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.

I’m on one of the new fliers for ELLA, the group that I teach Lindy with in Eugene. It’s the group that gave me my first swing lessons, too. We have a dance every Wednesday evening, with a drop-in, beginning lesson just before. If you’re in Eugene, come join us at Agate Hall, at the University of Oregon.

This flier was designed by my friend, Karly Barrett. My partner in the photo is another friend, Renukah Hunter. The photo is by Martin & Renee Norred.

I just read in Brock & Barnard’s Procedures in Marriage and Family Therapy about Wolin and colleagues’ research into rituals in alcoholic families. Apparently, the negative effects of an alcoholic parent were predicted better by the amount that family rituals were disrupted by the alcoholism than by the presence of alcoholism itself. For example, if the family continued to eat dinner together every night, continued with their bedtime rituals, etc, children remained about as well off as those in non-alcoholic households. But if the family rituals were destroyed, the children were much worse off, including much more likely to become alcoholic or marry an alcoholic themselves.

I haven’t read any of the original research, so I don’t know for sure if it is that these rituals actually provide resiliency or if the presence or lack of rituals served as a proxy measure for how bad the alcoholism was. It could also be a combination of the two. It does look like the family therapy literature considers that rituals promote resiliency in general, providing structure and comforting predictability for kids, and resulting in better outcomes. (I doubt they are bad for the adults, either.)  Something to think about, parents!

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.

My favorite new term from my family therapy program is parataxic distortion, coined by the “American Freud” and one of the grandfathers of family therapy, Harry Stack Sullivan.

A parataxic distortion is when a current situation or person reminds you of something from your past, often without you knowing it, such that you behave to some degree as if you are in your past, dealing with that situation or person. Parataxic distortion is an umbrella term for confusions like Freud’s transference (client gets inappropriately emotional about therapist) and countertransference (therapist gets inappropriately emotional about client). It is also very much like to co-counseling’s “restimulation of distress.” Most likely every psychotherapeutic school has its own name for this phenomenon.

The idea is that there is a way in which your memories are categorical, not specific. That is, if your dad hit you when you were a kid, you not only attach fear and anger to your dad in your memory, you also attach it to a range of things, maybe bald men, short men, men in general, authority figures in general, certain kinds of places or rooms, etc.

Mostly, our memories are useful. This ability to generalize, for example, helps us avoid burning ourselves on hot stoves in general instead of having to painfully learn not to touch each hot stove. Neat trick!

But with a parataxic distortion, our unconscious memory keeps us from being able to understand and deal with situations as they are, in the present. It patterns your behavior. It limits your options. Usually without your knowing it, it makes your life more scary, sad, irritating, and ultimately isolated than it needs to be. Most therapeutic modalities have some version of this three-stage recipe for resolving parataxic distortions: 1) Form a trusting relationship with someone who has less distortion in the area you have trouble with. 2) Have a “corrective emotional experience,” where you basically re-experience your distortion-driven emotional pattern while demonstrably safe in this trusting relationship. 3) Have a “cognitive reappraisal,” meaning come to a new understanding of your behavior in light of current reality as it is. Go meta.

Easier said than done, of course, but well worth it!

I listened to a story on NPR a couple days ago about a how high divorce rates and teen-pregnancy rates are correlated to the state’s political ideology. Republican states have significantly more divorce and teen pregnancy. In fact, as a whole, the US divorce rate has been holding steady since the mid-90s, while the “red state” divorce rates (and teen-pregnancy rates) continue to rise. That means the blue states make up the difference and their rates are falling. NPR speculated that it’s because in family-values states, people get married earlier because of social pressure or so they can have sex, but choose badly because they don’t know themselves as well as they would several years later, when Democrats tend to get married. They also note that states that are swinging Democratic, like New Hampshire, are starting to have less divorce and teen pregnancy too.

It makes some sense, though I wouldn’t have guessed it. There are a couple of things not made explicit in the story that I wonder about. First, I wonder if the Republican fixation on “family values” issues is being driven by this phenomenon; to someone living in a Republican state, divorce and teen pregnancy are really pressing issues, because their ideology and behavior are not matching up. It could even be a vicious cycle: Values driving divorce driving values…. Second, I wonder how much of this has to do with money. Social class, really. Red states tend to be poorer, and poverty puts serious stress on a marriage. And poverty is correlated with a lot of other stressors, like substance abuse, domestic violence, and child abuse. Also, they mention that the demographic whose divorce rates are dropping the most are women who have graduated from college. I’ve been attending a state university for a few years now, and I can tell you that it’s not full of poor people. These kids (‘ parents) have money.

My mother, Darlene Lester, is an amazing woman. I am lucky to be her son. Someday I will write a more eloquent post about that. Tonight I’ll just show you a couple things. First is a note that I wrote her when I was about four:

This note says a lot about my mom. First, she had taught me how to write letters by the age of four, which I think is unusual. I can still remember her teaching me to write “N.” (The secret, by the way, is to remember the phrase “Up, down, up.” That’s how she taught me.) The second is the story of the note. (This is as I recall you telling me, Mom–correct me if I’m wrong) I asked her to tell me what letter made each sound over quite a long period of time, maybe an hour or two, as I painstakingly sounded out my message. She was so available and patient with me! Third, the note says, translated, “I would like some orange juice. Signed Nathen.” I handed her the note when I was done with it, probably translating it for her, too. I was asking for orange juice, which was about the closest thing I ever had to candy until I was about nine years old. Mostly I was eating from my mom’s garden, goats, chickens, and the whole-foods co-op my mom helped run back in the 1970s in Joshua Tree. Fourth, my mom kept this note for thirty years. She gave it to me a few years ago and told me the story, still so delighted and proud that she had gotten to be with me, to spend so much time with me as a kid. My mom loves her sons so whole-heartedly! It’s been a pleasure and a privilege to be one of them.

Here’s a photo of us from about that time.

Nathen, Darlene, mid-1970s

Happy Mothers Day, Mom!

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.

I don’t really have time to post. I’m busy reading sentences like, “There is ample clinical research methodology available presently, and such interactions can be reliably described, characterized, and codified in a relatively objective manner,” from page 412 of Textbook of Family and Couples Therapy, by Sholevar and Schwoeri.

There are several reasons that that sentence is an unpleasant read, but none of them are unusual in the books and articles I am reading. I think this kind of writing comes from a frustrated desire to have one’s field recognized as “real science.” Many important and useful ideas have been garbled by this desire.

What grabbed my attention here, though, was the use of the word “presently.” I read that and thought, can we really have a word that means both “soon” and “now”? Yes, we can, of course, but it’s a funny thing to do. When I was learning Mandarin by the Learnables method, where you just listen and look at pictures, I was unable to distinguish between the words for “on top of” and “underneath.” I made a big joke out of that. If you’re going to have a homonym in your language, don’t use it for two such closely related but different concepts! It would be like having the same word for up and down.

To a Mandarin speaker, though, the words for “on top of” and “underneath” sound quite different. “Presently” is even worse than a homonym for closely related but very different concepts. It’s the exact same word for them. Silly.

Every year I work at a summer camp for home- and unschooled teenagers, Not Back to School Camp. This will be my twelfth year–thirty some sessions. It is usually the highlight of my year. An NBTSC alumni, Allen Ellis, made this video about it in 2009. Maya posted it on her blog a couple of months ago, and I’m copying her. In moments like this I really wonder who it is that reads my blog. I suspect you are 97% my family and NBTSC friends, who have already seen this. Oh well. This is for the other 3%, whose names are mostly David, Ceri, and Emily.

The guy in the still shot that heads the video is my friend Blake Boles. Every time I see this shot I wonder if Allen asked his permission to use it like that. It’s a funny one.