Category Archives: Treatment Team

Recovery Rules! Part 2: A Quality Treatment Team

What makes a quality treatment team? How will you know when you’ve come across a quality treatment team? What if you don’t think your treatment team is competent? What are your options?

A quality treatment team includes a competent psychiatrist, a medical doctor who has gone to medical school and who, upon completing four years of medical school, went on to more schooling to specialize in psychiatry. A psychiatrist can prescribe medications. Most psychiatrists spend about 15 minutes a month with each of their clients/patients. Some will spend more time, especially if you don’t feel stable. A good psychiatrist should be open and honest with you about your diagnosis, treatment, and prognosis, along with how she feels you are currently doing. And she will prescribe medications appropriately.

These traits are also important in a good talk therapist, someone who has her master’s degree or Ph.D. in clinical psychology or mental health counseling. A good therapist will spend 45 minutes to an hour each week or every other week, talking to you about your day-to-day life, how to survive your symptoms and the good and not-so-good things life has to offer. She will also talk to you about any long-term goals you may have and help you achieve these goals or let you know that these goals may not be available to you right now but perhaps sometime in the future. A good talk therapist will listen and, often in subtle manners, attempt to give you other ways of looking at life.

An example that comes to mind that one of my therapists helped me see is that all work, regardless of its prestige factor, is worthwhile. Some work is menial; some is not. Some work is paid, some work is not (volunteer). However, that doesn’t detract from the idea that it is worthwhile. I ate the humble pie on this one, and you know what? I liked it! It was refreshing to know that I didn’t have to come up with the next great scientific breakthrough in order to feel good about myself.

An additional component of a competent treatment may be a case manager, a peer support specialist, and an employment specialist. Each of these team members functions to help you recover and build a life that has purpose and meaning.

How will you know when you’ve run across a quality treatment team? A good treatment team can be aggravating; growing pains are usually painful. However, if you have given a particular treatment team enough time (say 6 months to a year), you should start to think and feel better. I hesitate to put a time limit on treatment teams because there were plenty of times when, years into therapy, I would get aggravated with my talk therapist, even to the point of wanting to quit. I’m glad I didn’t. She taught me a lot. A good treatment team will listen to you and challenge you. A really good treatment team will teach you how to challenge yourself.

What if you have given your treatment team a chance and things just aren’t working out? Well, find another treatment team. You wouldn’t go into a clothing store and buy a pair of pants that were too short, would you? Likewise, you wouldn’t buy fruit at a grocery store that you weren’t particularly fond of, would you? Same goes for treatment teams. Personalities mesh and clash. Shop around. Find one that will work for you. You won’t be sorry you did.

The Therapeutic Relationship: Influences of Recent History

An evolving workforce

World War II ushered in a new era in the composition of the workforce. Until then, most women worked at home, tending to the daily needs of the family. Now, women were needed in the workplace. This changed the look of the American workforce and the American family. [Note to my friends and readers outside of the United States: Sadly, I’m not well-versed in the worldwide trends since WWII. If you can add the trends from your part of the world, please feel free to comment on this post and add your region’s experiences.]

This trend continued with the Baby Boomer Generation, as more and more women were given opportunities to further their education or enter the workforce directly from high school. Many Baby Boomers faced mounting social and economic pressures for both parents to work outside the home. The traditional nuclear family in the United States became a relic.

Given the demands of this trend, many Baby Boomers were exhausted by the end of their workday. Many were too tired to spend quality time with their children, so they parented by turning on the television. Many in my generation (Gen X, a.k.a. latch-key kids) watched “educational” programming like Sesame Street and Electric Company. We also watched cartoons like Bugs Bunny and Road Runner. And many of us watched Schoolhouse Rock, a cartoon version of Government 101. Sitting us in front of a television as a substitute for quality nurturing has had ramifications which I will detail later in this section.

As Gen Xers reached the working age, this trend accelerated. Having both parents working outside the home was commonplace. The burden of raising children shifted from the parents to the schools.

Schoolteachers as parents

This shift created an interesting dynamic. Prior to Gen Xers, mothers were the primary nurturing presence in the lives of young children. Fathers were present, too, but their influence was generally not as pronounced. So, while the norm had been for one parent to nurture one to five of her children, now the norm was for one teacher, usually a female in the early grades, to be responsible for nurturing twenty to twenty-five (or more) of other people’s children. Nurturing was diluted, children suffered. So did adults.

[It may seem like I am against women working; I am not. Women should have the same opportunities as men when it comes to work. However, the system should be set up so that children receive more nurturing than they currently receive, whether that nurturing comes from the mother or the father.]

More homework and an increased emphasis on extracurricular activities

Beginning with Generation X, there was a significant shift in the American education system. The norm had been that no homework was assigned for the beginning grades, roughly K-4 (or 5) and moderate amounts of homework in the middle and high school grades. Now, homework was being assigned in the early elementary grades and more homework was expected in the higher grades. The higher grades also saw an increase in pressure for students to participate in extracurricular activities, especially for those who desired to attend competitive colleges. The result: Kids lost play time, meaning they also lost out on being what they were — kids. They also lost out on what little time they had to be nurtured by their parents.

Shift from learning processes/systems to memorization of facts

A second shift occurred in education at that time. I call this The Slacker Shift. It is a product of both the Baby Boomer Generation and Generation X. Schools used to focus on essays and short answer test questions. Most of us hated these types of questions but they challenged us. [I am a Gen Xer.] That changed with advent of True/False statements, fill in the blank answers, and multiple choice questions.

The introduction of ScanTron test sheets made creating and grading exams easier, so many teachers accepted this new technology with glee and pride. Many parroted the purveyors of this new technology by praising it as progress in education. ScanTron created lazy teachers. Lazy teachers created lazy students. As a result of this “revolution,” critical thinking began to suffer, as did originality, novelty and identity. The essay question died within a few years. That is a shame.

Birth of a new kind of test and of a new style of conformity

Many ScanTron test questions had one and only correct answer. Answering that question was as easy as identifying the answer and filling in the corresponding space on the ScanTron sheet. The answer was given to students! It could be found on the test itself! Students learn best when they are actively engaged in the process. Learning and problem-solving and making mistakes and starting over until they discovered the answer on their own became extinct. The process of self-discovery disappeared from the American public-school system.

The simple act of filling in the correct answers on ScanTron sheets took away important skills like questioning traditional concepts and ideas and developing one’s unique perspectives. Unique ideas and concepts were replaced with a one-size-fits-all system, and in this system, questioning and developing concepts and ideas were discouraged and destroyed.

The new system didn’t afford students with the time to answer complex questions in meaningful ways. More questions, faster answers! More questions, faster answers! That was the mantra of The Slacker Shift. The method: Rote memorization of facts instead of in-depth evaluations and analyses of complex processes. The result: The death of individuality and the birth of a new tool for conformity. It worked. At least for public education. [The ironic part is that the children of the 1960s counterculture created The Slacker Shift and its pressure to conform.]

The advent of new technologies, instant gratification, and attention deficits

Gen Xers not only continued this dysfunctional parent-education macrosystem, they added to it in the form of video games, personal computers and smartphones. These new technologies have some upsides, one of those being that I can find almost any piece of information with a few keystrokes and a click of a mouse. This beats the old encyclopedia version of fact finding. Also, I can link up with virtually anyone who has access to a computer.

There are downsides, however. Now, not only are children taught to conform, they are being trained to expect and devour instant gratification. Accelerating the minds of young people has further deteriorated their abilities to ponder long-term problems and question complex issues.

The method was simple: Make more stuff accessible and make it go faster. The result: Not only were children not getting the quality parenting they needed, their attention spans were greatly reduced. Many Millennials think in terms of a few seconds to a few minutes. The idea of thinking about a topic for days, weeks, or months is foreign to many of them. Who is to blame?

The Blame Game

While Baby Boomers and Gen Xers shoulder much of the responsibility for the downfall of this macrosystem, Millennials should be wary of shirking their responsibility to help heal the system. If Millennials reject this responsibility, I fear The Slacker Shift will grow geometrically and may morph into a vastly different and more pronounced form of conformity and fact-regurgitation. I call this The Three Blind Mice Effect. These effects are as follows:

  • A continued emphasis on rote memorization causing further deficiencies in the critical thinking skills that are necessary to identify, question, and solve complex social and scientific problems.
  • A continued shift from responsible parenting to “parenting” via self-directed, technological gadgets. This will further dehumanize people causing important bonds between individuals and groups to weaken and fracture at an accelerated pace.
  • Faster video games and quicker access to smaller amounts of information will be further popularized, reducing people’s already short attention spans. Readers will “demand” shorter news stories that sacrifice the finer details and broader scope of events. Formulating and executing long-term plans will suffer as the “need” for instant gratification grows.

Healing this broken system will take many years, so training children to think long-term will be important. It will also take an intergenerational effort. Instead of blaming and warring with each other, our best tactic would be to work together on solutions to this problem. Yes, Millennials, past generations fucked up. You can focus on blaming us or you can work with us to solve this problem. Yes, Baby Boomers and Gen Xers, many of you don’t understand or don’t like the Millennials. Suck it up. We need to work with them and in many respects, follow their lead.

The Therapeutic Relationship: A Personal Note

I have had many experiences in my life. I earned my bachelor’s degree in 1994. I served in the military. I worked as a biologist on fishing boats in Alaska in 1995. I have lived in homeless shelters and on the streets. I write poetry and enjoy mathematics. I have been married and had a wonderful daughter. I have battled schizophrenia.

I was first treated and diagnosed in January 1997. I was suicidal and homicidal and in a great deal of psychological and physical pain. My diagnosis is Schizoaffective Disorder – Bipolar Type. I have been hospitalized dozens of times, probably close to 40, including two long-term stays in nursing homes. I have attempted suicide twice. I have had some experiences.

In my twenty-plus years of therapy, I have worked with some stellar therapists. These dedicated professionals were serious about the process of learning their craft and realized that the Number One aspect of therapy is the therapeutic relationship that develops between them and their clients. These therapists were not afraid of the therapeutic relationship. Instead, they embraced it and nurtured it. The therapeutic relationship is central to growth and recovery.

House and Home

Hello! I’m not sure how many of the “old-timers” will read this. I haven’t posted about schizophrenia in a very long time. But, I want to talk a bit about medications and therapy, or as I like to call them “house and home.”

Medications oftentimes provide the foundation and framework for recovery, much like cement and studs form the foundation and framework of a house. Nowadays, there are many medications available to treat schizophrenia. Finding the right one or combination may take time…probably months, maybe even years. Keep fighting to find the right combo.

So, medications make the house, but good talk therapy makes the house a home. Finding a good talk therapist can be difficult. Most are interested in the latest “evidence-based” therapies like Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT). These therapies have some value in my opinion but not a lot. The Number One characteristic of good talk therapists? Their ability to foster a strong therapeutic relationship with you and/or your loved one.

The therapeutic relationship is so important that I am going to devote a new series on this blog dedicated to it: defining it, finding it, and keeping it.

So, I hope some of you are still around and that you find this new series helpful.

Take care and jot me a note if you want. I would love to hear from you!

Edwin

created equal

do you believe
everyone was created
equal? i asked my—
therapist
of course, she
replied
don’t you?
of course, i
said with a—
grin
of course

so you think
doctors and
lawyers are equal
right? i posed, of course—
she replied and
a lawyer and his
doctor dining together is
okay, i asked
of course, she
replied

do you think doctors and
janitors are equal, i—
asked and after a brief but
noticeable pause, she
replied they were and
a doctor and her
janitor dining together is
okay, i asked and she—
anticipating my
question quickly confirmed
it was

and what about a white
man and a woman
of color, are
they equal and is their
dining together—
okay?
of course! of course! she
retorted we,
don’t live in a segregated
society anymore,
edwin!

again, i posed the question
to her, was everyone created
equal? a question which she—
now refused to
answer aloud, only the nod of—
her head
very well then! i said,
we should dine sometime!

"no!" she said, "i mean..."

december 19, 2014

 

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