Free Association Results

Start Word: SEA.                        End Word: MAIL.


Could this possibly be referring to a message in a bottle?

Happy Halloween everyone! Hope it's safe and fun. See you tomorrow.

 

Friday Free Association Chain

The word is........

SEA.

First commenter free associates with the above word. Second commenter takes the first commenter's word and free associates, and so on.

Remember -- FIRST thing that comes to mind. GO!!

T3 - Facets of Grief: Cognitions

The cognitive response to grief can be as varied as the Emotional and Physical responses covered earlier.

Initially, the cognitive response is disbelief. I'm not talking about denial, although that can occur if the disbelief persists. But the flat-out rejection of the horrific news is typically the first cognitive defense against grief, especially if the news is sudden. The grieving person believes the death absolutely could not have happened--did not happen. Usually accompanied by shakes of the head and repetitive "no's" even as his or her mind assimilates the new, life-changing information.

Denial in the most severe form can be the person going about their life as if the person never died. This is rare, though, and usually the bereaved exhibits signs of denial like inability to make decisions about a casket or funeral service. Their mind just hasn't yet fully grasped the idea that the loved one is gone, so they will put off even thinking about it at times by distracting themselves with senseless activities.

The mind might want to dwell on particular intrusive thoughts about how the deceased died, or what they were going through/feeling right before they breathed their last. This preoccupation isn't unhealthy in and of itself, but if not tempered with other positive thoughts of the deceased, it could easily slip into a morbid fascination. Other normal cognitive responses are confusion and difficulty organizing thoughts. A bereaved person might have a much harder time making themselves understood.

Maybe the more interesting aspects for writers of the grieving mind would be how the mind can play tricks on us. It's not unheard of for a grieving person to have a sense of the presence of the deceased. It doesn't have to be that they actually think the deceased is still living, and it doesn't have to be some inherently spiritual idea that the soul hasn't gone to heaven because of "unfinished business." (Think Patrick Swayze in Ghost.)

The grieving person might have auditory or visual hallucinations, which is still a cognitive response because it's origin is in the brain. It doesn't mean they are crazy, although they might think that they are. (For an example of this, read Bonnie Grove's Talking to the Dead.) On the other hand, the bereaved might find a strange sort of comfort from this after-death connection, and assign "spiritual or metaphysical explanation to the phenomena, which can help the bereaved to cope with the loss" (Worden, 1991).

Next week, we'll conclude the facets of grief series with a post about the behavioral response associated with grief. Hope to see you tomorrow for the weekly free association chain we do here on Fridays!

Technique Toolbox - Draw a Person

Draw a Person Technique

Credited to:  Florence Goodenough and Dr. Dale B. Harris

For use with: Children

What you will need:

3 pieces of paper
pencil

What you do:

The therapist requests the child to complete three individual drawings on separate pieces of paper. The original instructions require the child to draw a man, a woman, and themselves. I learned it in that the child is asked to draw a person with no other instructions given. If the child draws a man, then the next drawing would be a woman, or vice versa. The final drawing would be a self-portrait. It is preferable that the child draw the whole person each time, head to foot.

The therapist can then "score" the test using a rubric found in Harris' 1963 book. Points are given for various details, such as having 5 fingers on each hand, eyelashes, teeth, or having a proportionality that is feasible.

Purpose:

This is a non-invasive and non-threatening test and it's original purpose was to determine cognitive developmental levels without being influenced by other factors such as language barriers or special needs. The projective nature of the test came about later and were not endorsed by the creators.

However, I've found those projective measure to be spot on many times with the children I've worked with. For example, a child who draws a highly sexualized picture, with eyelashes, lips, jewelry, make-up, etc., typically have some background of sexual trauma. This is a good indication of it.

Also, I like to take the drawing of the child and the drawing of the same-sex and compare them. It's a good indicator of how the child sees themselves--and thus their self-esteem--when you do this. Children unconsciously project this into the drawings, sometimes drawing themselves really small or their feet or some other specific body part really big.

Funny FYI - When my supervisor first did this test on me in supervision, I drew my friend who worked with me as the other female drawing. When compared to mine, clearly, she was FAR more endowed than I was. Being honest, this is exactly  how I felt!!

Treatment Tuesday - May-December Romance

This week's assessment is for Jamie. She's writing a YA largely focused on the relationship between a 16-year-old high school senior Greta* and her teacher Mr. Corell*, and the aftermath of it being discovered. Greta is rumored to be the school slut after a mere kiss with her former best friend's boyfriend is gossiped to be much more. The few relationships she's had have been short-term with guys who invariably wanted sex, but Greta is still a virgin. She's eager to get out of high school because of the taunting and teasing her former bf has put her through. Greta's mother died when Greta was 8, and her father turned into an emotionally-abusive alcoholic as his was of coping with his loss.

Mr. Corell is an attractive older man in his early 50s (think Alan Rickman). He's a war vet who has been through several failed marriages and is currently in his fourth with a gambling addict who is also cheating on him. She spends large amounts of time away on her gambling trips, but Corell still won't leave her. He's either going to be Greta's English or Chorus teacher.

* Names have been changed to protect the fictional.

Jamie wants to know: From a psychological standpoint, what factors would contribute to both of the characters entering this relationship? What would be the realistic motivations behind both Greta's and Mr. Corell's actions? What kinds of emotions would be natural for them both to be feeling during the various stages of their relationship?

Fascinating idea here, Jamie. A May-December romance between a teacher and student isn't new (nothing is, right?), but what you do with this one could really set this apart. How exciting for me to get in on the beginning of your story!

I think you've boiled down the essential psychological factors at play for at least Greta. Her emotional trauma (from both friends and father) paired with her low self-esteem make her ripe for the picking with a more experienced older man. She's not getting any support from her father, so she'd likely absorb any support from a father figure like a sponge. Greta isn't going to be your issue.

Corell will be. The trick will be to write him in a way that's not creepy, to actually make the reader cheer a bit for him, even though he's completely out of line professionally and could be charged with statutory if things go badly for him. So how to accomplish that?

Corell's backstory will have to get fleshed out considerably. How can you make the reader have empathy toward him? Granted, he's had 3 previous wives, and his current wife isn't treating him great, but maybe he's trapped into marriage with her somehow? A reader would wonder why he doesn't just leave her, so I'd make that connection to cheating gambling wife really airtight, and I'd make it airtight for a positive, empathy-building reason, such as Corell helping someone else somehow by staying with her.

But that's his outward situation. What would internally draw him to the abused innocence of Greta? Maybe he initially sees a way to help foster confidence in a girl who reminds him of a lost daughter or even of himself at her age? Maybe he wants better for her than he had himself. His involvement at the beginning would be purely with altruistic motives to help another hurting soul. This would fit in with your inclination to have the teacher initiate the relationship. I'd advise not to have the relationship start with romance in his mind, as that might be one way to help the reader over the hurdle of his professional misconduct later.

I'm not sure if you plan on this relationship working out in the end, but I was picturing a relationship sort of like what Mr. Holland had with Rowena Morgan in Mr. Holland's Opus, at least to start with. They shared an initial common interest of musical talent, and in her girlish mind, she had them running off together, even though Holland was married. So Corell wouldn't have a steady marriage like Holland had most of the time, but it would make him less creepy if he didn't initiate the romantic part. A reader would have more empathy for a caring professor who gets caught in the crosshairs of the adulation of a young student and the forbidden stirrings of a desire for her.

As for emotions they would be feeling during various stages of their relationship, my guess would be that Corell should experience a lot more anxiety about things, as he has the most to lose. He might find himself intrigued with the idea of being with a girl who worships him, as he's never had that type of relationship with his previous wives. It'll boost his ego, for sure, and he'll probably eventually seek out opportunities to have her around him for that very reason, almost like an addiction. He might become reckless with their rendezvous locations or times.

Anyone who's ever been in love can fill in exactly what Greta will be feeling. She'll be on top of the world, finally having found someone who doesn't just want her for sex, who understand her and supports her and believes in her. She might grow frustrated at not being able to share this with anyone, yet it doesn't look like she has any friends to share things with anyway. I doubt someone with her low self-esteem would ever demand for Corell to divorce his wife or run away with her. I picture her more as a puppy dog gratefully licking up what crumbs Corell throws her in this regard.

As Mr. Holland walked away from Rowena's offer to run away with her, maybe Corell will eventually see things the same way. We'll have to read this when it gets published to know for sure! But there's nothing wrong with a fantastic story that ends in Greta gaining confidence and walking away from Corell, having gotten from him all she could for the next chapter in her life. Even if you don't have a HEA ending for these two, they both need to end the book in better places than they were before, mentally, emotionally, physically.

Thanks for writing in. Good luck with this story! Any related questions, leave them below.

Q4U: Any May-December romances out there in your WIPs? Any reverse age/gender scenarios? I did a review here on Lisa Lickel's Meander Scar, which is the first book I've read with an older female lead and younger male romantic interest. Leave any other examples you know of below.

Review of The Preacher's Bride by Jody Hedlund

I was honored to be included on the influencer list for Jody Hedlund's debut Bethany House historical, The Preacher's Bride.

Here's a blurb from Jody's website:



She was determined to serve a wounded family.
He was determined to preach the truth.
Neither expected to fall in love.

In 1650s England, a young Puritan maiden is on a mission to save the baby of her newly widowed preacher—whether her assistance is wanted or not.

Always ready to help those in need, Elizabeth ignores John’s protests of her aid. She’s even willing to risk her lone marriage prospect to help the little family.

Yet Elizabeth’s new role as housekeeper takes a dangerous turn when John’s boldness from the pulpit makes him a target of political and religious leaders. As the preacher’s enemies become desperate to silence him, they draw Elizabeth into a deadly web of deception. Finding herself in more danger than she ever bargained for, she’s more determined than ever to save the child—and man—she’s come to love.

This really was such a pleasure to read, for two main reasons. One, Jody's writing speaks for itself. Her word pictures and metaphors bring the characters and countryside to life, making it easy for me to transplant myself from my couch in California to 17th century England.

Two, Jody is a blogging buddy of mine and this was the first published book I've read from one of "our group." A bunch of us started blogging at about the same time, and we all hooked up with each other online and were able to meet at the 2009 ACFW conference. Jody was a double finalist in the Genesis contest that year, and things really picked up for her super quick! We've all been enthralled reading about her journey to publication at her blog, Author, Jody Hedlund.

So it was a double joy to read because it was so super special to know the ins and outs behind it. I encourage you to read Jody's back posts regarding how this dream became a reality for her, as it's very inspiring.

Back to the book, though! I was immediately captured in the first chapter as young Elizabeth Whitbread is caught up in the whirlwhind that originates when the wife of preacher John Costin dies, leaving John with three young children and a tiny infant to manage. Elizabeth feels the call to minister to this family as a housekeeper, even though her services aren't initially wanted or even desired by the grieving widow. Read: tension! It was lovely.

I love how Jody portrays the children, especially the oldest girl, Mary. Mary's disability proves to be her biggest challenge and greatest strength, as her blindness gives her a different perception, a deeper one, that enriches the scenes throughout the book and tugs at the heart of the reader.

John's grieving is splendidly written. I was worried about how the romantic connection between Elizabeth and John would happen, given that John lost his wife at the very beginning of the book, but the passage of time is perfect and their growing connection realistic and satisfying given the circumstances.

As a therapist, and a Licensed Marriage and Family Therapist at that, my interest centered on John's calling as a lay preacher and the very immediate danger in which this put him and his family. I could easily put myself in Elizabeth's shoes and see myself begging with my husband not to go out and preach, because I simply wanted him to live to come home to dinner and a warm bed one more day.

Jody handled this really well, as John did begin to doubt his calling due to Elizabeth's requests, as any man might do. And Elizabeth struggled with feeling second rate to John's calls, and many preacher's brides feel this exact way. Marriages have suffered because a balance couldn't be found, and this made me think about my own marriage and any undue stress I might be placing on my husband's calling, or vice versa.

I would encourage anyone reading this book to not skip over the Author's Note at the end. I have a tendency to skip those, and this was one time I'm glad I didn't. Jody's Note adds depth and realism to the story that would have been lost on me otherwise, and it brought home the true sacrifices we are called to when we enter the holy state of matrimony. Thank heavens for the saints who have gone before us as utmost examples of how to handle this awesome responsibility with grace and perseverance.

Thanks, Jody, for such a wonderful book to pass away the very few hours it took me to devour it. I can't wait to see many more from you in the future!

Free Association Results

Start Word: WINDOW.                        End Word: EYES.


Analyzing the results, there weren't any super intriguing associations. Pretty run-of-the-mill kind of stuff. But it IS interesting that our association ended with EYES, which everyone knows are the WINDOWs to the soul.

Great job, everyone! Thanks for participating...see you back next Friday!

Friday Free Association Chain

The word is........

WINDOW.

First commenter free associates with the above word. Second commenter takes the first commenter's word and free associates, and so on.

Remember -- FIRST thing that comes to mind. GO!!

T3 - Facets of Grief: Physical Perceptions

We looked at the emotional response of grief last week, and this week we'll tackle physical perceptions or sensations.

While tears might be the most common manifestation of grief, this post will delve more into the result of crying, which would be dry, itchy eyes. The dryness and itchiness would be the physical sensations. What are some other common physical perceptions of grief? You'll want to be sure to include one or two of these, as they have clinical research backing their validity (Barbato & Irwin, 1992).

1) Tightness in throat/chest

When a person is in severe mourning, their face often scrunches up, their mouths turn downward, and they close off their airway at the throat. Give it a try. Make a face as though you are grieving. Feel the movement in the throat, almost a half-swallow. Soreness and tightness in that exact area is to be expected. Also, when trying to staunch tears and remain strong and stoic, that area is again over-utilized.

As for the chest, irregular breathing can cause that tightness, almost as if a heavy weight was pressing against the chest cavity. People experiencing this physical sensation often have trouble breathing (see #3). The joy as a writer is in finding new and fresh ways to say "her chest/throat tightened."

2) Oversensitivity to noise

A person grieving becomes sensitive to the smallest things. It could be argued that this sensitivity is the mind's way of dealing with overstimulation, or it's the person's feeble efforts to distract themselves from the grief. But suddenly, little noises like a tick of a clock can become like pounding drums. Things that never would have woken the person before now send them bolt upright in the middle of the night. Their perceptions are off, some are dulled and some are heightened. Sound is definitely heightened.

3) Breathlessness

Being unable to draw breath is a regular occurrence. Panic-like symptoms follow the perceived inability to breath, which is also a normal component of grief. The heaviness of the chest is also a factor, and many bereaved people will say they feel as if there is an actual weight, but it's psychosomatic (meaning, a physical condition caused or aggravated by a mental factor). Inability to fully fill their lungs is also somewhat psychosomatic, because in most cases the lung capacity didn't diminish, just the perception of breathing did.

4) Muscular weakness/lack of energy

Think about all that goes into a good cry. Body wracking sobs. Fetal position. Soaked pillows. I looked it up online and got the guesstimate that crying burns about 1.3 calories a minute (which the source said was about the equivalent of laughing, interestingly enough). But it's not just the crying that promotes muscular weakness. Usually, it's the lack of regular food intake, which makes the body run off caloric fumes, which, in turn, promotes a lack of energy.

All of these things considered, people who are recently bereaved are much more vulnerable to illness. research supports this, as well.

Next week we'll look at cognitive facet of grief. See you then.

Q4U: What is a fresh way to say "her throat was tight" or "her chest was tight?"

Happy Birthday...

...to ME! 

If that doesn't get me a day off blogging, then nothing will. See you tomorrow!

Treatment Tuesday - Fan Fiction Forever

This week's assessment is for Nancy. She's writing about a 53-year-old secondary character who essentially has lived in her mind since she was 12. She obsesses about and writes fan fiction for her long-defunct favorite TV show. She identified strongly with a male character on the show who got made fun of and bullied a lot. Every thought seems to about about the show itself or her writings for the show. She knows this is idolatry, and she learns several memory verses to use against this, but always comes right back to it. The protagonist is the best friend who wants to help her before Satan wins another soul.

Nancy wants to know: Is there a name for this type of condition? Is there any hope for the character except to lock her away? What do you suggest or recommend?

Nancy, your character has JPN Disorder, also known as Just Plain Nuts Disorder. No, just kidding! This one stumped me for a while, because there were a few different directions to go. For now, I'm going with the working diagnosis of Schizoid Personality Disorder. It makes the most sense given the information. With that in mind, I have a few suggestions for you to make this character realistic.

Since she's 53 and obsessed with writing for a discontinued TV series, I would assume that her social life has really suffered. Most Schizoids have difficulty with interpersonal relationships, and this begins in their early teens and follows them through adulthood. There discomfort is apparent in multiple arenas, such as work or church. They usually have restricted emotional expression, as well.

Perhaps your character finds her expression--her release--in the writing of her fan fiction. The strong connection she felt with the male lead of the show is a bit odd, since young children seldom cross the gender barrier to find such a strong connection. (Meaning, it might be more powerful to have the lead be a female to which your secondary character gravitated toward.)

A person with Schizoid PD would have to have four of seven traits, which you can read more about in my post here.

You mentioned that she identified with the TV character so strongly because he was teased and bullied, which is very much in line with the type of childhood someone with this disorder would have. You'd want her to be unmarried, perhaps her obsession with the fan fiction writing being a social barrier she never could overcome in order to lead a "normal" life. Schizoids aren't known for close relationships, even their own family, and they always choose solitary activities. What could be more solitary than writing fan fiction all the time? It's likely the only thing she derives pleasure from.

Take the emotional flattening seriously. This will be a woman who doesn't care what others think of her, even your female protagonist who is her friend. Schizoids can have best friends, but I doubt that friendship would look much like the one between you and your best friend. They are a bit "off," and it's noticeable when others encounter her.

She wouldn't need to be locked up. These are loners, but can do well in jobs where they are socially isolated. They can be productive members of society, as long as that society fits into their concept of what society should be. So to answer your question of what hope there is for such a character, that depends largely on where you want her to end up? Happily married? Never writing fan fiction? Neither of those will happen easily for a Schizoid.

I'd want to ask her what started the writing in the first place. What was going on in her life when the show was cut off? I toyed with some sort of post-trauma reaction to her show being discontinued, but that would only make sense if you revealed some huge personal need to watch the show, like it being an escape from some sort of terrible life situation, etc.

I'd also want to ask you as her writer where you're going with the obsession being idolatry. That can be a fine line to walk/write, depending on how it's done. People with obsessive-compulsive disorder don't make the choice to do what they do. They can't stop it no more than they could cut off their own arm. Is Satan "winning" while this lady writes fan fiction, or could Christ possibly be glorified through the writing in some way? Was she a Christian to begin with, because if she's memorizing scripture, it sounds like she might be. I caution you to proceed delicately with how you characterize her mental disability as idolatry, because there are plenty of Christians with mental disorders who might take offense.

Anyway, fascinating character. I really thought about this for some time. Good luck with the writing....any additional questions, feel free to drop me a comment below.

There's still time to enter to win Donna Anastasi's Spin the Plate! Click here!

Intimate Hope

This is a poem I wrote 10 years ago after going through a horrific break-up. No one can deny the therapeutic power of poetry or prose, certainly not this therapist-to-be who found comfort and solace in words I received from God and penned in anguish. I hope it speaks to you as it still speaks to me.

                                          Intimate Hope

                                                      His eyes always look lovingly at me.

                                                           That passion will never fade.

                                                      His hand will always reach for mine.

                                                           I will never grasp for thin air.

                                                      His feet will always walk beside me.

                                                           I will never go alone.

                                                      His chest heaves when mine does.

                                                           He feels all my pain along with me.

                                                      His cheeks quickly grin at my successes.

                                                           They are also familiar with tears.

                                                      His actions are only in my best interest.

                                                           He knows when to step in and when to let me battle it on my own.

                                                      His words are honest and His Word is truth.

                                                           His shoulders are so much bigger than mine.

                                                      His arms wrap all the way around my loneliness.

                                                           He gives me comfort.

                                                      His heart will never break mine.

                                                      © 2000 Jeannie Mood Campbell

To read the rest of an article I wrote to accompany this poem, click here.

Free Association Results

Start Word: DANCE.                        End Word: FINGER.


Analyzing the results, the most interesting association was when Anonymous took us from "STREET" to "FREEDOM." I'm wondering if perhaps the association was for "Dance" instead?

Great job, everyone! Thanks for participating...see you back next Friday!

Friday Free Association Chain

The word is........

DANCE.

First commenter free associates with the above word. Second commenter takes the first commenter's word and free associates, and so on.

Remember -- FIRST thing that comes to mind. GO!!

Oh, and there's still time to enter to win Donna Anastasi's Spin the Plate! Click here!

T3 - Facets of Grief: Emotional Response

A person experiencing loss has major changes in 4 areas: Emotional Response, Physical Perceptions, Cognitions, and Behaviors. This week we'll look at the Emotional Response.

The emotions people experience while bereaved range all over the map. The most overwhelming emotion is depression, since grief shares a lot in common with people experiencing a Major Depressive Episode. Sleep disturbances, appetite changes, and intense episodes of sadness and crying are common in both, but usually these behavioral changes are only present for a short period of time in someone who is grieving.

It's important to note that some people have a reactive response to significant loss, and that is not abnormal. By reactive, I mean that their intense feelings of being alone or isolated might become so overwhelming that they withdraw from even the supportive people who love them most. This emotional response is probably most common with an intimate relationship loss, but could be found in any type of loss and usually wanes over a year or so.

But there are a few emotional responses that, while normal, are difficult for others to deal with or know how to approach a bereaved person experiencing them. I've listed them below.

1) Anger 

One of the first solid emotions a person will feel after shock and denial is anger. The anger is frequently directed at the deceased person, either for leaving the grieving person alone or maybe anger at themselves because they couldn't prevent the death. Anger could be directed outwards, like blaming a cop or doctor who "didn't do their job."

How to approach: Let these angry individuals express themselves in as healthy a manner as possible. Provide outlets - like punching pillows or going to the gym. Don't take it personally if they lash out at you. You adding your hurt on top of what they are already experiencing won't help.

2) Guilt

Guilt could be caused by the angry feelings listed above, but maybe they also said or did something they now regret. People could also think they could have done something to prevent the death. "I should have been there," or "What if I'd recognized the signs of the stroke earlier?" Guilt is often internalized, and might make the bereaved withdraw or feel like they don't deserve the well-wishes of others. Guilt can also occur when the survivor feels relief at the death, perhaps in the case of a chronic long-term illness.

How to approach: Try to help the bereaved focus on the positive aspects of their relationship with the deceased, even if you have to go back to toddlerhood. Reiterating that the person did all they could to save the deceased (if, in fact, they did). Explain that relief in that type circumstance is simply the beginning of recovery, since their grief started much earlier than the actual death.

3) Anxiety

This emotion might be more common among those individuals who don't give themselves time to grieve, like the example I used earlier of a mother who doesn't allow herself to grieve because she's got to take care of her children. But anxiety can come from the confusion or uncertainty that the loss casts the survivor in. "How will I possibly pay all the bills?" "Should we move into a smaller place?" "Who can I count on to pick up Billy from soccer practice now?" Little anxieties can prove to be insurmountable obstacles to dwell on.



How to approach: Let them know that you are available to take care of the "little" things like soccer practices and housecleaning. Knowing they have someone dependable on their support team will go a long way in relieving everyday anxiety focused on maintaining the appearance of normality, especially where children are concerned.


Next week we'll look at possible physical perceptions and changes a grieving person experiences.

Q4U: What have you done in the past to bring comfort to someone who was grieving? What has someone done for you?

Technique Toolbox - ABCs

 ABC Chart Technique

Credited to: Aaron T Beck, founder of Cognitive Therapy

For use with: Individual therapy with adults.

What you will need:

Piece of paper
Pen

What you do:

Explain that every thought has an Activating Event (A). This is what actually happened and the client's immediate interpretations of that event. Then the client forms Beliefs (B) about that event--which can be rational or irrational. Those beliefs lead to Consequences (C), which is what the client feels or does. You can see this in the chart below.

Essentially a therapist can quickly make the above chart by dividing a piece of paper into three columns. Usually this type of assignment is given for homework, but the therapist would likely go over a couple of examples in session to make sure the client understands what they are supposed to do.

Purpose:

Helping the client to recognize their "stinkin' thinkin'" is getting them one step closer to psychological health. In order to do that, people have to recognize the distortions in their thinking, such as:

1. Black-and-White - Thinking or either / or thinking.
2. Making Unfair Comparisons – usually in the negative
3. Filtering – honing in on the negative, forgetting the positive.
4. Personalizing - The Self-Blame Game
5. Mind-Reading – thinking we know what others think (negatively)
6. Catastrophising – imagining the worst case scenario
7. Overgeneralising – “I always mess up…”
8. Confusing Fact with Feeling – “If I think or feel this way then my thoughts/feelings must be correct'.
9. Labelling – I’m a loser vs. I made a mistake.
10. 'Can't Standitis' – being unnecessarily intolerant
(from Basic Counseling Skills.com)

The reason this is called Cognitive Therapy is that it focuses on the second step of (B)elief. If a person's beliefs about something are irrational, then their resulting consequences will be unhealthy, leading to unmanageable behaviors and emotions. Beck believed that if the distorted thought could be intercepted and changed, then psychological illnesses, such as depression, would subside.

Q4U: Any one identify with some of the above examples of "stinkin' thinkin'"?

Treatment Tuesday - Acute Stress Disorder

This week's assessment comes from Sierra. She's writing a psychological thriller short story in the present day about Adriane,* a woman who stabs her husband with a kitchen knife after 6 years of being emotionally abused and constantly compared and found lacking to her husband's first wife. She was steady and reliable, smart and successful prior to this. She is seeing Dr. Black* who is consulting for the defense and conducting their sessions in prison. Adriane still doesn't remember what happened.

Sierra wants to know: Would it be normal for Adriane to remember as she goes through the process of therapy, and if so, what kind of reaction would an inherently good person have after finding out that they did something terrible to someone they loved? What kind of process does someone go through when they make a "mistake" with such horrible consequences?
This sounds like a fascinating plot, Sierra. You are right in assuming that Adriane dissociated to some degree while killing her husband if she does not remember it. We just have to figure out what diagnosis best fits the circumstances.

When a person dissociates, they separate their thoughts, emotions, or experiences from one another. 
This can be on purpose or involuntary. Adriane's was likely involuntary. The presence of amnesia is indicative of many different disorders, such as Dissociative Amnesia or Acute Stress Disorder, the two I want to look at more closely.

With Dissociative Amnesia, the person usually can't recall important personal information, and the information is too extensive to be explained by ordinary forgetfulness. This can happen once or several times. If the amnesia occurs during the course of another disorder, though, that disorder takes precedence. This leads me to Acute Stress Disorder after ruling out the below.

Since you had no indication that Adriane was two or more personalities, she doesn't fit Dissociative identity Disorder. Since you indicated no traveling away from her home or work or assuming a partial or complete different personality, she doesn't fit Dissociative Fugue. There is some indication that she could suffer from Posttraumatic Stress Disorder, but in your sketch, you didn't include any of the traditional symptoms like flashbacks or dreams or avoidance of things that remind her of the trauma.
 
So we are left with the likelihood that Adriane has Acute Stress Disorder. Adriane experienced an event in which she caused the death of her husband, which is definitely traumatic. Shen then would have to exhibit 3 of the 5 characteristics, one of which is the amnesia:

(1) a subjective sense of numbing, detachment, or absence of emotional responsiveness
(2) a reduction in awareness of his or her surroundings (e.g., "being in a daze")
(3) derealization (i.e., feeling a loss of reality or sense of unreality)
(4) depersonalization (i.e., feeling like she's not alive, floating above her body, not a person)
(5) dissociative amnesia (i.e., inability to recall an important aspect of the trauma) 

The last three traits are essentially all aspects of dissociation...a separation from her own body and mind.  Even though she doesn't remember the event at present, she could still experience recurring images or dreams associated with what happened, even if they don't make sense. You'd also want to give her some hyperarousal symptoms, such as inability/difficulty sleeping or concentrating, constantly trying to detect threats to herself (hypervigilance), or exaggerated startle response.

The only thing to consider with this diagnosis is that the symptoms last for a minimum of 2 days and no longer than 4 weeks. If this fits your thrilled time line, then great. If it doesn't, then you can consider a lasting diagnosis of PTSD, more than likely.

Yes, she could eventually remember. But she could also have blocked this memory from resurfacing. Some of my colleagues adhere to hypnosis for this type of memory recovery, but I've never done anything with hypnosis because you have to be trained in the process.

Sierra also wants to know: How would a therapist conduct this sort of thing? What constitutes mental competence to stand trial? How would the therapist go about discussing this with her?

I Googled what constitutes mental competence to stand trial (since I'm not lawyer), and it was pretty much what I thought: the person has to have the capacity to assist their lawyer to defend them and to understand the nature of the proceedings in which they are involved.

You're Dr. Black is going to have a clinical interview with Adriane in which he will assess her with psychological tests or personality tests, like the MMPI-2. He'll take a social and psychiatric history and may use a state competency exam, depending on which state you're in (I found out Georgia has one). Most importantly, Dr. Black will perform a Mental Status Exam and assess current level of functioning of Adriane.


So what's in a Mental Status Exam? I could go into a detailed approach, but why reinvent the wheel? I found a great website with a full explanation of each are of an MSE, so here it it. Essentially, Dr. Black will just ask pertinent questions to cover each of the areas, probably done in a very getting-to-know-you kind of way as part of building rapport with Adriane. However, this would be done at the beginning of the process. You mentioned "sessions" with Dr. Black while Adriane is in prison, which makes me think ongoing counseling. I'm not sure about the legal ins and outs of this type of set-up, and you also want to think about your time line of the diagnosis.

So as it stands, mental competency for Adriane to stand trial would be the results of the following equation:

Functional Assessment

Defendant's Current Mental Status

Specific Demands of Case

I've enjoyed this little foray into legal proceedings and learned quite a bit myself, so thanks for that, Sierra. Hope this helps....thanks for writing in!

Still time to enter to win Donna Anastasi's Spin the Plate! 
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Spin the Plate Review and Giveaway

Donna Anastasi's debut fiction novel, Spin the Plate, takes the life of one incest survivor and spins the outcome for her in a beautiful, redemptive way.

A description of the book from the author's website: Time has done nothing to heal childhood wounds inflicted more than a dozen years ago, nor fade the memories. Now as an adult, Jo has given up on the human race, men in particular, investing her energies in tattoo artistry and animal rescue. Francis meets Jo during an altercation between Jo and another passenger on the Boston subway. Francis, the brains and speech writer for a Boston philanthropist and billionaire, is painfully lonely as his job requires that he maintain anonymity plus have constant exposure to the shallowness, corruption, and cruelty of humankind. From the moment he lays eyes on Jo, Francis sees beyond her rough exterior to the genuine, passionate, fearless, and beautiful person Jo is and pursues her with unwavering passion.
In a compelling story on living as an incest survivor and the how-to’s of love, faith, and healing, Jo discovers she is not alone in her fight to leave her past behind and move beyond sorrow into joy.

Donna's book is remarkable in that it will reach survivors of incest and other acts of sexual abuse and leave them with something positive to take away from their experiences, as incredulous as that might sound. Jo's experiences are horrid, and she clearly suffers from Post-Traumatic Stress Disorder in that she plays flashbacks in her head as if they are on film, and she numbers them by episode.

And her flashbacks are intense and vivid. Fainthearted readers who take offense to language or mature themes won't appreciate it, but the fact of the matter is that people live with these types of nightmares every day. They are graphic and disturbing and shocking, and Donna portrays them realistically.

Jo's rough and tough. She likes the F-bomb. She's a tatoo-artist who does Sumo moves in her spare time. Francis is the opposite. Soft-spoken. Low-profiler. Yet he sees something in Jo that Jo herself doesn't even see. He sees not only potential, but the perfection we all have in Christ...who Jo doesn't have a relationship with.

Francis in many ways represents Christ in this book. His steadfastness and security, always being there, always being patient, always putting Jo first. Christ is just like that. Jo wrestles with the big question of why a loving God would allow her to go through incest, and Francis helps her realize that perhaps it was to give her a "burning desire to save others in similar circumstances," which is exactly what Jo has a passion to do.

I really like the "spin the plate" idea, and can see myself using this in a therapy session. On Donna's website, you can see the sermon which sparked the idea for the name of this novel. Essentially, just changing one's perspective on their situation can make everything more...okay. Better. More bearable.

There is head-hopping throughout the novel, but when I asked Donna about this, she said she chose to break convention and allow the reader to know what both Francis and Jo were thinking at the same time. The effect is a big jarring, though. Also, I wasn't kidding about the language and vivid flashbacks. But if you know someone who has been sexually abused or experienced incest, enter the giveaway so you can give this book to them. It just might "spin the plate" to their circumstances and touch their heart in a way nothing else has.

To Enter:
Leave a comment with your email address in a format where web trawlers can't pick it up and spam you. If you are already a follower, you get +1. If you are a new follower, you get +2. Tweet about it (using the button by the title) gives you an extra +2. Giveaway goes through Friday!

Free Association Results

Start Word: TABLE.                        End Word: SHORT.


Analyzing the results, the most interesting association by far was Cindy's, who took us from "WAIST" to "TIGHT." I hear ya, girl.

Great job, everyone! Thanks for participating...see you back next Friday!

Friday Free Association Chain

The word is........

TABLE.

First commenter free associates with the above word. Second commenter takes the first commenter's word and free associates, and so on.

Remember -- FIRST thing that comes to mind. GO!!