Category Archives: Uncategorized

Sexual Assault: The Basic Statistics

There many data sets with information about sexual assault and quite a lot to be said on the subject, as well.

Since my initial post was more related to what to do, I thought it wise to backtrack some and give additional foundation for the concerns regarding sexual assault. Essentially: why it matters.

I love infographics, so to aid me in this post, I looked around for one to use, but did not find anything I wanted so I created my own:

Tell me what you think and feel free to add your own resources and links!

 

Treating Sexual Assault

April is Sexual Assault Awareness Month, so I thought it only fitting to begin the month with a post on the topic. I hope to continue to share information regarding sexual assault throughout the month.

One of my areas of focus since beginning my training in psychology has been the treatment of those who experience sexual assault. I completed my dissertation on the topic – developing a treatment intervention, volunteered at Bay Area Women Against Rape (BAWAR) providing rape crisis services, and educating my peers – both formally and informally – on the impact of sexual assault.

I have memorized a lot of statistics about sexual assault, many of them staggering (the most recent report from the CDC can be found here) and which I intend to share throughout the month, but one thing I have found most surprising is the stigma which remains and the challenge in finding adequate treatment and long-term resources.

As a graduate student, I wrote an opinion piece to a paper and gave a presentation to my peers about how clinicians – particularly new ones – can approach their clients who report an experience with sexual assault. Since then, of course, my views have continued to evolve, but the foundation remains the same, and again I offer the following advice not only to therapists working with sexual assault survivors*, but to anyone wanting to help:

  1. Believe her when she** tells you what happened.
  2. Remember that it is never the survivor’s fault.
  3. Make space to talk about the assault, but do not force the issue.
  4. Validate her feelings (e.g., “Yes, that sounds awful.”)
  5. Normalize her experience – particularly that her reaction to the assault is understandable.

Of course, this is not comprehensive and is not meant to take the place of formal training. Instead, I offer these as building blocks and as a reminder to everyone that sexual assault is a complex and unfortunately common experience and should be treated and responded to with care.

 

*There is much discussion among professionals regarding the use of the term “survivor” as compared to “victim,” and I acknowledge that each side has valid points. For myself, I prefer “survivor,” and thus use it here.

**Because the majority of sexual assaults are committed against women, I use female pronouns and designations. This does not, however, suggest that men are not sexual assaulted.

Pin & Tweet

 

This is just a quick invitation to follow me on Pinterest and Twitter!

On Pinterest, I like to share infographics on mental health disorders, stress-management or coping skills, and inspirational reminders.

On Twitter, I like to share interesting articles, inspirational quotes, links to my blog posts, and resources.

I enjoy using social media as a way to connect with others, share my ideas, and build my knowledge as a therapist.

I would also love feedback regarding what you would like to see me post/tweet/pin about!

Suppressing Memories: Do We Have it All Wrong?

A recently published study from the University of Cambridge brings a surprising result regarding the tendency to want to mentally push back and suppress unwanted memories.

Unwanted memories – in the context of psychotherapy – usually arise when people experience unpleasant events, up to and including extremely traumatic events. A popular way of thinking about these events is that it is important to not push these memories away because then, instead of having control over the memory, it will unconsciously influence the choices that person makes, often negatively so. Simply put, popular opinion among psychologists has been:

Memory Suppression = Bad!

This new study evaluated that unconscious influence of suppressed memories on behavior and Science Daily offers a nice summary of the article. The researchers’ conclusions appear to be that if we can successfully suppress a memory, it will not influence our behavior. That is, if we try to forget something than it seems that we can, or at least to a degree we can.

What does this mean? Is conventional psycho-therapeutic wisdom out the window?

Not really. At least not in my view. Instead, consider that memories which we actively try to forget – an embarrassing moment when we have said the wrong thing, rejection by a romantic interest, or a traumatic car accident – tend to be memories of such strength that it is difficult to imagine being able to put it out of our minds successfully. The study focused on memory of neutral stimuli, not on highly emotional stimuli, which is usually the case when clients are trying to ignore or forget.

What it does mean, instead, is that forcing individuals to remember events which they cannot remember may not be as useful or necessary as previously thought. Instead, unconscious memories may have much less power than once believed.

Perhaps what can be learned here is this:

We remember what we remember and we do not have to force ourselves to recall everything in order to be psychologically healthy.

Licensed Psychologist

It is with great pleasure that I announce that I have recently attained my license and am now a licensed clinical Psychologist (PSY26218) in the state of California.

I realize that not all individuals may know what this means, and I hope to provide some information about that here.

To start, most health care professions – along with many other kinds of professions – are licensed, meaning that in order to provide the services, an individual must have registered themselves with a governing entity (usually the state in which they practice) and oftentimes must prove that they have a particular amount of knowledge and/or experience. This also means that that individual can be disciplined by that board and is beholden to set of standards.

Regardless of the kind of health services you are seeking, it is always a good idea to verify the license of that individual. The state of California has a website available – BreEZe – through which any individual may check for the licensing status of any person or business governed by the state. Here is an example of what a result looks like:

BreEZe license screenshot

 

So here you can see that both my status as Registered Psychologist and Psychologist are active, and that I have changed my name of record for the Board of Psychology.

If you click through on the Psychologist license, you will see details regarding when I became licensed and whether or not I have been the subject of any disciplinary action – which I have not.

For my part, becoming a licensed psychologist in California requires that an individual holds a doctorate degree in psychology, has 3000 hours of supervised professional experiences, takes several specific courses covering topics such as substance abuse and domestic violence, and passes each a national and state licensing examination. This is a lengthy and rigorous process, intended to ensure a minimum standard of competence in order to practice at this level.

I consider licensing to be a very important part of my work, and I encourage all people who ask me about seeking treatment to ask about the license of those from whom they may receive the treatment. Because it is possible to essentially provide mental health services without a license, receiving such treatment from an individual without a license leaves that person without any manner of recourse or any assurances that that individual will adhere to appropriate legal and/or ethical standards.

 

 

I don’t need therapy — I’m not crazy!

Something I hear frequently from my adolescent clients is: “I don’t want to be here – I’m fine. I’m not crazy.” That or some variation comes up with almost everyone over twelve who comes to see me. Usually their parents either do not explain what will be happening when they come to my office or they themselves do not know.

Either way, one of the most important parts of my job is to help people – including children of all ages – understand what therapy is and why it may be helpful for them or their families. To the littlest of my clients – sometimes three years old – I tell them that I am a “feelings doctor” (a term suggested by a previous supervisor). Most children know who a doctor is and that they help people feel better, and I find that it helps not only the little ones, but their parents and older siblings to understand, as well.

My job is to help people who don’t feel well to feel better. That does not mean that they are crazy. I can say with honesty that I do not think my clients are crazy. Generally speaking, they are dealing with difficult circumstances with which they could use support. Just like when a flu virus invades our bodies and our body functions change in response to that virus, so can our minds and emotions change when faced with emotional stressors.

Therapy is not just for those who have auditory hallucinations (hear voices) or who do not know their own names. Therapy is also for people who just need some help getting through a tough time.

If we all used mental health resources – like therapy – as much as we took vitamin C to ward off a cold and other such precautions against physical illness, we would be a much happier and healthier society.

My hope is that we continue to move along towards decreasing the stigma of mental health treatment and allowing it to be ok for us to seek help when we need it.

Explaining Cognitive-Behavioral Therapy

Much has been written on the merits and principles of cognitive-behavioral therapy (or CBT).  As I have stated in a previous post, I utilize CBT as a primary style of doing therapy.

For most of my clients, one of my first interventions (a fancy term for essentially anything a therapist does in a session) is to explain the theoretical model.  Part of the rationale for this is what therapists call transparency, which is essentially the idea that clients should be informed about what the therapist is doing and why.

CBT has a relatively shorter history than other therapy models, and there are a number of branches and specialties stemming from the crux of the ideas.  What I discuss here is how I choose to explain the concept to clients.

At the center of CBT the basic premise that, within each person, there is an interaction among their thoughts, feelings, and behaviors.  These are in turn affected by a person’s biological responses and the situation in which a person finds herself.

I often draw the concept in this way: cbt

Typically, as I draw, I explain some examples of how this works, using the experiences and symptoms of my client.

One example I use frequently is this:

Let’s begin with a situation.  Let’s say that you are driving in traffic and someone cuts in front of you dangerously.  Most people will say that they feel angry and scared when that happens. Well, how do we know that we’re angry and scared?  Usually, our heart beats faster, our palms get sweaty, our muscles tense, our chest can feel tight, and we have this feeling like we want to move.  That’s the biology that’s happening.  Our thoughts often go something like this: ‘What a jerk!,” “I almost died!,” and things of that nature.  Then, we’ve got our behaviors; these vary widely person to person, and can include vulgar language shouted at the windshield, rude hand gestures, or smacking of the steering wheel.

Of course, some people don’t react this way, and are able to be calm, even in dangerous and frustrating situations.  Generally, though, the principle stands. When we are in a situation, our body and mind react quickly, often in ways we never think to control; much of this happens immediately and automatically.  When people seek treatment, often there is a pattern of these reactions that are unhelpful or disruptive to their lives.  CBT focuses on interrupting the feedback loop by working to change a client’s thoughts and behaviors to ones more congruent with their goals.

The way that is achieved varies greatly from person to person, and CBT therapists have developed a slew of interventions, worksheets, and scripts to address these concerns.

Overall, one thing that makes CBT different from, say, psychoanalysis, is that CBT therapists do a lot of teaching, use handouts, complete worksheets, assign homework, and generally take a more active and concrete role in the therapy.  The focus is on action and change; something that many clients find helpful and empowering (although certainly not all).

In the end, however, my job is to give my clients the best treatment possible, and if, for that person, CBT is a poor fit, I use the training that I have in various other methods to provide my clients with what they need.

What is Psychotherapy, Anyway?

One of the most pervasive publicly-held ideas about psychotherapy is that it consists of the therapist simply listening to her client complain.  Everyone has seen the image of psychotherapy like this one:

toon283“All I want to do is lie around all day. This isn’t helping.”

In reality, none of the therapists I know work in this manner.  Instead, this modality is more consistent with a therapeutic style known as psychoanalysis, which is typically focuses on a client’s past, involves more frequent visits, and is commonly associated with Sigmund Freud.  This is what was developed at the psychotherapy’s beginnings; since then, a lot of research has been conducted, and many other styles of therapy have been created and tested.

Each therapist chooses his or her own style of treatment, including what is called their “theoretical orientation,” which basically means the way in which the therapist views her clients her beliefs about why people develop certain symptoms, and the best way to treat them.  Some that may seem familiar: psychodynamic, cognitive-behavioral, family systems, dialectical behavioral, and humanistic therapies.  Each has their own explanation of clinical psychological disorders, and each has their advantages and disadvantages.

There is also an entire body of research supporting the idea that a therapists’ theoretical orientation does not matter per se, as long as they provide their client with certain basic things – called “common factors theory” – their client will improve.  These common factors include things like warmth, empathy, and trust.

Most therapists I know do not ascribe to or use only a single theory.  Most, myself included, would describe themselves as using more than one, depending on the client. On the other hand, I also have very distinct leanings towards cognitive-behavioral therapy (or, CBT).

Part of the reason for this is my own personality; I am a person who likes structure and who enjoys color-coding, making spreadsheets, creating schedules, and following a specific plan.  Another reason why I like CBT is because, among many of the most popular orientations, CBT has a remarkably strong body of research supporting its results.

A part of this is assuredly because, by it’s nature, it is structured and therefore more easily lends itself to scientific inquiry (as compared to psychoanalysis, where there is no step-by-step procedure).  And, to be sure, many factors affect what gets studied and what does not.

All the same, to me, the science speaks loudly and I consider that part of my job is maintaining an awareness of the most current research in my field.  I believe that doing the best by my clients means using the information available paired with my own judgment and instincts.  For me, CBT is comfortable and effective.  And when I am most comfortable, I am most effective in helping my clients achieve their best results.

Still, it’s not right for everyone, and that’s why I don’t use it with rigidity; I use interventions from other theories and I listen to what my clients are telling me they need – even if they never use those words.

Ultimately, my job is to do the best for every client and that means tailoring treatment to the unique needs and preferences of each person, couple, group, or family with whom I work.  So I use the science available as much as possible, all the while knowing that said research is imperfect and that the human mind and relationships remain more complex than modern science can address.

On Being a Therapist

When I introduce myself to people for the first time and I tell them that I am a therapist, one of the first things I am usually asked is: “how can you stand listening to people whine about their problems all day?”  At first, I would give a lot of half-baked replies about the parts that I like about being a therapist.  Eventually, I realized, however, that what people were really asking is: “it is painful for you? and does my own therapist resent me?”

My answer: I love what I do, and I would not trade it for anything.
Yes, it is true that my job entails dealing with, talking about the most difficult and painful parts of people’s lives; more than that, though, it is about helping people improve their lives.  Clients do not come into therapy to complain, they come in to work; they want to make their lives happier and healthier, and my job is to help them achieve that goal.

Just like physicians are faced with disease every day, which is an unpleasant thing in of itself, so are psychotherapists faced with psychological and emotional difficulties.  And, like physicians, the focus of the work is essentially on the solution rather than on the problem.  Disease is not enjoyable, but finding and seeing the results of the right treatment is incredible.

At least, from my perspective as a therapist, that is what the focus should be.
With that, the difficulty of hearing about sadness, worry, and anger throughout my work day is far overshadowed by the joy of seeing people achieve their goals and change what is ailing them when they first come into my office.

Being a therapist is an amazing thing, and an incredible privilege.