Therapy concepts in practice - viewing a client using many perspectives from psychology

about the client, Angela:

The client is 17 yo, unmarried but w/same BF Tony since she was 14yo, Caucasian

currently pregnant with her 2nd child

Tony is less than supportive of her and the child's well-being - blames her for getting pregnant

Lives w/mother and two younger brothers, 14yo and 16yo. Living condition described as "not very good." Plumbing is rusty, pipes often get clogged. Frequent roof leaks after a day of rain. Landlord seems "careless"about the conditions of the house.

Mother's BF often stays at the house. Been through much drug/ETOH tx, however using cocaine "occasionally," he says. 1x made aggressive sexual advance at Angela when high on coke. told mother, did not believe her. No recurrence. Relationship between Angela and mother strained since. Feels "misunderstood and devalued."

Dropped out of school 2 yrs ago, after 1st child born.

unemployed

Been receiving federal assistance: WIC, food stamps, and cash assistance. Recently rec'd letter from Dept Soc Services that she is required to look for employment and/or go to job training to continue getting fin aid. Difficult to find job due to: childcare, current pregnancy, lacking transportation, lacking immediate family support.

Ct feeling optimistic that condition will change eventually. Several friends and extended family provide emotional support, but unable to help otherwise b/c they find themselves in similar conditions.

Ct already has goal to move out of mother's house, though worries about being able to support herself & children.

Axis III:

pregnant, 2nd child

dx diabetes, special balanced diet advised by MD, to avoid pregnancy complications

Difficulty attending prenatal care appts - lack of transportation. Feels physician does not understand her situation - tells her to be "more responsible and less neglectful." Physician "treats me like a child" ignoring "my suggestions and comments." Often gives her forms she doesn't know how to fill out.

1. What are major differences and/or commonalities between Constructivist / Social Constructionist Theory and Freudian’s Psychoanalytic Theory? (Consider assumptions & principles of each of these theoretical orientations when responding to this question. Also, consider discussing this comparison and contrasting of theoretical orientations within at least two different contexts - situations).

Psychoanalytic: Human behavior can be explained, predicted, dx, maladaptive behavior originating with defective dev/brain

Constructivism: no universal truth, but behavior can be explained.

Similarities:

development is important

individual internalization of experiences influences development

relationships are important in development

in tx, learning about self (psyc: bring unconscious conscious, and understand and moderate unconscious drives; const: client learns how their self has been constructed, and recreates it)

Differences:

Psyc: relationship to family/parents is focus; Const: rel at micro, meso, macro levels

Psyc: predetermined developmental stages and tasks, human behavior can be diagnosed, predicted and understood. Cause and effect is important. Practitioner is the expert. Client tends to be unaware of how thoughts influence behaviors.

Const: self constructed, deconstructed, and reconstructed throughout the lifetime. no universal assumptions about human behavior. People need not be confined to a "box" of existence. Language and communication give power. Client is the expert.

Const: focus on experience/repetition creating schemas, structure is constantly updated

Psych: Id & superego battle it out, mediated by ego. each at different level of consciousness.

2. What have been the dominant critiques of Psychodynamic Perspectives in social work and how has the perspective developed in light of these critiques?

3. What are major differences and/or commonalities between a Freudian’s Psychoanalytic Theory and Feminist Theory? (Consider assumptions & principles of each of these theoretical orientations when responding to this question. Also, consider discussing this comparison and contrasting of theoretical orientations within at least two different contexts - situations).

Similarities:

differences between genders (some flavors of feminism)

encouragement of clients to share their personal thoughts freely (free association and dream interpretation vs. personal narrative)

Differences:

no stages in feminism

feminism holds that gender differences are not morally important because every gender is capable of reason

feminism is non deterministic, while psyc is deterministic

psyc - femininity as a frustration about wanting to be masculine, not something valuable in and of itself

psyc focuses on childhood experiences, while feminism focuses on the present environment and changing it

4. What are major differences and/or commonalities between Freudian’s Psychoanalytic Theory and Erikson’s Bio-Psychosocial Theory? (Consider assumptions & principles of each of these theoretical orientations when responding to this question. Also, consider discussing this comparison and contrasting of theoretical orientations within at least two different contexts - situations).

5. Considering the assumptions and principles of the diverse theoretical orientations discussed in class, what would an eclectic approach look like?

Defining eclectic social work:

An eclectic approach is one which draws from many theories, including complementary, competing or even contradictory theories, depending upon the situation and client need.

Eclecticism can be used for both explaining human behavior and intervening in human behavior.

Clients benefit from eclectic interventions and explanations because they are less likely to feel placed into a steadfast category.

The eclectic social worker seeks to match the most helpful theoretical explanation or intervention to the client/community/population.

6. What are some of the implications of engaging in social work practice, with minimum to no understanding of different theoretical orientations, within the context of human development in diverse settings, encountering diverse strengths and challenges?

lacking in terms, language used to conceptualize client issues and strengths and communicate with client, help them understand.

theory helps organize and guide SW practice (though not define it)

theories give framework and rationale for treatment

theories can often compete, overlap, contradict, which gives social workers a rich base from which to understand different situations and client systems

lacking in theoretical understanding may result in a social worker lacking in insight, issues w/solving client's problems, may lead to superficiality or only surface social work.

may struggle with effective communication.

too much time wasted with "hit or miss" approach. missing out on experience of learning from the mistakes of others.

knowledge of theory increases knowledge of self, hopefully decreasing the harmful effects of transference and countertransference.

7. What are major differences and/or commonalities between Cognitive-Behavioral Theory and Freudian’s Psychoanalytic Theory? (Consider assumptions & principles of each of these theoretical orientations when responding to this question. Also, consider discussing this comparison and contrasting of theoretical orientations within at least two different contexts - situations).

Similarities:

exploration of the past (though this is more central to psyc)

assumption that behavioral change can come through cognitive change (though more central to cbt)

assumption that people can have control over their thoughts, emotions, and behaviors

differences:

CB therapy practice is shorter typically, and uses operant and classical conditioning vs psychoanalysis which typically lasts years

CBT is more substantiated in research

CBT is more task oriented, and the therapist plays a central role giving feedback, teaching skills. Psyc - patient does free association and dream interpretation.

psyc - human nature seen in pessimistic, cbt focuses on ability for self-knowledge and change

cbt is less complex in practice

sex not important to cbt unless they affect problematic thoughts or behaviors, while it is integral to psyc

8. What are major differences and/or commonalities between Constructivist / Social Constructionist Theory and Erikson’s Bio-Psychosocial Theory? (Consider assumptions & principles of each of these theoretical orientations when responding to this question. Also, consider discussing this comparison and contrasting of theoretical orientations within at least two different contexts - situations).

---

9. What are major differences and/or commonalities between Carl Rogers’ Person-Centered Approach and Freudian’s Psychoanalytic Theory? (Consider assumptions & principles of each of these theoretical orientations when responding to this question. Also, consider discussing this comparison and contrasting of theoretical orientations within at least two different contexts - situations).

Similarities:

Rogers: importance on uniqueness, potential and inner drive; Freud: motivation comes from Id and Superego, biologically driven

Rogers: everything client says has meaning to them; Freud: everything a person does or says has meaning, and through dream interpretation, free association, it can be found

Differences:

Rogers: self-actualization, optimism; Freud: pathology based

Rogers: self-understanding leads to natural motivation to improve and self-actualize; with Freud, motivation focuses more on overcoming an obstacle (negative vs. positive orientation)

Rogers: lifetime development/self-actualizing; Freud: childhood/adolescent development

Rogers: practitioner and client are in a partnership; Freud: medical model of practitioner expertise

Rogers: client driven; Freud: client driven in content, practitioner driven in process

Rogers: no stages as behavior is reflective of client's internal world; Freud: psychosocial stages rooted in biology

10. What are major differences and/or commonalities between Feminist Theory and Erikson’s Bio-Psychosocial Theory? (Consider assumptions & principles of each of these theoretical orientations when responding to this question. Also, consider discussing this comparison and contrasting of theoretical orientations within at least two different contexts - situations).

Feminism challenges that Erikson's BPS theory, about development as disconnection, independence and separation do not generalize to females, and in fact are opposite. feminism sees development as connectedness and caring. Erikson implies cross-culturality of his theory, and gender neutral.

Feminism believes that dysfunctional behavior is that which privileged groups believe it is, specifically that it is about behavior of less privileged groups, and not really "dysfunctional" but has been functional.

Some flavors of feminism believe that women are naturally more nurturing, and men more aggressive. Erikson appears to be gender neutral.

Feminism believes that knowledge is holistic, not linear as in Erikson's stages.

Feminist theory - "personal is political" concept that the political environment influences development - similiar to Erikson, except he includes the

Similarities:

focus on person in environment, interactions between person and environment lead to development

Liberal feminists believe in biological similarity between women and men. Erikson sees a biological component to development

differences in practice - Erikson would look to complete specific developmental tasks. feminism - develop empowerment

Feminism would look to increase social support, empower through optimism and understanding the importance and individuality of her experience. Additionally - learn to "work" the system, use resources which are available, build social capital, with confidence that she and her family deserve the help, and it's the society's failure to protect the vulnerable when there are significant social service shortfalls. Feminism would not see Angela in a predetermined linear developmental model.

11. What are major differences and/or commonalities between Cognitive-Behavioral Theory and Erikson’s Bio-Psychosocial Theory? (Consider assumptions & principles of each of these theoretical orientations when responding to this question. Also, consider discussing this comparison and contrasting of theoretical orientations within at least two different contexts - situations).

BPS: bio, psyc and social factors all play significant roles in human functioning

CBT: as I think, so I feel, and do; 1. Activating event; 2. Beliefs about the event or evaluation, either rational or not rational; 3. Consequences in the form of feelings and behavior; interplay of thinking and feeling produces behavior (similar to antecedent, behavior, consequent of behavioral theory)

Similarities:

both involve thoughts, emotions and behaviors

differences:

CBT focuses more on the individual's structure of thinking/schemas, including beliefs, attitudes, assigning of meaning, which is inherent in BPS. BPS also includes social and other environmental and biological forces which strongly influence development. In CBT, individual interpretation is heavily focused upon. In BPS, more holistic focus, and focus on 8 stages of development and meeting developmental tasks. A fully developed person

12. What are specific distinctions between Liberal, Radical, Socialism/Marxist, Black, and Postmodern Feminist Orientations? (Compare and Contrast)

helping understand how one is oppressed, and the practitioner empowers them

liberal feminism - wanting equality for men and women; no differences between sexes

focus on the denial of equal access to society's resources for girls and women. capacity for reason is equal. sex differences have been translated by cultural interpretations into gender roles

criticized for ignoring differences and preferences between men and women, interests and experiences

radical feminism - differences between the sexes; wants a cultural revolution against the patriarch

women have been made subservient and forced to be in specific roles in the family and society which are designed to meet male needs

values differences between men and women

socialism - focus on intersection of class and gender through the economics of capitalism and patriarchal social structures that maintain female subordinance;

stress has been placed on women b/c of the economic structure of the society and the family

criticized for not considering psychological consequences of oppression, such as depression

black feminism - emerged due to lack of feminist perspective on racial/ethnic/cultural differences between women and men. assumption: class, culture, color result in different types of oppressive experiences; also reaction to liberal feminism which did not give much appreciation to females who chose to be mothers/enjoyed parts of the traditional female role

postmodern - recognizes the multiple voices of women, deconstructs the traditional theories and opposes generalized propositions about 'what it is' or 'what it isn't' like to be female; a constructivism specifically applied to gender issues and women's rights. criticized because it's strong emphasis on diversity makes it difficult to gain solidarity for taking action

feminism - patriarchy is in charge, women are at mercy of the patriarchy; only solution is to becomes empowered individually and collectively to push change

practice:

knowledge and values are interrelated; your knowledge of the inequalities will also reflect on your values; you have to begin to wake people up; focus on the person's narritive; all of Angela's problems are partially due to patriarchy holding her down - job, stuck w/the kids alone

and she stays because she has been oppressed into believing that others hold the power

13. What are major differences and/or commonalities between Feminist Theory and Carl Rogers’ Person-Centered Approach? (Consider assumptions & principles of each of these theoretical orientations when responding to this question. Also, consider discussing this comparison and contrasting of theoretical orientations within at least two different contexts - situations).

feminist theory general assumptions:

Social structures, especially within the United States, privilege / give advantages to men and oppress women.

Knowledge and values are interdependent.

There are many ways of knowing – Knowledge is holistic not linear.

The personal is political.

Inequality affects gender relationships

Differences among the sexes should not promote a sense of female inferiority.

In order for egalitarian relationships to be promoted changes must occur at the individual and social level.

feminist theory principles:

goal: egalitarian society / relationships, women not marginalized

consciousness-raising promotes change. exposure to the dehumanization.

encouragement to take social action to change social conditions

use of an empowerment perspective / strengths

rogers basic concepts:

Individual experiences are subjective to their perceptions. (similar)

individuals react according the their perceived reality

behavior is used to satisfy needs

concept of self influences behavior (similar, and with feminism the society / political climate are emphasized in the creation of self)

incongruence occurs when there is a split between ideal and actual self (can be seen in feminism - dehumanization of women and their experiences is not congruence)

client is the expert (similar)

rapport, trust, collaboration vital (collaboration is key in feminism, as well as trusting oneself)

more similarities:

use of unconditional positive regard in tx, and non-directive style, fit well with feminism's focus on embracing and understanding individual humanness

focus on here and now, trusting self

14. If a Masculine Perspective was developed, adopting the logic of a feminist perspective, what would it look like?

Piaget and Constructivism as it relates to therapy and development

Constructivism is a philosophy of learning based on the principle that, by reflecting on our experiences, we can develop our own understanding of the world we live in. Each of us creates our own rules and mental models, which we use to make sense of our experiences. Learning is simply the process of adjusting our mental models to accommodate new experiences.It is through this process of accommodation and assimilation that people construct, deconstruct, reconstruct and retain knowledge from their own personal experiences.

Jean Piaget began his career as a genetic epistemologist (1919), meaning that he studied the development of knowledge.  During the course of his studies Piaget discovered a valuable relationship between schema’s (exploring environment to make sense out of it), assimilation (integrating new knowledge into an old schema), and accommodation (having an old schema adapt to a new object.

Assimilation and accommodation work together from the constructivist standpoint, increasing our understanding of the world and our ability within it.  According to Piaget, goal between assimilation and accommodation is to find balance between the structure of the mind and the environment, at a certain point between the two, that would indicate that you have a good understanding of your environment.  Piaget called this state equilibrium. 

Piaget  continued his investigation of development, he found that there were periods where assimilation dominated, periods where accommodation dominated, and periods of equilibrium, and that these periods were similar among all the children he observed and so the stages of cognitive development were formed.  These stages include sensory motor, preoperational, concrete, and formal operations stage.

The sensory motor stage is when the  infant uses senses and motor abilities to understand the world, beginning with reflexes and ending with complex combinations of sensorimotor skills.  This stage includes gaining primary circular reactions, secondary circular reactions, and tertiary reactions.

The preoperational stage lasts from about two to about seven years old. In the preoperational stage the individual develops the ability to use symbols and creative play.  Along with symbolization, the individual also develops an understanding of past and future.

The concrete operations stage lasts from about seven to about 11.  In this stage, the child not only uses symbols representationally, but can manipulate  symbols logically.  In addition, an individual learns the skills of classification and organization during this stage of development. 

From approximately 12 on, we enter the formal operations stage.  Here we develop the skills that allow us to become skillful at “adult-style” thinking.  This involves using logical operations, and using them abstractly, rather than the concrete.  This can be referred to as hypothetical thinking.   It is in the formal operations stage that we develop the skills to be able to  investigate a problem in a careful and systematic way.

In addition to Piaget’s social constructivist theory, there are many others who offer findings on social construction, such as Lev Vygotsky (1987) who developed his own sociocultral theory.  This theory has 5 basic principles which include,  Challenging tasks promote cognitive growth through the assistance of people and the use of zone of proximal development,  interaction with other people is important for cognitive growth, that culture can make daily living more efficient and effective, advanced mental methods start through social activities. As children advance they begin to use ideas on an individual level that were once learned on a social level, and lastly that  there is an increase of the independent use of language and thought during a child’s first few years of life.

A major focus of social constructionism is to uncover the various ways in which individuals and groups participate in the creation of their perceived social realities. This involves the individual looking at the ways their individual social phenomenon are created, institutionalized, and normalized by society. A socially constructed reality is one that is seen as an ongoing process that is reproduced by people acting based on their perceptions and the knowledge of their perceptions.

Constructivism has been used for over 60 years to address social and political issues such as poverty and homelessness.  From the political standpoint constructivism has been used to not only address homelessness but also to define it. 

Therapeutic approach when identifying and integration trauma

Identifying Trauma
The breadth of effects from trauma and the role of trauma in the development and exacerbation of other mental health issues are without parallel, except perhaps by psychoactive substance use. Despite similarity in destruction to substances, the devastation of trauma is paramount considering substances powerfully mimic and manipulate the nervous system at the chemical level. Trauma and associated effects can be just as damaging in shorter “doses” with more permanent consequences.

Trauma occurs when an event or series of events is perceived as very threatening. The traumatic event is so intense and/or unexpected that their brain generalizes the level of threat to non-equivalent situations. The brain does not realize that the traumatic event may have been abnormal or a special, unfortunate single instance. An overactive fight/flight/freeze/hide (also “fight-or-flight”) response becomes built into the person’s post-trauma response to the environment. The fight-or-flight response circumvents higher functions of the brain and diverts most energy to life-saving quick reflexes and responses (Castex, 2004; Demetral, 2010). Subsequent experiences of trauma, or retraumatization, can confirm and further encode the validity of the initial trauma and a tendency to respond in fight-or-flight (Castex, 2004). The effects of trauma are semi-permanent, persisting and affecting a person’s actions until the events are fully processed and new meanings are assigned to the traumatic events (Gagerman, 1997.)

Reactions to trauma and symptoms of trauma can vary greatly between persons, but follow some trends. An abnormal startle response is common for survivors of trauma, as are unprovoked or incongruently intense responses to seemingly harmless stimuli ((Patterson & Telesco, 2004; Demetral, 2010). Nightmares and flashbacks of traumatic images, sounds, and other perceptions can occur with or without related stimuli triggering recall (Westrup, 2010). Increased anxiety and panic attacks can follow traumatic events. There is a decreased window of tolerance of uncomfortable emotions, as emotional resources are chronically taxed due to hypervigilence and other overly active coping mechanisms (Curran, 2008; Demetral, 2010).

Substance use is often a symptom of trauma. Binge alcohol use is common particularly among males (but also females) with PTSD, as a way to cope with the chronic stress of trauma (Westrup, 2010). Consistent alcohol use where it was not present previously, and does not appear to be in response to a particular recent event, can be a symptom of underlying trauma. Some researchers have found a consistent correlation between traumatic stress and increased alcohol use (Patterson & Telesco, 2004).

Women tend to experience certain symptoms more often. Flackbacks, feeling dissociated, fear of being a wife or mother, and eating disorders are common responses to Military Sexual Trauma (MST) or other forms of PTSD. Of the staggering one-fifth of women who experience sexual trauma in the military, 76% also have a mental health condition – a much higher rate than non-sexually traumatized women in the military. (Westrup, 2010). Victims of sexual trauma can have immense difficulty in relationships with sexuality. The issue of repeated trauma, or retraumatization, is common for women in the military and victims of mass violence, among others (Castex, 2004; Westrup, 2010)

Law enforcement personnel experience trauma directly and through witnesses during their workweek. Along with other first responders, law enforcement personnel have the responsibility of constantly assessing safety for themselves, their colleagues, and civilians, leading to chronic stress, a form of trauma. Officers assigned to inner cities often experience the same trauma as military personnel at war. The effects of trauma on law enforcement personnel include emotional distance from families, disease due to being overstressed, compassion fatigue, and dismissiveness or dissociation from emotion. Family relations can become strained because the family cannot relate to the rush of power which officers feel during their work. Families typically do not follow the chain of command that is present in law enforcement, either (Patterson & Telesco, 2004). Military personnel can have similar problems, and families can have the experience of “putting the unit first.” Soldiers returning from war may have the added difficulty of feeling like an outsider in their families after being gone for so long (Curran, 2008).

Trauma responses can differ between age groups as well. Young children may cry, scream, suck their thumbs, have disrupted sleep or nightmares, be reluctant to leave the house, lose bladder/bowel control, and fear being alone, strangers, and darkness. Older children may have headaches, numerous physical complaints, depression, fears about weather, confusion, difficulty concentrating, and fighting. Adolescents can also experience headaches, and in addition they may have depressive symptoms, change friends, use substances, feel confused often, and perform poorly. Adults may have psychosomatic problems, such as a racing heart, ulcers or upset stomach, anhedonia, and cold or flu symptoms. Adults may also cry easily, have communication difficulties, feel overwhelmed, fear crowds or strangers, and have concentration difficulties at work. Older adults may experience memory loss, agitation, disorientation, confusion, accelerated decline in health, and suspicion (Castrex, 2004).

Treating Trauma

Like all mental health issues, treatment of trauma and related issues depends highly upon the individual. The following paragraphs outline a few trends in treatment.
Creating the experience of safety is crucial to healing trauma. Castrex (2004) recommends using open-ended questions, empowering people with choices and pointing out the multitude of choices, and normalizing reactions to trauma. Forcing or coercing clients to work through trauma can be retraumatizing (Castrex, 2004; Patterson & Telesco, 2004). Normalizing reactions to trauma is an important technique for helping people feel safe and work through traumatic memories (Gagerman, 1997; Castrex, 2004). Group therapy of trauma survivors can provide a safe environment where discussion, validation, and appreciation of traumatic experiences can occur. Individuals are able to recall repressed memories, assign new meanings to trauma, and reorganize their sense of self (Gagerman, 1997).

Both videos alluded to dialectical behavior therapy (DBT) being used as one modality of treatment for people affected by PTSD (Curran, 2008; Westrup, 2010). While DBT was not developed specifically for PTSD, it can be helpful due to the similar symptomology among PTSD and the populations for which it was developed, and the fact that many people who would benefit from DBT have experienced trauma (Patterson & Telesco, 2004; Psych Central Staff, 2007; Westrup, 2010). DBT is helpful for people experiencing abnormally intense responses to emotional situations. Affect regulation is built through psychoeducation, weekly homework, individual therapy, phone calls, and group therapy. The four modules of DBT teach skills in mindfulness, interpersonal effectiveness, distress tolerance, and emotional understanding or insight (Psych Central Staff, 2007).

Several other effective treatment were suggested by Westrup (2010). Seeking Safety (SS), described by Najavitz in 1996, is useful in treating people with PTSD and substance abuse. SS teaches very basic relationship and emotional regulation skills, similar to DBT. Each SS module can be used alone or as part of an ongoing curriculum. Cognitive Reprocessing Therapy and Prolonged Exposure Therapy both aim to assist clients with facing the memories they have been repressing, without victimizing themselves, and while increasing clients’ sense of control. For clients who struggle knowing self and have experienced trauma, Acceptance and Commitment Therapy (ACT) was recommended. ACT allows clients to connect to their past and present internal experiences, similar to the DBT skills of mindfulness and emotional understanding/emotional regulation.

Treating trauma survivors may be difficult for out-group practitioners because trauma has the power to bond people strongly, and the practitioner was not involved in the traumatic event (Castrex, 2004). Thus group can be effective in creating a therapeutic bond with alienated clients. For families, the practitioner can help the family members see themselves as a unit. Partaking in meaningful activities as a family may be beneficial to this process. Practitioners can assist families in brainstorming activities and break down barriers for follow-through (Curran, 2008).

Importance upon provider mental health cannot be overemphasized. The effects of secondary trauma upon providers can lead to high provider burnout, compassion fatigue, depression, and other difficulties (Patterson & Telesco, 2004; Westrup, 2010). Built into DBT is a recommended weekly support group for providers, to continue their personal growth and ensure processing of any countertransference (Psych Central Staff, 2007). Westrup (2010) describes how knowledge of the necessity of self-care is not equivalent to practicing self-care. She briefly recalled the effects of secondary trauma on her life while serving as program director for a highly regarded residential trauma treatment center.
Personal Reflections

When assessing for trauma in my clients’ histories, I know to look for the clusters of symptoms described earlier in this paper. Additionally, I will be more informed of the possibility of trauma in military families and law enforcement. The article by Patterson & Telesco (2004) was particularly illuminating, especially in its comparison of PTSD in law enforcement to soldiers. Personality disorders, especially borderline, have direct links to trauma assessment in my mind. Additionally, I know to assess for the age and context of the trauma, past treatment experiences, retraumatization, and current distressing situations which trauma has made easier to tolerate.

For myself, the treatment of trauma presents many rewards and challenges. Assessment for trauma begins upon first contact with the client or their parents. While much variation is always present, the trauma for most of my clients has come in the form of subtle relational discord or lack of attunement with primary attachment figures. Compiled upon the attachment breaks are usually years of shame and discounting or internal obsession upon emotion. The challenge of communicating the attachment breaks to parents in a disarming way often spans several sessions of education and intervention. When parents are able to see their blind spots and adjust themselves to match their children, my work feels very rewarding.

I have had some experience with survivors of severe trauma while working in an inpatient mental health program and while doing my current work at Recovery Happens. At Recovery Happens, parents of my primary clients more often have trauma then the clients themselves. The work with survivors of trauma at the inpatient level was very taxing for me personally. In my clinical work I focus on creating an experience of attunement for clients. In situations of severe trauma and mental illness, I often felt drained and withdrawn at the end of the day.

One client I worked with had an axis I diagnosis of major depression, recurrent, severe with psychosis, and an axis II diagnosis of cluster C traits, rule out dependent personality disorder. While doing his intake assessment he described growing up with incredible shame and internal discord due to his mother being repeatedly raped and molested by her father from a young age until she was in her 20s. He was a product of that rape. He often experienced auditory and visual hallucinations of his mother and father verbally abusing him, and flashbacks of his mother and father physically abusing him. Also, when he was 10 years old, he was riding his bike with a girl from his neighborhood. She was up ahead of him and a car T-boned her, smashing her into a tree and killing her instantly. He often struggled to free his mind of that image.

I grew professionally and personally due to working with that gentleman. Hearing about his intense trauma sent me into a withdrawn state for the next few days, and it took considerable discussion with my support, exercise and gardening to start feeling better. I was able to see firsthand how trauma shaped someone’s brain and (perhaps) caused psychosis. It gave me a new appreciation for self-care. Other experiences he described helped me understand how vulnerable he saw himself, which may have resulted in his dependent traits. It appeared that repeated traumas and psychological stress due to abuse and shame led to this man to have learned helplessness, void of self, and a sort of permanent Stockholm syndrome.

Having a fundamental understanding of trauma at the micro level will aid my practice at the macro level. Bad policy and poorly thought out business strategies can create chronic stress for affected populations. Swiftly implemented bad policy, such as the recent mental health budget cuts in Sacramento county, retraumatized the already severely traumatized low income population of mental health consumers. Good policy recognizes the attachment people have to the objects of “government” and “services” and embraces its responsibility to those who are served. Also, I know from my undergraduate research that when people are happier, they are more creative, more productive, and less likely to get sick – all of which create a more economically productive, efficient and stable society. As human beings in society, we cannot hide from our responsibility to do good for those who are most vulnerable and tormented.

I know now that for me, doing clinical work is probably not going to be something which lasts much longer, so in the future I believe experiencing vicarious trauma will not be as big a risk. I am filled with profound respect for clinicians who are able to remain balanced and work with trauma. I am personally drawn to bring social work values and practice skills into technology, science and business.

References
Castex, G. M. (2004). Chapter 9: helping people retraumatized by mass violence. In S. L. Straussner & N. K. Phillips (Authors), Understanding mass violence: a social work perspective (pp. 129-142). Boston: Pearson.
Curran, E. (2008). PTSD & Family Therapy. Retrieved April 1, 2011, from http://www.cominghomeproject.net/node/149
Demetral, D. (2010). The psychobiology of stress and the etiology of anxiety disorder(s). From Social Work 223 DSM: California State Univeristy, Sacramento; Fall 2010. Unpublished manuscript.
Gagerman, J. (1997). Integrating dream analysis with intersubjectivity in group psychotherapy.   Clinical Social Work Journal, 25(2), 163-178  
Patterson, G. T., & Telesco, G. A. (2004). Chapter 8: mass violence and law enforcement personnel. In S. L. Straussner & N. K. Phillips (Authors), Understanding mass violence: a social work perspective (pp. 117-125). Boston: Pearson.
Psych Central Staff. (2007). An overview of dialectical behavior therapy. Psych Central. Retrieved April 01, 2011, from http://psychcentral.com/lib/2007/an-overview-of-dialectical-behavior-therapy/
Westrup, D. (2010). Treating female veterans of war. Retrieved April 3, 2011, from http://www.cominghomeproject.net/node/143

Reflections on Zen concepts and ubuntu in therapeutic interactions

Bein’s concept of recognizing the client and practitioner’s relationship to the universe is similar to Tutu’s description of the ubuntu perspective. Bein describes how contemplating one’s place in the universe, and being fully present, allows the universe to speak through the practitioner to help the client (Bein, 2008, pp. 13-14). There is not a denial of the roles we play, such as practitioner and client, or oppressor and oppressed; but recognition that they are impermanent and unimportant in greater spiritual contexts. For Tutu, human beings are seen as equal, yet small parts of a great whole. By honoring the whole, one implicitly honors self. Self cannot be honored alone (Battle, 2009, pp. 2-3). Embracing the reality of our vulnerability makes compassion for others and community possible. Further, self-sufficiency is an illusion (Battle, 2009, pp. 40-42). Also, the Buddhist concept of the self as an illusion is similar to Tutu’s concept of self as a distraction from being close to God. In any case, the self is seen as a distraction to the nature of reality. It is implied that the client will get well when they embrace the present.

Bein describes being comfortable with “not knowing,” letting the client teach the practitioner. Practitioners are encouraged to not be fooled by the mind’s overreliance on cognitive schemas for quick problem solving. There is always nuance and surprise for even the most seasoned practitioner. This reminds me of a saying that goes something like: “Knowledge is a barrier to learning.” In class there was discussion of an article which reviewed research that found approximately 75% of social workers did not get any training relating to spiritual topics (Canda, Nakashima, & Furman, 2004). This made me think of how social work education, however comprehensive, cannot prepare students for everything they will face. Social work education is really just building a strong back with theory and basic experience, a soft front with client-centered activities and field experience, and a commitment to continued learning. Being comfortable with not knowing is something that social workers must grasp in order to be able to teach and model it to clients. Being comfortable with not knowing makes learning possible.

There is a theme in the readings of non-aversion to suffering and facing things as they are, for practitioners and clients. Taken at face value, this perspective could sound like an amoral, uncaring way to practice and live. Looking deeper, it is about not being at the whims of emotion. Emotions, including pain, are to be used as information, but not necessarily ultimate truth. Tutu has this value as well. He acknowledges the existence and unavoidability of sin and getting lost in materiality, but urges people to elevate to God-consciousness in order to not be lost in these things (Battle, 1997, pp. 5-7).

When Tutu says, “…let God empty us of ourselves…so that we become more and more Godlike,” (Battle, 1997, p. 7) I am reminded of Bein’s notion of the practitioner creating a container for interactions by having a strong back and open, soft front (Bein, 2008, pp. 10-18). Traditionally, being of service means taking action on someone else’s behalf, or doing something helpful for someone. Instead, in these readings, being helpful means creating a mental sandbox for others to work things out and become present, and make their own decisions, with less actual direction from the practitioner.

I understand the Zen concept of “embracing paradox” discussed in class somewhat less mystically. My scientific view on embracing paradox is just realizing that there is an underlying law of nature explaining the existence of seeming paradox. Really anything can be explained as a paradox. I can be both the shortest person in my class and the tallest person in my class. The underlying reality might be that I am the only one in the class. For me, “embracing paradox” could be fully explained as “embracing paradox until the underlying nature is understood.” When it comes to practice, being comfortable not knowing comes in handy when faced with apparent paradox, because it is not possible to have all the information, all the time.
Each of these readings share the theme of being present in the moment. It seems that all the authors would agree that oppression occurs when people forget their relationship to others and become engulfed by a materialistic focus. Being spiritually open and aware allows people to expand their consciousness and not be overwhelmed by disconnection and self-centeredness.

References
Bein, A. (2008). The zen of helping: spiritual principles for mindful and open-hearted practice. Wiley: Hoboken, NJ.
Battle (1997). Reconciliation: the ubuntu theology of Desmond Tutu. The Pilgrim Press: Cleveland, Ohio.
Canda, E. R., Nakashima, M., & Furman, L. D. (2004). Ethical considerations about spirituality in social work: insights from a national qualitative survey. Families in Society: The Journal of Contemporary Social Services, 85(1), 27-35.