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May 29, 2010

Carl Rogers’ Mechanisms of Action of the Therapeutic Relationship

Posted by Nathen under Carl Rogers, common therapeutic factors, emotions, lists, reality testing, therapeutic relationships, therapy
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What is therapeutic about therapy? It seems to have a lot to do with the kind of relationship that the therapist and client create. This is Carl Rogers’ version of what happens in an ideal therapeutic relationship, quoted from Yalom’s Group Psychotherapy (p. 62). If you want to see footage of Rogers trying to create this relationship, I posted clips here.

1) The client is increasingly free in expressing his feelings.

2) He begins to test reality and to become more discriminatory in his feelings and perceptions of his environment, his self, other persons, and his experiences.

3) He increasingly becomes aware of the incongruity between his experiences and his concept of self.

4) He also becomes aware of feelings that have been previously denied or distorted in awareness.

5) His concept of self, which now includes previously distorted or denied aspects, becomes more congruent with his experience.

6) His becomes increasingly able to experience, without threat, the therapist’s unconditional positive regard and to feel an unconditional positive self-regard.

7) He increasingly experiences himself as the focus of evaluation of the nature and worth of an object or experience.

8) He reacts to experience less in terms of his perception of others’ evaluation of him and more in terms of its effectiveness in enhancing his own development.

 

May 22, 2010

Dating a Family Therapy Model

Posted by Nathen under asking for help, Carl Whitaker, cognitive-behavioral family therapy, Couples and Family Therapy, cybernetics, David Epston, decisions, etiology, experiential family therapy, family therapy, intergenerational family therapy, lists, marriage and family therapy, Michael White, Murray Bowen, narrative therapy, psychoanalytic family therapy, psychodynamics, solution focused therapy, strategic family therapy, structural family therapy, therapy models, Virginia Satir
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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.

 

May 17, 2010

Albert Ellis’s 15 Irrational Ideas

Posted by Nathen under Albert Ellis, beliefs, cognitive therapy, emotions, etiology, ideas, lists, prefrontal lobotomy, psychotropic medication, Rational Emotive Behavior Therapy, therapy, thinking
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Albert Ellis was one of the guys who invented cognitive therapy, which began as a kind of wacky-fringe psychotherapy in the 1950s and has grown to be one of the dominant and most-researched forms of therapy today. It’s effective and simple–easy to teach. Ellis’s version of cognitive therapy, Rational Emotive Behavior Therapy, is alive and well too.

Ellis’s basic tenets were that thoughts or beliefs, not events, cause emotions and that irrational thoughts or beliefs cause our emotional problems. Most people think it’s their situations that are causing their problems, but Ellis said that we feel bad when our situation is in conflict with an irrational belief, and that it is the belief that makes us feel bad. So his style of therapy basically consisted of deconstructing people’s irrational thoughts and beliefs.

I think that he was right in a lot, though not all, cases. There are many other effective forms of therapy that, instead of cognitions, target behavior, emotions, social systems, or some combination of the four. There are also, of course, non-therapy interventions that aim to improve people’s psychological experience by targeting biological systems, like drugs or the prefrontal lobotomy, and interventions that target political systems–various kinds of activism.

But irrational beliefs are as good a place to start as any. Here is Ellis’s list of our major irrational ideas, quoted from Jacobs, Masson, & Harvill’s Group Counseling: Strategies and Skills (pp. 285-6). Keep in mind that these don’t usually exist as overt beliefs–you might have to dig to find them in yourself, running you.

Which few are your main irrational ideas?

1) It is a dire necessity for an adult human being to be loved or approved by virtually every other person in one’s life.

2) One should be thoroughly competent, adequate, and achieving in all possible respects if one is to consider oneself worthwhile.

3) Certain people are bad, wicked, and villainous and they should be severely blamed or punished for their villainy.

4) It is awful and catastrophic when things are not the way one would very much like them to be.

5) Human unhappiness is externally caused and people have little or no ability to control their sorrows and disturbances.

6) If something is or may be dangerous or fearsome, one should be terribly concerned about it and should keep dwelling on the possibility of its occurring.

7) It is easier to avoid than face certain life difficulties and self-responsibilities.

8) One should be dependent on others and needs someone stronger than oneself on whom to rely.

9) One’s past history is an all-important determiner of one’s present behavior and because something once strongly affected one’s life, it should indefinitely have an effect.

10) There is invariably a right, precise, and perfect solution to human problems and it is catastrophic if this perfect solution is not found.

11) One should become quite upset over other people’s problems and disturbances.

12) The world should be fair and just and if it is not, it is awful and I can’t stand it.

13) One should be comfortable and without pain at all times.

14) One may be going crazy because one is experiencing some anxious feelings.

15) One can achieve maximum human happiness by inertia and inaction or by passively and uncommittedly enjoying oneself.

 

May 14, 2010

Diagnostic Criteria for Oppositional Defiant Disorder

Posted by Nathen under adolescents, antidepressants, Attention-Deficit/Hyperactivity Disorder, children, diagnostic criteria, drugs, DSM-IV-TR, family assessment, family therapy, insurance companies, lists, mental disorders, obedience, Oppositional Defiant Disorder, practicum, psychopathology, psychotropic medication, SSRIs, stimulants
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According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM-IV-TR), there is a mental disorder that is usually diagnosed in childhood or adolescence called Oppositional Defiant Disorder. It afflicts somewhere between 2-16% of people, more boys than girls before puberty, but equal numbers of boys and girls after puberty. Family therapists are not into giving medical-model diagnoses in general, but in many cases, a DSM diagnosis is the only way for a family to get their insurance companies to pay for them to get help. In one of my internship sites, for example, I will need to provide a DSM diagnosis after the first session with a family in order to get the clinic paid for our work. As I understand it, this is a common diagnosis for kids who are giving their parents and teachers a hard time.

Note that the word “often” is used to mean something like “more than usual,” so whichever kids who are most like this will qualify for this Disorder, as long as someone important believes that their behavior is significantly impairing their social or academic functioning. Note also that these symptoms could be occurring in just one setting (say, just at school) and the kid will still qualify for ODD, unlike the symptoms for ADHD, which have to occur in at least two settings to qualify for the diagnosis.

Outside of family therapy, ODD is very commonly treated with Ritalin for “comorbid” ADHD. Kids diagnosed with ODD are also fairly commonly given antidepressant and/or antipsychotic medication, on the guess that they have an underlying Mood Disorder or Bipolar Disorder, though there is little to no research on these medications for children, especially in combination.

The following is word-for-word from the DSM-IV-TR, page 102:

Diagnosis criteria for 313.81 Oppositional Defiant Disorder

A. A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present:

(1) often loses temper

(2) often argues with adults

(3) often actively defies or refuses to comply with adults’ requests or rules

(4) often deliberately annoys people

(5) often blames others for his or her mistakes or misbehavior

(6) is often touchy or easily annoyed by others

(7) is often angry or resentful

(8) is often spiteful or vindictive

Note: Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level.

B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

C. The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder.

D. Criteria are not met for Conduct Disorder, and, if the individual is age 18 or older, criteria are not met for Antisocial Personality Disorder.

 

May 9, 2010

The Adverse Childhood Experiences Study

Posted by Nathen under alcohol abuse, battering, children, death, depression, disease, divorce, drug abuse, family assessment, lists, mental illness, neglect, parenting, physical abuse, predicting the future, rape, sexual assault, sexually transmitted disease, smoking, suicidality, unintended pregnancy
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I’m learning about child abuse and neglect in my Child and Family Assessment class. Today I read about the ACE study, by the US Center for Disease Control. It is a huge study, with over 17,000 participants, where they gathered information about childhood abuse, neglect, and household dysfunction, and then proceeded to see what health outcomes and behaviors they could predict with that information. It turns out they can predict a lot. They’ve published 50 articles on the study and the research is ongoing–they are continuing to collect health information as the participants in the study age. I’ll present a few of their findings below. For more, see the ACE Study.

Here are some of their findings. I’ll paste in the definitions of the categories of adverse childhood experiences below. Strong correlations were found with the following:

  • alcoholism and alcohol abuse (4 or more categories of ACE meant 4-12 times increase)
  • chronic obstructive pulmonary disease (that is, lung disease)
  • depression (4 or more categories of ACE meant 4-12 times increase)
  • fetal death
  • health-related quality of life (way more inactivity, severe obesity, bone fractures)
  • illicit drug use
  • ischemic heart disease (IHD)
  • liver disease
  • risk for intimate partner violence
  • multiple sexual partners (4 or more categories of ACE correlated with 50 or more sexual partners)
  • sexually transmitted diseases (STDs) (4 or more categories of ACE meant 4-12 times increase)
  • smoking
  • suicide attempts (4 or more categories of ACE meant 4-12 times increase)
  • unintended pregnancies

Here are the kinds of abuse, neglect, and dysfunction they asked about, quoted from the site:

Abuse

Emotional Abuse:
Often or very often a parent or other adult in the household swore at you, insulted you, or put you down and/or sometimes, often or very often acted in a way that made you think that you might be physically hurt.

Physical Abuse:
Sometimes, often, or very often pushed, grabbed, slapped, or had something thrown at you and/or ever hit so hard that you had marks or were injured.

Sexual Abuse:
An adult or person at least 5 years older ever touched or fondled you in a sexual way, and/or had you touch their body in a sexual way, and/or attempted oral, anal, or vaginal intercourse with you and/or actually had oral, anal, or vaginal intercourse with you.

Neglect

Emotional Neglect1

Respondents were asked whether their family made them feel special, loved, and if their family was a source of strength, support, and protection. Emotional neglect was defined using scale scores that represent moderate to extreme exposure on the Emotional Neglect subscale of the Childhood Trauma Questionnaire (CTQ) short form.

Physical Neglect1

Respondents were asked whether there was enough to eat, if their parents drinking interfered with their care, if they ever wore dirty clothes, and if there was someone to take them to the doctor. Physical neglect was defined using scale scores that represent moderate to extreme exposure on the Physical Neglect subscale of the Childhood Trauma Questionnaire (CTQ) short form constituted physical neglect.

Household Dysfunction

Mother Treated Violently:
Your mother or stepmother was sometimes, often, or very often pushed, grabbed, slapped, or had something thrown at her and/or sometimes often, or very often kicked, bitten, hit with a fist, or hit with something hard, and/or ever repeatedly hit over at least a few minutes and/or ever threatened or hurt by a knife or gun.

Household Substance Abuse:
Lived with anyone who was a problem drinker or alcoholic and/or lived with anyone who used street drugs.

Household Mental Illness:
A household member was depressed or mentally ill and/or a household member attempted suicide.

Parental Separation or Divorce:
Parents were ever separated or divorced.

Incarcerated Household Member:
A household member went to prison.

 

May 5, 2010

Assessing Sexual or Physical Abuse

Posted by Nathen under alcohol abuse, drug abuse, drugs, family assessment, family therapy, lists, parentification, physical abuse, practicum, sexual abuse, statistics, suicidality, violence
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Another unfortunately common situation I will have to assess for in the families I see (in addition to drug & alcohol abuse, domestic violence and many other things) is sexual or physical abuse. One of my texts (Patterson’s Essential Skills in Family Therapy: From the First Interview to Termination) estimates that 1 in 5 women and 1 in 9 men were sexually abused as kids. My other practicum text, Brock & Barnard’s Procedures in Marriage and Family Therapy, gives this list of indicators of abuse(p. 52):

The presence of an alcoholic parent

The family with poor mother-daughter connections/bonds

A mother who is very dependent either psychologically or physically as the result of illness or accident

A father who appears to be very controlling and possessive of his daughter(s)

An acting-out adolescent girl engaging in sexual promiscuity or suicidal gestures who is a frequent runaway or drug abuser

A child who appears to be very overresponsible and parentified in the family context

 

May 4, 2010

Diagnostic Criteria for Conduct Disorder

Posted by Nathen under adolescents, children, Conduct Disorder, crime, cruelty, diagnostic criteria, DSM-IV-TR, lists, mental disorders, psychology, rape, sexual assault, violence
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This is another DSM-IV-TR Mental Disorder diagnosis that is commonly given to children. The DSM says that its prevelence has been increasing for a few decades now and that up to 10% of kids, mostly boys in “urban settings”, have it. It’s a pretty serious label to give a kid. It’s linked with suicide, homicide, various criminal acts, and is thought of as a precursor to Antisocial Personality Disorder. Here are the criteria, quoted word-for-word from the DSM-IV-TR (pp. 98-99):

Diagnostic criteria for Conduct Disorder

A. A repetitive and persistent pattern of behavior in which the basioc rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months.

Aggression to people and animals

(1) often bullies, threatens, or intimidates others

(2) often initiates physical fights

(3) has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)

(4) has been physically cruel to people

(5) has been physically cruel to animals

(6) has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)

(7) has forced someone into sexual activity

Destruction of property

(8) has deliberately engaged in fire setting with the intention of causing serious damage

(9) has deliberately destroyed others’ property (other than by fire setting)

Deceitfulness or theft

(10) has broken into someone else’s house, building, or car

(11) often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others)

(12) has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)

Serious violations of rules

(13) often stays out at night despite parental prohibitions, beginning before age 13 years

(14) has run away from home overnight at least twice while living in parental or parental surrogate (or once without returning for a lengthy period)

(15) is often truant from school, beginning before age 13 years

B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

C. If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Code based on age at onset:

312.81 Conduct Disorder, Childhood-Onset Type: onset of at least one criterion characteristic of Conduct Disorder prior to age 10 years

312.82 Conduct Disorder, Adolescent-Onset Type: absence of any criteria characteristic of Conduct Disorder prior to age 10 years

312.89 Donduct Disorder, Unspecified Onset: age at onset is not known

Specify severity:

Mild: few if any conduct problems in excess of those required to make the diagnosis and conduct problems cause only minor harm to others

Moderate: number of conduct problems and effect on other intermediate between “mild” and “severe”

Severe: many conduct problems in excess of those required in excess of those required to make the diagnosis or conduct problems cause considerable harm to others

 

May 3, 2010

Predictors of Divorce, According to Elizabeth Gilbert

Posted by Nathen under age, alcohol abuse, battering, children, divorce, education, Elizabeth Gilbert, infidelity, lists, marriage, mental illness, relationships, statistics, violence
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Elizabeth Gilbert, in her book about marriage, Commitment, lays out her interpretation of a Rutgers report on divorce statistics. Here’s her list of things that correlate with divorce, in the order she mentions them. She lays them out with a lot more subtlety, humor, and personality, but read the book if you want that.

Your parents are divorced

You are alcoholic

You are mentally ill

You cheat on your spouse

You gamble compulsively

You are violent

You are younger than 25

You have not gone to college (especially the woman)

You have children

You lived with your spouse before marriage

You have different racial backgrounds

You are different ages

You have different religions

You have different ethnic backgrounds

You have different cultural backgrounds

You have different careers

You don’t know your neighbors

You don’t belong to social clubs

You don’t live near your families

You are not religious

The man does not do housework

 

April 30, 2010

Useful Tip For Grad School Students

Posted by Nathen under advice, engagement, graduate school, heroism, lists, long-distance relationships, love, reading, Reanna
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If you’re in grad school or going to start soon, consider getting engaged to an amazing woman. I have had the good fortune to do that, and believe me you won’t regret it. I could (and maybe will at some point) write long into the night about the qualities that I am talking about, but for now I’ll just focus on one telling detail.

In graduate school, you do a lot of reading. Many, many, many hours and hours of reading. Few people do all the reading that they are assigned in a grad program. The eyes and attention can’t take it. I have the advantage of being engaged to Reanna. She reads a chunk of my assigned reading to me each term. Understand that this is mostly dry, academic stuff, interesting if you really want to be a family therapist, but otherwise only tolerable if you are extremely intelligent, curious, and dedicated. Understand also that she doesn’t even get social time with me out of it. I live in Oregon and she lives in British Columbia. She reads my assignments into a voice recorder and emails the files to me. I get to do the dishes or whatever while hearing her voice and getting reading done. She gets to sit in front of a computer screen, reading. (Well, she does get to criticize the bad writing, of which there is plenty, but that’s not much of a payoff, especially for a professional editor.)

She also reads relevant books that she finds that I have not been assigned. How cool is that? I’m going to have a term on Susan Johnson’s emotionally-focused couples therapy next fall, and she’s already read me Johnson’s popularization, Hold Me Tight.

Here is a partial list of what she’s read, from my iTunes. Some of the times didn’t copy out (Open Office couldn’t recognize them, apparently, and made them into times of day), but take my word for it, this is about 50 hours of reading.

A Walk Down the Aisle – Prologue Kate Cohen 17:05
A Walk Down the Aisle – Pt 1 Kate Cohen 22:06
A Walk Down the Aisle – pt 10 Reanna A Walk Down the Aisle 23:01
A Walk Down the Aisle – pt 11 Reanna A Walk Down the Aisle 16:11
A Walk Down the Aisle – pt 12 – ch 8 Reanna A Walk Down the Aisle 43:12:00
A Walk Down the Aisle – Pt 13 – ch 9 Reanna A Walk Down the Aisle 30:41:00
A Walk Down the Aisle – pt 14a – ch 9 Kate Cohen 7:32
A Walk down the Aisle – Pt 14b – ch 9 Reanna A Walk Down the Aisle 1:28
A Walk Down the Aisle – pt 15 – ch 10 Kate Cohen 1:26
A Walk Down the Aisle – pt 16 – ch 10 Kate Cohen 1:47
A Walk Down the Aisle – pt 17 – ch 10 Reanna A Walk Down the Aisle 29:18:00
A Walk Down the Aisle – Pt 2 Kate Cohen 10:18
A Walk Down the Aisle – Pt 3 Kate Cohen 10:25
A Walk Down the Aisle – Pt 4 Kate Cohen 41:25:00
A Walk Down the Aisle – Pt 5 Kate Cohen 7:51
A Walk Down the Aisle – Pt 6 Kate Cohen 12:49
A Walk Down the Aisle – Pt 7 Kate Cohen 11:07
A Walk Down the Aisle – Pt 7 Kate Cohen 10:24
A Walk Down the Aisle – pt 8 Kate Cohen 45:32:00
A Walk Down the Aisle – pt 9 Kate Cohen 1:08:43
Pt 1 – Chapter 3 – Emotional Responsiveness Dr. Sue Johnson Hold Me Tight 34:40:00
Pt 2 – Conversation 1 – Recognizing the Demon Dialogue Dr. Sue Johnson Hold Me Tight 41:25:00
Pt 2 – Conversation 2 – Finding the Raw Spots Dr. Sue Johnson Hold Me Tight 35:02:00
Pt 2 – Conversation 6 – Bonding through Sex & Touch Dr. Sue Johnson Hold Me Tight 47:05:00
Pt 2 – Conversation 7 – Keeping the Love Alive Dr. Sue Johnson Hold Me Tight 23:59
Chapter 1, Part 1 Why Don’t Zebra’s Get Ulcers, ch1 Reading Aloud to Nathen 10:06:00 PM
Chapter 1, Part 2 Why Don’t Zebra’s Get Ulcers, ch1 Reading Aloud to Nathen 07:21:00 AM
Chapter 1, Part 3 Why Don’t Zebra’s Get Ulcers, ch1 Reading Aloud to Nathen 06:10:00 PM
Children’s Attachment Relationships Phillis Booth Reading Aloud to Nathen 30:05:00
Circle of Security – Terminology CoS Reading Aloud to Nathen 12:46:00 PM
Committed Ch 5 (pt 2) Marriage and Women Elizabeth Gilbert Committed 03:52:00 AM
Committed Ch 5 (pt 3) Marriage and Women Elizabeth Gilbert Committed 08:07:00 AM
Committed Ch 5 (pt 4) Marriage and Women Elizabeth Gilbert Committed 04:13:00 AM
Committed Ch 5 (pt 5) Marriage and Women Elizabeth Gilbert Committed 09:02:00 AM
Committed Ch 5 (Pt 7) – Marriage and Women Elizabeth Gilbert Committed 06:22:00 PM
Committed Ch 7 (pt 1) – Marriage and Subversion Elizabeth Gilbert Committed 10:21:00 AM
Committed Ch 7 (pt 2) – Marriage and Subversion Elizabeth Gilbert Committed 42:02:00
Committed Ch 7 (pt 3) – Marriage and Subversion Elizabeth Gilbert Committed 05:21:00 PM
Committed Ch 7 (pt 4) – Marriage and Subversion Elizabeth Gilbert Committed 12:34:00 PM
Committed Ch 8 – Marriage and Ceremony Elizabeth Gilbert Committed 08:25:00 PM
Committed: Ch 1 Marriage and Surprises Elizabeth Gilbert Reading Aloud to Nathen 50:31:00
Committed: Ch 2 (pt. 1) Marriage and Expectation Elizabeth Gilbert Reading Aloud to Nathen 35:17:00
Committed: Ch 2 (pt. 2) Marriage and Expectation Elizabeth Gilbert Reading Aloud to Nathen 08:50:00 PM
Committed: Ch 3 (pt. 1) Marriage and History Elizabeth Gilbert Reading Aloud to Nathen 01:05:07 AM
Committed: Ch 3 (pt. 2) Marriage and History Elizabeth Gilbert Reading Aloud to Nathen 03:38:00 PM
Committed: Ch 4 (pt 1) Marriage and Infatuation Elizabeth Gilbert Reading Aloud to Nathen 01:34:14 AM
Committed: Ch 4 (pt 2) Marriage and Infatuation Elizabeth Gilbert Reading Aloud to Nathen 07:37:00 PM
Death on a horse’s back Robert J Barrett Reading Aloud to Nathen 168:00:00
Dharma Punx Noah Levine Reading Aloud to Nathen 05:33:00 PM
The End of Innocence 1 Dusty Miller Reading Aloud to Nathen 12:45:00 AM
The End of Innocence 2 Dusty Miller Reading Aloud to Nathen 42:08:00
Family Process // The Language of Becoming Ellen Wachtel Reading Aloud to Nathen 01:04:24 AM
Feminism & Family Therapy 1 Virginia Goldner, PhD Reading Aloud to Nathen 34:43:00
Feminism & Family Therapy 2 Virginia Goldner, PhD Reading Aloud to Nathen 01:03:00 AM
Feminism & Family Therapy 3 Virginia Goldner, PhD Reading Aloud to Nathen 28:33:00
Feminism & Family Therapy 4 Virginia Goldner, PhD Reading Aloud to Nathen 03:49:00 AM
Fixed (New Yorker) Jill Lapore Reading Aloud to Nathen 32:04:00
Impact on Family Therapist of a focus on death, dying Becvar Reading Aloud to Nathen 06:41:00 PM
Impact, pt 2 Becvar Reading Aloud to Nathen 10:59:00 PM
Introduction, 1 Appetites Reading Aloud to Nathen 05:36:00 AM
Introduction, 2 Appetites Reading Aloud to Nathen 04:32:00 AM
Introduction, 3 Appetites Reading Aloud to Nathen 06:34:00 AM
Introduction, 4 Appetites Reading Aloud to Nathen 37:26:00
The last time I wore a dress – CH 11 Daphne Scholinski Reading Aloud to Nathen 08:28:00 PM
The Last Time I wore a dress – Ch 12 Daphne Scholinski Reading Aloud to Nathen 38:52:00
The Lobotomist Jack El-Hai Reading Aloud to Nathen 24:06:00
Marry Me St. Vincent Marry Me 04:41:00 AM
Minnie Mouse and Gunfire, Lucky Child Luong Ung Reading Aloud to Nathen 29:49:00
My Angel Rocks Back and Forth Four Tet Rounds 05:07:00 AM
My Lobotomy Howard Dully Reading Aloud to Nathen 32:41:00
Paris is the cruelest month Alan Alda Reading Aloud to Nathen 09:32:00 PM
Passionate Marriage David Schnarch Reading Aloud to Nathen 42:45:00
Prozac Nation Elizabeth Wurtzel Reading Aloud to Nathen 42:05:00
Real Weddings Media Hill Publication Reading Aloud to Nathen 06:44:00 AM
Running With Scissors Augustin Burroughs Reading Aloud to Nathen 38:30:00
Solution Focused Therapy – A Molnar & Shazer 1987 Reading Aloud to Nathen 10:01:00 PM
Solution Focused Therapy – B Molnar & Shazer 1987 Reading Aloud to Nathen 12:49:00 AM
Solution Focused Therapy – C Molnar & Shazer 1987 Reading Aloud to Nathen 05:39:00 AM
Stubborn Twig Lauren Kessler Reading Aloud to Nathen 52:15:00
Sybil, CH 7 Flora Rheta Schrieber Reading Aloud to Nathen 37:47:00
Truth Telling Candib Reading Aloud to Nathen 39:31:00
Truth Telling, pt 2 Candib Reading Aloud to Nathen 08:22:00 PM
Understanding the Rainforest Mind Paula Prober Reading Aloud to Nathen 09:36:00 PM
An Unquiet Mind Kay Jamison Reading Aloud to Nathen 38:33:00
The Voices of Children – 1 Sandra Stith Reading Aloud to Nathen 04:45:00 AM
The Voices of Children – 2 Sandra Stith Reading Aloud to Nathen 03:06:00 PM
The Voices of Children – 3 Sandra Stith Reading Aloud to Nathen 36:03:00
Where is the Mango Princess Cathy Crimmins Reading Aloud to Nathen 30:07:00
You Ain’t Got No Easter Clothes Laura Love Reading Aloud to Nathen 38:06:00
 

April 23, 2010

Gearing Up For My First Overnight Crisis Line Shift

Posted by Nathen under crisis line, helping, listening, lists, sleep, statistics, work
[2] Comments 

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.

 

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