Category: Empathy

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A Hands-On Approach to Psychotherapy?

00Empathy, Featured news, Health, Therapy, Trauma July, 17

Source: stux at Pixabay, Creative Commons

A friend of mine, Sigourney (name changed), once told me she would never see a therapist who wouldn’t hug her. Adamant that non-sexual touch in therapy helped her feel connected, she characterized a therapist who wouldn’t touch her as rejecting, cold, and untrustworthy.

The subject of non-sexual touch in therapy is controversial, and seems to vary depending on the professional training of the clinician. A study of clinical psychologists by Cheryl Stenzel and Patricia Rupert of Loyola University shows that many practitioners worry touch can be misinterpreted as erotic, or can damage a vulnerable client. There is also the risk of ethical complaints, so most psychologists refrain from touching clients under any circumstances.

In contrast, a summary of research by James Phelan of the American Psychoanalytic Association shows that, in surveys of psychotherapists and social workers, more than 80% touch their clients in non-erotic ways. This touch might include a pat on the arm or back, a side hug, or a full-on embrace.

So, when is touch appropriate in a therapy session?

Little training or discussion exists on therapeutic touch. Students of psychotherapy are often left confused, unsure of how to proceed, and afraid to broach the topic with their supervisors. The ethics code of the American Psychological Association does not prohibit non-sexual touch, while sexual contact, of course, is forbidden. In an interview with the Trauma and Mental Health Report, social worker Cara Grosset, a 20-year practitioner of trauma counselling, says that touching a client depends on the context and the person.

“I work with children and adolescents who have experienced or witnessed severe traumas. They may have discovered a parent who died from suicide or seen their parent killed. If they are sobbing uncontrollably in a session when describing this experience, it seems almost inhuman to not reach out with a comforting and appropriate touch.”

Grosset sees many of her clients in group situations, such as summer camps for grieving youth. In this type of setting, a soothing side hug or pat on the back during a difficult discussion happens publicly, leaving little room for misinterpretation. She has found that these gestures help the healing process.

Another example of successful non-sexual touch happens when Grosset facilitates therapy with children and their parents. Some of her young clients run to her at the beginning of a session to hug her as their parents stand by. An affirming response from Grosset is important for the child to feel nurtured and valued.

But Grosset understands why some therapists are reluctant. Many clients don’t want to be touched, and it’s important to know each person’s boundaries. Touch must be for the client’s sake, not the therapist’s. And when touch helps build connection with the client, it can be a beneficial adjunct to talk therapy.

At the same time, touch can be difficult to navigate in private sessions due to ambiguous professional guidelines and taboos surrounding touch in this type of setting. Grosset’s viewpoints are substantiated by other therapists in qualitative research by Carmel Harrison and colleagues at Bangor University in Wales:

“The values of touch included the ideas that touch could offer clients support, acknowledgement and containment. Despite this, all therapists emphasised the rarity and cautious use of touch in their practice. They discussed touch as being outside the remit of clinicians, and considered how limited discussion and training perpetuated this belief.”

It’s easy to find opposing points of view. Some clients feel that a touch from their therapist increases their self-esteem and enables them to move past feelings of worthlessness. For example, a response to a blog on the website ‘Jung at Heart’ read:

“Twenty years ago, my therapy sessions were, after the first six months to a year, almost always punctuated at the end by a hug. Those hugs saved my young life.”

On the same website, others state that they would feel awkward and violated by a therapist’s touch:

“As a therapy client, I really don’t want my therapist touching me. Not a hug, or a pat of the shoulder, or even a handshake.”

In a 2015 New York Times blog, psychotherapist Hilary Jacobs Hendel explains how she spontaneously hugged a client, but still feels uncomfortable about integrating touch into her practice. Instead, she uses imaginary touch, asking her clients to visualize hugs: “Even when I think a physical hug would be therapeutic, I continue to rely on fantasy.” This unique workaround ties back to concerns of actually touching clients.

The benefit of non-sexual touch in therapy is still open to interpretation. Even thoughresearch shows that human touch is important to wellbeing, individual clients and therapists differ greatly in their beliefs on the subject, and risk-management leans toward using it sparingly if at all.

–Lysianne Buie, Contributing Writer, The Trauma and Mental Health Report.
–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Photography Documenting Mental Illness Draws Criticism

00Caregiving, Emotional Intelligence, Empathy, Featured news, Health, Relationships, Resilience March, 17

Source: ethermoon on flickr, Creative Commons

For the past six years, Melissa Spitz of St. Louis, Missouri has been using photography to illustrate her mother’s experience with mental illness, referring to it as a form of “documentary photography”.

The photographs taken of Melissa’s mother Deborah are shared on Melissa’s professional website and on her Instagram in a project she calls “You Have Nothing to Worry About.” They artfully depict Deborah’s lifelong struggle with bipolar disorder, schizophrenia, depression, dissociative identity disorder, and problem drinking.

In an interview with Time Magazine, Melissa explained that the series aims to provide an intimate look into the life of an individual suffering from mental illness. She told Dazed Digital:

“For me, mental illness has a face and a name—and that’s mum.”

Melissa first became aware of her mother’s mental-health problems when she was a child, and Deborah had to be institutionalized for “psychotic paranoia”. After years of anger and blame, Melissa picked up her camera as a way of confronting her mother’s disorder head-on.

The project became an emotional outlet for Melissa to facilitate healing. In an interview with Aint Bad Magazine, she explained:

“By turning the camera toward my mother and my relationship with her, I capture her behavior as an echo of my own emotional response. The images function like an ongoing conversation.”

Research published in the Journal of Public Health has shown that creative media can serve as powerful tools to help people express feelings of grief. Art therapy specifically can provide a means of expression, relieve emotional tension, and offer alternative perspectives.

Through her project, feelings of pain and hurt that Melissa held toward her mother were ameliorated, and she found herself feeling greater empathy, visually acknowledging her mother’s struggle with mental illness.

While the project is not without its merits, the provocative nature of the photographs—ranging from Deborah’s hospitalization to images of her unclothed and bruised—may elicit shock and discomfort in viewers.

Which raises the question: where do we draw the line between exploitation and freedom of expression in art depicting mental illness?

Laura Burke, a drama therapist from Nova Scotia, Canada, sees Melissa’s project as crossing an ethical line. Laura was diagnosed with schizophrenia in 2005, and has suffered from depression her entire life. She believes that people with mental illness are often spoken for, and this is a common trap in representing their lives through art.

In an interview with The Trauma and Mental Health Report, Laura commented on Melissa’s project:

“It appears sensitively done, but the line between exploitation and reverence is a tough one to walk. If the focus was more explicitly on Spitz’s perspectives of her mother, and not an objective account of how things happened, which is sometimes how a photo can appear, I might feel more comfortable with it.”

Another issue that can arise is the power differential between photographer and subject. Even when consent is provided, subjects who struggle with mental health issues are particularly vulnerable when someone else is formulating the vision and acting as “the voice” of the art piece.

Laura addressed this concern in her interview:

“I feel that focusing more on the family member’s experience, and less on the subject living with the mental illness would be a less exploitative choice.”

Melissa is aware of the criticism her project has garnered from audiences. In an interview with Time Magazine, Melissa said:

“I am fully aware that my mother thrives on being the center of attention and that, at times, our portrait sessions encourage her erratic behavior. My hope for the project is to show that these issues can happen to anyone, from any walk of life and that there is nothing to be ashamed about.”

Despite the criticism, art can be transformative for both the artist and the audience by exposing mental illness in its rawest form. Max Houghton, a Senior Lecturer in Photojournalism and Documentary Photography at the London College of Communication, appreciates what Melissa’s project can do, and how it can help break down stigma surrounding mental illness.

Houghton told BBC News:

“I think photojournalism is criticised when it looks at the miserable side of life and depressing issues. However, in the right hands, photography can be used as a tool to discover and tell important stories differently”.

Projects like Melissa’s You Have Nothing to Worry About often spark much needed discussion around mental illness and are important and necessary to address stigma. And yet, one is left wondering whether such depictions of the vulnerable may do more harm than good.

–Nonna Khakpour, Contributing Writer, The Trauma and Mental Health Report

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Learning to Manage Emotions Boosts Children’s Well-being

00Child Development, Education, Emotion Regulation, Emotional Intelligence, Empathy, Featured news, Relationships February, 17

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English, Math, History, Geography…classes found in school curricula build foundational knowledge and promote future success.

Schools lay the groundwork for cognitive development, especially in academic areas. But what about emotional development? Proficiency in that is equally important for leading a successful life. Yet, little effort has been made in school to teach children how to manage their feelings.

With the introduction of RULER, this may not be the case for much longer. More and more schools around the U.S. are implementing the program aimed at teaching students—and teachers—to ‘Recognize, Understand, Label, Express, and Regulate’ emotions.

Supported by the Yale Center for Emotional Intelligence, it incorporates social and emotional skills training into the school curriculum to support child development. Specific curricula are available from kindergarten to grade 12, and ongoing implementation is necessary to solidify these skills as children get older.

“They’ve started to teach students about feelings as explicitly as they teach math and reading,” writes Seattle Times education reporter John Higgins.

The program is based on the work of two psychologists, John Mayer and Peter Salovey, who began their scientific study of emotional intelligence over two decades ago. They focus on a direct link between critical-thinking skills and emotions.

According to Meyer and Salovey emotional intelligence is the ability to identify, monitor, and manage the emotions of others and oneself, to guide actions and ways of thinking.

Studies show that those who are reluctant to understand and express their feelings experience higher levels of anxiety, depression, and certain psychiatric disorders. They also report lower levels of well-being and social support.

At school, children experience a wide range of emotions every day. In addition to the stress of managing their studies and homework, they face a number of social struggles, such as conflicts with friends, romantic relationships, and bullying.

Marc Brackett, Director of the Yale Center for Emotional Intelligence, and one of the developers of RULER, says that the way students feel at school has a profound effect on how they learn, influencing their chances of success at school, at home, and with friends. And some individuals are generally more successful at handling emotions than others.

Through different tools, RULER provides a common language for expressing emotions, for dealing with conflicts between students, and for addressing conflicts between students and teachers, making for an open and supportive environment necessary for learning. For example, the “mood meter,”—a sheet of paper divided into four coloured quadrants—is designed to help students build a vocabulary around different emotions.

“I have a teacher who checks in with the Mood Meter on Monday mornings and it’s nice to just know that someone’s listening. It gets us in the mood to work, eases us back into school,” explains a grade 11 high-school student in the program.

Other tools, such as the “meta-moment”, train students to use the few seconds following a moment of anger to take a deep breath and imagine how their “best self” would react.

One 7-year-old student talks about her experience with the meta-moment:

“When I’m not in a good mood, RULER can help me solve the problem. Like when my brother pushed sand on my sand castle and wouldn’t fix it. I felt really angry at him, but I took a meta-moment and realized it wasn’t hard to fix what he did and he didn’t do it on purpose. Then I felt a little more forgiving.”

Some are critical of social and emotional learning initiatives within a classroom setting, arguing that schools are not an appropriate venue for emotional education. Others emphasize the price-tag; an online resource and four days total of in-person training costs $10,500 per school (for up to three participants).

However, Brackett’s research shows that implementing RULER can improve a school’s climate while fostering positive development and academic achievement among its students. Some notable improvements include better relationships between students and teachers, more student autonomy and leadership, improved academic success, and fewer reports of bullying.

Students’ mental health profiles greatly improve as well. Kids and adolescents who are involved with this program have experienced reduced levels of anxiety, depression, aggression, hyperactivity, social stress, and alcohol and drug usage. And research shows how children’s ability to handle their emotions and to be mindful of others’ feelings has a significant effect on their mental health.

Not all children come with the tools necessary for academic and social success. Programs like RULER provide a platform for children to learn how to navigate emotional struggles, so they can leave their primary education with methods to succeed in their work and personal lives.

–Eleenor Abraham, Contributing Writer, The Trauma and Mental Health Report

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Prisoners Gain Understanding of Others Through Literature

00Emotional Intelligence, Empathy, Ethics and Morality, Featured news, Psychopathy, Social Life December, 16

Source: Homes and Antiques

Does reading have the ability to increase empathy? Writer and activist Alaa Al Aswany thinks so. He believes that the role of literature has been captured by the single word ‘also’ from the Dostoyevsky novel The House of the Dead, in which a prisoner, witnessing the death of another, comments “He, also, had a mother.” Aswany says that in this context, the word ‘also’ is an attempt to understand what is common to all humans, and that this understanding is the essence of literature.

Literature as a tool for human understanding and empathy… The idea has been a powerful socializing influence in a very unlikely setting: prison.

The organization Book Clubs for Inmates facilitates 22 book clubs across Canada to allow inmates in federal penitentiaries to read and discuss novels. Their slogan is‘Literacy, Self-Awareness and Empathy’. They reason that most inmates will re-enter society at some point and, by encouraging reading while in prison, the organization believes that prisoners can improve vital social skills.

Volunteers guide conversations through themes that range from self-sacrifice to overcoming adversity, and how these topics relate to inmates’ lives. Through these discussions, prisoners develop pro-social skills, such as taking turns speaking and listening, which may enable easier reintegration later on.

The Book Clubs for Inmates website claims that 85% of prisoners report improved reading skills; 90% realize improved communications skills; 93% report reduced recidivism; and 86% see the book clubs as an opportunity to engage in meaningful discussion.

One inmate expressed:

“The Book Club is an enormous source of intellectual and social—sometimes even spiritual—inspiration to both myself and the many others who attend. I have watched men in that group realize their potential to analyze and reflect that I don’t know if they even realized they had.”

Research conducted by David Kidd and Emanuele Castano at The New School for Social Research in New York provides evidence to support idea that literary fiction can enhance the capacity to understand the thoughts and feelings of others.

In their study, participants read randomly assigned texts, either non-fiction, thrillers, romance, or literary fiction. After reading, they perform a series of tasks to measure empathy, social perception, and emotional intelligence by examining how accurately the participants could identify emotions in others. For example, one task involves inferring emotion simply from a picture of someone’s eyes. Scores of empathy were significantly higher for those who had read the literary fiction.

Kidd and Castano explain this phenomenon as literary fiction’s ability to leave more to the imagination by not explaining characters’ behaviour explicitly. Readers then have the freedom to make inferences about characters’ thoughts and motivations. This kind of interpretation requires sensitivity to emotional nuance.

Kidd explains:

“In literary fiction, the incompleteness of the characters turns your mind to trying to understand the minds of others.”

Readers can then carry this awareness into the real world to understand others who are different and think differently. Kidd argues that this transference is to be expected:

“The same psychological processes are used to navigate fiction and real relationships. Fiction is not just a simulator of a social experience, it is a social experience.”

Current research in the neurosciences supports the idea that reading allows people to experience life from a character’s perspective. A study at Carnegie Mellon University found that reading a Harry Potter excerpt, in which Harry rides a broom, activates the same brain regions that would be responsible if one were to actually fly a broom. That is, readers live vicariously through the characters they read about in literary works.

Raymond Mar, a social psychologist at York University, stresses the role of fiction in teaching empathy to children as well, saying that “Even though fiction is fabricated, it can communicate truths about human psychology and relationships,” which can be very important lessons for the developing child.

Exposure to fiction can improve children’s social functioning, as well. Not only does it allow them to step into another’s shoes, improving empathy, but it helps to develop vocabulary for their feelings, allowing them to communicate more effectively. Mar viewsreading as developing their theory of mind, their ability to understand others’ thoughts, desires and motivations.

As one inmate said:

“When you’re reading books, you realize that the world’s not all about you. You’re not the only one going through these trials and tribulations. You get to have a little empathy for other people.”

–Caitlin McNair, Contributing Writer, The Trauma and Mental Health Report

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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CIA Torture Techniques Harm Interrogators As Well

00Anger, Empathy, Featured news, Intelligence, Post-Traumatic Stress Disorder, Stress, Trauma August, 16

Source: KamrenB Photography on flickr

In December of 2014, the U.S. Senate Intelligence Committee released a tell-all report about the Central Intelligence Agency’s (CIA) detainment and interrogation of suspected terrorists, concluding that the “enhanced interrogation techniques” used were far less effective and ethical than previously thought.

Under the supervision of medical staff, detainees were deprived of sleep for as long as a week, confined inside coffin-shaped boxes for several days, water-boarded multiple times a day, and even subjected to medically unnecessary “rectal feeding” or “rectal hydration” in an effort to assert “total control over the detainee.”

The report shows that, to obtain information, CIA officers intimidated detainees with threats to harm their families, which included, “threats to harm a detainee’s children, threats to sexually abuse the mother of a detainee, and threats to cut a detainee’s mother’s throat.” These individuals were also led to believe they would never be allowed to leave CIA custody alive.

According to Mark Costanzo, professor at Claremont McKenna College, torture used as an interrogation device can have severe, long-lasting effects on physical and mental health.

In the Senate report, one detainee, Abd al-Rahim al-Nashiri, was initially deemed compliant, cooperative, and truthful by some CIA interrogators. Yet after years of intense interrogations, he was diagnosed with anxiety and major depressive disorder and was later described as a “difficult and uncooperative detainee, who engaged in repeated belligerent acts, which included attempts to assault CIA personnel and efforts to damage items in his cell.”

Al-Nashiri accused CIA staff of “drugging or poisoning his food, and complained of bodily pain and insomnia.”

Yet the report failed to thoroughly investigate the long-term psychological consequences such techniques may inflict upon not only detainees, but interrogators as well.

CIA personnel involved in the interrogations also experienced psychological distress. Some even elected to be transferred out of the interrogation sites until the CIA stopped using torture as a form of interrogation.

Costanzo notes that research on the psychological consequences of partaking in torture is limited. Most studies have analyzed medical professionals who previously supervised torture to identify the psychological consequences.

In 1986, psychiatrist Robert Jay Lifton interviewed Nazi doctors who participated in human experimentation and mass killings. Lifton concluded that after years of exposure, many of the doctors experienced psychological damage similar in intensity to that of their victims. Anxiety, intrusive traumatic memories, and impaired cognitive and social functioning were all common consequences.

Costanzo believes that interrogators who use torture techniques may have similar experiences. In February 2007, Eric Fair, an American interrogator who was stationed at the Abu Ghraib prison in Iraq, confessed to participating in and overseeing the torture of Iraqi detainees. In his memoir, Consequences, Fair discusses how those events continue to haunt him—leading to martial problems, reoccurring night terrors and insomnia, substance abuse, and depression.

The U.S. public seems split on the issue of torture use, with many believing that enhanced interrogation techniques are warranted if they help prevent future terrorist attacks. Days after the Senate Intelligence Committee released the report, the Pew Research Center polled 1,000 Americans and discovered that 51% believed the CIA’s interrogation techniques were justified.

But according to Costanzo, many who survive torture reveal false information in order to appease the torturer and stop the pain. The Senate Intelligence Committee supported this finding when they discovered that none of the 39 detainees subjected to the enhanced interrogation techniques produced useful intelligence.

Senator Dianne Feinstein of California, head of the Senate Intelligence Committee, further argues that the CIA’s techniques are amoral:

“Such pressure, fear and expectation of further terrorist plots do not justify, temper or excuse improper actions taken by individuals or organizations in the name of national security.”

Feinstein is now proposing a bill to reform interrogation practices in the United States. The bill suggests the use of techniques designed by the High-Value Detainee Interrogation Group, which rely on building rapport and empathy as opposed to relying on physical and psychological pressure. This model has seen great success in both law enforcement and intelligence gathering in countries like Norway and the United Kingdom. Feinstein explains:

“It is my sincere and deep hope that through the release of these findings and conclusions, U.S. policy will never again allow for secretive indefinite detention and the use of coercive interrogations.”

–Alessandro Perri, Contributing Writer, The Trauma and Mental Health Report

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Does Experiencing Therapy Make a Better Therapist?

00Cognitive Behavioral Therapy, Emotion Regulation, Emotional Intelligence, Empathy, Featured news, Psychoanalysis, Therapy February, 16
John Sloan on Flickr

Source: John Sloan on Flickr

It seems intuitive. Psychologically adjusted clinicians should provide better psychotherapy.

Aside from the stressors of their own daily life, therapists face the emotional struggles and traumas of their clients on a daily basis. To meet these challenges effectively and to avoid burnout, therapists need to maintain a high degree of self-awareness and personal wellbeing.

So how does experiencing therapy help clinicians with their work?

British psychotherapist Drew Coster says that personal psychotherapy has helped him broaden his repertoire of techniques and taught him to focus on achieving his clients’ goals instead of focusing on a prescriptive model of treatment. Similarly, Chicago psychologistGerald Stein has explained that going through therapy can help clinicians identify problems in their treatment approach based on their personal experiences.

Studies have also shown that the therapist’s wellbeing affects the quality of the relationship developed with the client. The clinician-client relationship is often referred to as thetherapeutic alliance and it is related to better therapy outcome regardless of the therapist’s specific style or school of thought.

Psychologists Leslie Greenberg of York University and Shari Geller of the University of Toronto, authors of the Therapeutic Presence: A Mindful Approach to Effective Therapy, argue that therapist self-care builds the foundation for developing a good therapeutic relationship with the client. Only through personal balance and stability can clinicians be fully present, attentive, and helpful during sessions.

Self-care can take many forms and can include going through therapy. For practitioners, experiencing their own therapy helps promote self-awareness and personal growth. And it allows them to address private issues and biases that would otherwise hinder progress in their clients. Becoming aware of one’s strengths and limitations can help therapists determine what clients to take on and when to refer clients to other therapists.

Traditional psychoanalysis is the only therapeutic orientation that requires the therapist-in-training to actually go through the therapy process. Self-reflection and exploration are key components of humanistic and experiential therapies. And while cognitive and behavioural approaches do not emphasize personal development on the part of practitioners, mounting evidence for the importance of solid therapeutic alliances may be shifting this tradition.

Psychiatrist Steven Reidford, argues: “At the most commonsense level, a therapist who knows what it is like to be a patient may be more empathic, and may anticipate unstated feelings more readily than a therapist without this first-hand knowledge.”

Reidford cites the requirement for practitioners of psychoanalysis to undergo therapy, explaining that the Freudian concepts of emotional transference and countertransference between patients and therapists are readily applicable to other therapeutic styles like CBT. Instead of relying on theory and patient-report data, he suggests experiencing the phenomena firsthand. He explains that therapists’ primary tool is their emotional sensitivity, which can be honed by attending psychotherapy and getting familiar with one’s own feelings and biases. He also notes that being in therapy de-stigmatizes the process and can help therapists see their patients as individuals instead of maladies.

Experiencing therapy may be helpful from a simpler, more practical standpoint. Associate professor James Bennett-Levy of the University of Sydney found in a recent study that students learning the cognitive therapy approach found personal therapy helpful in enhancing their understanding of the theory and process of treatment. They also found it helpful in gaining a better understanding of their role as a therapist, developing greater empathy, and gaining a better understanding of themselves.

Personal counselling also allows the therapist to experience what it feels like to be the client. Clinicians in Bennett-Levy’s study stated that personally experiencing the treatment process, beyond reading about it or conducting it, provided a deeper understanding of the models and techniques they were studying.

It is important to keep in mind that this research was based on the therapists’ self-evaluations. Are these benefits reflected in psychotherapy outcomes for clients?

Most research on therapy for therapists has focused on self-evaluations of the positive and negative effects. While clinicians purport to gain insight and professional skills by attending therapy, little research exists measuring the specific impacts of therapy for therapists on client satisfaction. Nevertheless, as with anyone, therapy can help clinicians gain self-awareness and empathy, which may otherwise wane as a result of life stress.

– Essi Numminen, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Patients with Misophonia require help and understanding

Patients with Misophonia require help and understanding

10Empathy, Featured news, Happiness, Loneliness, Neuroscience, Relationships, Social Life November, 15

Source: Rick&Brenda Beerhorst on Flickr

Some people find the sound of nails on a chalkboard or the rumbling of a snoring spouse irritating, but what if the sound of someone breathing sent you into a fit of rage?  This is a reality for many sufferers of misophonia.

Only recently garnering attention from researchers, misophonia is a condition where individuals have a decreased tolerance for certain sounds.  Chewing, coughing, scratching, or pen clicking can provoke an immediate aggressive response.  Verbal tantrums are common and in severe cases, sufferers may even physically attack the object or person causing the noise.

“I turn my eyes to face the source of the noise and feel myself glaring at that person in rage,” misophonia sufferer Shannon Morell explains to The Daily Record.  “The only thing I can think about is removing myself from the situation as quickly as possible.”

Many sufferers begin to structure their lives around their struggle with the disorder and avoid triggers by socially isolating themselves.  Public spaces like restaurants or parks are readily avoided and in extreme cases, eating or sleeping in the same room as a loved one can feel impossible.  Even establishing or maintaining relationships is very challenging.

Misophonia can interfere with academic and work performance.  In a study by PhD candidate Miren Edelstein at the University of California in San Diego, patients reported trouble concentrating in class or at work due to distraction from trigger noises.  In some cases, students may resort to isolating themselves, taking their courses online.

David Holmes tells The Daily Record that he finds refuge in using headphones (whenever possible) to block out external noises while at work.

The cause of misophonia is currently believed to be neurological, where the patient’s limbic (emotional) and autonomic nervous systems are more closely connected with the auditory system.  This may be why hearing a disliked sound elicits an emotional response.  Aage Moller, a neuroscientist at the University of Texas, describes it as a complication in how the brain processes auditory stimuli.

Research shows that misophonia usually develops at puberty and tends to worsen into adulthood.

But misophonia is still greatly misunderstood.  There is a lack of research examining its causes or possible treatments.  There is no cure, and some critics even wonder if misophonia should be considered a disorder at all, arguing instead that it’s just a personality quirk.

While it seems there is little help available for people with the disorder, Misophonia UK, an organization dedicated to providing information and support to misophonia sufferers, outlines a number of interventions.

Tinnitus Retraining Therapy (TRT) involves teaching patients how to slowly build sound tolerance, while Cognitive Behavioural Therapy (CBT) focuses on changing negative attitudes that can contribute to the severity of the disorder.  In some cases, hypnosis can be used to relax individuals.  Breathing techniques are also taught so patients can learn to sooth themselves when hearing their trigger noises.

Keeping a diary to record feelings and providing education to loved ones are also strategies recommended by Misophonia UK.  Support groups and online forums like UK Misophonia, Selective Sound Sensitivity, and Misophonia Support also provide a way for sufferers to share their experiences and interact with others.

Researchers in the Department of Psychiatry at the University of Amsterdam say that DSM classification may be necessary to pave the way for more recognition and research on the disorder, and that if misophonia is not regarded as a distinct psychiatric condition, it should at least be viewed as part of Obsessive Compulsive Spectrum Disorder (OCSD).

The prevalence of misophonia is currently not documented, and it seems few seek help.  Suffers of misophonia can only do so much on their own before the disorder starts intruding on their lives.

– Anjali Wisnarama, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Trauma Workers At Risk for Compassion Fatigue

Trauma Workers At Risk for Compassion Fatigue

00Burnout, Empathy, Featured news, Health, Resilience, Self-Help, Trauma, Work July, 15

Source: Brian Walker/Flickr

The expectation of unending compassion for others is unrealistic. For trauma workers, hearing devastating stories can take its toll. This can be seen in detrimental effects to physical and emotional health; that is, a specific type of burnout called compassion fatigue.

The Trauma & Mental Health Report recently spoke with compassion fatigue specialist and director of Compassion Fatigue Solutions in Kingston, Ontario, Françoise Mathieu, to discuss the symptoms of the condition and how trauma workers can protect themselves from it.

Q: What is compassion fatigue?

A: It is a gradual shift and decline in an individual’s ability to feel empathy and compassion towards others. It is not an illness or disorder. Often, the term compassion fatigue is used interchangeably with vicarious trauma or secondary traumatic stress (STS), but there is a distinction.

STS refers to a traumatic, stressful experience without direct exposure to the trauma. STS results from hearing traumatic stories, like hearing witness testimonies or stories of torture. Over time, those stories can shift your view of the world to a tainted and jaded one, to the point where you lose the ability to experience joy. For example, people who work with victims of sexual trauma may have a hard time trusting babysitters or coaches. Vicarious trauma is the result of the accumulation of several STS experiences.

Q: Who is susceptible to compassion fatigue, vicarious trauma, and STS?

A: Helping professionals are the most susceptible. This typically includes physicians, nurses, mental health care workers, allied health professionals, therapists, clergy, law enforcement, teachers, long term care workers, and personal support workers.

The public can also start internalizing trauma from continuous exposure to graphic images portrayed by the media. Overexposure of the September 11th, 2001 terrorist attacks created a heightened sense of danger and paranoia. The difference is that the relationship helping professionals form with their clients is very unique: You become deeply vulnerable. When you’re opening your heart and listening to someone’s pain, it can be very intense.

Q: Are there any signs and symptoms of compassion fatigue?

A: A major warning sign is workaholism. Many helping professionals are so dedicated to their jobs that they don’t have a balance between their work and home lives. The more caring you are, the more vulnerable you are. We call it a “normal consequence” of doing a good job. Helping professionals may experience a decline in empathy, reduced collegiality, dreading client appointments, and belittling their stories.

Or, someone might be doing a great job at work, but they have nothing left to give at home. Warning signs are irritability, social isolation, emotional and physical exhaustion, or self-medicating with drugs, alcohol, or even excessive shopping.

Q: What can protect trauma workers?

A: With increased budget cuts, many trauma workers do not have adequate training, so Trauma Informed Training can be highly protective. Richard Harrison and Marvin Westwood, researchers from the University of British Columbia (UBC), studied experienced trauma therapists and found that those who connected spiritually or creatively with something outside their work and felt supported by their families and communities managed well with the stress of their jobs.

Establishing a deep therapeutic alliance characterized by a meaningful relationship with clients, based on presence and heartfelt concern, also provided professional satisfaction.

Q: What can a person with compassion fatigue do to alleviate symptoms?

A: We can’t prevent compassion fatigue, but there are strategies and tools for professionals to be able to feel grounded, present in the moment, and well trained. Ask yourself these questions:

–Do I work somewhere where I have control? Control over your schedule can reduce compassion fatigue. Small changes can make a big difference.

–Do I have a debriefing process that might relieve some of the emotional strain?

–Do I have access to supportive people whom I can consult with, when I hear difficult stories?

–Am I trained in trauma-related concepts, so that I have a better understanding of the side effects?

–Do I have a transition ritual, a way to leave work behind and transition into my home life? (e.g., yoga, exercise)

Last, research shows that the most effective strategy is Mindfulness-Based Stress Reduction, which recommends relaxation techniques to reduce stress and improve self-compassion.

Mathieu adds that even if you have your own past history of trauma, it doesn’t mean that you shouldn’t be a helping professional. In this case, it’s important to identify your triggers, ensure you have a support system, and that your caseload doesn’t remind you of your personal trauma.

Mathieu cautions the trauma worker to “pay equal attention to the needs of your client, and yourself.”

– By Shira Yufe, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

empathy sand sculpture_1

I Feel Your Pain: The Neuroscience of Empathy

00Empathy, Featured news, Neuroscience, Relationships, Stress April, 15

Source: Empathy Sand Sculpture/photopin

“I saw you doubling over and it felt like a shot right through me. I didn’t see any blood and there was nothing that scared me. Just you, in your misery, and a horrible sensation…I could feel your pain.”

This was my mother’s explanation for fainting while watching the doctor treating me in the operation room.

While fainting from another person’s pain may be uncommon, it brings into view an interesting aspect of human experience: the ability to relate to and feel the sensations of others.

Empathy is understanding and experiencing emotions from the perspective of another, a partial blurring of lines between self and other. We put ourselves in the shoes of others with the intention of understanding what they are going through, we employ empathy to make sense of their experiences.

Pain empathy takes the concept of empathy to the next level, describing physical sensations occurring to others. The concept has been portrayed in the form of sympathetic pregnancy, men reporting symptoms similar to those of their pregnant partners.

A subset of motor command neurons, mirror neurons are thought to be responsible for these sensations, firing in our brain when we perform an action, or when we observe someone else perform an action. These neurons can make you feel like you know what the other person is feeling. Witnessing someone getting hit by a ball, you feel a twinge of pain too.

Originally discovered in primates, mirror neurons have been used to explain how humans relate, interact, and even become attached.

Mirror neurons connect us to others. Neuroscientist Vilayanur Ramachandran, at the University of California, has described mirror neurons as dissolvers of physical barriers between people (he even nicknamed them Gandhi neurons), explaining that it is our skin receptors that prevent us from getting confused and thinking we are actually experiencing the action.

Though not entirely responsible for empathy, mirror neurons do help us detect when another person is angry, sad or happy, and allow us to feel what the person is feeling as if we were in their place.

Ramachandran suspects that mirror neuron research will lead to understanding purported mind reading abilities, which may in fact have an organic explanation, such as a strong empathic occurrence in which one’s emotional/physical sensations are experienced by the other.

Mirror neurons are important in learning and language acquisition. Through imitation, vicarious learning allows for the construction of culture and tradition.

When malfunctioning, mirror neurons may have a big impact. Individuals diagnosed with autism have difficulty with empathy. And as Ramachandran suggests, it is indeed mirror neuron dysfunction that is involved in autism.

The discovery of mirror neurons also helps us rethink other concepts, such as human evolution. Ramachandran says that mirror neurons are what make culture and civilization possible because they are involved in imitation and emulation. In other words, historically, to learn to do something, we have adopted another person’s point of view, and for that we’ve used mirror neurons.

Empathy allows for intimacy and closeness, and mirror neurons provide evidence that humans are biologically inclined to feel empathy for others. More than just an abstract concept, empathy seems rooted in our neurological makeup.

My mother fainted because she couldn’t endure my pain. Perhaps my suffering triggered great anxiety that her body was unable to manage. Or maybe she physically felt my pain.

Mirror neurons are the interface that joins science and humanities. The connection allows us to reconsider concepts like consciousness, the self, even the emergence of culture and civilization.

Indeed, it’s not surprising that Ramachandran compares the discovery of mirror neurons in psychology, to the discovery of DNA in biology.

– Contributing Writer: Noam Bin Noon, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Child Criminals, Feature2

Children Who Kill Are Often Victims Too

00Adolescence, Attachment, Caregiving, Child Development, Empathy, Ethics and Morality, Featured news, Law and Crime, Parenting, Psychiatry, Punishment, Self-Control, Therapy, Trauma March, 15

Source: torbakhopper/Flikr

In 1993, in Merseyside, England, Jon Venables and Robert Thompson were charged with the abduction and murder of 2-year-old James Bulger.  Bulger had been abducted from a shopping mall, repeatedly assaulted, and his body left to be run over by a train.  Both Venables and Thompson were 10 years old at the time.

The public and the media called for justice, seeking harsh punishment and life imprisonment for the murder of a child.  The boys were labeled as inherently evil and unrepentant for their crimes.

When there are crimes against children, it is common for the public to view the victims as innocent and the perpetrators as depraved monsters.  But what do we do when the accused are also children?

Instances of children (12 years of age and younger) who have killed other children are extremely rare.  In a study conducted by University of New Hampshire professors David Finkelhor and Richard Ormrod for the Office of Juvenile Justice and Delinquency Prevention (OJJDP), murders of children committed by those aged 11 and under accounted for less than 2 percent of all child murders in the US. Cases also tend to differ significantly, so conclusions can be difficult to make.  But there are some similarities that have emerged, telling us about the minds of child murderers.

Children who murder have often been severely abused or neglected and have experienced a tumultuous home life.  Psychologist Terry M. Levy, a proponent of corrective attachment therapy at the Evergreen Psychotherapy Centre, notes that children who have severe attachment problems (which often result from unreliable and ineffective caregiving) and a history of abuse may develop very aggressive behaviours.  They can also have trouble controlling emotions, which can lead to impulsive, violent outbursts directed at themselves or others.

Other similarities among child murderers include having a family member with a criminal record, suffering from a traumatic loss, a history of disruptive behaviour, witnessing or experiencing violence, and being rejected or abandoned by a parent.  Problems in the home can be particularly influential.  If a child witnesses or experiences violence, they are likely to repeat violence in other situations.

What a child understands at the time of the crime is of great importance to the justice system.  The minimum age of criminal responsibility (MACR) is the age at which children are deemed capable of committing a crime.  The MACR differs between jurisdictions, but allows any person at or above the set chronological age to be criminally charged, and receive criminal penalties, which can include life imprisonment.

Many courts consider criminal responsibility in terms of understanding.  So they may consider someone criminally responsible if, at the time of the crime, they understood the act was wrong, understood the difference between right and wrong or understood that their behaviour was a crime.  But this approach has been criticized as being too simplistic.  Criminal responsibility requires the understanding of various other factors, many of which children cannot appreciate.

Children may know that certain behaviours are ‘wrong’, but only as a result of what adults have taught them, and not because they fully understand the moral argument behind it.  Morality and the finality of death are abstract concepts, and according to theorists such as Swiss psychologist-philosopher Jean Piaget (whose theory of child development has seen much empirical support), most children under 12 are only able to reason and solve problems using ideas that can be represented concretely.  It is not until puberty that the ability to reason with abstract concepts (like thinking about hypothetical situations) develops.

Prepubescent children are also not fully emotionally developed, and less able to use self-control and appreciate the consequences of their actions.  This, in combination with the fact that many child murderers are impulsive, aggressive, and unable to deal with their emotions, suggests that when children kill, they are treating their victim as a target, as an outlet for violence.  Most victims are either much younger than or close to the same age as the perpetrators, which may suggest they were chosen because they could be overpowered easily.

Research to date suggests that child murderers don’t fully understand the severity or implications of their crimes.  And psychiatric assessments have shown intense psychological disturbance, making true appreciation of the crime even less likely.  Yet many children have been found criminally responsible and sentenced in adult courts.

Jon Venables, Robert Thompson, and Mary Bell received therapeutic intervention while incarcerated, and have since been released.  As far as the public knows, only Venables has reoffended.  However, Eric Smith (convicted of killing 4-year-old Derrick Robie) remains behind bars today, even though he was imprisoned at 13.

Critics of judicial leniency for children accused of murder often cite the refrain ”adult crime; adult time,” choosing to focus on the severity of the crime rather than the age and competency of the offender.  Make no mistake; the murders of these children were brutal, depraved acts that caused intense suffering for the victims, their families, and communities.

But in our zeal, in our outrage, do we dehumanize these children?  Children who—like their victims—can be victims too.

– Contributing Writer: Jennifer Parlee, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

Photo Credit:torbakhopper/Flikr

This article was originally published on Psychology Today