Los Angeles Chapter — California Association of Marriage and Family Therapists
Voices — April 2019
Christina Castorena President, LA-CAMFT
Dear Friends and Colleagues,
I recently ran into a former colleague at the CAMFT Leadership Conference whom I hadn’t seen since I worked at the Youth Drop-in Center in Orange County over 15 years ago. When catching up with her, I was immediately transported back to a time I hadn’t thought about in years. Before I was a therapist, I was a health educator and outreach specialist. It was my first job out of undergrad. I was eager to help and, honestly, not quite sure what I was doing. I had several mentors who were more seasoned in their work with our eclectic clientele of LGBTQ youth, homeless young adults, and neighborhood kids.
There was one mentor in particular that stood out for me during this time. For the purposes of this article, I will call her Angela. Angela was one of the first people to greet me with her bright eyes and beautiful smile. She showed me the ropes of working at the center. She taught me how to run support groups for the LGBTQ youth and young girls in the neighborhood. She trained me on conducting safe street outreach to pass out food, hygiene supplies, and safer sex kits to the homeless youth in the area. She listened to me when I needed to talk, sang with me at the local karaoke bar, and, more importantly, she encouraged us all to have fun at work, even when things got heavy.
She was a Case Manager, and she was selfless in her work. She was a master at building rapport and could make anyone laugh. I witnessed her help so many people over the three years that we worked together; I can’t imagine how many lives she positively impacted in her lifetime. Her mentorship and modeling of compassion and empathy was an inspiration in my pursuits of becoming a therapist.
As I was happily reminiscing with my colleague about Angela, she offered me some very sad news that I wasn’t expecting to hear. She informed me that Angela died by suicide several years ago. My jaw dropped and I was in shock, I couldn’t believe it, I didn’t want to. The how’s and the why’s all crossed my mind, but no amount of information was going to make her death any less bearable. It had been so long since I had any contact with her, so I’m not going to claim that I knew anything about her circumstances or state of mind at the time of her death. What I do know is that she had a positive impact on my life, the lives of her client’s, and the lives of her colleagues.
I received this news the first day of the conference, so I had to compose myself and tuck it away with all the emotions that it had triggered in order to network, learn, and facilitate discussion groups throughout the weekend. It wasn’t until a few weeks later that I allowed myself to explore all the feelings I had put away that weekend. The painful loss of a gifted healer reminded me of the importance of self-care for myself and among people working in our field. Our lives aren’t put on hold as we sit with our clients in their pain, as we try to meet paperwork deadlines, or as we gain clinical hours. Our lives are in full swing and we often have to learn the art of putting aside our own needs and wants for portions of our day. We work so hard to develop the skill of attunement to our clients, and sometimes the cost of that is a loss of attunement to ourselves.
I don’t know about you, but I can go for hours without eating, drinking, or even using the restroom while I’m at work. I know it may sound funny, but it’s true. Something as simple and necessary as using the restroom is a lower priority to me than meeting the needs of my clients. This is an example of a lack of attunement to my physical needs, but as clinicians this lack of attunement can cross into dampening of emotional needs, which can have devastating and long-term effects to our well-being.
I’m not going to list off self-care interventions because I’m sure you all have your own lists of interventions that work for you. If you don’t, then I recommend making your list now. I use music to soothe my soul, I spend lots of time with my family, and play with my cats. I’ve also found that joining the LA-CAMFT community and getting involved has been integral to finding the support and resources that are important for my own mental health. I’ve found community, friendship, and a sense of belonging. If we want to stay in this field for the long haul, then it is an absolute must that we take care of ourselves. I cannot emphasize this enough.
I’ve noticed that words like “self-care” are thrown around a lot in workshops, supervision, or online forums, but what does it really mean for us as therapists? I’ve seen many clinicians still suffering from burnout and loss of attunement to self, even though discussions of self-care are prominent in our field. There is an apparent disconnect between knowing what to do and actually doing it. My hope is that we practice self-care every day until it is ingrained into our daily routine.
Finding out about the loss of Angela was a very painful reminder to me to take care of my physical needs, mental health, and spiritual wellbeing. As I process her death, I am also reminded of why I wanted to be President of LA-CAMFT. I wanted to advocate for the well-being of therapists, recognize and celebrate the hard work that we do, and the positive impact that it has in our world. I am thankful for Angela’s mentorship and support, and she will always live on in my memories as someone who positively impacted hundreds if not thousands of lives. To you, the reader, thank you for your dedication and passion for others. Your work is important so please take care of yourself. This is the best way to be our best selves for our clients and every person we meet.
Best Regards, Christina Castorena, LMFT
Christina Castorena, MS, LMFT, worked in community mental health before starting her private practice, Castorena Therapeutic Services, in 2016. She passionately serves adults, couples, and members of the LGBTQ+ community who are dealing with life transitions, parenting, relational conflicts, and anxiety. She employs family systems and mindfulness-based CBT. As president of LA-CAMFT, Christina strongly advocates for her professional community and celebrates the hard-working clinicians that facilitate healing. Christina Castorena may be contacted at castorenatherapeutic.com.
Valerie "Billie" Klayman, LMFT Membership Chair
As the new membership chair I will start communicating with various articles throughout the year. My intention is to highlight our members and how they’ve found our chapter to be useful professionally as well as personally. I know that as a member since 2012, I have benefited from our chapter in so many ways.
I have made long lasting friendships that continue to improve my life as a person. I was on the Executive Board as CFO from 2014-2018, and now am on the Full Board as your membership chair. The leadership training I have received from past presidents; Randi Gottlieb and Shelly Pearce has been so valuable for me. Our presiding president, Christina Castorena continues to provide the support and leadership qualities that I am able to use in other roles outside of our chapter.
This month I am going to highlight Pamela Payton, M.A., LMFT. I have had the pleasure of knowing and working with Pamela at many of our events. Pamela has always been a member who will ask, “how can I help?” Her commitment to our compassionate community continues to be the reason our chapter is so vibrant.
Pamela has been a licensed therapist for over thirty years. She is a brief/solution-focused therapist, with a primary focus on couples and relationship counseling. Clients receive support and guidance via cognitive/behavioral techniques to increase coping and communication skills, reduce anxiety and depressive symptoms, and manage grief and loss.
Pamela was a Board member of LA-CAMFT for four years and ended her position in December 2015. Pamela states, “I enjoy the structure, events, fun, people, speakers, networking, etc. I've derived a great deal of benefit and satisfaction from all the years that I've been a participant.”
hank you Pamela for being such a devoted member of CAMFT and the LA-CAMFT.
The LA-CAMFT Expressive Arts Special Interest Group (SIG) has been an integral part of the community. We’d like it to grow. We are reaching out to our whole community of 5000 Los Angeles therapists to locate and connect with all of you who have studied and utilize expressive arts in your work.
Expressive Art Therapies use a wide range of modalities in the service of human growth, development, and healing. Examples include: art (visual/digital arts), music, movement, dance, poetry, bibliotherapy, play, sand tray, drama, role-playing and storytelling. These therapeutic approaches are often used with individuals, couples, families, groups, and in community-based programs.
If you identify as an expressive art therapist and are interested in becoming a member or learning about leadership opportunities of this SIG, please take a minute to fill out the survey below. Email Jonathan Flier if you have any comments/questions.
Click here to complete the brief survey.
We’re looking forwarding to learning more about you.
Thank you,
Jonathan Flier, Special Interest Groups Chair Gina Balit and Michelle Bee, Expressive Arts SIG Co-Chairs
I feel compelled to write about this topic, as I have been a supervisor for almost 5 years. In my own journey I had many supervisors. I felt the disappointment when a supervisor was unwilling to listen to my experience in the room with a patient, and only wanted to supervise per their ego needs. I also had supervisors that were flexible in thought, willing to look at my process as a therapist, and help me use my process as a therapist to help my patients.
It is in those great supervisions that I gained insight into how “meeting the client where they are” made sense. It is important to be flexible in thought and understand how knowing different modalities can inform the therapist on how to work during a therapy session. Becoming an “Integrative Therapist” can expand the richness in the therapy room for both the patient and the therapist.
I have used Meaning Centered Therapy, (read Viktor Frankl and his Logo Therapy modality), as my foundation for over 10 years. This allows me to be fluid during a therapy session so I can integrate different modalities such as attachment, narrative, psychodynamic, in order to connect with my patient during the session. In my experience, therapy sessions are rarely a straight line and it is my responsibility in service to my patient to help them find insight and awareness into their process. This allows the patient to become independent and learn how to have compassion for themselves and others.
My group supervision usually starts with a short talk about what I may be noticing regarding process with my patients or what I’m hearing from other clinicians. I pose a question or a statement related to expectations the patient has of the therapist or therapy. We as a group find how these expectations can allow for deeper meaning in the therapy room. We then talk about each supervisee’s cases and attend to any “red flags” or crisis the patient may be experiencing. I encourage the group to support each other in supervision, as they might have a different perspective that is better than mine. This interactive approach creates cohesion within the group and also builds confidence.
Another piece of supervision entails how the trainee or intern is managing countertransference or (make them) aware that they are experiencing countertransference. Also, the experience of projective identification happens a lot more in the therapy session than one might be aware of. I feel it is my responsibility to help increase this awareness as to when the therapist might feel lost during a therapy session and how to recover. That experience can create havoc for the therapist, leaving them feeling inept and dis-regulated if not discussed in supervision. Projective identification and countertransference can be a wealth of information for the therapist. These experiences are not to be feared or avoided, but embraced. The more the therapist understands about their unconscious material the better.
As a supervisor I also see my role as a mentor as well. I invite my supervisees, whether in my group or in individual supervision to process how they are doing on their journey to licensure. So many moving pieces are in action and at times it feels overwhelming. Believe me, I have not forgotten my own journey, and that gained experience has given me the wisdom to pay it forward.
Supervision continues to be exciting and illuminating for me. It is a chance for me to challenge myself and continue my education by reading, attending workshops, and listening to my supervisees for their wisdom.
If you are a supervisor or a supervisee, please feel free to reach out to me. I love the collaborative process and believe that is what makes us better therapists. Also, I will take this opportunity to invite those of you who have not attended one of our Network Meetings or Special Interest Group workshops to come and experience the wonderful family that continues to grow at LA-CAMFT.
I’ve just read Cal Newport’s book entitled Deep Work: Rules for Focused Success in a Distracted World, where he explains how to avoid distraction and focus on your priorities. Although the book is written for people who have desk jobs, the concepts are applicable to our work as therapists.
Newport describes the idea of “attention residue” which means that every time we shift our attention from one task to another there is a “cost.” I noticed this recently when I was trying unsuccessfully to solve a bookkeeping issue during my lunch break. When my client arrived and our session began, I noticed that my mind kept returning to the bookkeeping problem, and I had to actively shift my focus back to my client. The skills I’ve learned in my meditation practice helped me return to the present moment and focus on my client.
Newport believes that “To be successful with deep work you must rewire your brain to be comfortable resisting distracting stimuli.” He recommends avoiding using the internet (especially social media) for entertainment. He suggests finding more intentional and less distracting ways to entertain yourself. He’s not anti-Internet, instead he suggests scheduling the time you want to spend using the Internet rather than randomly getting online. I started scheduling three 15-minute social media blocks on my calendar during the week.
I certainly don’t want to be thinking about what I read on Facebook or my accounting problem when I’m beginning a session with a client. I’m not suggesting we avoid doing any of our clerical work between sessions; what I am suggesting is being selective about the type of tasks we work on.
I’ve recently broken the habit of looking at Facebook during breaks by removing the app from my phone. I need my time between clients to be refreshing and when I look at Facebook, my brain becomes overstimulated, like I’ve eaten a bowl of sugary cereal. Instead of being online, I stretch my neck and shoulders or pick up one of my crystals and hold it while I take a few breaths. After a difficult session, I listen to Brainspotting bilateral music for a few minutes. I still enjoy using Facebook, but I only access it from my computer and at designated times during the week.
The place where Newport’s suggestions have been most helpful is with my writing. Newport believes in “Focusing on what’s wildly important.” This means cutting out the busywork and scheduling time for the things you’d really like to accomplish. I schedule 3-4 hours of writing time (about an hour from Thursday through Sunday) every week and I don’t check email or work on “busywork” during that time; I treasure and protect that time.
What’s wildly important to you?
An interesting thing happened in one of my therapy sessions this week. A young woman in the creative arts—let’s call her Carla—was talking about a part-time job she was taking in order to supplement her income. She had researched the company carefully, and she liked their commitment to being carbon neutral. She found the people who worked there to be friendly and engaging. She liked the clothes and accessories she would be selling and looked forward to shopping there with her employee discount. Like many young people in Los Angeles, she has been struggling to meet people, and she was looking forward to meeting more young women with values and interests similar to her own.
And yet she was quite anxious about accepting the job.
“Are you feeling confident you can manage the extra work?” I asked. She responded quickly in the affirmative. “Have you had a similar job in the past that was difficult in some way?” I inquired further. “Yes! The last time I did this, I was so exhausted all the time. I didn’t have the energy to pursue my craft.” She paused, then added, “I’m so afraid that if I take this job I am getting farther and farther away from my real goals.”
I have heard this before. Many of the young people I work with are stretched thin, working several jobs, or working like crazy to get ahead at just one. They are exhausted and dispirited at the end of their workday. Come Friday, they either stay home, order takeout, and watch Netflix, or they go out drinking with friends and spend the rest of their time recovering. Rinse, repeat.
They all suffer from high levels of anxiety.
Their anxiety is not always what it seems. Most of my clients are good at juggling their busy schedules. They know how to manage calendars and deadlines. They have healthy hobbies like yoga and playing the piano. So, where’s the disconnect?
Let’s go back to my original story. Carla knew exactly how to manage her schedule and her budget. She always made her rent, though sometimes it was close. And unlike many of her peers, she is paid to perform in her chosen field—a fact that she both appreciates and enjoys. Overall, Carla’s life is full and happy, and she enjoys being busy.
But in the past, when Carla was asked to take on an extra shift at the shop, she always said yes. She quickly went from being happily busy to being overwhelmed and miserable.
Carla didn’t really suffer from anxiety, she suffered from fear. Fear that if she said no, people wouldn’t like her. Fear that if she said no, she would be fired and wouldn’t be able to cover her expenses. Fear that if she said no, she would end up alone.
Once we were able to distinguish the difference between the anxiety and the fear, I gave Carla the good news — “Carla, this is actually something you have some power to control. We just have to make sure you are clear on what your boundaries are at work.”
I continued, “First we will identify the values you are expressing by taking this job. Then we can clarify your goals and your boundaries. You can learn to be comfortable sticking to those boundaries because they accurately reflect your values and your goals. Then, you will change this dynamic where you are accepting too much work and are exhausted all the time. Better yet, you can conquer the anxiety that tells you to be worried that you will become overwhelmed and have no time or energy for your art.”
“Now let’s talk about the fear.”
Of course, working with the fear of being fired, or of not being liked, is not easy. We all know this. But it will make a difference, because it is the real problem.
There is a lot of buzz these days about #JONO: the Joy Of saying NO. But truly, the joy is not in simply saying no; it’s more complicated than that.
We must help our clients clearly identify their values and goals so that they can be comfortable holding their boundaries.
Once they are clear about their Why, they will feel comfortable saying no because it is aligned with their values. They will be basing their behavior on their core beliefs, and not on the whim of a co-worker, boss, or client.
Carla left our session with a big smile on her face. She had taken back the power to decide her fate. Two extra shifts per month—that’s all she would accept. Just deciding this for herself, and being clear on her goals and her boundaries, was what made all the difference.
“I just can’t do it anymore.”
People burnout everywhere, in every field. They burn out professionally. They burn out in taking care of others. I live in Los Angeles and I can understand how just driving a car can burn someone out in this level of traffic.
No one plans to burn out. Maybe they do have a little awareness that they’re going down that road, though.
We have a level of control over where we place our attention, as well as our effort. If you’re worried you’re burning out, consider preventing it.
There’s two parts, I believe, to preventing burnout.
For the first, I’d like to borrow from a simple model I first heard from Dr. Christine Moutier (a psychiatrist and former supervisor of mine at UCSD), modified a bit here. Imagine a gas tank. It’s feeding an engine. That engine is you. If the engine shuts down, you shut down. This gas tank has a leak in it. It’s losing gas. Gas is pouring out. Eventually if we do nothing, the tank will be empty. When it’s empty, the engine stops. It doesn’t run anymore. The engine burns out.
We don’t want the engine to stop, so we need to fill the tank. It has to be filled faster than it’s losing gas. In life we each have our strategies to fill the tank. Sleep. Food.
Socializing. Rest. Sex. Yoga. Watching TV. Meditation. Talking to people. Exercise. Make a note of your ways to fill the tank, and note what others do, since one way might not be enough. One way might not be able to fill it fast enough. It’s for your own well-being.
On the other side, look at the size of the hole that gas is leaking out of. This is the effort we put out into the world. We can try to narrow the hole, to hold back. That may be effective, to a degree. If done too much, it leads to apathy. The hole can’t ever be completely plugged up, in a normal life.
It’s not a particularly complex model, I’ll give you. Yet really smart people neglect themselves all the time. They think their tank will never run out, as if there’s a secret reservoir somewhere. Running on empty hurts the engine. So the first step is to keep the tank filled.
The second part of not burning out is to Not Overextend. We all have projects we’re asked to be involved in, whether that be something at work or even fixing up something in the house. Or maybe it’s arranging an event for family or friends. Presuming this is not a startup business that is your idea, ask yourself – how much am I putting into this? How much are the other people putting into it?
Here’s the key: If you’ve been asked to do this project by someone else, and you decide to invest a lot of time/energy in it, make sure the other person is as invested in it as you. The plan, the approach, and if possible, the energy/time. If you’re thinking up a lot of aspects of it, make sure the other person agrees along the way, or has as much skin in the game.
Let’s say I’m asked by my wife to plan a party for our friends. I put a lot of time into planning and arranging it, and then my wife tells me she doesn’t like what I did. I devoted hundreds of hours into the project, she devoted none. My response to any criticism she might have is anger and wanting to quit and disconnect. I would feel burned out. Such is the way when only one party in a group does most of the work, and the other critiques or doesn’t support it.
Now in many situations the division of labor is unavoidable. One side will do more work than the other. Chances have to be taken. When they are done with open eyes, though, the disappointment may be less.We can clarify the point, then, that the other party needs to buy into the plan at least. Don’t overdo it expecting the other party to be wowed by the amount of time you’ve put into it. What if they aren’t? You may end up apathetic and withdrawn. Check in with them frequently, to get their buy-in on the approach, so they won’t be surprised, and you won’t be surprised. And finally, try to discern endeavors that might not be worth the investment.
The idea is basically to not overextend yourself in any project to the point you're running on fumes. And if you're investing in some kind of project with other people, make sure they're buying into it to the degree you're expecting them to. Otherwise you'll end up feeling burned, as a precursor to feeling burned out.
Oh, and chocolate. Regular bursts of chocolate.
Charlyne Gelt, Ph.D.
“Don’t look away, Kurt,” Elisabeth implores her young nephew. “Never look away — everything that’s true is beautiful.” (from Never Look Away)
Never Look Away, an historical drama, takes us through three decades of German life, from the 1930s into the 1960s and focuses on the artist, KURT BARNERT (Tom Schilling). The film, written and directed by Florian Henckel von Donnersmarck, was inspired by the real-life story of Gerhard Richter, one of the 20th century's most respected visual artists.
In the opening scene, set in Dresden in 1937, six-year-old Kurt is taken by his beautiful, free-spirited aunt ELISABETH (Saskia Rosendahl) to a Nazi-organized exhibition of “degenerate art," intended to be jeered at for their decadence and moral deformity ― a propaganda blast against "impurities" in German culture. We watch Kurt stare at a small abstract Kandinsky as a tour guide sneers with contempt at the piece: "How does this elevate the soul?" (This question of soul reverberates throughout the movie). Elisabeth whispers to Kurt, “Don’t tell anybody, but I like it.” Kurt is bonded with Elizabeth, who introduces him to art, music, and sensuality, and teaches him to trust his gut. From their bond Kurt is first awakened to the spiritual, to a sense of oneness with the universe. We observe Elizabeth orchestrate a group of Dresden bus drivers to shine their headlights on her then honk their horns simultaneously as she holds up her arms and experiences a state of transcendent oneness. While for Kurt, visual imagery becomes his connection to beauty and truth, sound acts as a metaphor for Elizabeth’s sense of oneness with the universe.
Elisabeth, tall and fair, is given the honor of handing the Fuhrer a bouquet of flowers as his car goes by, but it soon becomes clear that she is not mentally stable. Kurt finds her sitting at the piano in the nude, then she stands up, hits herself on the head, drawing blood, and says, “I’m playing a concert for the Führer.” Tragically, Nazi Germany does not tolerate such mental defects and impurities, and Kurt tries to cover his eyes as his final sight of his beloved aunt is being ripped away from her family and taken by ambulance to an institution where she will later be “relieved of her meaningless existence.” She is part of a brutal eugenic genocide perpetrated under the Third Reich by the famed gynecologist, PROFESSOR CARL SEEBAND (Sebastian Kock). Like a camera with the shutter left open, Kurt observes and stores to memory many such horrific experiences. These images burn into his brain and mark him for life. Later, as an artist, he transfers them from memory to his canvases which mark him as a respected visual artist.
Kurt has taken his Aunt Elisabeth’s words “never look away” to heart, enabling him to stumble upon a spiritual solution to coping with his pain. One day, while sitting in a branch of a tree observing the lush green landscapes of his father’s farm, Kurt views life from another perspective. He sees more than the landscape, beyond what the eye views, and he is moved by a feeling of being as one with the landscape. He runs home to tell mother that she no longer has to worry about him because, “he gets it” ― he understands the oneness and the interconnectedness of the universe. Kurt’s father, who is more practical, tells him that it’s all right, but one can’t live as a dreamer.
We follow Kurt as he survives the war and the Nazis, then enrolls in an elite art school in divided post-war Germany. Here he meets and falls in love with fashion student ELLIE SEEBAND (Paula Beer). She sews him a new suit, which indicates a new sense of identity. Unbeknownst to either of them, Ellie’s father is the same Professor Seeband who sentenced Kurt’s aunt Elisabeth to sterilization and death. The Professor also has not yet made the connection but opposes his daughter’s relationship saying Kurt is from a poor gene pool. Thus, he terminates his own daughter’s pregnancy and makes her sterile. Kurt does not know that he is marrying the daughter of the man who euthanized his aunt Elizabeth.
In art school, the post-war Communist regime turns out to be just as unforgiving as the Nazis were in their attacks on artistic expression. Kurt is forced to paint murals of noble workers as his teacher exclaims (decrying the modernist obscurities of the West) that to serve one’s personal needs, in paint, is to yield to the “Me, me, me!” Kurt, conflicted between what he feels and what he is forced to paint, flees to West Germany with Ellie just before the Berlin Wall goes up.
Once Kurt and Ellie have settled down in West Germany, Kurt starts to probe the wounds of the past in his paintings, evoking not only his own buried traumatic memories, but also Germany's. His memories and his artistic talent, bring Kurt’s “truth” to life. While Kurt is in a restaurant, dining with his father-in-law (who has also fled East Germany), a newsboy bursts in to hawk a newspaper, crying out that a prominent Nazi doctor, Professor Seeband’s former boss, is under arrest. Kurt, still not making any connection, is inspired by the newspaper article about the captured Nazi doctor and starts copying black-and-white news photos into his paintings. His studio overflows with paintings ― portraits of inquiry bearing witness to Kurt’s “truth.” They line the walls and sit stacked on the floor leaning against the wall. When Professor Seeband first sees them, and sees the incorporated photographs, he freezes, confronted by the undeniable “truth” of his cruelty, and his history. As the Professor sees a collage of Kurt’s aunt and the Nazi-doctor, he skulks away from Kurt’s studio like a beaten animal. As Kurt’s paintings become known, and as Professor Seeband’s role in the Nazi eugenics program is revealed, the outcome is inevitable. The truth, once seen, cannot be unseen.
The film closes as Kurt, now a respected artist, is interviewed at a gallery showing his art. When he is questioned about the identities of the people in the photos in his paintings, he denies knowing them stating that he prefers not to know them. The interviewers miss the point ― Kurt knows “their truth” and his paintings reveal these truths – and he has an uncanny ability to see inside them and bring out the truth in them, and all that is true makes them beautiful.
Psychological Implications: A child’s truth cannot be denied although he may hide it behind invisible walls to save his tortured soul. To understand NEVER LOOK AWAY from a depth perspective, we have to question what childhood trauma, fears, and unmet need drove Kurt to hide away the truth of his outer world, Nazi Germany. Kurt’s heart was broken by trauma. “In terms of the psyche, trauma is any experience that causes the child unbearable psychic pain or anxiety. Pain is unbearable when it cannot be metabolized” (Kalshed, The Inner World of Trauma). When a child’s sense of self is repeatedly threatened, and the child has no way to process the perceived threat, the child enters the domain of trauma. Compounded trauma threatens the personal spirit, so a line of defense is created. Kurt’s miraculous life-saving emotional defense to witnessing the recurrent extremely traumatic events was to go “inside”. Though conflicted, he needed to make sense of his world, learn what is “truth,” and cope with the pain, which in the era of his Nazi upbringing was understood as a defect. What saved him emotionally from going mad like aunt Elizabeth was his ability to “mask” his internal conflict, express his pain in his art, and what he intuitively stumbled upon in childhood – the ability to transcend pain by tapping into a felt sense of “oneness” with the universe, no matter what the world was inflicting upon his psyche.
“Oneness” is defined as ‘being at one with the universe,’ or the evaporation of any sense of separation from others, a subjective sense of ‘connectedness’ with all. Meditators and mystics describe it as gaining access to internal states of knowing by tuning out the noise and flow of incoming sensory information so that subject and object become as one, “a single entity, physically, mentally and spiritually inseparable.” (from judo expert Juchi Watanabe in The Secrets of Judo). In the film’s closing scene, Kurt instructs the Dresden bus drivers to orchestrate a sounding their horns. Again, we experience a felt sense of oneness.
Outside, Kurt presented as a self-confident artist; Kurt’s inner world was another story. There, embedded in his unconscious, were scenes he couldn’t forget. Yet, unlike Elisabeth, he did not split, did not have to “go mad” to cope. Because he had embraced a spiritual “oneness,” the chaos of his past did not define him or derail him. “Oneness” is what defined him and kept him on track. Loving Ellie as she lies atop him, leads him to find peace and heals his pain. He “sees” her beauty, and not only do their bodies mesh, Kurt is again awakened to his sense of oneness with the universe. He understood that both his traumatic experiences and his love for Ellie would someday enrich his art. His artist’s eye, like a camera lens, bears witness to and would ultimately tell the “truth.” Only the artist can give the people a sense of freedom and by freeing yourselves you are liberating the world.
Each horror witnessed, each injury to his developing psyche, was but one thread of his story but woven together, experienced as a whole, formed a tapestry of “truth.” He received a silent message from aunt Elizabeth, and from that day sitting in a tree feeling a spiritual moment of connection with the universe: stay vigilant, eyes open, so nothing about life’s truth is missed.
“Never look away — everything that’s true is beautiful.”
Monday April 22 marks the 49th anniversary of Earth Day, the day to inspire awareness and appreciation for the earth’s environment. This important day has become so popular that many people observe and celebrate Earth Month. Here are some easy things we can all do in consideration of our planet.
Reduce the mail – Most of us receive more mail than we want or need. This tends to accumulate and pile up creating just one more “To Do.” There are ways to reduce the amount of junk mail sent to our homes. ‘Visit the Direct Marketing Association’s DMA choice website www.dmachoice.org for info on how to manage your mail including catalogs, credit offers, promotional mailings and more. Another source for catalog management is www.catalogchoice.org where you can set your preferences for how you would like to receive (or not receive) catalogs that seem to show up every other day.
Pick up after your pet – In addition to it being un-neighborly, unsanitary, and in some cases illegal, pet waste can create storm water pollution. Pet waste should be disposed of in the trash. Eco-friendly waste bags are available. You can also research the proper way to bury or compost pet waste.
Properly Dispose of Household Hazardous waste, and U-waste –
Most people know that products labeled poison, flammable, combustible, etc. should not be put in the trash. These include products that are for lawn and garden care, painting, automotive use, and cleaning supplies. But Household Hazardous Waste (HHW) also includes beauty products such as nail polish and miscellaneous items like shoe polish, moth balls and some glue. Some county and state information sources refer to another division of hazardous waste, U-Waste which consists of batteries, compact fluorescent light bulbs (CFLs) and items containing mercury. Check with your sanitation company, but in most jurisdictions, these items should not be placed in the regular trash. Instead they should go to a drop off location where they can be properly disposed of.
Minimize flushing of medications – Unused medication is household hazardous waste and should be properly disposed whenever possible since they can negatively affect the water supply and soil. It used to be recommended to flush unused or expired medications, or to mix unused medicines with coffee grounds or kitty litter and place them in the trash. A better option is proper disposal. Many local pharmacies and sheriff stations will accept medication. Check the website or phone ahead for the most current information. (Most sheriff stations have removed their drop off boxes due to inappropiate use.) The S.A.F.E centers noted below will also accept medication, (except controlled substances). The National Prescription Drug Take Back Day will be on April 27, 2019 and many options will be available to conveniently and safely dispose of prescription drugs. NOTE: Current recommendations suggest flushing certain pain medications and other controlled substances which are dangerous if improperly or illegally taken. Visit www.fda.gov (search for disposal of unused medicines) for a list of medicines recommended to immediately flush if takeback options are not readily available.
Reuse or recycle electrical equipment and e-waste – If you upgrade your equipment such as a printer, consider donating the gently used still working device to an agency that can still use it. Or take it to a facility that will recycle it. A tool to locate innovative reuse and recycling companies can be found at the CalRecycle website, www.calrecycle.ca.gov under E-waste. E-waste is the term used for electronic products near or at the end of their useful life. This includes televisions, computers, cables, fax machines, telephones, etc. Of course, you should remove any sensitive data from the device prior to recycling. Some local shredding services will remove and destroy your hard drive, and then properly recycle it. The small investment required is well worth it in exchange for the closet space you will get back by safely disposing that old technology.
Where to dispose – There are many collection locations around town to drop off your items. Watch for free events offered by real estate agents and other businesses that will be promoted on sites like Facebook and NextDoor. Check the official sites for the city or county where you reside or work. The City of Los Angeles offers 7 S.A.F.E (Solvents/Automotive/Flammables/Electronics) collection centers for residents including one at UCLA. And… when you go to the S.A.F.E collection center, you won’t even have to get out of your car. The associates there will remove it from your trunk.
Now wasn’t that easy?
Mental health is moving into the digital era with increasing use of telehealth services. In preparing my own practice for this new form of service delivery, I have reviewed some 20 separate sets of office agreements by mental health professionals across the country. Despite the variety of forms, a number of principles emerge that seem to be setting a standard for the use of this modality.
Definitions Sometimes called telemedicine, teletherapy, distance therapy, e-therapy, internet therapy, or online therapy, telehealth involves using electronic media to provide interactive, real-time mental health services remotely, including consultation, assessment, diagnosis, treatment planning, counseling, psychotherapy, coaching, guidance, psychoeducation, and the transfer of medical information. Telehealth includes both video and audio communication, either over the phone or over the Internet using videoconferencing software. Telehealth services don't include email or texting, however.
Basic Standards Telehealth is covered by the same laws and ethics that guide in-office, in-person, face-to-face mental health service. Therefore, policies and consents already in use in the professional's office will apply to telehealth services. However, there are additional components to cover the unique characteristics of telehealth services.
Advantages and Disadvantages Proper informed consent should include a balanced disclosure of the potential advantages and disadvantages of this form of service delivery. The chief advantage is that telehealth can provide continuity of care flexibly when an in-person service cannot be conducted. However, telehealth is not a universal substitute for in-person mental health service. Telehealth services may not provide the same level of comfort when talking about personal matters. Misunderstandings can occur, and this may have an impact on the therapeutic relationship.
Contraindications Some presenting problems will not lend themselves well to telehealth services. These may include overwhelming or potentially dangerous circumstances––for example, psychosis, suicidality, or other clinical emergencies in which in-person assessment or intervention may be necessary.
Only a Part of Care Under many if not most circumstances, telehealth may be best to augment services to established patients who continue to have at least intermittent contact in the office with the clinician. Consequently, telehealth is frequently used when the patient is unable to come in to the office due to temporary limitations. Examples of these limitations include medical conditions that prevent physical mobility, distance due to travel, and scheduling conflicts. If periodic in-person sessions cannot be arranged, the clinician might discuss referral to another appropriate provider who is more accessible or local.
Licensure An important limitation in telehealth service is that services are being provided under a state-regulated license. This is generally interpreted to mean that both patient and therapist should physically be located within the state of licensure at the time that service is rendered. However, many states do allow mental health professionals licensed in another state to provide a limited number of hours of service within their state. So, there may at times be a conflict between licensing jurisdiction and the best interest of the patient. The best interest of the patient should come first. An example is when a patient is temporarily out of state but would suffer clinically from the lack of continuity of care with a provider who is familiar with the patient's history, circumstances, and mental health needs.
Confidentiality The laws that protect confidentiality also apply to telehealth sessions, including mandatory and permissive exceptions. Because of a greater risk of being overheard by a third party on either end of a telehealth session, the consent should include a recommendation that the session be conducted in an enclosed private room and with no one else present or observing without the other's consent. Moreover, a thorough consent may include a statement that both patient and psychotherapist agree to not record a telehealth session without prior written consent of both parties.
Security No electronic transmission system can be considered completely safe from intrusion. Electronic media and the internet pose inherent risk for release of private information, including audio and images. The patient should be advised that they are responsible for the security of their own laptop, tablet, or smartphone. While a variety of software programs are available for videoconferencing, such as Skype, FaceTime, or GoToMeeting, not all are encrypted––or compliant with federal law to protect the privacy of healthcare information. Look for software that is HIPAA-compliant.
Scheduling Just like an in-person appointment, telehealth sessions are generally scheduled in advance. Prior arrangement should be made about who will initiate the session. The therapist should establish a policy regarding technical difficulty in establishing a connection, for example, how long or how many times the therapist will attempt to reach the patient and when the therapist will discontinue if a connection is not established, analogous to an unkept appointment.
Telephone When using a telephone to provide telehealth services, not all phone calls are equally secure. A landline is preferable because it is more secure, more reliable, and often offers clearer audio quality.
Video Conferencing A telehealth agreement may stipulate that the patient is responsible for their own hardware and software, audio and video peripherals, and conductivity and bandwidth considerations. In the event that a video telehealth session is interrupted after several reasonable attempts by technical difficulties, it is recommended that the patient be open to having a telephone session as a backup.
Payment A thorough consent may clarify that telehealth is a professional service and that a fee is charged, either at the same or a different rate than in-person services. A consent may also caution that while health insurance often covers in-person services, health insurance may limit or deny coverage for telehealth services. It is wise to remind the patient they are responsible to know in advance what their insurance may or may not cover. For example, videoconferencing may be covered while telephone sessions are not. If their insurance does not cover telehealth services, specify how services will be charged.
Technical Instructions In preparing for an initial telehealth session, provide some specific technical instructions to the patient in advance. Video conferencing software may be recommended. Instructions for set-up can include taking time to learn and test the software ahead of time, exchange login information, and conducting a brief test call. Videoconferencing requires attention to video and audio quality, including sufficient light and minimal glare, camera angle so faces can be seen, and freedom from extraneous noise. The most critical part of a video conference is not the picture but the sound. A headset or earbuds are often better than a speaker and microphone. "Doubletalk" is a phenomenon when people at both ends of the conference speak at the same time. Doubletalk may cause audio feedback, echo, or clipping because audio has a very slight delay.
Conclusion While telehealth is a new and flexible vehicle for providing mental health services, think through a fully-informed consent to address the unique characteristics that telehealth creates.
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