practicum


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.

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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

I am a few weeks past halfway through my 38th year, conveniently marked by my brother Damian’s birthday, and the start of my spring term. Here’s an update on how my intentions for the year are coming along.

1. Add new knowledge to the field of social psychology: I have just finished (I hope) crunching numbers for my honors thesis, and I can say that I have helped produce some new evidence, at least. It is not as sexy as I had hoped, but I have learned a whole lot about the process of psychology research, and that is the main point, as my advisor keeps reminding me.

2. Break my habit of scratching and picking my skin, including biting my lip: I have made some progress here, using a technique Reanna told me about: snapping myself with a hair band around my wrist whenever I had the urge to touch myself. My success varies clearly with my stress level. It requires mindfulness. Another insight/confusion: picking and lip biting, I can tell, are pure stress responses, but the scratching I think is more than that. I seem to be an itchier than normal person. A dermatologist told me that it was the “notoriously harsh” hand-made soap I have been using. I accepted that explanation until I realized on my ride home that he had been wrong. I only use soap on a few key areas. By his reasoning my armpits should be itchier than most of me, and they are not. Any ideas?

3. Celibacy: This has been no problem. I have not been tested, however; no one that I am aware of has wanted to have sex with me. When I first told Grace about this one, she said, “You are going to learn a lot from doing that, but you know, now that you are committed, you will immediately meet someone who will make it very challenging.” Well, not yet.

4. Dance every day, working on 1) musicality 2) vocabulary 3) style: This is going pretty well, though some days my dancing is just a token, so I could say I did. I had a big breakthrough in musicality on my fast dancing at Seattle Balboa Festival in February. The choreography I have been working on with Karly has been helping my working vocabulary. And the main reason I decided to take ballet is to improve my poise and lines. It is easy for me to get into an I-could-be-doing-so-much-more/better state. There is a guy who started in the same beginning class that I did in Eugene who really dove in and is now a rock-star dancer in Portland, winning national competitions. But I still give myself a thumbs up on this one.

5. Finish bachelor’s degree: Yes. I am on track to graduate with honors on June 13, 2009.

6. Get accepted into a couples and family therapy graduate program: Yes. I start in the University of Oregon’s CFT masters program on September 29 (happy birthday to me!), 2009. I’m very excited.

7. Maintain this blog: I have a lot more ideas for posts than actual posts, but I am pretty happy with NME so far. It has been a consistent source of inspiration for me. I get about 20 clicks a day, on average, which seems pretty respectable. The lowest I go is three (two of which are my ever-hopeful-for-a-post Mom, I just discovered), and my peak was 62 on March 31, the day after I posted the guide to my sidebar. I wonder who you all are.

8. Meditate every day: Yes. Sometimes just a few minutes, but yes.

9. Produce a record with David Waingarten: This is not going to happen this year, which I’m sad about. I love this guy’s voice and songwriting. He also makes movies, though, and that’s what he did with his time and money this year. The movie looks good, though. Here’s a preview: This Is Now

10. Record an EP with my band, Abandon Ship: This project is not on schedule, partly because of #12, below, and partly because of how much work an honors thesis is, on top of an internship and classes. I am working on it , but it will almost certainly not be done by my birthday.

11. See healthcare provider each month until all my body concerns are resolved: Yes, I have been doing this. I’ve seen a dermatologist, an orthopedist, a urologist, and two chiropractors. I’m disappointed with the results, so far. I seem to be collecting concerns faster than I am resolving them. Hmm… That makes it seem like I am on my last legs. I am quite healthy, overall, actually.

12. Set up a slick system of musical collaboration over the internet and use it regularly: This has come together much slower than I anticipated, but I have every reason to believe I will be up and running by early May. I can hardly wait.

13. Shift my schedule three hours earlier for at least one term: In bed by 11 pm: I’m very happy with this one, so far. I have not pulled it off perfectly for a term straight—my dance schedule conflicts somewhat with it—but I’d say 90% of the time I’m in bed by 11:30, at least, and that means I’m waking up naturally before my alarm 90% of the time. I love it!

14. Sing out every day: I have not been doing this as I had hoped. I am still inspired to sing out like my friend Zen Zenith, but I have not been working on it with any regularity.

15. Take African dance classes: Yes, I have taken two classes from master dancer Alseny Yansane, and they were awesome. Unfortunately, I have been having this low back pain that has kept me from dancing with that extreme athleticism. When my back stops hurting, I will go back.

16. Write at least one song per month: Nope. I have not written even one complete song. Ouch.

17. Make at least one of each item in Maya’s cookbook: Yummm. I have made four of 19 recipes: Fluffy Whole Wheat Pancakes, Super Hero Granola, Corn Chowder, and Maya’s Tomato soup. They were all excellent except I burned the granola.