Our Blog - Healing Pathways Psychological Services

The Healing Power of Sound

Leave a comment   , , , , , , , , , ,
Share Button

The Healing Power of Sound

Photo credit: Blue Heron Crystals and Minerals

by Dr. Leona Kashersky & Nicolina Santoro, MA

The crystal bowls can assist in reducing stress, anxiety, and pain, promote happiness, peace of mind, and help you hear the music of your life-purpose.

The next class is on May 27th at Healing Pathways Psychological Services. 

For registration call: 916-595-7233
Email soundhealinghpps@gmail.com for registration details
Cost $140 3 hour instruction and experiential didactic

Please enjoy the following snapshot of some of the theory and practice used in the facilitation of sound healing at Healing Pathways! 

The Chakra System, in yogic practice

The seven chakras, in the yogic tradition are the centers in our bodies in which life sustaining energy flows through.It is thought that blocked energy in our seven chakras can often lead to illness, so it’s important to understand what each chakra represents and what we can do to keep this energy flowing freely.

The Chakras In Summary

  • Root Chakra — Represents our foundation and feeling of being grounded.
  • Location: Base of spine in tailbone area.
  • Emotional issues: Survival issues such as financial independence, money and food.

 

  • Sacral Chakra — Our connection and ability to accept others and new experiences.
  • Location: Lower abdomen, about two inches below the navel and two inches in.
  • Emotional issues: Sense of abundance, well-being, pleasure and sexuality.

 

  • Solar Plexus Chakra — Our ability to be confident and in control of our lives.
  • Location: Upper abdomen in the stomach area.

Emotional issues: Self-worth, self-confidence and self-esteem.

  • Heart Chakra — Our ability to love.
  • Location: Center of chest just above the heart.
  • Emotional issues: Love, joy and inner peace.

 

  • Throat Chakra — Our ability to communicate.
  • Location: Throat, just above the collar bone.
  • Emotional issues: Communication, self-expression of feelings and the truth.

 

  • Third Eye Chakra — Our ability to focus on and see the big picture.
  • Location: Forehead between the eyes (also called the Brow Chakra).
  • Emotional issues: Intuition, imagination, wisdom and the ability to think and make decisions.

 

  • Crown Chakra — The highest chakra represents our ability to be fully connected spiritually.
  • Location: The very top of the head.
  • Emotional issues: Inner and outer beauty, our connection to spirituality, wonder, and pure bliss.

 

EMDR 

EMDR is an acronym for Eye Movement Desensitization Reprocessing, a tool to process traumatic experience. EMDR works through bilateral neural stimulation or brain stimulation to integrate traumatic material. The singing crystal bowls create a sense of bilateral stimulation, while the meditation focuses on reprocessing, and altering core belief patterns. The bilateral processing is not only possible using the eyes; we can use sound, touch, and movement of any bilaterally moving body parts with a split timed rhythm. Some psychologists conceptualize EMDR as a form of ‘Exposure Therapy’, desensitizing people to traumatic material and thus relating it to exposure therapy. A more accurate description would be that it integrates the traumatic material.

“Memories evolve and change. Immediately after a memory is laid down, it undergoes a lengthy process of integration and reinterpretation—a process that automatically happens in the mind/brain without any input from the conscious self. When the process is complete, the experience is integrated with other life events and stops having a life of its own. As we have seen, in PTSD this process fails and the memory remains stuck—undigested and raw.” ~ by Bessel Van Der Kolkata, M.D. In The Body Keeps the Score chapter entitled Letting Go of the Past: EMDR

 

Three summarizing factors about EMDR:

  1. EMDR loosens up something in the mind/brain that gives people rapid access to loosely associated memories and images from their past. This seems to help them put traumatic experience into a larger context or perspective.
  2. People may be able to heal from trauma without talking about it. EMDR allows them to observe their experiences in a new way, without verbal give-and-take with another person.
  3. EMDR can help even if the patient and the therapist do not have a trusting relationship. This is intriguing because trauma, understandably, rarely leaves people with an open, trusting heart.

 

 

Physiological and Therapeutic Effects of Drumming

Recent studies have shown physiological benefits to drumming meditation practices such as, the reduction of the physical symptoms of anxiety, stress, the body’s immune system, brainwave activity, dual cerebral hemisphere activation, and connection with the present moment.

Because of the deep sense of tranquility that the act of drumming facilitates within the Central Nervous System, the effects of stress, and the accumulation of trauma stored within our cellular memory can be processed and integrated through this non-confrontational and deeply personal act even in group settings. This form of mindfulness based attention has also shown to activate the cells themselves, allowing for deep trauma to be released from cellular memory with little interference from the mind’s protective measures and defenses as the trauma is engaged and released by group participants. The chemical messengers of the brain or neurotransmitters reinforce this practice by stimulating alpha wave activity, inducing feelings of well-being and happiness.

The shared experience of drumming in groups is observed to facilitate a shared space of connection and consciousness among its members, alleviating common feelings of isolation, social fear, and inhibition.

Drumming seems to provide a platform for people to experience religious or spiritual connection through a universal practice that has been used by all cultures in some form or another. Through this connection, a space is created to access the deepest parts of our human condition.

 

 

References

  • The Body Keeps the Score science grounding in sound, breathe, and movement as a healing modality. Bessel Van Der Kolkata, M.D
  • R. Damasio, The Feeling of What Happens: Body and Emotion and the Making of Consciousness (New York: Random House, 2000) 28
  • K. Holzel, et al., “Mindfulness Practice Leads to Increases in Regional Brain Grey Matter Density,” Psychiatry Research: Neuroimaging 191, no. 1 (2011): 36-43.
  • K. Holzel, et al., “Stress Reduction Correlates with Structural Changes in the Amygdala,” Social Cognitive and Affective Neuroscience 5, no. 1 (2010): 11-17.
  • W. Lazar, et al., “Meditation Experience Is Associated with Increased Cortical Thickness,” NeuroReport 16 (2005): 1893-97. Pesso
  • N. Demos, Getting Started with Neurofeedback (New York: W.W. Norton, 2005).
  • J. Davidson, “ Affective Style and Affective Disorders: Prospectives from Affective Neuroscience,” Cognition and Emotion 12, no. 3 (1998): 307-30.
  • J. Davidson, et al, “Regional Brain Function, Emotion and Disorders of Emotion,” Current Opinion of Neurobiology 9 (1999): 228-34.
  • Bittman, M.D., Barry, Karl T. Bruhn, Christine Stevens, MSW, MT-BC, James Westengard, Paul O Umbach, MA, “Recreational Music-Making, A Cost-Effective Group Interdisciplinary Strategy for Reducing Burnout and Improving Mood States in Long-Term Care Workers,” Advances in Mind-Body Medicine, Fall/Winter 2003, Vol. 19 No. 3/4.
  • Winkelman, Michael, Shamanism: The Neural Ecology of Consciousness and Healing. Westport, Conn: Bergin & Garvey; 2000.
  • Bittman, M.D., Barry, “Composite Effects of Group Drumming…,” Alternative Therapies in Health and Medicine; Volume 7, No. 1, pp. 38-47; January 2001.
  • Winkelman, Michael, Shamanism: The Neural Ecology of Consciousness and Healing. Westport, Conn: Bergin & Garvey; 2000.
  • Friedman, Robert Lawrence, The Healing Power of the Drum. Reno, NV: White Cliffs; 2000.
  • Mikenas, Edward, “Drums, Not Drugs,” Percussive Notes. April 1999:62-63.
  • Diamond, John, The Way of the Pulse – Drumming with Spirit, Enhancement Books, Bloomingdale IL. 1999.
  • Winkelman, Michael, “Complementary Therapy for Addiction: Drumming Out Drugs,” American Journal of Public Health; Apr 2003, Vol. 93 Issue 4, p647, 5p
  • Mikenas, Edward, “Drums, Not Drugs,” Percussive Notes. April 1999:62-63.
  • Friedman, Robert Lawrence, The Healing Power of the Drum. Reno, NV: White Cliffs; 200

 

Share Button


Using Meditation to Tame this Mind of Ours

Leave a comment   , , , , , , , , , , , , ,
Share Button

 Using Meditation to Tame this Mind of Ours

family yoga on the beach at sunset

 

By Nicolina Santoro, MA

Mahayana Buddha, the progenitor and prophet of the middle way, had encapsulated an entire philosophy into short, clear directives. “Commit not a single unwholesome action, Cultivate a wealth of virtue, To tame this mind of ours; this is the teaching of all the Buddhas” (Rinpoche, 1993). Meditation is part of the practice of taming the mind. Often described as the still mind, or still waters of the mind, meditation appears to be a kind of martial art for one’s thoughts. To even begin to feel the stillness of mind that comes with the practice of meditation, one must endure the onslaught of thought as it runs through the beginning meditator’s mind rampantly. Even more interesting, is the realization that this pattern of thought is a regular occurrence in the mind. Meditation highlights the never-ending barrage of thought, as the student tries to negotiate the noise to a place of quiet within the mind (Fontana, 1992).

Meditation is actually a common practice among many different platforms of faith, although called many different names throughout time, but the goal of calming the turbulence in the mind remains the same. The practical applications of meditation have far reaching benefits to those who suffer from a variety of illnesses. Mental illnesses such as anxiety, depression, obsessive-compulsive disorder, and manias have all shown to be positively affected by the regular practice of meditation. Some of the therapeutic benefits of regular meditation practice include enhanced self-esteem, reduction in feelings of hopelessness and depression, and a sense of spiritual connection (Lindgren & Coursey, 1995).

Since the mind, by its various sense mechanisms can create and maintain a subjective reality, one seems to be at the mercy of the mind and its myriad of emotional states of being. Thoughts create emotional experiences based on the electrical impulses that send messages to various chemical centers to whip up recipes for certain emotional states. These emotional states hold tremendous power over self-efficacy, and emotional well-being. Most people have had the experience of having a “bad” day, or a lack of desire to get out of bed. These types of feelings and their sources are often overlooked by people experiencing them, as the emotional tide they create has a strong influence in coloring one’s perceived reality. Over time, the continuing pattern of similar emotional states can create long-term relationships between neurons in the brain. In other words, relationships between a thought and the subsequent emotional state that the thought triggered become a learned response with different chemical markers for different emotional states (Berger, 2006).

Meditation is the act of awareness, noting a thought as it travels through the mind’s eye, rather than grabbing on to it for dissection. It is in the act of dissection that the emotional response is created. A sort of fixation then occurs, making it very difficult to regain a sense of calm detachment which is the focus of the meditation practice. Observe, but be not of the waves of thoughts that roll through the ocean of conscious awareness, and breathe which is certainly not as easy as one might think.  Buddhism imparts that suffering, and dis-ease are certainly inevitable in life however, there is an opportunity for personal transcendence in the observation rather immersion in this state of suffering  (Rinpoche, 1993). A meditation posture is grounded, comfortable yet deliberate. One may elect to sit on the floor with legs crossed in front of them, arms relaxed and poised comfortably in the lap, eyes closed. One then begins to notice their breath, every inhalation and exhalation is noted in the awareness space. As this practice begins, the mind seems utterly flooded with thoughts, worries, randomness, and chaos. However, through each breath, the subject becomes accustomed to the flow of thoughts which become a sort of background noise, and the central focus of breathing creates an altered or trance like state in the consciousness of the meditator. This altered state of being allows the meditator to observe self from a place of detached compassion which is the place of mindfulness that the Buddha described (Rinpoche, 1993).

Common mistakes that people make when entering into the practice of mediation exists in the misapplication of the quiet mind concept. The term is slightly misleading. The mind, it seems, is never truly quiet. Thoughts run constantly because the mind is always taking in information, processing it, encoding it, retrieving it, and deciphering it. The stillness of mind exists in the unfettered observance of this process. Unfettered meaning that one never holds on to, or tries to single out the thoughts as they steadily move through conscious awareness of the subject. As meditation becomes familiar to the mind itself, the thoughts no longer control the emotional state of the meditator, and stillness is observed by a state of total acceptance, and symbiosis  (Fontana, 1992).

The meditation process has been reported to be difficult, and even frustrating to those who are new to the experience, but long term benefits have also been relayed by those who were able to get through the frustration, and experience the trance-like state where feelings of calm and clarity exist. Meditation as a response and treatment for stress is now common advice from health practitioners even in the west because of the positive impact it has on the central nervous system (CNS), (Fontana, 1992).  The effect that mediation has on the body is noted further in the American Psychological Association’s book entitled Integrating Spirituality into Treatment. Meditation lowers respiratory rate, heart rate, and brain wave states, placing the body in a state of rest which is very helpful in dealing with chronic anxiety. Meditation has also been used frequently in the redirection of addictive behavior because of the altered state that it can enhance bio-chemically. In behavioral and cognitive behavioral types of therapeutic interventions, meditation is also useful in the reprogramming of negative thinking, through the natural change in thought patterns that are facilitated by the practice (2006). 

Research conducted by Lindgren & Coursey, published in 1995 shows a strong positive correlation between the use of meditation practice and increased feelings of well being among those who suffer from severe forms of anxiety and depression.  Those who are being treated for more severe mental illnesses such as schizophrenia and bipolar disorder have also reported positive cognitive effects on mood and self-esteem (Psychosocial Rehabilitation Journal, Vol. 18(3), pp. 93-111). These trends can enhance the level of care that practitioners bestow upon their clients, giving them the tools to help alleviate some of the distress associated with negative automatic thinking, placing some of the control back in their hands with regard to better self-care.

Self-care is something that even mental health practitioners overlook for themselves. In the mental health fields, burn-out among therapists and social workers is high. The culprit seems to be a lack of self-care and over extension according to the (APA). Regular meditation practice can also help alleviate the stress that in the field of mental health seems almost inevitable to its practitioners. Self-care processes that the (APA) advocates include the awareness of the levels and types of stress in the practitioner’s environment, case load management, outside support networks, and extra-curricular activities that promote a sense of health and well being. A professional support network, boundaries, and realistic expectations upon the self are also highlighted as areas to which the practitioner should attend for optimum results. The clarity that accompanies regular meditation can also invigorate a flagging practitioner, providing a sense of calm and clarity toward the greater good of all concerned (American Psychological Association, 2006).

 

References

American Psychological Association. ed. by Miller, W.R. (2006). Integrating Spirituality into Treatment: Resources for Practitioners. Washington: American Psychological Association.

Berger, K. S. (2006). The Developing Person. New York: Worth Publishers.

Fontana, D. (1992). The Meditator’s Handbook. Rockport: Element Books, Inc.

Lindgren, K., & Coursey, R. (1995). Spirituality and Serious Mental Illness: A Two-Part Study. Psychosocial Rehabilitation Journal, 18(3), 93-111. Retrieved from EBSCOhost.

Rinpoche, S. (1993). The Tibetan Book of Living and Dying. New York: HarperCollins Publishers.

 

 

 

Share Button


A Series of Writings for Clinicians on Common Factors Research and What Promotes Change in Couple and Family Therapy Part 2

Leave a comment   , , , , , , , , , , , , ,
Share Button

A Series of Writings for Clinicians on Common Factors Research and What Promotes Change in Couple and Family Therapy

Part 2

by

Jason Briggs, MA

JBII

(photo credit: www.shutterstock.com)

What motivates a client to change and what are the processes therapists can use to help?

 

In the last writing, in this series on Common Factors research, the discussion was on aspects of two Common Factors used to promote effective outcomes in therapy.  They were client factors and therapist factors. These two Common Factors will be addressed in this second writing as well, along with how they interrelate with a third Common Factor called the therapeutic alliance, all within the Stage of Change known as Contemplation. I will also discuss what some of the change processes I use are and how they are also supported by Common Factors researchers. I will begin with what Common Factors researchers find is essential to Motivational Interviewing, since this was not discussed in my last post. Again, as with all my writings on Common Factors, I am reviewing three Common Factors researchers’ work, authored by Douglas H. Spenkle PhD, Sean Davis PhD and Jay L. Lebow, PhD, referencing information found in their book Common Factors in Couple and Family Therapy, The Overlooked Foundation for Effective Practice.

Motivational Interviewing has elements that when brought together in the context of our clients’ lives, can help therapists join with clients, inviting them to engage in and explore change in whatever Stage of Change they might be experiencing. Common Factors researchers contend and I agree with them, that “within the Motivational Interviewing approach there is no such thing as an unmotivated client. There are only therapists that are out of sync with a client’s motivation” (Spenkle, Lebow and Davis, 2009). So, working systemically, it is often the case that each member in an individual, couple or family system, is in varying Stages of Change and thus motivated at different levels with the different issues they might wish to address. Common Factors suggests part of the therapist role is to shift homeostasis within an understanding of each person’s motivation and the there are five principles to consider, to help us form a better connection with our client and help them move through whatever Stage of Change they are in. We can “(1) express empathy, (2) develop discrepancy, (3) avoid argumentation, (4) roll with resistance, and (5) support self-efficacy” (Miller and Rollnick, 2002) (Spenkle, Lebow and Davis, 2009). These five principles are suggested to fall into three broad therapeutic alliances, which therapists can use three interventions within each stage and they are: “(1) building motivation for change, (2) strengthening commitment to change, and (3) the follow-through (Spenkle, Lebow and Davis, 2009). So what exactly do Common Factors researchers know about the value and importance of these five Motivational Interviewing principles?

“Unpacking” what these Motivational Interviewing principles ignite in our clients, is a great way to motivate therapists to learn these concepts both intellectually and experientially with their clients. As noted above, these Motivational Interviewing principles inherently ask each therapist to embody a sort of attitudinal stance in therapy that helps facilitate a client’s movement toward change. They are (1) expressing empathy and is particularly effective with client ambivalence and is promoted by a listening stance and abandoning a superior/inferior stance, typically embodied by telling a client what meaning we give to their story. Common Factors researchers describe the Therapists’ Alliance in this way: (to be) “a supportive companion and knowledge consultant, (rather) than a forceful instigator of change” (Spenkle, Lebow and Davis, 2009). (2) Developing discrepancy, the second Motivational Interviewing principle is reflected in understanding that most, if not all humans’ emotional and psychological pain exists in direct proportion to the disparity/discrepancy between where they are now and where they want to be, “and when they know better, they will do better” ( BJ Davis, 2012). Common Factors researchers point out, “Depending on which Stage of Change the client is in, the therapist focuses on gently amplifying the discrepancy that is already there (for those in contemplation or preparation stages) or developing a discrepancy (for those in the pre-contemplation stage)” (Spenkle, Lebow and Davis, 2009). Here, we see an emphasis on the therapist knowledge about the Stage of Change in general and needing to know where one’s client is in terms of each Stage of Change and on differing issues, exploring the likelihood of a client having varying levels of motivation to change depending on any given issue and the Stage of Change the client is in with each issue. (3) Avoiding argumentation is the third principles used in helping a client experience the motivation to change. Expecting a client to embrace a certain protocol type therapy, a label, etc. is one way an unsuspecting therapist can invite arguments  against, instead of for change (with us or within the client and likely both). Helping to understand a client’s point of view regarding their preferences in therapy, how they have experienced labels, even “mental health issues” can be one way we can allow their meaning to be held up to unequivocal predominance and then join with the meaning our clients make about how they identify this meaning, amplifying, and reflecting it to them. Closely related Motivational Interviewing principle (4), rolling with resistance, which is an essential facet of Motivational Interviewing and the idea of accepting and not rejecting a client’s ambivalence to change. Emphasis is placed on joining with the client not on any particular interventions, trusting a solution will, if acceptance is present, naturally emerge within the client in the space created for them to explore their problems. This assumes an intention on behalf of the therapist, which trusts the client has their own answers within them, assuming a stance of psychological and emotional safety around any issues the client is considering facing. If the therapist achieves this stance and creates emotional safety for a client to explore what they need, want, and are willing to do based on the clients view, their therapist is seen as an “enlightened witness” (Alice Miller, 97). Supporting this safe emotional and psychological space means supporting the next principle in Motivational Interviewing, (5) supporting self-efficacy, the belief that a client can change and unless this empowering attitudinal stance is demonstrated by the therapist in relationship with their client, “a discrepancy crisis is likely to resolve into defensive coping (e.g., rationalization, denial) to reduce discomfort, without changing behavior” (Miller, 1995, p.5) (Spenkle, Lebow and Davis, 2009).  

The therapeutic alliance, another essential Common Factor, will be given its proper weight in understanding how client and therapist factors unite within the processes of change during the Stage of Change known as Contemplation. The therapeutic alliance is defined by Common Factors as both/and, what it is, and what it is not. “It is collaborative. The alliance can be misunderstood as a quality that the therapist brings to the client. However, the alliance is fully interactional and systemic, an operation between one or more clients and the therapist (Spenkle, Lebow and Davis, 2009).” This is a foundational therapeutic Common Factor. It establishes emotional bonds between a therapist and a client to form a connection and assists with providing effective outcomes in therapy. So, helping a client see choices for healing that the therapist sees the client may identify with and find helpful is only half of the picture, the other half is seeing what our clients are contemplating and helping them negotiate the changes they seek to make within all the Stages of Change and processes of change they are in and viewed as meaningful. Stated in another way, “On more careful examination, (our) successful alliance formation is better viewed as a dance in which everyone participated as the alliance co-evolved between the clients and the therapist” (Spenkle, Lebow and Davis, 2009). I will add that a felt understanding by the therapist of the clients’ worldviews are essential, along with a sense of therapist “okay-ness” about the clients’ interactions within the therapy room. These perceptions and interactions the therapist has in turn, will impact the client in therapy, whether the client is in therapy with their family, in a couple, or individual unit of treatment. When the therapist creates psychological and emotional safety in the relationship to their clients’ ambivalent interactions, and helps the client contemplate what it might be like doing inner work using certain stage specific processes of change, the client will reveal more of their ambivalence and ideas to contemplate that which will promote change.  

In the Stage of Change known as Contemplation, clients are intending to act “within the next six months.” (Prochaska, 1999) (Spenkle, Lebow and Davis, 2009).  Clients seeking to make a change in this stage are expressing discontent with their problems, want to overcome it, want to see themselves living a life without their problems, but also see why they shouldn’t try to change. Clients in Contemplation “are not very good candidates for behaviorally focused, action-oriented programs. Their motivation is not yet at the level where they will put all of their heart into behavioral change efforts. They are better suited for more passive insight-oriented approaches that help them explore their problem, weigh the pros and cons of changing and so forth” (Spenkle, Lebow and Davis, 2009). Like in the previous Stage of Change the suggestion for this stage is to continue to weigh the pros and cons of changing and decrease the number of cons. The only additional processes of change aside from three mentioned in Pre-Contemplation is self-reevaluation, to assist in transitioning to the next Stage of Change Preparation. So, the therapist is supporting the client in evaluating themselves without the problem. Aside from active imagination, guided imagery, self-acknowledgement of healing and growth, help consolidate steps the therapeutic alliance has made and clarify steps one still might make in the therapeutic alliance to successfully transition to the Preparation Stage of Change. “Values clarification, encouraging congruence between one’s own values and behaviors and the like can be helpful in this stage” (Prochaska, 1999) (Spenkle, Lebow and Davis, 2009).

A therapist being willing to build a foundational relationship with their client depends to a large extent, on a therapist’s ability to listen, explore, and respect the worldview of their clients, not as an intervention, but more as an attitudinal stance toward their shared humanity, a facet of which was addressed above in the therapeutic alliance discussion. Understanding Common Factors research is important and then applying it in our therapeutic practices can help our clients regain a sense of connection often ruptured in their past and current relationships. Common Factors research can help therapists and clients move through change in their own and their clients’ lives in a much more empathetic and meaningful way. Remembering there is always motivation present is essential, and it is the role of the therapist to identify what motivates our clients to bring about effective change, and to “stay with them” as they contemplate ways to move forward while having a timing and pacing that works for them. See the first writing in this series on Common Factors (CF), wherein I discussed what CF researchers suggested as helpful processes of change in the Stage of Change Pre-Contemplation. Doing so will enhance your focus on the processes of change you can use to help clients focus on increasing insight about moving from Contemplation to begin working in the next Stage of Change known as Preparation, our next blog topic.

Acknowledgements

Douglas H. SprenkleSean D. DavisJay L. Lebow. Common Factors in Couple and Family Therapy, Guilford Press, Aug 10, 2009

Alice Miller. 1/7/1997. http://www.alice-miller.com/en/the-essential-role-of-an-enlightened-witness-in-society-2/

Share Button


A Series of Writings for Clinicians on Common Factors Research and What Promotes Change in Couple and Family Therapy

Leave a comment   , , , , , ,
Share Button

A Series of Writings for Clinicians on Common Factors Research and What Promotes Change in Couple and Family Therapy

by

Jason Briggs, MA

jb-blog2

(Photo saved from nubbsgalore.tumblr.com)

What motivates a client to change and what are the processes therapists can use to help?

If you’re like me, most therapists have a period in their learning curve where they have spent countless hours being ahead of their clients’ abilities to promote effective change because we aren’t seeing what stage of change our clients are in, and aren’t sure what processes could help motivate our clients in therapy. We (therapists) can also be less skillful about being transparent with each other about our own work with clients and how we promote change and challenges to this process we call psycho (mind/soul) therapy (treatment used to treat issues, problems and symptoms one feels conflicted about). This series is  an homage to Common factors research (CFR), that points to common factors which underlie all therapy models that work together to promote change in therapy. The three Common factors researchers work I will be summarizing are authored by Douglas H. Spenkle PhD, Sean Davis PhD and (last but not least) Jay L. Lebow, PhD, which can be found in their book Common Factors in Couple and Family Therapy, The Overlooked Foundation for Effective Practice. Sean Davis is in private practice, a supervisor in the Roseville, CA area, and a local Professor at Alliant International University, Sacramento Campus. Dr. Davis was my past academic advisor and admittedly an “at a distance” self-selected role model.

In the age of having many models of therapy to choose from its helpful to know two Common Factors (CF) that help promote effective change in Common factors research (CFR), that being the ‘client factor’ and ‘therapist factor’ both, in connection with each other. What is it specifically about the client that lends itself to change and what is the role of the therapist in supporting this change, that both the therapist and client might have an effective therapy outcome?  Many therapists and clients assume it is what the therapist does that is the most important aspect of therapy, but Common Factors Research asserts that it’s not only what the client does in therapy, but what the client does in response to the therapist, or how a client uses and focuses on the information the therapist presents. Ultimately it’s a collaborative venture.

As is often the case, I will invite my clients to share in what is called a “here and now” time, at the end of our sessions to explore our shared experiences in the session. In the “here and now”, I invite my clients to share what they found was helpful, worked or what didn’t work, or just to relate their experience in our session and in particular, with me; their answers never cease to amaze me, often citing something I felt was just a passing comment, experience or interaction or some other very important aspect of their experience. Using this “here and now” time, it is a both/and way of interacting, the focus is on the client but the therapist is wise to find ways to work with clients’ perceptions, being curious about them, and helping them identify what works for them. This should include what they struggle with in sharing their own experiences, cultivating a focus on what a client may feel is “ok” in therapy according to their worldview, and then seek ways that help promote a motivation to expand their worldview and promote change.

The Common Factors researchers do note that an extreme view of Common Factors research may engender a therapist to say “even a poor therapist can do therapy” but in their book they actually say quite the opposite and tend to place great value and importance in their role, but not by placing their own role above the clients’ role. They note, that the therapist who places such extreme value on client factors, to the exclusion of the therapists’ own involvement and development, may run the risk of discouraging themselves to think they have nothing to offer to help the client change and a thus engender a “why try” attitude that could encourage therapist laziness and a lack of a sense of accountability to clients (p71).” The Common Factors research discusses the nature of clients’ and therapists’ factors as being reciprocal (giving and receiving in balance) and further discusses how the therapist can motivate a client to change also asserting that a client motivated to change can then impact the therapist’s motivation and behavior! That’s reciprocity! So, it is clear that their emphasis is on the value and importance of matching our own behaviors as therapists with the client’s motivation to change, and what processes will help them engage in such a change.

It seems all humans pass through Stages of Change (SOC-a common behavioral health model) and have various levels of motivation. Known by therapists as Motivational Interviewing (MI), MI has typically been thought to be helpful to only substance abusers, but it has been used successfully with individuals, couples, and families with other issues as well. Motivation is always present according to the researchers (Miller & Rollnick’s (SOC) and Prochaska’s (MI), but that it looks differently depending on each stage, and that each client is motivated by different things. There are 6 stages of change (SOC) and they are Pre-Contemplation, Contemplation, Preparation, Action, Maintenance, and Termination. There are 9 processes of change which are Consciousness Raising, Dramatic Relief, Environmental Re-evaluation, Self-Re-evaluation, Self-Liberation, Contingency Management , Helping Relationships and Counter-Conditioning and finally Stimulus Control (Prochaska, 1999) (Spenkle, Lebow and Davis, 2009).

This will only focus on clients in the SOC called Pre-contemplation, the helpful process and interventions that Common Factors research has shown will help clients at this particular motivation level in their process of change. These clients it would seem are not intending to change anytime in ‘the next 6 months’ and they are either unaware of or uninformed about the severity of their problems. Clients who wish to successfully move from this stage to the next, Contemplation, “need to increase the number of pros (versus cons) they see in a life without the problem.” The Common Factors researchers suggest helping clients focus on increasing insight, suggesting that using the Consciousness Raising processes are ideal during this (SOC). A couple of Consciousness Raising processes offered that I find effective in my practice are, bibliotherapy (book therapy) and psychoeducation (education of the psyche, and how it becomes rigid and flexible in its structures). Another is making a list of what the positive effects of living life without the problem and envisioning a life without the problem.  Another I enjoy is helping clients experience guided imagery that focuses on adaptive information they may need to make a shift or change.

Another process of change that may prove helpful during the Pre contemplation SOC is Dramatic Relief, which much like guided imagery, it activates emotions that are felt during the problem. Interventions using this process could be role plays, guided imagery that focuses on a life with the problem in the future, and experiential interventions, such as empty chair/Gestalt, sculpting, inner dialog, etc.

The last process of change Common Factors researchers note that is helpful during this SOC is Environmental Re-evaluation. These interventions include helping the client to accept the perceptions of their family members by carefully exploring each person’s readiness to give and receive feedback, and when ready (can manage emotions), preparing the client to lean into the perceptions of their family, and helping the client experience understanding (not necessarily agreement). Another process is to use any experiential technique that will allow the client to cultivate empathy for those impacted by their behaviors, how it affects the system’s environment, and to see how those behaviors are experienced by others in the system (Prochaska, 1999), (Spenkle, Lebow and Davis, 2009).

Being willing to explore, understand, and apply Common Factors research can help therapists and clients move through change in life in a much more empathic way. There is always motivation to be found and it is the clinician’s role to see what motivates our clients so they can bring about effective change in their lives.

Coming soon,  my next writing in this Common Factors blog series is on Contemplation, the next stage of change following Pre-contemplation and helpful processes for the therapist to help clients embrace their own limitless potential for healing and growth.

 

Acknowledgements

Douglas H. SprenkleSean D. DavisJay L. Lebow. Common Factors in Couple and Family Therapy, Guilford Press, Aug 10, 2009

Share Button


The Components of Trustworthy Relationships

Leave a comment   , , , , , , , , , , ,
Share Button

The Components of Trustworthy Relationships

by

Cassandra Vogeli, Psy.D. Candidate, M.A.

cassie-blog

(Photo saved from www.pintrest.com)

“Life isn’t fair. But Relationships can be.” – Janet Hibbs (2010)

In her book, Try to See it My Way: Being Fair in Love and Marriage, Janet Hibbs outlines the importance of fair give and take within relationships. We each come into life from families with various ideas about what is fair, what we are entitled to (constructive and destructive), and how to go about getting such needs met. Unfortunately, sometimes these ideas about fairness and the ways we go about meeting our own needs can end up working against our closest relationships and us.  Nagy & Krasner (1986) suggest that in order to create healthy and balanced relationships as well as get our needs met in a way that is constructive within our relationships; we need to understand our own fairness model. Hibbs (2010) outlines four very useful and practical elements in the process of being fair within relationships; first I will outline them below and then use them in an everyday example so that you can see what they look like in action.

 

  • The first is a concept called, reciprocity. Reciprocity as defined by Hibbs is, “The balance of mutual care and consideration.” Reciprocity is the act of giving to a partner or relationship with trust that they will reasonably give back in some way at some time. Be aware not to mistake this with tit-for-tat giving, where one might say, “I will do this for you (ONLY) if you do this for me”; this type of giving erodes trust.
  • The second concept is acknowledgment. Acknowledgement, although often undervalued and overlooked, is kind of a one-two punch for constructively giving in a relationship. It serves to give credit to your partner, affirm their good intentions, as well as validate their reality. This means putting yourself in your partner’s shoes and recognizing their effort or positive intentions.
  • Next there are (fair) claims. Fair claims are part of an earned entitlement based on past giving within the relationship, to ask for one’s needs to be met, or to request certain destructive behaviors to end. In order for a claim to be “fair” it should: (1) be realistic (2) not take advantage of your partner’s trust and (3) it must be earned between the two relating individuals.
  • The last element outlined by Hibbs is trust. Trust is created through each of the aforementioned: reciprocity, mutual acknowledgement of efforts and intentions, as well as fair claims. Trust can be built or depleted through different acts of reciprocity, acknowledgment, and fair claims. Trust grows when needs are considered, even if they are not met, this is important to remember. The more trust that exists within a relationship, the more a healthy “closeness” can exist between the couple (Hargrave & Pfitzer, 2003). Hibbs’ summarizes trust beautifully: “In a healthy relationship, you’re able to give freely and trust that you’ll receive care in return.”

 

Now let’s see these four elements of fairness in action. In the first example I will outline a situation in which reciprocity, acknowledgement, fair claims, and trust are not utilized:

 

Consider the couple James and Sara, who have been married for 12 years.  One evening Sara is working late, so James decides to cook dinner and have it ready when Sara arrives home. Sara enters and is so pleased to find dinner on the table for her.  After the couple finishes eating, Sara enters the kitchen and James sits down on the couch to wind down from the day. Upon entering the kitchen Sara sees a gigantic mess awaiting her, dishes everywhere, food all over the floor and counter tops, pans coated with a layer of sticky residue, and all she can think is, ‘why does he always make such a mess when he cooks!’ Trying to hold it together, Sara begins to clean the kitchen silently hoping that James will join in to help her. By the time she wades through the mess by herself, she is fuming, and her attempts to curb her aggression are futile. Unable to ignore the bubbling aggression, she explodes at James. “You always make a huge mess when you cook! You never clean up after yourself!” Triggered by her aggressive outburst James retorts, “You never appreciate anything I do, nothing is ever good enough! I tried to make dinner for you as a favor and this is the thanks I get?” Sara, still fuming, shoots back, “I didn’t ask for this! I would have rather picked up a pizza on the way home then have to clean up this mess!” The fight escalates and the emotional “bank account” within the couple system is eroded.

 

Now let’s look at how this situation may have gone using the four elements of fairness Hibbs outlines:

 

This time when Sara enters the kitchen she decides to handle things a bit differently.  Using acknowledgement, she states, “I appreciate you making dinner for me, I know you did it as a favor because I had a long day.” Not disregarding her own feelings, she makes a fair claim, “I am exhausted after today. Could you clean the kitchen for me?” James tired as well, acknowledges Sara and also makes a claim, “I bet you’re tired, I apologize for making such a big mess. I’m really beat as well, would it be okay with you if we left the dishes tonight and did them in the morning?” Sara acknowledges his effort and agrees while she also makes a claim for James to be more conscious of making a mess when he cooks and the couple leaves the situation having built trust and reciprocity, instead of putting more stress on their relationship. Following these guidelines may help to ensure that we grow from mistakes and shortcomings, rather than depleting our relationships unintentionally.

 

If you are interested in learning more about fairness within relationships, or about your own fairness model, I recommend checking out “Try to See it My Way” by Janet Hibbs. It is a wonderful book full of great resources and hands on exercises to really help your self-awareness and your relationship with your partner grow. Happy reading!

 

References and Further Reading

Boszormenyi-Nagy, I., & Krasner, B. R. (1986). Between give and take: A clinical guide to contextual therapy. New York: Brunner/Mazel.

Hargrave, T. D., & Pfitzer, F. (2003). The new contextual therapy: Guiding power of give and take. New York: Routledge.

Hibbs, J. B., Getzen, K. J. (2010). Try to see it my way: Being fair in love and marriage.

Penguin Group, New York, NY.

 

Share Button


Enhancing Resilience

Leave a comment   , , , , , ,
Share Button

Enhancing Resilience

by
 Dr. Jennie Lorena Thomas

resilience-pic (Photo Credit: Danielle Kambrey)

Most of us may not like to be reminded of this, as being human means we will face pain at some points during our journey through this world. Unfortunately, we cannot avoid this life’s truth no matter who we are. Fortunately, we now know that the sooner you internalize this truth and grieve your losses, the happier, less stressed, and healthier you will feel and live.
Thus, while you journey towards this truth, let me reinforce the truth of the strength our resilient spirit is capable. This spirit or energy essence can allow us to stand up to, and breathe through any adversity; it allows us to shine both inside and out. In fact, Change Basics (Russell and Russel, 2006) contains resiliency tips that solidify this point.

  • Proactive people actively engage change and shape their own vision, keep their locus of control focused internally, preserve their self-efficacy, have a strong self-confidence and self- assurance, and are aware that their choices influence their response to challenges
  • Develop a personal meaning and vision so they have a clear belief and vision of what they want to create. They allow that purpose to propel them forward, so when adversity approaches, they can see it through hopeful eyes as a possible opportunity and stay focused on the larger more realistic view of life beyond it
  • They nurture interpersonal competence, our ability to truly empathize with others, thus magnifying their social awareness and interpersonal efficacy
  • They remain flexible and adaptable by staying aware of what’s happening around them so they can then make sensible adjustments in response.
  • They take a moment to think before acting. The more you practice the skill of organizing your thoughts and feelings; the result tends to yield an inner focus and outward stability. (Prioritizing to-do lists, and then following that prioritization, will enable you to manage your time effectively)
  • Strive to problem solve by analyzing and breaking down complex challenges to discover and explore their root causes. Recognize and clearly define the interdependence of these challenges within the larger system, and then set manageable goals.
  • Connection with community is important in attracting healthy caring and supportive relationships that create love and trust, provide effective mentors, and offer encouragement and reassurance. This is a foundation for continued personal efficacy.

 

Ways to Strengthen Resilience

After reading through these examples, perhaps select one tip a day and work with it a bit. For example, take the flexibility concept and consciously work on growing your awareness of your surroundings for a day. See the ways you’re less flexible and perhaps choose to let that some of that rigidity go. Alternatively, be that problem-solver for a day by taking a problem and breaking it into its constituent parts, then analyze how the parts fit together, and see how your various responses can be part of the problem and solution. Just observe how things can become more manageable. And add an extra kick of self-confidence to your day. Speak from your belly, look people in the eye, straighten your spine and put your shoulders back a bit. Feel yourself grow taller.
What everyone needs to know is that we actually have access to everything we need for a balanced life: awareness, determination, vision, creativity, love, passion, faith, and intuition. These human endowments begin to be realized when we focus on them, and they come into full bloom when we let them ripple through us, further building our innate resilience.
Admittedly, the journey as life students is sometimes arduous, often working full-time, and/or going to school while taking care of our families, maintaining ourselves, working to complete our degrees, get that position, that promotion, or that bonus. Let me now acknowledge each of you—great job for your hard work and continued effort. Keep smiling and know you are not alone.

Acknowledgments

I would like to gratefully acknowledge the following contributors to this publication:
Mary K. Alvord, PhD, Director, Group Therapy Center at Alvord, Baker, and Associates, LLC, Silver Spring, MD
Robin Gurwitch, PhD, University of Oklahoma Health Sciences Center
Russell and Russel, (2006) Measuring Employee Resilience, Published in the 2006 Pfeiffer Annual Training
Jana Martin, PhD, private practice, Long Beach, CA; (2003) President of the California Psychological Association
Ronald S. Palomares, PhD, Assistant Executive Director, Practice, American Psychological Association

Share Button


Self Compassion

Leave a comment   , , , ,
Share Button

Self-Compassion
By Christine Brady, MA

beyourself (Photo Credit: Thich Nhat Hanh, Calligraphy)

When was the last time you recall hearing something like the following; “I can’t believe that you did that, what an idiot, you are so stupid, you always mess everything up.” Would you be surprised to know that many people speak to themselves like this on a daily basis?

While most of us would never dream of saying something so toxic to others we may have no problem speaking to ourselves this way. It may seem natural to respond with compassion and empathy to others that may be struggling while at the same time we may choose not to extend that same consideration to ourselves. It’s as if we believe that by coming down hard on ourselves we will somehow improve our performance.

Life naturally includes challenges and setbacks. We can add to the impact of intense events in our lives by colluding with an internalized bully. Constantly ruminating about past mistakes, current errors, and potential future gaffs keeps you out of the present moment and can exacerbate feelings of depression, anxiety, low self-esteem, relationship problems, and difficulty in recovering from setbacks.

Developing a sense of self-compassion isn’t merely positive thinking or repeating mantras in an attempt to quiet your internal bully, it is based in the relationship that we have with ourselves. Self-compassion is the willingness to treat ourselves with the same caring support that we extend to others.

Self-compassion balances the truth of a situation such as “I made a mistake” with the ability to realize that making a mistake does not diminish your worth and value. This allows you to both acknowledge what happened directly while avoiding the feelings of shame that can lead to feelings of hopelessness, thereby increasing the level of difficulty in finding solutions.

Self-compassion is a skill that allows us to navigate our humanness with objectivity, empathy, understanding, and kindness. It is a way in which we can relate to ourselves both when we’re struggling and when things are going well. This compassionate view of ourselves brings light to the dark places, soothes the soul, and provides a safe space for imagining creative solutions to everyday problems.

The following is adapted from KimFredrickson.com (2015) We All Need Kindness, Identifying Self-Compassionate Ways that we can relate to Ourselves.

Truths we can Share with Ourselves

~ You are valuable and precious, no matter what is happening

~ Even in the suffering you are going through, you are valuable and of great worth

~ Most people do the best they can with what they have. It is true that we want to live as healthy lives as possible, and it is also true that there are deep reasons why we make choices that can cause us harm

~ It is ok, and normal to be angry, confused, sad, and all jumbled up inside. These feelings are a normal and necessary part of the process of adjusting to what you are going through

~ Allow yourself to have and express your feelings if possible, because this expression cleanses and will subside

~ No matter what is happening, you can be a good friend to yourself

~ Take this time to allow your body/mind/spirit to heal. This is just as important as other things you need to do. Make sure care of yourself is in your schedule

~ Listen to yourself (your heart, feelings, thoughts, body, and spirit). What do you need right now? What would a really good friend do for you right now? You can be that friend

~ You are going through such a difficult time. What would the kindest person you know say to you right now?

~ Give yourself time to have a good cry and sleep. This may be just what you need

~ Breathe….and Rest…and be Kind…to You!

References
Fredrickson, K. (2015, November 19). We all need kindness. [web log post] Retrieved December 4, 2015 from http://www.kimfredrickson.com/we-all-need-kindness/
Fredrickson, K. (2015). Give yourself a break turning your inner critic into a compassionate friend. Grand Rapids, MI: Revell.

Share Button


‘Thinking in Pictures’ Helps Us Understand Life on the Spectrum

Leave a comment   , ,
Share Button

Temple Grandin, Ph.D. at a TED Conference in 2010 (Photo Credit: Red Maxwell)

By Nicolina Santoro, MA, IMF 77972

As I read Thinking in Pictures: My Life with Autism by Temple Grandin, Ph.D., a pang of jealousy pervades my thoughts. Having the ability to engineer intricate machinery, memorize volumes of information, or create art that inspires us to new levels of emotional ecstasy, would seem to be an amazing gift.

However, on the autism spectrum, it is not without deficit to other areas of functioning. Thinking in Pictures also highlights the discrimination people with disabilities endure. Temple Grandin describes her visual memory skills as similar to the way Pinterest can group thoughts visually. Any information she needs for her task can be called up at will in a series of picture associations. These pictures are the road map she continuously develops to bring her to the next door of personal evolution, and how she copes with the lack of sensitivity to social cues and abstract conceptual understanding that most of us take for granted.

Thinking in Pictures is not just a story of the author’s life with autism, it is a comprehensive overview of the symptoms of autism, past and current research, and treatments now widely used.

Grandin is extremely high functioning on the autistic spectrum. Most people envision the autistic as mute, unresponsive and unreachable, like trying to interact with someone through opaque plate glass. For so long the autistic mind has been shrouded in mystery, its intricacies and strength misconstrued by the strange behaviors autistic people sometimes exhibit. It’s easy for most of us to relate to one another. Social situations are, for the most part, pleasurable and enlightening to the normal mind. Due to difficulties with these types of abstract concepts, a person on the autistic spectrum usually lacks the ability to easily comprehend social cues for etiquette and relationships.

Grandin recounts her difficulties in school when trying to form relationships with her fellow students, but relating to animals, and seeing as they do was her inherent passion and gift. Her visual memory enabled her to engineer significant contributions to this world in how animals are humanely treated and slaughtered. Grandin also furthered research around the concept of squeezing a person in midst of a meltdown to abate the symptoms of anxiety that accompany sensory overload.

Thinking in Pictures allows us to imagine many of the challenges that people on the spectrum have to contend with, including sensory hyper-arousal, difficulties with verbal expression, and motor tics. Grandin has made many significant contributions to the study of autism. Her ability to describe life with autism has enabled to her to create systems for dealing with various symptoms. The author’s own hyper-arousal experiences coupled with seeing cattle in distress before their slaughter, enabled the creation of a device that can bring the user down from a hyper-aroused state using a squeezing machine. The user crawls into a box in which the sides can be manipulated to cause the amount of pressure that would produce the desired state of calm. In Grandin’s research of others who suffer from autism, pressure seems to be an effective manner of coping with the hyper-arousal anxiety component of the disorder.

Grandin emphasizes that people on the spectrum need to be encouraged to explore what they are good at from an early age, so they are not depriving the brain of much needed sensory experiences. As high functioning adults, jobs and hobbies are also important.

Science has advanced our knowledge of autism greatly, and the high functioning have given the world a view of life on the autism spectrum, and several ways they use to cope with a highly sensitive arousal response. Thinking in Pictures emphasizes that inside the seemingly closed world of the autistic person lives enormous potential for contribution and growth, while science has helped to make Grandin’s journey accessible to everyone.

accept_understand_love_autism

Share Button


World Sickness and the Thirst for God

Leave a comment   , , , , , , , , , , , ,
Share Button

World Sickness image

By Nicolina Santoro, MA, IMF 77972

Once upon a time, in the vast kingdom of the helping professions, there lived a therapist whose thirst for knowledge and desire to aid in the process of personal and interpersonal change was unrivaled in all the land. This therapist had taken it upon herself to rewrite the story of her own history in a manner that changes the context of painful past experiences from blockages into tools that create a larger understanding and empathy for those she has chosen to serve in her work.

This constantly evolving therapist became immersed in theory and work of great minds such as Carl Rogers and William James. Realizing that human potential is vast, she wanted to understand how important stories and fairy tales were to constructing the memories that colored the landscape of reality, a reality that seemed to have the power to dictate how people see themselves and live their lives.

These dominant fairy tales permeate the fabric of our perceptions which also bump up against the lives of others we come into contact with out in the world. Personal narratives or “life styles” are filled with characters that are archetypal in nature, influencing us to play out repetitive sequences in life. These characters tend to take on the personas of stereotypical themes that are reinforced by learning them at a young age, or by the social referencing effect of our dominant culture.

William James calls the mental fatigue effect of living in an environment laden with unrealistic scenarios or fairy tales “world sickness.” It appears as though living in a world dominated by stereotypes and fairy tales could be implicated in the aggravation of many types of mental health issues.

How can we address the fatigue, depression, anxiety, and thought distortions that world sickness creates and impacts?

Let’s start with being gentle with ourselves. When we imagine a supreme spiritual being, the embodiment of certain characteristics seems to be present across many cultures. Some of these characteristics include unconditional love (a love that exists beyond judgment), a superconscious presence that never dissipates or abandons, and the ability to create out of seemingly thin air. For the scientists who have a different path, god could also be described as the picture of what we theorize as the highest human potential. We have the potential to express this in our own reality by living our lives in accordance to our deepest and strongest values while moving away from comparing ourselves to the unrealistic standards or “fairy tales” woven into the fabric of our society, loving ourselves and others through the lens of acceptance and vulnerability, a gentler version of happily ever after.


References
James. W. (1902). The Varieties of Religious Experience: A Study on Human Nature. Longmans, Green & Co. London, UK.

Miller, W.R. (2006). Integrating Spirituality into Treatment: Resources for Practitioners. Washington: American Psychological Association.

Share Button


School Refusal Solutions for Parents and Teachers

Leave a comment   , , , , , , , , , , ,
Share Button

school kid

By Christine Brady, M.A.,
Intern of Marriage & Family Therapy

What parent among us has not experienced the plaintive pleas of little ones, their little voices crying out, “I don’t want to go to school!” Sometimes these requests are due to vague physical complaints such as, “I don’t feel good”, or “My tummy hurts”. Other times, the range of reasons can vary from mean teachers to lack of friends, or perhaps an exam is scheduled for that day. For a lot of children these occurrences are few and far between. For others, this is a pattern which seems to happen almost daily, increasing family stress, and causing harried parents to count down the days until graduation (a daunting task if your child is in elementary school).  School refusal, if left unchecked, this pattern can escalate lead to chronic lateness, repeated absences, and consequences from truancy officials at school.

Consistently truant children often attempt to conceal their absence from parents and spend their day away from home while children typically termed as school refusers tend to stay home during all or part of the day with parental knowledge. School refusing children commonly become upset at the prospect of going to school and may show signs of fearfulness, crying, temper tantrums, unexplained physical symptoms, or other behaviors, such as stalling, missing the bus, or oversleeping. Children who are refusing to attend school may be attempting to avoid a fearful experience. Being bullied, the structure and discipline of the school setting are common reasons for avoidance. Another motivation for school refusal could be pursuing a positive experience like staying at home with access to video games, access to the internet, or gaining parental concern or attention.

School refusers can have anxiety around specific situations such as the bus ride, cafeteria, restrooms, or locker rooms thereby increasing the desire to avoid school. A child may or may not be able to identify their specific fear, only knowing that they don’t want to be at school because it makes them feel awful. Another group of school refusers may find the social or performance aspects of school such as interactions with peers, writing on the board, being called on in class, tests, or performance classes such as PE make the prospect of attending school frighteningly unbearable. Some children experience school as a place where they are constantly reminded that they are not good enough to achieve at a normal level, let alone, excel.

Dr. Haarman further relates in his book, School Refusal Behaviors, that the most important factor in increasing the likelihood of success with children who can’t or won’t go to school is to return to school as soon as possible. The longer the child avoids a normal school day routine, the more difficult and traumatic it will be to return to school.  A viable starting point for the effective exposure therapy of the child returning to regular school attendance may be to build tolerance to the anxiety provoking activity by attending some portion of the school day whether attending particular classes for a limited time period, or certain days until the child’s anxiety returns to near normal levels. This may require cooperation of school administration, such as a modified schedule change, a teacher change, or allowing the child to arrive late or leave early.

Treatment of School Refusal

This chart is adapted from research conducted by Kearney and Albano, identifies a number of possible intervention strategies most suited for each of the four types of school refusers.
Function Treatment Components
(crying, nausea, distress, sadness, and various phobias, i.e. bathrooms, cafeteria, teachers, bullies, etc.) Somatic control exercises such as breathing retraining and muscle relaxation

Gradual re-exposure to school

Reduce physical symptoms and anticipatory anxiety

Self-reinforcement, self-talk, self-esteem

To escape aversive social and evaluative situations (social phobia, test anxiety, shyness, lack of social skills) Role play restructuring of negative self-talk

Gradual exposure to real life situations

Social skills training and reduction of social anxiety

Coping strategy templates

To get attention  (tantrums, crying, clinging, separation anxiety) Parent training in contingency management

Clear parental messages

Evening and morning routines

Use of consequences for compliance/noncompliance

For positive tangible reinforcement  (lack of structure or rules, free access to reinforcement, avoidance of limits) Family contingency contracting to increase rewards for attending school and decrease the rewards for missing school

Curtail social and other activities for nonattendance

Alternative problem solving


References and Further Reading:

Albano, A.M., Chorpita, B.F., & Barlow, D.H. (2003). Childhood anxiety disorders. In E. Marsh and R. Barkley (Eds.), Child psychopathology (279-330).New York, NY: The Guilford Press.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Washington, DC, American Psychiatric Association, 2013.

Berg, I. (1996). School avoidance, school phobia, and truancy. In: M. Lewis (ed.), Child and Adolescent Psychiatry.  Baltimore, MD: Williams and Wilkins.

Berg, I. (1997). School refusal and truancy. Archives of Disease in Childhood, 76, 90-91

Bernstein, G.A., Helter, J.M., Burckhardt  C.M., & McMillan, M.H. (2001). Treatment of school refusal: one-year follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 206–213.

Broadwin, I.T. (1932). A contribution to the study of Truancy. American Journal of Orthopsychiatry, 2, 253-259.

Coolidge, J.C., Hahn, P.B., & Peck, A.L. (1957). School Phobia: Neurotic crisis or way of life? American Journal of Orthopsychiatry, 27,296-306.

Dube, S.R. & Orpinas, P. (2009). Understanding excessive school absenteeism as school refusal behavior. Children and Schools, 31(2) 87-95.

Duckworth, K. & deBug, J. (1989). Inhibiting class cutting among high school students. High School Journal, 72, 188-195.

Evans, L.D. (2000). Functional School Refusal Subtypes: Anxiety, avoidance, and malingering. Psychology in the Schools, Vol. 37(2), 183-191.

Fremont, W. P. (2003). School refusal in children and adolescents. American Family Physician, 68, 8, 1555-1560.

Haarman, G.B. (2012). School Refusal: Children who Can’t or Won’t go to School, Foundations: Education and Consultation Press. Louiseville, KY.

Share Button