Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT June 28, 2002 "The trouble with experience is that by the time you have it you are too old to take advantage of it." - Jimmy Connors
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Mental Health Moment Online Gulf War Syndrome This site contains annotated information for links to reports, history, medical and psychological information, research, resources and help information about the Gulf War and Gulf War Syndrome. It is presented in five sections: Introduction; Official Response; Medical Research; Conspiracy Theories; and Resources
CONFERENCES AND WORKSHOPS:
Fifth Annual Innovations in Disaster Psychology Conference
Sept. 29-Oct 1
Call for Papers is now available. This year's topic is "Psychosocial Reactions to Terrorist Attacks".
It will feature Annette LaGreca and Colonel Larry James as keynotes and half day paper sessions.Effectiveness of Rehabilitation for Cognitive Deficits
September 17 - 19, 2002
Location: Cardiff, WALES
Contact: Professor Peter Halligan
Email: HalliganPW@cardiff.ac.uk
Fifth International Conference of the Learning Sciences (ICLS 2002) October 23 - 26, 2002
Location: Seattle, Washington, USA
SUMMER EMOTIONS INSTITUTE:
Les Greenberg, Ph.D.
August 19-22, 2002
Skills training in working directly with emotion in psychotherapy Location: York University Toronto
Phone: (416) 410-6699
DID YOU KNOW: AGNES VISITED 30 YEARS AGO
Last Friday (June 21) marked the 30th anniversary of Tropical Storm Agnes' arrival for an extended stay in Pennsylvania in 1972. Agnes, at that time the most costly natural disaster to hit the United States, killed nearly 120 people and did nearly $3.1 billion in damage from Florida to New York. With Pennsylvania declared a disaster area, Penn State's graduation ceremony at the University Park campus with speaker James Michener was sparsely attended. In the state capital area, as the Susquehanna River raged more than a half-mile out of its banks, the Penn State Harrisburg campus became a refuge for more than 1,000 displaced people. Seniors forewent their graduation ceremony to work with other students, faculty and staff to assist the homeless. Trailers were placed in front of Olmsted Building, where 100 families lived for almost a year in "Flood Village."
WILDLAND FIRE INFORMATION
Information and links to sites about Wildfires, updates and agencies, organizations and groups who fight fires and provide training, assistance, and other related services. https://www.angelfire.com/biz3/news/wildfires.html
HENSEL FIRE INFORMATION PAGE
Incident information about the Hensel Fire by Laramie Peak in northeast Albany County, WY.
Potential for spread remains high and will persist until the fire area receives significant precipitation. Burnout on the southeast corner progressed with favorable winds. One Blackhawk helicopter from the Wyoming National Guard arrived Sunday and another was expected on Monday. Fire containment could occur by June 30 under weather conditions predicted for the next few days. http://wildfires.nwcg.gov/wyoming/hensel/index.html
DISASTER MENTAL HEALTH SERVICES - A Guidebook for Clinicians and Administrators
Produced by the Department of Social Work - Walter Reed Army Medical Center and the National Center for Post Traumatic Stress Disorder. http://www.wramc.amedd.army.mil/departments/socialwork/provider/DMHS.htm
HELPING AMERICA COPE
May was Mental Health Awareness Month. The National Mental Health Association's theme for this year is "Mental Health Matters - Now More than Ever", emphasizing the key role that mental health plays in people's lives during these troubled times - and in all times. It has been a difficult period for many Americans following the September 11 terrorist attacks. It is important that not only physical wounds are attended to, but mental health needs as well. This is especially true for vulnerable populations such as children. http://www.7-dippity.com/bom/bm_index.jsp Also go To: http://www.7-dippity.com
Relief Comes to Thousands Left Homeless by Epic Chinese Floods
As heavy rains continue to pound central and southern China, some 400 people have been confirmed dead and hundreds of others have been declared missing in the worst flooding to strike the nation in years.
Recovery Effort Begins After Syrian Dam Collapse
On June 4, 2002, the 1,000 residents of Zeyzoun, a village in northern Syria, were enjoying a typical day. At 3:00 p.m., however, everything changed when the unthinkable occurred.
Second in importance only to family interaction, the total school experience exerts a profound effect (positive or negative) on an adolescent's concept of self and his/her future educational/ vocational/social options. School performance becomes one of the most crucial diagnostic tools to assess the relative stability or the degree of pathology of the adolescent. Because the school plays such a central role in adolescent development, no effective treatment relationship can ignore what happens there academically and socially. Schools are in a unique position to monitor the social network by providing invaluable information about individual attitudes and behavior. Adolescents generally spend a good deal of their time involved in school activities and in forming social relationships with other students. It is significant to note that when adolescents are truant from classes, they often go to the school and associate with their classmates or with former students. Generally, after hours, schools remain the center of social planning and adolescents congregate on or near the school property. Moreover, the school has "custody" of adolescents for at least six hours a day, five days a week. Educators can provide much clinical data based on individual performance in the classroom, social maturity (or immaturity), relationships with adult authority figures, etc. When adolescents know that there will be ongoing communication between school personnel and their counselor/therapist, opportunities for deliberate denial, distortion, and deceit are minimized. Sharing information also reduces the divisive "divide and conquer" manipulatioins often seen among adolescents. The presentation of a unified front helps diminish an adolescent's need to test limits by acting out in a self-destructive manner, which places him/her in a "no win/ no exit" quagmire. When the counselor/therapist knows there is a potential problem with a teacher, the issue can be examined and defused before the adolescent creates a crisis to which the school must react. Helping the individual to stabilize school performance is one of the priorities of psychotherapy with adolescents. Academic achievement certainly affects future educational and vocational opportunities, which determine the quality of life for adults. Serving as a consultant/catalyst for schools to help adolescents is a legitimate expenditure of therapeutic time and focus. Schools can often alert the counselor/therapist to a potential problem as the adolescent may be unaware of the impact of his/her behavior. Adversarial Relationships It is important for both the school and the counselor/therapist to recognize that the credentialized professional retains a primary allegiance to the adolescent, not to the educational institution. The opposite is true for the educator who needs to consider effects of an adolescent's behavior and subsequent decisions on policies designed for management of the larger groups. The therapist/counselor needs to understand the implicit and explicit constraints affecting decisions. The ability to appreciate the philosophical dilemna of the educator can help facilitate a positive resolution of the problem. In the beginning, there is likely to be some inevitable tension since the therapist/counselor seeks to redress an injustice, to stimulate change, or to request that an exception be made. The educator may want to maintain the status quo, seek security by citing a precedent, and be prepared to sacrifice one for the sake of the majority. It's therefore incumbent on the counselor/therapist to prove the validity of his/her request before the educator accedes. Stated another way, the therapist/counselor wants the answer to be "yes". On the other hand, the educator is prepared to say "no!" This situation is often complicated by the fact that most contact with schools by therapists/ counselors happens ex post facto after the institution has already reacted by punishing (disciplining) the offender. Too frequently, a meeting is convened after a number of school personnel (an administrator, a dean, the teacher) have already determined what they consider to be an appropriate outcome. Educational team members invariably want to protect their colleague, who may feel insulted, hurt, angry, or unappreciated, or whose authority has been challenged. Schools retain a vested interest in discouraging any further infractions for fear that anarchy will result. Thgerapists/counselors can suggest that a goal of treatment is to help the adolescent exist in harmony within the infrastructure to maximize further educational and professional options. The reality is that the adolescent must learn coping skills. This is because for the most part, the system will be resistant to change in order to accommodate idiosyncratic behavior. The counselor/therapist must remember that it can be an important learning experience for the adolescent to be "forced to endure" an incompetent teacher or one who is antagonistic because in the world of work not every supervisor or employer will be favorably inclined or sensitive to the individual. Instead of demanding or requesting a transfer, a lot more may be gained by assisting the adolescent in learning how to resolve a damaging or disastrous situation. Therapists/counselors must carefully assess probable gains and potential consequences. In discussions with school personnel, therapists/counselors need to communicate an appreciation and awareness of this realistic expectation. This can help elicit support from educators. It is rare that a teacher will experience difficulty with only one student. Initially a school may appear defensive or in denial. However, it will sometimes be conceded that an instructor inadvertently overreacted or is less than competent. The administration may wish to consider dismissing the educator. It is obvious that when the therapist/counselor is privy to such information, he/she is in a position to help negotiate a favorable settlement. Quid pro quo transactions can occur when a therapist/counselor performs an invaluable service to the school resulting in an advantageous outcome. The other side of the coin is that the student may be clearly the one at fault. Unless the student is prepared to demonstrate remorse or, at the very least, to offer an apology, or to guarantee that "It will never happen again", odds of achieving some sort of compromise are remote. It is advisable for the therapist/counselor to not offer to intervene as he/she may jeopardize future credibility. Prior to agreeing to contact the school, the therapist/counselor must achieve an understanding with the adolescent and form a strategy for negotiation of a solution. However, the counselor/therapist does retain significant leverage with the school. The school usually views the counselor/therapist as having expertise and power it may lack in controlling potentially disruptive and non-conforming students. The school may be very willing (and even appreciative) to delegate management of the student to the counselor/therapist following receipt of reassurances concerning the potential for and probability of a successful resolution. The therapist/counselor must consider whether he/she wishes to become so involved as to require ongoing contacts with school personnel, such as phoning, writing, and conferences. Extramural Relationships Extramural contacts with the school can be mutually beneficial for therapists/counselors working with adolescents. In negotiations where one party functions as an advocate, personal contact can definitely positively influence the outcome. For example, in a court of law, an attorney who personally knows the judge will, in all probability, be in a position to achieve a favorable disposition. On the other hand, an attorney who needs to be an adversary will candidly prefer to not know much about the personhood of the individual. An educator enjoys the opportunity to have a casual and cordial lunch with any community resource. Educators like discussing the pressure of their profession, or even their personal lives. If the counselor/therapist can clarify issues and provide helpful suggestions, educators are likely to remain grateful and be favorably predisposed. Prior to accepting referrals from a school, the counselor/therapist must not only discuss the school's perception of the presenting problem(s), but must also articulate tentative treatment goals. The potential for conflict and possible areas of collaboration should be discussed prior to meeting the adolescent. In making a referral to the counselor/therapist, the school is implicitly requesting a favor - to quell a potential problem. When in such a position, and prior to accepting the assignment, the therapist/counselor should anticipate probable future concessions to facilitate resolution. In order to help enhance credibility and visibility, the counselor/therapist should participate as a panel member at school functions or conduct workshops for teachers. The therapist/counselor should also volunteer to serve on committees. In so doing, he/she can interact with school personnel. All of these activities help build a bond of mutuality inspiring cooperation and communication. Therapeutic Alliance Confidentiality is guaranteed in therapy/counseling. There is no justification for divulging the identity of an adolescent who acts responsibly and is productive. In recent years, the stigma of seeing a counselor/therapist has been minimized. In some communities, it has become so common that it has even become a status symbol to have "your own shrink". Adolescent may often discuss their "shrink. They often quote, or misquote, their counselor/therapist to suit their fancy. When it began, psychotherapy was often prescribed for individuals whose lives were stable, but who wanted to gain insight and understand themselves better. Now psychotherapy has expanded to include people who engage in self-destructive, life-threatening acts or threaten the welfare and lives of others. The famous case of Tarasoff v. Regents of the University of California (1976) has modified the issue of confidentiality. There now exists a prima facie case for the "duty to warn". In recognizing the obligation of the therapist/counselor to protect not only the individual being seen, but also those who may be harmed, Bratter (1986) wrote:
WORKING WITH ADOLESCENTS Most professional organizations have explicit guidelines regarding confidentiality which state that this remains the purview of the individual in psychotherapy. Yet when substance abusers engage in destructive and death endangering behavior, it remains countertherapeutic to enter into a conspiracy of silence because the individual so demands.When an adolescent chooses to create a crisis by engaging in self-annihilative behavior, the counselor/therapist must consider intervening. In extreme cases, this may require informing others. In their review of the impact of the Tarasoff decision, Kermani and Drob (1987) suggest that the individual must recognize that there can be consequences to engaging in self-destructive behavior or threatening others. Thyey suggest that the process of psychotherapy can be enhanced because:The trust that a patient has for his therapist not only involves a belief that the therapist will not breech his confidence, but also a faith that the therapist cares enough about him to take measures that will prevent the patient from causing serious harm to himself.... The therapist who reports a threat of murder, far from telling his patient that he cannot be trusted, is presenting a very different message, a message that he cares enough about his patient to set limits on his self-destructive behavior and demand that he act responsibly toward the rights, and particularly the lives, of others.Angry and alienated adolescents don't confess present or future self-destructive behavior because they feel guilt or discomfort. They disclose information because they recognize the potential for personal harm and want to be restrained. A counselor/therapist who preserves confidentiality may encourage sadistic or masochistic acts by joining the conspiracy of silence. A therapist/counselor who decides to work with self-destructive adolescents with poor impulse control and are hedonistic to a point where they have little awareness about future consequences should consider expanding the treatment team to include significant others who can help contain and control malignant behavior. It is no coincidence when friends and relatives contact the therapist/counselor. They often know about the therapist/counselor from the adolescent. There are no reasons why therapists/counselors should discourage such clandestine contacts. These contacts can provide necessary corraboration in gaining the perspective needed to help these adolescents stabilize and become more honest. The counselor/therapist can listen and doesn't need to say anything other than to thank the caller for their interest. The therapist/counselor who adopts such a pragmatic philosophical orientation should anticipate inevitable conferences with school personnel. Prior to contacting the school, the counselor/therapist should candidly discuss the rationale for doing so. It is important to understand that the adsolescent retains the prerogative to permit or prohibit such collaboration if no emergency exists. There are only two legitimate reasons for the counselor/therapist to contact the school. The first is the "duty to warn". The second is when the adolescent will benefit from collaboration. The dual role of the therapist/counselor was discussed by Mariner (1967) and has implications for those professionals who contact the school.If a therapist is guiding other agencies in their dealing with the patient, and in turn, is being guided by them...through the exchange of information and opinion, then he no longer has a therapeutic relationship with the patient in the usual sense. Indeed, it may be warranted for the psychotherapist to extend the treatment limits further.Awad (1983) assumes that it may be necessary to modify techniques for antisocial adolescents and provides another justification for communicating with the school:Antisocial adolescents have the penchant to get into trouble and not talk about it. In addition, many parents, teachers...are troubled by the behavior of the adolescents and would like to discuss it with the therapist. Some therapists elect to have no contacts with these people in order to protect the confidentiality and the transference. However, this attitude may provoke termination of therapy when these people get frustrated by the unavailability of the therapist. Instead, what seems to be more useful is to allow the important figures in the adolescent's life to have access to the therapist but on conditions that are clear to them and to the patient. Thus, it might be decided that the parents and/or significant adults could call the therapist if they are concerned. However, these calls are not confidential and every call will be discussed with the patient, even though sessions cannot be discussed with the parents.... Such contacts rarely affect the therapeutic relationship. In addition, they give the patient the message [that] every aspect of his life is a focus of therapy.When the counselor/therapist has input, he/she can help the school develop a constructive strategy that includes reasonable consequences for continued disruptive and rebellious behaviors. In this way, the school is converted into a catalyst for positive growth. The counselor/therapist has more leverage and credibility than parents in persuading the school to consider additional options. Such a collaborative effort allows the counselor/therapist to co-opt the school, which becomes a "sub rosa" adjunct to the treatment team. This can result in a serendipitous payoff. Acting-out, non-conforming, disrespectful, and disruptive adolescents can permanently antagonize individual teachers and administrators. These, in turn, can adversely affect their colleagues' perceptions log after the annoying acts have stopped. Malicious gossip in the faculty lounge may result in unwarranted and prolonged reprisals. It is probable that the counselor/therapist would be privy to such an injustice. He/she may be in a position to neutralize such acrimony through discreet discussions. Advocacy The counselor/therapist functions as a liaison between two "hostile" parties - the adolescent and the school. They both remain suspicious because neither wants to acquiesce or change. An incentive for the adolescent to change would be for the counselor/therapist to make a pledge similar to the following:"I'll negotiate on your behalf with the school and attempt to convince them to be less punitive and give you a final chance when you convince me you sincerely recognize the wrongness of your attitude and/or behavior."Preliminary communication with the school might be:"I promise to help persuade the adolescent not only to repent, but also to behave more reasonably from now on if a few concessions can be made."Protecting individuals from arbitrary and punitive administrative action is not a new concept. The omsbudsman, originating in Sweden about three centuries ago, provides an historical model in which an impartial and independent person investigates citizen complaints and subsequently recommends solutions to resolve conflicts and injustices. In 1809, as described by Rowat (1965), the omsbudsman was an officer of parliament who investigated the individual's allegations of unjust government treatment. If the omsbudsman concluded that the complaint had merit, the official would propose corrective action. However, the omsbudsman remained impotent in implementing any modification because the government was not legally forced to comply. Due to this, binding arbitration was introduced where both sides, when they reach an impasse, agree to abide by the resolution presented by an acceptable third party. A judge who is legally empowered to enforce compliance often serves as a mediator. There is a third more realistic model of conflict resolution available. Schools are not likely to view the counselor/therapist as an obsbudsman. They surely will not relinguish their power. The concerned clinician can, however, function as an advocate. Advocacy is a unique relationship in which one party agrees to not only protect the interests of the other, but also to attempt to gain preferential consideration. The advocate, at times, attempts to influence a positive outcome to the detriment of another party (or parties). The dynamics of the advocacy relationship parallel those of the attorney and client. The lawyer zealously guards and argues for the interests of the client. Bratter (1976-1977) describes an advocate as being"assertive and competitive. (S)he must be able to respond to a momentary defeat with a unique and more vigorous plan of action.... Periodically, the advocate must be prepared to challenge the system when (s)he believes there has been an injustice or discrimination.... The advocate, therefore, never remains neutral, but becomes a partisan who seeks preferential treatment."Summary Sobel (1984) contends,"The limits of confidentiality need to be clearly defined...including what and how information if any will be released to their parents and other parties.... The issues of dangerousness and duty to warn are sensitive ones in any psychotherapeutic practice."The counselor/therapist must consider innovative and humanistic ways to extend the treatment alliance and how to relate to school personnel in order to protect and promote the interests of the adolescent. ************************************************************************************************REFERENCES Awad, G.A. (1983). The middle phase of psychotherapy with antisocial adolescents. American Journal of Psychology, 37, 193-194. Bratter, T.E. (1986). Negotiating the therapeutic alliance with unmotivated, self-destructive adolescent substance abusers in independent practice: Some pre-treatment issues. In R. Faukin berry (Ed.), Drugs: Problems in the 70's, solutions for the 80's. Lafayette, LA: Endac Enterprises. Bratter, T.E. (1976-1977). The psychotherapist as advocate: Extending the therapeutic alliance with adolescents. Journal of Contemporary Psychology, 9, 119-126. Kermani, E.J. & Drob, S.L. (1987). Tarasoff decision: A decade later dilemna still faces psychotherapists. American Journal of Psychology, 41, 282. Mariner, A. (1967). The problem of therapeutic privacy. Psychiatry, 60, 66-72 Rowat, D.C. (1965). The omsbudsman: Citizen's defender. London: Allen and Unwin, p7. Sobel, S.B. (1984). Independent practice in child and adolescent psychotherapy in small communities: Personnel, professional, and ethical issues. Psychology, Theology, Research & Practice, 21, 112-118. Tarasoff v. Regents of University of California. (1974). 13 Cal. 3d. 177, 529 P. 2d 533, 18 Cal. Rptr. 129. Tarasoff v. Regents of University of California (1976). 17 Cal. 3d. 425, 551 P. 2d 334, 131 Cal. Rptr. 14. To search for books on disasters and disaster mental health topics, leaders, leadership, orgainizations, crisis intervention, leaders and crises, and related topics and purchase them online, go to the following url: https://www.angelfire.com/biz/odochartaigh/searchbooks.html ********************************************************************** ********************************************************************** Contact your local Mental Health Center or check the yellow pages for counselors, psychologists, therapists, and other Mental health Professionals in your area for further information. ********************************************************************** George W. Doherty O'Dochartaigh Associates Box 786 Laramie, WY 82073-0786 MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
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