Sunday, March 18, 2018

The Function Of The Arts

Kurt Vonnegut has a collection of this graduation speeches in a little book entitled, "If This Isn't Nice What Is?

Tuesday, March 13, 2018

Narrative Processes in Emotion-Focused Therapy For Trauma

The current book being read and discussed is "Narrative Processes in Emotion-Focused Therapy for Trauma" by Sanda C. Paivia and Lynne E. Angus.

Here is the description from Amazon:

Because dropout rates and noncompliance with exposure-based procedures are notoriously high in trauma therapies, effective treatment options are essential. 

Emotion-Focused Therapy for Trauma (EFTT) is an evidence-based, short-term individual therapy that has proven highly effective in treating clients with trauma through its emphasis on both narrative and emotion processes. 

A fundamental assumption underlying most trauma therapies, including EFTT, is that recovery requires the client to engage emotionally with trauma memories to achieve better affect regulation and self-understanding.

EFTT draws upon storytelling as a fundamental aspect of the human experience that permits this kind of engagement with trauma memories, promoting a sense of continuity and self-coherence, and bringing meaning to the client’s emotional responses.   

Richly illustrated with clinical examples and excerpts from therapy sessions, this book fully integrates theory, research, practice, and training.

Sunday, January 21, 2018

Our Souls At Night - The movie and the book

Our Souls At Night was Kent Haruf's last lovely novel before he died situated, as most of his novels, in Holt Colorado.

Addie Moore and Louis Waters, a widow and widower, have lived next door to each other for years. When Addie tries to make a connection with her neighbor, the two begin sleeping in bed together platonically, with the innocent goal of alleviating their shared loneliness. As their relationship deepens, however, they each deal with grief and loss, and a real romance begins to blossom.

Robert Redford produced the story as a movie starring himself and Jane Fonda. It is available streaming on Netflix.

This novel and movie are clearly for grown-ups. Young people would not understand the tenderness and grief at the end of life that comprise the content of this story. The mutual support that develops is based on respect for each other more than romance.

Erik Erikson describes his eight stages of psychosocial development and names the last and eighth stage for people 65 and over as "integrity vs. despair." Both Louis and Addie have made their mistakes and have their regrets but have arrived at this eighth stage of life with great integrity even though Louis is mocked by his buddies, and Addie judged and criticized by her adult son.

Mocking, judgement, and criticism aside, Addie and Louis have forged a truly loving relationship which is inspiring to witness filling the viewer with great hope in the goodness of human beings and the wonders to be found in the later years of life.

This movie is well worth watching and is recommended for people at this stage of life or those who want to understand what this stage in life might have to offer.

Thursday, January 18, 2018

Books on dying and death.

Irvin Yalom, the famous existential psychiatrist, published his book, Staring At The Sun: Overcoming The Terror of Death, in 2009. He describes his own death anxiety and those of his patients and how he helped them and himself.

Dr. Paul Kalanithi, a young neurosurgeon,  published his book about his terminal lung cancer and dying entitled When Breath Becomes Air which many critics named one of the best nonfiction books in 2016.

The book about dying which is one of my favorites is by Eugene O'Kelly, the high powered business executive, Chasing Daylight: How My Forthcoming Death Transformed My Life which was published in 2007.

Cory Taylor, the Australian writer, wrote, Dying: A Memoir, which was published just this past year in 2017.

The great human equalizers are, of course, birth and death. What happens in between is unique and special, but the two epic events in life occur to everyone, the first unconscious and unmemorable, and the second which can be very much conscious and the process of which is memorable for ourselves and for those in our orbit who witness it.

Psychotherapists, like physicians, nurses, clergy, and morticians can be companions in the process whether imminently or as an anticipated future event. The aspects of death most familiar to psychotherapists are grief experienced by clients for a loved one, or trauma from witnessing violent and sudden deaths of others, or anticipating the deaths of clients, family members or our own.

Perhaps the most difficult traumatic and complicated grief reaction is when a psychotherapist works with a perpetrator of the death of another both intentional and accidental.

Death raises all kinds of existential questions such as the purpose of life, the meaning that life has for the individual and others, and what happens to the individual consciousness when death occurs. The further question is whether there is a good death and if so what does that entail?

Ira Byock, the palliative care physician, teaches in his book, The Four Things That Matter Most, that as an expected death approaches, in general, the individual needs to say four things to those the person is leaving behind, "Please forgive me," "I forgive you,", "Thank you," "I love you." It seems that peace and healing are restored and people can say their goodbyes.

Cory Taylor never seems to quite get there. She struggles with whether she will kill herself or die a natural death. She acquires the needed drugs from China to overdose but it is unclear at the end how she actually dies from a brain melanoma.

Ms. Taylor describes her tortured family relationships and while her parents pre-decease her, it seems her two siblings survive her, an older sister with whom it seemed she was communicating and an older brother from whom she is estranged.

Ms. Taylor is a gifted writer and is survived by her husband and children which she writes little about.

We want to have closure to death stories and we desperately want things to be okay at the end. Spiritual connections are important, if possible, even when physical connections will imminently be ruptured. We don't get a clear picture of Ms. Taylor's situation at the end but she does seem to exude a degree of acceptance and peace.

At the age of 72, and having had my own bout with melanoma which is in remission, I anticipate the end of my life. Thinking about this, I reflect on Erik Erikson's eight stages of psychosexual development, the eighth of which, for people 65+, is "integrity vs. despair." The sign of integrity at this stage is wisdom, satisfaction, and a sense of fulfillment. To harvest the fruits of a good life lived in virtue is a blessing and the culmination of a lifetime adventure.

As a psychotherapist, I like working with grief. I think I am good at it and people seem to obtain a great deal of peace and relief from having and understanding other who is not distressed by their distress. The expression of grief is very important for the individual's acceptance of the loss and the restoration of hope.

Thursday, December 14, 2017

Join the Psychotherapy Book Discussion Group

You are invited to join the group PBDG.
If you have questions about this invitation, send them to
To join click here.

Articles on the Psychotherapy Book Discussion group are discussed and we look forward to your ideas.

David G. Markham, L.C.S.W.-R
58 Market Street
Brockport, NY 14420

Therapists learn from their clients as much, if not more, than their clients learn from them.

Irvin Yalom writes on page 8 of his book, The Gift Of Therapy, in the chapter entitled "Therapist and patient as 'fellow travelers'":

"Instead I prefer to think of my patients and myself as fellow travelers, a term that abolishes distinctions between “them” (the afflicted) and “us” (the healers). During my training I was often exposed to the idea of the fully analyzed therapist, but as I have progressed through life, formed intimate relation-ships with a good many of my therapist colleagues, met the senior figures in the field, been called upon to render help to my former therapists and teachers, and myself become a teacher and an elder, I have come to realize the mythic nature of this idea. We are all in this together and there is no therapist and no person immune to the inherent tragedies of existence."

Yalom, Irvin. The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients (p. 8). HarperCollins.

It is an important idea in A Course In Miracles that we learn what we teach, and we teach what we want to learn. One of the primary factors that is satisfying in doing therapy is the vicarious learning that goes on by the therapist. Clients and their families teach us a lot. Therapists who are humble are very grateful for what they learn from their clients.

Wednesday, December 13, 2017

"How Can You Do This Work?" invites consideration of joining with others to make the world a better place

Sue Mann in her essay, "How Can You Do This Work?" in Trauma: Narrative Responses To Traumatic Experiences asks how therapists can find ways to document, and find an audience for, the skills and knowledges which people who have struggled with problems in their lives have learned and developed? In the Narrative model these knowledges and skills are called "local knowledge" and are aquired from what is called "co-research" conducted and engaged in by the therapist and client team.

In Alcoholics Anonymous there is common agreement that "it takes one to know one." This means that people who have struggled with the problem are the most perceptive and helpful if they are working on the twelfth step and trying to share what they have learned with others impacted by the problem.

Ms. Mann suggests a few questions which help us articulate what has been learned that could be shared with others:

  1. Who else would have an interest in the management of this problem?
  2. How could we join with others in planning how to better manage the problem?
  3. How can what we have learned be applied to policy development, organizational responses, education of other therapists and helpers?
  4. How can we influence those in authority over people with problems so they are more understanding, compassionate, and helpful?
  5. How can we change cultural norms and attitudes in a more positive direction towards people affected by the problem (decrease stigma)?
  6. How can we honor and celebrate the accomplishments of people who have successfully managed and/or overcame the problem?
  7. How do we support other helpers who help people with the problem?

The title of Sue Mann's essay, "How Can You Do This Work?" is so rich that it's deconstruction helps us appreciate it's multiple nuances. The devil, they say, is in the details. Rising above the details it is important for us to remember that as helpers we are on a mission from God to help make the world a better place by removing the blocks to awareness that Love is our natural inheritance.

Tuesday, December 12, 2017

New Psychotherapy Book Discussion Group forum.

 A Psychotherapy Book Discussion Group has been started on You can sign up to be a member of the group in the right hand column. I look forward to some interesting and stimulating discussions. The two books we are continuing to read in December and probably into January are The Gift Of Therapy by Irvin Yalom, and Trauma:Narrative Responses To Traumatic Experience. You can participate in the discussions even if you haven't read the books. We look forward to your ideas.

Nominations for books for discussion are welcome and appreciated.

Wednesday, December 6, 2017

For psychotherapists, the work itself is its own reward

A lot of time and energy is spent in Social Work training on helping aspiring Social Workers to understand their motivations for getting into the field. Students are asked to consider their values, hopes, dreams and wishes for how the world should be and the problems, blocks, and obstacles which prevent their vision from being realized.

Sue Mann in her wonderful essay "How Can You Do This Work?"in the book Trauma:Narrative responses to traumatic experiences,  describes how workplace practices may support or detract from therapists' work with clients who have experienced trauma. For example she asks:

  • What opportunities are available for workers to talk about the many experiences of the work?
  • Of the many different stories of work that could be shared, what stories and whose stories are being privileged?
  • How are the connections people have to what is important and of value to them shared in the workplace?
  • What opportunities are there for celebrations in relation to the achievements in the work?
  • Are there opportunities to share moments of sadness, moments of beauty, moments of joy? p.17-18
Because of confidentiality therapists rarely have opportunities for their work to be publicly acknowledged. Therapist service, competence, integrity, and accomplishments are rarely recognized let alone acknowledged. The profession, consequently, is an isolating and lonely one and the professional's motivation for engaging in it must be the satisfaction and fulfillment of the work in and of itself. The work is its own reward.

Tuesday, December 5, 2017

People are not their diagnoses

"And what therapist has not been struck by how much easier it is to make a DSM-IV diagnosis following the first interview than much later, let us say, after the tenth session, when we know a great deal more about the individual? Is this not a strange kind of science? A colleague of mine brings this point home to his psychiatric residents by asking, “If you are in personal psychotherapy or are considering it, what DSM-IV diagnosis do you think your therapist could justifiably use to describe someone as complicated as you?”

Yalom, Irvin. The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients (p. 5). HarperCollins.

Dr. Yalom has it so right about a person not being their diagnosis. The diagnosis is for the insurance company. It may have some clinical value if it is accurate, but it rarely is. Psychiatric diagnosing is as much an art as a science and is notoriously unreliable between diagnosticians. I personally diagnose mostly as a perfunctory exercise so I can get paid from the insurance company. The DSM-V diagnosis has very little, if anything, to do with the treatment plan. Problem formulation, on the other hand, is very important to good therapy and is a collaborative process, one in which the therapist is better off taking a de-centered approach.

Bill O'Hanlon has said that when patients tell him they are seeking help for depression, he asks "How do you do depression?" Great question. What is depression like for you? When did it start? How can you tell when you are depressed and when you are feeling better? What seems to make it worse and what seems to alleviate it somewhat? The answers to these questions leads to a more personal customized description and definition of what the problem is that plagues the client. Once it can be named, it can be better managed, but without naming it more specifically the therapy is doomed to failure.