Stories as a Window Into Schizophrenia
A beautiful article on oral histories for those living with schizophrenia.
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Treating Bipolar Disorder: It Takes A Family
Dr. Hudak shares an article "It Takes a Family" about the necessity to involve family in the treatment of Bipolar Disorder.
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Bringing Family to the Table
Last week I had the opportunity to co-lead a family meeting with my colleague, Dr. Rob Garfield in the inpatient psychiatric unit here at Penn.
Dr. Garfield and I reviewed the patient, Anna’s history with a group of psychiatry residents and medical students. While the residents and students observed, we arranged a group of chairs in the front of the room to accommodate the family meeting.
Anna, an African American woman in her 60’s, was visited by two brothers and a sister. When the patient arrived in the meeting, although very upset, she recognized her family members and was quite emotional, eliciting stories from the past that clearly held deep meaning for them all.
Anna was too ill to remain in the meeting, but the family was eager to tell us about her and their family’s life. They spoke of the issues that triggered their sister’s initial break so many years go. With deep emotion and love, a brother spoke of the promise he made to his mother on her deathbed to always care for this sister.
Stories were shared about long held family secrets that, like pieces of a puzzle, added dimension and clarity to the struggles this patient has had. A narrative of devotion and care emerged, as one brother spoke about his need to assure his sister’s safety and take her to the hospital when needed.
After the interview was over, the family was invited to join those around the table who had been observing, and listen to what thoughts and reactions they had to the family meeting.
Residents and students shared with the family the commitment and love they observed. They spoke also of the courage of family members being able to discuss issues that were long silenced. “It was one of the most moving family interactions we have seen on the inpatient unit.”
The family joined in the conversation about what their experience has been like with a seriously mentally ill member, and around that table, talked about how their experience at Penn this was the first time that they had ever been consulted about their sister’s condition, or the burden of caregiving they experienced through the years.
Can there be any doubt that families deserve a seat at the table?
As psychiatry moves forward and espouses the need for integrative care, it is of utmost importance that families have a seat at the table, as a vital part of the collaborative care team.
Transcending Trauma: How the Study of Holocaust Survivor Families Sheds Light on the Challenges Faced by Today's American Military Families
The Center for Couples and Adult Families is co-sponsoring a talk with the University of Pennsylvania Jewish Studies Program on Monday, April 28, 2014. The talk will explore ways in which the study of Holocaust survivor families and their ability to rebuild after complete devastation sheds light on the challenges faced by today’s returning American war veterans.
What We Can Learn from Military and Veteran Families
Five questions with Evan Imber-Black
New Directions for the Center for Couples and Adult Families
The CCAF was featured in the February issue of the Department of Psychiatry newsletter, the Penn Psychiatry Perspective.
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Love in the Time of Neuroscience
Interesting review of Sue Johnson's new book, "Love Sense."
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When is it time to go to couple therapy?
I'm happy to feature the work of CCAF Clinical Faculty Member and couples' therapist, Dr. Steven Sayers. In this post, he writes about the often difficult decision to begin couples' therapy. In response to the question "How do you know it's time?", he has clear, concise suggestions that will resonate with any partnered pair.
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The Stories That Bind Us
As a narrative therapist, I am acutely aware of the many ways in which family stories shape our lives: our identities, sense of history, and, perhaps most importantly, our sense of possibilities. I'm excited to share this research about the impact of family stories; it is intuitively what I have know from my many years of clinical work with families. Click here for NY Times article
Thinking About the Institution of Marriage
Dr. Hudak quoted by Dr. Alison Heru in Clinical Psychiatry News,"As family therapists, we are uniquely poised to transform the meanings attached to ‘marriage’ and ‘family,’ to focus on the quality of relationships rather than on the gender of a partner or the assumption of particular roles."
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Family Therapy for the Holidays
Each year around this time, conversations with clients turn to the predictable stress of time with family over the holidays. Like ghosts in the night, old issues, long dormant, reappear at holiday time. How is it that an adult with partner and children can walk into their parents' home and instantly feel 10 years old again? The anticipation of a holiday encounter can lead any adult to feel slightly unhinged in a way that few other situations do.
Let's face it, no one can upset you like a family member.
Here are some ideas to try on this holiday season. They are born of basic tenets of family therapy theory and are utterly applicable to a variety of anticipated holiday situations:
1. Plan and be strategic.
It's always a good idea to warn someone that you are going to make a change before you actually do:
"I was thinking about the holiday, and this year I might do something a bit different."
You don't even have to be sure of what specific change you're going to make, the point is to warn others first. That way, you can attempt to avoid their shock and surprise when you decide not to follow the family script - you know, ‘the way it's always been and everyone (but you) wants to continue'.
This can be particularly useful when, for example, you have young children and want to begin to create your own traditions around the holidays. Perhaps you feel the stress of traveling with small children in an effort to please everyone, or because 'you've done it every year, and they're counting on you.' So let people know in advance and find allies to support your change.
Which brings me to the next point.
2. Expect a reaction.
It is true that relationships have much in common with physics: for every action there is a reaction. Families attempt to maintain a homeostasis - a state of balance, maintained by familiar patterns and expectations. Think of the tremendous impact it has upon relationships when a family member joins or leaves the system; these points of normative developmental crises, birth, adolescence, marriage, or death, each require a renegotiation of previous roles and rules in the family system. Holiday traditions are valued as markers of continuity, so changes, however minor, can feel disruptive and unsettling.
3. Focus on yourself.
You can change only your behavior, not the behavior of others.
Admittedly, this is a tough one. It's the balancing act between giving up the dream of what can be, and accepting what is. There is much integrity in changing one's own behaviors in a respectful and compassionate way, and it's sad to realize that, for now, others may just not be who you want them to be.
Developing a curiosity about yourself may help. This might be a good time to entertain the questions: Why does this person still hold so much power over me? Why do I still need my mother/father/sibling to compliment or recognize me? How is it that I have come to this place in my life carrying that old wound?
4. There's always next year.
Your opportunities to practice being different in your family are boundless. Try to think of this as one of many steps toward change. It will most likely take more than one conversation and there can be complicating factors: addiction, trauma, divorce, remarriage. Relationships take time, so keep in mind the long term; families are full of surprises and unpredictability as the family life cycle inevitably moves into the future.
When I hear a person in their 20's or 30's say "I'll never have a relationship with my brother, I respond, "Well, let's think about this for a moment. If you both live until you're 80, are you telling me nothing will happen over the next 50 years? Most likely, your parents will predecease you, and you and he will together become the oldest living generation in the family. You may each partner with someone, and perhaps become aunt and uncle to each other's children." There are endless circumstances that create opportunities for us to evolve in our family system.
5. Lastly, I try to remember at this time of giving thanks, that to even think about the quality of relationship is of itself both a blessing and a privilege.
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