June 16, 2010

How To Make Eye Contact

Posted by Nathen under advice, eye contact, lists
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I read this sample of how to explain eye contact to couples a few weeks ago, in Brock and Banard’s Procedures in Marriage and Family Therapy (p. 71):

“Good eye contact is designed to communicate that the listener is paying attention to what is being said so that the speaker feels attended to. When good eye contact is present, a speaker usually does not need to get angry or resort to some other attention-getting strategy to make sure that the listener pays attention. Good eye contact consists of looking in the pupil of another’s eye and moving back and forth from eye to eye while the other speaks.”

I agree with all of that except for the last sentence. When making eye contact with your partner, do not shift from eye to eye. That kind of eye contact is better than nothing, but it’s not great. Shifting your eyes back and forth make you look nervous and shifty if you do it fast enough, and even if you slow it down you give the impression of looking at your partner’s face, rather than into their eyes. The same goes double for other popular advice about eye contact, like looking at your partner’s nose or hairline.

Here’s  how to make good, intimate-feeling eye contact:

1) Figure out which of your eyes is dominant. To do this, look at a small object that’s fairly far away, then make a circle around the object with your thumb and first finger. Close each eye and see which one has the object in the circle. That is your dominant eye–the eye that you really look out of. The other eye is more of a backup eye.

2) When making eye contact, look into the pupil of your partner’s eye that is directly across from your dominant eye. If your left eye is dominant, for example, look into their right eye. Check the other eye once or twice to see if that feels better, and stick with the eye that feels the most like you are looking into each others’ eyes. (The reason to check is that your partner may have the same dominant eye as you do, and thus across from your dominant eye. You don’t need to remember or even understand this, but if you’re interested, the ideal situation for eye contact is that you and your partner have opposite dominant eyes, one left, one right. That makes everything easy. If not, you end up figuring out whose dominant eye is more dominant and going that way. Try the procedure with someone you know and love and you’ll see what I mean.)

3) Remember that it can take some practice to do this and stay relaxed, but it is worth it. I recommend setting aside time with romantic partners to simply sit and look into each others’ eyes. And make plenty of good eye contact when talking with each other.

4) Remember also that different people of different cultures may have different reactions to direct eye contact. And I don’t just mean people from other countries. There are  people in eye-contact-making cultures who can’t stand to make eye contact for more than a fraction of a second. Be sensitive to this. Do not force eye contact on anyone. I’ve seen dancers who crane their heads to catch and keep their partner’s eyes and it makes the partner uncomfortable. Remember that there is the I’m-just-looking-at-your-face strategy and the even less intimate I’m-just-looking-at-your-face-every-once-in-a-while strategy.

 

June 14, 2010

Irvin Yalom’s Existential Factors

Posted by Nathen under existential factors, existential therapy, Irvin Yalom, lists, the meaning of life, therapy, therapy models
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Existential psychotherapist (and the author of Lying on the Couch, When Nietzsche Wept, and The Schopenhauer Cure) Irvin Yalom suggests that humans face five existential factors that play a large role in our lives and in the success of psychotherapy. This is how he describes them in The Theory and Practice of Group Psychotherapy, on page 98:

1. Recognizing that life is at times unfair and unjust

2. Recognizing that ultimately there is no escape from some of life’s  pain or from death

3. Recognizing that no matter how close I get to other people, I must still face life alone

4. Facing the basic issues of my life and eath, and thus living my life more honestly and being less caught up in trivialities

5. Learning that I must take ultimate responsibility for the way I live my life no matter how much guidance and support I get from others

 

June 12, 2010

Congruent & Incongruent Communication, Paradox & Double Bind

Posted by Nathen under behavior, children, communication, congruent communication, cybernetics, double bind, experiential family therapy, family therapy, going meta, incongruent communication, lists, love, mental disorders, paradox, parenting, Paul Watzlawick, psychology, relationships, talking, therapy, transparency, Virginia Satir
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Family therapy got started when the grandparents of the field, interested in cybernetics–the science of self-regulating systems–started studying communication in families. Some of the more interesting ideas they came up with were the three progressively more problematic kinds of contradiction. This is a summary of Virginia Satir’s version of those contradictions, from Conjoint Family Therapy:

Simple contradiction: This is when a person says two things that contradict each other straightforwardly, as when someone might say, “I love you but I don’t love you.” This kind of contradiction consists of assertions that are incompatible, but at least out in the open, in an easily decodable way. That means that the receiver of the message can easily comment on the contradiction, saying “I don’t understand what you mean. You didn’t make sense to me just then.”

Paradoxical (or incongruent) communication: A paradox is a special kind of contradiction, where the incompatible statements exist on different “logical levels.” That is, one of the statements is part of the context of the other statement. These are significantly more difficult to decode and comment on. The two logical levels in human communication are usually verbal and non-verbal behavior, where the non-verbal behavior is the context for the verbal. For example (from p.83) “A says, ‘I hate you,’ and smiles.” If A had said “I hate you” with an angry look on their face, that would be congruent, but what does “I hate you” mean in the context of a smile? This is more confusing than the simple contradiction, both because it is more difficult to track the two levels of communication simultaneously, and because we have unspoken social norms against commenting about how someone is speaking. Consequently, it takes more awareness and bravery to question the speaker’s intent when they present you with this kind of contradictory communication. (Satir calls paradoxical communication “incongruent communication.”) Being able to metacommunicate, or comment on the communication going on, is the major tool of the psychotherapist. We don’t usually know it, but this skill is the main thing we go to therapists for.

The double bind: The double bind is a special kind of paradoxical communication that was first laid out in Watzlawick and colleagues’ Pragmatics of Human Communication. A double bind is a paradox with two additional rules, giving four total requirements:

1) A verbal statement

2) A contradictory non-verbal context

3) A rule that you are not allowed to metacommunicate

4) A rule that you are not allowed to leave the field

This happens to people all the time. Children, especially, mercilessly, unconsciously, are put in this position a lot because they are not in a position to leave their parents “field.” They are completely subject to their parents on every level.

Here’s an example: A parent, obviously stressed out, tense, and in pain for whatever reason, says to their child, “I love you.” This puts the child into a double bind, because the statement is contradicted by the “I don’t love you” expressed by the parents’ body language and facial expression. That’s 1) and 2). Third is that the child can’t comment on the contradiction because they don’t have the tools, and even if they did, and said something like, “Mom, I hear you saying that you love me but it doesn’t really seem like you love me right now. It seems like you’re having other feelings,” the child would almost certainly be punished in some way for being insubordinate, for questioning the parent’s love, for questioning the parent’s word, for making the parent feel uncomfortable. Fourth is that the child is not allowed to leave the field. That is, even if they had the communication tools, the awareness, and the bravery, they have no where else to go if they are rejected by the parent. Their lives are dependent on the love and support of the parent. They are stuck in the field. To cope, they “learn” one or both of the following:

I am not lovable. My parent knows this, and I have figured it out, but at least they are pretending that they love me, which keeps me alive, so I’ll go along with the pretense that they love me.

I may be lovable, but love feels awful. Still, it’s the best thing available.

Then the child grows up and, having their own children, perpetuate the process, being a pretending-to-be-lovable parent with awful-feeling love to give to the next generation. Not only that, but they develop adaptations to this way of living that look like DSM-diagnosable Mental Disorder conditions.

Metacommunication and congruent communication: Notice that metacommunication is the key out of all of these situations. In the case of a true double bind, you might need the help of someone else’s (a therapist’s or friend’s) metacommunication, but metacommunication is still the key. Someone needs to stand up and say, “I’m confused! Can we slow down here and talk about what we’re talking about? What can you say to me right now that your body language and facial expression will agree with?”

 

June 10, 2010

Meditation as Brain Control

Posted by Nathen under electroencephalogram, Ken Wilber, meditation, sleep, video
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This video makes me want to get an EEG machine. It’s of Ken Wilber narrating footage of himself moving through a few different meditative states while hooked up to an EEG machine. (EEG machines show you a picture of the electrical activity from your brain from electrodes on your scalp.) He says what each state feels like, too. Pretty neat.

(Minor correction: He makes it sound like dreaming sleep is mostly associated with theta waves, which is not quite true. Dreaming sleep does have some theta activity, but it’s mostly beta or “beta-like” waves. Theta is strongly associated with stage 1 sleep, that 5 or 10 minute transition between waking and sleep. It’s a minor point, but I so rarely find corrections to make in his work, I thought I’d take this chance.)

 

June 8, 2010

Proposal for a Long-Distance-Relationship-Difficulty Index

Posted by Nathen under comparisons, Jonathan, lists, long-distance relationships, math, Skype
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I was just on Skype with my friend Jonathan, who is also in a long-distance relationship. His is between Vancouver, BC and Germany. Mine is between Eugene, OR, and Vancouver, BC. We started coming up with a scheme for measuring the difficulty of a long distance relationship. Here are the major factors we came up with:

1) Financial impact of making the trip

2) Number of travel hours separating the couple

3) Amount of time difference between locations

To that I’m going to add,

4) The availability of high-quality video chat.

5) Number of days left before final reunification.

Obviously, any such attempt will result in a major oversimplification, but I’m thinking we should stick with easily measurable factors. For example, the communication ability of each partner plays a huge part in the success of a LDR, but is difficult to measure, so I’m leaving it out. If the couple prefers not to fly for ethical or other reasons, it will factor in, too, but I’m leaving that out as well. And so on.

So, how do we calculate this index? Generate numbers for each factor:

1) Cost of a round trip, divided by the combined income of couple.

2) Number of hours travel, round trip, by that mode of transportation.

3) Number of hours difference between locations, plus 1. So if you’re in the same time zone, you get a 1 here, and if you’re eight time zones off, you get a 9. The plus 1 is just to make a no-time-zone-difference a nonzero number, for calculating the index.

4) I’m going to estimate that having good video chat makes LDRs ten times easier, so if you have it, you get a 1 and if you don’t, you get a 10.

5) The number of days left before final reunification.

Let’s try those elements in the following equation:

difficulty of long distance relationship = (cost of trip/combined income) x number of hours travel x number of hours difference x number of days left x video chat

It’s a start. Let’s see what kinds of numbers it gives us, using about what Reanna and I have left to go–a little over a year: For Bill Gates, the index would range between about .01 to maybe 30, depending on the difficulty of the trip, or between .1 and 300, without video chat. For someone poor, with a long, difficult trip that costs their yearly salary and no video chat, the index would be about 600,000. If this very unfortunate couple had 10 years to go instead of a year, they get 6,000,000. I know, that doesn’t sound like much of a relationship, but I’m looking for the upper end of the scale.

Reanna and I get about a 30. Not too bad, I guess, though it goes up to 300 when I’m at Not Back to School Camp, which is way out on the information-dirt-road. So we get a range of 30-300, which is the same range as Bill Gates’ worst-case scenario–if he had to take his private Lear jet to the central Asian steppe every time he wanted to see Melinda.

OK, here’s where you can help me out, if you want. There are certainly several problems with this scale. Here are two, off the top of my head: First, the range of .01 to 6,000,000 is too big to think very clearly about. How hard is my 30 compared to Bill’s .01, or Mr. Unfortunate’s 6,000,000? Other than “somewhere inbetween,” it’s difficult to say. The equation needs some kind of transformation to produce easier numbers, say between 1 and 100. Second, some things aren’t working out with the math. As it is, if a couple is very poor, even a 10-day LDR with an easy trip comes out harder than Bill’s 10-year LDR with a very difficult trip, as long as Mr. Unfortunate doesn’t have Skype. That can’t be right. If any of you are math people, what do you think? Third, there are other factors that should be included but are difficult to operationalize, like communication skills and depth of commitment. Any ideas, conceptual people?

 

June 6, 2010

The Color of Fear

Posted by Nathen under anger, beliefs, Chad, communication, diversity, documentaries, endorsements, group therapy, identity, Lee Mun Wah, power, privilege, race, racism, video
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Many years ago, my friend Chad told me if he could make even a very modest living fighting racism, that is what he would do with his life. The idea had never occurred to me before. In that conversation we also talked about how it was really only people who were on the fence about race that were good targets for intervention; good luck changing the mind of an entrenched racist! So where do you find these on-the-fence-folks, and how do you make a living working with them? We made no more progress on the question.

Lee Mun Wah does just what we imagined. He is a “diversity and communication trainer” and the founder of Stirfry Seminars & Consulting. The population of Whites he works with are a lot more egalitarian-minded than I had imagined necessary, back in those relatively naive days–they are Whites who consider racism appalling but don’t see their own part in perpetuating it.

I watched these clips from Lee Mun Wah’s documentary of one of his groups, called The Color of Fear. It was some of the most moving footage I’ve seen this year. If you watch it, watch both clips to the end, and be prepared for some members to express anger. (Keep in mind that (according to my teachers) both David and Victor became diversity and communication trainers after this film was made.) This is incredible work. I hope I get the opportunity to lead groups like this in my career.

 

June 4, 2010

Jay Smooth’s Ill/Nil Doctrine

Posted by Nathen under feminism, homophobia, homosexuality, Jay Smooth, politics, Potter & Heath, Rebel Sell, video
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A couple days ago I posted a great clip from Jay Smooth, called “How to Tell People They Sound Racist.” I’ve looked over his websites, illdoctrine.com and nildoctrine.com and his you tube channel and have decided to officially endorse him. He’s very smart, very hip, and I just like him. He’s a feminist hero, too in an often mysogynous hip hop culture. About half of his posts are political and about half are about hip hop. All of them seem insightful and funny, though keep in mind that I am no judge of hip hop or hip hop commentary.

Here are three clips I liked a lot. The first reminds me of Potter & Heath’s Rebel Sell: It’s a critique (and possibly a mocking) of the idea that you can simultaneously (and self-righteously) know nothing about politics and somehow “know” that politics is not worth paying attention to. It’s great.  The second is about homosexuality in hip hop (this is him being a hero). The third is about hipsterism. They are all short and good.

 

June 2, 2010

How To Tell People They Sound Racist

Posted by Nathen under Jay Smooth, racism, talking, video
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This clip was part of a lecture in my Group Therapy class. It’s from video blogger Jay Smooth. I haven’t seen many of his clips but so far they are insightful and entertaining. The clip on top of his blog is about Rand Paul and called “Atlas Ducked.” It’s worth watching just for that hilarious title.

 

May 31, 2010

Diagnostic Criteria for Schizophrenia

Posted by Nathen under diagnosis, diagnostic criteria, disease, documentaries, drugs, DSM-IV-TR, etiology, family therapy, lists, mental disorders, mental illness, psychology, psychopathology, psychosis, psychotropic medication, schizophrenia, tests, therapy, World Health Organization
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Schizophrenia is a fascinating set of phenomena, the study of which has launched a thousand ships including, arguably, my field, family therapy; many of the original family therapists left psychiatry to study schizophrenia (or, as the DSM would have me write it, Schizophrenia–capitalizing words gives them more authority, don’t you think?) as an interactive process. That is, if all behaviors make sense in their context, what context might make schizophrenic behavior necessary?

There was an almost violent backlash against this line of thinking, as it seemed to (and did, in many cases) blame mothers for their schizophrenic children–as in the unfortunate phrase “schizophrenogenic mother.” The conventional wisdom about schizophrenia these days reads like a pharmaceutical company press release, something like, “Schizophrenia is a biological disease of the brain which is at present incurable, but there are drugs which can help manage the symptoms, and if taken regularly can provide a decent quality of life.”

So schizophrenia is assumed to be a biological disease of the brain though it, like every other Mental Disorder, has no laboratory test that can detect its presence. The best we can do is a set of behavioral diagnostic criteria which, frankly, are a bit of a mess. You may notice as you read that different flavors of schizophrenia may have nothing or little in common with each other. Are they really the same “disease”? We don’t know.

We do have good evidence that you can inherit, in some fashion, a tendency for one of these constellations of behaviors. There is good evidence that environmental factors are also important, though they are not a big part of the mainstream discussion. We also have evidence that therapy helps in a lot of cases. There is some (hotly contested, I’m sure) evidence from the World Health Organization that unmedicated schizophrenics can eventually recover while those on medication do not. Here is a trailer for a moving documentary about two recovered women and the public perception of schizophrenia, called Take These Broken Wings. Also, consider checking out the documentary A Brilliant Madness, about John Nash, in which puts the lie to A Brilliant Mind, which showed Nash recovering with the help of psychopharmaceuticals.

The DSM says that schizophrenia may be overdiagnosed (or at least is diagnosed more often) in African- and Asian-American men, that it affects men differently than women (men tend towards the negative symptoms were women tend towards delusions and hallucinations), and that incidence rates are something like .5-1.5% of adults.

Here are a few terms that you’ll need to know to get through the criteria:

affective flattening: does not show emotion. Also, “affect” means “emotion” to scientists and people who like to talk like scientists.

alogia: lack of speech.

avolition: lack of motivation.

prodromal: symptoms coming early on in the course of a disease.

echolalia: repetition of others’ speech sounds.

echopraxia: repetition of others’ movements

And here are the diagnostic criteria, word-for-word, from the DSM-IV-TR, pp. 312-319:

Diagnostic criteria for Schizophrenia

A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):

(1) delusions

(2) hallucinations

(3) disorganized speech (e.g. frequent derailment or incoherence)

(4) grossly disorganized or catatonic behavior

(5) negative symptoms, i.e., affective flattening, alogia, or avolition

Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts, or two or more voices conversing with each other.

B. Social/occupational dysfunction: For a significatn portion of the time since th onset of the distrubance, one or more major areas of functioning such as work, interpersonal relations, or self-care are mardekly below the level achieved prior to the onset (or when the onset is in childhood or adolewscence, faliure to achieve expected level of interpersonal, academic, or occupational achievement).

C. Duration: Continuou signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. Doring these prodromal or residual periods, the signs of the ditrubance may be manifested by only negative symptoms or two or more symptoms listen in Criterion A pressent in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

D. Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either (1) no Major Depressive, Manic, or Mixed Episodes have occurred concurrently with the active-phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.

E. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition.

F. Relationship to a Pervasive Developmental Disorder: If there is a history of Autistic Disorder or another Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated).

Classification of longitudinal course (can be applied only after at least 1 year has elapsed since the initial onset of active-phase symptoms):

Episodic With Interepisode Residual Symptoms (episodes are difined by the reemergence of prominent psychotic symptoms); also specify if: With Prominent Negative Symptoms

Episodic With No Interepisode Residual Symptoms

Continuous (prominent psychotic symptoms are present throughout the period of observation); also specify if: With Prominent Negative Symptoms

Single Episode In Partial Remission; also specify if: With Prominent Negative Symptoms

Single Episode In Full Remission

Other or Unspecified Pattern

Diagnostic criteria for 295.30 Paranoid Type

A type of Schizophrenia in which the following criteria are met:

A. Preoccupation with one or more delusions or frequent auditory hallucinations.

B. None of the following is prominent: disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect.

Diagnostic criteria for 295.10 Disorganized Type

A type of Schizophrenia in which the following criteria are met:

A. All of the following are prominent:

(1) disorganized speech

(2) disorganized behavior

(3) flat or inappropriate affect

B. The criteria are not met for Catatonic Type.

Diagnostic criteria for 295.20 Catatonic Type

A type of Schizophrenia in which the clinical picture is dominated by at least two of the following:

(1) motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor

(2) excessive motor activity (that is apparently purposeless and not influenced by external stimuli

(3) extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism

(4) peculiarities of voluntary movement as evidenced by posturing (voluntary assumptions of inappropriate or bizarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing

(5) echolalia or echopraxia

Diagnostic criteria for 295.90 Undifferentiated Type

A type of Schizophrenia in which symptoms that meet Criterion A are present, but the criteria are not met for the Paranoid, Disorganized, or Catatonic Type.

Diagnostic criteria for 295.60 Residual Type

A type of Schizophrenia in which the following criteria are met:

A. Absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior.

B. There is continuing evidence of the disturbance, as indicated by the presence of negative symptoms or two or more symptoms listed in Criterion A for Schizophrenia, present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

 

May 30, 2010

Diagnostic Criteria for Sexual Sadism and Masochism

Posted by Nathen under control, diagnostic criteria, DSM-IV-TR, humiliation, lists, mental disorders, pain, sexual masochism, sexual sadism
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I was surprised that these criteria did not specifically mention pain. I had thought that sadism and masochism were about wanting to hurt and be hurt. Reading these makes me think that it’s more about issues around control and humiliation than enjoying the sensation of pain.

This is word-for-word from the DSM-IV-TR, pages 573 and 574:

Diagnostic criteria for 302.84 Sexual Sadism

A. Over a period of at least 6 months, recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving acts (real, not simulated) in which the psychological or physical suffering (including humiliation) of the victim is sexually exciting to the person.

B. The person has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.

Diagnostic criteria for 302.83 Sexual Masochism

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act (real, not simulated) of being humiliated, beaten, bound, or otherwise made to suffer.

B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or important areas of functioning.

 

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