Sunday, March 29, 2009

Lost in Translation: Addressing Adolescent Slang in the Therapy Setting

One of the populations I work with is teenagers. I really enjoy this because aiding the development of our youth has a direct impact on the future of mankind. People in this age group are struggling for self-identity. In that quest to find themselves there is a creation of language unique from adults. This has, of course, been going on for many generations. The slang evolves uniformly over the years and is fed by current phenomena and popular culture. It evolves very quickly so that a younger sibling's slang might be completely different than his older sibling of 5 years. Speaking their own language not only helps them define themselves as separate from us adults put also serves as an encryption so that authority figures can not easily eavesdrop on their conversations and glean content. Part of being an effective therapist is breaking down people's defenses and the slang mechanism is often used to obfuscate true meaning and stall the therapy process. Breaking through this barrier is a "listening skill," that all therapist working with adolescents and children should have.

In forming an alliance with teens, I don't think that "speaking their language," is very effective in gaining trust. It forces you to behave in an unnatural and deliberate way that usually comes off as a bit phony. It is often initiated after an adult hears a slang term that he or she may or may not fully understand. So trying to seek clarity by using nomenclature that the clinician is not adept at might just further the misunderstanding, not gain clarity. Often the adolescent client is using the slang in lieu of actually identifying their meaning and feelings themselves. The slang is adjective filler because they don't have the right word in their vocabulary. So with some, just asking "what do you mean by.....," will get a more concise response. Or simply asking them to restate what they said might glean a more easily interpreted version the next time around. These probing and restating techniques are far more sincere and effective than trying to enter their precarious world of informal language.

While it may not be helpful to personally verbalize teen language, it is certainly effective to be versed in it and operationalize it. I often surprise my young clients by my understanding of some hip, new reference they made. Just keeping up with pop culture is helpful in this area. Slang is generated by observations made by teens through media and entertainment, so occasionally watching a movie about a nerd coming of age or sitting through a speed metal song will help me become more aware of youth's language and mindset.

Another aspect of slang is that by nature it must be fluid and changeable. This helps reinforce its function as cryptic, rebellious and unique. The use of the word "like," has this chameleon like quality. I think we can thank the SC valley ladies of the 80's for its popular inception, although it has been around longer than that. Depending on tone and emphasis, "like" can have many meanings. Initially, it was used as a method to stall the listener, to buy time till the right word came along. Also, it is used as filler, if the correct word never does come along. If it is expressed as slightly pressured and loud, the person is cuing you that something really profound is about to be disclosed. If "like' is stated rapidly or almost mumbled as the speaker is relating a past conversation, the listener may be warning you that he is paraphrasing the words that were said, often to make it appear that the speaker was the fairest, most cordial and accommodating or the real victim during this interchange. The speaker is signaling you that the other party said something "like" what he or she is repeating, but is also cuing you that the content is being slanted or manipulated to further his or her standing as it relates to the outcome of the conversation. This type of usage is very subtle and at the same time potentially confusing and nebulous in its meaning. So a simple 4 letter word becomes tremendously variable depending on the way it is expressed contextually.

So as a therapist, I have to try to untangle these nuanced slang references to have full understanding of where the adolescent client is coming from. When I started in this field and first heard the term "listening skills," I thought "what can be so hard about that?" But my brief discourse on understanding and treating teenagers illustrates the deeper levels of interaction and disseminating of information that occurs with this skill. Not just with teenagers, but with any unique ethnic, cultural or age cohort. Being an effective therapist and genuinely individualizing treatment is dependent on refined and practiced listening skills like these.

Sunday, March 8, 2009

Your Therapy Experience: What to Bring with You on Your 1st Appointment

We live in this modern and complicated world. When we are beset by troubles and seemingly insurmountable challenges in our lives, we often find it difficult to consider all of the viable alternatives. Having exhausted every possible course of action we can think of, we turn to friends and loved ones for guidance and reassurance. Often this resource can be successful in terms of providing comfort and support, but the deficit, the "problem" and the associated discomfort, pain and anguish are still there.

So we reach out further from our small circle for support from our community. We enlist the help of clergy, teachers, principals, our family doctor and other authority figures that we know and are familiar with and trust in our dealings of everyday life. Often the advice and wisdom of these authority figures proves fruitful and we are able to successfully address whatever mechanism is inhibiting our quest for personal happiness.

When these interventions do not work, the next logical step is to seek "professional help." This action is, in fact, often one of the solutions that is presented by these visible members of the community that your have relied on for many years. Behavior clinic's referral sources are prominently fueled by relationships with schools, doctor's and churches.

But, alas, so many are reluctant to take this next step. Although statistically supported as a viable resource for individuals who are in psychogenic pain or discomfort, many avoid the next step of talk therapy and are destined to unnecessarily suffer through many years of their lives. There are many reasons people are reluctant to do this. One I believe is cultural. An American value is to be self-reliant and vigilant. The shame and embarrassment of baring one's soul to a stranger and of being reliant on them for help contradicts this ingrained value of independence and autonomy. Another obstacle to people seeking treatment is the stigma that is attached to having their problems institutionally addressed. As one of my client's once said to me at an initial appointment "when I think of psychotherapy, I think of 'psycho,' like I am nuts or something is seriously wrong with me." There is this old-fashioned, archaic view of the therapist picking the client's brain apart over the course of many sessions and months and the identification of some serious mental disorder or cognitive deficit.

This "couch and chair," era of psychotherapy has given way to new and exciting treatment techniques that focus on one's personal betterment and more on what is "right" with the client than "wrong." Therapists identify client strengths and assets and help them develop and utilize them to overcome admitted weaknesses, deficits and external sources of stress. Hence, you are not the "problem," but it exists in your social or occupational environment and as therapists we are here to help you with that problem.

The 1st attitude "to bring with you," to an initial talk therapy session is an open mind. Do not suppose that your experience will be akin to something you were exposed to in the media or heard from a friend. Every client-therapist relationship is unique and has a life of its own. The course, quality and length of treatment are dependent on the invested energy and mutual development of trust and honesty by both parties. Relinquish that trust in your therapist at a pace you feel comfortable with, with the rate of your disclosure being one that he or she earns based on the quality of their input and the sincerity of their reactions. Remember, we are working for you.

Another important concept to grasp when preparing for that 1st session is one of equality or parity. A therapist will engage with you in a manner which is not condescending, self-righteous or critical. We are all frail human beings and it is the therapist's task to observe your behavior but not to past judgment or make value-laden recommendations. A competent and experienced therapist has been exposed to a wide spectrum of behaviors and should be accepting of yours. If the therapist can not objectively treat you based on a difference in personal values, then it is an ethical responsibility for the therapist to refer you to another. You also have the option to request another therapist if for some reason you feel uncomfortable with the current relationship.

So when you seek talk therapy services, give the therapist the benefit of the doubt. Be assured that this "stranger" will soon be a skilled confidant. Engage with them in a truthful manner and with an air of mutual respect and be comforted by the fact that there are many years of experience, training and education in the helping professions available as a resource for you. The result will be a happier, better adjusted, actualized you. The quality of future experiences and accomplishments for you, family and friends may very well depend on what you bring to that 1st appointment.

Sunday, March 1, 2009

East Meets West: Body Symmetry and Mental Health

In terms of practicality we find the old time tested ways are the best. The past 30 years of medical science has witnessed the infusion of far eastern health practices. Most of these practices are in the form of self-help as opposed to being strictly medicinal. They are considered as corrective and preventative and require the affected person's participation on a nearly daily basis.

One good example of enhancing physical health in this manner are body cleansing practices. The deliberate use of specific foods, nasal irrigation and enemas have been gaining acceptance in traditional allopathic medicine. The flushing out of toxins in specific regions of the body has been found to reduce the onset of degenerative disease in several studies.

So how does this relate to mental health, anxiety and mood? One aspect that can be borrowed from eastern medicine in enriching our emotional well-being is the concept of body symmetry. When we feel balance in our body this manufactures confidence and an air of self-content. We maintain a physical posture and development of evenness throughout our body. A recent study (Prokosch,Yeo, Miller,2005) has now indicated that environmental factors have an effect on the even development of one side of the body compared to the other. That is to say the way we move and the conditions we are exposed to effects this even sided development. The prominent and distinguished use of right-handiness, for instance, will cause a relative atrophy in the left arm and hands. Do keep in mind that perfect symmetry is an absolute, a perfection that we can all strive for but never perfectly obtain.

There are several discovered correlations between body symmetry and depression, intelligence and cognitive skill (see Prokosch et all, 2005 and Thornhill, 2002 for instance). Other studies find a correlation between body symmetry and posture and how positively we are received in courtship and in business presentations. When others around us perceive us in a positive manner, we feel better about ourselves.

Other studies by M. Sathiamurthi measure the symmetry of body auras (the Yoga and Tantra term is "chakras") by examining electromagnetic fields around our body. He has found a correlation with people who are mentally disturbed or physically ill and a significant asymmetry of these auras.

Correcting the asymmetry and finding better mental health can be achieved through some simple day to day practices. Two of the SRT exercises I discuss in the three part 'Treating Anxiety," incorporate the use of body symmetry. Body awareness and movement emphasized the smooth and deliberate movement and posture with an emphasis on balance and equal distribution of weight. This day to day, moment to moment practice will help promote and maintain body symmetry. Transcendental meditation exudes the importance of sitting in a symmetrical position to promote that relaxed state and peace of mind. This posture during meditation is thought to correct the distorted body auras and physical manifestations of asymmetry.

Another exercise to help achieve body balance can be done laying down, in bed. Lay on your back in the "dead man's position," with your arm extended fully along your side. Try your best to make everything "equal" on both sides, the slight bend in your knees, the formation of your fingers in your hands (preferably slightly bent with your palms facing outwards). Attempt to equally align and distribute your weigh along your back and spine. Feel the balance of both sides of your body being at the same time equal components forming that feeling of "oneness."

In this position, begin to examine specific dualistic elements of your body, Start with the top of your head. Feel the muscle tension on your forehead and the sinus tension below. Say to yourself "as one side feels, does the other"? Make slight adjustments by moving your neck to try to achieve the feeling of sameness on both sides. Another technique to achieving this balance is a bit more difficult to describe. It is simply focusing or "willing" that sameness and symmetry. Use your mind's strength to achieve this balanced feeling.

Continue the checklist down your head, include your eyes, nostrils and mouth. Work down your arms and hands. Try to mimic the exact position and muscle tension in your biceps, forearms and hands, for both sides, left and right. Do the same with the various facets of your legs and feet, saying "as one side, so the other side."

You will feel this amazing balance and harmony and a state of content and relaxation you have never felt before. With practice you will drift into a semiconscious state while still maintaining this personal balance. The healing of body and mind will be profound.

With current research data supporting the importance of symmetry to improved mood and adjustment, the benefit of striving for the perfect bodily state can only have a direct impact on your overall happiness and feeling of confidence and self-worth.