decisions


I have always driven slow cars. It’s not that I have anything against fast cars, though. It was more or less an accident, aided and abetted by poverty. When I was young and wanting to drive fast, I got my first slow car, an extravagant $1,200 gift from my grandmother, a 1979 Honda Civic. It would go about 80 miles an hour with a tail wind, and I managed to get a few speeding tickets in it before I turned 20. It looked just like this except with a lot less paint:

1979 Honda Civic CVCC Hatchback

I bought my second (and current) slow car at 20, a 1988 Mazda pickup, and got my next and final speeding ticket a few months later. I was on the I-5 just south of Corning, CA. The Highway Patrol officer said, “You were going well over 70 miles per hour.”

I decided at that moment that speeding was not worth it. It was expensive and stressful because of the tickets and because of constantly watching the rear-view. “Oh crap, is that a Mustang? Is is black and white, or is that just sun glinting off of it?”

So why would I want a fast car? If I can get speeding tickets in slow cars, why would I want to tempt myself with all that velocity-headroom? No reason I could think of, until now.

Reanna and I just drove to Joshua Tree from Whistler in a fast car, a 2001 Acura 3.2CL. Borrowed. The owner told us he’d been clocked by radar at just under 150 miles per hour, and then the officer who clocked him (after he was off duty) drove it just over 150.

Still, I was not much tempted to speed. My aversion to paying speeding tickets has only grown over the years. But I realized that velocity is not the real reason to have a fast car. It’s acceleration. Driving is a series of decisions about what is safe to do. Is it safe to pass this slow car? Do I have enough room to change lanes? Make this left turn? Etc. In my Mazda, the answer is very often, “No, I’d better not.” In my decades of driving it, all those “No” decisions became invisible. It’s not a choice if there’s only one choice, right? In the Acura, even with my habitually conservative driving style, the answer is usually “Yes, no problem at all.” A very different experience!

Fast Car, Slow Car

And even though I was still driving the speed limit, I think that all those “Yes” decisions add up to to a faster trip, especially on a long trip like we just made. I continue to think that fast cars are probably not worth the extra money for the purchase price or for the lower gas mileage, but I concede that fast cars probably increase your quality of life.

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I just went to my first Alcoholics Anonymous meeting. It was the closest one I could find using a Google search–a few blocks from my house, maybe a four minute ride, in a house that I’ve passed hundreds of times. I didn’t expect that. I probably would have guessed that there were something like five or ten AA meetings in all of Eugene and Springfield, but when I searched “Eugene 12-step meetings” I immediately had a list of one hundred and seventy-eight meetings within 15 miles of my zip code. One hundred and thirty-four of those were AA, most of the rest were Narcotics Anonymous, and some were Gamblers (4) and Overeaters (10) Anonymous. They happen every day of the week, from early in the morning until late at night. This movement is huge. No one knows exactly how big because there is no registry, no dues, and the meetings are self-organized, but there were 10 people at my meeting, and this was Halloween night. If 10 is average, that’s something like 1,800 attendees per week, though there is certainly lots of overlap–people attending multiple meetings. Still, that’s a lot of people sitting in a lot of meetings, and that’s in an area with a population of about 200,000.

It was interesting to be so outside of my normal social bubble. I was nervous to go, and nervous when I got there, but everyone was super nice. There were 6 boomers, 2 X-ers (including me), and 2 millenials. I guessed a few were middle class and the rest working class. I’ve been working class my whole life, but these days my social circle is mostly upper-middle, with thin skin and clean hands. My eyes were drawn to the “mechanic hands,” with grease practically tattooed into the grooves of the fingers, and the rough, thick faces of hard lives. We sat in a circle, introduced ourselves, and started reading from Alcoholics Anonymous, the Bible of AA. We each read a paragraph and then passed to the next person. About half of us had what sounded like a grade-school reading level, another reminder of the thin slice of society I live in, so highly educated.

The story was about a rich alcoholic, who failed to get sober in the US and went to Carl Jung in Europe, who also failed to cure him. Apparently, after some effort, Jung told him something like “I have never had any success helping your type of drunk. Sometimes a spontaneous spiritual epiphany can do the trick, and I have been trying to produce that in you, but have failed. You are a hopeless case.”

The format was that anytime anyone felt moved to speak, they would pipe up: “I’m so-and-so, and I’m an alcoholic” and then tell their story or make their comment on the reading. I found it moving to hear their stories and even just to cop to being alcoholics. There was clearly power behind that ability to admit powerlessness. One woman shared about how her life before sobriety was “insanity,” not only in that she was constantly miserable to the point that she felt like her life was “hell,” but in that “What I thought or what I decided about drinking had no impact on whether I drank that day.”

A lot of the readings for my Modern Issues in Addiction class are critiques of the 12-step model, the “disease model,” of addiction. The in-vogue model in post-modern circles like my Couples and Family Therapy program is the “harm-reduction model,” which is secular, so it requires no spiritual epiphany to reorganize the addict’s behavior, and is not aiming at abstinence, but at reducing the damage done by the addiction. One reason harm-reduction is appealing is that you are allowed to count positive outcomes that fall short of abstinence; isn’t it a victory if someone who used to get drunk every night now gets drunk just 3 nights a week? Yes, I think so. Another reason harm-reduction is appealing is that God, even as vaguely defined as it is, is such a dicey topic, hard to manualize for therapy, hard to justify getting behind for us multiculturalists, not wanting to offend the atheists or the theists who have another word for God. The AA God has a male pronoun, for God’s sake. So unhip. It’s hard for us to get behind a program that is not for everyone.

The critiques of the 12-step model have all been theoretical critiques of theory–a form which is quickly becoming my least favorite form of writing. If you have a theory you want to critique, please use data to do so. Please build your counter-theory on data. That would be lovely. The trouble is, the data does not contradict the 12-step model. The summaries of evidence I’ve read (which were written by the critique-ers) basically say that 12-step programs work at least as well as harm-reduction programs, however you measure outcomes, and they work significantly better for addicts who are religious.

The God part of the program was clearly a key part for the folks in my meeting. Two men told harrowing stories about their pre-sobriety days that focused on their denial of their problem. They would go to meetings but they didn’t really “get it” and things got worse and worse. Both described turning-point moments that turned on a prayer. One night, one said in anguish simply, “God, help!” The other said, “Oh, God, I will do anything.” And suddenly they knew that they had a real problem, and that they were personally powerless against it.

I have a difficult time relating to the concept of a second-person God–it’s hard for me to believe anything I can’t directly experience–but I think there is something real and useful going on here. It reminds me of what it’s like to sit in Vipassana meditation. I sit and systematically observe the sensations in my body. It seems as if I have some control over what part of my body I’m focusing on, but I don’t seem to have any control over what sensations I experience in that part of my body. I look and feel what is there, and what is there is given. I am learning to relinquish control over the things that I cannot control. I am practicing not reacting against what is given. And really, how I react is also mostly not in my control, also part of what is given, so I sit with the intention of allowing reality to happen and watch. Suffering is part of the reaction. If I have pain in my body and I react against it, that is suffering. If I have pain and I don’t react against it, that is just pain, which is radically different. And the difference between reacting and not reacting, I think, is grace. It’s my willingness to sit and pay attention, and grace. This is not so different from an alcoholic turning their life over to God. It’s like the serenity prayer, which we said:

God, grant me the serenity
To accept the things I cannot change;
Courage to change the things I can;
And wisdom to know the difference.

When we went around the circle introducing ourselves, each person (just like in the movies) said their first name and that they were an alcoholic. When it came to me I said “Hi, I’m Nathen, and I’m new here.” I was a little nervous about it, but they seemed to like that fine and said “Hi, Nathen!” with just as much enthusiasm as they did for the others.

I’m not an alcoholic. I don’t like alcohol. The first swallow can be pretty interesting, especially if it’s expensive stuff, but after that it starts tasting like something you would scrub your sink out with. I think I inherited that from my mom’s side of the family. That’s how you can tell the Pikes from the in-laws at a family reunion: The in-laws are drinking, the Pikes are not.

I can relate to compulsive behavior, though, mostly around food. And when I say food, I mostly mean sugar. (I seriously considered going to an Overeaters Anonymous meeting for this project instead of AA. I think that I didn’t because I (unfairly, I’m sure) imagined the real food addicts staring at me, maybe hating me in my effortlessly thin body.) At times, I can relate to the woman who said it didn’t matter what she thought or decided about drinking. I can make what feels like a very serious decision not to eat any more cookies today, for example, and then find myself rationalizing my way back to the package. Or ice cream, chocolate, pretty much anything sweet. I can remember sitting, my stomach already feeling kind of bad, looking at a half-eaten bag of chocolate chips, and realizing that I was going to finish those chips. It didn’t matter that I would feel terrible. It didn’t matter that I would have trouble getting to sleep. They weren’t even tasting that good anymore. But I was going to eat them all. I find that disturbing. I think of myself as the kind of person who can and does make decisions and follow through, all the way. That is the kind of behavior psychologists call “ego-dystonic,” or counter to the conception of the self.

So I had my moment of feeling like I was in the right place. It was Halloween night, and they had a big container of candy on a table in the middle of the circle and said, “Help yourself!” It was all crap, in the sense of my intention for this year, “Do not eat crap.” I saw that immediately. I was not hungry, but I wanted some candy. I thought, “I should probably eat a piece or two of that candy to take part in the culture of this group.” I took and ate two Reese’s Peanut Butter Cups–probably my favorite of the crap-class candy–during the meeting. I’m certain no one would have noticed if I hadn’t. My rationalization was just my rationalization. I felt a little guilty for breaking my intention and I noticed my attention going back to the candy throughout the meeting. It was easy not to eat any more, but that may have been because there were no more Reese’s Peanut Butter Cups visible. I would have had to dig noisily through the container while others were reading or sharing.

But while I did have that experience, I don’t mean to make light of the experience of the people at that meeting, or of actual food addicts. I am not a food addict. I have some usually-mild compulsive behavior around food, but not to the point that I’ve ever done anyone wrong or maintained an unhealthy lifestyle. These folks were dealing with something on a whole other level of suffering and trouble. And they seemed to be doing admirably. One man described how when he started craving alcohol, he knew it was time to “reach out”–go to more meetings, call for support, be with good people. As with the others’ sharing, I was moved by his sincerity, conviction, and wisdom.

After an hour of talking, we stood, held hands, and closed with the Lord’s Prayer. I did not expect to be moved by it, but their delivery of the about temptation and evil had such feeling and meaning after hearing their stories:

Our Father who art in heaven,
hallowed be thy name.
Thy kingdom come.
Thy will be done
on earth as it is in heaven.
Give us this day our daily bread,
and forgive us our trespasses,
as we forgive those who trespass against us,
and lead us not into temptation,
but deliver us from evil.
For thine is the kingdom,
the power and the glory,
for ever and ever.
Amen.
Staff of NBTSC

NBTSC 2010 Oregon Staff

I’m in the woods of Vermont, preparing for the start of the east coast sessions of Not Back To School Camp. Today is staff orientation and the campers arrive tomorrow–over a hundred teenaged unschoolers. If I’m counting right, this will be my thirtieth session. I’ve only missed two since 1999.

In our first go-round of our first meeting, Grace asked us to say why we come to camp. This was my answer:

First, because this is where my people gather. The staff here are like family to me and for the rest of the year, they are dispersed. I can visit them one at a time or in clumps, by traveling. Camp is also where I am most likely to meet my future people. I’ve met almost all of my post-high school close friends at NBTSC.

Second, NBTSC provides the perfect supportive atmosphere to practice how I want to be and serve in the outside world: I want to be a space for love and inspiration to show up, strong and clear, for every person who crosses my path.

Third, since NBTSC happens once a year, every year, with the same basic mission, structure, and community, it provides a consistent backdrop to check myself against. My outside life continues to change, but here I am every year, back at camp. How am I showing up differently? How have I grown? Here that is quite clear.

Last, it’s super, super fun. The young people are beautiful, inspiring, and open. There’s lots of music, dancing and hilarity. I love it.

2010 Oregon session one group photo

NBTSC Oregon Campers (session 1) 2010

I like to know what everyone thinks is going on. To this end, about a year ago, I filled up my igoogle home page with feeds from a bunch of different news sources. They are political news sources, for the most part. I don’t care at all about sports or celebrities. I tried to pick stuff from the hard left and hard right and then some mainstream stuff, thinking I could read headlines every day or two and read the articles that grabbed my attention.

It’s not working out that well. I’m too busy to read much. I do glance over the headlines a bit, but there are a lot of them and often my eyes just glaze over. And while I want to know about the rest of the world, I’m even more interested in what my friends and family are doing. If my sister-in-law, Maya, has posted on her blog, or my mom on hers, my brother Benjamin on his, or my friend Jeannie on hers, or my friend Ethan on a couple of his blogs (one about everything and one about his wife Susannah’s struggle with leukemia–both amazing), or several other friends and family with blogs have posted, that’s what I read while I’m brushing my teeth or during whatever scanty extracurricular-reading time appears.

So I need to cull. I’m considering getting paring it down to the few feeds that I actually click on. That would look like this:

Paul Krugman and Thomas Friedman columns at NYTimes.com–occasional reads.

Wall Street Journal feed–very occasional reads.

NPR’s political feed–pretty regular use, but usually just audio clips from “All Things Considered,” plus a nearly-daily five-minute news overview, also audio.

A google news feed gathered from a bunch of sources–very occasional reads.

Plus PsychCentral‘s Mental Health News and Children/Parenting News feeds–pretty frequent reads, a few a week–and Nildoctrine‘s feed for his hilarious feminist political vlogs.

And plus my podcasts, which I have absolutely no problem keeping up with: Left, Right and Center, Planet Money, This American Life, Radiolab, and The Long Now Foundation’s Seminars About Long Term Thinking. These I love the most.

I’d call that a US-centric, left-leaning-centrist list. I’d be ditching my right-winger stuff besides the Wall Street Journal–FrumForum which looked pretty good when I checked it out, but I just haven’t been checking it out, and National Review, whose cartoony headlines and terrible writing meant that I almost never looked at it, and regretted it when I did. I’d ditch quite a bit of left-winger stuff–The New Republic & Mother Jones (cartoony headlines again), Truthdig (generally good but not catching me), and Democracy Now! which I think is great but consistently depressing. Also The Onion, which is hilarious but I’ve stopped looking at it, and a CNN feed, which is weak.

That list doesn’t really do what I originally wanted–covering hard left to hard right–but it seems OK for now. What do you think? I’m interested in the media-intake schemes of anyone who made it this far through my post. How do you make these decisions? Do you think I’m missing anything crucial? Make me some recommendations!

Also, anyone interested in my actual media diet can look at my reading list here.

A while ago I wrote a list of things that almost always make me happy, so I thought I should make a list of things that almost always make me unhappy. For symmetry, you know? In no particular order:

All things “scented”: soaps, lotions, deodorants, colognes, candles, cleaning products etc. I like the smell of roses, hate the smell of rose-scented soap.

Small talk: Please do not talk to me about things that you are not actually interested in.

Unripe fruit: I would much rather not eat a banana than eat a green banana.

Unsalted butter and peanut butter: In these cases, unsalted is often better than nothing, but generally disappointing.

Buying airline tickets. Or, really, buying any pretty expensive item that might not work out as I’d hoped.

Shoes that are the slightest bit uncomfortable in any way. Don’t tell me that they will break in. That’s the line of a lazy and/or evil shoe salesman.

The hard sell. This is the only real downside to being nice–you become a target.

Unpleasant sensations, especially pain, nausea, and cold feet.

Injuries that do not heal or that take a long time to heal.

Bigotry.

Spots on my camera lens that I cannot remove.

Not being able to see the stars for man-made reasons.

Packaging of most kinds.

Dust jackets for books. They are supposed to protect the book from dust? All they do for me is give me another, more fragile, thing to try to keep nice looking.

Being helpless in the face of injustice on any scale.

Bad food, especially Amtrak, airline cuisine.

Almost made the list: mild and sharp cheddar.

In May, this blog got 1,082 “views,” which means that many of its pages showed up on other people’s computer screens for some amount of time in 31 days. That’s my new record, and my first 4-digit month. I got quite excited as the number approached. I was checking my stats page several times a day. It was exciting and uncomfortable. I almost decided that I would not let myself check my stats for all of June. It’s not that I was wasting a lot of time on it, it’s just that I started feeling embarrassed about it.

NME Stats at May 31, 2010

I started this blog as a way of letting my friends and family know what I’m doing and thinking about, as a way of attracting Reanna’s attention (or someone else just like her), as a way of staying connected with friends and family and recording my history as I made it, they way I used to do with a yearly zine of the same name. I knew that writing my ideas publicly made me think more critically about them, and I liked the idea of living out loud, being the same person to everyone.

I’ve accomplished all these things, and this blog has been my most consistent source of inspiration for the last coming-up-on two years. It’s been great. My excitement over breaking 1,000, though, has got me thinking. Am I also trying to be famous?

To be clear, I don’t think I’m getting famous by writing this blog. It’s just making me think and feel about it. Even if I keep this pace up, 1,082 views is only about 34 per day, and I posted almost every day this month. I get a few people I don’t know finding the blog with search engine terms that I’ve written about, like “schizophrenia diagnostic criteria” or “are anti-inflammatories bad for you,” but most of my traffic comes directly here, on purpose. I imagine that means that there are maybe 40 folks who read this fairly regularly, and that’s easily accounted for by family and friends from school and Not Back to School Camp.

Still, 1,000 views means a lot more people are reading my writing  than they were two years ago, and that number could keep going up. My friend Jeannie recently beat 6,000 views and I thought, “Wow, that would be cool!” But there’s no way 6,000 views are all friends and family. A blog with 6,000 views is beginning to hit the public sphere–almost 200 a day. That’s not fame either, of course, but I bet those numbers keep going up, and maybe I could get there too, and I’m feeling a little tension about it.

Part of the tension is aesthetic. My aesthetic ideal of fame is from my music and record production career: I’d like to become just famous enough that fans of my kind of music are waiting for my next project, but not famous enough to get recognized on the street.

I’ve always felt comfortable with that picture, but now I’m becoming a therapist, and it appears that the therapist-fame aesthetic is different. My supervisors tell me that I should be unfindable–no public phone numbers, websites, etc. Clients should not be able to contact me except through the clinic, and they definitely shouldn’t be able to find out about my personal life. I can see the wisdom in that, but I don’t want to do it. I can make my phone, myspace, and facebook private, but I’ve got this blog and my band’s website, plus I show up on other websites that I prefer to be publicly affiliated with, like Not Back To School Camp, my swing dance group ELLA, and my family‘s music sites.

Another part of the aesthetic tension is about transparency. I have to be one person to everyone on this blog. Being the same person to everyone is an ideal for me but makes me uncomfortable. I have psychology-research friends, therapy friends, and co-counseling friends, all of whom would be distressed to some degree to learn how deeply involved I am in each field. My atheist friends can see that when I say I am agnostic, I really mean it. I’m not a hedging-my-bet atheist. I think about God a lot and take the idea seriously. My religious friends will see that I mock fundamentalism pretty regularly. And so on. The more well-known I get, the less I get to show people the parts of me I think they will like and hide the parts I think they won’t like.

And then there is the ethical aspect of fame. In a way, the better known I am, the better off my friends and family are–the more traffic I can drive to our businesses by mentioning them, the bigger audience I’ll have built for books I write or records I make. I can also bring more attention to worthy causes, potential problems, things like my Headlines From Psychology, that people would be better off knowing. The more fame, the more impact. A famous Nathen would be a stronger force for good. If I do say so.

On the other hand, the extent of my fame also forces transparency onto my friends and family, and they don’t all share my aesthetic preference for transparency. I didn’t really get this as an ethical issue until Reanna asked me not to use her last name on the internet. She wants to control what people can find out about her, and who doesn’t? I regularly tell people who video me dancing, “No YouTube!” But it didn’t even occur to me to ask the friends and family I’ve written about whether I could use their full names, or even post their photos. I’ve been considering starting that project soon. I like using full names, talking about real, specific people. So and so said such and such. This, however, a big reason Kerouac died friendless. I guess ethics trumps aesthetics.

[Oh! Here’s my opportunity to make that project easier for myself. If I’ve used your name (or if it seems likely that I will) in NME, please email me your preference: last name or no last name.]

I wrote most of this in early June, not knowing if I my views would continue spiking. It turns out they did not. At the end of June I’m almost exactly where I was at the end of May. I suppose it’s possible that staying level is an achievement, though, since I posted almost every day in May but only every other day in June. I’ve also lost a good deal of my both excitement and tension about my stats, though I still check them every day. Maybe it’s having watched them level off again. I’m tempted to start posting every day again to see if I can get another spike, but I think I’d rather post even less frequently and give myself time for more thoughtful essays. I’ll keep you updated.

I am going to start seeing clients in a few weeks in the clinic at the University of Oregon. Part of that process is beginning to “date a model.” That means I have to choose one of the many styles of family therapy and try it out to see if it’s really my thing. I’m a born generalist and integrator, so this is a difficult choice to make. Below, I typed up the “In a Nutshell: The Least You Need to Know” sections for each family therapy model in Diane Gehart’s excellent book, Mastering Competencies in Family Therapy. (Actually, I’ve left out one–collaborative therapy–because I know almost nothing about it, so it’s not one of my active choices.)

Those of you who know me (and I believe that’s pretty much all of you, readers) and have the stamina to read these eleven paragraphs, I would love to know which of these models you think sounds the most like me.

Systemic and Strategic Therapies: Using what most therapists consider the classic family therapy method, systemic family therapists conceptualize the symptoms of individuals within the larger network of their family and social systems while maintaining a nonblaming, nonpathologizing stance toward all members of the family. Systemic therapies are based on general systems and cybernetics systems theories,  which propose that families are living systems characterized by certain principles, including homeostasis, the tendency to maintain a particular range of behaviors and norms, and self-correction, the ability to identify when the system has gone too far from its homeostatic norm and then to self-correct to maintain balance. Systemic therapists rarely attempt linear, logical solutions to “educate” a family on better ways to communicate–this is almost never successful–but instead tap into the systemic dynamics to effect change. They introduce small, innocuous, yet highly meaningful alterations to the family’s interactions, allowing the family to naturally reorganize in response to the new information. Because this method effects change quickly, systemic therapies were the original brief therapies.

Structural Therapy: As the name implies, structural therapists map family structure–boundaries, hierarchies, and subsystems–to help clients resolve individual mental health symptoms and relational problems. After assessing family functioning, therapists aim to restructure the family, realigning boundaries and hierarchies to promote growth and resolve problems. They are active in sessions, staging enactments, realigning chairs, and questioning family assumptions. Structural family therapy focuses on strengths, never seeing families as dysfunctional but rather as people who need assistance in expanding their repertoire of interaction patterns to adjust to their ever-changing developmental and contextual demands.

The Satir Growth Model: One of the first prominent women in the field, Virginia Satir began her career in family therapy at the Mental Research Institute working alongside Jay Haley, Paul Watzlawick, Richard Fisch, and the other leading family therpists in Palo Alto. [These were the folks who came up with the “systemic and strategic therapies,” above.] She eventually left the MRI to develop her own ideas, which can broadly be described as infusing humanistic values into a system approach. She brought a warmth and enthusiasm for human potential that is unparalleled in the field of family therapy. Her therapy focused on fostering individual growth as well as improving family interactions. She used experiential exercises (e.g., family sculpting), metaphors, coaching, and the self of the therapist to facilitate change. Her work is practiced extensively internationally, with Satir practitioners connecting through the Satir Global Network.

Symbolic-Experiential Therapy: Symbolic-experiential therapy is an experiential therapy model developed by Carl Whitaker. Whitaker referred to his work as “therapy of the absurd,” highlighting the unconventional and playful wisdom he used to help transorm family. Relying almost entirely on emotinal logic rahter than cognitive logic, his work is often misunderstood as nonsense, but it is more accurate to say that he worked with “heart sense.” Rather than intervene on behavrioral sequences like strtegic-systemic therapists, Whitaker focused on teh emotional process and family structure. He intervened directly at the emotional level of the system, relying heavily on “symbolism” and real life experiences as well as humor, play, and affective controntation.

For the astute observer, Whitaker’s work embodied a deep and profound understanding of families’ emotional lives; to the casual observer, he often seemed rude or inappropriate. When he was “inappropriate,” it was always for the purpose of confronting or otherwise intervening on emotional dynamics that he wanted to expose, challenge, and transform. He was adamant about balancing strong emotional confrontation with warmth and support from the therapist. In many ways, he encouraged therapists to move beyond the rules of polite society and invite them selves and clients to be genuine and real enough to speak the whole truth.

Bowen Intergenerational Therapy: Bowen intergenerational theory is more about the nature of being human than it is about families or family therapy. The Bowen approach requires therapists to work from a broad perspective that considers the evolution of the human species and the characteristics of all living systems. Therapists use this broad perspective to conceptualize client problems and then rely primarily on the therapist’s use of self to effect change. As a part of this broad perspective, therapists routinely consider the three-generational emotional process to better understand the current presenting symptoms. The process of therapy involves increasing clients’ awareness of how their current behavior is connected to multigenerational processes and the resulting family dynamics. The therapist’s primary tool for promoting client change is the therapist’s personal level of differentiation, the ability to distinguish self from other and manage interpersonal anxiety.

Psychoanalytic Family Therapies: These therapies use traditional psychoanalytic and psychodynamic principles that describe inner conflicts and extend these  principles to external relationships. In contrast to individual psychoanalysts, psychoanalytic family therapists focus on the family as a nexus of relationships that either support or impede the development and functioning of it’s members. As in traditional psychoanalytic approaches, the process of therapy involves analyzing intrapsychic and interpersonal dynamics, promoting client insight, and working through these insights to develop new ways of relating to self and others. Some of the more influential approaches are contextual therapy, family -of-origin therapy, and object relations family therapy.

Behavioral and Cognitive-Behavioral Family Therapies: In the general mental health field, cognitive-behavioral therapies (CBTs) are some of the most commonly used therapeutic approaches. They have their roots in behaviorism–Pavlov’s research on stimulus-response pairings with dogs and Skinner’s research on rewards and punishments with cats–the premises of which are still widely used with phobias, anxiety, and parenting. Until the 1980s, most of the cognitive-behavioral family therapies were primarily behavioral: behavioral family therapy and behavioral couples therapy. In recent years, approaches that more directly incorporate cognitive components have developed: cognitive-behavioral family therapy and Gottman method couples therapy approach.

Cognitive-behavioral family therapies integrate systemic concepts into standard cognitive-behavioral techniques by examining how family members–or any two people in a relationship–reinforce one another’s behaviors to maintain symptoms and relational pattern. Therapists generally assume a directive, “teaching,” or “coaching” relationship with clients, which is quite different from other approaches of “joining” or “empathizing” with clients to form a relationship. Because this approach is rooted in experimental psychology, research is central to its practice and evolution, resulting in a substantial evidence base.

Solution-Based Therapies: Solution-based therapies are brief therapy approaches that grew out of the work of the Mental Research Institute in Palo Alto (MRI) and Milton Erickson’s brief therapy and trance work. The first and leading “strength-based” therapies, solution-based therapies are increasingly popular with clients, insurance companies, and county mental health agencies because they are efficient and respectful of clients. AS the name suggests, solution-based therapists work with the client to envision potential solutions based on the client’s experience and values. Once the client has selected a desirable outcome, the therapist assists the client in identifying small, incremental steps toward realizing this goal. The therapist does not solve problems or offer solutions but instead collaborates with clients to develop aspirations and plans that they then translate into real-world action.

Narrative Therapy: Developed by Michael White and David Epston in Australia and New Zealand, narrative therapy is based on the premise that we “story” and create the meaning of life events using available dominant discourses–broad societal stories, sociocultural practices, assumptions, and expectations about how we should live. People experience “problems” when their personal life does not fit with these dominant societal discourses and expectations. The process of narrative therapy involves separating the person from the problem, critically examining the assumptions that inform how the person evaluates himself/herself and his/her life. Through this process, clients identify alternative ways to view, act, and interact in daily life. Narrative therapists assume that all people are resourceful and have strengths, and they do not see “people” as having problems but rather see problems as being imposed upon people by unhelpful or harmful societal cultural practices.

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