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Understanding & Handling Resistance

As a student therapist, I am spending about 20+ hours a week at a substance abuse treatment center.  The biggest lessons I’ve learned thus far, pertains to the nature of resistant as it appears within addiction.   Since understanding this concept is critical to my effectiveness, I’m stopping to reflect upon what I’ve learned thus far….

From The Client’s Perspective…..

Last week at my internship site I was leading a therapy group for individuals struggling with addiction.  At one point, during the session, someone asked me “what do you think of all of us?” This followed an exercise on awareness that required participants talked a bit about the consequences of their addiction.  With the spotlight faced squarely upon me, everyone awaited silently for my response.  I knew what I wanted to say, but was nervous in my ability to communicate it effectively.  Starting off with a desire to put myself in the client’s shoes, this is what I hoped to convey…

I wanted to acknowledge their overwhelming sense of shame about what they had done, & how this made forward motion difficult. 
I tried to let them know I understood they were struggling without their coping tools.  I was aware of the full-on rush of thoughts & feelings came with this…  
I hoped to convey empathy for their traumatic histories as well as the daily struggles that made quitting so difficult…

A perplexing mix of empathy and gratitude filled my mind.  While my heart went out to them, a need for radical acceptance, opposite action, and responsibility lay before them.  My mind floated toward my own pathway of recovery & healing.  I was grateful for the long road to toward this present moment.  I’ve really come a long way.

Paradoxical Dualism – Subjectivity & Objectivity

As I see it, a perplexing dualism exists within the counselor’s mind while providing therapy.  On the one hand, you have a Rogerian unconditional positive regard as an essential element in the therapeutic relationship.  On the other hand, you have the sort of confrontational style found with addiction counseling’s history.  Where is there a middle ground between these extremes?  In today’s medically-based climate, objective analysis of presenting symptoms is emphasized.  Adding to this is is the attitude of individualism prevalent in Westernized medicine.   As an INFP, I gravitate toward empathy, understanding, & validation.  As a biracial individual, multicultural sensitivity is a priority.   Is the pendulum swinging away from these things as it pertains to the practice of therapy?

From clinical perspective resistance to recovery is as infuriating as it is perplexing.  Effective solutions to escape the miseries of addiction are available  What is preventing them from utilizing these tools?!?!

Not surprisingly, this question is reminiscent of the  “Why don’t you just leave?” response I got from my family during the “it years”. Its so hard to understand what it is to “live the problem”, when you’re outside it from a safe and objective distance.  Unresolved baggage from childhood traumas, produced a shame-filled reality wherein I was worthless – unimaginable to outsiders.  The “I need him” mentality brought about by prolonged ostracism was difficult to understand.  Emotionally, I felt lost with nobody in my corner.  I needed someone – ANYONE – to love me…..

…So how can one begin to step outside the empathist’s hat, and begin to develop a discerning clinical judgment on the matter of this perplexing resistance, that allows you to prolong & magnify misery when healing solutions exist within one’s reach? My first answer to this question came in the form of insights from the “SASSI-3”

Measuring Resistance – SASSI3

“SASSI” stands for “Substance Abuse Subtle Screening Inventory”.  It is utilized in intake evaluations at the inpatient substance abuse facility I’m interning at currently.  This brief self-reporting instrument helps identify those who are likely to have a substance abuse problem (sassi.com, n.d.).  Of relevance to this post, are a few “subtle scales” which don’t have a direct bearing on substance abuse behaviors, but are useful for making”inferences” (sassi.com, n.d).  I describe a few interesting subtle scales below:

“OAT” Obvious Attributes

“OAT Scale scores measure the extent to which an individual endorses statements of personal limitation…low scorerers are likely to be reluctant to acknowledge personal shortcomings. (Miller, Renn & Lawzowski, 2001, p. 3)”.  As I understand it, this score reflects characteristics of our temperament that can either function as strengths or areas of growth.  Low scorers are more prone to deny their shortcomings.  Miller, Renn, & Lazowski, (2001) suggest that “it is not useful to agree or disagree with clients’ self-appraisals” (p. 3)..  When encountering individual’s with low OAT scores, it is important to avoid being too critical since this can cause clients to become defensive.  Instead motivational interviewing is useful to build discrepancy and reduce resistance.

“SAT” Subtle Attributes

The SAT score is useful in identifying “characteristics of substance misuse that are not easily recognized as such  (Miller, Renn & Lawzowski, 2001, p. 3).”  The utility of this measure, is in its ability to help reveal information clients deny to themselves or become deluded about.  In other words, it is a measure of an individual’s degree of self-deceptiveness regarding the consequences of one’s behavior.  Miller, Renn, & Lazowski, (2001) note the “sincerely deluded” (p. 3) nature of an addict’s tendency to avoid acknowledging the consequences of continued use.  So how does one begin discussing such subjects?

“There is no point in giving people messages that are too strong and too discrepant from their points of view. On the other hand, there is also no point giving a message unless it promotes positive change. Successful feedback depends on starting from a point that clients can accept and then increasing the breadth of their understanding.(Miller, Renn & Lawzowski, 2001, p. 4).”

“DEF” Defensiveness

“The primary purpose of the DEF scale is to identify defensive clients who are trying to conceal evidence of personal problems and limitations (Miller, Renn & Lawzowski, 2001, p. 3).”  In other words, it assesses an individuals tendency to conceal of an personal or situational problems in their lives.  This is ego-driven activity, reveals how they feel about themselves in relation to others.  For example, low DEF scores indicate low self esteem & feelings of hopelessness about one’s situation.  In contrast, elevated DEF scores indicate individuals are concealing their problems in order to “fake good” (Miller, Renn, Lazowski, 2001, p.4).   Concealing problems in this way serves to protect people from something painful they wish to avoid dealing with.

So to conclude, the SASSI-3 characterizes resistance as a: (1) a refusal to acknowledge personal shortcomings, (2) a tendency to remain deluded about the consequences of one’s actions and (3) a general desire to conceal personal problems from oneself.

So How Do You Address this Resistance????

Earlier this week, in a supervisory meeting, the interns sat down to discuss the cases they were assigned.   As the “newbie” of the group, I stepped back and listen throughout most of the session.  At one point, an intriguing debate ensued between the supervisory therapist and an experienced intern who is close to graduation.  From their discussion, I noted two divergent attitudes on the utility of confrontation and direction.  Underying these divergent attitudes were two very different approaches to therapy.  What follows are two different therapeutic approaches that appear as opposite ends on a continuum.  What follows is a description of the two extremes along this continuum of variance in therapy approaches:

A Rogerian Nondirective Stance

Non-directive therapy, considers the client to be his/her own expert.  In other words, the direction that therapy takes depends on a client’s own personal judgment and not the therapist’s.  Rogers describes non-directive therapy as client-centered in the sense that they have a capacity for self-understanding and self-direction.  It is a mirror opposite of authoritarian confrontation common in addiction counseling.  This empathetic approach involves the establishment of “a collaborative partnership that respects the client’s capacity for and right to self-determination (Policin, 2003, p. 20)”

From this perspective a therapist’s job is unconditional positive regard and an acceptance of their feelings.  It excludes a need to explain, challenge, or direct (Raskin, 1948).  The client’s subjective stance, takes presidence over the therapist’s clinical judgment:

“the nondirective point-of-view on this issue is that to the extent that some other frame of reference than the client’s is introduced into the therapeutic situation, the therapy is not client-centered”  (Raskin, 1948, p. 106).

Confrontation in Counseling…

Defined as “process by which a therapist provides direct, reality-oriented feedback to a client regarding the client’s own thoughts, feelings or behavior” (White & Miller, 2007, p. 2), therapeutic confrontation has a long history in the field of addiction counseling.  Historically, this counseling style was utilized in chemical dependency treatment to overcome denial & resistance (Policin, 2003).  Aggressive confrontational styles like “Synanon’s attack therapy” Pokin, (2003), were utilized to break down the defense mechanisms underlying an addict’s utilized to deny their problems.  White & MIller (2007) described this confrontation as a highly varied form of confrontation ranging from “frank feedback to profanity-laden indictments, screamed denunciations of character, challenges and ultimatums. (p. 2)”.  This description resonates with a story my own therapist told me of her own internship experience at a substance abuse treatment facility in the 70’s.

A Comparison of Non-direction & Confrontation

Understanding of the client?

According to White & Miller (2007) the prevalent view of addicts changed somewhere between the 1920’s – 1950’s from an individual who was struggling with side effects of medications to a “‘vicious’ addict who sought narcotics as a source of pleasure” (p. 4).  Implicit in this confrontational perspective is a view of the client the cause of these problems.  This perspective focuses on an addict’s “defective, psychopathic personality (White & Miller, 2007, p. 4)”.  In contrast, a Rogerian non-directed approach, focuses on the client not as a cause of the problems, but as the solution to them.  Finally, modern perspectives point toward alterations in brain function.

Understanding Cause?

A Confrontational Perspective holds the client as the cause of his/her problems and attributes their issues to a personal defect of some sort (White & Miller, 2007; Policin, 2003).  In contrast, a modern view of addiction holds a medically based-perspective which dictates that addiction is a disease.  The cause of addictive behavior are neurological alterations in the brains reward system.  These alterations in the reward and control circuits of the brain (Inaba & Chen, 2014) are associated with addiction since they are responsible for encouraging us to engage in those behaviors that are beneficial for our survival. Our textbook calls this reward pathway the “go switch” (Inaba & Chen, 2014, p. 2.13), since it is the brain’s motivator and reinforces beneficial behaviors.  In an addict’s brain, alterations can be found in this area.  Personally, I believe an epigenetic & biopsychosocial perspective best describes the complex causal factors underlying addiction.

Understanding the solutions?

Underlying the confrontational stance common in counseling’s history, is the fact that – if left to their own devices – addicts would continue to engage in self-destructive behavior.  “…addicts avoid dysphoric affective states, anxiety, and genuine intimacy by using substances and engaging in antisocial behaviors, such as manipulation of others for their own needs” (White & Miller, 2007, p. 5).”  This observation, appears to underlie the extreme forms of confrontation described earlier.

In contrast, modern treatment approaches involve symptom management during detox alongside some form of therapy (inpatient,outpatient, group and/or individual). Motivational interviewing is useful in helping the client attain self-awareness.  This can involve helping clients gain insight into their addiction while uncovering behavior patterns and attitudes underlying their habit.  Personally, I haven’t seen a pure non-directive stance in the addiction counseling field. However, I believe an empathetic stance and collaborative approach are critical factors of successful counseling.

In the next section, I’d like to return to that internship supervisory meeting I mentioned earlier.  Here’s an overview of the two sides of the debate I listened to on that day….

Can There Be a Middle Ground Between Extremes???

Side one – Sugar Coating Truth.

The intern in this conversation made a comment on the pointlessness of sugar-coating the truth & asked the supervisor what the point was if we never confronted them on anything.  “Isn’t there a case in therapy when it is warranted to give our opinion on matters pertaining to the client’s well-being?” After all, “to sugarcoat the truth is to do a disservice for the person who is on the receiving end. You don’t do anyone favors by avoiding blunt truth (Nguyen, 2015).”

Side Two – Raising Concerns on Confrontation & Coercion….

“It is time to accept that the harsh confrontational practices of the past are generally ineffective, potentially harmful, and professionally inappropriate. (White & Miller, 2007).”

“Confrontation continues to play a strong role in many treatment programs (White & Miller, 2007, p. 176).”  Obviously, it isn’t utilize in the extreme forms common in counseling’s history.  However, despite its continued research has shown this method as often less effective than supportive approaches (White & Miller, 2007).  Additionally Policin (2003) notes that confrontational styles, are shown to produce “harmful effects including increased drop-out, elevated and more rapid relapse, and higher DWI recidivism (p. 20).”  My own impression of this approach is it has the potential to be harmful, shame-inducing. It focuses on change through emotional coercion over insight or conscious choice.

My thoughts thus far?   Somewhere between these extremes lies a healthy balance.

References

Miller, F.G, Renn, W.R. & Lawzowski, L.E. (2001). Sassi Scales: Clinical Feedback. Springville, IN: The Sassi Institute.
Polcin, D. L. (2003). Rethinking Confrontation in Alcohol and Drug Treatment: Consideration of the Clinical Context. SUBSTANCE USE & MISUSE, 38(2), 165-184.
Raskin, N. J. (1948). The development of nondirective therapy. Journal of Consulting Psychology, 12(2), 92.
Nguyen Vincent (2015, February, 23).  How to Deliver Cold Hart Truth and Stop Sugar Coating Reality. Retrieved from: http://www.selfstairway.com/cold-truth/
sassi.com (n.d.) Sassi Institute – “Early Intervention Saves Lives”.  Retrieved from:  https://www.sassi.com/
White, W. & Miller, W. (2007). The use of confrontation in addiction treatment: History, science and time for change. Counselor, 8(4), 12-30.

 

 

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Arrested Development??? (Erikson not the show)…

Recently, I was talking with a therapist at my internship site about my therapy group in the hopes that she might share a few curriculum ideas.  One interesting subject matter she threw by me pertained to Erik Erikson’s “Eight Stages of Man” (Broderick & Blewitt, 2010, p. 9).  Erik Erikson proposed a theory of personality development that includes eight stages.  In each stage we face developmental crises in order to develop a sense of identity alongside interpersonal beliefs through interactions with significant others (Broderick & Blewitt, 2010).  Since Erikson’s theory focuses on attitudes about the self and others, it provides a useful social context to human development (Broderick & Blewitt, 2010).  According to Erikson, in eight stages of these psychosocial stages, two potential outcomes can result depending on how we address and resolve each developmental crisis:

“Individuals are pushed through these life stages by biological and social demands…Individuals will experience conflicts as they progress through these stages, but it is how the individuals handle these conflicts that will indirectly impact their lives…The unsuccessful resolution of conflict…will influence how subsequent stages unfold…These stages build upon [& this]  impacts the rest of development (Wurderman, 2015, p. 5-6).”

Interestingly, while I do recall reading about Erikson way back in my human development, this insight never fully clicked.  I remember reading, and thinking about my two young boys.  However, the utility of its insight as a means to describe my own unique life course, never occurred to me.  Below, I reflect upon key stages in Erikson’s theory that resonate with my own life history & the early arrested development

Industry vs. Inferiority

Around ages 6-12 Erikson stated that a feeling of competence is critical (Broderick & Blewitt, 2010).  Labeling this stage “Industry vs. Inferiority”, Erikson states that the “child needs to learn important academic skills and compare favorably with peers in school.” (Broderick & Blewitt, 2010).  As a bullied child, I always felt very inferior to my peers.  I remember loathing recess, since I had nobody to play with. I recall lingering by the front door, hoping would notice me out of fear they would call me a loser or something.  The shame of complete friendlessness was overwhelming.   Inevitably, the nuns noticed me and encouraged me to stop lurking by the doorway & “get some exercise”…

As time progressed, things never did get better, I was the girl with the cooties.  I clung to the few friends who were willing to associate with me and was grateful for some form of meaningful interaction.  My grades never did go above a “C” average.  Everybody knew about my abysmal performance in this small private Catholic school.  One of my first bullies liked to wear this t-shirt to school with the “I’m with Stupid” logo on it.  Since he sat right next to me, everybody thought it was hilarious.

Developmental Consequences:  Insecurity, Poor Self-Esteem & An Inferiority Complex…

Identity vs. Role Confusion

“…during early to middle adolescence…the crisis of identity versus identity confusion…represents the struggle to find a balance between developing a unique…identity while still being accepted and ‘fitting in.’ Thus, [a] youth must determine who they want to be, and how they want to be perceived by others. (Oswalt, 2010).

During the ages of 12-20, individuals enter the Identity vs. Role Confusion Stage.  During this stage we develop a sense of identity: a sense of who we are, and where we fit in the world.  Broderick & Blewitt, (2010) describes the positive outcome of this phase as “fidelity”.  I associate this concept with the idea of commitment, or an ability to commit to something greater than yourself.  I suppose its not surprising that I have difficulty opening up to others & tend to isolate myself.

It’s also worth noting again Erikson’s assertion that each stage builds on an earlier one.  As a bullied child, I left the previous stage with an Inferiority Complex.  Against this developmental backdrop, I entered  a new stage of development only to lose my best friend who moved out of town at the end of sixth grade.  With her gon, I was now alone and completely friendless, “The Girl With the Cooties”.  My sister thrived as the popular girl, my parents were focused on their careers as doctors.  All were emotionally MIA.  I retreated into my own world…

“Ego Identity means knowing who you are and how you fit into the rest of society.  Too much ego-identity can result in fanaticism [i.e. my sister] where the child believes his way is the only way, and no one is allowed to disagree…A lack of identity can result in repudiation [me]

Intimacy vs. Isolation

During this stage, I notice a an intriguing turnaround.  Broderick & Belwitt, (2010) describe this stage as involving a willingness ‘to share identity with other[s] and commit[ing] to affiliations and partnerships”. During this stage of my life, I had met “IT”.  After a horrendous four year F-D up relationship, I left and never looked back.  My personal development took a “turn for the better” as I entered counseling, and eventually met my husband.  I guess this just goes to show that just because one stage goes bad, that doesn’t mean they all do……

….As I reflect on these stages of my life, I’ve had to come to terms with a loss that’s hard to describe: arrested development….

Coming to Terms w/ “a loss”

There are times when this arrested development “rears its ugly head”.  There’s something called “normal” that I just can’t do.  I missed so many opportunities socially and in terms of my sense of competence and identity.  I have worked to fill in the pieces in adulthood, but still.  I’m not quite like those who never had to deal with this sort of arrested development.  Its hard to explain, but maybe I’m like a blind person.  You can’t describe purple to a blind man.  I’m like the blind man, and the “normal’s” are trying to tell me how great purple is.  I looked at them perplexed, not knowing what the hell they are talking about…..

….and as I continue with this forward motion in life, the big question on my mind is, how does this affect my future career development????

All of who I am comes out in my efforts as a therapist.  The “Kathleen-ness” of my nature is inevitably there at some point.  I can’t hide it.  Can I possibly catch up in some way that allows me to be as effective as those who didn’t get a full 14 years of stagnation??

References

Broderick, P. C., & Blewitt, P. (2010). The life span. Human development for helping professionals. Upper Saddle Creek, NJ: Pearson.
Oswalt, Angela. (2010, November, 17). Erik Erikson and Self-Identity. Retrieved from:  https://www.mentalhelp.net/articles/erik-erikson-and-self-identity/
Wurdeman, M. (2015). Impact of Abuse Throughout a Child’s Psychological Development.  Retrieved from:  https://www.winona.edu/counseloreducation/Media/Impact%20of%20Abuse.pdf

 

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I am Brutally Honest About All My Baggage

Holding onto Hurt or Letting it Go…

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Shame, Invalidation, & A Little Baggage…

imageMarsha Linehan, Phd., founder of Dialectical Behavioral Therapy, defines invalidation as trivializing, punishing, judging, or ignoring a person’s thoughts, feelings, behaviors, and identity (Linehan, 1997). In order to understand the importance of this concept it is vital to differentiate how its definition in the field of psychology is unique. A quick review of Merriam Webster’s online dictionary yields the following definition: Invalid: “being without foundation or force in fact, truth, or law…logically inconsequent.” (invalid, n.d.)

 

Anatomy of a Misunderstanding…

Image“I am extremely hurt by this labeling Kathleen. I am COMPLETELY misunderstood. And I don’t think there is anything that I can do about it…”

The above quote is my sister’s response to an email I sent to my family when I first entered therapy back in 2010. I became interested in the insights from therapy models (like the DBT Skills Group I was enrolled in at the time. I applied these skills daily and found them very beneficial. I also was fascinated by the results of some MBTI assessments of myself and immediate family members.

 

And Cancer Trumps PTSD…

ImageAround late fall of last year as I was entering my final year of coursework, I was assaulted by a patient at work. This re-traumatizing experience forced me to seek the rhelp of my old therapist, whom I now visit with monthly. In our initial session she was quite direct with me about her disappointment about my lack of self care. This much-needed wake up call has resulted in a new exercise and nutrition regimen. Other steps taken included reaching out to others and taking time to de-stress. Finally, I made a conscious effort to avoid isolating myself and reached out to others.

 

“It was the most miserable day of my life…”

My husband stood in the kitchen watching our two young sons snuggling on the sofa in the living room. They were watching their favorite cartoon before bedtime. My husband’s eyes welled up with tears as he whispered quietly: “look at them, so happy, contented, safe and secure.” Knowing of my husband’s own painful childhood, I couldn’t help but get caught up in his love and gratitude for what we’ve created together

 

“IT’s Unspoken Rules”

Emperor In a previous post I shared my story of an bad relationship, titled “Stages of Change”. It has been over twenty years since I managed to leave. I often refer to this period as “the IT years” after my mother jokingly one day to “please stop saying that name!!” It was the most trying time of my life. In the 20+ years since leaving, I’ve grown by leaps and bounds. I’m grateful for the lessons learned and the loving marriage I enjoy today. In this post I share some of my 20/20 hindsight. What follows is an overview of his “modus operandi”. If you’re dating a guy who thinks like this – RUN!!!

 

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I am Talan & Josiah’s mom

My Shameful Parenting Story….

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For anyone who wants to know what shame-based parenting looks like, this picture from my old journal would do splendidly. In this “I’m Fucked up & I’m Fucking up My Kids” journal post, I review experiences with the mother of my son’s best friend from kindergarten through sixth grade. Over the course of time, as our boys grew close, we developed a friendship as well. However, our sons’ friendship took a slow turn in another direction around fourth grade. Her son was a very sensitive, sweet and creative child. My son had a rebellious streak, and liked “marching to the beat of his own drum”. Early experiences as a critically sick child, had left a lasting impact on his trajectory of physical and emotional development (more on this later).

 

Good Enough Parenting…

everybody seems to have an opinion that there is a “right way”.  There are those who feel stay-at-home mothers are best.  There are those who feel working mothers are best.  I’ve heard it all:  We eat out to much, we have too many electronic devices, we stay up too late, they’re too rambunctious and “free thinking”.  The list is endless.  In fact, everyone has an opinion. Despite the fact that nobody has a window into my heart and soul and understands my struggles, it still hurts when I receive this criticism.  Despite the fact that nobody knows my two boys like I do, I still question myself when people list the pragmatics of “good parenting” vs. “bad parenting”.  For all these reasons, a concept from my course textbook: “Good Enough Parenting” (Ingram, 2012, p317), is worth examining closely here.

 

Happy birthday piglet!!!

“JOE RON NUCKING”

imageOn this day, ten years ago, my youngest son Talan was born.  Since he hates cake, we decided to be creative and make a donught cake instead.  I love this young man with all my heart and cringe at how fast he is sprouting up.  At over five feet tall, wearing men’s shoes, I know already he’s gonna be tall like his daddy.

 

 

He turns sixteen today!!!!

“COOL MO FUTS”

imageOn this day, 16 years ago I gave birth to my oldest son Josiah.  I won’t bore you with a long story here of my experiences as his mother….I simply desire to create a post acknowledging the importance of this day, as well as the love & gratitude I feel for his presence in my life…


 

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I am a freaky oddball

The Girl With The Cooties

ImageAs far back as I can remember, I’ve always been an optimal target for bullies. In fact, as the “girl with the cooties”, bullying has always been a constant issue: from kindergarten at St. Agnes up through high school graduation. Admittedly, the bullies changed from year to year, but they all saw me the same way. I was the perfect target: I am highly sensitive and don’t fight back…For those who have never been bullied, you’d be surprised to learn that the actually bullying isn’t the worst of it. The collateral damage it sustains upon your social life is devastating. You see, when you get picked on often enough at school people start to notice and a reputation develops. Now a “loser”, you’re essentially walking around with a scarlet letter tattooed to your forehead.

 

The Nature of Belief Systems

Emperor Societies and cultures are a byproduct of belief systems, which provide a means of constructing the “stories we tell ourselves to define our personal sense of reality” (Usó, 2015, p. 1). In this sense, they are meaning paradigms that define the nature of our lived experience. Societies benefit because belief systems create a mutually agreed-upon reference point for all its members. When everybody complies, belief systems carry social consequences that allow it to develop a surface appearance which mirrors “objective truth”. In this respect, their existence is not dependent upon a believer, but society as a whole. It remains an integral component of our culture, woven throughout our history until we as a society begin to question it. Only then can systems of belief loosen their definitive hold upon our daily lives.

 

…the go-it-alone mentality

image Recently, I came across an article online titled “The Psychological Cost of Being a Maverick”, Essentially, this article cites research which debunks a common American myth of individuality as the key to personal freedom and control. Since I was curious, I decided to download the research paper this article referred to (Greenway, et al, 2015). After reading it, I felt is was worthy of a blog post on two unique fronts. Firstly, in a older post I discuss the notion of personal identity as a hot-air notion…After re-reading this post, I feel there is much more to say on the subject if identity. Where are the grains of truth? What role does identity play in our lives?

 

Shame, invalidation, & a little baggage

So what exactly is invalidation, and why is it so important? Marsha Linehan, Phd., founder of Dialectical Behavioral Therapy, defines invalidation as trivializing, punishing, judging, or ignoring a person’s thoughts, feelings, behaviors, and identity (Linehan, 1997). In order to understand the importance of this concept it is vital to differentiate how its definition in the field of psychology is unique. A quick review of Merriam Webster’s online dictionary yields the following definition: Invalid: “being without foundation or force in fact, truth, or law…logically inconsequent.” (invalid, n.d.)

 

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I’m a reformed fuck-up

The “Art” of Failure…

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In my career counseling course, I had an assignment which required me to review my career path. While I’m glad to have finally “landed in the right direction”, finding my way to here has taken some time. I end up with a bachelors in the social sciences after making a decision on this major, midway through my third year. I graduated, with no marketable skill or career experience, and landed in a slew of dead-end clerical jobs. With marriage and kids came the need to find a job that worked around my husband’s schedule. We were financially strapped in these early years after a series of hospitalizations due to my son’s illnesses…

 

Stages of Change…

imageThat Nike commercial that tells us “Just Do It!”, irks the hell out of me. While intended as an inspirational message of empowerment, it misses the mark on how to create and sustain lasting change. As I’ve come to realize (both professionally and personally) change is a process that takes time. When I reflect on my own steady progression of growth thru life, two resources seem to describe this journey well. The first is the transtheoretical stages of change model which addresses feelings of ambivalence toward change..In this post I intend to discuss the process of change from two unique standpoints. One perspective will provide a theoretical overview of the stages of change from those in the helping professions. Another perspective will be a first-hand accounting of my experiences in a past relationship. .

 

Shit Job

…Assigned as a “safety advocate”, my job is to prevent another fall. I gently placed her legs back in bed and straightened her sheets. She responds with a series of punches and kicks.

 “Maggie, don’t do that, I’m just trying to help.”

“Go to hell!” She screeches, while picking at her I.V.

Grabbing hold of her hands so she’s unable to pull out her lines, I remind her:  “Don’t do that or you’ll bleed.”

While covering them up with kerlix, I divert her attention to what’s playing on t.v.  A look of disgust forms on her face as she responds, “You know what, you’re a f*cking idiot….”

 

Collateral Damage

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In the aftermath of the “it years”, my family and I have had to work hard to recover from the experience.  I was hurting, they were too.  As years past, we put the experience behind us and moved forward….

….Many years later, as a happily married woman I re-entered therapy. I was considering a return to school to switch careers.  My youngest was in 1st grade and I finally had some time to myself.  As a result of therapy, I’ve struggled with blame, resentment, shame & guilt.

 

accepting responsibility: shame, blame, guilt & resentment…

imageAbout three weeks ago I started the final segment of my educational journey: the internship.   In a series of three classes I have to complete a minimum of 700 hours over the course of approximately ten months. This will require a 60+ hour work week for almost a year.  I will continue to work full-time as a weekend night shift CNA in a float pool for large hospital system.  I will be adding 20+ hours of unpaid work as an intern at an inpatient treatment facility for recovering addicts.   As a wife and mother, this means I’m literally spending most of my waking hours in the service of others.

 

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Who THE HELL do you think you are anyway?!?!

Understanding Shame…

imageIn a previous post I review a favorite self-help author of mine, Brene Brown (link above). I first learned about her from a now-famous Ted Talk video (see link above). Through her work, I was first introduced to the concept of shame: “an intensely painful feeling that we are flawed, and therefore unworthy of accepting and belonging” (Brown, 2006, p45). In this post, I’d like to continue with this train of thought & share some insights on how to recognize shame. While no real preventative cure to shame exists, if you are aware of what triggers feelings of shame, you’re empowered to grow beyond its confines. What follows are insights I’ve recorded in an old journal based on Brene Brown’s work on shame resilience….

 

Personal Identity – on being full of hot air…

EmperorOne night after my family went to bed, I began my homework. While sifting through journal articles, the above quote jumped out at me. In light of recent affairs, it forced me to stop and think. At this point in life, I’m working hard to overcome old patterns and “get unstuck”. In addition to working on a Master’s degree, I’m trying to pay off some debt, and lose weight. As I work on accomplishing these goals, (and overcome a few old vices), I hope to maximize my efforts with a bit of radical self-responsibility. The idea that my hard work could yield another hamster-wheel experience frightens me.

 

Ego vs. Shadow

imageI found this strange table in an old journal titled “ego vs. shadow”. It described the consequences of denying certain parts of myself while presenting other parts to the world. I’m sure its a byproduct of the Jungian and Transactional Analysis stuff I’ve been reviewing. Since I thought you might find it entertaining, I’ve reproduced it here. This divisiveness of self starts out with a description of my hidden self and lived self. Keep in mind, I wouldn’t describe it as an iteration of theory but instead application of insights.

 

On Being Contrarian…

fddAs a mother, therapy student, and healthcare worker, it seems the majority of my time is spent in the care of others. As a Healer INFP personality type this endeavor suits my personality for the most part. However, as time has progressed, I’ve come to the realization that I’m becoming the adaptive reaction to others’ needs. I have so little say in who I am becoming. Everybody’s “baggage” tends to pile up after a long week. When I review the endless needs, thoughts, feelings, and desires of the people I care for after a long week, an “F’d” up hall of mirrors presents itself. Within each individual’s worldview are a set of perceptual distortions and I find I become lost in the mixed. I am unseen behind what other people tend to project upon me….

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Arrested Development??? (Erickson)

FireShot Capture 5 - erikson's eight stages - Google Search_ - https___www.google.com_search
Erik Erikson proposed a theory of personality development that includes eight stages.  In each stage we face developmental crises in order to develop a sense of identity alongside interpersonal beliefs through interactions with significant others (Broderick & Blewitt, 2010).  According to Erikson, two potential outcomes can result depending on how we address and resolve each developmental crisis [for each stage]…

 

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He turns sixteen today!!!!

On this day, 16 years ago I gave birth to my oldest son Josiah.  I won’t bore you with a long story here of my experiences as his mother.  If you wish, you can read this post titled “My Shameful Parenting Story” or this post titled “Good Enough Parenting”….

I simply desire to create a post acknowledging the importance of this day, as well as the love & gratitude I feel for his presence in my life…

Then…

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Now…

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Collateral Damage….

In the aftermath of the “it years”, my family and I have had to work hard to recover from the experience.  I was hurting, they were too.  As years past, we put the experience behind us and moved forward….

….Many years later, as a happily married woman I re-entered therapy. I was considering a return to school to switch careers.  My youngest was in 1st grade and I finally had some time to myself.  As a result of therapy, I’ve struggled with blame, resentment, shame & guilt.  Since I just completed putting together material in this subject matter for a group therapy session, I thought I’d post briefly a pic of an old letter from my father.  It was written to us after I left for NYC.  Refusing to leave this bad relationship I felt a strange & inexplicable compulsion to follow him wherever he went.  I hated what he did, realized this was wrong but this didn’t hit matter…..

if you wish to read the backstory behind this letter, click here.

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My emotional reaction to this letter today is mixed.  I regret what happened.  I feel bad I hurt my family.  However, a bit of resentment lingers within.  When I read my fathers words I feel frustrated for how my parents weren’t available emotionally in the years leading up to this relationship.  Had they been aware of how sad, depressed & suicidal I was, maybe they could have done something.  Maybe, I wouldn’t have been so fucked in the head when meeting him years later….

The “what-it’s” are endless and forgiveness is an ongoing effort…

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second chances

Shakesphere notes astutely that “when sorrows come, they come not as single spies but battalions.” At first, I react to crises like these with a momentary WTF!!! piss-n-moan session.  After I’ve regained my “sea legs” I struggle to see beyond my hedonic knee-jerk reaction.  Throughout life, holding onto this deeper meaning  has been vital for purposes of emotional resiliency.  For example, despite how much I can complain about my job, I appreciate knowing I’m positively impacting my patients in some small way.    Thus far, I’ve only discussed this coping indirectly as it pertains to daily life.  I believe, however, it is best illustrated when facing a life crisis.  As I reflect on my life, I realize I’m much like a cat, granted with more than my share of second chances in life.

What follows are personal stories of  three “almost” losses including: (1) my sister’s breast cancer diagnosis; (2) my mother’s pancreatic cancer; and (3) my son’s heart surgeries….

Almost is not Actual….

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Before I continue, it’s worth mentioning that almost losing someone isn’t the same as the finality of actual death.  I can’t speak to this loss in any way and have no desire to try. As a healthcare worker, I’ve seen more than my share of it first-hand.  The emotional impact of losing a loved someone is truly “unknowable” until it happens to you…

…the experiences I share here involve the impact of serious illness on your life perspective. During my sister’s recent cancer diagnosis I was assigned to the oncology floor.  Watching someone pass away from this diagnosis was impactful in ways which are difficult to verbalize,  When my son was first diagnosed with a heart defect, I met a family who had just lost their son due to a similar diagnosis. During his last surgery, I met a mother who was grieving the loss of her son.  My mother lived 40 days with a pancreatic cancer diagnosis only to find out it was a “mistake”.  These experiences have left me a changed perspective…

A Series Of Wake-up Calls…

With the benefit of 20/20 hindsight I see these events as a series of second chances or “wake-up calls”.  As an Oprah fan, I recall a comment she once made that summarizes these wake up calls perfectly:

“A lesson will keep repeating itself until it is learned. Life first will send the lesson to you in the size of a pebble; if you ignore the pebble, then life will send you a brick; if you ignore the brick, life will send you a brick wall; if you ignore the brick wall, life will send you a demolition truck.” – Oprah.

“pulmonary atresia with a ventricular septal defect”

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My oldest son was born on June 26, 2000, after an uneventful pregnancy and painless delivery.  At just under six pounds I called him my little peanut.  I will never forget the moment I first laid eyes on him.  The love is instantaneous and overwhelming.   I couldn’t let him go and refused to let him leave my sight….

Those initial months flew by, and consisted of a blur of sleepless nights.  However, one morning everything changed.  It was late August and we were celebrating his “2-month birthday”.  My husband had left for work in a town about sixty miles way.  He was unusually colicky that morning.  Since he as normally a contented baby, I was terrified by the way he cried.  I called the doctor’s office and brought him in immediately…

…On the way to his office I heard a strange grunting from the back of the car.  After pulling over to the side of the road I noticed his skin was mottled in appearance. No blood was visible in his oral mucosa and was a dull skin-colored tone.  I started yelling at him and shaking his arm gently to elicit a reaction, but he remained unresponsive.   Nobody was home.  I would learn later that day he was in cardiogenic shock for an (as yet) undiagnosed congenital defect.

The remainder of that day was a blur, however I managed to make it to the hospital in one piece.   I recall being brought up to the neonatal ICU area and being pulled aside by a few nurses who attempted to comfort mew old hospital staff hovered around my son.  Since this was early 2000, fancy cell phones were a thing of the future.  I stepped aside and started calling family while watching them attempt to revive my son from a distance.  I notified my husband first about what was happening.  He told me he would get home as quickly as he could.  Since he was working in a neighboring town about sixty miles away it would take just over an hour for him to make it there. While waiting on his arrival, I called my parents.  Since my mother is a physician, I looked to her for guidance.  After speaking for some time with the pediatric cardiologist on call, my mom began explaining the particulars of his diagnosis.  They would need to drive him in an ambulance to the children’s hospital nearby since there was no available helicopter at that time.  The plan was to stabilize his condition and install a shunt in a vessel called the “ductus arteriosis”.   Since he was so small, they hoped this would give him time to grow before doing a complete repair.  This full repair involved replacing his pulmonary artery with a tube. 

By the time my husband made it to the hospital, the ambulance had arrived and they were ready to take my son to Children’s Hospital.  Two nurses and a respiratory therapist would take the drive to Omaha and manually bag him on that hour-long trip.  Since there was no room for me in the ambulance, I was told to go home, pack, and meet up with them at the pediatric ICU.  My mind was a jumble of nerves and I began crying uncontrollably on that drive home.  Unable to know of my son’s condition during this hour-long trip, I prayed I would arrive to find him stable.  I tried to console my panicked mind by reminding myself that my mom would call the physician’s assigned to his case for updates…

…When we arrived at the hospital he was hooked up to tons of tubes.  They took him into his first heart surgery that evening.  Thankfully, all went well and we were home within the week.  The next seven blissful months flew by despite mounting medical bills.  As his second surgery loomed in our near future, our house we went into foreclosure ans we initiated plans to file for bankruptcy in the weeks following his surgery….

…ironically, my prayers for a respite from these financial stresses came in ways I would not have expected.  While his surgery went well, my son was struggling after his second surgery.   Doctors all came in with a look of concern.  Fearful of how his lungs responded to removal of the breathing tube, they told me the next few hours should give us an option few of how well he would recover. Since my family had left to eat, I was all alone with my son.  I tried my best flto soak in every sensory experience associated with that moment.  My was a mind flood of mixed emotions, as I began to beg God for more time For us to be together. Nothing else mattered to me in that moment than the hope of a chance to watch him grow, and shower him with all the love I had to give…

Pancreatic Cancer: A horrific misdiagnosis

imageOn the wall of our living room is a painting my mom did of a butterfly.  Whenever I see it, I’m reminded of that time she was diagnosed with pancreatic cancer.  This was back in 2007, when my oldest was in second grade and my youngest was a toddler.  My sister just had her oldest child, still an infant.  As per usual, my parents decided to handle things privately.  “Impression management” has always been a concern of theirs, especially when it comes to feelings.  They are logical, pragmatic intellectuals who exude an air of stoicism.  They avoid any open expression of emotions and utilize intellectual distancing as a defense mechanism….

In this instance, they sought to provide my sister and I with what they would want in a similar situation.  They kept us out of it in order to spare us needless worry and useless emotion.  We only learned of this diagnosis in the days leading up to a review of that could confirm this diagnosis.  It was only some time later that I have slearned, my mother lived with a pancreatic cancer diagnosis for 40 day mistakenly.  Additionally, the specifics of my mother’s health scare are limited, since I had only learned about all this “after the fact”.  My sister, however, was fortunate enough to learn about it a bit sooner and provide support.   In the week leading up to a final confirmation of this diagnosis, they invited my sister and her daughter up to visit.   Hoping to spare my oldest son from having to see his grandmother gravely ill, they kept me out of the loop.  Meanwhile, my sister and her daughter could keep my father’s mind busy enough to stave off idle worry….

I was formally notified on Saturday, that they would learn something more definitive that Monday.   Since I was off those two days, I spent most of that time worrying, with little-to-no sleep.  My drifted back and forth between three troubling thoughts. Firstly how would my father fare without our mother.  I imagined this lonely “curmudgeon”/hermit with no meaningful social access to the world around him.  My mind then fluttered with glee at the impending release of duty at my mother’s insistence that I maintain a civil relationship where they make sister.  Finally, when the reality of this impending loss hit me, I fretted that there would be things left unsaid between us…

My sister’s breast cancer diagnosis…

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Since my sister’s breast cancer diagnosis is fairly recent I’ve already touched upon it in a recent post.  For a blow-by-blow of my immediate reactions to this information start with this post.  In the months since this post, my sister ended up having a mastectomy and hysterectomy.  However, since she does not carry the “breast cancer gene”, she won’t be needing any chemotherapy.  Finally, since my own breast cancer gene results appear negative, life has fallen back into that familiar swing.   The familiar coldness and brevity that defines our relationship is  restored.  My biggest challenge  is accepting the reality that things might never be different between us.  Since I can only change myself, there is only so much that can be done to remedy the situation.  Its only since her recent diagnosis, that this fact has been clear to me.  I intend to respond by leaving the door open, remain civil, and allow things to unfold naturally….

So what have I learned?

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When life hands you “second chances”, it is best to look at them as gifts.  However, making most of these gifts is often easier said than done.  Doing so requires you to take in a bitter truth as a much-needed reality check.  This reality-check has the potential to alter your life-course for the better for those willing to do the work.  That’s where I am now: letting go of the past, accepting radically those things I can’t change and directing my attention toward what I can…

So where am I at now??? I hold onto the gratitude I have for these second chances in the aftermath of an “almost loss”.  I’m trying to accept responsibility for all my actions and/or misdeeds as a mother/wife/sister.   As I reflect upon it now, here are the lessons I’m struggling to work through….

My son has taught me life is a gift & that I shouldn’t allow the inane details in my day obscure this fact.

It is for this reason, that I hold my role as mother a top priority, before all others.  I live each day in awe of how my boys are maturing and am grateful for the opportunity to watch them grow.  The idea that life is a precious gift rarely escapes my mind.  As a result, I’m aware that all well-laid plans are just minor details against the realization that they can obscure my enjoyment of the journey.   As a married mother of two boys in graduate school, I cling to this insight and grateful for the perspective. Almost losing my son taught me that the only things I can give that cab have lasting impact on my boys are: (1) happy memories; (2) unconditional love; (3) a sense of self; and (4) an education.  These are my priorities and I don’t stress over the details (or anyone else’s opinions for that matter…)

…And I’ve kept that promise I made in my prayer almost 16 years ago at my then-infant-son’s bedside.  I tell him everyday I love him, and everyda I say it, I mean it with all my heart…

My mother has taught me that the truest measure to who I am is in the lasting impact I make upon others….

By upholding a culturally-relevant ideal of duty and obligation as an unwavering force in my life, my mother has always provided me  love and support.  While familiar to my mother based on her own cultural background, it was unfamiliar to me and remained unacknowledged far to long.   I am at fault, for failing to consider mother’s actions and words from the standpoint of intended meaning.  By taking time to understand my mother I’ve learned quite a bit bout the all-encompassing influence of culture on how we perceive, communicate, live, think and feel.  For this reason I’m actually grateful for the cultural divide that had one separated us.  It brought into our lives, several valuable lessons.

The differences between us don’t end here though. My mom is an ESTJ: a polar opposite to my INFP personality type. My mom is an ESTJ: a polar opposite to my INFP personality type. Our innate cognitive preferences are divergent based on Myers-Brigs Typology.   She is extroverted and I am introverted.  She is a thinker and I am a feeler.  She is a sensor and I am an intuitive.  Isn’t it fascinating that two people so different could be placed in such a relationship with one another?  It has forced us  to see an unfamiliar side of the coin in life we would otherwise avoid altogether.

This second chance inspired me to enter therapy so I could get “unstuck”.  I learned my problems were largely due to “backasswards” thinking.  I misperceived consequence as cause.  What I got in relationships existed as a byproduct of what put into them.  In this respect, the issues weren’t so much a matter of what I was “looking at” but how I chose to “look at it”.

My sister is now teaching me valuable lessons in forgiveness and letting go…

I have to be honest, as the last in a series of “second chances”, I still struggle with the life lessons brought about by this experience.  Lately, my interactions with her feel like pouring salt on a wound.  I struggle to let go of the past hurts and am truly my best to forgive as we move forward.  It is definitely a long and complicated process much like watching an ice cube met or pot of water boil…

….In a future post I will discuss this struggle in more depth and review the concept of Forgiveness and Radical Acceptance. For now, here’s a snapshot of an email I just got from my mother, as she attempts to provide a bit of encouragement…

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