaining commitment to the plan and contracting for safety if they have been thinking about suicide. Throughout the process I am to be assessing the potential for suicidality, listening for clues like “feeling overwhelmed,” “worthless”–any indication that they might be thinking about hurting themselves. If that comes up, I have another process to go to. Maybe I’ll write about that in another post.

Well, wish me luck. I’m not sure what being lucky would be. It’s easy to hope for no calls–“no news is good news,” as my dad likes to say. On the other hand, if someone is out there in trouble, I really want them to call. I’d feel lucky to get to help someone out of a jam. That’s something to know. Crisis line workers want you to call if you need help. We’re not particularly doing this for the money. I make something like $85 per shift. Not a lot.

If no one does call, I’m planning to study until I get tired and then go to bed. I’ll let you know what happens. I won’t be able to tell you the details, of course, but I can say if I got a call.

Or one in four, if you prefer a less “conservative” definition of rape.

I learned this in my training for the University of Oregon Crisis Hotline. It makes me sick. The statistics are from the US Department of Justice. Here are three others, from the USDJ as reported in my training manual:

80-90% of these rape victims know the perpetrator.

Though it meets the legal definition (basically, forced sexual intercourse, vaginal, anal, or oral, with a body part or object, though it varies some by state) half of rape survivors do not label their experience rape.

Less than 5% of rapes are reported.

I posted in February about how the committee that is redesigning the DSM is accepting feedback on their proposed changes. The Diagnostic and Statistical Manual of Mental Disorders is the book used around the world by clinicians to determine what kinds of human suffering count as mental disorders, what symptoms one has to show to qualify as having one of those disorders, and what what can get covered by insurance. The content of this book will shape the lives of those who will interact with the mental health system for the next generation. Being labeled with a mental disorder is a big deal, and which one you get can mean the difference between decent and indecent treatment. Personality Disorder? You’re pretty much screwed. Very few people think they can help you and no insurance will cover you. Adjustment Disorder? PTSD? You’re in luck, most likely. We’re all very hopeful for, and will pay for, your recovery.

If you’re life has in any way been affected by anything labeled a mental disorder, I encourage you to look at the appropriate proposed changes to your future and the future of your loved ones, and write them an email about what you think. You have until April 20, 2010.

Structural, Cross-Cutting, and General Classification Issues for DSM-5
Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
Delirium, Dementia, Amnestic, and Other Cognitive Disorders
Mental Disorders Due to a General Medical Condition Not Elsewhere Classified
Substance-Related Disorders
Schizophrenia and Other Psychotic Disorders
Mood Disorders
Anxiety Disorders
Somatoform Disorders
Factitious Disorders
Dissociative Disorders
Sexual and Gender Identity Disorders
Eating Disorders
Sleep Disorders
Impulse-Control Disorders Not Elsewhere Classified
Adjustment Disorders
Personality Disorders
Other Conditions that May Be the Focus of Clinical Attention

One thing I will have to assess in the families I see is possible drug/alcohol abuse, because substance abuse is pervasive, problematic, and interpersonal. One of my texts, Procedures in Marriage and Family Therapy, recommends using “objective” measures such as the Michigan Alcoholism Screening Test (25 items), or the MacAndrew Alcoholism Scale of the Minnesota Multiphasic Personality Inventory (49 items), to give weight to the assessment. However, it also says that there is a correlation of .89 (that’s very high) between answering yes to two or more of the following four questions  and alcohol abuse (p. 47):

1) Have you ever felt you ought to cut down on your drinking?

2)have people annoyed you by criticizing your drinking?

3) Have you ever felt bad or guilty about your drinking?

4) Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye opener)?

Also, they list Heilman’s eight symptoms of alcoholism:

1) Thinking or talking a lot about drinking or getting high.

2) Increased tolerance. This is not a sign of health!

3) Drinking or taking a drug in a way that speeds up the onset of its effects.

4) Non-social use.

5) Drug/alcohol starts to seem like a medicine. Thoughts of drug/alcohol immediately upon a stressful event.

6) Blackouts. “How did I get home last night?”

7) Taking care to always have a supply of alcohol/drug.

8) Using more than planned.

Finally, Heilman says that anyone who answers yes to the question “Is your drinking ever different from what you would like it to be?” is very likely suffering from alcoholism (p. 48)

I will start seeing clients this summer, so I’m reading two texts about how to structure my sessions, Procedures in Marriage and Family Therapy, by Brock and Barnard, and Essential Skills in Family Therapy, by Patterson. One of the things I am to assess as a top priority is the possibility of family violence. (I’ll get a whole class on this next year.) It’s almost always perpetrated by a male. According to Patterson, battering is the biggest cause of injury to women. Here is Brock & Barnard’s list of characteristics that can help identify violent men (p. 46):

1) Believes in the traditional home, family, and gender stereotypes

2) Has low self-esteem and may use violence to demonstrate power or adequacy

3) May be sadistic, pathologically jealous, or passive-aggressive

4) Has a Jekyll and Hyde personality, capable of great charm

5) Believes in the moral rightness of his violent behavior even though he may go too far at times

6) Has perpetrated past violent behavior, which includes witnessing, receiving, and committing violent acts, violent acts during childhood; violent acts towards pets or inanimate objects; and has criminal record, long military service, or temper tantrums

7) Indicates alcohol abuse

To this list, Patterson adds preoccupation with weapons or control.

I’ve been tracking my driving and biking mileage since my last birthday, just over six months. I just broke 400 miles on my bike, so I thought I’d figure out my mileage ratio. I’m at 401.8 miles on my bike and 3,283.2 miles on my truck. That’s 1 to 8.17 biking to driving, or 12.24% biking.

That’s pretty good, I think, considering I’m just a commute-cyclist. I drove less than half of the average miles for an American (7,500  in six months, according to WikiAnswers) and biked 37 times the average American miles (using 6.2 billion miles biked in 2001 from the Bureau of Transportation Statistics, and 285,669,915 people in the US in 2001, according to the GovSpot.com, giving about 11 miles per person per six months, if my math is right.)

I expect my biking to catch up some to my driving, too. I drove to Joshua Tree for Christmas this year, accounting for over 2,000 of my driving miles, and I won’t be making another trip like that for quite a while. Without that trip, I’d be at about 1/3 of my miles biked.

Hmm… maybe next year I’ll track my walking too. That would be cool to know.

My parents forwarded me an email from a family friend, Lauren (musician and poet), who is going off email for six months. She’s concerned about distraction (including in her email the quote “It’s commonly believed and understood that it takes about 4 minutes to recover from any interruption. If the computer dings at you and you look 30 times, that’s 120 minutes of recovery time. That’s the crisis.” —Marsha Egan, Author of Inbox Detox), concern over what seems like addictive behavior, valuing face-to-face or at least voice-to-voice communication, and this article about a study which found that emailing reduced productivity more than pot.

She had a series of questions about it email and her project, which I answered. By email. I think she’s starting on April 14, but if she’s already started,she can read my answers in six months.

1.     How many times a day do you check your email?
I don’t know. It varies between one and many–20?–depending on the style of my day. There have been days that I don’t check–camping, procrastinating. If I need to concentrate, I do not check email or even keep a browser open until I’m done.
 
2.     How many times a day do you send or receive a text?
Zero. I sent one text in my life, just to try it out, and I strongly encourage my friends not to text me. It doesn’t appeal to me. I’m also vaguely offended by the use of “text” as a verb.
 
3.     Have you ever had a miscommunication via email or text?
Yep, at least a few. It took a while to realize that the pragmatic (i.e. non-verbal) context of communication really does not come across in email.
 
4.     Do you feel anxious over the thought of not having email for
six months? Do you feel anything negative at all? Happy? Just tell me
how you think you would feel.
Hmm. It would be tough. First of all, I’m in grad school and email is how all of my profs and peers communicate important info. We often get our reading over email, and turn in our papers, too. Second, I’m in a long distance relationship, and email is helpful in keeping a sense of connection. We depend mostly on Skype, which is allowed in your plan, but I wouldn’t want to give up email before Reanna and I are living in the same house. Plus, she emails me mp3s of her reading articles I’ve been assigned, so I can “read” while cleaning my kitchen. Plus, she edits my writing over email. Third, I’m so busy that losing the super quick, no-strings-attached communication ability would mean isolating myself even more from my geographically dispersed family and community. Last, as I understand it you are going off of Facebook, blogging, texting, messaging, and chatting as well as email. That all sounds fine except for blogging. I’m pretty attached to my blog. It’s my most consistent form of creative expression these days.
 
On the other hand, I feel relieved and relaxed when the power goes out, and a big part of that is losing the computer. I went to a lecture years ago by a woman whose name I can’t remember who said “You’re not ‘connected,’ you’re ‘tethered.’ She recommended taking vacations from the leash–phone included. That appeals to me. When I climbed Mt. Whitney, ten years ago, two behaviors really confused me, seeming to miss the point: At the summit, a few people lit up a cigarette and many people immediately called home. It seemed like in sharing their moment they were also missing it. At least they weren’t texting, I guess.
 
 5.     Do you think there is anything important to be learned/gained
by not having email for six months?
Yes.
 
6.     Do you use email more for work related messages or for
family/friend correspondence?
Mostly school. Family and friends second. Work a distant third.
 
7.     How do you feel about me not emailing you for 6 months?
Well, we haven’t communicated in years, so I don’t feel much about it. If we were close I might have feelings.
 
8.     Are you sitting with a Bluetooth in your ear, reading and
sending a text with one hand, eating soup with the other, glancing
frequently at your To Do list, all on your twenty minute lunch break?
Don’t feel bad. While writing this letter I checked my email 3 times,
ate handfuls of dry Panda Puff cereal, and listened to my sweetheart
talk about his online class.
No, actually, I’m sitting at my first shift on the University of Oregon Crisis Line, waiting for someone with a crisis to call me. I do have my cell phone with me (and will almost certainly use it at least once), I am (obviously) using email, and have a to-do list that you wouldn’t believe, but I doubt that I’ll check my email more than three times today. Mostly I’ll be reading about counseling gifted children, assessing families, and conducting group therapy.
 

April 9, 2010

Dear Nathen,

We are very pleased to inform you that you passed the comprehensive exam. Our standard in grading this exam is high; your work was of a very high quality. Congratulations!

You have worked very hard and you have demonstrated excellent understanding of core course material. We look forward to working with you as you move into your clinical work. In the Beginning Practicum course Dr. Tiffany Brown will continue to inform you about the Advanced Practicum course, about internship options throughout the community, and about orientation dates and plans for beginning at the Center for Family Therapy.

The vast majority of your cohort received a passing score this year. This is a statement of both your individual abilities and the support you give each other.

Again, congratulations.

Deanna Linville, Ph.D., LMFT

CFT Program & Clinical Director

Assistant Professor

Couples and Family Therapy Program

University of Oregon

I’m reading Froma Walsh’s Spiritual Resources in Family Therapy (1st edition) for my Wellness & Spirituality Throughout the Life Cycle class. Here’s a quote:

“Active congregational participation as well as prayer tend to become increasingly important over adulthood. Whereas only 35% of young adults aged 18-29 attend their place of worship weekly, 41% of persons aged 30-49, 46% of those  aged 50-64, and 56% of those over 65 attend weekly.”

That quote is from the 1999 edition of the book, and so those numbers are probably based on a survey conducted in the 1990s. The source is not cited, so I can’t be sure, so take this criticism with a grain of salt. I’m just using this example to point out something that happens a lot with the analysis of age-based research. That is, this presentation makes it sound as if humans attend church more and more as they get older, but these numbers say no such thing.

What these numbers say is that at the time of the survey, 35% of young adults say they are going to their place of worship weekly and that each age group above them at this time show more of that behavior. Each generation has its own characteristics. It may well be that this group of young adults is part of a less church-going generational cohort, which will stay more or less that way as they age. Imagine, for example, that such is the case and the next generation that comes along attends church more often. A survey at that time will show that place-of-worship attendance is relatively high in young adults, drops off in middle age, and then resurges in old age, and many will assume, based on that, that this is the “natural” progression of human church-going behavior.

As far as I know, Walsh is accurate in her analysis, based on information she is not giving. It’s a potential error to be aware of, though, and one often overlooked by researchers in psychology. I’ve noticed it often since reading Strauss & Howe’s Generations. They make the point really well, that we often think that increasing age causes people to become more or less something-or-other–more conservative, say–basing our reasoning on the generational cohorts that are currently alive, but it may just seem that way because of the quirks of our sample.

In order to know, we would need more information than this snapshot. We need multiple surveys conducted over quite a period of time, while different generational cohorts were alive, to get longitudinal information. Does each generation attend church more and more as it ages? Is the difference in church-going between a generation in its young years and that generation in old age greater or less than the difference between that generation and another generation entirely?

On Friday I had my first Wellness & Spirituality Throughout the Life Cycle class in my couples and family therapy program. We had an open discussion of the meaning of spirituality that got pretty tense. I admit that I was pretty confused about what was making things tense–I was not in the clearest of minds, as I’d just taken comps the day before. It did get me thinking about Ken Wilber’s essay in Integral Spirituality about the four meanings of the word spirituality. In it, he says that there are at least four very common ways that people mean that word, and that if the specific meaning is not made clear it can lead to confusing and confused arguments. Here’s my paraphrase of his four common meanings:

1) Any human intelligence, skill, or ability taken to the highest level. Think Einstein’s intellect, Carl Rogers’ empathizing. In Kosmic Consciousness, Wilber mentions Michael Jordan playing basketball as an example of this meaning of spiritual.

2) Spirituality as its own kind of human intelligence, as in James Fowler’s Stages of Faith. Wilber cites Fowler’s stages  as just one example: Humans have a capacity for faith that can progress throughout their lives, from an “undifferentiated faith” at infancy through stages like “mythic-literal faith” and eventually, possibly, to “universalizing faith” as his furthest potential.

3) Spirituality as a state of consciousness, as in meditative states or other meaningful altered states. Also peak experiences.

4) Spirituality as a facet of personality or personality type. People who are very compassionate or loving, for example, might be described as spiritual.