Centers for Family Change Blog

Brothers: On his Brothers and Brothers in History: by George Howe Colt

admin — Sun, 12 May 2013 15:35:59 +0000

Brothers, by George Howe Colt, is a combination memoir and psychological examination of the relationship between brothers. Colt alternates between an examination of his relationship with his three brothers (from their early childhood into adult life) and a psychological and historical consideration of the relationship between brothers throughout history. He devotes 5 chapters to the complex relationship of 5 sets of brothers: Theo and Vincent Van Gogh, John Wilkes and Edwin Booth, Will and John Kellogg, the Marx Brothers, and John and Henry David Thoreau, while also touching more briefly on other sets of brothers.

Colt’s thesis appears to be that the relationship between brothers is one great emotional intensity, characterized by intense competition and complex conflicts between loyalty and rivalry. In considering his own relationship with his brothers, and those of famous brothers, he offers vivid examples of how brothers’ struggle to manage a sense of loyalty versus the desire to best, or even rid oneself, of one’s brother. Colt discusses David Kaczynski’s loyalty to and eventual decision to turn in his brother, Ted, the Unabomber, and contrast this with how Whitey Bulger’s brother Bill (a successful Massachusetts politician) appeared to turn a blind eye to his criminal brother’s actions, and even possibly help his brother allude capture for many years. Colt also discusses research suggesting that the relationship between brothers is fraught with conflict, often physical at younger ages, while noting that this conflict can continue through adult life. While it may be of comfort to know that conflict is common, it is also disconcerting to acknowledge just how difficult and strained the relationships between brothers can be.

I would highly recommend this book to anyone interested in the relationship between brothers, particularly those of you with brothers. The personal memoir provides a window in to the complexities of one’s relationship with one’s brothers, while the historical discussions are both interesting history as well as thought provoking. If there are any shortcomings to this book, and frankly I can think of hardly any, they would be the fact that Colt can only write from his own perspective, a younger brother, and that the role of parents in influencing sibling relationships is not given great attention. However, in the case of parental influence, it may be that parents have less ability to positively influence sibling relationships than we (psychologists and parents) would like to acknowledge.

Brothers, Colt, G.H. Scribner, New York, 2012 .

Ethical Challenges Posed by Technology & Social media

admin — Mon, 22 Apr 2013 02:15:16 +0000

Today’s therapists have the opportunity and challenge of using a variety of tools that did not exist (or were not readily accessible) 10 years ago. Many private practitioners have websites and participate in on-line forums and list-serves. Email, social media and text messaging all offer new ways for potentially communicating with clients. In addition, how and when to move to electronic record keeping and other innovative practice management tools are questions most therapists need to consider. Not only do these new technologies pose technical challenges for clinicians (we must learn how to use them effectively) but new technology also raises a number of ethical challenges for clinicians. Questions ranging from: should I communicate with my clients via email? by text messaging? to whether to have a website (and more vexing, what and what not to have on the site), or even whether to have a personal Facebook page? need to be considered.
Fortunately, there are a number of solid resources for clinicians looking for guidance on these issues. Keeley Kolmes, Psy.D., has an excellent websiteand offers clinicians guidance and resources on how to navigate the challenges posed by new technology and social media. Dr. Kolmes describes her social media policy and generously offers clinicians the opportunity to copy and modify her social media policy.
For those interested in more resources on the topic the journal, “Professional Psychology: Research and Practice,” published a number of articles examining the impact of technology on clinical practice (see Dec. 2012, Vol. 43 #6, and Dec. 2011, Vol. 42, # 6). A number of these articles focus on ethical challenges these innovations pose. In addition, the American Psychological Association’s has recently released a draft set of guidelines on Telepsychology.

In upcoming posts I will consider some of the specific challenges new technologies pose and offer some discussion and suggestions on how to respond to these challenges. Finally, I would like to thank my colleagues on the Illinois Psychology Association’s Ethics Committee for their thoughts and ideas on these issues, which have been invaluable in helping me continue to refine my thinking on these issues.

A Must Read: “Bitter Pill: Why Medical Bills are Killing Us” by Steven Brill

admin — Mon, 18 Mar 2013 00:16:56 +0000

The cost of medical care has been debated vigorously (and at times viciously) for the past 5 or more years. Many concerns have been raised about the cost of healthcare, as well as issues of access to healthcare. Steven Brill’s recent article* highlights not only the high cost of medical care but the incredible profits and salaries being made by pharmaceutical companies, insurance companies, and hospitals. While filled with examples of the impact of medical care on the uninsured and the under or poorly insured Brill’s article repeatedly illustrates the excessive charges for medical services and medication. He does praise some of the features of Obamacare including the elimination of life time caps on benefits, the prohibitions on the exclusion of pre-existing conditions, and the increased coverage for preventative care. However, Brill reiterates that the cost of healthcare is too high.
Of particular interest to those of us who are providers of health care services is that Brill’s focus on the high cost of medical care is not primarily on outpatient care (particularly not on office visits) but on hospital costs, hospital charges and profits, and insurance and pharmaceutical company profits. Many who provide health care services would argue that we too are being squeezed by these large players who control what we are paid and what services we can provide. Though Brill does raise concerns about the over provision of services, as an issue that is part of the problem.
Brill does not offer a laundry list of solutions. In fact he focuses on how solving these problems will be difficult because of the political influence of hospitals, insurance companies, and pharmaceutical companies. He notes that the pharmaceutical and health-care-product industries, combined with organizations representing doctors, hospitals, nursing homes, and insurance companies spend far more on lobbying than any other groups, including oil and gas companies and defense manufactures. Brill also intimates, on several occasions, that a for-profit/ profit driven health care system may be inherently problematic because while one can defer purchasing many things it is hard for most of us to consider deferring health care, particularly at times of emergency.

*This article can be found in the March 4, 2013 issue of Time Magazine or on-line at: http://www.time.com/time/magazine/article/0,9171,2136864,00.html

Why I Still Recommend Family Therapy

admin — Mon, 04 Mar 2013 02:29:43 +0000

Why I Still Recommend Family Therapy
February 27, 2013
Over 25 years ago my partners and I founded the Centers for Family Change. One of our motivations, at that time, was to develop a private practice that emphasized family therapy as the primary modality or approach. It was our belief that the most effective way to address many common childhood and adolescent problems was with family therapy. In a series of posts I will discuss why I still believe that family therapy is the best way to address many problems facing children and adolescents. These posts will examine topics such as: the original arguments/rational for family therapy; the elegant simplicity and common sense truths of Structural and Strategic family therapy models; the factors that appear to have stymied the use of family therapy; and a call for more family therapy and examples of how family therapy fits for many problems of childhood and adolescence including ADHD, anxiety disorders, underachievement and defiant and oppositional behavior.
Let me begin this discussion by indicating that I understand why many therapists do not do family therapy, and why many families do not seek it out.
Family therapy is harder than individual therapy:
• the views of more than one person have to be understood, addressed and balanced.
• patterns of interaction need to be identified and tracked; therapists need to think in terms of how systems work in addition to examining feelings and beliefs.
• conflicts can occur quickly and become quite intense.
• the therapist cannot just empathize with and understand the perspective on only one person; there are multiple perspectives and truths to balance.
Families often do not prefer or event want family therapy:
• teenagers may want the privacy and autonomy offered by individual therapy.
• parents may believe the problem lies completely within their child.
• family members may not want to address difficult and painful family issues.
Logistical Challenges exist:
• it is hard to schedule families, more evening or weekend hours are needed.
• insurance may not want to pay for family therapy.
• training programs may not have provided adequate training in family therapy.
Despite these challenges, and in some cases because of them, family therapy is often called for. Unaddressed issues, multiple perspectives on problems, unresolved conflicts, and problematic patterns of interaction all may need to be addressed to effectively resolve problems. Failing to fully consider these problems may hinder or prevent individual therapy from succeeding, where family therapy, despite its challenges, can.

Are We a Brand? “Reflections on What Brand Is Your Therapist?”* by Lori Gottlieb

admin — Sat, 24 Nov 2012 17:47:26 +0000

In this thought provoking New York Times piece Gottlieb, a relatively new therapist (and former journalist) describes the dilemmas many clinicians face in terms of “how much” and “how to” market themselves. This challenge is compounded on increased pressures on clinicians: growing number of available therapists, renewed pressure from insurance and managed care to limit services, and competition from coaches. Gottlieb thoughtfully discusses the pressures she experienced to market her practice and her concerns that adopting an aggressive marketing approach might compromise her clinical work. In the end, Gottlieb reaches a balance that would likely strike many of us as reasonable: a website but clear limits on the use of social media. What is surprising is that she offers no mention of more traditional marketing approaches (e.g., networking with other professionals) which are widely accepted by most practitioners.

Gottlieb touches on challenges therapists face as they consider incorporating social media into her practice and her concerns that an excessive use of social media might disrupt/undermine her clinical work. The debate about social media is ongoing. Clinicians such as Ofer Zur strongly recommend the extensive use and incorporation of social media into current practice, whereas many others argue for more caution. Keeley Kolmes, PhD, a San Francisco psychologist offers a very thoughtful discussion of these issues on her website: http://drkkolmes.com/.

I would argue that despite the pressures to market and adopt new technology that we need to proceed cautiously. Going along with current trends may not always turn out for the best (for us, as clinicians, and for our clients).

The Black Swan: Second Edition; A really worthwhile read!

admin — Fri, 23 Nov 2012 03:56:49 +0000

“A thought provoking book” is a gross understatement when it comes to Nassim Taleb’s The Black Swan. Taleb forcefully argues that the way we think we understand the world is not valid. Taleb asserts that randomness, unforeseen and unpredictable events, have a far greater influence than we wish to acknowledge. He argues that outlier events (rare, unusual and unexpected ) have a far greater impact on human life than we believe (in fact he argues that these events are the primarily movers and shakers for our lives and our world). In addition, he notes that we concoct explanations of these events after the fact to try and make them seem predictable, but he asserts, they are not. Taleb is highly critical of “experts” and their (our?) ability to predict what will occur. He argues that what we “do not know” is more important than “what we know,” i.e., that an awareness or understanding of how little we know is more valuable than focuses on and trying to confirm our theories. Moreover, Taleb argues that we are prone to a variety of errors in our attempts to understand and make sense of the world: we often rely on anecdotes and observations (highly unreliable sources of evidence) to draw conclusions and make predictions; and we are prone to retrospectively making sense of things that we had no idea were going to occur, in order to make them (our lives, the world around us) seem predictable. Again, thought provoking, underestimates this book. Taleb’s arguments force the invested reader to question and re-examine his/her assumptions (which I might venture to argue is a very worthwhile exercise).

For the record: the complete title of the book is: The Black Swan: Second Edition: The Impact of the Highly Improbable: With a new section: “On Robustness and Fragility” by Nassim Nicholas Taleb Random House, 2010, USA.
This book is available in hardcover, paper and Kindle editions.

Freud’s Last Session or is there a God

admin — Fri, 08 Jun 2012 22:56:23 +0000

For those with an opportunity, the play, Freud’s Last Session, by Mark St. Germain, is highly recommended. This play features an elderly Freud, dying of cancer, engaged in an intense discussion with C.S. Lewis. Freud angrily challenges Lewis’ faith in God. Lewis, in turn, is far more affable, be equally sure of his convictions. Throughout the play, Lewis and Freud debate the existence of God, and the value (or lack thereof) of a belief in God. Their discussion is humanized as Freud visibly struggles with his failing health. The conversation occurs just as WWII is beginning, which places the role of beliefs in a historical context. In light of the increased emphasis on the value of spirituality it is unusual to see the importance of spirituality and religion so directly challenged. Regardless of one’s particularly belief system it is intellectually stimulating to watch such a lively discussion of these issues.

This play is currently running through Sept. 2nd, 2012, at the Mercury theater (http://freudslastsession.com/).

Book Reviews and more: A new blog Feature

admin — Wed, 06 Jun 2012 17:22:49 +0000

In this section of the blog I will periodically discuss books that I have found to be thought provoking. These will not always be works about therapy, and in fact my hope is to identify a wide range of literature that is both thought provoking and helpful (in terms of understanding and identifying ways to help people change behavior).

The Power of Habit: Why We do What We do in Life and Business, by Charles Duhigg

In this highly readable work, Duhigg advances the idea that much of behavior is driven or controlled by habits. His deceptively simple thesis is that if we can better understand how habits work, how they can control behavior, that we will be much more able to change behavior. Duhigg is not referring to only individual behavior but also to behavior on a corporate and community levels, as well. His examples range from an analysis of how habits can explain compulsive gambling to how the famous Montgomery Bus Boycott was successful, in part, because of the power of habits. The Power of Habit is clearly not a self help book. Rather, it is an analysis of human behavior, and how something as simple as habits influence and shape behavior. Duhigg’s work calls into question many of our cherished explanations for how and why people behave the way they do. It also suggests that behavior can be changed quite effectively if we understand how habits work.

I would highly recommend this book. While it may be unsettling to think that something as simple as habits underlie many negative and positive patterns of behavior, it is also a hopeful idea, because it suggests that change is quite possible.

Guest Blog Entry by Kenneth Burnstein, MSW, LCSW: Part II in Anger Management Series

admin — Wed, 18 Apr 2012 15:14:07 +0000

Anger Management for Teenagers: Individual, Family, and Peer Dynamics

By Guest Blogger : Kenneth Burnstein MSW LCSW

Individual beliefs, family stresses and challenges, and peer norms/pressures are the major factors that influence or account for problems with anger management. Thus, therapists working with teens need to taken into account each of these dynamics.

Individual Dynamics: One of the most important treatment dynamics to consider is the degree of personal responsibility and accountability a teenager has with regard to his* behavior. Many times initial attempts to teach anger management skills fail simply because the teen believes that his behavior is justified. Unless the a teenager accepts responsibility for his behavior (regardless of how others acted toward him) it is very unlikely that the teen will be invested in and work at learning how to better control his anger and aggressive behavior. In addition to accepting responsibility for their actions teenagers need to be able separate their feelings from their behavior, understand that while it is okay to feel angry it is not acceptable to hurt others or seek revenge. For many teens this becomes an ongoing theme within the treatment. While treatment may focus on other issues and concerns this concept is a touchstone which often needs to be approached from many angles in order to help teenagers fully integrate this value into their belief system. Finally, engaging teenagers in therapy is critical. In order to engage teenagers the therapist may need to express much empathy for the teen regarding how others (parents/ teachers/ authority figures, peers) are treating the teen. However, even while doing this the therapist needs to continue to work to help the teenager accept accountability for his actions and choices.

Family Dynamics: Understanding how parents interact with the teen is also critical. All too frequently, teenagers with anger problems have parents who have difficulty managing their anger. In some instances, parental anger may be present in many spheres of life, while in others, it primarily surfaces in how parents react to their teenager. Anger management for teenagers with parents with anger management problems is “a family affair.” Helping parents make changes regarding their own anger, particularly in terms of how they react to and interact with their teenager, often brings about rapid positive change. If parents can show more empathy and model more appropriate behavior, this can often be extremely therapeutic for their teenager. Many times parents need to be helped to better understand their teenagers’ angry behavior is a product of immaturity. This understanding often makes it possible for parents to find more effective ways to respond to their child’s problematic behavior. Moreover, reducing stress and conflict within the family also helps to defuse and decrease anger problems, for many teenagers.

Peer Dynamics: There has been much written about the importance of the peer group on the teenagers’ self-concept, values, behaviors, and choices. Understanding the impact and influence of peer relationships is often important because the values of the peer group frequently influence and affect the teen. Specifically, if the teen’s peer group views the expression of anger and aggression positively this needs to be taken into account and addressed in therapy. Often teenagers will assert that they need to be “respected” before they show respect to others. This type of value or belief is clearly important in understanding their angry and aggressive behavior. Moreover, it is important to determine whether a teenager is expressing peer group norms about anger (i.e., is in overt conflict with parents, authority figures, and other peers not directly in their peer/ friend group) or whether a teen has anger problems with members of their peer group (fights with friends, or has no friends). Teenagers who act in angry and aggressive ways with all of those in their lives, may have underlying problems with impulse control (or mood), which will need to be addressed as part of treatment.

*The male pronoun is used a teenage boys typically present with anger problems. However, anger problems can and are a concern for some teenage girls.

What makes therapy work?

admin — Sun, 29 Jan 2012 19:20:32 +0000

Recently, I have found myself thinking about this question. I know that my thinking is spurred by the several trends or developments in the mental health field: the push by the American Psychological Association (APA) and other professional groups for Evidenced Based Therapy (therapy that is clearly demonstrated to be effective); ongoing pressure from managed care organizations to demonstrate the effectiveness of therapy in order to obtain authorization for additional covered therapy sessions for clients; and increased requests from clients (and others) for CBT (cognitive behavioral therapy) or other types of therapy that they have heard are reportedly most effective.

How important is the client-therapist relationship?

At the same time that there has been an increased call for Evidence Based Therapies there has been a growing body of research which has strongly suggested that the “working relationship,” or “alliance,” between therapist and client, is one, if not the most important factors in predicting whether therapy will have a successful outcome. John Norcorss, Michael Lambert, Bruce Wampold and others working in this area has gone on to delineate what factors are key in considering the client-therapist relationship and have stressed that seeking feedback from clients about therapy, is it working for them, is a key factor in improving the working alliance, improving therapy outcomes, and decreasing premature terminations (clients dropping out of therapy).

How does this help us?

These findings suggest that an increased focus on the working relationship can help improve therapists’ effectiveness. Related research has clearly shown that soliciting feedback from clients is particularly important. There is much evidence that consistently asking clients for their perceptions about how therapy is working for them can improve the working relationship, and thus increase therapeutic effectiveness.

For further additional information the reader is directed to the works of John Norcross, Michael Lambert, Bruce Wampold, Scott Miller, to name just a few.