I’m sure you all know that most therapists don’t usually do that much dream exploration any more, despite its prominence in Freud and hence pop culture depictions of therapy.

I do a lot of work with trauma-based nightmares, but those are quite different from non-trauma-related dreams. The dreams are not generally subtle, so the work is more to get rid of them than to explore what they mean; it’s obvious what they mean. In those cases, the client was traumatized and is re-experiencing it in nightmares which don't contain any deeper meaning, and from which no insight can be gleaned because the insight (client was traumatized in a specific event) is already known.

However, I do sometimes have clients tell me a dream that either isn’t obviously trauma-related, or might be but also seems to have some deeper meaning, and ask me what it means.

I might say something like, "I can't tell you what your dream means. Dreams are totally individual - you're the only one who can know what it means. What do you think it’s about? Were there any parts that felt especially meaningful, or that reminded you of anything in your life or your past?"

If they don’t have any ideas, I’ll try asking about cultural ideas about dreams. I’d phrase it as something like, “In your culture, do people have ways of interpreting dreams? Is there someone in your family or someone you know who knows a lot about dreams?”

Generally, if their culture does have ideas about dreams, they will know some specific person who could interpret their dream. In that case, if the client says that yes, there is someone they know who knows about dreams and they'd believe their interpretation, I'll ask how they'd feel about asking that person. If they go for it, I’ll check in next session about what Grandma or Auntie had to say, and how the client felt about it.

But if there wasn't anything like that, or the client didn’t believe in it, or if they asked Grandma but found her explanation unsatisfying or insufficient, and they’re still really curious about the meaning of the dream, I tell them that there’s another way of exploring dreams.

"It involves art,” I’ll say, “but it’s not literally drawing anything from your dream. Though you can do that too, if you want to."

If the client doesn't already do art, I’d say, "Anyone can do this. You don't have to be good at drawing, or even know how to draw or paint at all. It's not about making good art, it’s just a way of exploring your dream in a way that you can’t do by just talking about it. It won’t necessarily tell you what your dream means, but it might give you some ideas or insight. It's easier to do than to explain."

This method is based on something I learned in a class and I now am not sure what it's called or what the exact source is; it’s Jungian, though. Possibly Robert Johnson.

This is the sort of thing that a client will either really get into, or not want to do at all. It takes the entire session, so make sure they want to do it before you start. It’s usually something you’ll tell them about and ask if they want to try it in one session, and then actually do it in the next session. All else aside, you’ll need to collect a number of sheets of blank paper, and paints and/or color pens, pencils, or crayons.

To begin the session, even if they’ve told me the dream before, I ask, "Can you tell me the dream you want to work on?"

If there's multiple ones, I have them pick the one that feels most important, frightening, emotionally intense, etc.

The client tells me the dream. I listen to the whole thing. You can listen uninterrupted, or occasionally ask questions.

If there's a lack of vivid detail, in whole or in part, I ask questions. If you ask questions, they should be geared toward enlarging on the details of the dream, not on associations or possible meanings. You want to keep the focus on the narrative of the dream itself.

If it involved snakes, a good question to ask would be, "What did the snake look like? Was it a particular type of snake? How big was it? What color was it? Did it make a sound?" etc. (Not ALL those questions, but one or maybe more if the client doesn't elaborate on their own.)

When they're done, I ask, "Can you pick ONE moment in the dream that feels important to you? Like, the most intense, the most scary, the most mysterious, the one you're most curious about…?"

They say what that moment is. If it's too long or complex, narrow it down. For instance:

Client: "The moment when I opened the door to my home and saw my mother covered in snakes and then the snakes started chasing me."

Me: "Okay, but of that part, which was most intense or meaningful? Was it the door opening? Was it seeing your mother…?"

Client: "I think it was seeing my mother."

Me: "Okay, now paint that moment. It doesn't have to be literal at all. It could be just how you felt. Or if you want to try to represent it literally, feel free, but just remember that it doesn't have to be a good or accurate drawing at all."

Clients are often hugely self-conscious about not being good at art, so unless the client is already an artist, I’d emphasize the “doesn’t have to be good” a lot.

The client then creates a painting. We look at it and I ask if anything jumps out at them about it. If so, we talk about it. Then I ask (if I haven’t already) exactly what part of the moment of seeing her mother the painting represents.

They show me on the painting: “Those black lines are the snakes on her body.”

Me: “Okay, you know how on shows like CSI, they have the photo of the crime scene, and then blow it up, to show more detail? We’re going to blow up that part of your dream. Of the moment when you saw the snakes on her body, pick a detail that seems like the most important or emotional or scary, and just paint that. Maybe a detail of your mother, or of one of the snakes…?”

Client: “Yeah, this one snake had its mouth open and I could see its fangs. It was really scary!”

Me: “Okay. Paint that. Remember, it doesn’t have to be literal – just the feeling of the fangs.”

On a new sheet of paper, the client paints the fangs.

If we have time, I’ll have them blow up the dream several times, painting various details.

Also, have them do at least one association that may or may not be in the dream itself: “Did anything in that moment of the dream remind you of anything else in your life? Was any part of it a real thing from your past?”

Client: “Yeah, the light from the window reminded me of sunset in the town I used to live in.”

Me: “Can you paint the sunset, or the feeling of the sunset…?”

You should end up with at least three paintings: one original, one blow-up, and one associational. Ideally, you will also do a blow-up of the association: one detail of the sunset that seems most important.

Then you have the client go through them one by one and look at them as paintings, as if she walked into a room and saw them hanging on the walls. What feelings do they evoke if she looks at them as if someone else painted them? How are they related to each other? Is there some kind of progression from one to the next?

This is the part where clients should start noticing things they didn’t before. You’re having them step back and look at their paintings from a perspective they didn’t expect to take. Talk about what they see and how it makes them feel.

Then have the client look at the paintings again, this time relating them back to the dream. Do they say anything about the dream that she didn’t notice before? Do they remind her of anything, maybe something from her past? “Looking at the paintings, how do you feel about the dream now? Do they shed any light on it? What about the town where you used to live? Does the dream have anything to do with that?”

You can continue as long as you like, blowing up details or delving into associations, then alternately looking at the paintings as paintings and as they relate to the dream or associations from the dream.

This can be really interesting for a client who wants to explore their subconscious or see things in new ways. It’s not a source of answers, but it’s a source of inspiration, insight, or simply having a new experience in therapy. You can do it yourself, but I think it’s easier to do with someone else. It’s hard to describe, but powerful to experience: a dreamlike experience in waking reality. It produces a feeling of insight which is hard to put in words.
The Essential Jung. When people tell me Jungian stuff, I love it! And then I attempt actual Jung. Where are they even finding all those cool ideas? All I am seeing is (opening at random) Even though alchemy was essentially more materialistic in its procedures than the dogma, both of them remain at the second, anticipatory stage of the coniunctio, the union of the unio mentalis with the body.

And it's not just because I'm opening at random. When I was in school I started from the beginning. The effect was exactly the same as if I'd opened it at random. Has anyone here read Jung in German? Is this just a translation effect, or is he equally incomprehensible in the original? (And what if you do know German, but you don’t know Latin? WHY IS THE LATIN NEVER TRANSLATED?)

Owning Your Own Shadow, by Robert Johnson

First sentence: The shadow: what is this curious dark element that follows us like a saurian tail and pursues us so relentlessly in our psychological work?

This is not Johnson’s fault but I was irresistibly reminded of Ursula K. Le Guin’s The Language of the Night (one of my all-time favorite books, by the way) in which she mentions a terrible sf story she read as a child which concluded with “And so they returned to the saurian slime from whence they sprung!” She and her brother created the jingle,

The saurian slime from whence they sprung
Unwept, unhonored, and unsung.

No, okay, that is Johnson’s fault. That is a ridiculous sentence and it also deserves a mocking jingle. I know it’s a metaphor, but it is also an image. Please take a moment to picture a psychoanalyst being stalked by a disembodied lizard tail.

If you don’t know the concept of the shadow this book is a decent introduction to it, but you could do much better. Unimpressive.

Inner Work, by Robert Johnson. This is actually a pretty good book on working with dreams and imagination and the unconscious. I’m not keeping it because I get the principles and it’s not so well-written or uniquely insightful that I’d re-read. But if you’re interested, this will give you a lot of useful tools.

I don’t do a lot of dream work, either for myself or for my clients, but it comes up occasionally. (I do a lot of work with PTSD-related nightmares, but that’s a different thing. Those are not subtle.) When clients ask me what a dream means, I tell them that only the dreamer can know the meaning of the dream and ask them what they think it means. If they have no idea, I start asking what specific parts make them think of, if anything has a cultural meaning or how dreams are generally interpreted in their culture, etc. (“Is there anyone in your family who knows a lot about dreams?” Not uncommonly, there is.)

Treating Eating Disorders, ed. Werne. This is from 1996. I’d rather read something more recent. I think a lot of ideas in the field have changed since then.
In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness, by Peter Levine. This is the guy who invented somatic experiencing. I am sure it works when he does it. Lots of therapies work because they're done by charismatic, compassionate, insightful people who believe in what they're doing. (In fact, therapy in general works that way, even when using highly structured therapies like CBT for phobias.)

This book? USELESS. FACTUALLY INCORRECT. STUPID. He explains that he saw lions chase zebras on TV, and the zebras who escaped would shake and twitch, then recover and go about their lives without getting PTSD. HOW CAN YOU TELL? YOU WATCHED ANIMAL PLANET. YOU DID NOT FOLLOW UP WITH THE ZEBRAS. He concluded that animals don't get PTSD (FACTUALLY INCORRECT. Anyone who has ever seen an abused pet has seen PTSD in animals.) and that the reason is that they physically shake out the trauma. And so he created a treatment based on shaking out the trauma. I am being unfair and simplistic but only slightly. This dude was highly respected at my school, too. I'm sure someone will appreciate this book over there.

Help for the Helper: The Psychophysiology of Compassion Fatigue and Vicarious Trauma (Norton Professional Books), by Babette Rothschild. Summary: vicarious traumatization is a thing. If you're a therapist, maintain boundaries, be aware if you're getting too affected by other people's pain, and practice self-care. There, now you don't have to read this book.

The Psychology of the Transference (Ark Paperbacks), by Carl Jung. From this we must conclude that the symbolism of the stories rests on a much more primitive mental structure than the alchemical quaternio and its psychological equivalent. I am not smart enough to read this book.

The Theory and Practice of Group Psychotherapy, Fifth Edition, by Irvin Yalom. This is a pretty great and classic work on a very specific type of group therapy that I HATE and never intend to do. ("I have difficulties relating to others, let's work these out experientially in a group focused exclusively on how the group interacts with each other." I'm sure this actually works very well when someone as skilled as Yalom is running it, but 1) it's not my thing, 2) it can very easily turn into a parody of itself in a very specific way, 3) I was permanently traumatized by a badly run group of this sort in college, which did become the parody, in which this exchange actually occurred:

Group Member A: "I notice that your foot is pointing in my direction. I wonder what you intend to convey by that."

Dude with Foot (hastily moves foot): "Er… No, my foot just happened to be there. I didn't even notice it was pointing at you."

Group Member A: "You sound defensive. Were you pointing it at me subconsciously, because you have some unexpressed anger at me?"

Dude with Foot (moves foot back): "No… but NOW I'm feeling angry!"

It's also a very expensive required text at Antioch. Someone else will benefit from this book, but I don't need it.

Fast Girls: Teenage Tribes And The Myth Of The Slut, by Emily White. This is actually a pretty good book on sexism, rape culture, how girls get labeled "sluts," how this is perpetuated by both girls and boys and society at large, and the effect this has on everyone. It's just that I get this, so I wouldn't need to re-read it, and it's not so brilliantly written that I'd keep it just for that.

Therapeutic Communication: Developing Professional Skills, by Herschel Knapp. If you don't find that therapeutic communication (validating, challenging, interpreting, etc) comes naturally to you or is something you learn by doing, this is an EXCELLENT book. I personally find that I learn it by doing or by listening to other therapists describe what they do in specific cases rather than in generalities.

Also, I find that responding instinctively/intuitively/spontaneously - even if it's something I technically shouldn't say - goes over better with clients than when I say the "correct" thing in a more artificial/non-spontaneous way. (There is a specific technique key to narrative therapy called "externalizing the problem" that for whatever reason feels really unnatural to me, and whenever I try it, my clients look at me like I have two heads. My own therapist does it with me, and it works great. I use a narrative philosophy and other narrative techniques, and just ignore externalization. You have to do what works for you.)

So for me, this was not a book I'd return to. It will help someone else, I'm sure.
But first, a brief health update. The relevant bit for this entry is that while my most recent experimental treatment (rifaximin) had no effect whatsoever, I am still feeling good enough from the combination of the semi-successful sleep experiment (it didn't permanently fix the problem, but it did improve it) and the previous successful experimental antibiotics that I am attempting to catch up on six months' worth of stuff I didn't due because I was too sick.

I have just begun experimental antibiotic treatment # 4: two of the same ones that worked before for a slightly longer period (14 rather than 10 days) and one at a higher dosage, minus the one that had horrible side effects. If it is a complete failure, that will at least suggest that the key factor was fucking tinidazole (or tinidazole combined with something).

Anyway, I am procrastinating starting with the easier long-delayed chores before working my way up to the harder stuff.

Problem: I have too goddamn many random books that I don't want and are cluttering up my apartment. One of today's tasks, chosen for being low-energy-required, amusing, and producing a visible and wanted change, is to get rid of a chunk of them.

Step 1: Sort unwanted books into three categories based on what I'm going to do with them.

Category 1: Psychological books that are outdated, not useful, etc. Some of these are quite expensive textbooks, but I don't have the time/energy to sell them or mail them to people who want them. Instead, since I am going to Antioch (old campus) anyway on Thursday, I will leave them in the student's lounge with a note saying to take them if you want them. Some student or students will be very grateful to save hundreds of dollars on required texts.

Category 2: General books I don't want. These will be delivered to the library. If the library doesn't want them, they go to the thrift store next to the library.

To help motivate me, I will record the books as I go along. This is the possibly amusing part. Please feel free to comment! That will also help motivate me. The next post will be updated daily with actual books.

My opinion on books meant to be helpful to the therapist, by the way, is that they are mostly useless. Or rather, that they are the wrong books. Want to treat combat veterans? Read memoirs by veterans. Those are about a billion times more helpful than textbooks. Want to apply Jungian principles to therapy? Read Robertson Davies' The Manticore. I doff my hat to anyone who gets anything out of reading Jung himself but a headache. Want to understand Carl Rogers? Watch videos of him in action. (His book is fine. It's just that the videos are SO MUCH BETTER.)

If anyone cares, when I am done I may do an overview of the short list of books that I did find helpful.
Sixbeforelunch asked about this. (Yes, month meme answers will spill into next month.)

I won't go much into logistics because those are so localized. However, I will mention that therapists frequently have dreadful websites, so I take those with a grain of salt and just look for giant red flags (for me) such as phrases like "holistically incentivizing inner growth via process-oriented 'out of the box' thinking" or "we shall dance together in the inner sphere of oneness" or "Byron Katie."

Statistically speaking, the most important predictor of the success of therapy is the rapport between the therapist and the client. So the most important questions to ask yourself are, "Do I like this person? Do I think this is someone I could come to trust? Do I think I could talk to this person about the stuff I want to talk about?"

If you hate the therapist on the first session, don't go back. If you're not sure, maybe try one more session. You should feel at least reasonably/tentatively good with them by session three. It's not just about how competent they are; it's about chemistry and having a good match. You can do OK with someone you don't bond with (especially with some very skills-oriented therapy like CBT) but if it's not skills-oriented or you actively dislike them, you probably won't get much out of it.

That being said, rapport alone will do just fine for life problems. It will also often do just fine for life problems plus mental illness or trauma that has already been treated and that you already have a reasonable grip on. If you have a mental illness or trauma that you're addressing for the first time, or have never successfully addressed, there are a lot of very specific treatments that not all therapists will know about or use. This is where experts come in handy.

(Including but not limited to OCD, ADHD, specific anxiety like phobias or social anxiety, and PTSD. If you have serious specific anxiety and you've never tried CBT, an anxiety specialist who uses CBT can be life-changing.)

Think about what's important to you and what you're worried will be misunderstood. What are your dealbreakers?

I had a phone conversation with my current therapist before ever meeting him in which I interrogated him at length about his opinions about the internet. Only when I was satisfied that he would treat internet-based relationships as real relationships and not judge me for caring about online interactions did I go to see him. I also sounded him out about certain issues involving being a therapist that I'd previously clashed with other therapists I knew over. Only when I was satisfied that we were on the same page about that did I go to meet him.

Feel free to ask questions!
I am currently enrolled in an expensive graduate program at Antioch University, to get an MA in clinical psychology with a specialty in Trauma. I intend to become a psychotherapist specializing in survivors of trauma, such as child abuse, domestic violence, war, serious accidents or illness, secondary trauma (such as police, war reporters, even trauma therapists), and so forth.

This degree will enable me to help others, and have a satisfying career for myself. It may enable me to write books on the subject. While I am in school, I have been honing my skills and amusing you by diagnosing fictional characters.

If you would like to help support me in all or any of those endeavors, I have put up this "donate" button.

For my own benefit, I am looking for stories of two types of therapy moments:

1. Things a therapist did right.

2. Things a therapist did wrong.

In both cases, I'm looking for things that weren't obvious.

For "wrong things," I'm not thinking of clearly, extremely terrible things that I would never do in a million years, like having sex with a client, telling a client their abuse was their own fault, telling a client not to be gay, etc. I'm looking for mistakes that were more subtle than that - things a well-meaning but inexperienced therapist might do. For example, it was not beneficial to me (as a client) to let me sit there and recount lengthy abuse stories, and then have the therapist immediately start delving deeper into the abuse. But that's not an obvious mistake on the level of "It was all your fault it happened."

For right things, also, I'm looking for moments that went beyond the obvious "She was very empathetic," "He told me it wasn't my fault," or "She helped me see the connections between my childhood and my adult relationships." I am particularly interested in any times in which a therapist managed to do a good job with identity issues (gender, culture, etc), whether or not the therapist had the same identity as the client.

I realize that everyone is different, and what's right for one person may be wrong for another. I'm not looking for a rule book, but rather for inspiration and food for thought.

Anonymous comments are enabled but screened. If you comment anonymously, please let me know whether or not you'd like me to unscreen.
Asakiyume had a post about romanticism and mental illness with some good discussion in comments.

I wrote, "I have mixed feelings about that one. Yes, it's obnoxious to write stories in which mental illness is actually nothing but magical specialness, whether the magic part is literal or metaphorical.

On the other hand, the flip side of the "mentally ill people are better and more special than the rest of us tools of the system" myth is the "mentally ill people are doomed to a miserable, squalid existence filled with nothing ever but loneliness and pain" myth.

I think there's room for realistic depictions of mental illness in which the intent is to de-glamorize, focus on the pain, and have the hope be in the slow, difficult work of healing. But maybe there's also room for non-realistic in which people live with mental illnesses and have those be part of the fabric of their lives as they have romanticised adventures and pursue villains and do magic and get the girl. Why should the non-mentally ill get all the escapist literature?

The key, I think, is not to take some painful and unpleasant mental illness and pretend that the illness itself is not painful and not unpleasant, and just looks that way because the mundane world doesn't understand how magical and awesome it really is. That's not cool. But I'd love to see, say, a paranormal romance with a heroine in therapy for social anxiety torn between a bipolar vampire and a werewolf with Asperger's.

Why not? Very few of us are out on the streets murdering people because the voices in our head told us to. Most of us are living our lives - with struggle and pain, but who doesn't have that?"

I am interested, too, in stories in which mental illnesses and non-neurotypical states are dealt with not unrealistically by accident, but with extrapolation and deliberate fantasy applied: Walter Jon Williams' breathtaking space opera Aristoi ($4.99 on Kindle; also has excellent martial arts), in which people deliberately induce multiple personalities in order access the full richness of their psyches; the later books of Scott Westerfeld's Uglies, in which the characters take on various cognitive/neurological templates, raising the question of whether identity is something separate from brain chemistry. Very similar questions come up in Westerfeld's novel Peeps, in which vampirism-causing parasites create OCD-like irresistible compulsions and aversions. And, of course, the many, many, many magical or science fictional versions of brainwashing and de-programming, from Cyteen to The Avengers to Mockingjay.

There is sometimes a tendency to see any non-realistic treatment of serious issues as inherently trivializing or even insulting. But I think it depends on the individual work, as well as the judgment of the individual reader. I would like to see more extrapolative works dealing with the subject, as well as more stories in which mental illness or non-neurotypicality is part of a character's character, not the subject of the story.

I would like to see fewer soft-focus, romanticized depictions of beautiful fragile mad girls.

What do you think? Good examples? Bad examples? Things you'd like to see more of? Things you'd like to see less of?
I just took the MMPI-2. Taking and scoring the thing took so much time that the in-class explanation of what our results meant, plus any non-scoring class discussion of the test, must wait till next week. But for the record, my scores are below. Please feel free to interpret if you happen to know how. I think everything is in the "normal" range (below 65, IIRC) so I don't know how meaningful they are.

Read more... )
For one of my classes (Queer Counseling and Narrative), I need to write a paper in which I do a "first session" counseling an LGBTQ person or couple, then write up a summary of the full course of therapy.

This is not about diagnosis, and the character does not need to have a mental illness. They just need to have some sort of issue or life circumstance which might be helped with therapy.

Can you suggest a character or characters who might be fun to do this with? Criteria:

1. They must be LGBTQ. (They don't have to necessarily explicitly identify that way.)

2. The work they come from must be contemporary (or near-contemporary) realism. No fantasy or sf.

3. Ideally, this will be something I've already read. If not, it should be something comparatively easy to read and obtain.

4. The work must be fiction.

Please give a little bit of detail if you suggest something.
If I get through all this tonight, I will go eat dinner and watch some Flashpoint. Really dense material below - but interesting.


- PTSD is largely a matter of conditioned physiological changes, which are very hard to change via insight and introspection alone.

- Many people face trauma, but not all develop PTSD. People are wired to respond to fear with action (fight/flight.) If they are immobilized and helpless, literally or metaphorically, during a trauma, they are likely to develop PTSD. This may have a biological basis. If they could take action - complete the fight/flight response - they may be able to decondition some of their PTSD reflexes.

- Traumatized people often freak out when meditating due to its internal focus's tendency to send them straight into traumatic memories. But meditation or mindfulness would probably be helpful if they could manage it. Wonder if movement-based meditative practices are less likely to cause freak-outs? If so, that would explain why so many survivors find movement practices helpful. Maybe the movement provides a balance between interior feelings (scary/bad) and external focus (move left arm to block), thus decreasing interior focus and making it more tolerable.

If the trauma is partly caused by the interruption of the fight/flight response and people being forced, physically or by circumstance, into helplessness or inaction, then maybe movement lets them work through the fight/flight (action) response they needed, thus rewiring conditioned responses.

Lots of detail below cut.

Read more... )
Right now I'm in several classes which are presenting completely different views on some central psychological issues. Let's take this one: "Why do I do self-destructive things?"

Simplified enormously for the sake of being able to actually post this before I have to run off, but please feel free to correct me if I've misinterpreted anyone:

Freud: People have a death instinct, which is intertwined with their superego - the critical, self-hating part of their psyche - the internalized scolding voice. Also, they feel deep-seated, unconscious guilt, possibly over early incestuous desires, which makes them feel that they don't deserve to live.

Jung: Perhaps repressing and failing to confront one's Shadow makes it emerge in the form of seemingly inexplicable self-destructiveness?

Melanie Klein: Infantile envy of the mother's "good breast" and inborn aggressive/destructive impulses turned inward.

Trauma perspective: If you experience enough trauma, abuse, emotional neglect, etc, that state feels natural and real to you, and a state of calm and safety feels unnatural, frightening, and false. So you recreate a state of trauma for yourself, with your actions or purely by maintaining an internal state of fear, paranoia, etc.

Narrative perspective: Society and prior negative experiences impose a negative narrative on you, and so you consciously or unconsciously conform to it by doing self-destructive stuff, noticing negative impulses and acts, and ignoring and discounting positive and constructive moments.

Cognitive perspective: Very similar to narrative, but based around "thoughts and ideas" rather than "stories;" also, less concerned with social messages. We sabotage ourselves due to the (irrational and negative) thoughts we have which point us toward self-destructive or unproductive actions, and we can change our actions by changing our thoughts.

Like I said, very simplified. But what strikes me is that all of this stuff is basically metaphoric. None of it is provably "true." (Okay, trauma-based is the most testable. But it's also got metaphoric qualities.) It's all just frameworks for conceptualizing, understanding, and treating common issues. (In my example, "Why are people self-destructive, and how can they stop being self-destructive?")

Any metaphoric framework makes sense to therapist and client is probably going to work as well as any other, for issues that are treatable by therapy at all. (ie, let's assume the client either doesn't need medication or is already on medication and needs therapy also.) Whatever you believe is the truth of your situation - "I do these self-destructive things because..." IS the truth. It's the truth BECAUSE you believe it's the truth.

The metaphor that feels true to you is probably also the metaphor that will help you, whether it's "I was neurologically rewired by trauma" or "I have repressed Oedipal feelings for my mother."
rachelmanija: (Naruto: Super-energized!)
( Dec. 1st, 2011 09:40 am)
Registration this go-round was much less painful than last time, when the computer enrolled me in classes at the same day and time (Help desk guy: "That's supposed to be impossible,") causing me to madly enroll last in whatever was still open.

This time I did do some mad rushing last night to formally declare a double specialization in Trauma (non-combat) and Spiritual/Depth Psychology before registration to get into classes held for people with specializations, but everyone was very helpful and it worked out. I am seeing the benefits of belonging to a small, private college, because if this was anywhere else I've ever attended, I would probably still be at the registrar's office now.

I still don't know if I can go to Japan. Registration for that was delayed for everyone due to some technicality. When it opens, we all put our names on a wait-list, and then they hold a lottery.

My classes for next quarter:

Monday 10:00 AM: PSY 548 Ethics and the Law
Sect 1: Joel Andres 3 units

Monday 1:00 PM PSY 501A Process/Psychotherapy I -
Sect 1: Zari Hedayat 2 units

Monday 4:00 PM: PSY 531A Personality I -
Sect 1: Doug Sadownick 3 units

Wednesday 7:00 PM: PSY531H Intercultural Transpersonal and -
Depth Psychology
Sect. 1: Thomas Mondragon 3 units

PSY522 Effects of Trauma on Human Development and -
Neurobiology; Social History and Current Issues.
Sect 1: Joel Andres 2 units
Dates: Jan. 15 and Jan. 29 , 9am - 5pm


PSY 525F Japanese Approaches to Mindfulness and Mental Health -
Sect 1: Matt Silverstein & Marli Kakishima 3 units
March 14-March 24, Shunkoin Temple, Kyoto, Japan

Three classes on Monday - yikes. But all three are core classes I need to take next quarter. I haven't had any of those professors before. The Wednesday class is taught by my favorite professor from this quarter, so I pounced on it. No idea what it will actually be like, but judging by the class I have with him now, it should be intense and amazing.
rachelmanija: (Fishes: I do not see why the sex)
( Nov. 30th, 2011 12:32 pm)
[Poll #1799574]

Final paper is looming terrifyingly on the horizon. I have limited time this week, and it is due Monday. I have widely varying knowledge on the topics I listed on the poll, but I would have to do substantial research for any of them. So if anyone has tips like, "This one slim volume is the single best resource on the soul-figure/asexuality/fisting which can be read in a short period of time," please go for it! (These are not all the possible topics. They're drawn from a much longer list, whittled down considerably by factors like lack of interest and the phrase "object relations," which in my very short experience so far tends to point to excessively eye-glazing articles.)

I got so frazzled last week that I misread the due date for the final paper for another class, and madly wrote and turned it in yesterday... a week early. I guess that turned out to be a good thing, all things considered.

Also, I have to register for classes tomorrow and am worried that I won't be able to get into the classes I am most dying to take, now that I know who the best professors are.

Given my current state of stress-driven absent-mindedness, I should probably mention now, since it randomly popped into my mind, that there is a new Sarah Tolerance book out! I have my own copy of The Sleeping Partner: A Sarah Tolerance Mystery, and am saving it for the winter break, when I will have more relaxed time to read. Also, Sherwood Smith's Blood Spirits (Coronets and Steel), sequel to Coronets and Steel, is out! I read it in manuscript, and it is excellent. Both series will satisfy all your "women who fight with swords amidst a background of history and intrigue" needs.

ETA: Okay, I'm doing fisting. I found the Pat Califia essay I had recalled. It's called "Gay Men, Lesbians, and Sex," and it's worth reading. On Google Books. If anyone has further good fisting resources, online or offline, keep them coming!
rachelmanija: (Fishes: I do not see why the sex)
( Nov. 30th, 2011 12:32 pm)
[Poll #1799574]

Final paper is looming terrifyingly on the horizon. I have limited time this week, and it is due Monday. I have widely varying knowledge on the topics I listed on the poll, but I would have to do substantial research for any of them. So if anyone has tips like, "This one slim volume is the single best resource on the soul-figure/asexuality/fisting which can be read in a short period of time," please go for it! (These are not all the possible topics. They're drawn from a much longer list, whittled down considerably by factors like lack of interest and the phrase "object relations," which in my very short experience so far tends to point to excessively eye-glazing articles.)

I got so frazzled last week that I misread the due date for the final paper for another class, and madly wrote and turned it in yesterday... a week early. I guess that turned out to be a good thing, all things considered.

Also, I have to register for classes tomorrow and am worried that I won't be able to get into the classes I am most dying to take, now that I know who the best professors are.

Given my current state of stress-driven absent-mindedness, I should probably mention now, since it randomly popped into my mind, that there is a new Sarah Tolerance book out! I have my own copy of The Sleeping Partner: A Sarah Tolerance Mystery, and am saving it for the winter break, when I will have more relaxed time to read. Also, Sherwood Smith's Blood Spirits (Coronets and Steel), sequel to Coronets and Steel, is out! I read it in manuscript, and it is excellent. Both series will satisfy all your "women who fight with swords amidst a background of history and intrigue" needs.

ETA: Okay, I'm doing fisting. I found the Pat Califia essay I had recalled. It's called "Gay Men, Lesbians, and Sex," and it's worth reading. On Google Books. If anyone has further good fisting resources, online or offline, keep them coming!
As many of you probably know, Freud and Jung had quite an intense relationship. Freud apparently had a pattern of getting into idolizing father-son relationships, and then having dramatic breakups with them. I notice that of his psychosexual stages, Freud seemed to have been most interested in the phallic stage (Oedipal complex), which is the most Daddy-son-centric of them.

What I did not know was that Freud dramatically fainted in Jung's presence, and Jung carried him to a couch! And that this happened not once, but several times! (Freud was apparently given to fainting - a classic "hysterical" symptom - during intense emotional encounters.)

The first time, Jung was discussing mummies. Freud demanded to know why Jung was going on and on about corpses, then fainted. Upon waking, Freud accused Jung of having a death wish for Freud.

Later, Jung was lecturing about how Egyptian pharoahs would scratch out their fathers' names on monuments, and replace them with their own. Freud promptly fainted again.

It's hard not to give all that a Freudian interpretation: Freud thought that Jung, his son-figure, was trying to usurp Daddy's role as the head of the psychoanalytic family. When confronted with that idea, or with the thought of Jung wishing him dead so Jung could replace him, Freud ensured that he didn't have to think about it by passing out.

Alternatively or additionally, Freud was in love with Jung. Freud himself discussed the possibility of repressed homosexual feelings.

Robert King suggests, Twice placing Freud on a couch after a faint was consistent with Jung's wish to be Freud's analyst as well his analysand.

King (google books)

Freud A-Z (google books)
This is purely for study purposes (mine) and entertainment (yours and mine). I cannot actually diagnose any real person.

Young Miles

Presenting Problem: Miles Vorkosigan is a 29-year-old white male who appears older than his reported age. He is of below-average height and weight, and has visible disabilities affecting his legs and back. He wore a military uniform, and his grooming and hygiene were above average (normal for Barrayaran military.) His speech and movements were very energetic, and he appeared restless and fidgety. Upon initial questioning, he appeared cooperative but irritated.

The client relaxed when he was assured that the contents of the meeting were not only confidential but top secret, and was quoted back (by advance permission) Imperial Security Chief Simon Illyan’s comment, “I don’t want to fix him. I just want to know what makes him tick.”

The client then confirmed that he was present due to an experimental pilot program bringing in Betan therapists to assess and, if necessary, treat members of Barrayaran Imperial Security. He rapidly diagnosed himself as “a bit bipolar, hyperactive, split personality, and megalomania,” then laughed when it was pointed out that the last two are not diagnoses.

Client stated that he has a history of depressive episodes and combat-related flashbacks, but neither interferes with his job performance. He stated that he has satisfying relationships with his family, is happy with his work, and has ongoing romantic relationships. Upon closer questioning, he admitted to a suicide attempt as a teenager and frustration over being unmarried. Client denies current suicidal ideation.

Personal History: Serious physical disabilities. Social prejudice due to ableism. Satisfying and very successful military career. High-stress life, but client stated that he enjoys this. Client seems very invested in his secret identity.

Family Background: Good relationship with parents and extended family. History of conflict with deceased grandfather. Recently learned of existence of clone-brother, but clone-brother cut off contact, to client’s regret.

Psychiatric/Treatment History: No previous diagnoses. Client said that he has never been treated for a mental illness, and speculated that he is probably allergic to all psychiatric medications.

Differential Diagnosis: Described manic and hypomanic states to client, and asked if he was having one now. Client stated that he is “always like this” except when he is having a depressive episode. Acquired client’s permission to call his mother, who agreed that client’s baseline met all the clinical criteria for hypomania, except for the existence of a non-hypomanic baseline. Client’s mother described client’s behavior as a child, which met the criteria for Attention-Deficit/Hyperactivity Disorder, Predominately Hyperactive/Impulsive Type. Client and client’s mother stated that the client has never had a manic episode except while under the influence of a substance.

Symptoms of PTSD are concentrated on the reexperiencing and increased arousal axes. Avoidance symptoms are missing, but reexperiencing ones (dreams, flashbacks, psychological distress, and physiological reactivity) are sufficiently intense as to justify the diagnosis.

Rule out Dissociative Identity Disorder. Client’s over-investment in his secret identity is common in military operatives, and there is no amnesia present.

Rule out Narcissistic Personality Disorder. Client’s grandiosity and sense of specialness don’t seem unrealistically inflated given his circumstances, and he shows no more entitlement and arrogance than is common among wealthy, high-status people. Other symptoms are not present.

Recommendations: 1. Individual therapy services to address his PTSD and Major Depressive Disorder. Recommend a cognitive-behavioral approach.

2. A complete medical examination to rule out possible physiological or medication-based causes for his conditions.

3. A medication consultation. NOTE: See extensive list of allergies. Be aware that while the therapist did not diagnose Bipolar II, it could be present in a non-diagnosable form.

4. Individual therapy services from a Jungian perspective to address issues of Persona and Self.

Axis I (clinical disorders): Major Depressive Disorder, Recurrent, With Catatonic Features. Posttraumatic Stress Disorder.Attention-Deficit/Hyperactivity Disorder, Predominately Hyperactive/Impulsive Type.

Axis II (personality disorders and mental retardation): : No diagnosis.

Axis III (general medical conditions): : See attached files.

Axis IV (psychosocial and environmental problems): : High-pressure occupation. Ongoing search for wife.

Axis V (GAF: Global Assessment of Functioning): : 65 (Some distressing symptoms, but generally functioning well.)

Rachel's note: What do you think? Do you need the existence of a non-hypomanic baseline to diagnose Bipolar II? Or should I have gone ahead and diagnosed it anyway? (Or guessed that brief non-hypomanic, non-depressive periods probably existed but had gone unnoticed?)
The Silent Tower: The Windrose Chronicles (Book One); The Silicon Mage: The Windrose Chronicles (Book Two)

For the purposes of this exercise, I'm assuming that I know all about magic, other worlds, etc, and take that into consideration when assessing my clients.

Presenting Problem: Antryg Windrose is a slightly disheveled and eccentrically (but not bizarrely) dressed man with somewhat but not markedly tangential speech, and somewhat labile affect. When asked what brought him here today, he states that he is sad and frustrated over his inability to work magic in Los Angeles.

Client denies suicidal ideation, but says he has moderate anxiety over realistic fears of being returned to his home country for execution. Client still takes pleasure in daily life and current relationship, and is employed.

Personal History: Childhood abuse, torture and imprisonment by government, refugee. Client discusses this with insight and appropriate emotion.

Family Background: Client was raised by unrelated abusive man; has no contact with biological family.

Psychiatric/Treatment History: Previous diagnosis of paranoia proved to be incorrect: the client’s seemingly paranoid beliefs were objectively true. Client states cheerfully that “everyone knows he’s mad.” When asked if he believes that he’s mad, he is evasive, then states that he understands why others think he is. Exploration of this point produces several statements of “odd” beliefs regarding magic theory and the likely truth of superstitions. Client has no hallucinations, and possible “delusions” are within the realm of eccentricity.

Differential Diagnosis: Evaluated for depression. Client states that he has no history of mania, major medical condition, substance use, somatic symptoms, symptoms of major depression, or dysthymia. Client agrees that depression and anxiety developed in response to stress.

Consider adjustment disorder with mixed anxious and depressed mood. Rule out on basis of lack of sufficient impairment of social and occupational functioning.

Rule out PTSD (due to trauma history): client states that he has no symptoms of PTSD. Rule out schizophrenia: no symptoms. Rule out paranoid personality disorder: no symptoms. Rule out schizotypal PD: Client is indeed “odd.” But he lacks a pervasive pattern of social and interpersonal deficits due to oddness, is comfortable with close relationships, and is not distressed by being “odd.”

Client appears to be quite well-adjusted and emotionally healthy, especially given his background and circumstances.

Treatment Plan: Therapy for grief over loss of magic. Refer to orthopedist for consultation on injuries to client’s hands.

Axis I (clinical disorders): No diagnosis.

Axis II (personality disorders and mental retardation (note: yes, that is the term for diagnosis)): No diagnosis.

Axis III (general medical conditions): Injuries to hands from torture.

Axis IV (psychosocial and environmental problems): Loss of former career. Exposure to torture and imprisonment. Threat of execution. Refugee.

Axis V (GAF: Global Assessment of Functioning): 80. (Transient and expected reactions to psychosocial stressors.)

(GAF explanation: 100: Buddha. 50: Seriously affected by mental illness. 0: Catatonic or currently randomly shooting passersby.)

ETA: I'm going strictly by the book here. In real life, he probably would have gotten an "adjustment disorder" diagnosis so his treatment would qualify for insurance.
I am taking a class on Treatment and Assessment. Yes, MFTs can diagnose. (We can't prescribe medication.)

To help familiarize myself with the DSM-IV and the process of diagnosis, terminology, etc, please recommend a fictional character I am familiar with who you think might have a mental illness, and I will attempt to diagnose them according to the DSM-IV criteria, as time permits. It would be helpful to note some incidents or traits which make you think they may need treatment.

For this go-round, please don't throw characters at me who you think might have something obscure, like (checks index) Mixed Receptive-Expressive Language Disorder. The class is currently focusing on mood and anxiety disorders, but I am also reasonably familiar with psychotic, dissociative, and personality disorders from my recent class in Abnormal Psych.

This is purely for study purposes (mine) and entertainment (yours and mine). I cannot actually diagnose any real person.


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