lists


A few weeks ago, one of my posts received a comment that was worth a whole post:

I am also a therapist (though I’m still in training). I’m wondering if you would be willing/able to recommend some family therapy books you’ve found helpful. My program is very focused on the individual and I’m trying to fill in some gaps and find your perspective on therapy to be very resonant with my own.

I’d love to recommend some family therapy books! My program was extremely family-systems focused, which I’ve been grateful for since leaving school. If you want to see an exhaustive reading list (I can’t remember having been assigned a real dud), you can see reverse-order lists of everything I read in my first year here and my second year here.

I’ll try to create a bare-bones list for you here—much more useful for you and a good exercise for me. I should warn you before I begin that I am super nerdy when it comes to family therapy reading and I can imagine many in my cohort rolling their eyes at my “must-read” list. If you are nerdy like me, though, here goes:

Pragmatics of Human Communication: A classic and profound book by Bateson’s MRI team, the first and probably still the best attempt to apply system theory to human relationships.

Susan Johnson’s books The Practice of Emotionally Focused Couple Therapy and Emotionally Focused Couple Therapy for Trauma Survivors. Johnson combines system-thinking, Rogers-style experiential therapy, and attachment theory, creating one of my most-used therapy models.

John Gottman’s books, especially The Marriage Clinic and The Science of Trust. Gottman has taken up the project started with Pragmatics, largely abandoned by family therapy, and is doing it in fine style, with solid science.

Metaframeworks: This book presents my favorite meta-model of family therapy, combining the best parts of the many family therapy models.

A major work by each family therapy model-builder is also important reading: Haley, Madanes, Satir, Whitaker, Minuchin, Bowen, Selvini-Palazolli/Milan group, Weakland/Fisch/MRI group, deShazer/Insoo-Berg, Epson/White, and Hubble/Duncan/Miller. Keep in mind that their books are presentations of informed opinion, not science. Every one of these folks have got some things right and some wrong. They have also advanced the field significantly, and are the largest part the conversation on how to think about families.

Finally, a couple things that I was not assigned in school, but I found extremely helpful in making sense of the flood of information. First, a grounding in systems/complexity theory: Family therapists think of themselves as system-theory experts and throw around a lot of lingo that they may or may not really understand. It’s easy to get confused in this situation. The best introduction to modern system thinking is still Capra’s The Web of Life (though we’re overdue for an update). Also, check out Bateson’s books Steps to an Ecology of Mind and Mind and Nature. Second, familiarity with Wilber’s integral theory really helped me navigate the heated arguments about modernism vs. post-modernism and intervention at the level of individuals vs. family systems vs. larger systems. Check out Integral Psychology or A Theory of Everything.

I read Whitaker’s Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America as a counterpoint assignment in one of the diagnosis classes in my Couples & Family Therapy program. It was an excellent book about the history and science of several psychological problems, both as phenomena and diagnoses, including depression, depression, bipolar disorder, ADHD, and schizophrenia. As a university student, I had the opportunity to check out for free any of the many academic citations in the book that piqued my interest, and each one that I looked at seemed indeed to provide the evidence he claimed. I haven’t read anything like all of them (there are nearly 700), but enough to satisfy myself that Whitaker has done some good journalism here, and that his hypotheses are credible.

Two of these hypotheses is about childhood bipolar disorder, the first of which he calls the “ADHD to bipolar pathway.” The side effects of stimulants such as those used to treat ADHD are substantially similar to bipolar symptoms, as shown in the table below, from p. 238. (The formatting is slightly different than Whitaker’s, thanks to an Open Office/Wordpress interaction.) Multiplying the estimated rate of stimulant-induced bipolar-like symptoms by the 3,500,000 children and teens taking those medications, Whitaker estimates we should see approximately 400,000 “bipolar youth” as a result.

The ADHD to Bipolar Pathway

Stimulant-Induced Symptoms

Bipolar Symptoms

Arousal

Dysphoric

Arousal

Dysphoric

Increased lethargy

Intensified focus

Hyperalertness

Euphoria

Agitation, anxiety

Insomnia

Irritability

Hostility

Hypomania

Mania

Psychosis

Somnolence

Fatigue, lethargy

Social withdrawal, isolation

Decreased spontaneity

Reduced curiosity

Constriction of affect

Depression

Emotional lability

Increased energy

Intensified goal-directed activity

Decreased need for sleep

Severe mood change

Irritability

Agitation

Destructive outbursts

Increased talking

Hypomania

Mania

Sad mood

Loss of energy

Loss of interest in activities

Social isolation

Poor communication

Feelings of worthlessness

Unexplained crying

The second part of Whitaker’s thinking on childhood bipolar disorder is an SSRI to bipolar pathway. Estimates of the rate of the well-know SSRI side effect of mania, multiplied by 2,000,000 children and adolescents on the medications, give us the possibility of producing at least 500,000 SSRI-induced bipolar disorders in young people.

If true, these hypotheses could go a long way to explain the skyrocketing rates of childhood bipolar disorder diagnoses, as most diagnoses of childhood bipolar disorder are made on children who are already taking stimulants and/or SSRIs. The primary alternative, and more mainstream, hypothesis is not that stimulants and SSRIs are iatrogenic, but that since those medications solve the problems of ADHD and depression, the symptoms of bipolar disorder that emerge show that the diagnostician had initially guessed wrong, and that bipolar disorder was the previously-existing and underlying cause of the ADHD and/or depression. This, of course, may be true, but it seems very important to discover for certain whether it is!

John Gottman is best known for his research on couples (which I’ve written a few things about here) but I think that some of his most important work has been distinguishing two distinct parenting styles: emotion coaching and emotion dismissing. I’m reading his new book, The Science of Trust, right now, and he goes over these findings because it turns out these styles of relating to emotions have big ramifications on building or losing trust in one’s partner. I’ll write more about that as I come to understand it better. (And by the way, if you are a serious couples therapy nerd like me, this book is great. Check it out.)

The basic idea is that parents have different reactions to emotions in their children. We call these reactions “meta-emotions” because they are emotions about emotions. “Emotion coaching” means when an emotion shows up in your child, you treat it as useful information, you engage your child around it in a way that tells them it is OK to have that emotion. “Emotion dismissing” is the opposite. You communicate that they are choosing to have this emotion that you find unpleasant and that making that choice is unacceptable. (This is similar to a problematic parenting technique called “mystification” which I wrote a little about here.)

Clearly this is a potentially complicated phenomenon, because we can have different emotional reactions to each emotion in our kids. We may, for example, have a coaching reaction when a child shows, say, pride, but a dismissing reaction when they show anger. Or vice versa. And our reaction may be different in different contexts, like at home versus out shopping. And other cultural factors are at play, too, like gender or age of the child, which can cause us to react differently. For the following lists, Gottman is using the coaching/dismissing distinction with a broad brush. The list items are direct quotes from pp. 181-188, but the list titles are my paraphrases (note that “affect” is psych-speak for “emotion”):

What Emotion-Dismissing Parents Do:

  • They didn’t notice lower-intensity emotions in themselves or in their children (or in others, either). In one interview we asked two parents about how they reacted to their daughter’s sadness. The mom asked the dad, “Has Jessica ever been sad?” He said he didn’t think so, except maybe one time when she went to visit her grandmother alone and she was 4 years old. “When she boarded the airplane alone,” he said, “she looked a little sad.” But all children actually have a wide range of emotions in just a few short hours. A crayon may break, and the child becomes immediately sad and angry. These parents didn’t notice much of Jessica’s more subtle emotions.
  • They viewed negative affects as if they were toxins. They wanted to protect their child from ever having these negative emotions. They preferred a cheerful child.
  • They thought that the longer their child stayed in the negative emotional state, the more toxic its effect was.
  • They were impatient with their child’s negativity. They might even punish a child just for being angry, even if there was no misbehavior.
  • They believed in accentuating the positive in life. This is a kind of Norman Vincent Peale, the power-of-positive-thinking philosophy. This is a very American view. The idea is: “You can have any emotion you want, and if you choose the have a negative one, it’s your own fault.” So, they think, pick a positive emotion to have. You will have a much happier life if you do. So they will do things like distract, tickle, or cheer up their child to create that positive emotion.
  • They see introspection or looking inside oneself to examine what one feels as a waste of time, or even dangerous.
  • They usually have no detailed lexicon or vocabulary for emotions.

What Emotion-Coaching Parents Do:

  • They noticed lower-intensity emotions in themselves and in their children. The children didn’t have to escalate to get noticed.
  • They saw these emotional moments as an opportunity for intimacy or teaching.
  • They saw these negative emotions–even sadness, anger, or fear–as a healthy part of normal development.
  • They were not impatient with their child’s negative affect.
  • They communicated understanding of the emotions and didn’t get defensive.
  • They helped the child verbally label all the emotions he or she was feeling. What does having words do? They are important . With the right words, I think the child processess emotions usually associated with withdrawal (fear, sadness, disgust) very differently. I think it becomes a bilateral frontal-lobe processing. Withdrawal emotions still are experienced, but they are tinged with optimism, control, and a sense that it’s possible to cope.
  • They empathized with negative emotions, even with negative emotions behind misbehavior. For example, they might say: “I understand your brother made you angry. He makes me mad too sometimes.” They do this even if the do not approve of the child’s misbehavior. In that way they communicate the value, “All feelings and wishes are acceptable.”
  • They also communicated their family’s values. They set limits if there was misbehavior. In that way they communicated the value, “Although all feelings and wishes are acceptable, not all behavior is acceptable. (We had other parents who did everything else in coaching but this step of setting limits, and their children turned out aggressive.) They were clear and consistent in setting limits to convey their values.
  • They problem-solved when there was negative affect without misbehavior. They were not impatient with this step, either. For example, they may have gotten suggestions from the child first.
  • They believed that emotional communication is a two-way street. That means that when they were emotional about the child’s misbehavior, they let the child know what they were feeling (but not in an insulting manner). They said that was probably the strongest form of discipline, that the child is suddenly disconnected from the parent–less close, more “out.”

Teaching by Emotion-Dismissing Parents

  • They have lots of information in an excited manner at first.
  • They were very involved with the child’s mistakes.
  • They saw themselves as offering “constructive criticism.”
  • The child increased the number of mistakes as the parents pointed out errors. This is a common effect during the early stages of skill acquisition.
  • As the child made more mistakes, the parents escalated their criticism to insults, using trait labels such as “You are being careless” or “You are spacey.” They sometimes talked to each other about the child in the child’s presence, as in: “He is so impulsive. That’s his problem.”
  • As the child made more mistakes, the parents sometimes took over, becoming intrusive.
Teaching by Emotion-Coaching Parents
  • Gave little information to the child, but enough for the child to get started.
  • Were not involved with the child’s mistakes (they ignored them).
  • Waited for the child to do something right, and then offered specific praise and added a little bit more information. (The best teaching offers a new tool, just within reach. Then learning feels like remembering.)
  • The child attributed the learning to his or her own discovery.
  • The child’s performance also went up and up.
Outcomes for Children of Emotion-Coaching Parents
  • They had higher reading and math scores at age 8, even controlling statistically for IQ differences at age 4.
  • This effect was mediated through the attentional system. Coached children had better abilities with focusing attention, sustaining attention, and shifting attention.
  • Coached children had greater self-soothing ability even when upset during a parent-child interaction.
  • Coached children self-soothed better, delayed gratification better, and had better impulse control.
  • Parents didn’t have to down-regulate negativity as much.
  • Coached children don’t whine very much.
  • Coached children had fewer behavior problems of all kinds (aggression and depression).
  • Coached children had better relations with other children.
  • Coached children had fewer infectious illnesses.
  • As coached children got into middle childhood and then adolescence, they kept having appropriate “social moxie.”
  • Emotion-coaching parents also buffered the children in our sample from almost all the negative effects of an ailing marriage, separation, or a divorce (except for their children’s sadness). The negative effects that disappeared were: (1) acting out with aggression, (2) falling grades in school, and (3) poor relations with other children.
  • As Lynn Katz, Carol Hooven, and I reported in our book Meta-Emotion, coached children, as they develop, seem to have more emotional intelligence.
Steps to Learn Emotion Coaching
  1. Noticing the negative emotion before it escalates.
  2. Seeing it as an opportunity for teaching or intimacy.
  3. Validating or empathizing with the emotion.
  4. Helping the child give verbal labels to all emotions the child is feeling.
  5. Setting limits on misbehavior, or problem-solving if there is no misbehavior. If the parent doesn’t do this last step, the kids tend to wind up becoming physically or verbally aggressive toward other children.

John Gottman is a rock star of the science of marriage relationships. He studies them in great detail, minute interactions, facial expressions, heart rate, stress hormones. Using that data he can predict with a high degree of accuracy which relationships are heading for happiness or unhappiness, stability or divorce. I should say that this is prediction in a technical, statistical sense, not in the sense of prophecy. He can’t tell you if your relationship will fail, only whether your relationship behaves in similar ways to those that have failed in the past. Still, that’s a lot better than nothing, and it’s been enough for him to build an exciting theory of relationships.

In his theory, the most important, without-which-all-is-lost part of your relationship is the friendship. By friendship, he means several very specific things. Here is a summary of his summary from his newest book, The Science of Trust:

  1. Track your partner’s inner experience by asking lots of questions and remembering the answers.
  2. Make a habit of finding things to appreciate your partner for and letting them know each time you do.
  3. Notice the things your partner does and says that could be responded to, and respond positively to them. Pretty much all of them—you can miss or fail to respond to at most 3 out of 20.

If you are not doing this work, he says, you are not behaving like couples who manage to sustain satisfying, meaningful, passionate relationships, who manage conflict well enough, and who stay together longer than 6 years. Maintaining friendship in this manner is the bare minimum.

Reanna and I explored  LA’s fashion district last week. I think her favorite part was looking at the (to me) bewildering assortment of fabric. My favorite part was this sign, in a frozen yogurt joint near Santee Alley:

We read this sign while eating the store’s product, the most intensely sugary frozen yogurt ever created. This snack was pure entertainment, not food, so the fact that the store was plastered with signs like these was… hilarious?

Another odd thing is the indefinite reference of the sign: is is about the health benefit of blueberries or yogurt? (They offered a few fruits as toppings. We had strawberries on our pina-colada/cheesecake frozen yogurt and they were the only really enjoyable element of the snack.)

Then there’s the singular “benefit” mentioned in the sign, followed by four bullet-points.

Then there are the points themselves. Firstly, the yogurt–or the giant blueberry, or some other thing–“fights and lowers cholesterol.” This may only be funny to me because of all the research I’ve done lately on cholesterol. (I discovered I may have familial hyperchoesterolemia, so I looked into it.) Cholesterol is a kind of fat molecule that our bodies make to use as structural elements in our cell walls, sex hormones, and other stuff. It’s not a poison or virus. Fighting cholesterol makes about as much sense as fighting protein or fighting B vitamins. “Lowers cholesterol” is somewhat less nonsensical, but it turns out that what seems to matter is not so much the high- or low-ness of cholesterol in your blood, but how your body is packaging that cholesterol. If your body is packaging cholesterol in big protein sacks (called LDL) more than in small protein sacks (HDL), then you may be in trouble. And even then, your health risk depends a lot on the size of the big protein sacks that you make–if your big protein sacks of cholesterol are properly big, you are probably OK. If they are relatively small, that is bad news. My point is, this sign’s emphasis on “lowering” serves advertising purposes only.

Next point: “Improves the digestibility of food constituents.” I love the wording. I wonder if they are referring to eating in general, here, as putting food constituents into a digestive tract definitely improves their digestibility.

Next point: “Strengthens the immune system.” Compared to what, I wonder? And what are the units of immune system strength?

And my favorite: “Enhances one’s nutritional status.” I imagine nutritional status is a kind of social status, conferred by eating a big tub of frozen yogurt in public. That would explain why our relatively small portion cost over $7.

I first saw a version of this chart on the fridge door of my complexity theory teacher, Alder Fuller, about eight years ago. I have only been able to find this version, which is associated with the Voluntary Human Extinction Movement (“May we live long and die out”). Maybe the meme made its rounds and died out or maybe it never caught on. I found it thought provoking: And I don’t know how much these Google ngrams can really tell you about the coming and going of memes, but here are a couple:

Use of "ecology" and "deep ecology" in English print since 1880

Deep ecology, anthropocentrism, ecofeminism, environmental ethics, 1980-2008

This was from the lecture “The Mismeasure of Man” by Ralph Horwitz at Stanford. It’s a nice way to distinguish between a few different ideas about our relationship to reality.

1) “I call them how they are.” This umpire believes that he has direct access to reality. In his mind, he just watches what happens and makes the call appropriately.

2) “I call them the way I see them.” This umpire acknowledges the limitation of his senses. He knows he may make a call that doesn’t reflect reality accurately because of his lack of direct access to reality.

3) “They ain’t nothing til I call them.” This umpire thinks he defines reality. Horwitz paints this one as the most arrogant, and he probably is. Whether or not this umpire thinks he has direct access to reality, he knows that he is the person who can say what we call a particular human/bat/ball interaction.

It shows a certain amount of self-awareness to be able to say what the third umpire said, which I admire. It is a kind of awareness that is necessary (though not nearly sufficient) for those of us with the inappropriate power to define the situations of others to give up that power. That is, no matter whether our power comes from race, gender, money, or whatever, we can’t give it up until we understand that we have it.

A note on gender in this post: Horwitz used the title of his lecture as a way to get in an apology about how much more research is done on men than women. He also used male pronouns for his umpires. Thinking that there are probably umpires of all genders, I tried to use “they” instead of “he,” “she,” or variations on “he/she.” It felt like bad writing so I went back to “he.” No offense meant, and if you want to take a crack at it, send me what you come up with.

I’ve often wished I had a biofeedback device that could tell me whether something I was doing was good, bad, or neutral for my body. I have found pain and other sensations ambiguous directors. What are they asking for? This has been especially important in the last few years, dealing with injuries and slower healing. I recently asked my physiotherapist, Shannon, for her general recommendations for reading pain related to an activity. This is what she said:

1) Joint pain is never okay. If you experience joint pain during or after activity something is wrong; consider getting help to figure out what.

2) You should have no muscle pain during an activity (if you do, it means you are doing way too much).

3) Muscle pain after an activity means you are close to the right intensity – try lowering intensity and/or duration for a while and see how you respond.

4) Mild to moderate muscle pain in the next couple days is fine as long as it doesn’t escalate.

5) Each time you add an activity, do it at a constant level for 1-2 weeks before increasing duration or intensity

Another psychometrically-produced typology of love is John Lee’s “colors of love.” Like Sternberg, Lee found three primary styles of love, or “primary colors,” which Lee called eros, ludus, and storge. He found that these styles combined to form three secondary styles or colors, for six love styles total:

Erotic love: Immediate, powerful, exclusive, preoccupying, sexual

Ludic love: Love as entertainment, for pleasure rather than for bonding, commitment-phobic

Storgic love: Stable, not intense, based on bond and shared interests

Pragmatic love: A combination of storgic and ludic love, which Lee called “shopping for a suitable mate.”

Manic love: A combination of erotic and ludic love, obsessive, jealous, self-defeating

Agapic love: A combination of erotic and storgic love, unconditional devotion, difficult to maintain

Here’s a visual of the typology I stole from dating-relationships.co.uk:

Before the mid-20th century, typologies of love were works of philosophy, ethics, introspection, and intuition. In the 1980s, Robert Sternberg produced a typology of love psychometrically, meaning he asked people about their experiences and used factor analysis to determine which experiences tended to co-occur. He came up with a three-factor model of love: intimacy, passion, and commitment. Intimacy is stuff like warmth, closeness, and bondedness. Passion is stuff like romance, physical attraction, and sex. Commitment is the decisions involved in maintaining love over time. By combining those factors, he came up with the following typology:

Relationship Type Intimacy Passion Commitment
Nonlove Low Low Low
Liking High Low Low
Infatuation Low High Low
Empty Love Low Low High
Romantic Love High High Low
Companionate Love High Low High
Fatuous Love Low High High
Consummate Love High High High

Here’s a typical triangular image of the system:

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