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I have completed my thesis, entitled “Metaphorical Language and the Nature of Hope Among Mothers of Children who Deal with Mental Illness.” If you are interested in a complete copy, please email me.

A qualitative study of mothers’ experiences raising a child who dealt with mental illness is presented. Twelve (n=12) mothers participated in this grounded theory study. Metaphorical analysis was used to understand how mothers conceptualized mental illness and hope. Mothers described mental illness in both static and dynamic terms, meaning that for some mental illness was primarily a fixed entity, or a “fact of life,” whereas for others, mental illness was an active entity that maneuvered to change their children’s and their own lives. Mothers described hope in terms of striving for presence, “normality” and productivity. Emotional experiences of mental illness, grief and loss, and stigma were also discussed. Recommendations for further research are made.

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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.

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.

(CNN) — The medical journal The Lancet on Tuesday retracted a controversial 1998 paper that linked the measles, mumps and rubella (MMR) vaccine to autism.

The study subsequently had been discredited, and last week, the lead author, Dr. Andrew Wakefield, was found to have acted unethically in conducting the research.

The General Medical Council, which oversees doctors in Britain, said that “there was a biased selection of patients in The Lancet paper” and that his “conduct in this regard was dishonest and irresponsible.”

The panel found that Wakefield subjected some children in the study to various invasive medical procedures such as colonoscopies and MRI scans. He also paid children at his son’s birthday party to have blood drawn for research purposes, an act that “showed a callous disregard” for the “distress and pain” of the children, the panel said.

After the council’s findings last week, The Lancet retracted the study and released this statement.

“It has become clear that several elements of the 1998 paper by Wakefield et al. are incorrect, contrary to the findings of an earlier investigation. In particular, the claims in the original paper that children were ‘consecutively referred’ and that investigations were ‘approved’ by the local ethics committee have been proven to be false. Therefore we fully retract this paper from the published record.”

-from CNN

What a great day for science, kids’ welfare, and parents.

I finished my first semester at UW – Stout with flying colors.  Over the course of the semester I learned a ton of things, notably, the differences between the classic family theories (Structural, Bowenian, Strategic, ect), that due to the fact that we live in a pervasively racist society, everyone really is a racist, and at the end of the day I want to be a female version of Carl Whitaker.  (Carl Whitaker, for those of you who don’t know, was a sort of grouchy old man who believed that everyone was crazy and to effectively create change in families, they must have the motivation within themselves to do it.  He was very confrontational and often was accused of “not liking his clients.”  He agreed with his accusers.)  In short, I am taking on the socially constructed identity of a marriage and family therapist and liking it.

One thing that I did not like very much over the course of the semester was working full-time while doing school full-time.  Although I was able to successfully do both of those things, I was not able to do things like have free time or invest in friendships.  Both free time and friendships are important to me and because of that, I am cutting my hours at CRTC to part-time.  I am looking forward to having time to be more than a great student and employee.  At the beginning of February, I will be in the Part Time Overnight position.  Although the sleep schedule will take some adjusting, I think that it will be worth it, especially because I will be able to use some down time during the overnight to do homework.  I am also hoping to have some more time to keep this blog maintained.

Over the course of Holiday break, I have been spending time with family, playing the Sims, and reading “fun” books.  (It should be noted that “fun” is in quotes because I decided to see what all of the Twilight fuss was about.  It is as bad as you’ve heard.)  One of the things I want to try in the Sims is make a polygamist relationship and a polyamourous relationship.  I want try this: 1) to see if I even can with the way the game is coded and 2) to see how harmonious I can make both of those types of relationships work within the game.  The problem I run into with running social experiments on the Sims is that I start to feel attached to my avatars – I don’t want them to suffer.  So when they start fighting with each other and sobbing into their hands (you Sims players know what I am talking about), I fold like a cheap suit and start giving them what they want. Does anyone else experience this?  With a simulation game (one without a win point), do you find yourself feeling bad for your avatars?  Assuming that I don’t just have an excessively sensitive heart, I wonder if people who struggle with empathy would empathize with their avatars in a game like the Sims.  Would someone who is dealing with Antisocial Personality Disorder or Reactive Attachment Disorder feel bad for or attach to their Sim?

Thoughts?

As you probably have noticed, I have not been blogging as much lately.  I started grad school about two weeks ago and my time is pretty solidly split between working, being in class, doing homework or spending time with my husband.  Due to time constraints, I will not be updating as regularly as normally.  Every now and then I will try to post an interesting article or link.  For instance, I suggest that you check out this link.  It’s a comic a man wrote about dealing with schizophrenia.  Again, check it out.  Peace,

Anna B

In Reclaiming Children and Youth a recent article took a look at Conduct Disorder’s etiology for youth.  The writer of the article, Robert Foltz maintains that although brain imaging techniques can see some of the signs and signals of conduct disorder in adolescents already diagnosed with the disorder, the fact that children are already diagnosed suggest that the brain changess through neuroplasticity as a result of life experiences.  He notes that in 1999 the Surgeon General noted that “no drugs have been found to consistently decrease aggression in youth.”  However, Multisystemic Therapy and Positive Peer Culture have been found to be effective.  Ecological interventions would appear to be the most effective for youth dealing with conduct disorder.

Flotz, R. (2008).  Behind the veil of conduct disorder: challenging current assumptions in search of strengths. Reclaiming Children and Youth. 16(4). 5-9

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