My Couples and Family Therapy program has a lot to say about epistemology. Epistemology is the study of knowledge. We don’t get so much into the history of it–what various philosophers have decided gets to count as knowledge–but we do get a decent overview of what they call modernist, systemic, and post-modern epistemologies.

The basic question for someone thinking about epistemology is, “At what point can I say I know something to be true?” Here’s a super-oversimplified version of a few “epistemologies”:

Pre-modern: I can say I know something if a book or person that I believe has sufficient authority says it is true. Forever. Also, if I feel very certain about something I might consider it true.

Modern: If I observe something with my own senses, I can say that it is true, at least for that instance. If others who look at the same thing make the same observations, that gives more weight to my belief. I ideally keep the possibility open in my mind, however, that new evidence may come along and change my belief.

Post-modern: I can never really say that something is true, as I am forever limited by the perspective given me by my sense organs, my mind, and my acculturation. I will never have direct apprehension of reality. The closest I can come to real knowledge is a guess that produces useful results.

My program conflates post-modern epistemology with what they call “systemic” epistemology. “Systemic” refers to cybernetics, or systems theory, and in my view is actually an extension of modernism. Traditionally, modernism looks for linear causality and uses reductionism to learn about things. Systems theory looks at causality in terms of networks of interacting, mutually affecting/effected influences, all of which you must see, in action, to understand. It’s holistic, not reductionistic. It doesn’t rely, however on the post-modern insight about the limitation of each person’s perspective.

What I like about my program’s emphasis on epistemology, though, is that they encourage us to examine our “personal epistemology,” so that we know as much as possible how the lens that we view reality through shapes our perspective. A very post-modern idea. We are to think about how we think about reality and own our epistemology. We wrote a series of essays in this vein.

Gregory Bateson, one of the founders of the field of family therapy, said that anyone who doesn’t think they have an epistemology just has a bad epistemology. How would you describe your epistemology? What is your bar for labeling an idea “truth”? What things do you believe are certainly true? Why? Do you think your experiences tell you something directly about reality? Can you take anyone’s word about reality confidently?

I’m reading Virginia Satir’s Conjoint Family Therapy. She was this amazing, giant, super-loving woman, one of the founders of the field of family therapy–kind of the Julia Child of family therapy. I’m learning her style of therapy, possibly in part because I was introduced to her work very young, maybe 11 or 12. My mom bought me Elgin’s The Gentle Art of Verbal Self-Defense. It was my first introduction to going meta on communication–thinking and talking about communication, a very useful skill, possibly the central skill of a therapist.

I’m really enjoying reading the original Satir. One of her (many) assertions is that pretty much any time you say anything you are making a request. It could be a request for any number of behaviors, but ultimately they are all requests for some kind of validation. The difference between functional and dysfunctional communication is how overt your requests are. Here’s one of her examples (p. 86):

Functional:

“Let’s see a movie,” or even better, “I would like to see a movie with you.”

Dysfunctional:

“You would like to see a movie, wouldn’t you.”

“It would do you good to see a movie.”

“If you want to see a movie, we’ll see one.”

“We might as well see a movie. It’s Saturday night.”

“There’s a new movie house down the street.”

“My voices are ordering me to see a movie.”

Dysfunctional requests require decoding. If both the sender and receiver of the communication are clear about the codes they use, this is fine, but in general, the more decoding required, the more trouble you get into.

The problem is, if you make a clear request, you can be clearly denied your request. You make yourself vulnerable by saying “Let’s see a movie,” or “Do you like me?” because the answer could be “No.” Unless your self-esteem is quite high, a “No” hurts.

If you send a code, say, “There’s a new movie house down the street,” you can pretend that you’re not putting yourself out there. If your receiver says, “I don’t want to see a movie,” you can say, “What do you mean? I was just commenting on the new building.” Or your receiver can say “No” in code, maybe, “Yeah, that place looks like a dump.” Then things are really fuzzy. You don’t know if they decoded your message accurately, and they don’t know if your message was coded in the first place. It might feel like protection–it might even be protection–but it’s confusing and it lacks intimacy.

Why do we code our requests? We learn to. Maybe we’ve learned not to trust our receiver with a vulnerable request–the way they responded to such requests in the past have been painful. Or maybe it’s just habit, left over from accumulated painful experiences from our younger years. It could be part of your family’s culture, and uncoded requests seem harsh or demanding.

Try watching your communication. How coded is it? How do you feel when you imagine speaking in less coded requests? And try being vulnerable. Try to do even better than Satir’s, “I would like to see a movie with you.” Unpack it more. If you can say with honesty, “Hey, I really like you and I’d like to spend time with you tonight, watching a movie. What do you say?” then do it!

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.

Or one in four, if you prefer a less “conservative” definition of rape.

I learned this in my training for the University of Oregon Crisis Hotline. It makes me sick. The statistics are from the US Department of Justice. Here are three others, from the USDJ as reported in my training manual:

80-90% of these rape victims know the perpetrator.

Though it meets the legal definition (basically, forced sexual intercourse, vaginal, anal, or oral, with a body part or object, though it varies some by state) half of rape survivors do not label their experience rape.

Less than 5% of rapes are reported.

I posted in February about how the committee that is redesigning the DSM is accepting feedback on their proposed changes. The Diagnostic and Statistical Manual of Mental Disorders is the book used around the world by clinicians to determine what kinds of human suffering count as mental disorders, what symptoms one has to show to qualify as having one of those disorders, and what what can get covered by insurance. The content of this book will shape the lives of those who will interact with the mental health system for the next generation. Being labeled with a mental disorder is a big deal, and which one you get can mean the difference between decent and indecent treatment. Personality Disorder? You’re pretty much screwed. Very few people think they can help you and no insurance will cover you. Adjustment Disorder? PTSD? You’re in luck, most likely. We’re all very hopeful for, and will pay for, your recovery.

If you’re life has in any way been affected by anything labeled a mental disorder, I encourage you to look at the appropriate proposed changes to your future and the future of your loved ones, and write them an email about what you think. You have until April 20, 2010.

Structural, Cross-Cutting, and General Classification Issues for DSM-5
Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
Delirium, Dementia, Amnestic, and Other Cognitive Disorders
Mental Disorders Due to a General Medical Condition Not Elsewhere Classified
Substance-Related Disorders
Schizophrenia and Other Psychotic Disorders
Mood Disorders
Anxiety Disorders
Somatoform Disorders
Factitious Disorders
Dissociative Disorders
Sexual and Gender Identity Disorders
Eating Disorders
Sleep Disorders
Impulse-Control Disorders Not Elsewhere Classified
Adjustment Disorders
Personality Disorders
Other Conditions that May Be the Focus of Clinical Attention

One thing I will have to assess in the families I see is possible drug/alcohol abuse, because substance abuse is pervasive, problematic, and interpersonal. One of my texts, Procedures in Marriage and Family Therapy, recommends using “objective” measures such as the Michigan Alcoholism Screening Test (25 items), or the MacAndrew Alcoholism Scale of the Minnesota Multiphasic Personality Inventory (49 items), to give weight to the assessment. However, it also says that there is a correlation of .89 (that’s very high) between answering yes to two or more of the following four questions  and alcohol abuse (p. 47):

1) Have you ever felt you ought to cut down on your drinking?

2)have people annoyed you by criticizing your drinking?

3) Have you ever felt bad or guilty about your drinking?

4) Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye opener)?

Also, they list Heilman’s eight symptoms of alcoholism:

1) Thinking or talking a lot about drinking or getting high.

2) Increased tolerance. This is not a sign of health!

3) Drinking or taking a drug in a way that speeds up the onset of its effects.

4) Non-social use.

5) Drug/alcohol starts to seem like a medicine. Thoughts of drug/alcohol immediately upon a stressful event.

6) Blackouts. “How did I get home last night?”

7) Taking care to always have a supply of alcohol/drug.

8) Using more than planned.

Finally, Heilman says that anyone who answers yes to the question “Is your drinking ever different from what you would like it to be?” is very likely suffering from alcoholism (p. 48)

I will start seeing clients this summer, so I’m reading two texts about how to structure my sessions, Procedures in Marriage and Family Therapy, by Brock and Barnard, and Essential Skills in Family Therapy, by Patterson. One of the things I am to assess as a top priority is the possibility of family violence. (I’ll get a whole class on this next year.) It’s almost always perpetrated by a male. According to Patterson, battering is the biggest cause of injury to women. Here is Brock & Barnard’s list of characteristics that can help identify violent men (p. 46):

1) Believes in the traditional home, family, and gender stereotypes

2) Has low self-esteem and may use violence to demonstrate power or adequacy

3) May be sadistic, pathologically jealous, or passive-aggressive

4) Has a Jekyll and Hyde personality, capable of great charm

5) Believes in the moral rightness of his violent behavior even though he may go too far at times

6) Has perpetrated past violent behavior, which includes witnessing, receiving, and committing violent acts, violent acts during childhood; violent acts towards pets or inanimate objects; and has criminal record, long military service, or temper tantrums

7) Indicates alcohol abuse

To this list, Patterson adds preoccupation with weapons or control.

I’ve been tracking my driving and biking mileage since my last birthday, just over six months. I just broke 400 miles on my bike, so I thought I’d figure out my mileage ratio. I’m at 401.8 miles on my bike and 3,283.2 miles on my truck. That’s 1 to 8.17 biking to driving, or 12.24% biking.

That’s pretty good, I think, considering I’m just a commute-cyclist. I drove less than half of the average miles for an American (7,500  in six months, according to WikiAnswers) and biked 37 times the average American miles (using 6.2 billion miles biked in 2001 from the Bureau of Transportation Statistics, and 285,669,915 people in the US in 2001, according to the GovSpot.com, giving about 11 miles per person per six months, if my math is right.)

I expect my biking to catch up some to my driving, too. I drove to Joshua Tree for Christmas this year, accounting for over 2,000 of my driving miles, and I won’t be making another trip like that for quite a while. Without that trip, I’d be at about 1/3 of my miles biked.

Hmm… maybe next year I’ll track my walking too. That would be cool to know.

My parents forwarded me an email from a family friend, Lauren (musician and poet), who is going off email for six months. She’s concerned about distraction (including in her email the quote “It’s commonly believed and understood that it takes about 4 minutes to recover from any interruption. If the computer dings at you and you look 30 times, that’s 120 minutes of recovery time. That’s the crisis.” —Marsha Egan, Author of Inbox Detox), concern over what seems like addictive behavior, valuing face-to-face or at least voice-to-voice communication, and this article about a study which found that emailing reduced productivity more than pot.

She had a series of questions about it email and her project, which I answered. By email. I think she’s starting on April 14, but if she’s already started,she can read my answers in six months.

1.     How many times a day do you check your email?
I don’t know. It varies between one and many–20?–depending on the style of my day. There have been days that I don’t check–camping, procrastinating. If I need to concentrate, I do not check email or even keep a browser open until I’m done.
 
2.     How many times a day do you send or receive a text?
Zero. I sent one text in my life, just to try it out, and I strongly encourage my friends not to text me. It doesn’t appeal to me. I’m also vaguely offended by the use of “text” as a verb.
 
3.     Have you ever had a miscommunication via email or text?
Yep, at least a few. It took a while to realize that the pragmatic (i.e. non-verbal) context of communication really does not come across in email.
 
4.     Do you feel anxious over the thought of not having email for
six months? Do you feel anything negative at all? Happy? Just tell me
how you think you would feel.
Hmm. It would be tough. First of all, I’m in grad school and email is how all of my profs and peers communicate important info. We often get our reading over email, and turn in our papers, too. Second, I’m in a long distance relationship, and email is helpful in keeping a sense of connection. We depend mostly on Skype, which is allowed in your plan, but I wouldn’t want to give up email before Reanna and I are living in the same house. Plus, she emails me mp3s of her reading articles I’ve been assigned, so I can “read” while cleaning my kitchen. Plus, she edits my writing over email. Third, I’m so busy that losing the super quick, no-strings-attached communication ability would mean isolating myself even more from my geographically dispersed family and community. Last, as I understand it you are going off of Facebook, blogging, texting, messaging, and chatting as well as email. That all sounds fine except for blogging. I’m pretty attached to my blog. It’s my most consistent form of creative expression these days.
 
On the other hand, I feel relieved and relaxed when the power goes out, and a big part of that is losing the computer. I went to a lecture years ago by a woman whose name I can’t remember who said “You’re not ‘connected,’ you’re ‘tethered.’ She recommended taking vacations from the leash–phone included. That appeals to me. When I climbed Mt. Whitney, ten years ago, two behaviors really confused me, seeming to miss the point: At the summit, a few people lit up a cigarette and many people immediately called home. It seemed like in sharing their moment they were also missing it. At least they weren’t texting, I guess.
 
 5.     Do you think there is anything important to be learned/gained
by not having email for six months?
Yes.
 
6.     Do you use email more for work related messages or for
family/friend correspondence?
Mostly school. Family and friends second. Work a distant third.
 
7.     How do you feel about me not emailing you for 6 months?
Well, we haven’t communicated in years, so I don’t feel much about it. If we were close I might have feelings.
 
8.     Are you sitting with a Bluetooth in your ear, reading and
sending a text with one hand, eating soup with the other, glancing
frequently at your To Do list, all on your twenty minute lunch break?
Don’t feel bad. While writing this letter I checked my email 3 times,
ate handfuls of dry Panda Puff cereal, and listened to my sweetheart
talk about his online class.
No, actually, I’m sitting at my first shift on the University of Oregon Crisis Line, waiting for someone with a crisis to call me. I do have my cell phone with me (and will almost certainly use it at least once), I am (obviously) using email, and have a to-do list that you wouldn’t believe, but I doubt that I’ll check my email more than three times today. Mostly I’ll be reading about counseling gifted children, assessing families, and conducting group therapy.
 

April 9, 2010

Dear Nathen,

We are very pleased to inform you that you passed the comprehensive exam. Our standard in grading this exam is high; your work was of a very high quality. Congratulations!

You have worked very hard and you have demonstrated excellent understanding of core course material. We look forward to working with you as you move into your clinical work. In the Beginning Practicum course Dr. Tiffany Brown will continue to inform you about the Advanced Practicum course, about internship options throughout the community, and about orientation dates and plans for beginning at the Center for Family Therapy.

The vast majority of your cohort received a passing score this year. This is a statement of both your individual abilities and the support you give each other.

Again, congratulations.

Deanna Linville, Ph.D., LMFT

CFT Program & Clinical Director

Assistant Professor

Couples and Family Therapy Program

University of Oregon