Unproven therapies used on traumatized kids

Puppet therapy Reuters reported on September 9, 2008 on a CDC report which will appear in the American Journal of Preventive Medicine that a lot of therapies provided to kids with PTSD are not proven. Here is a snippet from the article:

Many doctors and therapists use unproven approaches such as drugs, art or play therapy on children suffering trauma when old-fashioned talk therapy has been shown to work, a report released on Tuesday said.

A review of a dozen different studies showed no evidence that alternative therapies helped children traumatized by violence or abuse, even though more than 75 percent of U.S. mental health professionals who treat children and teens with post traumatic stress disorder may use them.

But cognitive therapy -- a type of talk therapy aimed at changing negative thoughts -- does work, the group at the U.S. Centers for Disease Control and Prevention said.

"The good news is there is substantial research showing the effectiveness of group or individual cognitive behavioral therapy in treating children and teens experiencing the psychological effects of trauma," the CDC's Robert Hahn, who led the study, said in a statement.

"We hope these findings will encourage clinicians to use the therapies that are shown to be effective."

Children can be traumatized by many things including physical or sexual abuse, witnessing domestic violence, community violence or natural disasters.

In my office, I use cognitive based therapy and, when relevant, include parents and/or caretakers in on the sessions. I find that children and adolescents usually do very well. I am chagrined to hear about the play therapies, sand tables, EMDR, and other things my colleagues are doing with kids which they usually learned at some workshop and now have become born again disciples of the technique. I have often wondered, as the research report above suggests, why they didn't take a workshop and learn how to do therapy that works instead of the latest fad? Like many things in life we are enamored with the new, the novel, the gimicky approach which promises quick and almost miraculous success.

I find it increasingly difficult to find good therapists to refer people to. The mananged care system and the atrophy of the community mental health centers have made it difficult for young therapists to find adequate training environments.

MedlinePlus: Unproven therapies used on traumatized kids -study.


Abstinence based sex ed programs don't work - Bush Administration gets it wrong

 Abstinence based sex ed Reuters HealthDay reported on August 21, 2008 on a study which appears in the journal Perspectives on Sexual and Reproductive Health which found that abstinence based programs don't work.

In 2007 alone the Bush administration spent 176 million dollars on abstinence only sex education for our young people and nothing for comprehensive sex education. Here is a snippet from the HealthDay article:

"Interventions that have been created to encourage abstinence have treated abstinence and sexual activity as opposites. However, teenagers say they don't think of them as opposites," lead author Tatiana Masters, a doctoral student in social work, said in a university news release.

"These (abstinence-only) interventions are less likely to work than more comprehensive sex-education programs, because they are not meeting adolescents where they are, and they are speaking a different language," Masters said.

The study included 365 adolescents (230 girls, 135 boys) in Seattle who took part in an intervention to reduce HIV risk behavior. The participants filled out questionnaires asking them about their attitudes and intentions about abstinence and sex, and about their sexual activity in the previous six months.

At the start of the study, 11 percent of the boys and 4 percent of the girls had had sexual intercourse. That increased to 12 percent of the boys and 8 percent of the girls six months later, and to 22 percent of the boys and 12 percent of the girls one year later.

"This paper demonstrates that increasing abstinence intention does not lead to less sex. In fact, when abstinence intention and sex intention interact with each other a teenager is more likely to have sex," Masters said.

The study was published in the journal Perspectives on Sexual and Reproductive Health.

In 2007, the U.S. government provided $176 million for abstinence-only programs, but there is no federal funding for comprehensive sex education programs. This study's findings "raise serious concerns about the abstinence-only approach as a risk-reduction method for adolescent sexual behavior," Masters and colleagues concluded.


"The Red Menace", "Terrorists", used to manipulate Americans into compliance as their pockets get picked by the plutocrats - Capitalism out of control

Viet Nam 58,000 of my peers were killed in Viet Nam. Hundreds of thousands were injured and came home with PTSD. Millions of Viet Namese were killed, for what? Ostensibly, a domino theory that communism had to be stopped in Asia or it would come to the US. Americans were convinced by the politicians during the cold war that the bogey man was at large and threatened American security.

Bottom line it was good for business selling billions of dollars of weapons and drafting hundreds of thousands of poor baby boomers so they couldn't raise too much hell at home getting high, listening to seditious music like rock and roll, and marching for civil rights.

Viet Nam was another pre-emptive and immoral war which the US lost and should have lost because it was wrong. The plutocrats manipulated the public most of whom were too stupid to see through them and they elected Richard Nixon, of all people, to end the war which he had no intention of doing and it took him 6 years to finally get around to it amidst his paranoid criminal activities which lead to his resignation to avoid impeachment.

Whether it's the Red Menace or Terrorists it is interesting how easily the public is manipulated by politicians and corporations into perpetrating evil policies for economic reasons. Once again, when people tell you it's not the money, it's the principle of the thing, you can bet your last buck, its the money.

Mammon once again reigns as the American God. Greed rules and when in bed with the politicians human suffering and death ascend to horrific proportions. Another example of capitalism out of control.


Capitalism out of control

I have started reading Naomi Klein's book, The Shock Doctrine, and it is one of those epiphany experiences where the light bulb goes on and I think to myself, "Holy Shit, that explains it."

Shock doctrine is a very exciting book for me because Klein brings a lot of events together with government policies which finally make sense for me. My initial impression is that the title of the book could also have been, "Capitalism out of control: How greed destroyed America and wreaked havoc in the rest of the world."

In the name of capitalism, the U.S. govenment has been increasingly privatizing previous government functions by outsourcing these services to private companies making political supporters rich on the public's dollar. It is a neat scheme to keep the politicians in power giving the public's money away to their cronies crowing about less government while they rob the public coffers and turn power over to the corporations to run the country.

It is time that Americans became aware of the new paradigm since they are ones paying for it and suffering under it.

I will be writing more about this topic in coming weeks and will tag these posts "Capitalism out of control".


The boot camp of life

Boot camp In the book, Daily Afflictions, Andrew Boyd uses many concepts and phrases which are eye catching. One such phrase is "The boot camp of life." In the glossary at the back of the book, Boyd, defines this phrase as - "A traditional child-rearing practice in which the child is trained to handle the dysfunction of adult institutions by being relentlessly drilled in dysfunction by his own family." p. 91

As a therapist as well as in my personal life, I am continually struck by the observation that parents don't deny the dysfunction that their children are subjected to but excuse it as being good for them. There are many phrases such as "what doesn't kill you will make you stronger." "Compared to what I have to endure this is nothing." "He better get used to it now so he is prepared for real life." etc.

I have referred to this as the callous theory meaning that parents excuse the abuse that their children suffer as "toughening them up" so that he/she can better deal with abuse later on in life.

I don't think there is any research evidence to back up this callous theory - that abuse and dysfunction earlier in life makes one more resilient later on in life. In fact, the research evidence appears to be the opposite, that abuse and dysfunction earlier in life is a risk factor for problems later on in life.

This callous theory is part of what John Bradshaw named "poisonous pedagogy".

One of reasons that my wife and I decided to homeschool was to protect our children from the institutional dysfunction that occurs in Middle school. Schools are bureaucratic institutions which are very self serving and subject children to dysfunction which mirrors the dysfunction in families, - bullying, cliques, playing favorites, mind numbing worksheets and busy work, obedience and compliance with requirements that are artificially imposed, loss of control over one's own life, disrespect, and fear being used as a motivating factor.

In the criminal justice system, boot camps began being popular 25 years ago where rigorous physical exertion and browbeating inmates for compliance was thought to  bring about compliance, obedience, and self discipline. Research has found that boot camps don't work. The belief that dysfunction and abuse is somehow good for people is similarly erroneous. Whilte the boot camp of life is an eye grabbing metaphor, one would do well to question, deconstruct, and dismiss this idea as beneficial for facilitating the development of a high quality, healthy, happy life.


Suicidal soliders is not so much a mental health problem as a spiritual crisis

Suicidal soldiers Reading about the increased incidence of sucides in the military and the huge numbers of soldiers with PTSD has gotten me interested in something which very few people in American society talk about and that is what Dr. Rachel MacNair calls "Perpetration-Induced Traumatic Stress", PITS.

PITS is the anguish and guilt which one human being feels when he/she kills another human being. This has been increasinly labeled as a mental health problem which it surely is, but even more, it is a spiritual problem in my view. All the mental health treatment in the world, and all the medications cannot absolve the guilt induced by the willful, deliberate killing of another human being.

There is a good article that attempts to describe this problem which was published in the Seattle Times 4 years ago on July 21, 2004. Here is a snippet:

Tucked behind a gleaming machine gun, Sgt. Joseph Hall grins at his two companions in the Humvee.

"I want to know if I killed that guy yesterday," Hall says. "I saw blood spurt from his leg, but I want to be sure I killed him."

The vehicle goes silent as the driver, Spc. Joshua Dubois, swerves around asphalt previously uprooted by a blast.

"I'm confused about how I should feel about killing," says Dubois, who has a toddler back home. "The first time I shot someone, it was the most exhilarating thing I'd ever felt."

Dubois turns back to the road. "We talk about killing all the time," he says. "I never used to talk this way. I'm not proud of it, but it's like I can't stop. I'm worried what I will be like when I get home."

The men aren't Special Forces soldiers. They're troops with the Army's 2nd Armored Cavalry Regiment serving their 14th month in Iraq, much of it in daily battles. In 20 minutes, they will come under attack again.

Many soldiers and Army psychiatrists say these constant conversations about death help troops come to grips with the trauma of combat. But mental-health professionals within and outside the military point to the chatter as evidence of preventable anguish.

It is very difficult for us as a nation to face up to the immoral and illegal war which we have perpetrated and are paying for which was based on lies and deceit by our government, let alone for our soldiers who have actually killed other human beings, civilians, women, children, for reasons that are not clear at behest of psychopathic and irresponsible leaders. What does this killing do to a person's soul other than lead to anguish, revulsion, self-recrimination, and too often self destruction in one form or another.

Families of these suffering souls have wanted to be proud of their relative's service and to believe it was for a good cause, but the truth does not match the delusion. The inability of people back home to "understand", let alone accept, the truth, leaves the suffering soldier even more isolated and tormented.

What is the answer to the spiritual suffering? The truth and repentence. Will McCain or Obama lead us there? I doubt it very much unless we as a country are willing to face our demons and admit that what has been done in our name is wrong. Witnessing the suicides and PTSD of our returning soldiers fortunately or unfortunately won't let us ignore or forget the heinous acts they have been asked and compelled to do in our name. The guilt belongs to us all not just to the perpetrators, but they are the more active participants while we just watch, cheer them on, and lie to them telling them they are doing grand, honroable, and glorious things when deep in their souls they know better.

I intend to write more on this topic so I am adding a new category to my blog today called Perpetration induced stress.

Nation & World | Soldiers trained to kill, not to cope | Seattle Times Newspaper.

 

Praying for clients?

Praying for clients Continuing with the discussion of spirituality in therapy I was struck by Lorraine Wright's statement that she sometimes prays for her clients. Here is part of what she writes in her article, “Spirituality, Suffering, and Beliefs”,

“ Over the past few years, I have on occasion, independently adopted Dossey’s (1993) practice of praying for, although not with, clients and families with whom I work. As Dossey (1993) suggested, if a health professional believes that prayer works, not to use it is analogous to withholding a potent medication or surgical procedure: ‘Both prayer and belief are nonlocal manifestations of consciousness, because both can operate at a distance, sometimes outside the patient’s awareness. Both affirm that, “it’s not all physical”, and both can be used adjunctively with other forms of therapy.” (p.141) In praying for our clients, we perhaps also heighten our connection with them and our investment in their recovery and well-being.”

P. 64 in Spiritual Resources In Family Therapy edited by Froma Walsh

In further research, Dossey's claims have not been affirmed and it appears that there is no physical benefit to praying for someone who does not know they are being prayed for.

However, I wonder if praying for clients detracts from the psychotherapy? Is this a counter transference issue that would enhance the therapeutic alliance or interfere with it in some ways? If you had a student or supervisee who told you in clinical supervision that he/she was praying for his clients without the client's knowledge how would you handle it? Supposing it was with the client's knowledge?

Is praying for clients something that should be encouraged or discouraged? 

I, myself, sometimes pray for my clients and if wishing them well is considered praying, I pray for them all. I think that whether a therapist or a health care provider prays for clients would depend on the therapist's beliefs and spiritual practices. Certainly, clients pay a health care professional for a professional service and not for prayer, but I think that most clients would want their therapist to wish them well and care about their lives and the outcome of the therapy and not just be in it for the money.

Unfortunately, health care has turned into a business. It has become a commercial enterprise and is no longer a human service or a ministry in the broad sense of the word. I do not run my practice only as a business enterprise. I want to be of service to my clients and my community and take a number of clients pro bono and at reduced fees. I could make more money if I only served the more affluent who could pay me full fee, but that is not why I became a therapist and that is not what I believe God has called me to do with my professional skills.

Perhaps it is this desire to serve that is a prayer in and of itself.


Happiness more or less constant over the course of life

Happiness An interesting study done in Germany and reported on the BBC found that happiness is more or less constant over the course of a person's life. Here is a snippet from the article:

Momentous events in your life such as having children, or getting married, may make you happier, but only temporarily, say researchers.

Our basic happiness level essentially stays the same throughout adult life, the Economic Journal reports.

Economists from the UK, US and France based their conclusions on a 20-year analysis of the life satisfaction of hundreds of people from Germany.

Even after traumatic events, overall mood dipped but then recovered.

BBC NEWS | Health | Happiness 'immune to life events'
.


Psychotherapy involves a sense of reverence

Lorraine Wright in her article, Spirituality, Suffering, and Beliefs writes about an incident that occurred when she was being observed working with a family behind a one way mirror. A team member who was observing said to Lorraine that

"...what he believed to be the most powerful aspect of my clinical work with families: the notion of 'reverencing' that occurred between families/clients and myself. In those moments of reverencing, there is a profound awe and respect for the individuals seated in front of you. It is not a linear phenomenon in these moments. I feel that same reverencing from family members being given back to me. In those moments of reverencing in clinical work something very special happens between the therapist and the family; it is something felt by all - a deep emotional connection. I know and have felt these moments in therapy, both in the therapy room and from behind the one-way mirror as a supervisor or team member."

Spiritual Resources in Family Therapy edited by Froma Walsh, p. 63

I am reminded of Jesus' statement that where two or three are gathered in my name, there I will be. There is something about psychotherapy that can be sacred not in a religious sense but in a spiritual sense.

Psychotherapy is a trust between the therapist and the client(s) where the psychotherapist is duty bound to put the clients needs ahead of his/her own. The psychotherapist is ethically bound to use his/her personality in a purposeful way to help the client get the clients' needs met. There is a deep listening that is empathically profound and an attentiveness that goes way beyond the ordinary. It is the conscientious attentiveness on the part of the therapist that makes psychotherapy hard work in the sense that it takes discipline to set aside one's own narcissistic preferences and desires in service of another. This "being there" for another is what begins to make the rapport sacred and the quality of reverencing begins to emerge.


Discussing clients spiritual beliefs as part of therapy

I have been reading Spiritual Resources In Family Therapy edited by Froma Walsh and there is an article in the book by Lorraine Wright entitled, "Spirituality, Suffering, and Beliefs: The Soul Of Healing With Families."

 

Lorraine describes herself as a family therapist/nurse educator who works predominantly with families experiencing illness. She says some interesting things like:

 

The influence of family members’ spiritual and religious beliefs on their illness experiences has been one of the most neglected areas in family work.” P. 62

 

I wonder why that would be? What is the fear or the constraining beliefs that therapists have that would make it nonconductive to discussing clients' spiritual beliefs as part of the therapy?

 

Part of the contraints probably have to do with the split between the secular and the sacred, between science and religion, between evidence based practice and the clinical arts, between the psychological helper and the ministry.

 

I have been trained as a psychotherapist not as a pastor and our roles are different and yet without understanding and taking into account my clients' spiritual and religious beliefs especially when they are suffering, I am not likely to be of much help.

 

Thankfully, there is increased interest in the health care professions in the role that spirituality and and religion play in a person's physical health and mental well being. To describe someone as "broken hearted" or as having "killed their spirit" is to describe a person who is in need of some sort of spiritual uplift. There is a difference between a physical cure and a healing of the spirit.

 

My friend and colleague, Ed, recently died on June 30, 2008 at age of 56 of Esophogeal cancer. I last had lunch with him on June 18,2008. Even though physically he was having difficulty his spirits, as always, were good. I am not sure what Ed's religious and spiritual beliefs were, but he loved life, he loved people, and he lived every day up to his last to the best of his ability and for this I am very grateful to Ed for inspiring me with a great example of how to die.

 

Paul Pearsall, the neuropsychoimmunologist, who had four near death experiences himself, said, that no therapist can hope to be of much help to someone unless the therapist understands at least three basic things about the person's world view. The therapist needs to understand how the client would answer these three questions: Why was I born? What is the purpose of my life? What happens to me when I die?

 

I usually don't ask clients directly these 3 questions unless they come up in our conversation but usually by the 3 interview I have some good understandings of how they might answer these questions.

 

"I don't know. I don't know, and I don't know" are not good enough answers and people have to be pushed sometimes to a scarier and more difficult place, but if they trust the therapist enough, they usually can come up with some sort of answer that probably means more than they would like to believe.

 

The purpose of a healthy spirituality is to decrease suffering as both Jesus and Buddha and other spiritual masters have taught. This is the same goal of good psychotherapy.