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Diana Laufenberg presents a TED talk on teaching kids to learn.

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.

Melanie Klein - Founder of Object Relations Theory

One rarely discussed element of attachment is the internal object. When children interact with responsive caregivers as infants, they learn not only that the world around them is safe, but that they are safe. Their image, or internal object, becomes integrated. They can experience happiness, sadness, anger and fear in step, knowing all at once that they are still present and safe. When those integrated infants become adolescents, those who have experienced identity crisis, explored, and made a decision within a given domain, are described as “achieved” by James Marcia. Soares’ of the flexible goal-seeker seems to fit well with both Marcia’s identity process and Object Relations’ conceptualization of the categories of the internal object (2005; Engler, 2006; Santrock, 2007).

The “flexible” problem solver described by Soares can deal with threats to their competence and validate their internal object by responding in situationally appropriate ways (2005). With the validation of their internal object, they develop intrinsic goals, thusly increasing their competence at conceptual learning (Vansteenkiste, 2005).

Both the Soares and Vansteenkiste studies were completed on early adolescents, ages 11-14 and 11-12 respectively (2005). Most adolescents do not reach identity achievement in many domains until later on in adolescence or early adulthood. Is it reasonable to expect young adolescents to demonstrate identity achievement and its parallel, flexible goal setting? Although flexible goal setting and intrinsic motivation has been demonstrated to be effective at learning more conceptual than rote frameworks, does teaching conceptually increase intrinsic motivation and flexible goal setting? If those two behavioral outputs increases, does integration of the internal object also increase?

Further research is needed before any conclusions can be drawn. However, if it is found that conceptual learning is one route to a more cohesive self object, I imagine that freed from the constraints of standardized testing, more educators would turn to student directed projects than rote memorization of required knowledge. Exploring whether or not the self object can be repaired or enhanced through engagement with the production of meaning will also change the current paradigm for education and especially, mental health treatment.

Due to the high correlation between attachment disruption and mental illness, I imagine treatment planning that intentionally includes service to others. How could the mental illness paradigm shift if standardized treatment for a variety of mental illnesses included serving the less fortunate? In short, where does meaning production, through education, goals or service, fit with recovery from a traumatic or invalidating infancy?

Engler, B. (2006) Personality Theories. (7th ed.) Houghton Mifflin Company: Boston, MA

Santrock, J. (2007) Adolescence. 12th ed. McGraw-Hill: New York, NY

Soares, I., Lemos, M. S., & Almeida, C. (2005) Attachment and motivational strategies. Adolescence , 40(157), 129-154.

Vansteenkiste, M., Simons, J., Lens, W., Soenens, B., & Matos, L. (2005) Examining the motivational impact of intrinsic versus extrinsic goal framing. Child Development , 76(2), 483 – 501.

When considering the development of emotional regulation, it is important to consider not just the superficial means to that goal, but also the underlying mechanisms that make gaining emotional regulation possible. From infancy, children look to their trusted others, nearly always caregivers, to determine the emotionality of novel stimuli (Hutman, 2009). Identifying pleasurable and uncomfortable emotions would intuitively seem to be important building blocks to developing emotional regulation skills. When those skills begin to express themselves in friendships, children who demonstrate greater emotional regulation seem to enjoy a variety of benefits including a tendency to have more satisfying peer relationships (Spinrad, 2006). Determining the specifics of where and when emotional competence are most highly correlated should consider underlying mechanisms. How can future studies consider confounding factors like the gaining of belongingness and mastery in the means of gaining emotional competence?

Donaldson, 2006 studied adolescent involvement in sports and emotional well-being. Being a correlative study, it simply measured involvement in sports and emotional well-being through validated measures. Unsurprisingly, they found that degree of athletic involvement positively correlated with emotional well-being for adolescents. However, the study did not expressly consider previously mentioned underlying mechanisms for emotional well-being: namely, belongingness and mastery. Belongingness and mastery are well-established human needs (Deci, 2000). Being on a team contributes to fulfilling both of those needs through camaraderie and skill acquisition.

Donaldson’s study does not presume that athletics are the only way to gain emotional competence (2006). However, in its focus on athletics it ignores other avenues to belongingness, mastery and social referencing. In toddlerhood, children learn about the safety of novel stimuli by referencing caregivers. Beginning in childhood and intensifying in adolescence, teens begin to learn the safety and frameworks for adult interaction by referencing peers, and thus prepare to master the upcoming developmental crisis of intimacy versus isolation. Future studies should focus on the perceptual experience of athletics, drama clubs, religious groups and other purposeful activities. Additionally, exploring adolescents’ intrapsychic experience of membership will be an important element of future research. An adolescent must perceive their mastery to experience its benefits.

Organized activities seem to play a role in adolescent development of emotional regulation. What happens when those organized activities are unavailable or understaffed/underfunded? How do adolescents develop emotional regulation without positive adult influence? I am suspicious that although a few effective alternatives to “traditional” organized activities do evolve, such as kinship and neighborhood networks, developing appropriate emotional regulation skills requires some influence of consistent adult leadership. Peer created and managed alternatives, though an essential element of developing independence and priming for intimacy, are only one element of positive adolescent development. If positive and consistent adults are unavailable, by either personal or systemic obstructions, adolescents are left with only the peer-led option, which may contribute an intensification of the personal fable and the normalizing of reactive emotional states. Both factors would seem to, in turn, leave young adults unprepared for a world in both emotional expression and non-expression are socially relevant and appropriate at certain times (Kennedy-Moore, 1999).

Creating the space for organized activities and more informal multigenerational networks is a daunting task. From my perspective, it begins with those three words: “creating the space.” Adults cannot devote time to their neighborhoods if they are working long hours to make a living. Teachers will not devote time to afterschool activities if they are already overworked with classrooms of 35-40 children. Make classrooms smaller, pay people living wages, create safe community spaces and give communities and individuals the resources they need to require so they can devote their intrinsic resources to their children.

Deci, E.L., & Ryan, R.M. (2000). The “what” and “why” of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry, 11(4), 227-268

Donaldson, S.J., & Ronan, K.R. (2006) The effects of sports participation on young adolescents’ emotional well-being. Adolescence, 41(162), 369-389.

Hutman, T., & Depretto, M. (2009) The emergence of empathy during infancy. Cognition, Brain, Behavior: An Interdisciplinary Journal, 13(4), 367-390

Kennedy-Moore, E. & Watson, J.C. (1999) Expressing emotion: myths, realities and therapeutic strategies. The Guilford Press: New York, NY

Spinrad, T.L., Eisenberg, N., Cumberland, A., Fabes, R.A., Valiente, C., Shepard, S.A., et al. (2006) Relation of emotion-related regulation to children’s social competence: A longitudinal study. Emotion, 6(3), 498-510

I just finished putting together a curriculum on male emotional development and regulation for one of my classes and I would love it if any of you would be willing to go and check it out, let me know what works and what doesn’t, and improvements I can make.  I love the beauty of 1.0.

Naming His Feelings

Children and adolescents depend not only on the relationships they have with their parents and peers for normative and validating experience (Field 2002), but they also seem to depend on relationships with non-parental adults (Rishel 2005).  For very young children, at the beginning of their grade school years, forming relationships with adults is something that may seem to come naturally.  They may seem to idolize the adults around them, or at the very least, their eagerness for learning as identified by Freud and Piaget, make them into children who are easy to nurture.  However, how many of those early non-parental relationships are long term?  Although research may not yet exist to demonstrate this unequivocally, it makes intuitive sense that long term relationships would be more vital than fleeting ones to a child’s continuing sense of self.  Working from that assumption, one can begin to piece together the importance of relationships with grandparents, aunts and uncles in determining the self-concept of both the young child and developing adolescent.

Considering the importance of non-parental adults in the development of normative self-concept flies in the face of traditional Freudian psychoanalytic approaches.  Whereas Freud was solely interested in the parental influence in how it affected psychosexual development, new research compels the practitioner to also consider the interaction between psychosocial and intrapsychic factors.  Development of the concept of self within others is a relatively new psychological construct.  How will the conceptualizations of self as interpsychic processes change how philosophy and practice view normative development?

Considering the role of the self-concept also flies in the traditional behavioral psychology.  To Skinner, the personality was a black box, unobservable and thus unimportant to creating change.  Although many of the practices developed for use specifically with young children focus on the role of behavioral interventions (sticker charts, token systems, ect), considering interpsychic processes, like interactions with significant adults, flies in the face of this philosophical standpoint.  What is more important, fidelity to a particular philosophical paradigm or fidelity to the client?  In other words, do we make our tools fit our box, or get a box that fits our tools?

Church, E.B. (2004) Joining the group: how kids learn to be themselves with others. Scholastic Parent and Child. September. 76

Field, T., Diego, M. & Sanders, C. (2002). Adolescents’ parent and peer relationships. Adolescence. 37(145).  121-130

Rishel, C., Sales, E. & Koeske, G.F. (2005) Relationships with non-parental adults and child behavior. Child and Adolescent Social Work Journal. 22(1).  19-34

A recent study put out by Emory University looked at brain development for adolescents who engaged in risky behaviors.  In spite of previously assumed theories issuing that risky behaviors were associated with the underdeveloped adolescent brain, researchers found that from a structural standpoint, adolescents who engaged in risky behaviors actually showed more highly developed white matter.  Researchers suppose that this may be due to the increasing complexity of performing adult like behaviors and the extended adolescence American culture employs throughout the college years.  Erik Erikson believed the primary conflict of adolescence was Identity vs. Role Confusion.  As opposed to 100 years ago, when adolescents were expected to be married and raising families by their 20th birthday, 20 year olds are typically college sophmores, just deciding a major and generally figuring out what it is that they want to do with their lives.  That task of sophmore year, and the college years in general, fits in well with Erikson’s postulate on adolescence.  Because of extended adolescence, teens’ brains may mature before they have the wisdom and life experience to make healthy decisions or engage in safer risk taking (as opposed to anti-social or delinquent behaviors).

An interesting study put out by the Journal of Consulting and Clinical Psychology found that multisystemic therapy seems to be more effective than usual community based services at reducing recidivism rates for adolescent sex offenders.  Adolescents that are committing sex offenses rarely have issues in one domain.  More often than not, they are dealing with a gamut of interpersonal, family and individual issues.  When multisystemic therapists came into the young offender’s homes and completed therapy in that setting, it was found to be incredibly effective over 8+ years.  Reducing the cost of sex offenses should be an important goal for public and private agencies.  Dealing with sex offenses alone cost over $1 billion dollars (granted, it wasn’t stated whether or not this is for individual states or the country in general).  By doing therapy effectively the first time around, professionals can reduce the cost long term.  One factor important to note here is that the two types of therapies offered were either multisystemic/in=home therapy or usual community services/office based.  Because of the difference in location and modality, it is impossible to know what made the difference.  Needless to say though, it would appear that meeting the client where they are at ecologically in both geography and psychology would seem to increase the effectiveness of treatment.

Borduin, C.M., Schaeffer, C.M., Heiblum, N. (2009). A randomized clinical trial of multisystemic therapy with juvenile sexual offenders: effects on youth social ecology and criminal activity.  Journal of Consulting and Clinical Psychology. 77(1). 26-37

My first job out of college was working at a group home for adolescent males who were former gang members or sex offenders.  One night I was chatting with my supervisor and asked him what the average long-term outcome was for the teens we were working with.  He asked what I meant by long term.  As it turned out, most of the adolescents I was working with would be dead or in prison by age 30.  At 15, they were middle-aged.

A recent study put out by the University of Minnesota found that one in seven adolescents believe that they will die before age 35 and that belief coincides with greater risks in sexual, drug and alcohol and behavioral decision making.  How can we encourage far-reaching expectations in already at-risk adolescents?

University of Minnesota (2009, June 29). Teens Who Believe They’ll Die Young Are More Likely To Engage In Risky Behavior. ScienceDaily. Retrieved July 4, 2009, from http://www.sciencedaily.com­ /releases/2009/06/090629081124.htm

A recent longitudunal study put out by the University of San Fransisco found that family obligation may serve as a protective factor against depression for Chinese American adolescents.  A strong family bond may provide adolescents with a secure bond from which to explore the surrounding world while maintaining a home base to return.

This makes me think of the research regarding attachment styles in infants.  Infants may have a variety of attachment types which I will explore in later posts, but the goal of attachment is to have a style in which the child feels safe to explore a room, but returns every now and then to “check in” with their parent or caregiver.  Maybe adolescents continue to need that sort of “checking in” point to rank their emerging identity against accepted norms within the system.  What role do you think family alliance plays in identity development for adolescents?

San Francisco State University (2009, June 4). Family Obligation In Chinese Homes Lowers Teenage Depression Symptoms. ScienceDaily. Retrieved June 6, 2009, from http://www.sciencedaily.com­ /releases/2009/06/090604124804.htm

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