Search Results for: shame

NCE – Family Secrets

Overview…

In an old assignment for my family therapy class we discussed Evan Imber=Black’s discussion of secrets.  Imber-Black defines secrets as information which is withheld from someone that produces distress and shame as well as create symptoms of dysfunction in a family. Keeping secrets requires a degree of heightened tension and anxiety. Communication is less open and individuals are less emotionally present. For the secret-keeper a feeling of shame perpetuates the secret and an anxious worry that “if you knew you wouldn’t love me anymore” pervades their thinking (Family Secrets, 2006). In contrast the person unaware of this secret, exists in the family as an outsider within the system. At some level they are aware of this fact and that there is a problem, but they feel they are not supposed to notice. (Family Secrets, 2006). In addition to worry and confusion, individuals left in the dark begin to doubt their own intuitions. Over time, family secrets develop into a systemic problems that affect many generations. Imber-Black (Family Secrets, 2006), describes relationships as booby-trapped, waiting to explode symptomatically as a result of the ongoing secrecy. Triangles, betrayal, and hidden-alliances as just a few symptoms of secrecy in families that can develop over time (Family Secrets, 2006). In the end, nobody is able to live as a whole individual in full acknowledgment of the truth (Family Secrets, 2006). In time boundaries are laid down in which those who know and don’t know become divided (Family Secrets, 2006). Symptoms of these secrets are maintained and supported by efforts as by family members to maintain secrecy for the sake of a systemic homeostasis.

Secrets Supporting Symptoms

Imber-Black states that “knowing, but acting like you don’t know and pretending you are what you are not” are key components of secret keeping (Family Secrets, 2006). With this in mind, what exactly is meant by Imber-Black’s assertion that “secrets support symptoms” (Family Secrets, 2006)? The maintenance of family secrets requires a concerted and coordinated effort by everyone in the family. These efforts can involve the closed communication systems, rigid boundaries and emotional distance. By keeping a secret, the family is able to maintain homeostasis, although change is unable to happen for the better. For this reason, I am in agreement with Imber-Black’s therapeutic stance regarding the Reiger family secrets. While Imber-Black is supportive of whatever decision the family makes, and allows them to move at their own pace, she makes her position clear (Family Secrets, 2006). Secrets restrict the free flow of information, harming everyone involved. The secret keeper, is left with distress and shame and unable to live life outside this reality (Family Secrets, 2006). At the same time, this secret violates a person’s right to know, and “affects their ability to freely [process all information] about their lives” (Family Secrets, 2006)

Understanding The Positive Outcome

​What factors attributed to a positive outcome in this particular case? Not all instances of revealing family secrets, are likely to go as well as they did within the Reiger family. Fortunately several important factors were working in their favor. Firstly, I feel it helps that Dr. Imber-Black was the therapist. As an individual who has studied, written, and researched extensively on this issue, she was able to delineate several symptoms of family secrecy in the video. Additionally, I do feel it helps that some time has pasted since the tragic circumstances of Jerry’s death. The emotions surrounding these events are a bit “less raw”. I also think the strength of Ray and Liz’s marriage helped them work through this issue together. They appeared willing to listen and support each other throughout this process. Finally, while Liz’s parents and Jerry’s family had strong opinions about their marriage at the time, fortunately they were able to move past these issues. It seems they were open-minded enough to see things from Galen’s viewpoint, and how this secrecy was a dis-service to him.
​In cases where things do not go very well, I would expect to see a family divided, as a result of this new information. The mourning of a lost relationship is strangely similar to a death “of sorts” as family members stopped communicating. The end result is a long process of “radical acceptance” and “forgiveness” in order to begin moving forward. The toughest thing in such cases is the realization that you can only have control over your own actions and behavior.

References

Family Secrets: Implications for Theory and Therapy [Video file]. (2006). ​Psychotherapy.net. Retrieved October 15, 2015, from The Psychotherapy.net Collection.
Imber-Black, E. (1999). The Secret Life of Families: Making Decisions about Secrets: ​when Keeping Secrets Can Harm You, when Keeping Secrets Can Heal You–and ​how to Know the Difference. Bantam Dell Publishing Group.

Share This:

Welcome

image

img_0506

I am a full-time working mother living in the midwest who adores her family. As a healthcare worker & novice therapist, I spend 90% of my time in the service of others.  While this sort of activity suits me well as an INFP, I have to admit it the responsibility can be overwhelming at times.

This blog is the culmination of over 5 years of procrastination & represents for me a huge victory in overcoming a perpetual stuck-ness in my life.  With 5 years of therapy and well-earned lessons under my belt, I share my random thoughts on this journey through life.
This blog is a brain-dump for all the crap that collects within my mind after a long day.  There is a generous smattering academically-oriented information from years spent as a perpetual student.  Then there are the honest reflective thoughts collecting in my heart after years of personal and professional growth.  One common thread throughout it all is my own unique, contrarian & nerdy perspective

A lot of thought went into the creation of this blog. Ultimately, I’ve opted for a brutally honest approach to this creative endeavor.  I understand fully that there’s a chance that somebody I know might find this site, read it’s contents, & not like what they see here.  While I do regret the hurt feelings, when it comes to the traumas of my past, I feel it is vital that I speak of these experiences with great candor.  Doing so has been critical in my own healing process…

Read more about me here…

Thank’s for visiting!

Turning A New Leaf…

Since graduating & starting a new career, I’m entering a new phase in life…

As a full-time working mother & graduate student, I had many things on my plate.  I had to par down my life & focus only on the most critical elements.  Self-care came first.  At the time, this meant getting enough sleep & learning to manage my stress.  Family time, came a close second on my list of priorities.  As a mother of two boys (11 & 17), I am aware that in just about 7 years time, I’m looking at being an “empty-nester” (and honestly this scares me more than just a little bit).

Then to top it off, with a weekend night-shift job in healthcare, I’ve felt perpetually fatigued.  I struggled to complete my homework and internship hours.

Then graduation came & I suddenly found myself with some extra time on my hands….

…And now its about 1.5 months since graduation & I’m finally ready to start my new career.  The hard work was worth it, & I look forward to a new chapter.  Many of those life-goals on the back burner can now receive the focus of my full attention.  In addition to losing weight & cultivating a stronger spiritual fondation, I am wanting to indulge in my creative energies, by doing some fun things with this blog….

But here’s my problem.  I am conflicted with two seemingly contradictory concerns that leave me unsure of how to proceed….

On the one hand, I hope to live my life from a place of authenticity rather than shame.

Brene Brown (2006) defines shame as “an intensely painful feeling that we are flawed, and therefore unworthy of acceptance and belonging”, (p 45).  

As a bullied and ostracized child, I responded to the daily peer abuse by becoming very reclusive and introverted.  I would go days without saying more than a few words from people.  At school this might be an “excuse me”.  At home it might be a “pass the salt”.  Nobody knew I was in pain since I held it in.  Nobody had concern for me because I did as I was told and never got in trouble.  As life moved forward, this relational pattern has remained with me.  I have difficulty opening up to others and have few if any friends.

You see, as I may have mentioned, this blog has helped me to “get unstuck”.  When I started this blog, I promised myself to stick with it, and not let fear and shame take over.  So therefore, I decided to opt with radical honesty & live authentically.  When I created this blog, I laid things all out there.  I have been very honest, (sometimes to a fault).

On the other hand, I don’t want my brutal honesty to harm anybody.

I am needing to carefully reconsider this decision to opt for radical honesty.  I am a newbie mental health therapist.  While the ACA does state that there are many benefits to blogging, you need to progress with caution.  The following quote comes from the onlinetherapyinstitute.org and leaves me with much to consider as I progress forward:

“A competent practitioner working online will always adhere to at least the following minimum standards and practices in order to be considered to be working in an ethical manner….Practitioners have a sufficient understanding of their Ethics Codes and Social Media and can integrate how they relate to professional conduct online. Practitioners are mindful that Social Media activity can blur the boundaries between personal and professional lives, and they take great care to consider the potential impact of these activities on their professional relationships” (Onlinetherapyinstitute. n.d.).

…And then there are significant others in my life. I need to balance a need to tell my story, with my concern for others.  For the majority of my life, I’ve felt like that kid in the “Emperor Has No Clothes Fable” who gets in trouble for asking why the king is naked.  The truth of my life and experiences, have been unspeakable to others.  I was going through hell, and struggling to keep going, but nobody wants to hear it so I held it all in and blamed myself.  By speaking the truth of my life experiences, I feel I’m reclaiming my power back.  It is a way of saying “this is my story” & your opinions are irrelevant in my need for validation. However, if I tell my story, it could hurt others….

Do I keep quiet to protect others?  If I do, it will be at my own continued expense…

Or  do I tell my story so I can heal, and risk hurting others?

References

Brown, B. (2006). Shame Resilience Theory: A grounded theory study on women and shame.  Families in Society. 87(1), 43-48.
Onlinetherapyinsititute.org (n.d.)  Ethical Framework for the use of Social Media by Mental Health Practitioners.  http://onlinetherapyinstitute.com/ethical-framework-for-the-use-of-social-media-by-mental-health-professionals/Retrieved from:

Share This:

The story of an (almost) suicide…


I struggled in futility to make sense of my surroundings but without my glasses there was no point. Lying on that hospital gurney, all I could see were the bright hot examination lights.   As the fear and confusion grew, an animal instinct in my foggy brain was urging me to resist.  However, all efforts proved fruitless.  As the sedative effects of the sleeping pills took hold, I struggled in futility to regain control of any motor function.  All I could manage in that moment was nonsensical slurred speech while flailing about the bed like a crazy homeless drunk. When I tried sitting up, hospital staff surrounded me while tying hands and feet to the bed. The last thing I recall was the big plastic tube they shoved down my throat.

I opened my eyes several hours later to mental clarity and events of the previous evening began flooding back.

I recall waking up to a knock on my door late Sunday night. Laying on the sofa, I was prepared for an eternal slumber. As the door opened, I became enraged with myself for forgetting to lock the dang door. A crew of emergency responders walked in, including my old college roommate (a cop) & a former high school classmate (an EMT).

At the lowest point of my life, there were 2 people from my past who existed as reminders of traumas I was struggling to forget.  The idea of this made me so angry my hands began to shake uncontrollably.    They now had a ring-side seat to the assorted details of my fucked up life.

 Wanting nothing more than to run away in shame, I stumbled into the bedroom but didn’t get far before my old roommate grabbed me by the arm. As she sat beside me on my bed, I was hit immediately by barrage of questions:
“A friend of yours was concerned about you and told us to check up on you. Did you take this bottle of pills”
“Can you tell me why you decided to do this?”
“I can appreciate that you don’t want to talk about it but I can’t help if I don’t know what’s going on?”
This line of questioning continued for what seemed like an eternity. I sat there & ignored the questions & recalled our last conversation.  I was hopeful for what lied ahead as a new college freshman and grateful for the opportunity to move away from my home town.  However, life was not destined to unfold as I had hoped.  My roommate, on the other hand, achieved everything she had set out to.  She had her criminal justice degree, was now a cop, and married her college boyfriend.  I began to despise her normalcy as a reminder of how pathetic my life was. A lump formed in my throat as I came to the realization my life was a reflection of my worst fears.  “I really am a walking shit magnet,” I thought to myself dully.

As she informed me of her plans to take me to the hospital, a blind panic took over. “I can’t let him see me like this!!!”

A blind panic overcame as I remembered the old high school classmate, waiting in the next room. I felt like that awkward bullied kid again terrified to show my face.  The idea that he might spread details of this evening throughout town, pained me.  My mind flooded with painful memories of my childhood.  He was your adverqfe kid just trying to survive.  He always avoided me and pretended to not notice the bullying I suffered – an implicit acknowledgement of the fact that I was the social leper. As a silent bystander he was “the enemy” in my mind.  All I wanted to do is hide out in the bedroom. In my mind.  I was that scared kid who hid in the girls locker room to avoid the daily lunchroom torture – all over again.   It wasn’t until he left that I was willing to leave my bedroom and be escorted to the hospital…

After surviving this nightmare, I was simply grateful the sedative-induced fog had lifted & my mind was finally clear.

I reoriented myself to the surroundings. The ER room was large and expansive with long curtains separating a row of hospital beds. I wondered in horror, how many people were able to witness the “humbling events” that unfolded just hours ago. As a nurse approached my bedside, I asked for politely my glasses.   She ignored me as if I wasn’t there and sat down to scribble some notes in my chart.
I laid there in silence, and wondered what I had done to make her angry. Still tied to the bed, unable to move, there was really nothing I could do but wait.  I began to recall the conversation hospital staff had while hovering around me just hours ago.  They were talking about me as if I wasn’t there, unaware that I was still conscious.  A male nurse, at one point, called me a pathetic loser, since “only losers kill themselves”.   The ER doctor got mad at him for saying this and ordered him to help someone else.

Sitting by me at eye level, I could tell by his kind eyes and sincere voice that he genuinely cared. He told me it would be okay and he would make certain the nurses took good care of me…

I squinted my eyes and searched for a figure in a white lab coat.  However, the ER was quiet, and the nice doctor was no where to be found. The nurse remaining by my bedside, was stoic and cold.  Without a hint of acknowledgement she approached my bed and forcibly sat me up & turned around to search for my clothes.  I sat there stunned and dizzy, as the my fuzzy surroundings began spinning about.  I struggled to grab hold of something, however my arms were still tied firmly to the bed and my hands felt numb.  As my untied hospital gown started gradually falling down my shoulders, my breasts were exposed.  With no curtains drawn to ensure privacy, I became fearful that some random person might walk by and see me sitting here.  I asked her to pull up my gown up or close the curtain.  However, She ignored my requests.  Frustrated and ashamed, I noticed a phlebotomist milling around, ogling at me with an evil grin on his face.  I bowed my head down towards my feet in a futile attempt to use my hair as a privacy shield.   After what seemed like an eternity, the nurse finally turned around and pulled the curtain shut, so I could finally be spared another second of feeling like a side-show oddity.


She was 16 years old and brought in by an ambulance to the ER.  Her parents called 911 after finding her in the bathroom with her wrists slashed.

She arrived covered in blood and could have passed for an extra for a slasher flick. Her arms were wrapped in towels as they wheeled her in. I was instructed to clean her up so the doctor could do the stitches. Her mother stood by, crying uncontrollably as I wheeled her into a room and pulled the curtains for privacy.  After getting her into a hospital gown, I laid her down on the gurney, unwrapped her wrists and began scrubbing the dirt and dried blood away from her arms.  After a period of silence I asked her what happened.  Her affect remained flat as she shrugged shoulders and contemplated my  question for a minute. Looking away, she replied: “I’ve had a rough time at school and my parents are getting divorced.”

I continued cleaning her up and recall saying that I was sorry I was to her about the hard time she’s going through. I attempted to reassure here I was there to help and available in this capacity should she need anything. Beyond the polite smile and thank you, I could see she was in a world of pain.  I recalled my own suicide many years ago.  I shuddered at the possibility that the care she was being provided might make her to feel like I had several decades ago. 

As I continued to scrub away the blood and grime, the details of my life quickly fell into the background.  Before me, was a human being who is just hurting.  She simply wanted the pain to stop.   I wished in futility for a way to make it better and continued cleaning her silently and meticulously.  Sounds of ER chaos unfolded just beyond the drawn curtain.   The air was ripe with a cold and emotional neutrality that reflected a jaded “I’ve-seen-it-all” mentality.  I could recognize the “survival mode” mindset in the staff working that evening.  They were overworked, stressed, and entire hospital was short-handed.  Everybody was focused simply on the tasks at hand with cold and steely determination.  A sadness grew within me as I began to witness this clashing of perspectives.  I was vividly aware of the client’s needs and the hurt overwhelming her.  However, as a healthcare worker, I also understood how difficult the job an be at times.

In that moment, it was clear to me that the client’s need for compassion, and understanding, would be met with a clinical focus on the overarching goal of simply ensuring patient safety.  She could expect to receive repeated punitive reminders that what she did a very bad thing…

Finally, some parting words as “food or thought”:

“Perhaps nowhere is the ability to empathize with another person more important than when one is interacting with a person who is on the brink of suicide.  This is true whether one views one’s task as helping the individual choose continued living over suicide or, more rarely, as helping the individual make a wise chose between suicide and continued life.  The ability to hold a person within life, when that is needed, and to allow a person who has chosen suicide to die, when that is needed, depend on an experiential appreciation of the other’s world view. Finding hidden or obscure ways out as well as seeing that there is no way out require both the ability and the willingness to fully enter the experience of the individual ready to suicide and, at the same time, not become that experience…” (Linehan, 1997, p. 353).

References

Linehan, M. M. (1997). Validation and Psychotherapy. In A. Bohard & L. Greenber (Eds.) Empathy Reconsidered: New Directions in Psychothrerapy. Washington DC: AC 352-392.

Share This:

G.A.D – “The stress is killing me!!!”

Click here for a “Quick-&-Dirty” overview of Generalized Anxiety Disorder….

During a discussion with my therapist recently I learned that some of my symptoms are reflective of Generalized Anxiety Disorder.  Until she mentioned this, it hadn’t occured to me.  However, I must admint, she does have a point.  I’ve always been a worry wart, and find my anxiety the most difficult to manage on a daily basis.   Anxiety urges us to action perceived in that moment as a solution to our concerns and fears.  When overcome with anxiety, I try my best to “keep it in check”.  However, sometimes it does get the better than me, and I react in an irrational and/or poorly-thought-out manner.  What follows is a quick review of research that provides interesting causal explanation for G.A.D….

Beliefs & G.A.D.

Koerner, et al, (2015) note that certain beliefs about worry correlate with Generalized Anxiety Disorder, including “negative beliefs about uncertainty, and schemas reflecting unrelenting standards…the need to self-sacrifice…and less positive views of other people and their intentions” (p. 441).  Additionally, how we view worry effects the way we handle and mange this emotion.  “When individuals encounter a threatening situation, positive beliefs about the usefulness of worry are activated, which in turn initiate worrying as a coping strategy” (Koerner, et al, 2015).

Stressful Life Events & G.A.D.

Life events play a role as precipitating factors in the onset of generalized anxiety disorders and panic disorders….The objective of this study was to investigate the frequency, specificity and typology of stressful life events occurring in patients with generalized anxiety disorder and panic disorder…A significant proportion of patients in both groups reported stressful life events occurring in the year before the onset (87.5% in the group with generalized anxiety disorder and 76.3% in the group with panic disorder). More patients in the panic disorder group have reported events of the “loss” type and at least one event considered to be severe and very important compared to the generalized anxiety disorder patients. A significant proportion of patients in both groups have reported conflict and events involving threats. (Romosan, et al, 2004, p. 36).

Theoretical Interpretations of G.A.D.

A Psychoanalytic Perspective…

“According to psychoanalytic theorists, individuals with anxiety experienced difficult early relationships with unavailable and unresponsive caretakers In psychodynamic models, psychopathology is understood to occur as a result of excessive defenses against anxiety and guilt-producing, mixed feelings toward loved ones.” (Greenberg & Watson, 2017, p. 20-21)
  1. Click here to read about Sigmund Freud’s Psychoanalysis

  2. Click here to read about Psychodynamic Therapy

  3. Click here to read about Carl Jung’s Analytic Psychology

  4. Click here to read about Alderian Psychotherapy

  5. Click Here to read about Karen Horney’s Psychoanalysis

A Learning Theory Perspective

From a learning theory point of view, people are anxious and fearful of feelings that are associated with negative outcomes. Learning theory approaches to GAD have suggested that uncontrollable and unpredictable aversive events may play an important role in the devel- opment of GAD (Greenberg & Watson, p. 21)
  1. Click here to read more about Classical Conditioning

  2. Click Here to read more about Operant Conditioning

C.B.T. & G.A.D.

“Cognitive behavioral worry is a result of problems with affect regulation, including (a) heightened intensity of emotions, (b) limited understanding of emotions, (c) negative responses to current emotions, and (d) unhelpful management of emotions. According to this view, GAD results from deficits in affect regulation with an over reliance on worry to manage diffiult emotional experiences” (Greenberg & Watson, 2017, p. 23)

Click here to read more about Aaron Beck’s CBT

Carl Rogers & G.A.D.

“Rogers suggested that anxiety occurs when the needs of the organism are in conflict with introjected conditions of worth from signi cant others. Fully functioning people do not need to distort experience…with introjected conditions of worth” (Greenberg & Watson, 2017, p. 24)

Click here to read about Carl Roger’s Nondirective Approach

Existential theorists

Existential theorists see anxiety as a core part of the human condition and as an unavoidable component of life. In their view, anxiety results from individuals having to face choices without clear guidelines and without knowing what the outcomes will be, and from being aware that they are ultimately responsible for the consequences of their actions…existential view sees anxiety as stemming from the inability to cope with the challenge of living and to choose to live in a healthy and productive way.” (Greenberg, & Watson, 2017, p. 24)

Click Here to read about Existential Psychotherapy

E.F.T. & G.A.D.

Repeated exposure to threatening, painful, and negative life events…without adequate protection, soothing, and nurturing compromises people’s emotional processing and affect regulation capacity, as well as their identity formation…If needs for connection and protection go unmet, individuals become distressed and their feelings of fear, sadness, and shame remain inadequately symbolized and soothed….These children feel solely responsible for their well-being. The lived experience plus the harmful situation are coded in emotion schematic memory. Thus, from an EFT perspective, an important contributor to GAD is the inability of people to process their emotions and soothe, comfort, and protect themselves when experiencing distress so as to return to a state of peace and calm.” (Greenberg & Watson, 2017, p. 25).

Click Here to Read My Posts on Emotions…

Image: 1

References

Greenberg, L.S. & Watson, J.C (2017). Emotion-Focused Therapy for Generalized Anxiety. American Psychological Association.
Koerner, N., Tallon, K., & Kusec, A. (2015). Maladaptive core beliefs and their relation to generalized anxiety disorder. Cognitive behaviour therapy, 44(6), 441-455.
Shrestha, R. (2015). Stressful life events and coping strategies among patients with generalized anxiety disorders. Journal of Institute of Medicine, 37(3).
Arul, A. S. S. J. (2016). Study of Life Events and Personality Dimensions in Generalized Anxiety Disorder. Journal of clinical and diagnostic research: JCDR, 10(4), VC05.
Romosan, F., Lenci, M., Stoica, I., & Dehelean, L. (2004). Stressful life events and anxiety disorders. Timisoara Med J, 54(1), 36-38.

Share This:

Stages of Change & Domestic Abuse Survivors

In this post, I’m reviewing literature that discusses the stages of change as it applies to providing care to victims of intimate partner violence. As an intern working at a homeless shelter for women, I find the work highly relevant to what I see from day to day.  This post includes segments of old assignments…

“Why does’t she just leave him?!?!?!?”

“Queries like, “Why does she put up with that?” and “Why does she stay?” continue to haunt battered women…The implication is that the battered women’s behavior is problematic…This ego-deflating and incriminating element can serve to keep a woman trapped in a situation she may view as incapable of ending herself” (Burman, 2003, p. 83).

During my internship class last quarter, a fellow classmate began discussing a client she was seeing who was just left an abusive relationship.  At one point my professor made an interesting statement that made me stop and think:

“The key is to understand the unresolved issues they have yet to work through”

This statement made me stop and think a bit about my own history, and the “it years”.  Mind you, the abusive behavior was psychological and emotional.  However, there is certainly a parallel.   Throughout the relationship, I can’t tell you how many times I heard someone say: “Why don’t you just leave him?”  I recall thinking silently, “it’s just so complicated, you don’t understand.”  My response was, often to remain silent, and simply ignore the question.  There was no point in explaining to those who ask, what they are blind to and unable to conceive…

It is for this reason, that my professor’s comments really struck me.  In response to questions such as these I might say iterate what my own professor said, “what unresolved issues lay in their life history that I hadn’t worked out yet as an explanation for why they would be in a relationship like this?”

To put it another way, let’s look at this issue from a behavioral perspective.  Mind you, this theory isn’t necessarily my favorite since I feel we are much more than pavlovian dogs.  However, what’s clear about human behavior is that we do what works.  Even, if at first, behaviors appear self-destructive, we must ask ourselves what they “payoff” is.  In my own case, there was an emotional “hot potato” was the unresolved trauma of bullying and ostracism in my childhood.    I was so incredibly desperate to avoid the rejection and loneliness of my childhood, this relationship was the “lesser of two evils” as an alternative to re-experiencing the traumas of my childhood.

Admittedly, this personal perspective in my own life history, might not apply to many other cases of domestic violence.  However, the point is, rather than asking “why don’t they leave?”  We must ask ourselves, how this relationship reflects the the summative emotional impact of life experiences?  I love John Malkovich’s assertion that to a create character successfully we must see them without judgment.  Maybe this is also true with clients:  to see their life experiences without judgment.

“Attempting to understand the nature of the battering and how women cope, we can glean some insights into…the strengths that are utilized to make the decision to leave, act upon and sustain this goal” (Burman, 2003, p. 84).

Two articles are useful in providing information in understanding a domestic violence situation as a guide throughout the counseling process.  These articles describe a woman’s adaptations to spousal abuse in terms of the following stages: pre-contemplation, contemplation, preparation, action, maintenance, and termination (Burman, 2003; Fraser, et al, 2001).  According to this theory, change is not a singular event but a process that occurs in an observable sequence of stages.   For example, during pre-contemplation, a woman tends to minimize and deny the issues and their consequences. Traumatic bonds are quite pronounced at this point and a sense of isolation and dependence grows along with a growing feeling of responsibility and self-blame (Burman, 2003, p85). The contemplation phase marks a period of ambivalence during which an increasing level of cognitive dissonance develops and a woman vacillates on whether to leave (Burman, 2003, p85). Determination and Action involve the process of preparing to leave and enacting one’s plan. Finally, brief descriptions are provided of the maintenance and termination stages.  What follows is an overview of the stages of change as it applies to victims of intimate partner violence.

Overview of The Stages of Change

Pre-Contemplation

The pre-contemplation stage is characterized by either denial and minimization of the problem.  For example, during this stage a client may resist any attempts to discuss and acknowledge that abuse is occurring. This might can present as a defensiveness towards anyone who suggests and/or suspects that there is a problem (Burman, 2003).  Alternatively, the client might also present with a desire to accommodate “herself to the situation, constantly hoping that by pleasing her partner he will change his ways” (Burman, 2003, p. 84).  Sometimes expressions of hopelessness regarding the possibility of change can also be seen (Frasier, et al, 2001).  Alternatively, the client may describe the hopelessness of the situation while blaming herself and/or others:

“There is no need to talk about it; it won’t change a thing,”

“If the supper had been ready on time…”

“But, he is a good provider…”

“If the children weren’t so noisy…”

During this early stage, the traumatic bond begins to develop.  I prefer to call it a “boot camp” period, where you’re slowly broken in like a pair of new boots.  Momentary expressions of love and/or positive reinforcement are intermingled with various forms of abusive behavior.  You’re slowly isolated from others and dependency upon your partner grows slowly over time.  An extremely low self-esteem exists that one cannot see beyond, as an all-encompassing perspective of oneself.  This is the hardest to explain, for those who don’t understand.  However, I would simply like to note that people can’t see what they haven’t experienced, like explaining the color purple to a blind man.

Contemplation

This stage is characterized by feelings of ambivalence as the client vacillates between “concern and..unconcern, motivation to change and to continue unchanged” (Burman, 2003, p. 85).  The therapist’s primary goal is to addrress feelings of ambivalence.  As the situation continues in an unremitting manner, the client’s coping mechanisms wear down. Consequently, denial is no longer possible and they begin to recognize that a problem exists.  The client struggles to make sense of their partner’s behavior and process their feelings of ambivalence by weighing various options as “what if’s”.

“I wish that I could figure out what to do differently so he won’t get so angry with me,.”

“What would happen if I did leave, can I ‘go it alone’?”

Preparation

“Patients in this stage are consciously aware of their problems. They are `committed’ to taking action usually within the next month” (Frasier, et al, 2001, p. 214).  During this stage the primary goal is to “determine the best course of action and prepare to carry it out” (Burman, 2003, p. 86).  Planning is underway as the client seeks counseling, legal assistance, saving money, and a safe place to stay.  Both resources for this post mention that change is sometimes a fluctuating process and clients can occasionally be seen moving back and forth between preparation and contemplation (Burman, 2003; Fraser, et al, 2001).

Action

During this stage, the client begins putting her plans into action and makes efforts to change.  “The prospect of leaving, is often dangerous and scary, provoking feelings of fear and anxiety (Burman, 20030.  Therefore, great energy is now directed toward ensuring your personal safety and rebuilding your life.   Victims of abuse may seek counseling, participate in a local support group for victims of domestic violence, and/or request that their partner seek treatment as part of a court-ordered protective or restraining order. Some victims may also train for or seek work outside the home in order to establish economic independence.” (Fraser, et al, 2001 p. 214).

Maintenance

During the maintenance stage, clients are struggling to avoid problematic behaviors.  The goal during this stage is to prevent relapses into old destructive habits.  Burman, (2003) states that 5-7 attempts are commonly made to leave an abusive relationship before success is achieved. “Various reasons have been given for this action, including ‘fear, continuing emotional involvement, desire to keep the family together, and lack of viable alternatives'” (Burman, 2003, p.86).   “Maintenance depends not only on the thoroughness of the action plan but also on a continuing support system” (Fraser, 2001, p. 2014).

Assessment Client Needs

Nature of Abuse

It is also important to obtain more detail on the nature and severity of the past abuse history in order to begin working through the effects of these experiences (Burman, 2003).   This should also entail an assessment for symptoms of PTSD and dissociation.

Self-Esteem & Coping Style

Issues for women recovering from a history of spousal abuse include a diminished self esteem, as well as dysfunctional cognitive and affective adaptations (Holiman & Schlilit, 1991). This diminished self-esteem can be thought of as a sense of powerlessness and low self-worth. It causes individual’s develop maladaptive belief systems about themselves in relation to others (Holiman & Schlilit, 1991). Emotionally, long-term spousal abuse also causes a paradoxical attachment, in which victims come to rely on a hope for something they never receive (Holiman & Schlilit, 1991).

Readiness for Change

Interventions should be geared towards a client’s level of readiness for change and aimed addressing resistance. For example, for women who have not yet left relationships, you would note they are either one of two things. They may be in the pre-contemplative change and unwilling to acknowledge the problem. Or they may be in the contemplative change and considering leaving, but unsure of how they may do so.

Depression & self-care (Kakurt, 2014)

Participants in this article described feeling depressive symptoms and difficulty engaging in adequate self-care (Karkurt, et al, 2014). Additionally they felt a mixture of emotions including being overwhelmed and stressed about the big life decision they just made. These overwhelmed feelings would arise when they began discussing the tasks before them as they attempted to rebuild their lives. Others were angry for themselves for not having left sooner.

Shame & Self-Blame (Karakurt, 2014)

A subgroup of participants in this research suffered with several more severe co-morbid diagnoses that required additional interventions. Issues common in this group include bipolar disorder, depression, suicide, dissociative PTSD, borderline personality disorder (Karakurt, et al, 2014). Finally, individuals who had suffered longer-term severe abuse, were most likely to deal with feelings of excessive guilt and self-blame (Karakurt, et al, 2014).   These feelings of guilt and self-blame made their decision to leave particularly difficult to cope with. For example, this article describes one participant stating they felt they had betrayed the trust of their partner (Karakurt, et al, 2014). This insight points at the importance of understanding an abusive situation from the perspective of someone who has lived it.   From an outsider’s point of view, these feelings make little sense. On the other hand, from the perspective of someone living the experience, the feelings are altogether different. It is our job to work at appreciating things in this vantage point, and helping from within this perspective.

Emotional Response to Violence

Holiman, (1991) “describes a paradox for women in violent situations: the woman is trapped because she feels even more afraid when she contemplates separation than when she imagines being intimate in a battering relationship…the fear of being without a partner was overriding, more important than whether or not the violence stopped” (p. 346).

When I read the above quote, I was again reminded of that relationship in college.  I would like to reiterate it wasn’t physically violent,  however emotionally, psychologically and sexually abusive.  I can recall a similar feeling of fear upon separation.  I recall breaking up with him during a family vacation to London.  My mother had arranged it with his parents.  He was going to visit them for a week, while I went to London.  It was my first time away from him.  I recall breaking up with him from this safe distance, and feeling a nagging fear & anxiety throughout the remainder of the trip.  This paradoxical feeling is admittedly difficult to explain however quite overwhelming.  Holiman (1991) suggests this is due to a process of traumatic bonding takes place between the woman and her partner, similar to the relationship between hostage and captor.” (p. 346).

Interventions

“Effective Interventions Matched with Stages of Change” for victims of abuse. (Fraser, et al, 2001, p. 215).

“Roberts’ Seven-Stage Crisis Intervention Model & Battering Severity Continuum” (Holiman, 2003, p. 88).

Burman, (2003) includes a description of a Crisis Intervention Model based on research that focuses on domestic violence.  This Crisis Intervention Model is based on the idea that abuse can be observed to occur along a continuum of severity.  “Divided into seven stages, the model details hierarchical assessment and intervention activities that aim to subdue a crisis so that strength-oriented empowering cognitive, and independent function can be achieved” (Burman, 2003, p. 88).

Crisis Defined:

“An acute disruption of psychological homeostasis in which one’s usual coping mechanisms fail and there exists evidence of distress and functional impairment. The subjective reaction to a stressful life experience that compromises the individual’s stability and ability to cope or function. The main cause of a crisis is an intensely stressful, traumatic, or hazardous event, but two other conditions are also necessary: (1) the individual’s perception of the event as the cause of considerable upset and/or disruption; and (2) the individual’s inability to resolve the disruption by previously used coping mechanisms. Crisis also refers to “an upset in the steady state.” It often has five components: a hazardous or traumatic event, a vulnerable or unbalanced state, a precipitating factor, an active crisis state based on the person’s perception, and the resolution of the crisis.” (Roberts, 2005, p. 778)

Seven Stages of Intervention (Roberts, 2005).

Continuum of Abuse (Burman, 2003).

A treatment plan

The following is a hypothetical treatment plan I created for my practicum course some time ago.  I utilized the resources below to create it…

References

Burman, S. (2003). Battered women: Stages of change and other treatment models that instigate and sustain leaving. Brief Treatment and Crisis Intervention, 3(1), 83.
Fraser, P. Y., Slatt, L, Kowlowitz, V., & Glowa, P. T. (2001). Using the stages of change model to counsel victims of intimate partner violence. Patient Education and Counseling. 44, 211-217.
Holiman, M. & Schlilit R. (1991). Aftercare for battered women: How to encourage maintenance of change. Psychotherapy. 28(2), 345-353.
Karakurt, G., Smith, D., & Whiting, J. (2014). Impact of Intimate Partner Violence on Women’s Mental Health. Journal of family violence29(7), 693-702.
Roberts, A. R., & Ottens, A. J. (2005). The seven-stage crisis intervention model: A road map to goal attainment, problem solving, and crisis resolution. Brief Treatment and Crisis Intervention, 5(4), 329-339

Share This:

Empathy, what is it?

In a previous post, I describe a growing feeling of incompetence as a student therapist.  When I express these concerns to my supervisor he jokes: “Give it about 5 years”.  

As time has progressed, I’ve adapted to the “learning as you go process”.

As a therapy student, I’m focusing on learning those “basic counseling skills” everybody talks about. In this series of posts, I hope to reflect on what I’m learning slowly week by week from an experiential rather than academic perspective.   Therefore, I did a quick google search and am using three online PDF’s as a quick jumping off point.  In this post, I will focus on empathy…

Empathy is derived from the German word “Einfuhlung” which directly translated means “one feeling”, (Pedersen, et al, 2008, p42).  It can be thought of as “the ability to perceive another’s experience and then to communicate that perception back to the individual to clarify and amplify their own experiencing and meaning. It is not identifying with the patient or sharing similar experiences, not ‘I know how you feel’!” (Abraham Lincoln University, n.d., p. 5).  In other words, empathy is a two-fold process that involves accuracy of perception and effectiveness of communication.   Two big questions naturally loom in my mind:

FIRSTLY, How can we improve our ability to appreciate another person’s perspective, thoughts & feelings?

SECONDLY, What considerations need to be kept in mind to communicate this empathy effectively?

4/12/17 @ 2:30 p.m.

I’m in the car, dictating another post into my IPhone.  A few thoughts have sprung to mind regarding the importance of empathy as a result of several events over the last several weeks…  

Therapy seems to require a dialectical thought process of oppositional perspectives.  We must discern diagnostically while remaining nonjudgmental empathetically.  The process of diagnosis first requires the observational skills to develop a phenomenological diagnostic understanding.  Then, in order to guide our progress an ever-changing case conceptualization provides an complex causal understanding.

In complete contradiction to this is the empathetic perspective which requires us to suspend judgment.  In those moments, you are attending to the human being before you and simply honoring the validity of a person’s experiential reality with a goal of developing a deeper felt understanding of it.  The divergent nature of these two simultaneous tasks makes the counseling process is oddly dualistic at times.  As a newbie, I’m interested in getting down the basics.

How can I know if my understanding of the patient’s felt & experiential reality is correct???  How can I be sure that I’m adequately conveying this empathetic understanding???  Here are a few random thoughts:  

Marsha Linehan on Suspension of Judgment 

Within every definition of empathy, the suspension of judgment is highlight as an essential characteristic.  Regarding the judgment suspension, I am reminded of something John Malkovich said once about characters and the importance of not judging them.  As I’ve observed, this requires a constant questioning, do I understand everything? What am I missing? Where are my blind spots?

A great way to begin answering this question is to first examine those instances where I experienced a lack of empathy from others who were trying to be “helpful”  

For example, in an earlier post I discussed an  abusive and dysfunctional relationship in college.  While I don’t tend to share this story often, it isn’t necessarily a secret.   I have on a few select occasions shared this experiences with people.  One response I real is: “why the hell did you put up with him for so long”, or “why didn’t you leave?”  Then there are those who attempt to be sympathetic yet misconstrue my motives or very nature.  The helpless victim who just lacks self-esteem.

All these responses fall short of the reality of things.  The fact is, I was a child who had experienced chronic invalidation and shame growing up….  

I discuss these experiences in greater length in posts on ostracism, bullying, & rejection amongst extended family members.  A professor I had last quarter made an interesting comment regarding battered women & why they don’t leave.  She noted that the key is to understand the issues they have not worked out.  When she said this, I silently thought to myself what it was I needed to work out.  It was simply a desire to not re-experience the hurt, rejection, and isolation I had in my childhood.  As a parasuicidal teen, who held on for no other reason than not to hurt her family, I met that “it” at a vulnerable time in my life.  I had just left home and was trying to fit in but experiencing difficulty as a freshman.  Years of isolation from sixth grade on, left me feeling “different” from fellow dorm-mates who had “grown up fast”.

It comes down to something I heard John Malkovich say about creating characters.  To do so successfully, you need to view them without judgment.   Doing so requires that we – for a moment – set aside our preconceived notions, and see the world through their personally experienced reality.  What would it be like, if you experienced chronic rejection, isolation, and invalidation as I had growing up?  These experiences were so bad, I was parasuicidal, hanging on day by day, just promising myself to keep going.

I simply desperately sought validation & acceptance from someone as a way of avoiding the possibility of re-experiencing the hurt I had long ago…..

I would take promises of acceptance & validation (even if he never did deliver),  like a carrot on a stick, over nothing at all.

Imagine yourself in my situation as a child, minus the judgment.  There would be  someone who had no other context in which to view herself than what others reflected to her.   You would then be left with a one-sided view of yourself as a result of a lot of unhealed baggage.  This would cause you to seek the first solution to avoid dealing with with the unresolved crap from your childhood.

The idea of re-experiencing the hurt similar to the childhood rejection in my childhood was overwhelming.  I just couldn’t do it.  

I would just like to conclude with some comments by Marsha Lenehan , founder of DBT.  There is a quote from something she published on validating a person’s emotions when they are suicidal.  This notion contradicts the sentiments of workers in the mental health care environment who all make a potion of  telling you that what you did is wrong and you did a bad thing and you were wrong to do this.   There is no one who is simply listening to what you’re saying and appreciating your story and how you feel without judgment that is the critical thing and the thing that often goes overlooked.

“Perhaps nowhere is the ability to empathize with another person more important than when one is interacting with a person who is on the brink of suicide.  This is true whether one’s views one’s task as helping the individual choose continued living over suicide or, more rarely, as helping the individual make a wise chose between suicide and continued life.  The ability both to hold a person within life, when that is needed, depend on an experiential appreciation of the other person’s worldview.  Finding hidden or obscure ways out as well as seeing that there is no way out require both the ability and the willingness to fully enter the experience of the individual ready to suicide and, at the same time, not become that experience…In attempting to apply standard behavioral therapy to severely and chronically suicidal individuals…focusing on client change is often experienced as invalidating by clients who are in intense emotional pain…focusing on understanding in absence of a…efforts help the client change..is often experienced by these same clients as invalidating because it does not recognize the uninsurability….of the present unremitting pain…” (Linehan, 1997, p. 353-354).  

Brene Brown on Empathy

In the above video, Brene Brown begins describing the difference between sympathy and empathy.  As a fan of her work, I feel the need to include this brief view by her in this post.  She states that empathy requires four critical factors:  (1) Perspective taking, (2) remaining nonjudgmental, (3) recognizing the feeling in others and (4) effective communication of this effectively.  In other words, empathy requires much more than putting ourselves in someone else’s shoes, we must be able to effectively communicate this to others. In the next section, we discuss how to communicate empathy effectively.

Rogers on Empathy

“I have come to believe that empathetic listening is one of the most powerful forces for growth that I know…. (Rutsch, 2015).

“…When I can let myself enter the softly and delicately into the vulnerable inner world of the other person…(Rutsch, 2015).

“…When I can temporarily lay aside my views and values and prejudices…(Rutsch, 2015).

“…When I can let myself be at home in the fright, the concern, the pain, the anger, the tenderness, the confusion that fills their lives…(Rutsch, 2015).

 “…When I can move about in that inner world without making judgment…(Rutsch, 2015).

“…When I can see that world with fresh unfrightened eyes…(Rutsch, 2015).

“…When I can check the accuracy of my acceptance with him or her and be guided by the responses I receive…(Rutsch, 2015).

“…Then I can be a companion to that person, pointing at the felt meanings of what is being experienced.  Then I find myself to be a true helper…(Rutsch, 2015).

As I stated earlier, empathy is a two-fold process that involves accuracy of perception & effectiveness of  communication.   In this section I’d like to begin by consider how to communicate it effectively.  After reviewing old papers, I noticed there are two that discuss the effective communication of this concept.  I include them below, for my own education / review….

PAPER #1 – Active Empathetic Listening 

Active empathetic listening is defined as an “active and emotional involvement of a listener during a given interaction – an involvement that is conscious on the part of the listener but is also perceived.” (Prout & Wadkins, 2014, p134). As a multidimensional concept involving sensing, processing, and responding, it isn’t enough to simply attentively listen and consciously process information. Affectively communicating this empathetic understanding is critical as well. With this in mind, what follows are key factors that are of a concern to this author from the standpoint of skill development.

Top-Down Processing & Culturally Inclusive Empathy.

Top-down processing is one of two forms of listening discussed in our course textbook. It involves the utilization of education and experience to contextualize the meaning of the communication with clients. It is a critical counterpoint to the bottom-up processing that exists as at a more automated level in which we respond to what is said at a face value (Prout & Wadkins, 2014, p135).

In fact, when considering the concept of top-down processing in the process of active empathetic listening, the author is reminded of a related concept: Inclusive Cultural Empathy. Discovered coursework elsewhere in this program, it is defined as “a dynamic perspective that balances both similarities and differences at the same time integrating skills developed to nurture a deep comprehensive understanding of the counseling relationship in its cultural context” (Pedersen, et al, 2008, p.41).   In considering this concept as a part of the active empathetic listening process, it is clear to this author that such skills require an ongoing lifetime commitment to skill development and self-reflection.

Affect Tolerance & Mindfulness.

Two final concepts are of concern to this author as key skills in the active empathetic listening process. Firstly, our textbook describes affect tolerance as an ability to handle distressing emotions experienced vicariously through hearing the client’s story without “becoming engulfed” (Prout & Wadkins, 2014, p136). Alongside this concept, the textbook mentions the notion of meditation as an ongoing practice. Essential in paying attention more fully, when considering such factors the idea driven home is a realization that one gives to others based on who they are and not just what they do (Prout & Wadkins, 2014). With this in mind, much work on oneself is necessary and essential, as an ongoing process of growth and personal development.

Active-Empathetic Listening Scale

            In this portion of the paper it is the goal of this author to review the Active-Empathetic Listening Scale discussed in our course textbook (Prout & Wadkins, 2014, p135).   As per the instructions I am to rate “how frequently [I] perceive each of the following statements to be true for [me] on a 7-point scale ranging from 1 (never or almost never) to 7 (always or almost always true).” (Prout & Wadkins, 2014, p135)

  1. “I am sensitive to what others are not saying.” (Prout & Wadkins, 2014, p135) – Based on an honest self-assessment I would rate myself around the 6-7 range.
  2. “I am aware of what others imply but do not say.” (Prout & Wadkins, 2014, p135) – Very similar to the question above, I would also place myself around the 6-7 range, depending on circumstances and degree of personal stress.
  3. “I understand how others feel.” (Prout & Wadkins, 2014, p135) – I rate myself at a 7 here. In fact the skill of affect-tolerance is an important skill for me as a result.
  4. “I listen for more than just the spoken words.” (Prout & Wadkins, 2014, p135) – As a mother to a teenager, and CNA/Psych tech, I actually spend quite a bit of time doing this and would be around the 6-7 range.
  5. I assure others that I will remember what they say.” (Prout & Wadkins, 2014, p135) – As mentioned above, I spend the majority of my time caring for others. I’m constantly being asked to reassure others I’ll remember what they are requesting and/or desiring from me. In this respect I do this as well all day long, and would be around the 6-7 range.
  6. “I summarize points of agreement and disagreement when appropriate.” (Prout & Wadkins, 2014, p135) – This factor doesn’t occur as much in the work context for me. In my personal life as much, (as I do agree it is a critical personal skill), I can at times get more caught up in making points than summarizing them. I would at about 5 here.
  7. “I keep track of points others make.” (Prout & Wadkins, 2014, p135) – As stated above, I do need a bit more work here and would rate myself at about a 5.
  8. “I assure others than I am listening by making verbal acknowledgements.” (Prout & Wadkins, 2014, p135) – As someone who cares for others, I do this all day long, and would be in the 6-7 range, in acknowledgement of the fact that nobody can ever be perfect.
  9. “I assure others that I am receptive to their ideas.” (Prout & Wadkins, 2014, p135) – I the context of my work as a C.N.A./psych tech, I am often acting as an “ambassador”. On the one hand there are the needs of the client and on the other hand there are the parameters that need to be followed according with the doctors plan of care. Finally, the hospital has its rules that we all must follow such as visiting hours and no smoking. With this in mind, I also work to reassure clients of this fact, and do my best to advocate for their needs. Based on this fact I would rate myself in the 6-7 range.
  10. “I ask questions that show my understanding of others’ positions.” (Prout & Wadkins, 2014, p135) – This skill isn’t utilized as much in the context of my job. While pretty good at it, I’m probably not as adept as in other areas and am about a solid 6.
  11. “I show others that I am listening by my body language.” (Prout & Wadkins, 2014, p135) – With many stresses and demands in my life, I find my ability to care for others is often depleted by these things.   While I am good at verbally showing that I listen and try my best, sometimes my body languages reflects my exhaustion and stress levels more than anything. I would rate myself at around a 5 here.

Effectiveness of Self-Rating

            After completing this scale, it must be acknowledged that as a self-rating method the results are clearly skewed on that basis. How I think I may come across to others may not be the same as how they tend to experiential first-hand encounters of me. It would be interesting to have key individuals in my life review my answers and provide their own feedback. The ultimate conclusion likely made would be that I may not communicate my intentions as well as I hope to. Additionally, as I will discuss next, any plan for improvement must acknowledge the depth to which these skills exists as core elements of how we choose to be in the context of our lives.   In this respect they really do require an ongoing commitment of personal growth and self-awareness as an lifelong process.

Plan for Improvement

In completing this assessment, this section briefly reviews my plan of improvement. It will combine insights from the scale above, with key skills this author feels are important.

  1. GOAL ONE – Multicultural Competency. Culture exists as an unseen paradigm in our lives defining not just our values and beliefs, but patterns of thinking and overall affective style, (Hays, 2008). With this in mind, active empathetic listening, does require a skill described in literature as inclusive cultural empathy (Pedersen, et al, 2008). Making an ongoing commitment to the development of multicultural competency is critical with this in mind.
  2. GOAL TWO – Mindfulness Practice & Self-Care. – The one biggest lesson from the self-rating scale its reaffirmation of the idea that self-care is critical.   Being there for others requires that I be there for myself first so I have something to give. Alongside this notion, is the idea of a daily mindfulness meditative practice that can aide in reducing stress levels and still my busy mind.
  3. GOAL THREE – Affect Tolerance. – It is natural, when encountering difficult emotions from others in the context of an interaction to take them in to a degree and personally experience them as well. We can take on some of the emotions of others and feel for them in an active empathetic sense. While clearly a good thing in some respects, over-identification is not healthy. This skill has been very critical in the acute mental health setting, and is one that requires much patience and active commitment to engage in at times.
  4. GOAL FOUR – Seek Volunteer Experience for New Learning Opportunities. Yet another insight from the self-rating skill is the fact that certain elements of active empathetic listening are practiced more than others.   When reflecting on the reasons underlying this, the hospital environment I work in, seems conducive to some forms of listening over others.   Engaging in brief communication more often than lengthy discussion, certain skills aren’t practice as much. It would be necessary, therefore, to seek other volunteer opportunities to engage with clients in a different capacity than what I’m familiar with at work.
  5. GOAL FIVE – Improve Listening Skills. Reviewing the basic listening and interviewing skills periodically, and being mindful of them as I engage with others, can be an effective way of learning to naturally incorporate them in the context of my interaction with others. 

Paper #2 – Inclusive Cultural Empathy

Culture and Emotion

The singular most beneficial lesson throughout this course is the realization of how culture exists as an unseen paradigmatic influence in our lives.   Definitive of our worldview, it represents a learned perspective that consists of instilled values, beliefs, and norms.

Beyond these obvious influences though, are less visible culturally impacted factors such as identity, emotion, and metacognition. Discussed often from a psychological, individually reductionist perspective, this paper will instead provide a unique sociocultural point-of-view of matters.

In determining the exact focus for this paper, I chose the topic of culture and emotion based on insights gained from the second exploratory paper activity. In the process of reviewing related literature for an interview with my mother, I came across the following:

“To the Filipino, actions always speak louder than words, so instead of conveying love and fondness with words, parents will endure extended periods of separation and/or hold down two jobs so that they can send their children to the best schools, pay for lessons and activities, and provide material support and other opportunities. This is the way they express their affection, and children are expected to recognize and value it. If they do not express or show appreciation, parents might perceive them as lacking utang na loob – serious infraction of social mores.” (Fortune, 2012, p12).

This quote manages to summarize a huge misunderstanding that existed between my mother and I throughout much of my childhood. As an American child, I failed to understand my Filipino mother’s expressions of love through action, (Fortune, 2012).   Preferring to hear and witness outwardly visible affective indicators of her love, it was instead an unseen dedication to her duty as my mother. As I only am able to contextualize now, it seems the underlying the cultural gap between us, was the byproduct of a failure to acknowledge key differences among us. At the core of these differences were varied views of what it means to be a person in the world, and what perspective we are to take it in from.

With this in mind as the focus of the paper, I begin with a discussion of the concept of inclusive cultural empathy. This concept provides a view of empathy from a unique multicultural perspective. Understanding how this concept as it relates to the overall notion of culturally competent counseling is critical if I am to effectively communicate it in such a manner. Also included in this paper is a brief review of the relationship between emotions and culture, and concluding commentary on with how to incorporate these insights into my future career development.

Inclusive Cultural Empathy.

Empathy is derived from the German word “Einfuhlung” which directly translated means “one feeling”, (Pedersen, et al, 2008, p42). From this perspective, empathy can be thought of as an ability to understand another’s experiences as if they are your own.   Best understood as an ability to relate to others due to shared experiences, the western Euro-American definitions predominating mental health are clearly problematic (Pedersen, et al, 2008). With traditional conceptions of empathy tending to reflect this cultural viewpoint, a more culturally inclusive perspective is vital. (Chung, 2002; Pedersen, et al, 2008).  What follows is a definition of this concept from literature:

“Inclusive Cultural Empathy describes a dynamic perspective that balances both similarities and differences at the same time integrating skills developed to nurture a deep comprehensive understanding of the counseling relationship in its cultural context.” (Pedersen, et al, 2008, p.41)

In light of this definition, it is useful to note that providing empathy in a culturally relevant manner requires more than simply understanding. Adding to the ability to “put yourself in the clients shoes”, is the notion of being able to adeptly communicate this (Pedersen, et al, 2008). After all, as a shared experience the therapist communicates and the client experiences, this notion encompasses two often culturally diverse perspectives. With culture as the key divergent component it is important to understand its influences over our emotions and our preferred means of affective communication. Therefore before beginning to discuss inclusive cultural empathy as a component in multicultural counseling I will discuss research on the nature of emotion from both a cultural and biological perspective.

Understanding Emotion.

“Emotions can be defined as psychological states that comprise thoughts and feelings, physiological changes, expressive behaviors, and inclinations to act.” (Vohs, et al, 2007, p285). Overall, two divergent perspectives exist regarding research that focuses on the nature of emotion.  Appraisal theories are based on the premise that emotions result from the way we appraise and interpret our environment. Research that utilizes this theoretical perspective focuses on culture and its influence over our manners of emotional regulation, perception and interpretation (Ellsworth, 1994). In contrast to this, categorical theories tend to view emotions as universal, innate and discrete.   Focusing on basic emotions such as fear or sadness, research from this theoretical perspective tests the hypothesis that feelings are hardwired byproducts of neural programming. (Ellsworth, 1994, p28).

Then & Now.

In reviewing literature for this paper, I found it interesting that research seemed to reflect the field’s developmental history overall. Based upon a predominantly westernized Euro-American perspective, the mental health field historically focused on DSM-based empirical data (Hays, 2008; Pedersen, et al, 2008). Along the way, notions such as social context and cultural relativitism seem to have been forgotten until recently. Interestingly, it seems the meaning of empathy in literature has undergone a shift in definitive focus reflecting these changes:

“The underlying assumptions about psychology are moving from a mono-cultural to a multicultural basis with profound consequences for counseling. The old rules of psychology focused on dissonance reduction. The new rules focus on the tolerance of ambiguity.” (Pedersen, et al, 2008, p224)

As per this historical shift, I begin with a review of biological perspectives of emotions, and then discuss emotions in relation to culture. I will then conclude by reviewing inclusive theories providing insights from both perspectives.

Emotion: A Biological View.

Universality Thesis. Some research exists that focuses on a limited number of innate and universal emotions as “basic” in nature. (Ellsworth, 1994). Described as matters of neural programming hardwired into the species overall, this research reflects a “Universality Thesis of Emotions.” (Effenbein & Ambady, 2002). While still asserting some degree of cultural variation this perspective stresses the universality to facial expressions in relation to basic emotions across culture. (Ellsworth, 1994; Ekman & Friesen, 1971). Referred elsewhere as categorical theories, research utilizing this perspective comprises the following key propositions: “(1) universality of facial movement as a form of emotional expression, (2) universality of attribution and understanding of key facial expressions, and (3) an associated rate of correctness regarding these attributions across culture” (Russell, 1994).

Examples of Studies. In one study by researchers Ekman & Friesen, the universality of facial expressions across cultures, was examined (Ekman & Friesen, 1971).   Using samples of individuals from cultures with little exposure to western society, research results supported their hypothesis, (Ekman & Friesen, 1971). Nonetheless, it is important to note in this research that “The growing body of evidence of pancultural element in emotional facial behavior does not imply the baselessness of cultural differences” (Ekman & Friesen, 1971).

While this study exists as an example of research that predominated the field prior to its focus on multicultural competency, recent literature focuses on contextualize these results. For example, Elfenbein & Ambady in 2002 re-examine the universality of emotional recognition, (Elfenbein & Ambady, 2002). In this study, it is found that while emotions were universally recognized, varied degrees of accuracy were noted. With greater in-group accuracy in expression and recognition, an advantage was also seen in culturally diverse settings (Effenbein & Ambady, 2002). Also notable was the fact that minority groups displayed greater degrees of accuracy in recognizing emotions from majority groups, as opposed to the other way around, (Elfenbein & Ambady, 2002).

Emotion: A Cultural Perspective.

Appraisal Theories. Appraisal theories of emotions interpret emotions as byproducts of the way people interpret and understand their environment, (Ellsworth, 1994). Research utilizing this theoretical perspective has traditionally focused on a few key dimensions such as: (1) individualism/collectivism, (2) certainty/uncertainty (3) Attention to Novelty (4) Valence/Degree of Perceived Pleasantness, (Ellsworth, 1994). Differences in emotional expression are largely attributed to emotional regulation, stating that culture defines the beliefs about appropriateness of emotional expression. Accounting for differences in understanding of emotional expression, the assertion is made that culture “provides a framework for understanding culturally general emotional phenomena,” (Ellsworth, 1994). With this as a quick and dirty overview of current research from this perspective, what follows are key insights I found particularly intriguing.

Emotion as a Social Function. Emotions function as cultural scripts that are comprised of an array of biological and cultural factors, (Kitayama & Markus, 1994). Developed as a result of individual, interpersonal and collective experiences, they represent culturally constructed adaptations to our surroundings. In this respect emotions are a “psychological process that may be seen primarily as social and cultural in nature” (Kityama & Markus, 1994):

Emotion as a Perceptual Process. When viewed within the context of a perceptual process, emotions can be seen as a level of readiness in response to immediate events (Frijda & Mesquita, 1994). For example, individuals experience emotions in response to events they encounter that are deemed significant. This significance is determined by the manner in which this situation is then appraised. This form of appraisal exists as a byproduct of both individual temperament and cultural influences. Culturally this appraisal reflects a system of meanings that are social in origin. Emotion then can be seen as a form of readiness to act, that reflects norms of expression based on cultural imbued interpretations (Frijda & Mesquita, 1994).

Emotion From a Goffmanesque Perspective. Yet another perspective of emotions can been seen when taken in the context of social interaction.   From this perspective they aren’t internal affective states influenced by cognition but a form of interaction with others and our surroundings. (Frijda & Mesquita, 1994). For example, witnessing emotional displays in others can be viewed as a social event. In expressing these feelings we “transmit important messages about ourselves in relation to our surroundings” (Leu, 2001). When we then interpret someone’s behavior we do so within the framework of norms regarding behavior, and cultural meaning systems. As a result of this event appraisal and the emotional responses we can then respond accordingly. Emotion in this respect contains five characteristics reflective of culture including: “1. quality, 2. intensity, 3. behavioural expression, 4. the manner in which they are managed and 5. Organization.” (Leu, 2001) This all occurs within what may be called a cultural framework defined as follows:

“A cultural framework includes a group’s sense of and attitudes toward emotions, that is what emotions are or feelings are, why they are experiencing, and what their significance is in social life, as well as the implicit answers to questions like when does one feel, where does one feel, and how does one feel.” (Frijda & Mesquita, 1994, p.99)

Culture & Biology: An Integrated Perspective.

In pulling together the insights from all of the above research, it seems to me all of the insights above play a part as elemental insights into what makes us work as humans. In other words, there are both biological and cultural factors that exist in influencing emotions. What follows is an example of research that considers particular/cultural factors, alongside the universal/biological ones.

Affect Valuation Theory. In an article titled, “Cultural Variation in Affect Valuation”, a key differentiation is made between ideal and actual affect, (Tsai & Fung, 2006).   Whereas our ideal affect reflects what we want to feel, our actual affect reflects our current emotional state. Based on the Affect Valuation Theory this research hypothesizes a difference between ideal and actual affect with greater cultural influence on ideal affect preferences, (Tsai & Fung, 2006).

With results of the study supporting their hypothesis, a brief example is provided that compares collectivist and individualistic cultures. With an individualistic cultural orientation likely to endorse values such as elation and excitement, participants from such cultures are likely to express this as an ideal affect orientation (Tsai & Fung, 2006) In contrast to this, collectivist cultures value a calm peaceful and relaxed state and participants are likely to endorse these as ideal affect preferences (Tsai & Fung, 2006).

As an interesting side note to this, it may be useful to mention the Marsha Linehan’s research that focuses on the concept of Dialectical Behavioral Therapy. I learned about this theory while in therapy myself.   Differentiating between primary and secondary emotions as a way of better understanding our emotions, it is a useful application to the above research.

While primary emotions comprise our immediate reactions to an event, our secondary emotions are aessentially our own interpretations of our emotional states. In other words, secondary emotions exist as “feelings about our feelings”. Utilizing the above research as an example, individuals from a collectivist culture would display more negative reactions to their own displays of excitement as a result of their own cultural references.

Empathy & Multicultural Counseling.

“Empathy has been described as the counselor’s ability to enter the client’s world, to feel with the client rather than for the client, and to think with the client rather than for or about the client. Empathy requires the therapist’s ability and effort to place him- or herself symbolically in the position of the client and understand the client’s world, “(Chung & Bernak, 2002, p154).

After a brief review of relevant literature on the nature of emotion and its relation to culture, a clearer understanding of inclusive cultural empathy seems vital. What follows is a bit of clarification on the concept, and how it fits in within the concept of cultural competency.

Clarifying the Concept.

Defined as an ability to put yourself in someone else’s shoes, empathy is a culturally relevant concept. Traditional perspectives of empathy are naturally self-limiting, based on a perspective that is largely empirical and individualistic in orientation. In contrast, culturally inclusive empathy is a useful dynamic perspective that requires two seemingly divergent viewpoints. Essentially, this concept requires that a counselor hold onto their own cultural perspective while maintaining an appreciation for their client’s culture (Chung & Bernak, 2002). Ensuring the counselor holds onto their own cultural perspective can be a useful and essential assurance against potential countertransference (Chung & Bernak, 2002) At the same time, appreciating and understanding a client’s culture is critical in the difference between sympathy and empathy (Chung & Bernak, 2002).   With this clarification in mind, what follows are key recommendations for the development of inclusive cultural empathy.

Developing Inclusive Cultural Empathy.

It seems in reviewing all of the above research, the best advice I found to develop inclusive cultural empathy existed as a reiteration of what I learned in this course. Essentially, two bits of advice stand as key insights I intend to utilize in moving forward. I discuss these each in turn below.

Attitudes, Knowledge, & Skills.  The concept of inclusive cultural empathy can best be understood as a dynamic process that exists as an exchange between client and counselor, (Pedersen, et al, 2008). It comprises three key skills: Affective Acceptance, Intellectual Understanding, & Appropriate Interaction (Pedersen, et al, 2008). With intellectual understanding best understood as a knowledge of similarities and differences, it is an essential to note this is not enough in and of itself. Affective acceptance requires that a counselor acknowledge culturally learned assumptions underlying divergent forms of affective communication (Pedersen, et al, 2008).  Finally, effectively communicating this means developing key interactive skills and abilities through ongoing direct contact within the community (Pedersen, et al, 2008). It is interesting to note that this discussion reflected much of what discussed in the class handout titled, “AMCD Multicultural Counseling Competencies” (Arredondo, et al, 1996).

An Ecclectic MAP/FACTS Approach. Alongside this ongoing commitment to the development of key skills as they relate to inclusive cultural empathy, is the need to utilize what our textbook describes as an eclectic approach, (Hays, 2008, p176):

“Eclecticism in psychotherapy can take two general terms. The first involves an integration of diverse theories into one transtheoretical mode. The second, known as technical eclecticism, describes the increasingly common practice of systematically choosing and using a wide range of interventions and procedures.” (Hays, 2008, p176)

Firstly utilizing the “Addressing Model” in a modified Axis-6 relevant to the DSM-5 (Hays, 2008), it will be essential to assess for sociocultural context throughout the counseling process, (Hays, 2008). Additionally, ongoing case conceptualization in the form of ongoing hypothesis formulation and testing will be important (Johnson, 2013; Pedersen, et al, 2008; Thomas 2007).  This ongoing hypothesis testing can occur much as described in the five-part FACTS Method approach including question formulation based on a knowledge and experience, and then assessing and adjusting as necessary, (Hays, 2008; Johnson 2013; Pedersen, et al, 2008; Thomas, 2007).   In conclusion, I wrap up this paper with a quote from an article titled “The relationship of culture and empathy in cross-cultural counseling.” (Chung & Bemak, 2002) This article contains a listing of seven useful guidelines in communicating cultural empathy:

“Counselors will not be effective working with clients from different cultural backgrounds if they cannot communicate cultural empathy in a way that demonstrates that they understand and appreciate the cultural differences and their impact on the therapeutic process.   Ridley (1995) identified the following seven guidelines for communicating cultural empathy….(a) describe in words to the client his/her understanding of the client’s self-experience; (b) communicate an interest in learning more about the client’s culture; (c) express lack of awareness regarding the client’s cultural experience; (d) affirm the client’s cultural experience; (e) clarify language and other mods of cultural communication; (f) communicate a desire to help the client work through personal struggles and challenges; and, (g) at an advanced level, help the client learn more about himself or herself and become more congruent.” (Chung & Bemak, 2002, p157)

Images: 1,

References

Abraham Lincoln University, (n.d.) Counseling Skills & Techniques.  Retrieved from:  http://courses.aiu.edu/COUNSELING%20SKILLS/10/10.pdf
Australian Institute of Professional Counselors, (n.d.).  Counselor skills series: Verbal & non-verbal communication skills.  Retrieved from:   http://courses.aiu.edu/COUNSELING%20SKILLS/10/10.pdf
Arredondo, P., Toporek, M.S., Brown S., Jones, J., Locke, D.C., J. and Stadler, H. (1996) Operationalization of the Multicultural Counseling Competencies. AMCD: Alexandria VA.
Chung, R. C., & Bernak, F. (2002). The relationship of culture and empathy in cross-cultural counseling. Journal of Counseling and Development : JCD, 80(2), 154-159.
Drab, K. (n.d.) The top ten counseling skills.  Retrieved from:  http://www.people.vcu.edu/~krhall/resources/cnslskills.pdf
Ekman, P., & Friesen, W. V. (1971). Constants across cultures in the face and emotion. Journal    of Personality and Social Psychology, 17(2), 124-129. Retrieved from:          doi:http://dx.doi.org/10.1037/h0030377
Elfenbein, H.A., & Ambady, N. (2002) On the Universality and Cultural Specificity of Emotion Recognition: A Meta-Analysis. Psychological Bulletin. 128(2). 203-235.
Ellsworth, P. C. (1994). Sense, culture, and sensibility. In S. Kitayama, & H. R. Markus (Eds.),   Emotion and culture: Empirical studies of mutual influence. (pp. 23-50) American         Psychological Association. Retrieved from: doi:http://dx.doi.org/10.1037/10152-001
Fortune, B. V. (2012). Acculturation, intergenerational conflict, distress and stress in Filipino -American families. (Order No. 3535626, Regent University). ProQuest Dissertations and Theses, , 115-n/a. Retrieved from: http://ezproxy.bellevue.edu:80/login?url=http://search.proquest.com/docview/1283231958?accountid=28125. (1283231958).
Frijda, N. H., & Mesquita, B. (1994). The social roles and functions of emotions. In S. Kitayama,            & H. R. Markus (Eds.), Emotion and culture: Empirical studies of mutual influence. (pp.    51-87) American Psychological Association. Retrieved from: doi:http://dx.doi.org/10.1037/10152-002
Hays, P. (2008). Addressing cultural complexities in practice. (2nd Ed.) Washington, D.C.: American Psychological Association.
Johnson, R. (2013) Forensic and Culturally Responsive Approach for the DSM-5: Just the FACTS. Journal of Theory Construction & Testing, 17(1), 18-22.
Kemper, T. D. (1981). Social Constructionist and Positivist Approaches to the Sociology of        Emotions. American Journal Of Sociology, 87(2), 336-362.
Kitayama, S., & Markus, H. R. (1994). Introduction to cultural psychology and emotion research. In S. Kitayama, & H. R. Markus (Eds.), Emotion and culture: Empirical studies       of mutual influence. (pp. 1-19) American Psychological Association. Retrieved from:  doi:http://dx.doi.org/10.1037/10152-010
Klafehn, J., Chenchen, L, & Chi-yue, C. (2013). To know or not to know, is that the question? Exploring the role and assessment of metacognition in cross-cultural contexts. Journal of Cross-Cultural Psychology. 44(6). 963-991.
Leu, C.M. (2001). Emotions as Dynamic Cultural Phenomena. The Journal of Linguistic and  Intercultural Education, 4. 62-75.
Linehan, M. M. (1997). Validation and Psychotherapy. In A. Bohard & L. Greenber (Eds.) Empathy Reconsidered: New Directions in Psychothrerapy. Washington DC: AC 352-392.
Markus, H. R., & Kitayama, S. (1994). The cultural construction of self and emotion: Implications for social behavior. In S. Kitayama, & H. R. Markus (Eds.), Emotion and    culture: Empirical studies of mutual influence. (pp. 89-130) American Psychological Association. Retrieved from: doi:http://dx.doi.org/10.1037/10152-003
Pedersen, P. B., Crethar, H. C., & Carlson, J. (2008). Inclusive cultural empathy: Making relationships central in counseling and psychotherapy (1st ed.). American Psychological Association. Retrieved from: doi:http://dx.doi.org/10.1037/11707-003
Prout, T.A., & Wadkins, M.J. (2014). Esssential Interviewing and Counseling Skills. New York: Springer Publishing Company.
Russell, A.J. (1994). Is There Universal Recognition of Emotion from Facial Expression? A  Review of the Cross Cultural Studies. Psychologial Bulletin 115(1). 101-141.
Sherer, K.R. (1997). The Role of Culture in Emotion-Antecedent Appraisal. Journal of     Personality and Social Psychology. 73(5). 902-922.
Thomas, J. C., Hersen, M., Sage eReference (Online, s. (Online service), & Sage Publications, i. (2007). Handbook of Clinical Interviewing with Adults. Los Angeles: Sage Publications.
Tsai, J.L, Knutson, B., Fung, H.H., (2006). Cultural Variation in Affect Valuation. Journal of      Personality and Social Psychology. 90(2). 288-307. Retrieved from:           http://ezproxy.bellevue.edu:80/login?url=http://search.proquest.com/docview/131977868  0?accountid=28125
Vohs, K.D., Baumeister, R.F., & Sage Productions, i. (2007). Encyclopedia of Social  Psychology. Thousand Oaks, Calif: Sage Productions.

Share This:

The Happy Family Game…

As usual my therapy session last Friday was very illuminating.

The session begins when I brought up some of the issues that came up over the week: (read this & this).  I then shared with him my “major light bulb moment”:  The most painful thing about my childhood was the consistent failure of all involved to acknowledge that I was hurting.   At home as well as school, all involved, I am the problem, and it’s solution.  Context didn’t matter and the role others played in the perpetuation of my own misery were irrelevant.  I was the problem, it was my fault.  Healing and moving forward has involved examining the context of the problem and that the issues were much bigger than me.

As I progress in therapy, I’m beginning to understand the depth of the unresolved crap that I carry inside me from my childhood.  There was never an opportunity for me to express how I felt, or share with someone what was  happening at home, at school, or with the extended family.  My misery was an all encompassing thing 24 hours a day that defined the reality of my existence.   I struggle, at times, with a doubt in the reality of my experiences, since all involved refuse to hear or acknowledge what I’ve been through….

Something happened at work that really disturbed me quite a bit….

I find myself, in a knee-jerk, matter complying with this bullshit idea that I must protect others from what they don’t want to see.  This habit is so automated that I can tend to do it quite a bit.  I hold within myself the reality of my emotional experiences, in order to get through my day.  I present a pleasant demeanor the majority of the time and appear pretty “even-headed” with such adeptness that it scares me at times.  In fact, a patient I cared for complemented on my pleasant and patient attitude.  He’s actually a very sweet individual & I enjoy caring for him.  However, the floor he’s on is always short-staffed and the nurses are clearly all “on edge”.  The lights are blinking like a Christmas tree and I’m trying to keep up with patient’s demands while getting vitals.  He calls often asking for small things and I know he’s lonely and needs to talk.  I become stressed & overwhelmed inside but try not to let it show.  At some point in the evening he states his sincere appreciation for me and how I always made time for him when nobody else did.  I smiled and responded with a quick thank you.

On the way out the door, I recall feeling dumbfounded and perplexed.  My mind was jostled by this complement & I instantaneously “snapped out of it”.

Until this moment, I was just feeling annoyed that I had to be on this particular floor.  It was a very heavy floor that was always short-staffed.  As the float pool tech, I felt I was being shit on and seething inside.  I began my shift with an internal piss-n-moan rant running in the back of my mind.  It wasn’t until I received a bit of acknowledgment from a patient that I started to reflect on my own thought processes that evening.  These thoughts had been acting as an internal narrator of the events of the evening:

“I can’t believe I’m dealing with the same person’s crap again for the fourth day in a row.   Why is it they have to shit on me & assign me to the stuff nobody wants to do?  If only they knew what I have on my plate,  I just don’t have the patience.”  My eyes began to well up with tears as I began to realize how good I was at “smiling and taking it like a man”.

By about 1:00 a.m. things start to quiet down & I’m able to sit down and have something to eat.

I found a quiet place so I could process what I learned from the meeting with my psychiatrist yesterday.  This pervasive tendency to suppress my emotions into the subconscious level of awareness was truly all-encompassing.  This just happens to be yet another consequence of the happy family game crap that I participate in.  This desire to create a certain public image involved hiding certain things and accentuating others things.  When my parents tell me they remember a happy girl, I believe they are sincere in this assertion, (however incorrect).  I came to realize, they were the beneficiaries of my coping mechanisms.  I protected them, and the family, at a huge expense to my own well-being.

The fact is, denying my truth was unhealthy.  Today, I’m so good at keeping things inside that it is almost a knee-jerk action.

This is why today, when I talk about my childhood with the family, they have such a very different memory of things.  I kept the reality of my day-to-day life out of their view.  I protected them from what I knew they were incapable of handling.    I would like, at some point, to tell the truth of my experiences as an act of defiance.  It would be a useful and essential opportunity to state publicly the reality of my life experiences.  However, before doing so, I need to prepare myself with the frustrating reality that some people might react very negatively to my story.  I would need to carefully weigh my options and consider my true motives for doing so….

My biggest struggle today is with a slow grieving process.  Neglect is a painful, yet frequently overlooked experience, in some respects just as painful as abuse…

Underlying everything that I’ve gone through is just the idea that I was alone.

There was no one there for me at home or in school.  The consistent message that I received is that context was irrelevant.  My own perspective wasn’t as important as is the idea that the problem is me and I need to fix it myself.   And the funny thing about this assertion, are how I react to it differently at varied levels of awareness….

In fact, I believe there are different levels of knowing.

I can take in the logic of what someone says and filter it against my own experience.  Yet emotionally, my feelings betray me.  When re-experiencing old trauma, I don’t care about logic, all I know I feel shame, hurt, and invalidation.   I ask myself about the purpose of this secrecy and why I’m not supposed to say anything.  Why are they so insistent on not seeing certain things?  There is fear, pain, and simply a desire to avoid those things that hurt to much to look at too long…

…So the frustrating thing is I’m left to figure things out on my own.  Like the serenity prayer, I focus on what I can change and let go of the rest.  It feels so lonely simply because there is no one in my life who was there that the way things went down. Instead, when the past comes up, it was me and my problems.

My mind is like a safety bubble within which I reside reside in order to avoid the body’s messages of the unresolved emotions I’m not ready to deal with…

I have a pervasive and f-d up tendency to separate the goings on in my body from an awareness in my mind

I am starting to appreciate the real consequences of this coping mechanism. It has repeatedly slapped me in the face over the last several weeks.  I am going through stuff throughout the week that impacts me.  The emotions and thoughts don’t present themselves until I am at my final straw.  Emotions bubble over & become too much to handle.  The cycle has been repetitive over the last several months…

I spend too much of my life with this happy smile on my face that allows everyone to believe that Kathleen’s doing just fine.  The happy game I play is now my own.  My outer presentation never fully justifies the reality of what I’m feeling in the moment.  I know that the reality of my childhood was a perfectly crafted performance.  They acted like they were fine and I had to act like I was fine not so we could seem like the perfect happy little girl & everybody we were okay…

HOWEVER, below the surface my dad had checked out, my mom was stressed, my sister felt alone, and I was depressed….

Image: 1

References

Van Der Kolk, B. (2014). The body keeps the score. New York, NY: Viking.

Share This:

Raggedy Ann & The China Dolls

So I just dropped the boys off at home after picking them up at school, & am in the car dictating  this on my iPhone…

I have a few errands to run and decided drop my kids off so they can do their assigned errands and start homework. I’m now stuck in traffic after stopping by Starbucks to pick up three Bacon Gouda Sandwiches since I am just too darn lazy to cook.

This particular Starbucks is in a very busy area, so I wait for my food about 15 minutes and unobtrusively people-watch. There are several small groups of high school and college students studying.  Wandering in and out are full-time working adults, picking up something to go really quick.

As I finish giving my order, I notice this lady walk in. She’s about my age and has two children with her. The oldest is boy about 12, I’m guessing. He is carrying a school bag and is wearing khaki pants and a button up shirt. His hair is perfectly combed.   Her daughter is about 5-6 and dressed in a pretty sunflower dress with matching bows in her hair and matching flats with white hose and a little purse.

As they walk by me, I notice her perfectly crafted appearance. She has her hair pulled back into a neat bun. Wearing a professional business suit, expensive shoes and fancy handbag, I notice her makeup is perfect down to the bright red lipstick and expertly drawn eyebrows. Together they look like the absolutely perfect family you find in empty picture frames at the store.

I then begin to think what sort of first impression I must leave…

I was up late last night finishing up some internship paperwork.   My husband ended up taking the kids to school so I could sleep in until 9 o’clock.   When I woke up that morning, I spent about fifteen minutes on my appearance before walking out the door. I threw something on that fit my personal standard of comfortable while still falling within the “business casual” dress code. I recall looking at my reflection that morning and cringing. As I got dressed, my lumpy out of shape body was truly a depressed sight. I berated myself for getting out of shape and longed for the day when I can find time to exercise. I pushed these thoughts out of my mind and told my inner critic to shut up.  I  reminded myself that I was working 65-70 hours a week. As a recovering shlumpadinka, I’m unfamiliar with daily makeup and hair routine. I try my best to cover-up my uneven skin and apply light eye shadow while leaving my hair as the last task, before walking out the door.

A feeling of sadness wells up inside as I gather the remnants of my once-long hair into a ponytail.

It was down to my waist last year, when I asked a friend to layer it a bit. I was hoping for a more professional appearance that fit my future counseling career. Anyway, my instructions to leave the length at about my shoulder blades were ignored as she made the executive decision to cut it at the shoulder. I now struggle every morning to get every last bit of shorn hair into a neat ponytail. I simply have no desire to look at it, and the ponytail is my only option….

By the time I reach Starbucks to pick up the Bacon Gouda Sandwiches, it as almost 4:00 p.m. and I had given up on the hair by that point. The ponytail was falling out and I looked like a disheveled mess. As this lady makes her way to the register she throws a quick side-glance in my direction that kind of spoke volumes in a way that words didn’t have to. I politely smiled at her and walked to my car.

On the way home, This experience reminded of some cousins on my dad’s side….

My dad is the oldest of four boys and has two brothers that are close in age.  Throughout their lives they hit all major life milestones around the same time. After finishing their degrees, they married within the same year and got their wives pregnant shortly thereafter. For this reason, I have one cousin a month older than me, and another who is eight months younger than me. Since we are all female there was an upper-middle class success-based comparison between us growing up…

What stands out to me most about this experience, is a feeling of less-than-ness that I intuitively knew had some sort of historical component.

It was also clear to me, that we weren’t allowed to talk about it openly with anyone.  For this reason, these experiences burn in my mind as unresolved questions that residing in the attic of my mind.   My father was raised in that perfect all-American family. He grew up in a cute gingerbread house that stood on the top of a hill overlooking a creek. It was built in the late 1800s and on the historical registry. Every year we visited around the holidays and I  marveled at how perfectly decorated everything was. My grandmother had a love of all things beige, and I was impressed at how clean she was to keep everything. The routine was always the same. We visited every thanksgiving and endured a 13-hour drive in the ’77 t-bird with no legroom. My dad and his brothers would gather in the kitchen with their parents and talk at the same time in loud booming voices.   As a young child, they were all imposing figures, standing at around 6 feet in height and always perfectly groomed.

My grandmother, always reminded me of June Cleaver.  She cooked thanksgiving meals in nice dresses & high heals in at perfect house, creating the perfect family meal.


I have to admit overall I’m pretty lucky. I believe the most profound legacy in a family is psychological in nature. In this respect I can’t complain. Nobody in his family has ever divorced and I am stranger to the idea. Everybody in the family is an “upstanding citizen of the community”. The ladies stay at home and the men hold respectable jobs, (i.e. lawyers, bankers, dentists, college professor, etc). They are able to uphold the upper-middle class lifestyle, and attain their own perfectly decorated homes. Coming from this background, if all I do is repeat what I know I’m doing pretty well. I am happily married, an upstanding citizen, well educated, and living a good life.

However, I am a firm believer there is a “shadow side” to everything in life.

I have always enjoyed digging deeper to expose the hidden underbelly of things. I suppose it is an inherent character trait or personality quirk. What I’ve discovered is that against this perfect image is something hidden that the family colludes together to conceal.  So what is meant by the term shadow??? The term is based on Jung’s concept of the shadow. At the Society of Analytical Psychology in the U.K., I found a great definition:

I noticed the small things each visit that indicated there was more to the story of than meets the eye & longed to know more…

The first indications of this came from my father.  My dad’s brothers all wore suits and ties like my grandfather. Together they presented a perfect image. However, for whatever reason, my dad bucked tradition and did his “own thing”. He lives in jeans and button up plaid shirts, (always un-tucked), with the sleeves rolled up just below the elbows. He never fastens the top two buttons and stained t-shirts are always visible above his collar.  Completing this ensemble is a thick leather belt with keys hanging on the side that make a klinking sound when he walks. He also loves gaudy rings. My favorite is the one of a grim reaper riding a motorcycle and large ruby eyes.   My earliest memories of my father are of playing with his scraggly beard while watching his untrimmed nose hairs wiggle when he would breathe. I always imagined that they were huge wooly bear caterpillars crawling up his nose.

While this description paints an “interesting picture”, I’d like to add that as a child, he was larger than life.

I looked up to my father as a hero and was proud to say I was a lot like him. As a bullied child who never fit in, his unique unapologetic attitude towards others’ opinions gave me comfort. I remember wondering what was wrong with me and why nobody liked me. I hated myself for being different and standing out like a sore thumb. My father’s stubborn refusal to be anything other than who he was, provided a feeling of comfort. It gave me hope that I could survive the bullying, if I could only be myself in the world, just like him…

Anyway, I recall an incident one year while visiting the grandparents on thanksgiving.

My sister was just a toddler so I’m guessing I was about 7-years-old. As my father took off his jacket and hung it in the kitchen closet, my grandmother began giving him the “once over”. A look of disappointment fell across her face and she turned away to stir the food on the stove. Once my dad left the kitchen to join his brothers in the den, the ladies sat down to chat a bit. My grandmother took a spot next to my mother and commented, “I was never able to get him to wear a suit but always believed his wife would succeed where I failed, I guess I was wrong”.   My mother sat there with a stunned look on her face as my grandmother looked at her with disappointment.

And then there were assorted side-comments & stories about my father, alluding to his “differentness”.

I remember being asked on several occasions by younger male cousins during the holidays, why my dad was “so weird”. Then there was one year, when we visited my uncle’s house & my aunt said something interesting.   This was after dinner & the ladies were sitting down in the living room. Since my aunt knew my dad from a young age, I had many questions.  According to my aunt, there was a point in high school when my father just decided to stop talking to everyone and spent all his time in his bedroom.  Apparently this happened during his last two years of high school when he was having trouble getting along with his parents. I wanted so badly to ask my dad about this, but my mother warned me, under no circumstances was I to discuss it with him….

So against this backdrop, I endured the emotional impact of thisconstant comparison.  The fact that I stood out like a sore thumb didn’t help matters.

I couldn’t help but wonder about this feeling that history was repeating itself, yet frustrated that there was no opportunity to talk about it.  When we were little, I recall no real feelings of being different from them. We all enjoyed playing together. However, as we reached our pre-teens, evidence of my odd-ball-ness became painfully clear.

One Thanksgiving on the way home from grandma’s house we stopped by my uncle’s house.

He was just 15-months younger than my father.  As, almost-Irish-twins, they have lots of stories to tell.  The adults gathered in the living room, as my aunt suggested I go bicycling with my cousin.  She was just about one month younger than me at the time. A look of anger flashed across her face as she stormed out the garage. Encouraging me to follow her my aunt continued insisting we go on this bike ride.  Sensing my cousin’s discomfort, I told my aunt that I was okay and started walking inside. However, my aunt was insistent. A heated discussion continues for – what seems like an eternity…

…To make a long story, my aunt wins the argument and this cousin ends up being forced to take me on a ride around town on bicycles. She first grabs an old bike for me to ride and tells me she needs to “adjust the gears a bit”. She then warns me not to bicycle next to her because she has friends in the neighborhood and doesn’t want to be seen with me. As we start riding, I notice that the bicycle doesn’t go very fast and begin to realize she screwed with the gears so I am unable to keep up. I try my hardest to stay within eyesight of her, but it’s useless.  She peaks her head over her shoulder every so often to make sure I’m keeping up. However, I have difficulty maintaining a steady distance from her since I don’t know how to readjust the gears.  My eyes fill with tears, as I realize that it is officially undeniable that I am an oddball. Her figure gets smaller and smaller down the strange and lonely streets until I’m completely lost.

By the time we reached high school, it was an undeniable fact that I was Raggedy Ann standing next two perfect china dolls.

My mind is chuck full of memories like the one above, that gnaw at my gut like day-old sushi. There was that year when a cousin got mad at me for going to a mall she frequented, out of fear that her friends would see me. Then there were the family dinners on thanksgiving in which my cousins would sit close together and exchange stories of their life. I could see our differences most painfully in that moment.

We were on opposite sides of an invisible fence that defined who was and was not “socially acceptable”.

Today, as I recall these experiences I know the how come and why of it all.  I am able to provide an explanation of things here, here, here, or here or here.   However, this clinical explanation does absolutely nothing to wipe away the twinge of sadness that fills my heart when I type this.  The nail on the coffin to this story was my sister’s advice when I shared this with her recently:  “Just ignore it, it’s years ago.”  That’s easier said than done since the pain still burns in me as if its yesterday.  It amazes that while we lived in the same home, we remember the experience in highly divergent ways.

If I have my way, I hope to never lay my eyes on those two *&%#@ again!!


Images: 1, 2, 3, 4, 5

References

Perry, Christopher (n.d.). The Shadow. Retrieved from: http://www.thesap.org.uk/resources/articles-on-jungian-psychology-2/about-analysis-and-therapy/the-shadow/

Share This:

A Recovering Shlumpadinka

A male friend told me once that I looked like Joey Ramone because of my long black hair, glasses, & large nose. Our friendship began somewhat incidentally in the waiting room of a job service agency where he struck up a conversation. On his way out he asked for my number. We went on a couple of dates but it didn’t really go anywhere. He had gotten out of a bad relationship & I was trying to recover from the “it years”.

It was the mid-90’s and we were both in our 20’s: no longer kids but not quite adults.  As was the case for many of my generation, we completed our college degrees only to find ourselves no better off financially. I held a variety of secretarial positions while he worked in retail. Dead broke with no promising career options, we hung out a lot simply to curb the occasional bouts loneliness.

It’s been years since we’ve spoken.  We grew apart because in time, I started to feel like his mom. He would come over and raid my fridge and use my washing machine. Or stop by to borrow a “few bucks”.  When we would actually hang out, I would have to hear his long and often complicated dating stories. He reminded me of Jack Black in that Shallow Hal movie.

Anyway, I can still recall that moment when he made that Joey Ramone comment. He had this Cheshire grin on his face as he looked at me, proud of his joke.   My face grew cold as I turned my head away to hide the tears.  I was really a just a sad pathetic joke to him.  He didn’t give a shit about me.  Memories of “the it years”  flooded back into my mind.  The verbal abuse, treatment and put-downs from this relationship reverberated in my head…  

“You know all the guys on the floor are telling me I should dump you for the girl with the huge tits.” He informs me of this in the weeks and months after I lose my virginity to him. I am insecure and desperate for acceptance, love, and belonging. He said I was just average looking: about five, (six on a good day). He said my breasts were too small and wanted me to get implants.  I had scrawny chicken legs, an ugly nose and horrible hair. On top of that, I had no sense of style and was more ‘”inexperienced” than the other women he cheated on me with. In short, I was a pathetic charity case…

A desire to avoid re-experiencing the pain of rejection from my child was so strong while I was in this relationship. It overcame logic or sensibility.  The only thing I could see was anxiety and panic, nothing else  was able to filter inward.  I needed to avoid rejection – it was just too hard….

What’s so strange is that this man who treated me like crap and told me I was worthless, wasn’t really “all that” himself.   His hero was Andrew Dice Clay (this was the early 90’s). However he looked more like Steven Assanti, that 800 pound man on TLC.

As women, we are all made to face a world that assigns us value based on an array of random qualities which happen to define our meat suit.  As someone who falls within the “have not” category, there is still quite of unresolved bitterness I need to work through.  The above video reflects fairly accurately how I’ve adjusted to this reality.

Heather Matarazzo, who played Dawn Weiner in my favorite movie “Welcome to the Dollhouse”  describes a similar experience in her blog  “What the Fuck is Fuckable”.

“Seriously? What the fuck is fuckable?? I don’t know if I can answer that question for you, but I can share my own experience. When I was 19 or so, I was standing in a Starbucks in West Hollywood with a director, talking about the upcoming film we were about to shoot. It had been a long road, but we had finally made it. Waiting for our coffee, I could see that he seemed a bit uneasy. I asked him if everything was ok. He said yes. I didn’t believe him, so I asked him again. He looked at me and said “Heather, I’m sorry, we have to give your role to another actor. The producers don’t want you.” I didn’t understand. I had been attached to this project for two years, and now two weeks before filming, I’m being let go. I asked him why. He looked me dead in the eyes and said “They say you’re not fuckable.” Well, fuck me. Even as I write this, I can still feel the pain, shame, and humiliation that came over me in that moment. This is a part that I had been so excited to play. She was bold, witty, sarcastic, sexy, but more importantly, she had a deeper vulnerability underneath. She had layers, she was complex. (Matarazzo, 2015, February, 6).”

A second online story that resonates with my experience comes from an anonymous post on reddit by a woman who describes the typical experience of the average “less-than” girl who is occasionally reminded of her inherent meat-suit based value.

“I am an ugly woman. Objectively, I really am. Please don’t argue with me on this one, Reddit. I am not overweight, actually in better shape than most women my age, I dress well, I am great with makeup. But last weekend the world just had to remind me that despite all this, people will go out of their way to kick me….There was a photographer going around the club, taking pictures of the people there. I assume it was for some promo for their website or something. He got to our group, and literally circled us several times, taking several pics from different angles. I was kind of psyched about this, so I did my best to look like I was having a good time, made sure he could snap me at my best. But after a while I realized he wasn’t circling us to get our best angles. He was trying to get a frame without ME. If I moved closer to the center of the group, for instance, he would tilt his camera a little the other way. I couldn’t believe it until finally, he actually came up to me and asked me to get out of the shot….I felt so ugly right then. For all the effort I had put into looking and feeling good that night, it seemed like it just didn’t matter. So the night ends with me leaving the club. My friend with the bf at home who was dancing with me left with me so I wouldn’t be alone. The rest of my girl friends didn’t notice what had happened with the photographer, so when they asked me where I was going I just told them I was tired and wanted to go home. And since I wasn’t leaving alone, they let me.” throwmeaway4352 (n.d.)

My earliest awareness of my “less-than-ness” came as young child in grade school.  I was half Filipino, raised in a small town in the midwest, (clicking on this link will take you to a book written by somebody who was raised in my hometown).   The popular girls were all pretty blondes, who dressed well and had a good handle on the in’s and outs of social politics at our school.  I, on the other hand, was a quirky girl with dark features, a large nose, and no sense of style.  As I grew up, and the ostracism and bullying increased, I withdrew in my own world.  I perceived the problem as “them” they were just mean idiots in my school.  Once I move away, I thought, it will be “all better”.  Things naturally, didn’t get better as I had hoped, and I entered an “unhealthy relationship”, with an individual who was intent of “beating me into submission”.

A consistent diet of put-downs and abusive behavior is what it took for my insecurities to become certainties…

My first boyfriend was the first one to make me aware that my meat suit defined my social value in today’s world.   He told me repeatedly that I was an ugly, and therefore, a “charity case”.  This was a painful punch in the gut much as Heather Matarazzo describes.  I was forced to face then that a world existed beyond what I create inside my head that evaluated me harshly against a physical beauty standard.  It was this standard of physical beauty that assigned me a value of me based on the random factors that defined my meat suit.  As I grew to appreciate the ramifications of this my self esteem crumbled.

Within my mind, there was a slow and gradual erasure of any remaining awareness of inner beauty, until it was completely gone.

So why am I writing this post???

I want to stress here, that this post isn’t about bitterness.  I admit there has been a bit of pissing and moaning occasionally on this blog.  However, the goal of this blog post isn’t to feel sorry for myself.  If I had to summarize all my life experiences and professional education into one critical insight, it would the following:

We become what we believe we are and get what we believe is possible.

This life lesson is summarized excellently in a series of videos on youtube based on books by Shel Silverstein.  Many of life’s problems can be attributed to how we are looking at things and not what we are viewing as the cause of our issues.  Gaining clarity in life takes a lot of work.  For the majority of us, it isn’t we’re “north of 40” that we can begin to feel an appreciable sense of clarity.   It is for this reason, that I believe youth is a vastly overrated experience.

I’m sincerely grateful to have made it to be where I am, and have absolutely no desire to wind back the clock of time…..


Missing Piece or Big O???

In my experience, becoming a “big O” requires us to simply see the world as it is.  Seeing the world as it is, can be daunting for those with a history of trauma.  There are elements of our past that are too painful for” direct viewing”.   Those without a history of trauma can also have difficulty seeing the ugly side of things can.   The problem with not seeing those ugly things in life, is that they are unexamined.  When unexamined, they affect our beliefs, thoughts, feelings and perceptions, and become self-fulfilling prophecies.  

So, here is the purpose of this post: To Get Real w/ Myself.

Lesson #1:  Bullshit is Infectious.

In a previous, I discuss the concept of self-deception as the perplexing ability we have to lie to ourselves, while not noticing we do so:

Bullshit is infectious & needs to be treated as a dangerous contagion In the previous section, I provide examples of unseen aspects of social experience. When you examine these unseen things closely you find that self-deception can become shared. Others’ bullshit ideas, when unexamined, can become our bullshit ideas. Bullshit is infectious and needs to be treated as a dangerous contagion.

Lesson #2:  Life is Unfair.  Deal with it.

There is a definite social reality which exists, that no amount of intellectual gymnastics can erase entirely.  It is true that within the minds of many, this meat suit, is an indelible fact.  We are reduced to an idea which doesn’t do justice to the reality of who we are.  This “less-than-ness” is painful simply because it is a perception based on bullshit while carrying a life of its own – independent of who we are.  I need to accept that there are many people who can’t see beyond my meat suit.  However, I must also acknowledge the fact that what I focus upon emotionally expands.  For example, when I read stories such as the ones above, emotions bubble up inside.  However, while I am aware of these feelings, I do not ruminat over them endlessly.  This will decimate many of life’s possibilities and my true inner potential.

(((If you don’t understand what I’m saying, re-watch the missing piece videos))) There’s that part in the first video, where that Pacman dude sets down the pie thingie.  That action is huge.  It is an act of realizing that he’s running on a hamster wheel, perpetuating bullshit by mindlessly consuming the ideas fed to him by others.  Set the missing piece down, and walk away.  It does not hold the answers.   Like Dorothy and the Ruby Slippers, you hold the solution and just need to believe in yourself.

Lesson #3:  Understand Society’s Motives

I don’t want to get too nerd-girl-ish but system’s theory is a useful perspective with which to understand society’s motives for assigning value to women based on the meat suit.  In a recent post I state the following:

Systems Theory can be thought of as a lens through which to view the relational processes of individuals and the significant others with whom they interact in their attempts to derive meaning and construct an identity. (Curtis & McPherson, 2000, p50)…hat is first notable about systems theory is its view of individuals as a subsystem within a larger subsystem (Arthur & McMahon, 2005). If one were to provide a diagrammatic picture of this theory, they would draw a series of concentric circles. With a picture that looks much like a target, each level, can be thought of as a subsystem within a subsystem. The individual is a system that exists within microsystems such as family, peers, or work environment. These microsystems, then exist within a larger ecosystem that can be thought of as society at large. How does this relate to counseling practice? Essentially it calls for an understanding of individuals holistically, people aren’t beings unto themselves, but parts of a larger whole (Curtis & McPherson, 2000, p50)

Basically this theory notes how individual’s cannot be understood independent of the social worlds they reside within.  Individuals and societies are interdependent concepts in the sense that the whole is not equal to the sum of its parts.  When stable, a state of homeostasis exists.

The point is, society and its members work together to perpetuate a system of beliefs upon which our culture and society are built.  If you take away the belief system or question it, the entire foundation upon which society is built crumbles.  It is important to aware, the valuation processes upon which women are evaluated, are simply social constructs that tend to act as the basis of the “game of life”.  They are essential for a social homeostasis, that many defend unquestioningly.  They aren’t fact, they are simply the rules of the game.  How is it you are choosing to participate???

https://india.blogs.nytimes.com/2013/01/16/indias-man-problem/?_r=0

http://www.economist.com/news/asia/21648715-distorted-sex-ratios-birth-generation-ago-are-changing-marriage-and-damaging-societies-asias

Lesson #4:  I’m missing the good stuff!!!

My husband complains often that our 18 years together still can’t compete with what some assholes said to me umpteen years ago.  He says he truly loves me as I am.  He sees me as beautiful and doesn’t understand why those words from so long ago can affect me so profoundly today.  As my “partner in crime” he calls me out on my bullshit.  I use my past experiences as an excuse for why I don’t work through this issue.

 I think he’s right…

Images: 1, 2, 3,

References

Curtis, D.F. & McPherson, R.H. (2000). The clinical utility of systems theory in counseling practice. Journal of Professional Counseling, Practice, Theory & Research. 28(1) 50-63.
https://heathermatarazzo.wordpress.com/ (2015, February, 6).  “What the Fuck is Unfuckable”  Retrieved from:  https://heathermatarazzo.wordpress.com/2015/02/06/what-the-fuck-is-fuckable/
Merriam Webster Dictionary, (2008, September, 5).  Shlumpadinka.  Retrieved from:  http://nws.merriam-webster.com/opendictionary/newword_display_alpha.php?letter=Sh&last=100
throwmeaway4352 (n.d.) People are just so mean to ugly women. Please be kinder, Reddit. Retrieved from: https://www.reddit.com/r/TwoXChromosomes/comments/2k3osv/people_are_just_so_mean_to_ugly_women_please_be/

Share This: