Friday 01/06/12

“What we look for shapes what we see. What we see shapes how we act with others. And how we act with others shapes what is possible to occur”- Madsen

This morning I have a family therapy session to conduct. In preparation, and almost as a tool for self motivation, I try to focus on what I can do to help my clients learn about their own resourcefulness and strength. Today I am doing this through the reading of a rather good book that I gave myself for Christmas. It’s called “Collaborative Therapy with Multi-Stressed Families” by William C. Madsen. So far the book is a pretty straight forward and well written treatise on things I already believe. But that makes it all sound too unimportant. We all need cheerleaders for our own positions, to remind us of the value of what we do in the first place. It is not that I am unopen to new information, in fact I hope and pray that this fellow is able to open me to some new ideas for managing in a session. It is however that the world of therapy as it exists today is a deficit model. We look at what is wrong with others instead of what is right. We have bought into the medical model, that therapists are here simply to fix some underlying problem.

“The application of a medical model to social functioning has encouraged us to
view life through a lens of disease, with a strong focus on presumed pathology
within the individual. In the process, the broader context of social interaction and
meaning is obscured. The family as a social context is essentially ignore except
as the locus and source of trauma (which can position counselors and families
in an adversarial relationship). And the influence of broader social, economic,
and cultural factors disappears almost entirely. As a result, what began as a
major triumph in one arena (infectious and acute physical illness) has become
quite limiting in the field of mental health. The problem here is not the medical
model, but our continued unquestioned adherence to it”- Madsen

The real challenge is that there is very little support system in the ‘system’ for someone to come in and address a family by their strengths. The presence of the medical model pervades the insurance that pays for mental health services so every piece of documentation implicitly underlines a deficit model. DFCS goes into a home and determines the future story of the family- this family is unfit to raise this child or this family needs to work on parenting skills or whatever it is they say. I believe that DFCS has tried to move to a more strength based model, and I certainly meet some caseworker who are dedicated to this model, but for the most part, the old guard DFCS, that is the long term case workers who have been around since the 70s and 80s, do not easily adopt this new fangled attitude. They are still looking at the world through dark eyes and rarely spinning a story of hope for the families we serve. So I sit in the middle, the intermediary between  those who see the family as irresponsible and unchanging, and the family who sees nothing so wrong. I acknowledge that there are problems, but I have to go in seeking to ally with the family or client. They need to know that in the midst of all of this bureaucracy that someone has their back, someone sees them for who they are, someone is looking for the good and the heroic in the story that is told in tragic language. This is my daily challenge and I appreciate writers like Madsen, who put into words something so important.

So here I go, chin up, ready for the day, hoping to help, and address everyone with the respect they deserve.

Monday 01/09/12

For those who are not acquainted with the fascinating world of therapy, you will not get there through the modern interpretations available to you. The fellow on How I Met Your Mother, the therapist on Revenge, Dr. Katz…it is truly amazing how maligned the world of therapy is in the mainstream media. Writers may have cracked a look at a psych 101 book but rarely go deeper. Bob Newhart may have gotten closest but it has been so long I don’t remember.

The mainstream media view seems to be a mixture of freudian couch sitting, free association, and sex. So most people have a poor idea of what a therapist or counselor does each day. For me in my attempt to be authentic and real and to offer positive regard to all it is a bit of a puzzle. Every time I enter a new home I am already seeking out ways to be helpful. Looking for handholds in our rapport building conversations that will allow me to convince them that I do indeed have their best interests at heart. It is not so much a performance, because that would make it all fake. Instead it is an attempt to suspend that part of myself that offers kneejerk reaction in favor of more thoughtful and clear thinking. I am literally trying to turn what I see into strength for my client, because all they need to know is that whatever they are going through, there is a way out and they have resources that they have missed in their personal assessments. In a sense it is a ritual in which I let the client take the lead, but that is not easy. When I first discovered the concept of therapy, I thought that this was the way we should all treat one another daily; unconditional positive regard, support and listening. Sounds good in theory but getting out of the way is much harder than you might think. If you go into a conversation with someone, try to divorce yourself from the part of you that strives to be heard, try to simply listen and be there for them without any ego reflex. It is just not an easy process and it can take its toll. The stories can be emotionally taxing, the ideas brought up can challenge the way you already think about your life, and you can end up hearing some things that will scare the bejesus out of you. It can drain you, but it is the good fight!

That was what last week was like. I had some amazing sessions with my clients, but when Friday came I had already hit the wall and Saturday then took it out of me. Yesterday was a recouperation day and a show day. I am happy just to be upright this morning.

This is music from one of the most amazing bands of our time: Genesis. In this one they sing about therapy. Not a good example but still an enjoyable song.

I also recently discovered another interesting blog post, this one from someone hoping to revamp our broken mental health system. It’s worth a read. You can check it out here: A Three Pronged Approach to Mental Health System Change

So here it is another day of craziness. I started my day with readings from Maisel’s “Mastering Creative Anxiety”. Here is the quote of the day that hit me:

“We put the research aside, announcing that it isn’t quite as interesting as we hoped it would be. We deny or do not quite know that it was the anxiety of thinking that thwarted us, but that’s what it was. People will do almost anything- not complete their dissertation, not deliver a book under contract- to avoid that anxiety”- Maisel

Well I fall into that category. For the last year I have been overwhelmed with work and I have lost interest in my dissertation topic. Not entirely, but part of the research and my own changing values have made it look less like what I expected. So it has languished. Now I have to try to pick it back up, dust it off, revise it for clarity, and build it up to a more meaningful work. I am actually still excited to do the research I just lost interest in the research portion. This week I will be headed off to San Francisco to charge my academic batteries at the Saybrook Residential Conference (the residency portion of my degree work). I am both excited and terrified. Excited to reconnect with the amazing people that make up the Saybrook family, and terrified of discussing the slow evolution that is my dissertation work. As a good friend of mine says, each drop of water in the bucket is one more, the bucket will eventually fill. My faucet was never turned off, but it is a very slow drip.

One more quote this morning. This one was posted by a friend on facebook:

Madness need not be all breakdown. It may also be break-through. It is potential liberation and renewal as well as enslavement and existential death.
R. D. Laing

May your days be excellent this week. I look forward to what the week has in store. Thanks for reading.

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