Friday, December 13, 2024

Crisis Intervention and Conflict Resolution

 This podcast discusses crisis intervention, focusing on the natural restorative process of systems and the limitations of crisis counseling. It emphasizes the importance of "environmental manipulation" or external controls to manage crises, particularly in power struggles. David G. Markham, LCSWR highlights the role of incentives in conflict resolution and the necessity of a safe, structured environment for productive discussions, advocating against "cancel culture" and promoting differentiated leadership. The email uses examples from various fields, including behavioral economics and family systems theory, to support its points. Ultimately, Markham stresses the importance of creating a supportive space for professional growth and development.


Subscribe to David G. Markham’s Behavioral Health in the upper right corner. 


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The contribution of trauma to genocide is multigenerational.

 Perhaps the intersection of clinical mental health services and politics is trauma.


There is a fascinating discussion on this topic between Chris Hedges and Gabor Mate. It is worth reading and or listening to or both.


Subscribe to David G. Markham’s Behavioral Health in the upper right corner. 

Send this article to friends and family to let them know the high quality of life afforded to citizens of New York State using the email icon at the bottom of the post. 

Post this article to your social media to help spread the good news that New York cares about mothers, babies, families, and their community.

Thursday, December 12, 2024

Understanding The Borderline Mother: Helping Her Children Transcend the Intense, Unpredictable, and Volatile Relationship, the book

Understanding The Borderline Mother: Helping Her Children Transcend the Intense, Unpredictable, and Volatile Relationship by Christine Ann Lawson is an extremely important book for any psychotherapist or layperson interested in the impact of parenting by a person with Borderline Personality Disorder.

The impact is huge and can be multigenerational. Dr. Lawson, in lay language and with clear case examples describes the dynamics that occur between mother and children and somewhat with fathers. She also has clear suggestions for how adult children can manage the relationship with the Borderline mother.

I believe this topic is so important that I am planning on posting a series of articles on this blog as I re-read and study the ideas in this book further. I am developing a new category on the blog which I am entitling, Borderline Parenting. While the focus of Lawson's book is on mother's, fathering plays a critical role  well.

In addition to reading this book and being a psychotherapist, I also have personal experiences with the topic which undoubtedly fuel my interest and resonance with the material described.

I highly recommend this book.

This is article #1 in a series of over 21 articles on borderline parenting.

Death notification: A Father's Grief

David Markham's account details the devastating night his family was involved in a drunk driving accident. The narrative recounts his frantic efforts to locate his injured wife and children at various hospitals, culminating in the heartbreaking discovery that two of his children died. Markham's description poignantly portrays his grief, the challenges of delivering devastating news to his surviving family, and his ultimate decision to become a DWI victim impact panelist to honor his deceased children and prevent similar tragedies. The included discussion guide proposes questions for reflection on the events described.

To read the article click here.

 

Psychotherapy happens in a political environment

 Summary

David Markham's email argues that psychotherapy inherently involves power dynamics, particularly concerning clients' self-determination. He contends that therapists face ethical dilemmas when clients' choices clash with restrictive governmental policies, citing reproductive healthcare and LGBTQ+ rights as examples. Markham suggests that these conflicts create a situation analogous to a totalitarian regime, forcing therapists to operate covertly to uphold their ethical values and support clients' rights. He emphasizes the potential legal risks for therapists who openly advocate for their clients in such circumstances. The email prompts reflection on the political dimensions of psychotherapy and the challenges faced by therapists in upholding ethical principles.



Wednesday, December 11, 2024

Guns are the #1 killer of children and teens in the US.

Summary 

David Markham argues that lax gun control policies, promoted by groups like the NRA, contribute to high rates of gun deaths, particularly among children and teens, in the United States. He contends that this stems from a lack of understanding regarding the long-term consequences of such policies and a societal embrace of guns as a means of protection, despite evidence showing this to be false. Markham emphasizes the need for increased public awareness and improved gun safety legislation. A commenter suggests that mental health issues are the root cause of violence, regardless of the weapon used.
 

Beyond the body, the spirit needs healing as well.

Summary Salman Rushdie's account of his rehabilitation after a stabbing explores the emotional rollercoaster of recovery, specifically highlighting the fluctuating levels of optimism alongside physical pain. A parallel is drawn by David G. Markham who details his own arduous orthopedic rehabilitation, creating personal scales to measure mental clarity, energy levels, and optimism/pessimism alongside pain. David emphasizes the crucial role of optimism in navigating such challenging circumstances and the importance of support systems, referencing his own despair and subsequent recovery. Both accounts underscore the complex interplay between physical recovery and emotional well-being during rehabilitation. David'd experience mirrors Rushdie's in the intense emotional and physical challenges of recovery.

 

It's not loneliness, it's the lack of meaning and purpose in later life.

Summary Explore the concept of successful aging, emphasizing the importance of meaning, purpose, and contribution in later life. They argue that combating the "loneliness epidemic" requires fostering a sense of usefulness and agency, rather than merely addressing social isolation. Maintaining autonomy and self-determination is highlighted, alongside the power of reframing aging to focus on continued contributions, such as the simple yet significant act of giving attention. The texts draw upon Atul Gawande's Being Mortal and offer strategies for individuals and society to support fulfilling aging experiences.

 

Psychotherapy and violence as a tool of social change

 David Markham, a mental health professional, reflects on the role of violence as a tool for social change in the United States. He observes the normalization of violence in American culture, citing recent political events and rhetoric as evidence. Markham questions the implications of this trend for psychotherapy and explores alternative approaches to social change, prompting a discussion among colleagues about effective strategies for facilitating positive change. He raises concerns about the implications for mental health professionals. The overall tone is one of concern and inquiry.


Sunday, December 1, 2024

Low levels of differentiation of self makes a person vulnerable to charismatic leaders.


In the past  I have shared the idea of  the usefulness of cognitive maps for a therapist as they attempt to guide the therapeutic process. One factor in the social regression and developmental stuckness is rapid social change engendering fear but this impacts people at different levels of "differentiation of self", a Bowenian concept. 

There are many characteristics of DOS and perhaps one of the most important is anxiety levels and the ability to be self aware and regulate one's thoughts, feelings, and behavior. To use the analogy again of childhood development, most followers of mass movements who attach themselves to charismatic leaders are at a relatively low level of DOS. They are insecure and lack a sense of well integrated self. 

In thinking about how to proceed with people with low levels of DOS, we might consider how a parent deals with a 5 or 6 year old anxious child. Usually it is through reassurance along with reality testing, encouragement to "use your words" and coaching on management strategies for regulating elevated amounts of emotional arousal (anxiety.) 

Radical acceptance, a concept from DBT, can only occur when anxiety levels are decreased through soothing behaviors both self activated and facilitated by a trusted other. Radical acceptance brings peace and peace brings that ability to radically accept. So what comes first, the chicken or the egg? Basically, security is enhanced with structure and predictability.

I had a client with Borderline Personality Disorder who I have seen probably 10 or 15 times who told me in our last session "Just be honest with me. Tell me when I'm wrong and what I should do!" 

So, I have been a bit more directive with this invitation but I still walk on eggshells thinking it is only a matter of further interactions before she is offended by something I suggest and fires me and looks for another therapist.

In the long run, peace, lower levels of anxiety are not to be found externally but internally. And this I see as a spiritual problem. Radical acceptance has been known for decades in 12 step programs as "Let go and let god" or turning it over to one's Higher Power whatever they conceive their Higher Power to be.

As John Bradshaw said people are trying to fill "the hole in their soul". That's where we psychotherapists come in. How do we help people fill the holes in their souls?

Wednesday, November 27, 2024

The rating scales beyond physical pain: optimism/pessimism, energy, mental clarity




Optimism flooded through me—optimism, my great weakness or my great strength (depending on whom you asked and on my own mood as well). In Voltaire’s Candide (whose full title is Candide, ou l’Optimisme), the hero’s positivity in the face of the world’s horrors is close to idiotic. (If this is the best of all possible worlds, then those parallel universes must be hellish indeed.) When I wrote my novel Quichotte I lampooned my own nature by making my title character an optimist of the Candidean kind. And now, bedridden and gravely injured as I was, I began to believe that the worst was past, that Milan’s arrival was a sign that a corner had been turned, and happy days would soon be here again.

Rushdie, Salman. Knife: Meditations After an Attempted Murder (p. 81). Random House Publishing Group. Kindle Edition.

Salman writes about his experience in rehab which I found interesting because I have spent five months in orthopedic rehab from September of 2023 to February of 2024. One of the things I noticed was how the nurses would frequently ask me to rate my pain on a scale of 0 - 10. Luckily my pain was usually minimal. However there were three other things that were very noticeable and troubling to me and I constructed my own scales to rate them daily and sometimes hourly.

After pain, my second scale was “mental clarity.” I often experienced a fogginess and lack of concentration.

The third scale was “energy level.” There were many times when I just didn’t have the energy to engage in minimal things like talking with visitors. There were many days when my energy level was at 2 and 3.

The fourth scale is “optimism/pessimism” which Rushdie describes in the passage above. There were days when my optimism was 0 and I wanted to die. Had MAID, medical assistance in dying, been available in New York State as it is in 17 other states and Canada I might have killed myself. I was that despondent and pessimistic. That’s when you need someone to love you. I am blessed by three good friends when my family abandoned me and I obviously got through that desolate period to write this post.

The turning point for me was finding an apartment I could be discharged to. Finding the apartment, a place to go, gave me something to live for. Also, the PTs and OTs were very helpful and encouraging. Without them I couldn’t have recovered to the extent I have.

Yesterday, August 23, will be one year since I tore the quadriceps tendon in my right leg, and tomorrow, August 25th will be one year since I tore the quadriceps tendon in my left leg. On the 29th of August it will be one year since I had the surgery on both legs to repair the tendons and I woke up from the surgery in two leg braces from my upper thighs to my ankles at full extension with no flexibility for 6 weeks. I was a beached whale, totally bedridden, and totally dependent on others for even the smallest things like picking up things I dropped on the floor from my bed.

Optimism when a person’s life has been totally turned upside down is a huge thing. I am filled with joy to learn that Salman got his optimism back. Been there, done that as they say.

Editor’s note: I am a member of the online Allnonfiction book discussion group which discusses a different nonfiction book every month.

During August, 2024, we have been discussing Salman Rushdie’s book, Knife, which describes his attack by a man wielding a knife at the Chautauqua Conference Center in August of 2022 as a result of the fatwa proclaimed in 1989 by the Ayatollah Khomeini for what the Ayatollah said was blasphemy in Rushdie’s novel Satanic Verses 33 years prior to the attack in 2022.

The book being read and discussed by the Allnonfiction book discussion group in September, 2024 is Being Mortal by Atul Gawande. 

Saturday, November 23, 2024

The Best Way to Stall Dementia: Quit Smoking

 From Cornell University

While the number of smokers is at a historical low, data demonstrates that smoking still affects public health. Smoking increases the risk of heart and lung disease, affects bone health, and increases the risk of birth defects. A growing body of research demonstrates that smoking also affects neurological health, specifically cognitive decline.

A longitudinal study published this fall in the journal Nature Communications tracked data from 32,000 adults between ages 50 and 104 for 15 years to identify lifestyle factors linked to cognitive decline. The surveys, conducted in 14 European countries, asked about a broad range of lifestyle factors including smoking, alcohol consumption, physical activity, and social contact. The surveys also measured episodic memory and verbal fluency, two domains affected by dementia.

Researchers found that most participants showed some signs of cognitive decline over the course of the study, but current smokers demonstrated the largest and most significant levels. The only exception were current smokers who had other healthy habits including avoiding or limiting alcohol, moderate to vigorous physical activity, and regular social contact; those participants showed less cognitive decline, similar to that of nonsmokers.

Editor's note: I have spent many decades of my 56 year career as a Psychiatric Social Worker helping people quit smoking. The interesting finding is that a person who is a long time smoker makes, on average, 5 quit attempts before they finally quit for good. So, I encourage people by telling them "Don't quit trying to quit."

Addiction to smoking is one of toughest addictions to overcome.

80% of people for whom alcohol is a significant problem also smoke. The outcome research shows that quitting both smoking and alcohol at the same time gets better outcomes than quitting these chemicals one at a time.

Friday, November 22, 2024

Cinematherapy can be useful in mental health treatment and recovery.

 The Transformative Power of Film.png

Do you use movies, TV shows, YouTube videos, etc. in your therapeutic work. If so, can you name such a film or video and how you use it?

Yesterday, I finished the Netflix TV series, (8 episodes) of Escape at Dannemora. I remember when this happened in 2015. This is a soap operish kind of story with a narrative that is predictable. What might be interesting is how manipulable people can be in institutional settings and how creative people can be in totalizing circumstances. 

I am not sure how I might use this series in therapy but Tilly demonstrates some of the signs and symptoms of what might be called "inadequate personality disorder." Her insecurities contribute to compulsive sexual behavior which gets her into criminal behavior with two of the inmates.

At any rate, do you have movies or TV shows that you refer to for therapeutic purposes in your work with clients?

If you have been a mental health patient, are there movies, novels, TV shows that have helped you resolve and transcend the mental health problems which have challenged you/

Does Narcissism Fade With Age?


If you’re hoping the narcissist in your life will make sweeping behavioral changes, you are likely to be disappointed, according to a systematic review published in the journal Psychological Bulletin.

For more click here.

Editor's note: As a Licensed Clinical Social Work Psychotherapist with 56 years in the field of mental health I have observed that some people with personality disorders do change in positive directions or at least "mellow" in their older age. However, I also have observed that some people, as this study finds about people with Narcissistic Personality Disorder, not only don't change but the symptoms even become worse.

Another sad observation is that people tend to die the way they have lived their lives. The old expression "you make your bed and you lie in it' is pretty accurate. Death bed conversions make great stories and movies but are exceedingly rare that's why they are so valued and appreciated if and when they do occur.

However a good story about end of life change is told in Dr. Irvin Yalom's book; "Love's Executioner: and Other Tales Of Psychotherapy" in the second chapter "If rape were legal..."


Friday, June 14, 2024

Trust in a benevolent universe is a key to spiritual health.


Even if your spirituality does not include a Supreme Being, children need to feel that the universe smiles on them. Einstein said that the most important decision each person makes is deciding whether or not this is a friendly universe.

Dr. Laura Markham, Great Spiritual Lessons Every Child Should Learn

Laura Markham is no relation to me and I don’t know her. However, I admire her work.

As I read and think about this quote, it seemed to me that this is an important decision for adults as well as children. To what extent is one of the foundational purposes of psychotherapy to help people shift their perception from a world of malevolence to one of friendliness? How do we help our clients shift their perception from a malevolent universe in which they feel victimized to a benevolent universe in which they are loved unconditionally?

One of the most important contributions to this mind shift from the negative, fear based perspective to a positive, optimistic perspective is the cultivation and expression of gratitude. Before bed, it is suggested by the positive psychologists that we reflect on the three good things that have happened to us during out day. What have we been blessed by? Identifying these things fosters an appreciation that allows us to become aware that we are loved by the Universe. 

At any age we can intentionally choose to recognize and acknowledge the blessings in our life. What greater gift could a parent give a child that to facilitate the child's awareness and expression of gratitude?

Sunday, March 3, 2024

Lethal drug overdoses in the year 2021 killed 100,000 people.

 


Lethal drug overdoses in the year in  2021 killed 100,000 people. After fentanyl, methamphetamine is the largest killer.

In my practice I know far more people who have died from drug overdoses than from Covid-19 and suicide.
 
The interesting observation is that people have much more control over lethal drug overdoses than they do of Covid-19 in the sense that the exposure to the agent of death is under the individual's control.
 
What are the factors that contribute to the high level of substance misuse in the United States?
What can we do as psychotherapists do to ameliorate the suffering that contributes to this phenomenon?