Dharma Bum

Therapeutic Conversations X - Day #3

Therapists come and go, but family and friends more often stick around for a lifetime. - Pru (a veteran consumer of human services)

Hello again! Day 3 of the Therapeutic Conversations conference in Vancouver and it once again it did not disappoint. This morning I had the opportunity to catch the exceptional workshop facilitated by Peggy Sax (pictured Bryna Andressen, Charley Lang, Peggy Sax) titled Neighborly Ways of Being: Building Communities, Linking Lives. Peggy Sax, through the use of video interviews and co-research, showed how the narrative practitioner can work to identify practices that strengthen naturally occurring communities of support using the rhizome metaphor as a guide for curiosity and surprise. Sax's workshop challenged common assumptions about working in individualized ways and how intentional therapeutic communal practices can strengthen social connectedness in ways that do not center the therapist. Sax showed how these communal practices can provide a wide range of non-prescriptive options for connectedness. It was a powerful workshop that gave me much to think about as I blew off the rest of the day to walk around Vancouver and see some art. Tonight is my last night in Vancouver. It has once again been a wonderful respite and opportunity to see what my narrative family has been working on. Goodbye Vancouver, I leave you with a song in my heart..

Therapeutic Conversations X - Day #2

Hello again! It was another wonderful day of learning Vancouver. The weather here was beautiful today so it was hard staying indoors, but fortunately for me all the workshops I attended made the lack of sunshine OK. The day started with a First Nation Welcome ceremony that included a song by the appropriately named band "The Externalizer's." Following that Stephen Madigan welcomed everybody to the conference and then gave the morning keynote. Madigan's keynote set the tone for the conference by declaring narrative therapy as a counter to longstanding therapeutic traditions of the privatized problemed self, doing this via an anti-individualist, relational stance. Madigan's keynote was an argument against de-politicized therapy. He also pointed out how quite realistically that anybody with little graduate studies can make claims of knowing on other bodies, and also name others pathologies. Powerful stuff. Madigan in a bit of humor went on to advance the idea that we should actually call ourselves Licensed Declassification Professionals.

Following the morning keynote I attended the workshop titled Insider, Outsider and the Generative Space in Between facilitated by Allison Rice and Dennis Dion (pictured with me in the middle). This was by far my favorite workshop. Allison and Dennis collaborated together for several years at the Peak House where they worked with youth and families struggling with the problem of substance misuse. Allison and Dennis did a wonderful job bringing forth their deep interrogation of the problem of addiction and its tactics and how an understanding of other theoretical frameworks (harm reduction, 12 step, etc.) help bring about a fluidity that resists binary ways of seeing problems or solutions. I understood both Allison and Dennis to have a poststructuralist and realistic understanding of substance misuse. I found them quite creative in the use of queer theory in their idea that it would be un-queer to attach a tag to someone that they don't prefer, but also that it would be un-queer to remove a tag that the person would prefer. I also found them to be quite pragmatic when they asserted that deconstructing modernist approaches to the problem in early abstinence could be quite dangerous. A bold position in this crowd for sure, but in my experience as an insider, their understanding resonated with me quite powerfully. Allison and Dennis' workshop really was an opportunity to see how a social constructionist/narrative lens really contributes meaningfully to those seeking our help.

In the afternoon I had the opportunity to catch the workshop where John Winslade did another outstanding job of making the work of Michel Foucault and Gilles Deleuze more user friendly. There was much helpful discussion added by the presence of Tom Strong, Joel Shapiro, and Jonny Morris who were all equally adept at making some dense material more understandable. Kudos!

The day ended with the afternoon keynote by Sheila McNamee who is the Vice President of the Taos Institute. McNamee's keynote was titled Pushing the Relational Edge: Constructing Narrative Practice and her project seemed to be one of promoting a promiscuous stance (mixing it up) as opposed to one of practice purity. I'm not sure how this talk went over with the narrative faithful, but it did have me thinking about the morning workshop where both Rice and Dion showed a real practice that was less worried about "getting it right" and more concerned about points of connection, effectiveness, and protecting the people who sought their help from getting caught in the middle of theoretical battles. Lots to think about today. So while I'm considering all that happened today, enjoy another Vancouver sunset:

Therapeutic Conversations X

Hello! I've found myself back in Vancouver for the 10th running of the Therapeutic Conversations Conference hosted by Stephen Madigan and the Vancouver School of Narrative Therapy. This years line-up looks to be pretty awesome and it is my intention to actually blog the conference. I will do my best to give daily updates of what the day held for me, and throw up a pic or two of the activities, and maybe even an interview or two of some of the narratively inclined folk in attendence. So please come back and enjoy the sights and sounds of beautiful Vancouver, BC.

Job & Internship Fair

Attn: Therapist/Counselor friends!

On Friday, April 27 from 10:00am to 1:00pm the The Long Beach - South Bay chapter of the California Association of Marriage & Family Therapists (LB-SB CAMFT), in collaboration with the Orange County American Association of Marriage and Family Therapy (OC AAMFT), and the Los Angeles chapter of CAMFT (LA CAMFT), invites you to their Fifth Annual MFT Job and Internship Fair. This job fair will be held at the Carson Civic Center located at 801 E. Carson Street, Carson, CA. The cost to attend is $10 and breakfast is included. For more info head on over to: www.lbsb-camft.org.

Supershrinks - Outcome Measures and Narrative Therapy

Training clinicians in 'evidence-based,' manualized therapies, diagnosis, and even the alliance has little if any impact on outcome - Scott Miller

This weekend I had the pleasure of attending the day-long workshop, Supershrinks presented by Scott Miller, the founder of the International Center for Clinical Excellence. Scott's presentation basically covered several themes, what works in therapy, how clinical excellence is achieved, creating a culture of feedback from clients, and what deliberate practice looks like. All of which nicely book-ended some of what I heard at David Epston's and Stephen Madigan's recent workshop. They had additional ideas about excellence, apprenticeship, practice, reflection, and more practice before and after sessions.

As the day progressed I was asking myself if these ideas about generating feedback fit with my poststructural leanings in therapy. As the day progressed I gradually became more and more comfortable with trying them out, and actually believed that they could be an effective tool for several reasons:

1. The ORS & SRS could go a long way toward flattening the hierarchy in the room. It seemed that tools like these could really put skin on the idea that the people who consult with us direct the treatment they receive, rather than the other way around.

2. Scott Miller was great about naming, and re-naming our fields go-to position of blaming the client if things don't work out in therapy, or people don't come back, etc. Tools like these would shift the burden of helpful therapy back to the therapist, where it belongs. But rather than a "beat up the therapist" evaluative tool, the ORS/SRS could in fact make us all better clinicians and more closely align us with peoples hopes and dreams.

3. How about using the OTRS/SRS in University training clinics or in supervision settings? Are trainees and interns getting what they need? Do you want to know supervisors? Have you created a culture where feedback is given, or have your trainees and interns "gone underground?" Once again, maybe a helpful tool to begin to flatten hierarchy, dissolve power in supervision settings, or at least start to have a conversation.

4. And what about excellence? What are our thoughts about being a more helpful clinician? How do we apprentice? What is our accountability to those we work with?

5. I also found it interesting, and it raised my curiousity, that a few of the people involved with ICCE including lead U.S. Trainer Julie Tilsen, are narratively inclined.

I have been using the ORS/SRS sparingly over the last few months at CYS. This week I intend to be more deliberate in using the ORS/SRS and begin to track my results. I am currently looking for a tool like Myoutcomes.com to track and hopefully share the results. For those that have shied away from tools like this because it would "kill the creativity" in the work. I get it, but this is something you do in the beginning and toward the end, and not necessarily in every session. I still will be able to stay very creative in my question development or narrative inquiry, but these tools seem to be a pretty effective resource at moving me closer to people's experiences, hopes, and dreams.

I am really interested in asking those I work with to help me become a better clinician. I mean really, who is more qualified for the task?

The Radical Therapist

I've been watching the occupy Wall Street gatherings recently and have been reflecting on my own political leanings. As a former punk rocker who lived by the motto "never trust a hippie" I have always tended to view these kind of movements as suspect, or as the Who would say,“Here’s to the new boss, same as the old boss.” I mean, the hippies sold out eventually right?

This weekend I found myself wandering into a used book store. I purchased two books, both with politics in the title. The first The Politics of Therapy by Seymour Halleck and the second R.D. Laing's The Politics of the Family. I started reading Hallecks' The Politics of Therapy this weekend and have found myself captivated. Written in 1971 during a time of much political upheaval, Halleck argues that any psychiatric intervention, even when treating a voluntary person, will have an impact on the distribution of power within the various social systems in which the person travels. Who knew that someone was writing about power operations in therapy in the U.S. that long ago? And I thought it all began with narrative practice.

I'm still early in the book but Halleck did introduce me to the Radical Therapist, a journal that emerged in the early 1970s. I have had fun learning about this journal and the Radical Therapy collective which can still be found in northern California alive and well.

Politics are in the air, I have been doing lots of reading and reflecting. I'm not sure where I sit with this new movement gaining traction in the U.S., but I have found myself recently with a few good ideas for signs.

The following is part of the Radical Therapist Manifesto (written 1971). Good stuff:

Therapy today has become a commodity, a means of social control. We reject such an approach to people's distress. we reject the pleasant careers with which the system rewards its adherents. The social system must change and we will be workers toward such change. But to be true instruments of change, therapy and therapists must be liberated from their own forms of oppression. Nor is it enough to pursue a medical model and try and develop popular programs to 'treat the masses.' Therapists must understand their place in the changing social and political reality; thus therapy must become politically aware. No therapist, no person, can claim detachment from social contact. Each human act is a social act and moral statement: a political fact. It then becomes important which values we hold and which of them comes first. This awareness must structure all radical therapy today; for liberation from within has to be accompanied by liberation from with out.

 

Psychology & Zen

For those that might be intererested, attached is a video of a talk I participated in at the Las Vegas Zen center early this year where I and some of my Dharma brothers, who happen to be Psychologist's, spoke about how Zen informs our professional lives. If you are my Mother, or my friend, and not interested in Zen or Psychology you can jump to my part at 12:48.

Good Therapy

Following is a wonderful piece by David Foster Wallace. Just change fiction to therapy and he captures my position in narrative practice. Often I have found myself in conversation with socio-politically aware folks wondering, where's the possibility here? How do I take that into the room with me? These conversations tend to be heavy on the dark worldview, light on the hope or possibility. Foster Wallace captures it beautifully when he says; ..do we need fiction that does nothing but dramatize how dark and stupid everything is? ...the definition of good art (therapy?) would seem to be art that locates and applies CPR to those elements of what’s human and magical that still live and glow despite the times’ darkness... Call me a sucker, I still believe in the magical. Rest of the quote follows..

If what’s always distinguished bad writing— flat characters, a narrative world that’s clichéd and not recognizably human, etc.— is also a description of today’s world, then bad writing becomes an ingenious mimesis of a bad world. If readers simply believe the world is stupid and shallow and mean, then [Bret Easton] Ellis can write a mean shallow stupid novel that becomes a mordant deadpan commentary on the badness of everything. Look man, we’d probably most of us agree that these are dark times, and stupid ones, but do we need fiction that does nothing but dramatize how dark and stupid everything is? In dark times, the definition of good art would seem to be art that locates and applies CPR to those elements of what’s human and magical that still live and glow despite the times’ darkness. Really good fiction could have as dark a worldview as it wished, but it’d find a way both to depict this world and to illuminate the possibilities for being alive and human in it.

— David Foster Wallace

Hearing Voices Network & Gail Hornstein

If you get a moment I highly recommend reading Sun Magazine's interview of Gail Hornstein. In the article Hornstein takes on labeling, questioning whether labeling benefits those being labeled. She also describes her position where she rejects the idea that psychiatric patients, however severe their symptoms, have a physical disease. Hornstein also has been instrumental in starting Hearing Voices Network (HVN) support groups in the U.S. The HVN is an international organization where empathy and non-hierarchical interactions supplant diagnostic labels and the traditional doctor-patient relationship. Hornstein also believes that real life experience can serve as medical evidence.

Read the interview HERE.

A Good Man Is Hard to Find..

There's a whole lot to take on in this recent article in the NY Times titled Need Therapy? A Good Man Is Hard to Find. The article tracks college psychology programs inability to attract male applicants and the “feminization” of mental health care.

I suppose it left me with more questions than answers.

Are men better positoned to invite other men into acountability? This is a topic thats comes up often in supervision. Has the influence of the large number women in the field countered the institutionalized oppression of women by the mental health field, and isn't that a positive thing? Is this another article that privileges male voices over female voices? I could go on..

I participated in graduation ceremonies on Saturday and it was pointed out a couple of times how few men were graduating from all the psychology programs. How should we make sense of this? I am not so sure. Any ideas? Please leave them in the comments.

Narrative & Pizza Featuring Charley Lang

This Friday from 6pm to 8pm is another Narrative & Pizza event hosted by John Winslade at CSU San Bernardino. This month's speaker will be Charley Lang from the Narrative Couples Center in Los Angeles. Charley will be speaking on addressing gay and lesbian issues in schools.The presentation will feature excerpts from an award-winning film, an interactive exercise, handouts and a narrative interview.

The regular Narrative & Pizza event is for students, faculty, alumni, supervisors, school counselors, social workers, psychologists, family therapists, and anyone curious about the application of the narrative perspective in practice domains. All are welcome.

The address is: College of Education Building, California State University San Bernardino, Room CE 120 (The Institute for Research, Evaluation and Training) in the Seminar Room.

More about Charley:

Charley Lang, LMFT is Director of the Postmodern Traineeship at the California Family Counseling Center and Director of the BA Psychology Program at Antioch University Los Angeles where he also has a private practice and enjoys capturing inspiring alternative stories in the form of documentary film (narrativecouplescenter.com).

Talk Doesn’t Pay..

So Psychiatry Turns Instead to Drug Therapy

Richard Perry/The New York Times

Alone with his psychiatrist, the patient confided that his newborn had serious health problems, his distraught wife was screaming at him and he had started drinking again. With his life and second marriage falling apart, the man said he needed help.

But the psychiatrist, Dr. Donald Levin, stopped him and said: “Hold it. I’m not your therapist. I could adjust your medications, but I don’t think that’s appropriate.” More HERE

Interesting article, you should take a look. If you don't think the drug companies are getting even more powerful, come over to my neighborhood. Recently two corner lots across from each other were razed and new construction started. At first I was hopeful, but quickly discovered that instead of anything interesting, we'd be getting a CVS across the street from a Rite Aid. Two pharmacies across the street from each other. I am still in a state of bewilderment.

Wisdom

The advice I like to give young artists, or really anybody who’ll listen to me, is not to wait around for inspiration. Inspiration is for amateurs; the rest of us just show up and get to work. If you wait around for the clouds to part and a bolt of lightning to strike you in the brain, you are not going to make an awful lot of work. All the best ideas come out of the process; they come out of the work itself. Things occur to you. If you’re sitting around trying to dream up a great art idea, you can sit there a long time before anything happens. But if you just get to work, something will occur to you and something else will occur to you and somthing else that you reject will push you in another direction. Inspiration is absolutely unnecessary and somehow deceptive. You feel like you need this great idea before you can get down to work, and I find that’s almost never the case. -Chuck Close.

 

The Price..

The way we as a society conceive of mental illness matters…It affects our moral instincts about what it is to be human…The real dilemma is faced by our society. It is whether we will allow the seductions of the vulgarized biomedical model to overcome our own responsible commitment to a complex view of human life…whether to understand [the mentally ill] only as the detritus of a broken brain or also as people whose suffering implicates us, whose struggles are resonant with our struggles, whose complexity and depth demand that we see their suffering as engaged in the struggle to be decent, responsible people.

We are so tempted to see ourselves as fixable, perfectible brains. But the loss of our souls is a high price to pay.

T.M. Luhrmann, Of Two Minds: The Growing Disorder in American Psychiatry

Via

Link Round-Up - Meditation in Jail/What Makes a Good Therapist?

Thought I'd share a few interesting links I've come across recently. Enjoy:

Scott Miller continues to be a strong voice in opposition to the narrow, specific-treatments-for-specific-disorders or "evidence-based treatments" movement. On his blog he points to the latest Journal of Consulting and Clinical Psychology which has a new article which basically states "neither adherence nor competence was...related to patient (sic) outcome and indeed that the aggregate estimates of their effects were very close to zero." or as Scott Miller puts it; "millions and millions of dollars of scarce resources are poured into an approach to behavioral health that accounts for exactly 0% of the results."

The L.A. Times discovers Buddhist Meditation classes in county jail are giving inmates tools for coping.

Aaron Beck the father of cognitive therapy discusses the relationship between Buddhism, Mindfulness and cognitive psychotherapy.

Someday I'm going to take this on in a larger post or...a book. Therese Borchard discusses the allegedly competing models of mental health recovery and the 12 steps. Take the "agent of the problem" stuff with a grain of salt. Borchard has built an industry around "being depressed."

Mentor

"One’s mind, once stretched by a new idea never regains its original dimensions." ~ Oliver Wendell Holmes

A lot of people have gone further than they thought they could because someone else thought they could. ~ Unknown

This is a photo of myself and Dr. Amy Tuttle, my mentor.

Prior to starting grad school I was having a conversation with a friend about my apprehension and fear in starting the program and she asked me if I ever had an influential teacher or role model in my previous schooling. Well, having a spotty educational background that included getting thrown out of junior high and dropping out of high school, I couldn't come up with any experience that would qualify.

I met Dr. Tuttle around my second month at Pepperdine. She had the reputation of being the toughest teacher at the Irvine campus. Students are known to go to the Los Angeles campus to avoid taking her classes. I had a different experience of Dr. Tuttle, beginning with the first day I met her at an immersion at the Village in Long Beach. I suppose she is tough, if tough means becoming a better clinician and a better writer.

I entered the program at Pepperdine thinking that when I was done I would start a little private practice by the beach and do my best to help the worried well. But the influence of Dr. Tuttle changed all that when she began to expand my understanding of what a MFT can do and be. She introduced me to systems/relational thinking, issues of social justice, cultural humility, post modern theory in family therapy, post modern research techniques, and I think most importantly she was an example to me that it was OK to be me, and that the way I looked at the world was going to be one of my best tools in my clinical practice. It also was Dr. Tuttle who nudged me to apply to the Loma Linda PhD program, introducing me to the Director of the program, and helping me to believe that it was a real possibility for me.

I wasn't looking for a mentor and I'm not sure how a woman 10+ years my junior became the most important mentor I've had in an educational setting, but it happened, and I feel very grateful and fortunate that it did. When I end up graduating from Pepperdine in December I will take many great memories and many new friendships with me, but at the end of the day, I will always remember Pepperdine as the place I met Dr. Tuttle.

Do you have a mentor?

Therapists & Social Media

I found an interesting article in the Washington Post, on the many challenges now facing therapist's who are online, and actively using social media tools.

Some of the questions up for debate in the article are:

Should a therapist review the Web site of a patient or conduct an online search without that patient's consent?

Is it appropriate for a therapist to put personal details about himself on a blog or Web site or to join Facebook or other social networks?

What are the risks of having patients and therapists interact online?

As you can tell I'm all over the internet. My Twitter and Facebook accounts are private, but this blog is not. The article was timely because I have been thinking over the last several months how I was going to negotiate social media and my work.

The article would make it seem that most of the concern comes from Psychologist's need to protect the "doctor-patient relationship." Now, right there I hold a philosophical difference with those quoted in the article. It is my goal when working with someone, to even the playing field and, not operate as an expert in anyone's life. I believe the idea of an imaginary wall between doctor and patient, is an old idea that no longer is effective. This wall works to keep us disconnected at best, isolated at worst. It is my goal when working with people, to engage, connect, and act collaboratively, so that they may experience themselves separate from the problems they came in with, and begin to live their preferred lives.

Does opening myself up on the internet move me closer to this goal in my work? I'm not sure, but maybe if someone should see me as I am, it might give them the courage to open up just a bit too.

There is still much to learn on this topic, and I'm sure more debate will continue. Any thoughts??

Showing Up..

Ever since I decided to do this little career change I'm going through I decided it was probably in my best interest to get active in some organizations that educate and promote the profession. One (of the many) organizations I participate in is the American Association of Marriage and Family Therapists. I'm active at the state level but also here in Orange County. Over the last several months I was part of the development team that started a networking district in the OC. Well after several months of planning we finally kicked off our first meeting at the Tustin Ranch Golf Club. We had 90+ people and it was a smashing success. We had a great mix of students (like me!), LMFT's and Psychologists. Even in my business life I have always found value in networking and participating with peers in events such as these, many doors have opened for me just because of my willingness to show up, even when all my insecurities scream to stay home. I look forward to participating in many more. Here's some photos of the event:

Twitter and Positive Overdose

Deepak Chopra: In the cycle of endless renewal, your speck of eternity is inviolate. As we live in our being, none of us ever dies.

Dr. Wayne Dyer: Become a person who refuses to be offended by anyone, anything, or any set of circumstances.

Byron Katie: When they attack you and you notice that you love them with all your heart, your Work is done.

Marianne Williamson: You were not created to be at the effect of lovelessness, in yourself or in others (ACIM). Shine your light, and darkness can't touch you...

These are some recent "tweets" I have received over the last several days from some of the top personalities of the self improvement industry. I have always been a believer in the idea that "thoughts are things" and the more you can get rid of your stinking thinking the better off you are. But lately I have found myself pretty much ignoring these tweets and rethinking why I even follow in the first place. All this positive thinking was getting me down!!

Then I discovered this little article discussing recent research that says that "repeating a positive self-statement backfired: It made them feel worse immediately afterward, rather than better."

Exactly! The longer I have been reading these "tweets" the more I began to realize that something was missing here, all this positivism was missing the mark. From my own experience I can tell you that life is neither black & white, not all black or all white, it is a kind of grey murky color. Anybody that knows me can tell you that in any typical week I will ride a roller-coaster of emotions and feelings from one of knowing my place in the world and having a sense of purpose, to the next day feeling like all is lost and it's just a matter of time before the rock lands on my head.  I think we do people a disservice when we ignore the shadow side of life and pretend it's not there. I also have the experience that it is not my success that people have connected with, although success is important and gives hope, but my struggles have seemed to connect me to more people. My struggles have made me more human.

So that's why I'm going to start mixing my twitter feed with some other stuff to keep it real. Like:

Shit My Dad Says: "You know, sometimes it's nice having you around. But now ain't one of those times. Now gimmie the remote we're not watching this bullshit."

The Language of Autism

I've been churning on this video since we watched it in class last week. I have a good friend with a child that was recently diagnosed with Autism. I know very little about Autism but I think this video went a long way to changing my perspective. Please spend the time to watch all the way through to the explanation. In the video author's words:

The first part is in my "native language," and then the second part provides a translation, or at least an explanation. This is not a look-at-the-autie gawking freakshow as much as it is a statement about what gets considered thought, intelligence, personhood, language, and communication, and what does not.