Final excerpt…

…This study contributes to existing research by exploring and analyzing metaphorical language mothers use with regard to mental illness and hope. It also contributes to understanding some of the emotional responses mothers may have to their children’s mental illness. Additionally, by highlighting metaphor as used by mothers of children who deal with mental illness, this study emphasizes the importance of the abstract, spiritual and meaning-based structures that frame experiences of mental illness. Anticipating, exploring and understanding the abstract elements of an individual’s experience with mental illness may promote therapeutic alliance, and thusly, would improve treatment outcomes. By including another family member (in this case, mothers), this study also contributes toward development of a systemic conceptualization of mental illness…

 

Thesis Excerpts Continued:

…Mental illness affects not only the individual who personally deals with it, but that individual’s family and friends. Research on microsystemic experiences of mental illness has generally focused on recommendations for social service providers and caregiver burden. Little research has been completed on the wider lived experience of family members and loved ones who may or may not be primary caregivers for individuals who deal with mental illness.

Familial caregivers of those who deal with mental illness report a variety of experiences and outcomes. The care giving experience, as perceived by caregivers, is at once described as stressful, unsatisfying and upsetting, and at the same time critical and therapeutic (Chang & Horrocks, 2006). When an individual presents with mental health concerns, it is not typical for family supports to be immediately offered. Additionally, it is rare for family members to report their own needs (Heru, 2000). Parents and families of those who deal with mental illness may be reluctant to seek psychotherapy for themselves, possibly because of a denial of their own trauma or the belief that their loss is not worth mourning (Burkhalter, 2010). A psychotherapist who wrote of that loss described his own experience parenting a special needs child as trauma: “There is the initial trauma, which for us was the realization that those silent ten fingers/ten toes prayers had gone unanswered…” (Burklalter, 2010, p. 23)…”

As I’m sure you’ve noticed, my posting has slowed down quite a bit on this blog. I’m working on my thesis, so for the next few months I’m going to focus on putting out excerpts from my thesis. If you are interested in a final copy of this project when I am finished, please feel free to email me.  The first excerpt begins below:

“The preoccupation with categorizing and diagnosing mental illness has led to an emphasis on the tangible and objective, and a corresponding de-emphasis of the subjective, emotional, spiritual and symbolic” (Young, Bailey & Rycroft, 2004, p. 191).

            Current conceptualizations of mental health and illness focus on the diagnosable individual. However, individuals who deal with mental illness also have families, friends, partners and other loved ones who are affected by their experience of the mental illness. Minimal research exists on loved ones’ experiences of mental illness. This is problematic because as Cowling, Edan, Cuff, Armitage and Herszberg, (2006) state: “the unwell person is enmeshed in a family context. The distress of the unwell person is also the distress of the family. Clinicians should be acutely interested in the family context” (p. 416)

Two of the things that seem to affect low levels of success for treating clients with depression are poverty and ethnic minority status.  Clients who are dealing with depression, in addition to being economically and socially disenfranchised, are dealing with compounding stressors.  They are statistically more likely to drop out of or disengage from treatment attempts.  The research question that Swartz’s 2007 study looked at was “What can be done lower rates of drop out and “no shows” among clients with depression?”

The authors addressed this question firstly, with a qualitative literature review, and secondly, by developing an “engagement session” protocol for use with clients with low levels of motivation.   After reviewing the literature on motivational interviewing (MI) and ethnographic interviewing (EI), and finding that MI in particular, is empirically supported for increasing engagement and motivation among clients with serious substance issues, the authors proposed and described the protocol for an “engagement session” that could be used at the beginning of treatment among clients with low levels of motivation.

Motivational interviewing is a technique I want to learn more about, especially given that I am currently doing my internship in corrections and want to continue to do client work with people who come from low-income and disadvantaged backgrounds like those that this article targeted with the EI/MI intervention.  It is described in the article as a “client centered, directive method of enhancing intrinsic motivation for change by exploring and resolving ambivalence” (432).  My instinct and first response when I sense ambivalence is to ignore it, which is not as effective as I would hope.   Motivational interviewing seems to provide an effective tool to deal with ambivalence.

Ethnographic interviewing will also be important for me to learn more about, especially because I am rather shamefully, quick to judge.  For instance, in my work with the young men in corrections, my initial instinct was to assume that both the client and I had the same idea about what the problem was: namely, their engagement in the criminal offence that got them incarcerated.  It has been good for me to learn to take a step back and ask about the client’s judgment of things, being aware of my own bias and quick response.  I hope that learning more about motivational and ethnographic Interviewing, and specifically, becoming more comfortable with ambivalence in general will help me be a better therapist, researcher and teacher.

A specific example of how I have been using motivational interviewing and ethnographic interviewing in my work with the young men at my practicum site has been during my initial interactions with the youth I serve.  As all of the young men I work with are court ordered into corrections and treatment, it would appear, initially, that motivation levels may be very low.  They have not actively sought treatment and therefore, their engagement in it would intuitively be lower than the “average” outpatient client.

However, levels of motivation at the outset of therapy seem to have quite a range, from “I’m never going to stop being a criminal and I’m going to die a gang member” to “I don’t ever want to come back to prison, I need to learn how to avoid police and subsequent incarceration” to “I need to change everything about my life, and the change I am going to make is going to be transformational, as opposed to a superficial in nature.”  Each starting level of motivation includes different ideas about what change is, what meaningful change would consist of, and whether or not change is a meaningful pursuit.  To make the last point more succinct, the value of change is not a duality; how meaningful change or growth or healing is bound to be is more accurately measured on a Likert scale.

Regarding the young men at my practicum site, ethnographic interviewing is also important.  Recognizing my own self of the therapist and knowing that I am walking into the room with my Masters degree nearly completed, my white skin, my thick and trendy glasses, I am, by appearance and speech often a world apart from the adolescent, impoverished, ethnic minority and often truant youth with whom I work.  While it may be easy and even not inaccurate for me to read the young gang-banger who states that he will claim his “set” until his early death as short-sighted, I may not know that in the community from which the young man comes, gang involvement is firstly, a matter of safety.  When I’ve worked to meet the young men I work with in their world and ask more questions to help me understand, more often than not I’ve found that their gang involvement serves an important and needed purpose in their life and in the lives of their family members.  Although they are currently incarcerated, their gang involvement protects their families.

Some of the questions I regularly use with my clients that come form a motivational/ethnographic interviewing stance include:

  • On a scale of 1-10, where 10 is “100% absolutely want to complete your goal” and 1 is “no way, not even going to try at all,” where are you as far as working toward your goal?  (Motivational Interviewing)
  • Why are you at the number you picked and not lower? (Motivational Interviewing)
  • If you felt 100% committed and had all of the time, resources and everything else you needed to work toward your goal, what would keep you from completing it? (Motivational Interviewing)
  • What do you do during a typical day at home?  Who do you see during a typical day? (Ethnographic Interviewing)
  • Who will be important to include in your treatment?  (Ethnographic Interviewing)
  • What nouns do you prefer for what we are doing here, for example, counseling, meetings, sessions? (Ethnographic Interviewing)
  • What do you think the problem is? What led up to the problem? (Ethnographic Interviewing)
  • Have you had other encounters with social service people or mental health before?  What have they been like?  What did you like? What don’t you like? (Ethnographic Interviewing)

By being honest in my ignorance and working to understand where clients are coming from, what is important to them, and engaging with them in those things that they perceive as important, I build connections that help my clients not only experience growth, healing and even change on their own terms, but also leave the door open for further help-seeking in social services and become the sort of person who can question harmful and criminal behavior in such a way that leaves my clients also questioning it.  When we work to know our client’s worlds, we connect in such a way that allows for and compels growth on both sides of the relationship.  Therapists and clients experience change.

Swartz, H.A, Zuckoff, A., Grote, N.K., Spielvogle, H.N., Bledsoe, S.E., Shear, M.K., et. al. (2007).  Engaging depressed patients in psychotherapy: Integrating techniques from motivational interviewing and ethnographic interviewing to improve treatment participation.  Professional Psychology: Research and Practice, 38(4), 430-439.

A blogger ‘came out’ as someone who deals with mental illness, and here he talks about what’s happened since then. The video is long, but beautiful and worth the watch.

“I was warned that I would lose myself. But I’ve never been more Michael Kimber.”

About a month ago, I started therapy.  The road into therapy was one that consciously began about a year ago, when I set “Beginning therapy” as one of my New Year’s Resolutions.  The only external effort I made regarding that goal prior to when I actually started, was in August this year, when I went back and deleted that item from the blog post detailing my New Year’s Resolutions.

When I decided I wanted to run a marathon back in 2007, I started running the day I decided. In contrast with nearly all of the other goals I have ever made for myself, starting therapy was one that I seemed prone to procrastinate.

There was a part of me that didn’t see the reason.  Another part of me didn’t want anyone to know that I thought there might be a good reason for me to attend therapy.  (Hence, my deleting that goal from my New Year’s Resolutions.)

In spite of the fact that I’ve been working in mental health for the past four years, I didn’t see, didn’t want to see the necessity in myself.  While I’ve advocated for my classmates to attend, actually doing it myself, getting in the door, was challenging.

Even as I’m attending and feel like I’m getting a lot out of being in therapy, I still feel my body and mind ready to run.  I’m a voluntary client, but the extent to which that is voluntary is not always felt in my calves, which flex throughout session; I’m ready to go.

While therapy has been valuable for me personally thus far, I think it’s also valuable for me professionally.  I can’t imagine that I’m the only client in the world that wants to be there and at the same time, doesn’t feel right being there.

I’m tempted to end this post with something both positive and pithy, like “Even though I have felt mixed feelings about being in therapy, I trust that it will be useful,” but I don’t know that that’s the whole truth. That is the truth: I have felt mixed feelings about this process and I do trust that it will be useful.

There is another truth, though, in my flexing calves.  I want to be there.  I trust it is and will be useful.  I also want to run.  Maybe that’s the process.

I wanted to put up a quick note saying that I started the second (and final!) year of my Masters degree and with that, my internship and practicum. I’m doing it part-time at the an outpatient clinic and part time at juvenile correctional facility. My experiences at both places so far have really highlighted both how much I know and how much I really don’t know.

One of the more interesting experiences I’m having as a staff person is in corrections. For the first time in my professional life, as a white woman on the staff I am in the minority. It feels really strange, as women especially and white people in general, have dominated all of the social service positions I’ve worked in previously.It’s also the first time I’ve been in any sort of non-direct care role. Figuring out how I want to navigate that power differential is on the top of my mind right now.

In addition to those foreign experiences, there are my actual clients, from whom I have so much to learn. It’s really exciting to me to have all of this stuff to learn and all of these people to learn from. It sounds strange, but for now, I’m really looking forward to the inevitable feeling of incompetence that these new challenges will bring and then expanding my world so that those challenges no longer leave me feeling off-balance.

Essentially, I have a lot to learn. My internship and practicum are compelling that learning.

Earlier this summer, I had the pleasure of attending a seminar on Narrative Exposure Therapy (NET) through the University of Minnesota – Twin Cities, Family Social Science Department.  Narrative Exposure Therapy is a relatively new, but very effective, intervention for Posttraumatic Stress Disorder (PTSD).  It was developed and is being used in mass trauma situations, like refugee camps.  Multiple experimental randomized, control studies demonstrate its effectiveness at eliminating PTSD for victims of multiple trauma events (Neuner, 2004; Onyut, 2005; van Minnen, 2002).

Narrative Exposure Therapy is conducted in a short series of structured sessions.  In the first, individuals participate in a diagnostic interview partially to evaluate for the presence of PTSD.  In the subsequent session, they asked to create their “lifeline” by laying out a length of rope and indicate positive events with flowers and negative events with rocks.  Subsequent sessions consist of explaining their “lifeline” with the inclusion of both their flowers and rocks.  They may also be asked to describe some of their hopes and dreams for the rest of their lives.

In each session, counselors record the individual’s life story and ask for corrections.  When counseling is completed, a digital photograph of their lifeline is taken.  Through the use of the lifeline, the traumatic event becomes integrated into the total narrative of the person’s life.

I ran into the literature for this approach earlier this year while I was working on a literature review with the U of M and was impressed by the elegance and effectiveness of the approach.  Attending the seminar really highlighted the theoretical basis, need and again, effectiveness.  I will probably be writing future posts about some of those other things from the seminar that really stood out to me.

Neuner, F., Schauer, M., Klaschik, C., Karunakara, U., & Elbert, T. (2004) A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating Posttraumic Stress Disorder in an African refugee settlement. Journal of Consulting and Clinical Psychology, 72(4), 579-587

Onyut, L.P., Neuner, F., Schauer, E., Ertl, V., Odenwald, M., Schauer, M., & et. al. (2005) Narrative exposure therapy as a treatment for child war survivors with posttraumatic stress disorder: Two case reports and a pilot study in an African refugee settlement. BMC Psychiatry, 5(7).

van Minnen, A., Wessel, I., Dijkstra, T., & Roelofs, K. (2002) Changes in PTSD patients’ narratives during prolonged exposure therapy: A replication and extension. Journal of Traumatic Stress, 15(3), 255-258.

A friend linked me to this video and I thought it was lovely.  Hope you enjoy:

Holding Hands

My husband and I have been married for just over two years now.  One of the things that we really like to do together is go for walks.  We walk through our tree-lined neighborhood, holding hands, and chat about our days, the weather, all of that average, mundane stuff that relationships are made of.  I treasure those walks.

While we are walking, we rarely get a second glance.  A neighbor or two might glance up and smile in greeting or extend an “ ‘Evening” but rarely do we get much more than that.  I’m okay with that.  We aren’t out for a walk to be recognized or announce anything about ourselves to anyone else.  We are simply strolling at dusk, anonymous and happy.

While we are walking, we are anonymous.  We are just a couple, like any other.

Another couple might be walking at the same time we are walking.  They, too, might have been together for over five years and be highly committed.  They may presently struggle with many of the same things young couples struggle with: defining their couplehood, maintaining family of origin relationships and navigating emergent adulthood.  They, too, may someday plan on buying a house, planting a garden and raising children.

When this couple walks, though, they are not anonymous.  They may be gay or lesbian, biracial, or have any the other characteristics that seem to require explanation.  In short, they deviate from “the norm.”

Over the past year, this has really struck me.  When I’m thinking about what being oppressed and privileged means, I think that one of the primary clues that I’m thinking about a category of privilege is that it does not require explanation.  When my husband and I walk at dusk, I feel like I can rest assured that nothing is assumed about us.  We could be liberal or conservative, parents or childless, in touch with our families or not.

As far as I know, holding my husband’s hand is not regularly construed as an overt political statement.

One of my assumptions is that all people have been both recipients of privilege and victims of oppression.  Where in your life are you oppressed?  Where in your life are you privileged?  If you are having trouble defining these areas, think about the parts of your life and context that demand explanation.  What does that mean?

*Many thanks to Dr. Terri Karis and Dr. Bruce Kuehl, two professors at the University of Wisconsin-Stout, who got these ideas rolling.

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