Some Very Good Television

I've had a good friend hounding me for 6 weeks now to watch some clips from an HBO show called In Treatment. It is a show that has been adapted from a popular Israeli series. It is a clever arrangement. Each day of the week Dr. Paul Weston sees a different client. On Monday he sees a distraught young anesthesiologist struggling with partner. Tuesday he sees an egotistical young navy pilot whose eventual death puts Dr. Weston in touch with his father. Wednesday his patient is a precocious teen gymnast who has come to see him for an evaluation for insurance to determine if injuries she's sustained have been self-inflicted or accidental. Thurs is a couple that has been trying for years to get pregnant and now are in struggling over the wife's unexpectedly exploring the option of abortion. And Friday he has supervision sessions with a retired therapist, with whom he has a complex past.

My friend that recommended this show has seldom steered me wrong, so when I was down with a cold this week, I took some time to check it out the show. HBO has a page where you can view the first three episodes of each character's story.

As a therapist it strikes me overall as being authentic. The patients seem like real people with some of the real problems that they come in with, both as far as current problems and in the longer term issues they find themselves coming up against. Like any movie or television show the drama is much more compressed and the everyday mundane aspects are filtered out.

The initial 3 episodes of In Treatment have been very interesting for me to watch, among other reasons, because Dr. Paul Weston does therapy quite differently than I do. A lot of this is accounted for by the fact that his character is doing psychoanalysis, a sort of therapy where the therapist tends to remain for the most part completely neutral in his demeanor, a blank screen where the patient play out the sort of relationships and attachments they have in their lives, represented in their mind. He makes very frequent interpretations of what they client is really saying, asking or thinking, because the assumption of psychoanalysis is that we are largely unaware of why we behave as we do, as the vast majority of our life is driven by unconscious motives, of which we have little to no awareness. The goal of psychoanalysis is to make the patient more aware of some of these unconscious motives. Because of this view he also frequently confronts his patients questioning their motives and asking them to do the same.

My approach to therapy is much more collaborative. On the front end of therapy, I am much more concerned with establishing a working alliance with the client than I am with remaining neutral as Dr. Weston does. That translates to my being warmer with clients. I also strongly encourage clients to be much more involved in selecting along with me what it is that we are going to spend our time doing...what topics from their lives they'll be exploring and what sort of approaches or exercises we might use to address the topics in a manner that fits who they are and what they're preferences are. I may express my professional opinion, even strongly at times, but the client gets the final say on where we head and how we proceed. Dr. Weston's character does say something similar about the client doing the steering, but this only seems to go so far. He always sticks to the same model, even if the client says they aren't finding it helpful.

I am generally much more free with the expression of empathy, letting the client know that I'm getting a sense of how they're seeing things and how they're feeling. I'm also much more apt to invite clients to look at something in a different way than I am to confront, as confrontation implies that I know what is actually going on, and that they do not. Finally, clients are much more apt to hear me ask, "How is this going?", or "Are we headed in the right direction here?" because I know that research shows that the client's opinion of whether we're making progress is very strongly correlated with clients actually succeeding in making the changes that they want to. All of this is not to knock a more traditional psychoanalytic approach. All types of psychotherapy, just as with anything else in life, have their benefits and their drawbacks.

The main question though is: Is this show realistic enough to tap into many of the complexities, joys and challenges of what work in the consulting room is like? For me that answer has been absolutely.

Working with Parts of Us

The conference was very worthwhile. It was nice because it was actually led the the creator of the model, Dr. Richard Schwartz—in my mind it is always best to get it straight from the horse's mouth when you can.

I continue to see this model as being very promising for working with a number of issues that clients commonly face. One of the things that I like about it is that it evolved out of clinical practice, and clients were very involved in letting Dr. Scwartz know how their inner lives functioned.

Likely because of how the model was created it seems to align very well with most people's experience of their problems. It fits well with experiences like when you are having a conflict with your spouse or partner and you know that the way that you are behaving is making things worse, and yet you find yourself unable to pull out of the way you are interacting. Another example would be settling on a certain course of action after working hard to make a difficult decision, being sure that this is how you are determined to proceed, and then suddenly finding yourself seeing the other option as making a lot more sense.

These experiences make a lot more sense to me when looked at in the way that the IFS model sees them. In fact, I think that Dr. Schwartz makes a convincing argument that many of our problems are made worse when we are unwilling to look at the different "parts" of us, and instead insist on seeing ourselves as a unified, "monolithic" whole.

The website associated with this work is the Center for Self Leadership. The link will direct you to the "About" page if you are interested in learning more. If you are a current client or you come in to work on any problem from depression, to couples issues, to parenting difficulties this is a powerful framework that we can draw on. Of course, I plan to keep with my collaborative approach to therapy, so my clients will always have the primary say in what approach that we take. But it is nice to have access to the array of opportunities that this model seems to provide.

Allergies Affect Kids In Multiple Contexts

Here is a Reuters story (pic from them as well) that certainly matches my own childhood experiences. I remember years of miserable days and nights in the spring and early summer. The gist of the story is that allergies don't just make kids uncomfortable. Allergies affect their sleep, concentration in school and even physical activity like on the playground. My bet would be that the interrupted sleep would be a huge piece that leads to some of the other problems, especially school performance. And we already know from other studies that sleep deprivation can actually take a toll on IQ over time. It's a good thing the medications available are better than the ones I had access to as a kid.

Kelso Helps Kids Practice Problem Solving Skills

When I was teaching elementary school out in Hillsoboro I ran across a copy of a handout that I found very helpful with young kids. It was a black line drawing of the choice wheel above. On it are eight options that visually illustrate what kids can do when they run into problems interacting with other children. I could tell immediately that it was going to be helpful so I did what many new elementary school teachers would do in such a situation: I laminated it. When kids would come in from recess upset about an interaction they experienced on the playground, that they weren't included in a game they wanted to play, that someone had called them a name or an older kid took their ball, rather than me telling them about possible options, I often would have them take a look at the Kelso's Choice wheel. Suggestions, like "Walk away" or "Apologize" were illustrated, which left kids able to choose an option that seemed to fit. If you've read much of my other stuff, you know that I'm a big advocate of shared control with children and of collaborative problem solving to give kids practice making decisions. Often we'd talk about how they might "experiment" with the option they chose, which took the pressure off from kids feeling like the suggestion had to work. The experience left the kids feeling good about the choices they made about how to go about getting recess to be a more enjoyable experience for themselves rather than walking away feeling that the teacher had solved their problem. You know the saying about teaching to fish rather than simply giving a fish.

Often in my work with parents and children playground, neighborhood or these days, playdate interactions come up fairly often. I found myself wishing I had that old laminated Kelso's Wheel. After a little looking around on Google I found that Kelso is alive and thriving. He is now available in color and can come along with a complete curriculum and materials package for schools. I got in touch with Diane Hipp, one of Kelso's co-creators (the other is Barbara Clark), and she was kind enough to allow let me use Kelso's Choice wheel with permission as a handout in my work with parents and children. I'm glad to have Kelso officially available. He's helped me assist a good number of kids to master social skills that can otherwise be might have been much more challenging to learn.

Check out their website. If your child's school doesn't have a conflict management curriculum, you might send them Kelso's way at KelsosChoice.Net http://enjoyparenting.blogspot.com/2008/03/kelso-helps-kids-with-decision-making.html

Multiplicity: I'm Talking to All of You

I'm off to a family therapy conference in Washington to learn about Internal Family Systems Therapy. It is an approach that I was recently exposed to and that makes a great deal of sense to me. The idea is that we all experience ourselves as having different parts to us. An easy illustration is how you can be yourself and feel comfortable visiting with your grandmother and you can feel comfortable and very much yourself, acting in very different ways while hanging out with with close friends you've known a long time. You interact in very different ways in these different contexts, yet both ways of being are somehow you. I need to head out the door to run some errands before heading out, but the basic idea is that when we aren't doing well, these different "parts" of ourselves can become polarized and extreme, and end up at odds with one another. When we are doing well, our parts seem to make themselves available for the contexts which they are best suited to help out. This method of therapy is all about restoring a sense of internal balance and harmony. It is also a way of looking at systems on multiple levels so that you address the parts within the individual, the family system and larger cultural systems that affect the family. Fascinating stuff. I'll give an update when I return from the conference.

"The Medicated Child" on FRONTLINE

Frontline is a show I enjoy as an info resource, especially in today's sound byte world because it attempts to stick to the facts and presents more or less evenhanded portrayals of whatever topic it takes on. It's been called "...the last best hope for broadcast documentaries." Coming up on Tuesday, January 8th at 9 pm on PBS they are going to examine the issue of the increase in psychiatric medications being prescribed for children. Their excerpt follows:

Ten years ago, stimulants like Ritalin and Adderall were the drugs of choice to treat behavioral issues in children. Today, children as young as four years old are being prescribed more powerful anti-psychotic medications that are much less understood. The drugs can cause serious side effects and virtually nothing is known about their long-term impact.
The increase in the use of anti-psychotics is directly tied to the rising incidence of one particular diagnosis — bipolar disorder. Experts estimate that the number of kids with the diagnosis is now over a million and rising.

As the debate over medicating children continues to grow, FRONTLINE producer Marcela Gaviria confronts psychiatrists, researchers, and big pharma about the risks and benefits of prescription drugs for troubled children in "The Medicated Child."

Local listings for your area can be found on this page.

A Factor to Consider with ADHD Treatment

I see parents frequently who are wondering whether to have their child assessed, believing he/she might have ADHD. The parents who do go on to have their child assessed and discover their child does meet criteria for the diagnosis of ADHD also wonder about whether to treat it primarily with behavioral approaches or whether to consider stimulant medication. This headline was all over the place recently and is worth considering when weighing all the important variables in an important decision. Study Finds Slower Brain Maturity in ADHD Kids