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  • May 10, 2013 6:45 AM | Admin EBCAMFT

    Dissociative Identity Disorder (DID), long considered a rare condition, in actuality has a prevalence rate of 1-3% of the general population.  The vast majority of DID patients do not make their dissociative disorder obvious to others, nor is it obvious to themselves. There are windows of diagnosibility (Kluft, 1991, Lowenstein, 1991) which allows for the appropriate diagnosis of DID. Though supportive therapies provide a helpful foundation for DID patients, it is only after the correct diagnosis is made that adequate healing can occur.  DID, a condition that originates in childhood, is typically not diagnosed until patients are well into adulthood, if diagnosed at all.  The average patient is in psychotherapy for 7 years prior to the correct diagnosis of DID.

    Because DID patients rarely volunteer information about dissociative symptoms, nor recognize their own dissociative tendencies, the absence of focused inquiry about dissociative processes prevents the actual diagnosis from being made. The reasons patients may present for treatment may be varied, often wit random and vague physical and psychological symptomatology.  Patients may present with complaints of impaired memory and concentration, but may report no significant history of trauma. Frequently, individuals with DID present as academically and professionally successful with strong interpersonal relationships.  Patients may not be able to give a clear picture about why they are seeking therapy.  They may remain in therapy, devoted to their therapist for many years, but without getting substantially better.

    The 6% of the DID population that presents with overt symptoms are readily diagnosed, and may present in crisis or in hospital settings, for either psychological or physical reasons, as there is considerable overlap with this population. The professional challenge in diagnosing DID requires not only a thorough history, but focused questioning on the presence of DID symptoms, as well as the use of well designed assessment tools.

    I have diagnosed, treated, and consulted about dozens of DID patients in over 20 years of practice.  With the exception of a few, all were diagnosed in their 30’s, 40’s or 50’s.  All had been in treatmenta with one or multiple therapists, frequently for a number of years; few presented with overt DID symptoms,.  As with many seasoned DID clinicians, I identified a couple of patients who were in my practice for a number of months or years before I recognized their dissociative disorder.

    Dr. Elizabeth (Betsy) Schenk is a licensed psychotherapist with orientations in both Clinical Social Work and Clinical Psychology. Dr. Schenk maintains a full-time private psychotherapy office on Lake Merrit in Oakland  She is Faculty emeritus SFSU School of Social Work.  She has worked a behavioral health administator for adult and pediatric hospitals, and currently works extensively with survivors of trauma,  specializing in the treatment of dissociative disorders and vicarious trauma.  Dr. Schenk is a recognized  immigration forensic psychological expert  and has prepared psychosocial assessments and courtroom testimony for over 15 years.  She has lectured and provided organizational consulting to hospitals, child welfare agencies, legal agencies and health and mental health clinics. She has been providing clinical consultation and supervision for over 20 years.  Email:  drelizabethschenk@gmail.com;  525  Bellevue Avenue #319   Oakland  510-208-3450
  • April 06, 2013 9:05 AM | Admin EBCAMFT
    Happy Spring!  

    Thank you to all who attended our social at Urban Legend Cellars last month.  There were about 35 people in attendance and it proved to be a successful event for networking, reconnecting with old friends and unwinding after a long week.   We look forward to hosting more socials throughout the year.  

    The Board of EB CAMFT has been busily planning and prioritizing as we launch into spring.  Peter Carpentieri, our current Treasurer, has volunteered to initiate the Intern and Trainee support group.  We will soon be offering ongoing groups for our Intern and Trainee members and welcome your participation and/or thoughts or ideas about ways to further offer support you.  Please contact Peter directly at peterc.mft@gmail.com for more information.  

    The Board is also in the processes of re-launching our Mentoring Program.  Several members at the social expressed interest in becoming mentors and we would love to hear from you if you would like to participate as a Mentor or Mentee.  State CAMFT recently announced they will no longer be providing a mentoring program, so we will attempt to fill the gap by providing local mentorship to our newly licensed and pre-licensed members.

    At our most recent Board meeting, EB CAMFT member Lynn Marie Lumiere provided us an overview of the legal consultation she has been receiving in regards to negotiating with insurance companies and anti-trust laws.  The Board shares many of our members’ concerns around the relationship with insurance companies and reimbursements.  We will continue to dialogue with CAMFT about their efforts to protect us, and will continue to seek outside legal consultation about potential options.  Stay tuned for updates and please contact us with your ideas, thoughts or comments around this very pressing matter.  Feel free to contact me at kellymsharp@gmail.com. 
  • April 06, 2013 9:04 AM | Admin EBCAMFT
    Unless one is actually afflicted with Cptsd, it is hard to comprehend the totalitarianism and viciousness of the client’s critic. When a child is raised by parents who thwart her attempts to bond, her superego grows into an outsized critic as she desperately strives for safety and belonging.

    Constant negative attention and a dearth of positive attention are typical of Cptsd-genic parents. Such parents use contempt …intimidation melded with disgust…to frighten and shame the child into total submission. The child’s two most fundamental developmental needs, safety and attachment, are constantly frustrated. Her superego morphs into a toxic critic, goading her to be perfect and self-deprecating in order  to gain acceptance and to avoid punishment and abandonment.

     Eventually, the critic forces the child to identify with her aggressors so thoroughly that she perpetrates their contempt and abandonment against herself. This is especially true of the “gifted child” [a la Alice Miller], who embraces perfectionism as a strategy to make her parents at least safer if not more engaging. She hopes that if she is smart, helpful, pretty, and flawless enough, that her parents will finally care for her.

    But as John Bradshaw points out, continued failure at winning their regard forces her to conclude that she is fatally flawed -  loveless not because of her mistakes, but because she is a mistake. She can only see what is wrong with or missing in her. Anything she does, says, thinks, imagines or feels has the potential to spiral her down into a depressed abyss of toxic shame and abject fear. Her superego fledges into a full-blown, trauma-inducing critic, which now keeps trauma alive throughout the day by attacking her for every minor foible…by filling her psyche with stories and visions of catastrophe… moment to endless moment during emotional flashbacks.

    Cognition in the Cptsd survivor is a maze of perfectionism and endangerment programs. [My article “Shrinking the Inner Critic in Cptsd” identifies 14 of these poisonous processes When the survivor is triggered, she perseverates about everything that has gone or will go wrong, obsessing all the while about triaging her imagined disasters. Hurrying, worrying, drasticizing and hypochondriasizing are ubiquitous cul-de-sacs of the critic’s negative focusing. Consciousness devolves into a process of negative-noticing – incessantly preoccupied with defects and hazards. Small potato miscues and peccadilloes trigger her into a full blown fight/flight response, which upon adrenalin exhaustion, collapses her into a depressed sense of helplessness and hopelessness.

    The Outer Critic
    The typical traumatized child also develops an Outer Critic, which projects his rejecting parent[s] on everyone around him.  He is plagued by intense social anxiety fueled by the belief that people abhor him as much as his parents did.  People are just too dangerous and too flawed to trust. Social interactions are routinely avoided or minimized.

    The outer critic also commonly projects perfectionism in another way. It focuses on people’s flaws to justify avoiding them.  It constructs expectations that no other human being can match. Drasticizing about a minor faux pas, the critic decides that the other is too untrustworthy for further relationship. Endless repetitions of this dynamic leave the survivor stuck in the legacy of his family’s original abandonment. Most of my Cptsd clients initially have no one in their lives who they can relate to other than superficially.

    Many survivors also experience relating as a highly stressful process of vacillating between outer and inner critic. Their negative-noticing oscillates between their own dangerous defectiveness and the deal-breaking defects of others. And some, of course, via repetition compulsion periodically plunge into dangerous attachments with others who replicate their parents’ patterns of abandonment and abuse.

    Countertransference and the Critic
    In the early phases of therapy, I sometimes feel hopelessly impotent and frustrated with the task of helping the client to deconstruct her critic. Sometimes, it seems as if the critic is the self, not some bothersome superegoic deformity or powerfully entrenched internalization. Standard tools, such as interpretation, psychoeducation, and mindfulness fail to even loosen a screw.

    After numerous futile attempts to loosen up any real resistance to the critic in the client, the urge to give up deconstruction efforts feels irresistible. Early in my career, I would think:  “This critic stuff is so Psych 101. I have addressed the client’s critic issues so often that we’re both clearly sick of it. If I don’t back off soon, she’s going to leave.  She’s just not going to get it. Her critic’s just too big for her to see. It’s a forest of perfectionism and endangerment blurred by her narrow focus on this particular moment’s catastrophizations.”

    Thankfully, I eventually learned that nothing would change for this type of client, until we shrunk the critic enough to eke out some psychic space for self-observation – for cultivating the developmentally arrested need of self-support. I now rely a great deal in early therapy upon psychoeducation and family of origin exploration. Out of an ongoing elicitation of the client’s childhood trauma, we weave an accurate narrative of how she was inculcated with a vicious and relentless critic.  I help her see how she was innocent and blameless, unlike the “care”-givers, who brainwashed her into routinely hating, shaming and abandoning herself.

    Psychoeducative interpretation about the genesis of the toxic critic is, in my opinion, a step that cannot be bypassed, and I do it as much as the client can tolerate. Sometimes, I derive motivation to persist with this very slow, repetitive process by garnering the energy of other countertransferrential feelings that I have. I now typically feel guilty and neglectful when I let the critic get away with abusing the client. At such times, I feel derelict in my human and professional duty to bring attention to how he is hoisting himself on his parents’ petard.

    I find now that I can no longer passively collude with the inner critic by failing to actively notice it, as various adults typically did while he was growing up. When an adult does not protest a child being attacked with destructive criticism, s/he tacitly approves it. The child is forced to assume contempt is normal and acceptable, and the witnessing adult forsakes his tribal responsibility to protect children from other adults who perpetrate child abuse.

    When I label the traumatizing behavior of the client’s parents as egregious, I begin the awakening of her developmentally arrested need for self-protection. I model to her that she should have been protected, and that she can now resist mimicking their abuse in her own psyche. This eventually encourages disidentification with the aggressor and weakens the internalization of the attacking parent as the locus of the critic. Ptsd expert, Harvey Peskin, adamantly proffers that witnessing and validating the criminality of traumatizing behavior is essential to ameliorating ptsd.

    In my own case, I felt loved by my grandmother who lived with my family, but she never helped me see that my parents’ vitriolic rages were wrong and not my fault. In retrospect, I believe that her neglect crystallized my belief that I totally deserved their abuse. The stage was then set for me to morph their contempt into self-loathing…chapter and verse for nearly two decades. I have also noted a marked difference in the ferocity of the critic in clients who had one influential adult in their childhood who helped them see that the destructive behavior of a caregiver was wrong and not their fault. In fact, some have survived horrible parental abuse without developing full blown Cptsd.

    To close I would like to encourage you to become the first person in the Cptsd client’s life who helps him see how horribly and unfairly he was indoctrinated against himself when he was too young and impressionable to resist.  Let me paraphrase Milton Erickson’s challenge to us all: we must remain resolute, brave and creative about repetitively confronting key deeply imbedded patterns that do not easily resolve from our attempts to treat them.
    I believe it is crucial to apply this advice to deconstructing the critic- patterns that block the client’s psyche from becoming user-friendly.

    [In my two articles on Shrinking the Critic, available for downloading at www.pete-walker.com, I offer an expanded perspective on deconstructing the influence of the hegemonic critic.]

    Pete Walker, M.A., is in private practice in Lafayette. He has been working as a mental health professional for thirty-five  years. He is also the author of The Tao of Fully Feeling: Harvesting Forgiveness Out Of Blame.  His various published writings on working with Complex Post Traumatic Stress Disorder and adults traumatized as children can be viewed and downloaded from his website:  www.pete-walker.com.  He can also be reached at 925.283.4575.
  • April 06, 2013 9:03 AM | Admin EBCAMFT
    Greetings friends and colleagues,

    On Friday March 8, as a representative of EBCAMFT, I attended the “Practicing Mindfulness and Compassion” conference (The Science of a Meaningful Life) at the Craneway Conference Center on South Harbor Way in Richmond. The conference was envisioned and organized by The Greater Good Science Center at UC Berkeley and Mindful Magazine, a brand new print magazine for fostering mindfulness and its benefits for the general public, and co-sponsored by numerous other groups and organizations, including EBCAMFT. The “headliners” at the conference were Jon Kabat-Zinn, Kristin Neff, Paul Gilbert and Shauna Shapiro, but their were numerous other inspiring speakers and presenters.

    From the outside, the conference center looks like a huge warehouse or factory and, come to find out, that's exactly what it is. Apparently the site was formerly a Ford Motor Company manufacturing plant where Model-T's were produced in the early part of the 20th Century. Also interesting to note is that Henry Ford III is apparently a proponent of mindfulness practices. Not sure if that had anything to do with the conference being held at this location.

    For me the conference was a wonderful, warm, inspiring, refreshing and enlightening experience which reinvigorated both my mindfulness practice and my self-compassion practice. These were the two primary focuses of the conference and we had many opportunities throughout the day to explore various ways of cultivating these two practices and understand their relationship to one another. Some of the presenters emphasized the pivotal place in our planet's evolution that we now occupy and the importance of widespread Mindfulness practice and Compassion for the survival and continued evolution of the species.

    Roughly 500 people turned out for the conference, most of whom were not therapists or mental health clinicians. We were all treated to a wonderful blend of direct experience, inspiration and information throughout the day with each of the contributors providing an essential piece of the overall picture. EBCAMFT had a small table set up, along with many other groups, where people browsed and networked before, during and after the event. We provided postcard brochures, newsletter samples and membership applications to anyone who wanted them.

    Jon Kabat-Zinn was the first speaker and mixed humor, warmth, Buddhist teaching, practical  exercises and anecdotes, providing a lovely overview of Mindfulness practice and it's place in modern society. Kristin Neff focused exclusively on Self-compassion as an essential aspect of Mindfulness practice and shared research findings and more practical exercises on the subject to give us a taste of where self-compassion fits in to the grand scheme of things and how important it is, especially in healing work. Shauna Shapiro focused on the health benefits of mindfulness practices as well as their importance in helping therapists and other professionals to be more compassionate and empathetic with their clients. Paul Gilbert, a British therapist, led us in a variety of therapeutic exercises based on warmth, empathy, compassion and mindfulness for integrating and healing conflicting aspects of the personality. He shared many clinical examples, answered many questions and entertained us throughout with his uniquely British brand of humor.

    Lastly, a panel of four presenters spoke about their work using Mindfulness practices “in the field” with prenatal care and birthing, school children, lawyers, and seniors and provided moving anecdotes and answered questions from the audience. Dacher Keltner, co-founder of the Greater Good Science Center, moderated the event.

    All in all, I came away from the conference with a deep appreciation for the Greater Good Science Center at UC Berkeley and a deeper commitment to Mindfulness practice in my own life and work as a means for helping our species and planet move in a direction that will foster peace, cooperation and harmony for the future. Definitely time well spent and I look forward to many more such conferences as I continue on my personal and professional journey.

    Thank you to EBCAMFT and the Greater Good Science Center for offering me this rich opportunity.

    Peter received his Masters Degree in Counseling Psychology, with a Transpersonal Focus and a Specialization in Child and Adolescent Therapy, from John F. Kennedy University. He is also Certified by the Kripalu Yoga Institute in Lenox, MA as a Holistic Health Counselor / Educator. He was originally trained in the Humanistic Client-Centered and Gestalt methods, gradually incorporating a myriad of other methods and approaches, 25 years of Zen Buddhist practice, and his training in Holistic Health Counseling and Education into his practice as a Psychotherapist. He also completed 12 units of Early Childhood Education at Merritt College and taught preschool for three years. Peter specializes in working with people in 12-Step Recovery, those who have survived the suicide of a loved one, adolescents and their families, and spiritual and existential dilemmas. He lives by the lake in Oakland and has an office in South Central Berkeley.

    Peter Carpentieri, MFT

    Comments and inquiries welcome.
  • February 12, 2013 10:17 PM | Admin EBCAMFT
    You might have heard that in 2012 California enacted legislation to protect youth aged 17 and younger from methods to change their sexual minority orientation and/nonconforming gender expression. Governor Brown signed ban into law calling the practices "psychoquackery."
    Originally CAMFT was opposed to the bill unless amended. CAMFT changed to neutrality on it before the legislature approved it. Meanwhile many state organizations like the California Psychological Association, National Association of Social Workers of California, the BBS and others supported it.

    The new law applies to a collection of practices referred to by the acronym SOCE, which stands for sexual orientation change efforts. SOCE goes by a variety of other names: "reorientation therapy," "ex-gay therapy," "conversion therapy," or "reparative therapy." The new law applies not only to sexual orientation change efforts. It also applies to methods used to influence or coerce children to be more gender conforming. The law does not apply to providers who help youth affirm their same-sex attractions or therapists who help youth understand their true gender identity, should they be feeling that it is different than the gender identity assigned to them at birth. The new law applies to prelicensed and licensed health providers, not to unlicensed counselors or clergy.

    I'm a MFT ten years post licensed and I have a private practice in San Francisco and Oakland where I work with adults and couples. I have a very deep and abiding interest in helping people realize that being LGBT is good and that reducing the myths against us is needed not only for our mental health but for our physical well-being and sometimes for protecting our very lives. That led me to volunteering to help get the new law passed. It was my first experience with seeing how a law becomes enacted. It was done with the support of untold numbers of people.  I plan to keep supporting this new law through all it's legal challenges and into implementation.

    The stakeholders who created the law did so to reduce the stigmatizing, dangerous outcomes from those practices, and to increase the a child's chances of getting affirming therapy. In creating the law, they drew not only from the participation of organizations such as CAMFT and the American Association of Marriage and Family Therapy in the process. They also drew from decades of solid research and clinical experiences about what is best for youth.

    The new law will impact only a very small percentage of licensed therapists performing child and family therapy. It is aimed at stopping--if any law can--the practices of a small number of SOCE practitioners. The new law was to take effect Jan. 1, 2013. However, it has been delayed by legal challenges. The latest case is called Pickup v. Brown and is brought by David Pickup, MFT, among others. Mr. Pickup has been a CAMFT member and perhaps currently is still a member. The 9th Circuit Court of Appeals reports that they will act quickly on the case.
    What does the law say? The first section of the law is a list of policies from major medical associations against SOCE. A typical portion of that section reads this way:

    "(c) The American Psychological Association issued a resolution on Appropriate Affirmative Responses to Sexual Orientation Distress and Change Efforts in 2009, which states: "T[he American Psychological Association] advises parents, guardians, young people, and their families to avoid sexual orientation change efforts that portray homosexuality as a mental illness or developmental disorder and to seek psychotherapy, social support, and educational services that provide accurate information on sexual orientation and sexuality, increase family and school support, and reduce rejection of sexual minority youth."
    (d) The American Psychiatric Association published a position statement in March of 2000 in which it stated: "Psychotherapeutic modalities to convert or 'repair' homosexuality are based on developmental theories whose scientific validity is questionable. Furthermore, anecdotal reports of 'cures' are counterbalanced by anecdotal claims of psychological harm. In the last four decades, 'reparative' therapists have not produced any rigorous scientific research to substantiate their claims of cure. Until there is such research available, the American Psychiatric Association] recommends that ethical practitioners refrain from attempts to change individuals' sexual orientation, keeping in mind the medical dictum to first, do no harm.
    The potential risks of reparative therapy are great, including depression, anxiety and self-destructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by the patient. Many patients who have undergone reparative therapy relate that they were inaccurately told that homosexuals are lonely, unhappy individuals who never achieve acceptance or satisfaction. The possibility that the person might achieve happiness and satisfying interpersonal relationships as a gay man or lesbian is not presented, nor are alternative approaches to dealing with the effects of societal stigmatization discussed.
    Therefore, the American Psychiatric Association opposes any psychiatric treatment such as reparative or conversion therapy which is based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that a patient should change his/her sexual homosexual orientation."

    What is does the law define as illegal? The section defining what is illegal reads:

    "Article 15. Sexual Orientation Change Efforts
    865. For the purposes of this [law], the following terms shall have the following meanings:
    (a) "Mental health provider" means a physician and surgeon specializing in the practice of psychiatry, a psychologist, a psychological assistant, intern, or trainee, a licensed marriage and family therapist, a registered marriage and family therapist, intern, or trainee, a licensed educational psychologist, a credentialed school psychologist, a licensed clinical social worker, an associate clinical social worker, a licensed professional clinical counselor, a registered clinical counselor, intern, or trainee, or any other person designated as a mental health professional under California law or regulation.
    (b) (1) "Sexual orientation change efforts" means any practices by mental health providers that seek to change an individual's sexual orientation. This includes efforts to change behaviors or gender expressions, or to eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same sex.
    (2) "Sexual orientation change efforts" does not include psychotherapies that: (A) provide acceptance, support, and understanding of clients or the facilitation of clients' coping, social support, and identity exploration and development, including sexual orientation-neutral interventions to prevent or address unlawful conduct or unsafe sexual practices; and (B) do not seek to change sexual orientation.
    865.1. Under no circumstances shall a mental health provider engage in sexual orientation change efforts with a patient under 18 years of age.
    865.2. Any sexual orientation change efforts attempted on a patient under 18 years of age by a mental health provider shall be
    considered unprofessional conduct and shall subject a mental health provider to discipline by the licensing entity for that mental health provider."
    That is the full description of what the law entails. What does the law mean for CAMFT members? CAMFT members who continue to use standard affirmative practices for healthy same-sex attractions in youth and to use standard treatment approaches for youth working through gender identity changes will not be in violation of the new law. Therapists who support the child's development through connectedness and caring as the child affirms for himself or herself his or her true sexual orientation and gender identity are in compliance with the law.  

    The new law complements a policy about SOCE issued by CAMFT last year. That policy states that CAMFT "is concerned about children and youth, who are especially vulnerable to harm and who lack adequate legal protection from involuntary or coercive treatment and whose parents and guardians may not have accurate information to make informed decisions regarding the child’s development and well-being." CAMFT's policy was developed to specifically support children--as this new law does--from attempts to change their attraction to their own sex. You can read CAMFT's position at their web site.

    Clinical research and experience has shown that when stigma and discrimination are proactively managed there are healthier outcomes than when the person is left with the option of trying to conform to societal norms to relieve distress. One body of research that substantiates this comes from Dr. Caitlin Ryan. Dr. Ryan heads the Family Acceptance Project at San Francisco State University. During the past decade Dr. Ryan has trained more than 30,000 health and mental health providers on the mental health care of LGBT adolescents. Dr. Ryan has earned awards such as the National Social Worker of the Year and many others.  Dr. Ryan actively supports California's new law banning SOCE.

    Dr. Ryan and her collaborators have used a new evidence-based family intervention model based on their extensive peer-reviewed research over decades. That research has identified 106 specific accepting and rejecting behaviors that parents engage in to respond to their LGBT children. Dr. Ryan reports "these accepting behaviors include advocating for their children when others mistreat or discriminate against them because of their LGBT identity or connecting them with positive adult LGBT role models."

    Their research has found there are "significant major health risks when parents insist on rejecting behaviors such as sending them to a therapist or clergy to change their sexual orientation, preventing them from learning about their LGBT identity, or making them pray and attend religious services to change their sexual orientation." She reports that they "found that these specific parental and caregiver rejecting behaviors were related to health risks for the LGBT youth in young adulthood, including attempted suicide, suicidal ideation, depression, illegal drug use and risk for HIV infection." (Ryan, Huebner, Diaz, & Sanchez, 2009). Their research also found that family accepting behaviors help protect LGBT youth against these major risks and promote well-being including higher levels of self-esteem and social support in young adulthood. (Ryan, Russell, Huebner, Diaz, & Sanchez, 2010).

    Researchers found that lesbian, gay or bisexual young adults who reported high levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression (at the cut off point for medication), 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse – compared with peers from families that reported no or low levels of these family rejecting behaviors (Ryan, Huebner, Diaz, & Sanchez, 2009).

    "Specifically," Dr. Ryan explains, "young adults whose parents sent them to a therapist or religious leader to attempt to cure, treat or change their sexual orientation during adolescence were far more likely to consider suicide and to attempt suicide than peers who were not sent to undergo SOCE. They also were far more likely to report clinical depression and to report levels of depressive symptoms that reached or exceeded the threshold for medication." (Russell, Ryan, Toomey, Sanchez, & Diaz, in preparation).

    Sexual and gender minority youth who are not affirmed for their attractions may miss out on important developmental milestones. At a time when heterosexual adolescents are learning to socialize about romantic and sexual attractions, sexual and gender minority youth who undergo SOCE may be disadvantaged. They will be conflicted about dating those of their own gender when dating them will subject them to stigma, and they will be conflicted about  dating those they do not romantically or erotically prefer (Hetrick & Martin, 1987; Lasser & Gottlieb, 2004; Ream & Savin-Williams, 2005). The American Psychological Association's Practice Guidelines for Lesbian, Gay and Bisexual clients (2012) indicate that these attempts to mask or deny sexual identity put sexual and gender minority youth at risk for unwanted pregnancy, unsafe sex, interpersonal violence, substance abuse, and suicide attempts.

    Minors are in the initial stages of exploring and acquiring information to enhance their understanding and skills associated with their sexuality and choices. The problem with offering SOCE to minors is that youth may not realize their long-term needs and may overestimate their ability to cope in the long-term with denying their deeper same-sex attractions. If youth are overfocused on meeting the religious needs of their parents and the heterosexual norms of society, youth may not realize that not acting on their authentic same-sex romantic and sexual desires will create deep conflicts and emotional pain for them later in life, if not sooner.
    The Mormon church has long disallowed same-sex attractions and relationships. In a recent major shift, church elders abandoned their former practice of encouraging members with same-sex attractions to marry members of the opposite sex. Too much emotional pain came out of that practice when spouses discovered they could not remain married without distress and pain coming from forcing themselves to deny or hide their attractions to their sex in order to be married to a person of the other sex. In 2012 the church leaders reversed their position after coping with decades of broken marriages and family pain resulting from encouraging young people to marry despite their same-sex romantic or sexual orientation. See http://gayandlesbianmormons.org
    Healthy sexuality depends on developing an integrated awareness and acceptance of one’s needs and values, which can provide meaning, authenticity, wholeness, and satisfaction as it orients the individual toward intimacy, love, and companionship. Sexual development therefore requires periods of exploration without bias. It requires learning how to live positively with one’s attractions, regardless of one’s sexual identity and life choices. Although some SOCE youth clients may feel supported by their SOCE provider, at its core, SOCE reinforces a message that their sexual/romantic desires are wrong. They are something to extinguish.  The new law reinforces that adolescent development is supported by therapeutic interventions that affirm living positively with one's same-sex attractions.

    For extensive, expert information about how to affirm LGBT and questioning youth, reliable information is available online at the following sites: http://leadwithlovefilm.com, http://www.genderspectrum.org,http://familyproject.sfsu.edu

    For more updates about the new law, watch the news this spring.

    Jim Walker, MFT
    510-684-4508  cell
    Offices in Oakland and San Francisco
  • February 12, 2013 10:14 PM | Admin EBCAMFT
    Judy Lightstone, clinician and researcher on eating disorders in the San Francisco Bay Area states, "The therapist must be aware of the role of dissociation in eating disorders." 1 I, too, believe the symptoms of eating disorders are a form of Dissociative Identity Disorder where the self splits into parts for emotional survival. People with eating disorders invariably have experienced significantly difficult or traumatic childhoods and teens.

    I coined the term "Mild Multiplicity" to describe dissociation in eating disorders.3  "Mild" indicates that this type of dissociation is a less severe form of the condition.                                

    Mild Multiplicity                                                                                      
    Normally, we all have different parts of the self acting somewhat independently, depending on the situation. We dress, act, and feel differently at home and at work, with relatives or with strangers. The extreme form of Dissociative Identity Disorder is defined in the DSM IV: "Each personality state may be experienced as if it has a distinct personal history, self-image, and identity…”.4

    Mild Multiplicity falls in between the bounds of normalcy and extreme dissociative disorder. On a scale from one to ten, a normal level of compartmentalization is a one. The DSM definition is a ten. Mild Multiplicity is from a six to an eight on the continuum.
    With Mild Multiplicity, the dissociation is generally restricted to eating disorder behaviors; the person is unable to stop the parts of the self acting out by yo-yo dieting, fasting, bingeing, compulsive overeating, or purging.  Apart from the eating disorder beliefs and behaviors, an executive-self provides continuity of personality, behavior, and emotion, managing life’s tasks fairly well. Relationships are usually problematic.                                                                   

    Freud and Eric Berne
    The idea of separate aspects of the self is not new. Freud, in his formulation of Id, Ego, and Superego, established that the human psyche is multi-faceted. Erik Berne’s theory of Transactional Analysis adapted Freud's divisions of personality.5 The Id becomes the Inner Child, (Natural and Adapted) Ego is the Adult, and Superego is the Parent (Good or Critical). These systems of thought, feeling, and behavior are warring factions in the unconscious, especially in eating disorder patients.                                                                                                                        

    The Parts in Mild Multiplicity
    Although sometimes criticized as simplistic, Berne's formulation of the introjected Child, Adult and Parent Parts is a useful and easily accessible theoretical base to describe dissociation in eating disorders. This is incorporated into my definition of Mild Multiplicity.                                 

    Child Parts in Mild Multiplicity
    With an eating disorder, the Natural Child, expressive and joyful, hides away while the Adapted Child acts out with dysfunctional eating behaviors and negativity towards the body (Body Dysmorphic Disorder).

    Adult Part in Mild Multiplicity
    This is usually highly developed and extremely functional. People with eating disorders are typically intelligent and resourceful, and have unconsciously chosen the route of dissociation for survival. Injunctions from doctors and diet organizations are ineffectual long-term, however, since the well-disciplined and rational Adult has vanished, replaced by the emotionally hungry Adapted Child who rejects each diet.                      

    Parent Parts in Mild Multiplicity                                                                       
    The Critical Parent is a harshly negative self-concept. Self-hatred is projected onto the body. "Fat, fat, FAT! You're nothing but a fat pig," one patient constantly said to herself, even though she was no more than fifteen pounds above the norm for her height.

    The Good Parent and Natural Child are undeveloped – often non-existent – in Mild Multiplicity                                                                                                        
    The Hidden Ones                                                                                         
    In working with eating disorders, I found far more hidden, unconscious Parts than the five Berne describes. They reflect:    
        Roles in the family of origin
        A difficult or traumatic childhood
        Unconscious ideas and beliefs
        Patterns of thought and behavior, especially around food and the body
        The emotional state at a certain age
        Reactions to experiences or people
        Various emotions, states of mind, or moods

    The Parts are divided into the Challenging and the Affirmative Parts. Unfortunately, people suffering from eating disorders are governed by the Challenging Parts. The rational, nurturing, joyous, and creative Affirmative Parts can restore balance and health.

    Naming a Part gives a handle to grab onto when it pops up unexpectedly and is followed by plunging into the knee-jerk, negative activity with food. Naming is the first step in allowing the disassociated Parts to emerge to conscious awareness.
    Here are examples of named Parts that my patients and I have discovered and personalized  over the years: the Challenging Parts that cause dysfunctional eating, and the healing, encouraging Affirmative Parts.

    Challenging Parts
    Conditioned Children:Hungry Baby, Black Hole, War Zone Child, Goody Two Shoes, Pirate, Rebel, E.T., Child in the Well
    Critical Parents: Slave Driver, Helpless Heap, Mad Monkey Mind, Daggers
    Monsters: Binge Monster, Two-headed Green Dragon

    Affirmative Parts
    Adults: Rationalist, Mover and Shaker, Ms. Competence, Problem-solver, Natural Children, Explorer, Cuddles, Happy-go-lucky, Good Parents, Earth Mother, Wounded Healer, Warrior Knight, Higher Beings Angel Michaela, Yoda, White Light

    The steps in managing the Parts are naming, accepting, and feeling compassion for them, dialoguing with them, strengthening the Affirmative Parts, and finally, integrating all the Parts.

    Bringing the Parts to consciousness remedies the dissociation. This heals the alienation and inner hunger of an eating disorder, promoting a connection with passion, joy, and meaning in life.


    1. Lightstone, Judy. (2005) Healing Intractable Eating Disorders. Home study course, p.23.

    2. Something Fishy (2006) Website on eating disorders: Exploring the Role that Abuse Plays in the Development of an Eating Disorder.                                                                  

    3. Kobrin, Shoshana. (2012) The Satisfied Soul: Transforming your Food and Weight Worries. Bloomington, IA: AuthorHouse.

    4. American Psychiatric Association. (1994) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, page 484. Washington D.C.

    5. Berne, Erik. (1964) Games people play: The Basic Handbook of Transactional Analysis. New York: Ballantine Books.

    Shoshana Kobrin LMFT, has a psychotherapy practice in Walnut Creek, specializing in eating disorders. She gives workshops, presentations, and trainings for professionals and the community. She’s the author of The Satisfied Soul GuideBook: Your Path to Transformation and The Satisfied Soul: Transforming Your Food and Weight Worries
    To contact her: (925) 256-8503 shoshanakobrin@sbcglobal.net
    www.shoshanakobrin.net  www.kobrinkreations.com

    Shoshana will present a CEU Presentation with EBCAMFT on March 9 at Epworth United Methodist Church in Berkeley. Please check our Events section for more details.

  • December 08, 2012 1:43 AM | Admin EBCAMFT
    This has been one of the most difficult reviews that I have ever had to write, because the subject is very close to my heart. I had to give myself some distance to really look at the film, which also speaks to its power.
    I think that this is a great movie, incredibly accurate in its depiction of men who were sexually abused as children, and I encourage you to see it. I feel that it is particularly important for those men who are childhood sexual abuse survivors, and the people who love them and work with them, to see Mysterious Skin.

    There is little suspense in the film; it is all well laid out. The journey is in watching the characters grow up and begin to deal with the pain and horror of their childhoods and the impact that had on their adulthood. The two central characters, both their adult selves and the boys portraying them as eight-year-olds, are great. The story is about two boys, both sexually abused by the same man, the local baseball coach. The meat of the film is about impact of the abuse on them as they grow up and the influence on their choices and their lives.

    The pedophile played by Bill Sage is well represented as a caring man who pays a lot of attention to the boys. It is not violence but subtle manipulation that seduces the boys. Often the boys who are yearning for a man’s attention are the most vulnerable, and this character gives the boys something they are desperately seeking.
    Our main character, Neil, played by Joseph Gordon-Levitt as the adult and Chase Ellison as the eight-year-old, was emotionally incested by his mother, so additionally being sexualized by his coach seemed only natural to him. He saw it as one of the great experiences of his life. He romanticized it and constantly tried to recreate the experience. This is called a “repetition compulsion” and is often mislabeled as sexual addiction. The sexual experiences with the coach were the most intense pleasure that he had ever received, and at eight years of age, he had neither the emotional nor physically ability to process the sensations. It is normal and common for a male in this situation to attempt to recreate the experience, to try and work through the feelings, to no longer freeze emotionally. Unfortunately, this method rarely works.

    The other main character, played by Brady Corbet as the adult and George Webster at age eight, was great. Webster, in particular, did an extraordinary job of showing the dissociation that often happens to a child being sexually abused. He literally went blank which continued into adulthood, and was unable to remember what happened, so he created a screen memory to explain the feelings that he has. As he is forced to relive the real experience, he regressed into the eight-year-old boy’s experience and begins to process in his adult body those feelings that were too much as a child. Corbet also showed the other side of sexual abuse: survivors who become sexually anorexic as a way to stay away from the experience that so traumatized them.

    Is he gay, when he rejects the advances of a girl and his new best friend is a gay young adult male? Who knows? He would probably not be able to figure that out until he continues to develop psychosexually after working through the trauma of the abuse where he has been frozen in time as an eight-year-old.

    There are three great scenes in the film. The first scene is where Brian (Corbet) confronts his father (Chris Mulkey) for not protecting him and missing that something awful happened to him. The second is the rape of Neil by his last trick. Males sexually abused as children are much more likely to be raped as adults. The third scene is the last 9 minutes of the film where the characters unite to reclaim their memories and feelings about what had happen to them. The emotion ripped across the screen, and we felt their pain. That is great filmmaking and acting.
    I feel like I am writing a paper on sexual abuse and attending this film for me was like watching parts of my own life as well as my work. I am a psychotherapist who is both a sexual abuse survivor and a specialist in the treatment of men who were sexually abused as adults and or as children.

    The performances were uniformly good and the direction was right on. It is the first Gregg Araki film that I enjoyed. It is his first mainstream film and is certainly deserving of all the attention and praise that it is getting. The women who played Neil’s and Brian’s mothers gave dead on performances. Elisabeth Shue as the incestuous mother was real in showing her caring, boundary-crossing, inappropriate behavior. Lisa Long was so funny as the Martha Stewart of backwoods Kansas, I would laugh every time she came on the scene. Her protectiveness was evident, and we loved her for it.

    My only real complaint is that I did not feel much emotion from the film. It is very detached and intellectual. You see horrible things but you never get the emotional kick except in the three scenes that I mentioned above. If the point was to see it from the emotional perspective of the two lead characters, it succeeded brilliantly. If Spielberg had directed this it would have been so over the top in feelings that I suspect it would have been unwatchable. I have to compare it to the play from the same material and to the best movie on sexual abuse of boys that I have ever seen, The Boys of St. Vincent. Both of these other vehicles showed both the horror of the abuse as well as hit-you-below-the-belt emotions.

    I highly recommend the film. I hope that theatre companies everywhere produce the Mysterious Skin play. This message about the abuse of boys must be told over and over if we are to save another generation from this life sentence of pain. The film is great and honest material.   When I do my workshop, Shedding Light on the Sexual Abuse of Boys and the Men They Become, I strongly encourage participants to watch the film before the workshop.
    It is particularly important for therapists to see this film. It will help them see in very graphic terms the abuse and impact on males and how it can look different than with females. Just getting a male to admit that he was abused is generally the first step and this film will help many in taking the first steps toward healing. It will also give the therapist and client a point of reference outside of the clients experience that can may it easier to examine what abuse looks like and how it compares to their own.

    The movie Mysterious Skin is based on the novel of the same name by Scott Heim.  

    Merle Yost is a 1991 graduate of the JFK Transpersonal Program. His has had a practice in Oakland for close to 20 years. He is graduate of the SF Gestalt Institute, an Approved EMDR Consultant and a specialist in PTSD and traumatic childhoods. www.myost.com

    As a Military Family Life Consultant he spent 30 days in Germany working with solders and their families.

    Merle has published 5 books, and is a leading authority on men with gynecomastia and expert on working with men that were sexually abused as children.

    He has been a supervisor for many years at the Pacific Center in Berkeley.

    Official Site: http://www.mysteriousskinthemovie.com
    A film by Gregg Araki, Director, Writer and Producer
    NC17, Starring Brady Corbet, Joseph Gordon-Levitt, Michelle Trachtenberg, Jeff Licon, Bill Sage, Mary Lynn Rajskub and Elisabeth Shue
    Film still taken from www.rottentomatoes.com 
  • December 08, 2012 1:41 AM | Admin EBCAMFT
    As therapists we are used to working in the “shades of gray” but one thing we know is that boys and girls are different.  When a parent comes to us it is vital that we understand the distinction between how boys and how girls bully each other.  

    Bullying is an issue that triggers emotional reactions in us because most of us have been bullied at some time.  Girl bullying is an important segment of the larger issue of female self-esteem and female friendships.  

    When parents come with issues of bullying, this presents the opportunity for you to help parents, to not only navigate this difficult situation, but also to give them education and tools to strengthen their daughter’s sense of self.  This will enable their daughters to grow into strong and confident young women.   

    Complicating this issue is that we are working with a generation of kids that are “digital natives” and use technology on a level that we will never fully understand. The anonymity and availability of Smartphones, Facebook and Twitter can make bullying a 24/7 problem.  

    When a parent comes to you saying their daughter is being bullied, certain techniques can be helpful:
    Educate them on what happens biologically and developmentally during the pre-teen and teen years.
    Inform them of what they can do at home before, and during, their daughter’s middle school years.
    Develop a plan of action when their daughter is being bullied. Incorporate tools they can use on a daily basis to continue to strengthen their daughter’s self-esteem.

    Biologically girls bond and build trust with people through relationships.  Dr. Louann Brizendine in her book “The Female Brain” has discovered that a girl’s behavior is not a direct result of socialization.  We are not born with a “unisex” brain, girls are already wired as girls and boys are wired as boys.  Brizendine writes, “girls arrive (in) the world better at reading faces and hearing human vocal tones.  A girl is born with a highly tuned machine for reading faces, hearing emotional tones in voices and responding to unspoken cues in others.”  

    When a girl enters puberty, according to Brizendine, “this is the first time a girl’s brain will be marinated with high levels of estrogen.  These hormonal surges assure that all of her female specific brain circuits will become even more sensitive to emotional nuance, such as approval and disapproval, acceptance and rejection.”

    Girls will be strong and confident one moment; miserable and sad the next.  Biologically girls are predisposed to react strongly to relationship problems.  Developmentally girls need to be liked and connected, while socially they are expected not to show too much anger or aggression.  These juxtaposing forces create a conundrum.  If a girl wants to express negative feelings toward a friend, she has to use subtle tools.  She will spread a rumor anonymously because she needs to remain socially connected.  She must avoid being perceived as mean or aggressive by the group.

    Parents can have tremendous influence over their daughter’s viewpoint of other females thus they must look at their own attitudes towards women.  Do they judge women on appearance in front of their daughters?  How do the females in the house speak of themselves?  Are they constantly criticizing their appearance and speak negatively of themselves?  Are the accomplishments of women being celebrated?  Our culture has so many unrealistic ideals for women.  Parents demonstrate through their praise the qualities they value.  This is the foundation for their daughter’s view of women and thus herself.

    If a parent comes to you because their daughter is being bullied tell them to do nothing.  Parents want to jump in and solve the problem, but their daughter has come to them because she needs to be listened to and heard.  If they react with panic or worry, this will make her shut down completely.  Let her vent the entire story.  Do Not Blame--all parties’, the aggressors, the victims, and the bystanders, are hurt by bullying.  Validate her feelings and normalize her stress.

    Ask her what she wants to do about the situation.  Find out what she thinks would be the best way to resolve this issue.  Hold your advice.  If it happens once let her speak to the bully directly.  If the problem persists or gets extreme, take action and make sure to involve your child in the process.

    Help your daughter learn how to deflect and ignore the insults.  Your daughter needs to develop resilience against the bullying.  Help her develop self-esteem outside of her school relationships.  Get her involved in athletics or a hobby.  If she can feel a sense of accomplishment in another aspect of her life, it will improve her overall view of herself.

    Parents can work on helping develop and improve their daughter’s self-esteem.  They can create rituals with their daughter by finding time each day, maybe 10 minutes before bedtime or at breakfast, to connect with their daughter.  No phones, computers, or talk of homework, this time needs to be focused on their daughter so she can really talk.  The small things that parents do everyday add up and can have tremendous influence.  It may not be apparent today, but it will payoff in the future.

    It is imperative that we give parents information about what is going on in their daughter’s brain and how it affects behavior.  This knowledge can help parent’s change how the family reacts to bullying as well as help them develop an atmosphere of positive female imagery.  Therapists can suggest ways to incorporate bonding activities that can become life long patterns.  Girls may always struggle with female relationships and with being able to express their negative feelings.  We need to have empathy, listen attentively and help them develop ways to resolve conflicts in order lessen the impact of girl bullying.

    Tess Brigham is a family therapist specializing in working with pre-adolescent and adolescent girls, helping navigate the complexities of being a teenager in the 21st century as well as helping parents find the ìrightî moments to build stronger connections with their daughters.  Tess offers practical interventions parents can use to establish trust and open communication with their daughters.  She currently works at Coyote Coast Youth and Family Services in Orinda and at Kaiser Permanente. She has a private practice in Oakland and lives in Berkeley with her husband and young son.


  • December 08, 2012 1:40 AM | Admin EBCAMFT
    Next year, in April 2013 the Bay Area Psychotherapy Training Institute (or BAPTI) will be celebrating 20 years as a counseling and training center. BAPTI was founded in 1993 with the intent of providing moderate fee counseling services to the Lamorinda and greater Contra Costa County community while also educating and mentoring mental health professionals interested in starting a private practice. This mission for BAPTI has not changed over the years, and we are excited to be celebrating its accomplishments while also preparing for its next 20 years.

    In the fall of 1992 Dr. Robert Marino began discussing his vision for BAPTI with a colleague, Margaret de Petra.  The ideas that developed--gathering top notch clinicians in various specialities and establishing a training program for MFT interns and Ph.D post doctorial students, soon came together, and in April 1993 the first offices were opened in Lafayette.  Within a few months, a local psychologist, Dr. Beth Ferree, joined Margaret and Bob as a partner and immediately joined in the implementation of the intern training component.  Margaret and Beth served as BAPTI’s first directors and Bob became Board President. But BAPTI has been much more than just a counseling center.  It is, and has been a collective of private practice clinicians who have taken to heart the idea that if they support each other, and share their skills they could both enjoy their work more deeply and serve their clients more effectively. This larger group of licensed clinicians came to be known as ‘MDF’ (for Marino, dePetra & Ferree)

    The community grew quickly.  Many interns who completed the BAPTI program elected to remain involved after they became licensed by becoming members of the board of directors, supervisors in the program, or by offering training or other skills to the newest class of interns. BAPTI and the clinicians associated with it have gone from four offices in one suite 20 years ago, to four suites shared by over 30 clinicians today.

    Currently, BAPTI interns collectively see between 50 and 60 clients a week with a client population ranging from children to adults in individual, couples or family sessions.  Some interns work from a CBT perspective, some from a psychodynamic perspective.  Others are developing specializations in trauma and EMDR. Working with couples from an attachment perspective is a growing interest for many, as is mindfulness and using ACT.  This holiday season BAPTI is offering a ‘Holiday Support Group’ on Thursday nights for clients that need extra support during the holiday, and to help provide coverage for therapists on vacation.  Interns come into the program with a variety of previous experiences, but all share the interest of becoming strong licensed clinicians who can survive in the private practice sector.

    Over the years a wealth of diverse perspectives have developed among the BAPTI and MDF clinicians.  By having seasoned MFT’s, Psychologists and LCSW’s with a variety of specializations involved in supporting BAPTI, the interns have the ability to consult on a wide range of topics whenever they like.  All of the MDF clinicians offer consultation to the interns, so interns are able to more easily educate themselves on a given topic whenever necessary for a specific case.  In building this supportive and skilled resource for the interns, they are able to provide clients needing a sliding scale a good option for mental health services.  

    Clients come from many sections of Contra Costa and Alameda counties for services, and have enjoyed the ability to continue working with their clinician after he or she has become licensed.  One of the unique aspects of the BAPTI training program is that it also allows interns to build their client base while in the program, and then take clients when they leave. This has been a critical piece for many newly licensed clinicians graduating from BAPTI so that once they are on their own they have the clients necessary to open their private practice.  Services for the client are therefore uninterrupted by the licensing process.

    As BAPTI enters the new year we are reflecting on what has been our history, and what we hope will be our future.  In this complex era, when mental health services are needed more and more, but are unaffordable to many, we hope to continue to provide an alternative solution.  We know we share the goal of excellent patient care with those of you who also work in the mental health field.  And, in the spirit of supporting everyone in this larger community of care providers, we wish you all a very happy new year.

    BAPTI's intake line is 925-284-2298. BAPTI is located at 3468 Mt. Diablo Blvd #B201, Lafayette, CA 94549. Marie Hopper can be reached at 510-919-1110.

    Marie Hopper, LMFT is the clinical director for BAPTI.  In addition to working at BAPTI, Marie has a private practice with offices in Lafayette and in El Cerrito.  She specializes in working with couples, parenting issues, and young adults. She also enjoys running women's support groups.
  • November 18, 2012 4:43 PM | Admin EBCAMFT
    “You yourself, as much as anybody in the entire universe, deserve your love and affection.” -Buddha

    According to Judith Herman (1992), the first stage of recovery from trauma is that of “Safety.”  This key stage can include skill building in order to prepare for the work of “remembrance and mourning,” which may involve exposure therapies.  With the best of intentions, we sometimes rush toward interventions that trigger Post Traumatic Stress Disorder symptoms which can cause people to fall apart in our office or when they return home. I’ll admit that I’ve had the experience of being shocked by what I heard during an intake in response to the routine question “Have you ever experienced any abuse as a child?”   I’ve listened, paralyzed, as the gory details of a rape tumbled into the room.  It can be difficult to stop a client mid story but sometimes that is exactly what we must do, gently, in order to prevent destabilization. Early on I assess what skills clients already possess for self-regulation when they are having overwhelming feelings.  Slowing down before entering into trauma work helps us assess where a client fits into this stage model for trauma, their symptom picture and their expectations of therapy.  

    When working on the stage of “Safety” with clients, we encourage them to spend time in therapy learning day-to-day coping skills.  That may mean helping clients decrease or stop using substances, self-harm or other compulsions. We focus on helping clients gain a sense of control or understanding of their symptoms.  Later we may move to help them establish safe environments and relationships with healthy boundaries.   At the core of this stage of recovery is that our clients become skilled at developing a safe relationship with themselves and others. This is where Seeking Safety: A Treatment Manual for PTSD and Substance Abuse (2002) by Lisa Najavits, can become a trusted companion.

    The Seeking Safety Program, designed by Najavits, comes in the form of a manual with 25 different topics for clients who have Post Traumatic Stress Disorder and also applies to those with a co-occurring Substance Abuse diagnosis.   Multiple studies have found there is a strong link between PTSD and substance abuse.  In one recent study, between 44% and 56% of women seeking treatment for substance use disorder had a lifetime history of PTSD (Covington, 2010).   The Seeking Safety model has been used in a variety of settings and has been found effective at reducing symptoms of PTSD. After fifteen years of different therapies, one of my clients, “Sharisa” noted that the program finally helped her to understand the connection between her history of incest and her abuse of alcohol.

    Seeking Safety is primarily geared toward adults and can be used individually, in groups, with all genders, and without any special training. Training materials and videos are available on Najavits’s website for those who want additional preparation.  It has been tested with a wide variety of populations, from veterans to incarcerated women.  A therapist who has knowledge (but not necessarily a specialization) in trauma and substance abuse will have all they need to use these materials successfully. Abstinence as well as harm reduction principles are promoted in the materials.

    The manual provides 25 topics that combine cognitive behavioral therapy, interpersonal skill training and psychoeducation. I appreciate that the program materials address how trauma informs a person’s core values and ways of making meaning of the world.   The topics can be presented to clients in any order.  I often provide clients with a topic list and they can then choose which topics they want to focus on. For some clients, I have presented only one or two handouts in the entire course of individual treatment.  Others take part in my six-month group therapy program.  Clients may work on topics such as “Asking for Help,” “Compassion,” or “Healing from Anger.”

    I routinely use these materials with clients who have no substance use issues as the program seems equally effective for them.  When we reach one of the rare sections of the handouts whose focus is primarily on drugs or alcohol, I ask clients who don’t relate to think of things that they do that may be harmful, in order to cope. Most trauma survivors I’ve worked with relate to the idea of having unhealthy compulsions or coping tools such as gambling, smoking, isolation or overeating.  

    In a group setting, using Seeking Safety handouts, we begin by listening to a quote, like the one above, about self-compassion by Buddha.  During every check-in period we ask about positive and negative attempts to cope over the week.  For example, last week one client talked about the self-harming behaviors she uses to cope, that of picking at her skin when stressed. I applauded her honesty and helped her analyze the impact of the behaviors.  We brainstormed other ways to manage her distress next week, such as returning to her weekly yoga practice.  All this was approached with curiosity, avoidance of shame and respect for her resilience.

    In Seeking Safety, each topic comes with a chapter to prepare therapists and includes handouts for clients.  Chapters, which I like to think of as my cliff notes, give background on the topic as well as tips on how to initiate dialogue and build insight.  One of my most cherished handouts is on “Detaching for Emotional Pain (Grounding)”  which helps clients “…shift attention toward the external world, away from negative feelings.” (p. 125)  The therapist gets a step-by-step ten-minute script to walk clients through physical, mental and soothing grounding skills.  These tools help clients reduce their reactivity and move away from their fight or flight response.  For example, to mentally ground, clients are encouraged to “play a categories game with yourself” and name as many cities or types of dogs as they can.  Or “count to 10 or say the alphabet very s…l…o…w…l…y.” Then they get to take home a trusty handout to practice the three types of grounding in their weekly commitment (homework).

    I love leading Seeking Safety Groups because my clients, most of who have complex PTSD, actually notice feeling more stable and using healthier coping skills after six weeks of the program.   However, sometimes giving up the familiar negative coping can lead to an upsurge in trauma symptoms.  Seeking Safety gives therapists and clients a foundation of tools to draw upon as the work challenges and deepens over time.  I encouraged clinicians to take a look at the materials and bring in a model that helps clients, who are often stuck, move toward healing.

    Licensed since 1999, Lisette Lahana, LCSW is CAMFT member in private practice in Oakland, CA and has run Seeking Safety Groups since 2008.  She has openings in her current Seeking Safety group in Lake Merritt/Oakland.   LisetteLahana.com. Learn more about Seeking Safety, the topics, the empirical research behind it and how to purchase the manual on SeekingSafety.org.

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