Pulling my Head out…..

I’m so F*CKING busy it really isn’t funny….

I’m currently in the 11th week of my second internship course.  As a full-time working mother with two young boys at home, I rarely get a day off.  I’m managing to maintain 60+ hours a week.  I work Friday-Sunday 7p-7a as a C.N.A.   I work at a homeless shelter providing individual and group therapy as a student therapist 8-3, Tuesday – Thursday.   I divide my spare time between: (1) family time, (2) conscientious self-care, and (3) mounds of paperwork….

I feel overwhelmed by how much I have to learn…

 I have just one more week left.  As I progress, I feel a burgeoning sense of ignorance:  the more I learn, the less I feel I know.  This perplexing experience leaves me feeling ambivalent.  I’ve worked so hard over the last five years to complete my graduate degree.   After spending half a decade cramming my mind with information, I feel at times it matters little when you get to the pragmatics of day-to-day direct client interaction.   There’s only so much you can learn about “how to be a therapist” from a textbook. When I expressed concern about the limitations of my current skill level, my supervisor joked: “Give it five years”….

So anyway, I started seeing a psychiatrist….

Until recently, I’ve had the same therapist.  I’m forever grateful for the personal growth I was able to achieve as a result of my experiences as her client.  However, in this last year I’ve desired to really understand the profound and lasting impact of past traumas in my life.  I searched for a psychiatrist who could provide a unique perspective on things.  Last Friday, I had my fourth session with this new psychiatrist & are just now moving beyond the initial “get to know you” process.   In our third session, I decided to take a risk with this new mental health professional & share honestly various aspects of earlier traumas: (things I’ve really resisted speaking with anyone).  To be honest, he’s the first person I’ve really opened up to honestly about these early experiences and their lasting impact on me.   Anyway, in our first session after sharing this information, I’m appreciative of the opportunity to reflect upon the impact of these experiences.  I walked away last Friday, with much to think about & reflect upon.

What follows are just a few random things I learned about myself after our last session… 

1st: Past experiences with emotional invalidation are still VERY, VERY, VERY, VERY big triggers…

The third session with my new psychiatrist was quite a pivotal moment.

I decided to be completely honest for the first time and share aspects of traumas that I had – until that moment – been unwilling to talk about with anybody.  During the week between my third and fourth session, many “interesting things came up”.

This session was on Friday at noon (its the only real time I have off where I’m not completely exhausted).  I was at my internship site Tuesday – Thursday.  I napped Friday morning since I had to work that night.  At 12:30 I had a session with my therapist & drove home afterwords to do some housework.  After picking up the kids from school I made dinner.

While getting ready for work, I started to feel depressed.  I didn’t quite understand why, and tried to push this feeling out of my mind.   It wasn’t until I started driving to work that the waterworks started.  I began to cry uncontrollably and had difficulty seeing the road.  While I wanted to call in, I realized a doing so “last minute” wasn’t feasible.  So I collected myself & went through the motions.  The weekend was a blur.  I did my job, came home and slept.  Before I knew it, Monday had come & I was just exhausted.  I slept all day and didn’t get off the sofa.

…Tuesday-Thursday rolled around again, and I was in the swing of another “work week.”  With a busy schedule filled with supervisory meetings, individual sessions, and group therapy meetings, I had a lot on my mind.  I struggled that week, feeling overwhelmed and anxious.  I wondered how I would be able to complete my internship….

Then Thursday evening came, & my husband surprised me by taking the afternoon off.

We spent the evening together: (a belated valentine’s).   I had a chance to breathe.   During this rare evening of “private time” with my hubby of 17+ years, I was finally able to stop and reflect on the past week.  He knows me like the back of his hand and could tell something has been wrong all week.  He expressed his concern to me: “you’ve been off all week, what’s up???”

When he asked this, I began crying. He held me a while and I told him: “I simply wonder if any of it was real? Or if it all was my fault & I’m the crazy one?”  He looked at me perplexed.  I provided the “cliff-notes version” of past traumas I’ve still struggled with.  I recalled, the most painful thing about the whole experience was the “gaslighting” nature of it all

  1. “All involved” acted on willful blindness, unable to acknowledge obvious fact that these shitty things happened to me and it was traumatic.
  2. Rather than acknowledging my feelings, I was blamed for what had happened. Somehow it was my fault and for that matter, my feelings were unjustified since “I did this to myself”.

And then the four session came up & I was able to finally process the feelings that came up during the last week.

I talked about everything that happened with a nervousness.  The idea of continuing with this level of honesty was terrifying.  However, my psychiatrist provided a sympathetic and calming presence, letting me somehow know it was okay.  During the course of our conversation, he questioned me at one point the meaning of the statement: “know what I mean?”   I was saying it frequently, stopping at points to make sure he was following me.  He reassured me he was, and understood completely.  “Was it rhetorical in nature?”  I stopped to ponder the question, unable to provide an honest answer.  A smile floated across my face as I was reminded of that famous Ernest quote: “know what I mean Vern?”

So what’s up with the “Know what I mean?” Question???

I do feel it is in part a rhetorical question, in the sense that it reflects the fact that I question the validity of my own past experiences.  Since nobody exists from my childhood, who is able to validate and fully understand the nature of my traumas, I wonder if it was really “all me”?  The logical part of my mind yells out “Pure idiocy” as these very words are being typed.  You see, I know logically, that the experiences are valid to me, as real, regardless of whether others are able to understand it.  The trauma was there, it was difficult, and painful, right?   YES, duh!!

However, the emotional part of my mind remains stuck as a little girl who simply was hurting, and didn’t understand the “gas-lighting” nature of things.  I felt I was what was wrong, it was my fault, & I’m the crazy one.  This is where the “know what I mean?” question reflects a desire to seek “safety”.  Will this person, I’m talking to invalidate my feelings??

2nd:  I appear to engage in a form of self-invalidation that reflects what I experienced in my childhood.

This brings me to the second major insight from my fourth session:  I engage in a form of self-invalidation that reflects early unresolved childhood experiences.  What’s pathetic is that while I’m already very aware I do this – I still do it.  WTF!?!?!  It appears that my desire for self-understanding, has yielded me an ability to write a book about myself, and little else.  It appears intellectual self-understanding, cannot really replace true healing.

3rd:  my favorite defense mechanisms are: (1) intellectualization, (2) denial & (3) dissociative emotional numbing.

Yup, I do these things.  As you can see by the content in this blog, I’m a “nerd-girl” art heart.  I get this tendency to intellectualize from my parents:  As doctors, their education and intellect was a superb defense.  It allowed them to create the perfect defensive armor.  They were flawed human beings lurking underneath a veneer of intelligence & merit-based respect.  As for the denial & dissociation, I have this disturbing ability to hold outside my mind the very feelings that have overwhelmed me.

NOW WHAT!?!?!

I have to keep reminding myself its not the journey, its the destination.  It seems like I’m an onion: you peel away one layer, and another arises.   Jere are a few things I am going to work on:

FIRST, I need to work on a relationship with “the man upstairs”

SECOND, I need to follow Bessel Van Der Kolk’s advice:  “You need to find some way where your body once again feels like ‘I am in control of myself.'”

THIRD, I need to apply what I learn to my future therapy practice.


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“AN ACE’S STUDY” (Advocacy / Data Collection Assignment)

 

OVERVIEW OF ASSIGNMENT

“In this assignment, students will demonstrate knowledge of prevention, education and/or advocacy activities which can assist their clients. Students will develop measurable outcomes, and analyze collected data with the goal of increasing the effectiveness of prevention, education, and advocacy activities at their current Internship site.

Students will work their site supervisor to identify a prevention, education, or advocacy component of services which could benefit from some analysis. This project (like all research) begins with good questions.”

For this assignment I focus on two survey’s: (1) The Adverse Childhood Experiences Questionnaire & (2) A Resiliency Scoring Survey.

The ACE’S Questionnaire

Overview of The CDC-Kaiser Permanente (ACE) Study

“The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study is one of the largest investigations of childhood abuse and neglect and later-life health and well-being…The original ACE Study was conducted at Kaiser Permanente from 1995 to 1997 with two waves of data collection. Over 17,000 Health Maintenance Organization members from Southern California receiving physical exams completed confidential surveys regarding their childhood experiences and current health status and behaviors.”  CDC.gov, 2011).  The purpose of this study was to discover if a correlation existed between early childhood experiences and overall well-being later in life.   The results of this study illustrate that wide-ranging social, psychological, and health-related consequences exist as a result of early childhood traumatic experiences.  Over 70 research papers have been published since 1998 (acestoohigh.com, n.d.).  All of these studies show a correlation between early child adverse experiences and deficits in well-being later in life.

A Definition of “Adverse Childhood Experiences”

So what exactly are Adverse Childhood Experiences anyway?  “ACEs are adverse childhood experiences that harm children’s developing brains so profoundly that the effects show up decades later; they cause much of chronic disease, most mental illness, and are at the root of most violence,” (acestoohigh.com, n.d.).  Adverse Childhood Experiences fall into three general categories: childhood abuse, neglect, and household experience (Felitti, et al, 1998).  The CDC.gov (2016) website provides a definition of these three categories of Adverse Childhood Experiences:

How does ACE’s survey define abuse?

(1) EMOTIONAL ABUSE: “A parent, stepparent, or adult living in your home swore at you, insulted you, put you down, or acted in a way that made you afraid that you might be physically hurt,” (CDC.gov, 2016).
(2) PHYSICAL ABUSE:  “A parent, stepparent, or adult living in your home pushed, grabbed, slapped, threw something at you, or hit you so hard that you had marks or were injured,” (CDC.gov, 2016).
(3) SEXUAL ABUSE: “An adult, relative, family friend, or stranger who was at least 5 years older than you ever touched or fondled your body in a sexual way, made you touch his/her body in a sexual way, attempted to have any type of sexual intercourse with you,” (CDC.gov, 2016).

How does the ACE’s survey define neglect?

(1) EMOTIONAL NEGLECT: Someone in your family helped you feel important or special, you felt loved, people in your family looked out for each other and felt close to each other, and your family was a source of strength and support.
(2) PHYSICAL NEGLECT: There was someone to take care of you, protect you, and take you to the doctor if you needed it2, you didn’t have enough to eat, your parents were too drunk or too high to take care of you, and you had to wear dirty clothes.

How does the ACE’s survey define household dysfunction?

(1) MOTHER TREATED VIOLENTLY: Your mother or stepmother was pushed, grabbed, slapped, had something thrown at her, kicked, bitten, hit with a fist, hit with something hard, repeatedly hit for over at least a few minutes, or ever threatened or hurt by a knife or gun by your father (or stepfather) or mother’s boyfriend.
(2) HOUSEHOLD SUBSTANCE USE: A household member was a problem drinker or alcoholic or a household member used street drugs.
(3) MENTAL ILLNESS IN HOUSEHOLD: A household member was depressed or mentally ill or a household member attempted suicide.
(4) PARENTAL SEPARATION OR DIVORCE: Your parents were ever separated or divorced.
(5) CRIMINAL HOUSEHOLD MEMBER: A household member went to prison.

Overview of Survey Questionnaire

For my data research project, I decided to utilize a shortened version of the ACE’s study questionnaire provided by the National Council of Juvenile & Family Court Judges, (n.d).   While the CDC’s original ACE’s study was much more comprehensive, it was quite lengthy and provided information well-beyond the scope of this project (CDC.gov, 2016).  Additionally, it was felt that the number of willing participants I could garner for this project would be turned off by the 20-pages survey that  over 100 questions.  Instead, the National Council of Juvenile & Family Court Judges (NCJFCJ.org) survey is just one page and includes ten questions.  This ACE’s survey includes just 10 questions with ten “yes or no” responses.  Additionally, the scoring system of this test is quite simple.  Respondents are to count the number off “yes” responses, and this gives them their “ACE Score”.  This score can then be compared against the results of the original CDC research.  Each of these question touch upon one  above-described areas of Adverse Childhood Experiences:

Question #1-3: Sexual, Physical & Emotional Abuse…

(1) Did a parent or other adult in the household often swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt?
(2) Did a parent or other adult in the household often push, grab, slap, or throw something at you? or
Ever hit you so hard that you had marks or were injured?
(3) Did an adult or person at least 5 years older than you ever touch or fondle you or have you touch their body in a sexual way? or try to or actually have oral, anal, or vaginal sex with you?

Question #4-5:  Neglect

(4) Did you often feel that no one in your family loved you or thought you were important or special? or your family didn’t look out for each other, feel close to each other, or support each other?
(5) Did you often feel that you didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or your parents were too drunk or high to take care of you or take you to the doctor if you needed it?

Question’s #6 – 10: Household Dysfunction.

(6) Were your parents ever separated or divorced?
(7) Was your mother or stepmother: Often pushed, grabbed, slapped, or had something thrown at her? or Sometimes or often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?
(8) Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?
(9) Was a household member depressed or mentally ill or did a household member attempt suicide?
(10) Did a household member go to prison?

This Link Provides convenient presentation graphics on the influence of Adverse Childhood Experiences on well-being later in life….

Resilience Questionnaire

Origins of Resilience Survey

“This questionnaire was developed by the early childhood service providers, pediatricians, psychologists, and health advocates of Southern Kennebec Healthy Start, Augusta, Maine, in 2006, and updated in February 2013. Two psychologists in the group, Mark Rains and Kate McClinn, came up with the 14 statements with editing suggestions by the other members of the group. The scoring system was modeled after the ACE Study questions,”  (Alaska Center for Resource Families, n.d.).  This survey focuses on protective factors rather than risk factors.  Additionally, it provides a causal explanation as opposed to a etiological one.  Rather than examining adverse childhood experiences as a cause for long-term deficits in well-being, this survey focuses on factors contributing to resilience in life.  In other words, what factors exist as a protective factor associated with someone’s long-term well-being.

What is Resilience?

“The Oxford English Dictionary defines resilience in two ways. On the one hand it stands for ‘the ability of a substance or object to spring back into shape; elasticity’. This is a more scientific oriented definition that refers to the elasticity of raw materials. On the other hand, resilience is de ned as “the capacity to recover quickly from difficulties; toughness’. Hereafter resilience will be understood in the ability of technical and/or social systems to be tough when facing disturbances, regardless of their kind. This highly general definition, with the commonly known keyword of ‘toughness’, (Mauer, 2016).”   In other words, the notion resilience is a toughness an individual presents to handle life’s challenges.   Many factors play a role in an individuals resiliency.

(1) Individual protective factors can include temperament-based characteristics that are reinforced within one’s environment that result in positive adaptive learned responses to daily challenges (Werner, 2005).
(2) Familial protective factors promote resiliency through the establishment of positive bonds with a caregiver who is reliable and able to provide a structured environment (Werner, 2005).
(3) Community protective factors promote resiliency “through elders and peers in their community for emotional support and sought them out for counsel in times of crisis”, (Werner, 2005, p. 12).

Overview Questionnaire.

The survey I utilized for my data project comes from the Alaska Center for Resource Families, which aims to provide resources to assist families who wish to either adopt or participate in the foster care system (acre.org, n.d.).   This Resiliency survey includes 14 questions based on the above-described factors (individual, familial, and community).  For example, question 14 asks “I believed that life is what you make it” (Alaska Center for Resource Families, (n.d.).  This is an individual temperament-factor contributing to one’s overall resiliency score.  In contrast question #1 asks: “I believe that my mother loved me when I was little” (Alaska Center for Resource Families, n.d.).  This question is a familial factor that contributes to one’s resiliency score.  Finally questions such as #7 reflect a community factor that contributes to one’s overall resiliency score: “When I was a child, teachers, coachers, youth leaders or ministers were there to help” (Alaska Center for Resource Families, n.d.).

Questionnaire Scoring…

The survey provides a likert-type scale with responses ranging from “Definitely true; Probably true; Not sure; Probably not true; and Definitely not true.”  All “Definitely true & Probably True” responses are count as one point.  The maximum score a person is able to obtain from this test is 14.  The high the score the more protective factors they had in childhood contributing to their overall resiliency to adverse life events.

References

acestoohigh.com (n.d.) ACE’S Science 101.  Retrieved from:  https://acestoohigh.com/aces-101/
Alaska Center for Resource Families, (n.d.)  What’s Your Resilience Score. Retrieved from:  http://acrf.org/assets/courses-pdf/course/ACES3ResScoreHO.pdf
CDC.gov (2016, April 1).  Adverse Childhood Experiences (ACEs). Retrieved from: ttps://www.cdc.gov/violenceprevention/acestudy/
Filetti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … & Marks, J. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine14(4), 245-258.
Maurer, A. (2016). In Search of the Golden Factor: Conceptualizing Resilience in the Framework of New Economic Sociology by Focusing ‘Loyalty’. In New Perspectives on Resilience in Socio-Economic Spheres (pp. 83-109). Springer Fachmedien Wiesbaden.
National Council of Juvenile and Family Court Judges. (n.d.)  Adverse Childhood Experience (ACE) Questionnaire.  Retrieved from:  https://www.google.com/webhp?hl=en&sa=X&ved=0ahUKEwir4MG0yIjSAhXHPiYKHTVQCI8QPAgD#safe=off&hl=en&q=adverse+childhood+experiences+questionnaire.
Werner, E. (2005). Resilience and recovery: Findings from the Kauai longitudinal study. Research, Policy, and Practice in Children’s Mental Health19(1), 11-14.
World Health Organization (2011, May 5).  WHO Adverse childhood experiences international Questionnaire Pilot.  Retrieved from:  http://www.who.int/violence_injury_prevention/violence/activities/adverse_childhood_experiences/global_research_network_may_2011.pdf
Zeller, M. (2014). Editorial: Turning Points–Changes in Disadvantaged Life Trajectories. Social Work & Society12(1).

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Promises


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