Trauma & Treatment

Greetings dear readers,

We are taking a course in Trauma: Theory & Treatment. It has been an eye-opening experience thus far. One of our first assignments was to read part of a book called Empire of Trauma, which tracks the development of how psychology has come to understand and view trauma now. It looks at the interaction between new ideas in the field of psychology and social/moral attitudes from the late 19th century into the 1970’s. I didn’t know that at one point, at least in Western countries,  experiencing trauma was seen a character defect! Wow, what a long way we’ve come! A character defect??As we look at what “trauma” has meant and what it means, we are also looking at what treatment looks like now. What techniques and approaches are available? How do we decide, as therapists, which to use? Which to include in our toolkit?

My understanding before undertaking this program was that trauma is about events and memory, and especially memory beyond the individual. For a long time I did believe that trauma was something you had to live with rather than something you can completely move on from. I believe now there isn’t one answer that matches all of humanity. For some, the legacy of trauma requires endurance and for others, moving on in a particular way is their natural response. A salient clinical implication I am left with is the importance of the therapeutic relationship. It seems trauma treatment in Europe was based on fear tactics and shaming for a long time, a very active sense of having to do something. The concept of durational time, and the shift in the notion of trauma wrought by the Holocaust, point to the power of witnessing. Witnessing is one part of the therapeutic process, and there is the larger posture that belongs to, which is simply about being present with someone. There is a lot of emphasis on techniques and the latest technique in this day and age, but what is it to simply be with someone? To witness them sometimes, to accompany them sometimes, to facilitate sometimes, to support with specific needs sometimes.

Posted in Global Mental Health

Cultural Competency and the DSM-5

At MSPP we talk a great deal about becoming culturally competent and building our skills of understanding how others interpret and understand their world.  In my studies, I have been reviewing the Cultural Information Interview (CFI) within the DSM-5.  I believe the set of interview questions will be an extremely important tool for me as a clinician serving refugee communities.

As a diversity consultant, I have spent a lot of time understanding the ways in which people are made aware or unaware of the ways in which their culture mitigates their experiences in life.  It is certainly the case that we all belong to various cultures – and I have found that many discussions of culture lean heavily on our understanding of race and ethnicity and overlook other aspects of culture that mitigate experience.  I also think it is important that the CFI not only be used for people whom I perceive as different from me, but is a useful tool for those whom I perceive as “like me.”  The CFI allows us to discover aspects of someone’s life that may not be obvious or may arise organically from the questions.  It is clear that the DSM-5 situates culture not as descriptive, but discursive – culture is not neatly ordered, it arises in language, it is filled with idiosyncrasies and complexity – the most significant of which may not even be of conscious awareness to the client.

Posted in Global Mental Health

Interview Days

Recently I bumped into a prospective student and her mother, as I was on my way out of the building. They were both milling in the lobby, looking at the list of floors, and generally had that look about them that most people have when they are looking for information but are unsure whether they are in the right place. So we chatted for a bit and I tried to answer some of their questions – it turns out the student’s interview would be the next day and they were just trying to get a sense of where the building was and where to go once they got there.

I figured I’d post a few of the tidbits that came up, as I know there are a lot of nerves around interviewing at schools.

Checking the school out beforehand is definitely a good idea. You want to know how long it might typically take you to get there and back during the week. Get a sense of the parking situation (MSPP has tons of it). Get a feel for the atmosphere – MSPP has more of a “corporate” feel and look than most schools, I think. It’s also pretty tough to take in anything when they do tours of the building on interview day, since nerves are pretty much in control then. It is also a good idea to know what is nearby – for example, in nicer weather I love taking a break between classes to sit outside with friends or walk through some of the trails outside.

I cannot stress enough just how beneficial it is to talk to a current student! Perhaps a first year and someone who is further along in the program. That way you get an idea of what it was like to transition back to being a student or into this new atmosphere, and you get an idea of what possible challenges/benefits/surprises/realizations might come your way as you go along.

I know it’s easier said than done, but there really isn’t too much need to get overly anxious on interview day. I think a lot of the pressure comes from being in an atmosphere where there are so many other anxious people. You know what you should do? See if you can bump into a current student in the first floor open area on your interview day, and get some real info on what your experience at MSPP might be like!

 That’s all I’ve got for now. Best of luck to all the students interviewing for next year, and maybe I’ll see you around next year!

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Art as Self Care

This weekend, despite struggling to overcome a wicked stomach bug, I took some time out to stroll through the Museum of Fine Arts (MFA) with a friend who was visiting town. Historically, I had considered taking in art as a luxury; currently, however, I am beginning to approach art viewing as a mode of self-care. It may not be the traditional example of “art therapy,” and I do love a good finger-painting session when possible, but for those of us who do not consider ourselves artists beyond Painting by Number, having the opportunities to delve into art as an observer (and by extension, an active participant) can be a healing and fulfilling process.

There’s something about walking around the MFA that is relaxing to me. I think it’s partially the quiet, the fact that visitors whisper when communicating, the absence of cellphone rings, along with the architecture itself – high ceilings grounded by stone upon which my boots made a hollow thud. And then, there’s the art. The number of pieces is overwhelming to me, so I try to have a plan of attack each visit. Most recently, my friend wanted to look at art of the ancient times, most specifically Greek and Roman sculptures. To me, there was an indulgent quality to getting lost in the marble, following the lines of the sculptures’ draperies. In a way, it’s a bit like an exercise meant to instill appreciation for the “here and now” by forcing me to focus on exactly what I see before taking a click out and thinking about the piece in historical context.

This rediscovered appreciation for art coincides with the arrival of new students at my practicum, some of whom are artistically inclined. Their work now serves as decoration in the classroom, and the creative use of colors, materials and perspective provides fodder for conversation in addition to enjoyment. Also, one of my clients recently completed a watercolor during an art enrichment period. We referenced it in a session, drawing upon the blend of colors as a parallel to the blend of emotions she experiences at any given moment. Maybe it’s spring’s arrival and the promise of crocuses popping up, or maybe it’s having the opportunity to catch my breath, but for whatever reason, I’m thankful that art has made its way back into my life.

I leave you with this image of Rodin’s hands sculpture as a “hurrah!” to art and as a reminder of how art can touch us.

(from http://www.statue.com/aber113.jpg?resizeid=-2&resizeh=500&resizew=500)

Posted in Around Boston, Personal Growth | Tagged ,

Nick Covino: Leveraging technology in education & mental health

Check out this interesting conversation with Nick Covino on leveraging technology in health care and education…

MSPP Veterans Conference, April 18!

Folks,

Don’t forget about MSPPs veterans conference! The conference is April 18, 2014 – hear details from Dr. Dingman directly below. It will be an exciting day, with a terrific program and speakers.

 

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Summer Breeze Makes Me Feel Fine

The school year feels as if it’s winding down… and it doesn’t. Getting through the month of March for any educator is always the last long push before the spring rolls by- there are no breaks, no long weekends in an endless haze of snow, mud, and MCAS. April 1st is in sight, and rumor of a sixty degree day over the weekend has everyone contemplating digging out their grills to take advantage.
I am already registered for summer classes (and given up nearly every single day of it) and am beginning the process of interviewing for jobs this fall. This process of looking ahead -which we are constantly doing in schools via IEPs, annual goals, and MCAS prep- makes me feel as though my vacations are already spent and make me desperate for some time to myself. I intend to spend some of this weekend in self care, doing my best to ignore all of the final papers I have to finish writing in favor of some quality time outside. Wish me luck!

Benefits of Early Childhood Assessment

early-childhood-2If you are concerned that your young child is not developing in an age-appropriate way, you should know that research demonstrates that early diagnosis and intervention are crucial.  When a diagnosis is made earlier, as the child’s brain is still developing, there are a number of outcomes.

  • Treatment can begin sooner and can be more effective.
  • There is also evidence that children who receive timely support in acquiring early literacy skills have better outcomes in areas of reading and mathematics.
  • Additionally, providing a child with appropriate behavioral supports at daycare or in the classroom leads to increased self-esteem, successful peer relationships, and sets the stage for the child’s positive attitude towards school in general.

The Brenner Assessment and Consultation Center at MSPP has a long history of providing comprehensive neuropsychological and psychological assessments to children and adolescents.  At our specialty service for testing young children (generally ages 2-6), we recognize that it is a special challenge for parents, teachers and others involved in the child’s care to have a clear understanding of what is interfering with age-appropriate development.  When it comes to very young children, not all skills develop at the same pace.  For example, young children whose language skills don’t emerge as expected may eventually catch up to their peers with little or no intervention.  Alternatively, delayed speech acquisition could be a sign of a potential Language Disorder or an Autism Spectrum disorder.  Comprehensive and specialized testing is the best way to address each unique child.

At the Brenner Center Neurodevelopmental Assessment Service for Young Children “NYC”, we use a developmental lens to understand each child’s unique presentation.   Over the course of the evaluation, we take time to get to know the child and the family.  As part of our comprehensive neurodevelopmental assessment, we observe the child in his/her natural environment (such as home, daycare, preschool or an Early Intervention playgroup).  This observation enables us to understand how the child copes with the demands of a group setting.  Additionally, we collaborate with the child’s teachers and other service providers, in order to understand their perspective on the child’s strengths and areas of concern.  We work hard to maximize the child’s comfort in the testing environment and typically see children over the course of several testing sessions.

Our evaluations result in comprehensive, jargon-free reports that include specific recommendations for parents, teachers, and others working with the child and the family.  In writing the recommendations, we collaborate with professionals from other disciplines (such as speech-language pathologists, occupational therapists and child psychiatrists) to ensure that our recommendations embrace all aspects of the child’s development.  We have a thorough knowledge of the IEP process and are available to attend IEP or other school meetings on request.  For more information about the Neurodevelopmental Assessment Service for Young Children (NYC) at MSPP’s Brenner Center, please visit www.mspp.edu/brenner.

Can You Spare Some Change?

Change. It happens to every single one of us every single day.Shift Happens

It’s oftentimes something that we simply allow to happen to us.  And at times we have no choice but to accept it.

Consider the following series of change events:

You wake up.  The temperature outside is 20 degrees colder than it was yesterday.  Now you have to re-think the light-weight outfit you had picked out for today.

In the shower, you tried out your new shampoo only to realize during styling that it’s affecting your hair differently than your last shampoo.  Now getting your cowlick to behave is proving a challenge.  You need to get creative with hair gel, and better make it work quickly because you’re running late for your new job.

Already, before even stepping out of the house, you have encountered change and found ways to overcome it.

At other times we realize a need for significant change in order to improve our status quo. At such times, we make a choice to seek it out.  Changes could include making the decision to apply for graduate school or to add an additional member to the family.

What about change within your organization? Have you ever lost a member of your team at work, and had to rise to the occasion to make up for their usual tasks? Have you been part of a workforce undergoing an organizational merger, and been forced to face the unknown of your future at work?

Dr. John Kotter, who is a leadership scientist of sorts, put 30 years of research into an 8-step model for leading change in a holistic way that can usher success for the individual and the team.  His overarching message throughout all of his work is that change is essential. And it is.  How else are we to grow as people and as a species if we do not seek out and readily embrace change?Threat to Opportunity

The principles of Dr. Kotter’s model, as borrowed from the Kotter International website, include:
1. Establishing a sense of urgency.
2. Creating the guiding coalition.
3. Developing a change vision.
4. Communicating the vision for buy-in.
5. Empowering broad-based action.
6. Generating short-term wins.
7. Never letting up.
8. Incorporating changing into the culture.

Some of the principles probably look pretty self-explanatory and make a lot of sense without knowing anything further about them.  They are all, however, worth taking a look at for eliciting positive change within your personal life as well as learning how to acclimate to and use change to your advantage at work.  Each principle is well-explained at
http://www.kotterinternational.com/our-principles/changesteps/changesteps.  I suggest you take a moment to explore them.

Time for ChangeUsing these principles, we can all spare some change…

Posted in Change of Career, Executive Coaching, Organizational Psychology & Leadership, Personal Growth | Tagged ,

Super supervision

We know that supervision is a vital aspect of becoming a good practitioner. As a trainee, I rely on supervision for several reasons. First, it ensures that my clients are receiving quality therapy. By reviewing my client interactions with my supervisor, we reflect on different approaches and tailor a treatment plan to help my client manage his or her experiences effectively in an effort to meet his or her therapeutic goals. Second, supervision is a space for learning; it allows me to ask questions that pop up at my practicum, and because I have good supervision, I feel comfortable doing so without shame or embarrassment. Supervision also provides a space for me to talk about my experiences as a clinician and as a graduate school student studying psychology.

I have three supervisors: an on-site supervisor at my practicum, an off-site supervisor from MSPP (because my on-site supervisor is not a doctorate-level practitioner), and supervision with a fourth-year Clinical PsyD student at MSPP. Yes, this is a lot of supervision, and it takes a considerable amount of time. However, each one offers a slightly different lens on my experience.

My on-site supervisor and I spend the majority of our meeting time discussing case management. Because most of my clients are at a crisis level, this is practical and necessary. With fairly consistent exposure to my clients in the milieu environment, my supervisor is able to make observations that enrich my understanding of my clients. Additionally, because my site produces comprehensive assessments of our clients, my supervisor and I spend time crafting these assessments.

My off-site supervisor and I meet with another MSPP student who also happens to be at my site. This provides a different experience in that there are more perspectives in the room. My off-site supervisor often reflects on what seem to be systemic observations about my site, which is helpful to hear. She also specializes in a particular field (assessments) that informs my understanding of my clients.  

Finally, my fourth year supervisor and I discuss two major areas: My cases and my experience at my site and managing MSPP (classes, expectations, etc.). Our time together is very helpful, and I am greatly appreciative of her investment in making this as fulfilling as possible. She has been an outstanding support and has offered gentle guidance while allowing me to explore on my own and to ask questions.

Yes, it’s quite a bit of time (about four hours of supervision a week), but it’s well worth it. As my cases become more complex, I am increasingly thankful for the diversity of supervision I have through MSPP.

Do you have questions about supervision, or comments you’d like to share about your supervision experience? Please share!

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