Gearing Up For My First Overnight Crisis Line Shift

Posted on April 24, 2010 by Nathen

I’m settling in for my second shift for my university’s crisis line, and my first overnight shift. It was a beautiful day, and it was difficult to drag myself into our underground lair, but here I am until 8 tomorrow morning. It’s a pretty nice little room, painted earth tones and with lots of nice nature photography framed on the walls. I have my own bathroom, TV, computer, fridge, microwave, bed, and, of course, coffee maker. I don’t plan on drinking any coffee. If no one calls, I’d like to be able to get to sleep tonight. I’m anticipating being able to sleep fine. It’s very quiet here, and the room gets very dark with the lights off. That is, unless someone calls–the phone rings very loudly. And it’s also possible that the possibility of getting a call will keep me up–I haven’t had a call yet. We’ll see!

The first thing I do is make sure the phones are working. We have two, one for crisis calls, and one backup. I have a backup colleague and two supervisors that I can call or text if I get in over my head. I can also bring them in on a three-way call, if it seems the right thing to do. I don’t anticipate that, but it’s nice to know I can. They are all very experienced at this job.

The next thing I do is look over the call sheets since my last shift. Every call gets its own sheet. It’s been pretty slow in the last week–only a few calls. It’s tempting to think that that means it’s unlikely I’ll get a call tonight, but I have no idea. I also looked back a couple months to see if there was any easily recognizable pattern for Friday shifts, but there wasn’t. Just in our current call sheet book we have calls going back about a year, and I believe that we have sheets for many years around somewhere. This line has been running for about 40 years. (And, unfortunately, the administration is shutting us down at the end of this term, for beaurocratic reasons.) I would love to enter all this info into a stats program and look for patterns! I don’t believe I would be allowed to do that, though. There would be no way to get consent from our past ”research participants.” The line is totally anonymous.

The next thing I do is look at our “regular caller” book. I didn’t know this about hotlines, but there are people who use them regularly, mostly very isolated individuals, taking advantage of a free, professinal listening service to help them deal with their troubles. Pretty smart thing to do, really. It had never occurred to me. We have extensive files on these folks, sometimes going back decades. They have “contracts,” too–agreements they’ve made with us about how often and what times they can call, because they don’t tend to be in crisis, just needing some listening. The regular caller book has all the regular caller call sheets, a record of their current contracts, and a list of their calls with how much time they have left until a certain date.

Then I wait for someone in crisis to call. We define a crisis as a situation where a person’s stress overcomes their ability to cope. This can happen a lot of different ways. Our call sheets have the following categories, in addition to “other”: academic, alcohol/drugs, anxiety (popular one), bereavement/grief (another popular one), depression (popular), domestic violence, eating disorder, harassment/descrimination, homocide, information/referral, interpersonal/relationship (popular), loneliness, medical/somatic, psychosis, sexual abuse/rape, sexual concerns, sexually exploitive (this is where a caller tries to use us as a masterbation aid), sexual orientation/gender ID, and suicide (also popular).

When someone calls, I am to go through a six-step process with them. 1) Assess for immidiate danger (“Are you in a safe place to talk?”), 2) establish communication and rapport, 3) assess the problem (keep it to one–the biggest problem–and make it specific, as vague problems are almost impossible to solve), 4) assess strengths and resources, 5) formulate a short-term (tonight) and long-term (tomorrow) plan, and 6) mobilize the client, obtaining commitment to the plan and contracting for safety if they have been thinking about suicide. Throughout the process I am to be assessing the potential for suicidality, listening for clues like “feeling overwhelmed,” “worthless”–any indication that they might be thinking about hurting themselves. If that comes up, I have another process to go to. Maybe I’ll write about that in another post.

Well, wish me luck. I’m not sure what being lucky would be. It’s easy to hope for no calls–”no news is good news,” as my dad likes to say. On the other hand, if someone is out there in trouble, I really want them to call. I’d feel lucky to get to help someone out of a jam. That’s something to know. Crisis line workers want you to call if you need help. We’re not particularly doing this for the money. I make something like $85 per shift. Not a lot.

If no one does call, I’m planning to study until I get tired and then go to bed. I’ll let you know what happens. I won’t be able to tell you the details, of course, but I can say if I got a call.

[First published on Nathen’s Miraculous Escape, April 26, 2010.]

Only a Few More Days to Weigh in on Changes to the DSMOnly a Few More Days to Weigh in on Changes to the DSM

Posted on April 15, 2010 by Nathen

I posted in February about how the committee that is redesigning the DSM is accepting feedback on their proposed changes. The Diagnostic and Statistical Manual of Mental Disorders is the book used around the world by clinicians to determine what kinds of human suffering count as mental disorders, what symptoms one has to show to qualify as having one of those disorders, and what what can get covered by insurance. The content of this book will shape the lives of those who will interact with the mental health system for the next generation. Being labeled with a mental disorder is a big deal, and which one you get can mean the difference between decent and indecent treatment. Personality Disorder? You’re pretty much screwed. Very few people think they can help you and no insurance will cover you. Adjustment Disorder? PTSD? You’re in luck, most likely. We’re all very hopeful for, and will pay for, your recovery.

If you’re life has in any way been affected by anything labeled a mental disorder, I encourage you to look at the appropriate proposed changes to your future and the future of your loved ones, and write them an email about what you think. You have until April 20, 2010.

Structural, Cross-Cutting, and General Classification Issues for DSM-5

Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence

Delirium, Dementia, Amnestic, and Other Cognitive Disorders

Mental Disorders Due to a General Medical Condition Not Elsewhere Classified

Substance-Related Disorders

Schizophrenia and Other Psychotic Disorders

Dissociative Disorders

Sexual and Gender Identity Disorders

Eating Disorders

Sleep Disorders

Impulse-Control Disorders Not Elsewhere Classified

Adjustment Disorders

Personality Disorders

Other Conditions that May Be the Focus of Clinical Attention

[First published on Nathen’s Miraculous Escape, April 14, 2010.]

Assessing Drug and Alcohol Abuse

Posted on April 14, 2010 by Nathen

One thing I will have to assess in the families I see is possible drug/alcohol abuse, because substance abuse is pervasive, problematic, and interpersonal. One of my texts, Procedures in Marriage and Family Therapy, recommends using “objective” measures such as the Michigan Alcoholism Screening Test (25 items), or the MacAndrew Alcoholism Scale of the Minnesota Multiphasic Personality Inventory (49 items), to give weight to the assessment. However, it also says that there is a correlation of .89 (that’s very high) between answering yes to two or more of the following four questions and alcohol abuse (p. 47):

1) Have you ever felt you ought to cut down on your drinking?

2)have people annoyed you by criticizing your drinking?

3) Have you ever felt bad or guilty about your drinking?

4) Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye opener)?

Also, they list Heilman’s eight symptoms of alcoholism:

1) Thinking or talking a lot about drinking or getting high.

2) Increased tolerance. This is not a sign of health!

3) Drinking or taking a drug in a way that speeds up the onset of its effects.

4) Non-social use.

5) Drug/alcohol starts to seem like a medicine. Thoughts of drug/alcohol immediately upon a stressful event.

6) Blackouts. “How did I get home last night?”

7) Taking care to always have a supply of alcohol/drug.

8) Using more than planned.

Finally, Heilman says that anyone who answers yes to the question “Is your drinking ever different from what you would like it to be?” is very likely suffering from alcoholism (p. 48)

[First posted on Nathen’s Miraculous Escape, April 13, 2010.]

Assessing Family Violence

Posted on April 13, 2010 by Nathen

I will start seeing clients this summer, so I’m reading two texts about how to structure my sessions, Procedures in Marriage and Family Therapy, by Brock and Barnard, and Essential Skills in Family Therapy, by Patterson. One of the things I am to assess as a top priority is the possibility of family violence. (I’ll get a whole class on this next year.) It’s almost always perpetrated by a male. According to Patterson, battering is the biggest cause of injury to women. Here is Brock & Barnard’s list of characteristics that can help identify violent men (p. 46):

1) Believes in the traditional home, family, and gender stereotypes

2) Has low self-esteem and may use violence to demonstrate power or adequacy

3) May be sadistic, pathologically jealous, or passive-aggressive

4) Has a Jekyll and Hyde personality, capable of great charm

5) Believes in the moral rightness of his violent behavior even though he may go too far at times

6) Has perpetrated past violent behavior, which includes witnessing, receiving, and committing violent acts, violent acts during childhood; violent acts towards pets or inanimate objects; and has criminal record, long military service, or temper tantrums

7) Indicates alcohol abuse

To this list, Patterson adds preoccupation with weapons or control.

[First published on Nathen’s Miraculous Escape, April 12, 2010.]

Don’t Overlook Generational Cohort

Posted on April 8, 2010 by Nathen

I’m reading Froma Walsh’s Spiritual Resources in Family Therapy (1st edition) for my Wellness & Spirituality Throughout the Life Cycle class. Here’s a quote:

“Active congregational participation as well as prayer tend to become increasingly important over adulthood. Whereas only 35% of young adults aged 18-29 attend their place of worship weekly, 41% of persons aged 30-49, 46% of those aged 50-64, and 56% of those over 65 attend weekly.”

That quote is from the 1999 edition of the book, and so those numbers are probably based on a survey conducted in the 1990s. The source is not cited, so I can’t be sure, so take this criticism with a grain of salt. I’m just using this example to point out something that happens a lot with the analysis of age-based research. That is, this presentation makes it sound as if humans attend church more and more as they get older, but these numbers say no such thing.

What these numbers say is that at the time of the survey, 35% of young adults say they are going to their place of worship weekly and that each age group above them at this time show more of that behavior. Each generation has its own characteristics. It may well be that this group of young adults is part of a less church-going generational cohort, which will stay more or less that way as they age. Imagine, for example, that such is the case and the next generation that comes along attends church more often. A survey at that time will show that place-of-worship attendance is relatively high in young adults, drops off in middle age, and then resurges in old age, and many will assume, based on that, that this is the “natural” progression of human church-going behavior.

As far as I know, Walsh is accurate in her analysis, based on information she is not giving. It’s a potential error to be aware of, though, and one often overlooked by researchers in psychology. I’ve noticed it often since reading Strauss & Howe’s Generations. They make the point really well, that we often think that increasing age causes people to become more or less something-or-other–more conservative, say–basing our reasoning on the generational cohorts that are currently alive, but it may just seem that way because of the quirks of our sample.

In order to know, we would need more information than this snapshot. We need multiple surveys conducted over quite a period of time, while different generational cohorts were alive, to get longitudinal information. Does each generation attend church more and more as it ages? Is the difference in church-going between a generation in its young years and that generation in old age greater or less than the difference between that generation and another generation entirely?

[First published on Nathen’s Miraculous Escape, April 7, 2010.]

Four Meanings of the Word “Spiritual”

Posted on April 5, 2010 by Nathen

On Friday I had my first Wellness & Spirituality Throughout the Life Cycle class in my couples and family therapy program. We had an open discussion of the meaning of spirituality that got pretty tense. I admit that I was pretty confused about what was making things tense–I was not in the clearest of minds, as I’d just taken comps the day before. It did get me thinking about Ken Wilber’s essay in Integral Spirituality about the four meanings of the word spirituality. In it, he says that there are at least four very common ways that people mean that word, and that if the specific meaning is not made clear it can lead to confusing and confused arguments. Here’s my paraphrase of his four common meanings:

1) Any human intelligence, skill, or ability taken to the highest level. Think Einstein’s intellect, Carl Rogers’ empathizing. In Kosmic Consciousness, Wilber mentions Michael Jordan playing basketball as an example of this meaning of spiritual.

2) Spirituality as its own kind of human intelligence, as in James Fowler’s Stages of Faith.Wilber cites Fowler’s stages as just one example: Humans have a capacity for faith that can progress throughout their lives, from an “undifferentiated faith” at infancy through stages like “mythic-literal faith” and eventually, possibly, to “universalizing faith” as his furthest potential.

3) Spirituality as a state of consciousness, as in meditative states or other meaningful altered states. Also peak experiences.

4) Spirituality as a facet of personality or personality type. People who are very compassionate or loving, for example, might be described as spiritual.

[First published on Nathen’s Miraculous Escape, April 4, 2010.]

Spring Term 2010 Reading List

Posted on April 3, 2010 by Nathen

OK, I’m done with my comps exam. It went well, I think. I’ll find out in a couple weeks. I’m already a week into my new term and am starting my reading. Here’s my reading list for the next 9 weeks. Each one of these is a chapter or an article for either Child & Family Assessment, Group Therapy, Wellness & Spirituality Throughout the Life Cycle, or Beginning Practicum.

[First posted on Nathen’s Miraculous Escape, April 2, 2010.]

624 Yalom 1	3/31/2010
623 Strauss, Hungry for Connection BB	4/5/2010
623 Stith et al., the voices of children BB	4/5/2010
623 Gil 2000, Engaging families in therapeutic play BB	4/5/2010
609 Brock ch 1	4/5/2010
609 Brock ch 2	4/5/2010
609 BB ch1 in Essential skills in family therapy	4/5/2010
624 Yalom 2	4/7/2010
624 Yalom 3	4/7/2010
624 Yalom 4	4/7/2010
630 Walsh 1	4/9/2010
630 Walsh 2	4/9/2010
630 Walsh 3	4/9/2010
630 Odell BB	4/9/2010
630 Prest & Keller	4/9/2010
623 Moon 1998 Family therapy w intellectually gifted BB	4/12/2010
623 Prober 2004 understanding the rainforest mind BB	4/12/2010
623 Mahoney, Exceptional children BB	4/12/2010
623 Gil 2005 From senstivity to competence BB	4/12/2010
623 Meth 2000 Involving fathers BB	4/12/2010
623 Canino 2000 Diagnostic categories BB	4/12/2010
609 Brock ch 3	4/12/2010
609 Prochaska 1999 How do people change BB	4/12/2010
609 essential skills ch 4 BB	4/12/2010
609 Experiential Text–1/6 of it	4/12/2010
Photo & bio stuff for camp as in email from maya of 3/29	4/14/2010
624 yalom 5	4/14/2010
624 Yalom 6	4/14/2010
624 Jacobs 6	4/14/2010
624 Jacobs 7	4/14/2010
630 Walsh 11	4/16/2010
630 Walsh 12	4/16/2010
630 Walsh 13	4/16/2010
630 Walsh 14	4/16/2010
630 Walsh 15	4/16/2010
630 Walsh 16	4/16/2010
630 Hodge BB	4/16/2010
623 http://www.circleofsecurity.org/docs/COS%20Teminology.pdf (terminology?)	4/19/2010
623 Booth 2005 Children’s attachment BB	4/19/2010
623 Rober 1998 Reflections on ways to create safe BB	4/19/2010
623 Watchel 2001 The language of becoming BB	4/19/2010
623 small group role play #1	4/19/2010
APPLY TO INTERNSHIPS	4/19/2010
609 Brock ch 4	4/19/2010
609 Snyder 1999 Hope as a psychotherapeutic BB	4/19/2010
609 BB essential skills ch 6	4/19/2010
609 Ward 2009 moving up the continuum BB	4/19/2010
609 Experiential Text–2/6 done	4/19/2010
624 Yalom 7	4/21/2010
624 Yalom 8	4/21/2010
624 Jacobs 8	4/21/2010
624 Jacobs 9	4/21/2010
630 Walsh 5	4/23/2010
630 Walsh 6	4/23/2010
630 Walsh 7	4/23/2010
630 Walsh 8	4/23/2010
630 Walsh 9	4/23/2010
623 small group role play #2	4/26/2010
623 assessment paper #1 due	4/26/2010
623 Nida 2000 Children’s social emotional development BB	4/26/2010
623 Canino 2000 influence of culture and multiple social BB	4/26/2010
609 Brock ch 5	4/26/2010
609 Gehart 2003 Theory based treatment planning ch1 BB	4/26/2010
609 Experiential Text–3/6 done	4/26/2010
624 Yalom 9	4/28/2010
624 Yalom 10	4/28/2010
624 Jacobs 2	4/28/2010
624 Jacobs 3	4/28/2010
624 Jacobs 4	4/28/2010
630 response paper #1 due	4/30/2010
630 Walsh 4	4/30/2010
630 SArmiento & Cardamil BB	4/30/2010
630 Walsh BB in Family Resiliency	4/30/2010
623 small group role play #3	5/3/2010
623 assessment paper #2 due	5/3/2010
623 Diller 2005 Bitter pill: Ritalin BB	5/3/2010
623 Josephson, Family therapy in an age of bio psych BB	5/3/2010
609 Brock ch 10	5/3/2010
609 Brock ch 11	5/3/2010
609 Brock ch 12	5/3/2010
609 Experiential Text–4/6 done	5/3/2010
609 http://www.dhs.state.or.us/abuse/	5/3/2010
624 jacobs 5	5/5/2010
624 jacobs 12	5/5/2010
624 Yalom 11	5/5/2010
624 Yalom 12	5/5/2010
624 Wichman 2005 BB	5/5/2010
624 Midterm reflection paper–see syllabus	5/5/2010
630 McGoldrick Family Life Cycle BB ch 1	5/7/2010
630 McGoldrick Family Life Cycle BB ch 2	5/7/2010
630 McGoldrick Family Life Cycle BB ch 4	5/7/2010
630 Erickson BB	5/7/2010
630 Sheridan, Peterson, Rosen BB	5/7/2010
630 Pardeck & Pardeck BB**	5/7/2010
623 small group role play #4	5/10/2010
623 assessment paper #3 due	5/10/2010
623 Ketering 2007 child physical abuse and neglect BB	5/10/2010
623 Benoit 1999 Parental abuse and foster homes BB	5/10/2010
623 Caffaro 2008 sibling violence BB	5/10/2010
623 Sholevar, The family and the legal system BB	5/10/2010
623 Tonning 1999 Persistent & chronic neglect BB	5/10/2010
623 http://www.cdc.gov/nccdphp/ACE/ familiarize w purpose and outcomes	5/10/2010
609 Treatment Planning due	5/10/2010
609 Brock ch 7	5/10/2010
609 Brock ch 8	5/10/2010
609 Experiential Text–5/7 done	5/10/2010
624 Yalom 13	5/12/2010
624 Jacobs 10	5/12/2010
624 Jacobs 11	5/12/2010
624 Jacobs 16	5/12/2010
630 Neda article BB	5/14/2010
630 Danielsdotir, Burgar, Oliver-Pyatt BB	5/14/2010
623 assessment paper #4 due	5/17/2010
623 Wind 1999 Developmental identity crisis in nontrad BB	5/17/2010
623 Volkow 2004 the adolescent brain BB	5/17/2010
623 Cohen 2005 psychotherapy w same-sex attracted youth BB	5/17/2010
609 Brock ch 9	5/17/2010
609 Brock ch 10	5/17/2010
609 Bischoff 2002 The pathway toward clinical self-confidence BB	5/17/2010
609 Avis 2005 Narratives from the field BB	5/17/2010
609 Experiential Text–6/7 done	5/17/2010
624 Jacobs 13	5/19/2010
624 Jacobs 17	5/19/2010
624 Anderson 2009 BB	5/19/2010
630 Response paper #2 due	5/21/2010
630 DAvis, WArd, Storm BB	5/21/2010
623 Imberti 2008 the immigrants odyssey BB	5/24/2010
623 Fon 1999 Multiple traumas BB	5/24/2010
623 Dolbin-MacNab 2008 Grandparent raising grandchildren BB	5/24/2010
609 virtual dialogs due	5/24/2010
609 observation due	5/24/2010
609 Brock ch 6	5/24/2010
609 Experiential Text–done	5/24/2010
630 Papernow BB	5/28/2010
630 King & Wynne BB	5/28/2010
630 Clunis & Green BB**	5/28/2010
630 Corbet-Owen & KrugerBB**	5/28/2010
630 Interventions paper DUE	5/28/2010
630 Interventions handout DUE	5/28/2010
624 Final group reflection–overall–see syllabus	6/2/2010
630 Intervention presentations	6/4/2010
609 final exam	6/7/2010
624 Proposal for group term paper–8-10 pp

Comps

Posted on April 1, 2010 by Nathen

[First posted on Nathen’s Miraculous Escape, March 31, 2010.]

At 8 o’clock tomorrow morning, I am taking my first round of comprehensive exams for my couples and family therapy program. The purpose is to make sure we understand all of the theory we’ve been learning before we start seeing clients. If I don’t pass, I will be given another chance at it in the summer–I won’t be able to see clients this summer, but I could start in the fall. I feel good about it. I am ready.

We will be graded Pass, Fail, or Pass With Distinction. I expect to get a Pass. I know the material quite well, but we’re supposed to write 3-4 single spaced pages on each of three questions, all in five hours. With citations. That’s a lot of typing. I’ve done three dry runs through the test, and the most I’ve been able to type, even with my outlines in front of me, is 7 1/2 pages, total. I’m not a fast typist, and I still have to think some about what I’m going to write. I’m fine with a “Pass.” Part of my learning curve is learning how to stop at “good enough.”

We’re allowed to bring food, drinks, ipods, and our reference lists with the references in any order. (I’ll paste in my list below). I’m also bringing my own keyboard (Microsoft Natural Keyboard Elite) and mouse (Logitech TrackMan Wheel). Five hours of fast typing–I need to be comfortable! I’d like to bring my chair, too (Herman Miller Aeron), but it’s difficult to bike with.

Tonight I’m treating myself to some food someone else made and getting into bed early.

Here are the questions. I’ve had them since December. Below them is my reference list. Wish me luck!

Question 1

Describe in detail systems theory, contrasting it with modernism (aka positivism). Be sure to include central concepts of both epistemologies and explain them fully. Also detail the main concepts of communication theory, and the connections between communication theory and system theory. Describe a family problem in detail using a specific model of family therapy (Structural, Strategic, Solution Focused, Experiential, EFT, Bowen) to describe the relevant associated concepts to understand the situation. What are the model specific concepts you will use to understand the family? How will it direct your treatment? What interventions might you utilize to help this family? Why are these interventions systemic? How will you evaluate outcomes based on this model of therapy? How will the common factors research influence your view of intervention with this family?

Question 2

Research ethics includes principles of social justice and dictates competence at each of the following levels: a) conducting research, b) consuming research, and c) utilizing the research literature.

Describe the key social justice considerations when conducting research, when evaluating the merits of a research study, and when utilizing research data as a clinician. In your response include notions of consent, validity, and the characteristics of a well-constructed qualitative and quantitative research designs. Finally, specifically describe how you will incorporate your knowledge of research and its relationship to social justice while a clinician at the CFT.

Question 3

Please describe a process for how you will develop a systemic diagnosis and treatment plan for the client system depicted in the vignette below. Carefully describe how your diagnostic impression and treatment plan are informed by your knowledge of (1) diversity, (2) empirically validated treatments, (3) relational ethics, (4) the diagnostic and statistical manual and (5) CFT theoretical frameworks (systems and communications theories). Finally, based on the vignette below, talk about your treatment approach and how it is informed by the five areas mentioned above. Clearly articulate your systemic diagnosis and treatment plan for this client system.

Kelly (39) and Kris (26) presented for couples therapy. The couple reports they have been together for about two years and are very serious about their future together. Kris reports they have “problems understanding each other. We just can’t communicate.” Kelly agrees and reports it’s been that way for several months. Every time they try to talk with each other about their problems they don’t get along and often engage in escalating verbal arguments. The arguments often lead to Kelly leaving the house very upset and not coming home until the next day. Each partner is hoping for it to get better and want to engage in ongoing couples therapy. Kris reports feeling down and “out of sorts” most of the time and has had difficulty in getting out of bed and making it to work on time the past few months; however, is able to have some good days feeling happy and energetic. After the third session, Kelly discloses to you over the phone that he is thinking of engaging in a sexual relationship with another partner but doesn’t want to bring it up in therapy yet, and doesn’t want you to, either. He states that he feels having another partner will help the relationship because he will “be able to get my needs met.” He further reports to you that they both occasionally seek out partners outside the relationship and feel an open relationship works for them, though made the decision years ago to just not talk about it when it is happening.

Comps References

Becvar, D. S. & Becvar, R. J. (2006). Family therapy: Systemic integration. Boston, MA: Pearson.

Burbatti, G. L. & Formenti, L. (1988). The Milan approach to family therapy. Northvale, NJ: Jason Aronson.

Fisch, R., Weakland, J. H., & Segal, L. (1982). The tactics of change: Doing therapy briefly. San Francisco, CA: Jossey-Bass.

Gehart, D. (2010). Mastering competencies in family therapy: A practical approach to theories and clinical case documentation. Belmont, CA: Brooks/Cole.

Haley, J. (1993). Jay Haley on Milton H. Erickson. New York, NY: Brunner Mazel.

Madanes, C. (1991). Strategic family therapy. In A. S. Gurman & D. P. Kniskern (Eds.)Handbook of family therapy (pp. 396-416). Madison, WI: Routledge.

Nichols, M. P. & Schwartz, R. C. (2008). Family therapy: Concepts and methods. Boston, MA: Pearson.

Sandberg, J. G., Johnson, L. N., Dermer, S. B., Gfeller-Strouts, L. L., Seibold, J. M., Stringer-Seibold, T. A., Hutchings, Andrews, J. B., & Miller, R. B (1997). Demonstrated efficacy of models of marriage and family therapy: An update of Gurman, Kniskern, and Pinsof’s chart. The American Journal of Family Therapy, 25(2). 121-137.

Sprenkle, D. H. & Blow, A. J. (2004). Common factors and our sacred models. Journal of Marital and Family Therapy, 30(2), 113-126.

Watzlavick, P., Bavelas, J. B., & Jackson, D. D. (1967). Pragmatics of human communication: A study of interactional patterns, pathologies, and paradoxes. New York, NY: Norton.

Sells, S. P., Smith, T. E., & Newfield, S. N. (1996). A clinical science for the humanities: Ethnographies in family therapy. In S. Moon & D. Sprenkle (Eds.), Research Methods in Family Therapy (pp. 25-63). New York: Guilford.

National Institutes of Health (1979). The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. URLhttp://ohsr.od.nih.gov/guidelines/belmont.html

National Institutes of Health (2010). The Nuremberg code: Directives for human experimentation. URL http://ohsr.od.nih.gov/guidelines/nuremberg.html

Sue, S. (1999). Science, ethnicity and bias: Where have we gone wrong? American Psychologist 54(12), 1070-1077.

Freire, P. (1970). Pedagogy of the oppressed. New York, NY: Continuum.

Aronson, E., Ellsworth, P. C., Carlsmith, J. M., & Gonzales, M. H. (1989). Methods of Research in Social Psychology. Columbus, OH: McGraw-Hill.

Creswell, J. W. (2009). Research design: Qualitative, quantitative, and mixed methods approaches. Los Angeles, CA: Sage.

Corey, G., Corey, M.S., & Callanan, P. (2011). Issues and ethics in the helping professions(8^th Ed.) Belmont, CA: Brooks/Cole Cengage Learning.

Fisch, R., Weakland, H., & Segal, L. (1982). The tactics of change. San Fransisco: Jossey-Bass.

American Psychological Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.-TR). Washington, DC: American Psychchological Association.

Bettinger, M. (2006). Polyamory and gay men: A family systems approach. In J. J. Bigner (Ed) An introduction to GLBT family studies (pp. 161-181). New York, NY: Haworth.

LaSala, M. C. (2001). Monogamous or not: Understanding and counseling gay male couples.

Families in Society, 82(6), 605-611.

I Passed my Comps Exam

Posted on April 1, 2010 by Nathen

April 9, 2010

Dear Nathen,

We are very pleased to inform you that you passed the comprehensive exam. Our standard in grading this exam is high; your work was of a very high quality. Congratulations!

You have worked very hard and you have demonstrated excellent understanding of core course material. We look forward to working with you as you move into your clinical work. In the Beginning Practicum course Dr. Tiffany Brown will continue to inform you about the Advanced Practicum course, about internship options throughout the community, and about orientation dates and plans for beginning at the Center for Family Therapy.

The vast majority of your cohort received a passing score this year. This is a statement of both your individual abilities and the support you give each other.

Again, congratulations.

Deanna Linville, Ph.D., LMFT

CFT Program & Clinical Director

Assistant Professor

Couples and Family Therapy Program

University of Oregon

[First posted as “Comps Update” on Nathen’s Miraculous Escape, April 9, 2010.]

DSM-IV-TR Diagnostic Criteria for Eating Disorders

Posted on March 18, 2010 by Nathen

There are two official DSM diagnoses for eating disorders, with two variations each. This gives us four options: Anorexia Nervosa, Restricting Type; Anorexia Nervosa, Binge Eating/Purging Type; Bulimia Nervosa, Purging Type; Bulimia Nervosa, Nonpurging Type.

This is are direct direct quotes from the DSM-IV-TR. “Postmenarcheal” means after the onset of the menstrual cycle. In addition to Anorexia Nervosa and Bulimia Nervosa, there is a category with no diagnostic criteria called Eating Disorder Not Otherwise Specified that clinician can give to someone “for disorders of eating that do not meet the criteria for any specific Eating Disorder.” People diagnosed with EDNOS are even more likely to die from their conditions than those in AN or BN.

[This post first appeared on Nathen’s Miraculous Escape, March 17, 2010.]

Diagnostic criteria for 307.1 Anorexia Nervosa

A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during a period of growth, leading to body weight less than 85% of that expected).

B. Intense fear of gaining weight or becoming fat, even though underweight.

C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

D. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.)

Specify type:

Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Diagnostic criteria for 307.51 Bulimia Nervosa

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

(1) eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances

(2) a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)

B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxative, diuretics, enemas, or other medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behavior both occur, on average, at least twice a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.