A Review of Plum Rains

Plum Rains (Andromeda Romano-Lax, 2018) is a peek into one possible future for modern Japan.

Because of a casual interest in Japanese culture, I wanted to understand the symbolism of the title. Turns out, the titular season is a hazy, wet herald of possibility. The plum tree blossoms in the early Spring, and the plum rains mark the Japanese Spring, ushering in the warm summer months. Plum, we are old, is symbolic of the bittersweet, contrasting with the sweeter cherry that arrives later in the year. This symbolism pops up at various points in the story.

Our adventure begins as a simple story about two women who come to know each other through the use of a technological device. Angelica and Soyoko are of different generations and cultures. Each locked inside herself, resentful and distracted but dependent upon each other. Their dutiful lives erupt in bloom after Hiro, an empathic robot prototype, joins them.

But Plum Rains is more than a book about lonely people brought closer by technology. It is a book about secrets and new beginnings, the Japanese cultural themes of isolation and purity, and the ethics of technology. The events of this story are rooted in modern Japanese history and bloom a century later on the withering stem of a Japanese future.

The world were the events of this story happen gives an engaging look at technology-assisted behavioral health therapies. We see several examples of therapies coming to fruition. There are medical assistance drones connected to government databases. There is an AI-enabled empathic android. There is a virtual reality device used to promote healing from psychological trauma. Readers can observe the potential of these devices for healing or oppression and make their own decisions about where the line exists between good and evil—a fascinating question when considering the future of technology-assisted counseling and psychological interventions.

This book also asks questions about the illusory power of perception, identity, and perspective. It details how we only often see what we want to see, even–maybe especially–in our closest relationships. The power of attention and listening and compassion as change vehicles are on full display, but not where we expect them. In the end, this plum of a story is about relationships, oppression, self-awareness, and change, just as summer follows the rains.

I grabbed a copy of this book on a recommendation from one of those websites listing the “best of” small press offerings and was not disappointed. The author’s mastery of her craft shows in many enjoyable sentences; yet, parts of this book are a tad slow. Genre categorization is a bit tough. Some focus on the technology and the near-future setting to classify this book in science fiction or cyber-mainstream; it does fit there as the book features technology throughout the environment. Some focus on the historical backstory that is still relevant today. For me, this is less a book about then and more a book about now and the impacts of social decisions on real people.

Finally. this book is for those readers confident in their perspective as much as it is for those who are not.

Professional Name Change–LPC to LCMHC

With Governor Cooper’s signature on NC Senate Bill 537, some behavioral health providers will change the letters behind their name. For Cox Family Wellness Systems, this means that we will change from LPC (Licensed Professional Counselors) to LCMHC (Licensed Clinical Mental Health Counselors). 

The purpose of this law is to update the rules that govern the behavioral health professions in NC. The name of the profession changes on 01 January 2020 to clarify what counselors do. The name change also prepares the ground for the future of service provision. 

First, the name change highlights that LCMHCs provide clinical services to people with mental health concerns. This change spotlights both the clinical aspects of diagnosing and treating health concerns, as well as the focus on the mental health of service consumers. 

Second, the name change prepares the profession for future expansions to care for people with disabilities and advanced age. Counselors cannot bill Medicare. Aligning the name with the one used by most states simplifies the push for Medicare recognition. The future of mental health service provision includes the use of technology. Telehealth and internet-assisted counseling may only be available when the client and the counselor are in the state where the counselor is licensed. Counseling across state lines is generally not allowed by law. 

While this law does allow a name change, it does not change training requirements or scope of practice. LCMHCs earn a Masters Degree in a counseling specialty, adhere to a code of ethics, and engage in continuing education throughout their career. Going forward, you can expect to receive the same high level of care from your current counselor. 

Let us know if you have any questions about this name change and what it means for you.

Trauma-Informed Care Overview

Stress is a natural physical response to a perceived threat. But, a brain changed by crisis can misread stressful situations and respond poorly. Crises may be one-time events, like a natural disaster or a catastrophic car accident. Or, crises may recur over time. Examples of recurrent crises include living in a substance-affected home or a racist environment. A brain injured by one or more crises is said to be traumatized. In behavioral health, trauma is a psychological reaction to a stressful event that reduces how a person or system functions in everyday stressful situations.

A crisis survivor with a traumatized brain may feel helpless and unsafe when under stress. They can develop unhealthy habits to soothe their discomfort. Too often, traumatized people use alcohol, drugs, crime, violence, gambling, sex, or spending to feel comfortable. Dr. Daniel Sumrok calls these habits “ritualized compulsive comfort-seeking”.
While it might help fast, ritualized compulsive comfort-seeking is less helpful in the long-term. These habits can create shame and separation from the people most able to help with healing. Reliance on dysfunctional self-soothing behaviors leads to never-ending cycles of comfort-seeking and regret. The question directed at people seeking solace is often, “what is wrong with you?”

Yet, as the links between trauma and substance use become clearer, new ideas come forward. One idea spreading in the addiction treatment field is Trauma-Informed Care (TIC). TIC steps back to change the question to, “what happened to you?”. This change shifts the focus of treatment from simple abstinence to healing. TIC is not a new idea. It is a common thought that when someone stops using, they will have address the problem that led to their using.

TIC shifts responsibility for the original hurt to where it belongs, with the cause of the crisis. No longer is the survivor the cause of the crisis–as they often believe. Instead, survivors can shift their efforts from soothing to healing.

The Science of TIC

Exposure to traumatic events is near-universal. In one study, 90% of people reported having one or more distressing encounters in their lifetime. Survey respondents reported that they lived through disasters, accidents and fires, hazardous chemicals, combat and warzones, physical or sexual assault, unexpected dead bodies and body parts, threat or injury to a family member or close friend, sudden violent death of a family member or close friend. These events happened at work or in the community. Kilpatrick and associates (2013) also found that 8.3% of people will develop PTSD in their lifetime.

In the late 1990s, the health insurance company Kaiser Permanente partnered with the Centers for Disease Control to survey a broad group of insured persons in Southern California. This study is known as the Adverse Childhood Events Study (ACEs). It was the first study to document the connection between events at home and physical and emotional illness later in life. The researchers found that “almost two-thirds of study participants reported at least one ACE, and more than one in five reported three or more ACEs.” These findings underscore the causal relationship between trauma and lifetime pain.

Trauma-informed environments stand on the realization that trauma affects almost everyone. So that, when we, clinicians and concerned significant others, recognize the signs of trauma, we can respond safely and compassionately to resist re-traumatizing people. The Centers for Disease Control shared some principles of trauma-informed care. They are (1) safety, (2) trustworthiness and transparency, (3) peer support, (4) collaboration and mutuality, (5) empowerment and choice, and (6) recognition of cultural, historical and gender issues.

TIC in Action

Cox Family Wellness Systems uses a trauma-informed stress-coping model of addiction. This TI model recognizes that many using triggers arise from chaos, stigma, and fear. It also recognizes that many coping skills grow from survival and protection in the face of those triggers.

At Cox Family Wellness Systems, we understand that past hurts can affect current behavior. We also believe in the power of resilience and self-compassion to change current habits and heal past injuries.

Our services are trauma-informed. We use mindful practices and self-compassion for healing. We believe in client-centered, strength-based assessments and treatment goals. Our strategies involve rewarding folks for a job well-done.
Let us know how we can support you and your family.

Don McPherson”s Response to Toxic Masculinity

Don McPherson’s You Throw Like a Girl: The Blind Spot of Masculinity (2019, Akashic Books) is a reflective memoir of how one man learned to be a man and what that means for society. A former star quarterback, the author tells how he learned to talk with boys and men about how to prevent violence against women by claiming themselves as people first and men second. McPherson shows us how men are restricted by social expectations and how this restriction leads to the dehumanization of those who are not Men. Importantly, he teaches men how their ideas about their roles as protectors and warriors harm themselves, as well as those they love most.

For those who are interested in promoting self-exploration, McPherson introduces tools like “The Man Box”, which encourages the deconstruction of social messages about gender. We all internalized ideas about what it means to be a man or a woman; sometimes, these ideas get distorted, leading to imbalances in our identity and our relationships with others. Vulnerability, not generally considered a male trait, is displayed on the pages of this book with significant effect.

His idea is to be a whole person, not a one-dimensional notion of gender, and through the process of becoming whole to discover fuller, equal relationships with others. When men step down off their self-created pedestals and model equality with women, then boys and girls will be emotionally and physically safer. The correlation between power and violence is a message that women have discussed for decades. In this book, we hear from a man, trained and reinforced with male privilege, speak to men about power.

Applying the man box tool—often used as a gender box—to addiction treatment is a topic for exploration sparked while I read this book. Here is a tool for understanding identity, including an addict identity. Each of us is constructed using multiple identities, so there is a lot to explore in how an individual’s identity directs their behavior—and how identity change is part of behavior change and healing.

I would like to see McPherson go further in his social criticism. Yes, men are trained to “not be women”, but there are whole other groups out there that deserve equal treatment from men. As society grapples with gender fluidity and gender identity, how do folks who are not men or women feel safe as they struggle to define affirming identities? An identity built on not being something still ties that identity to its mirror image; identity built on approaching an idea leads to more powerful change. Casting off the old mold is only a first step. It would be interesting to continue the discussion begun in You Throw Like a Girl onto what it means to be a whole, vulnerable, emotionally aware person.

This book caught my imagination and I recommend it to coaches, teachers, parents, and those who influence the psychological development of boys and adolescents. McPherson uses his story of transformation from sports idol to social activist to highlight lessons and tools we can all use to live a better life. Maybe the most essential message of this book is the author himself—he walks the walk to learn how to live the life he models.

A review of Hayes’ (2019) A Liberated Mind: How to Pivot Toward What Matters

Part self-help book, part research report, Steven C Hayes’ A Liberated Mind is an accessible summary of Acceptance and Commitment Theory (ACT) for the lay reader. ACT was developed by Dr. Hayes as a model for increasing psychological health, or flexibility, over his decades-long career. A Liberated Mind presents that story of that development. Sections include an introduction to ACT, descriptions of the ACT tools and techniques, and applications of the model for the adoption of healthy behaviors, improvement of mental health, nurturance of relationships, increased work performance, enhanced spiritual wellbeing, and coping with illness and disability. There is also a chapter describing how ACT principles informed the solution to an international public health situation. This book is recommended for readers who are familiar with applications of psychological research and who want to explore ACT for personal or professional growth. It can be used in the classroom to train counselors, and it can be used by clinicians to complement individual or group therapy.

ACT is a popular, accessible 3rd generation cognitive-behavioral therapy (CBT) that combines mindfulness techniques with a positive, approach-based strategy toward values-based actions that have been found transformational across diagnostic clusters and human cultures. Third generation CBT models build on the work of Albert Ellis and Aaron Beck, who pioneered psychotherapy models focused on changing how we think and perceive our worlds as a path to behavior change, by focusing on the story we tell about our thoughts and behaviors (Hayes & Hofmann, 2017). The ultimate aim of this process is to increase personal freedom from self-restrictive narratives and to build the flexibility to improve life satisfaction. ACT, like many cognitive-behavioral therapies, is especially helpful for resolving the anxiety and depression associated with feelings of powerlessness associated with the substance-affected family.

The ACT model seeks to increase personal psychological flexibility, the “ability to feel and think with openness, to attend voluntarily to your experience of the present moment, and to move your life in directions that are important to you, building habits that allow you to live in accordance with your values and aspirations” (p5). The goal is to turn toward your pain (acceptance) and to live a personally meaningful, purpose-filled life (commitment).  ACT takes an approach-oriented stance to adaptation and growth versus a pain avoidance plan, which can box us into a corner and cutoff escape from unpleasant situations.  It takes the idea of thinking differently to act differently and adds a layer of exploration of our identity, which is a story we created from our thoughts about our thoughts and behaviors.  By tweaking parts of our story we can change the whole.  Think Back to the Future.

ACT dovetails well with SMART Recovery. One place ACT and SMART Recovery fit together is the values orientation. Both models seek an understanding of the client’s values and sense of meaning as the foundation for action. Clarifying one’s values helps illuminate personal guide stars by aligning behaviors with beliefs. The SMART Recovery Hierarchy of Values (HOV) tool allows us to visualize what we care about, in terms of time and money spent on an activity, and direct our behaviors toward our values.

If you are interested in talking about how SMART Recovery or the ACT model can help you, please reach out.

The Counseling Process: 4 Tasks for Change

The counseling process can be mysterious. The popularity of books about counseling and change–there is a whole publishing industry for self-help–tells us that people want to know how counseling works. Clients’ curiosity centers around the process of becoming vulnerable and trusting another person while counselors look for a trustworthy model to use to guide their work with clients.

Counselors learn different counseling theories and models in graduate school. Later, through practice and experience, they develop expertise in one or more of these models. Some counseling styles are based in the application of theory to practical, real-life situations while others are research-based. In all cases, competent counselors only practice using theories, models, and techniques that they are appropriately trained to use.Quotation-Alice-Walker-No-person-is-your-friend-who-demands-your-silence-or-30-53-08

As counselors gain experience and confidence, they often begin to adapt their working style to fit their evolving personal and professional values. Such development is an expected and natural process in a profession where the counselor is the primary tool for helping clients change. Counselors learn from experience, continual study, and from reflection on the work they do with their clients. Their professional growth then informs their ideas about how they work. This feedback loop concept is known as the counselor-as-instrument or the self-of-the-therapist.

Many models exist to help clients move from possessing a problem to possessing a solution. Some of these models are stage-based, like Egan’s 3-stage model or Roger’s 7-stage model. The model that I learned and practiced for many years is Roberts’ 7-stage ACT model for crisis intervention. It is a good model, and because much of my work has been one session crisis intervention work, Roberts’ model is a good fit.

Albert Roberts, PhD developed his model in the early 1990s while working with a domestic violence crisis response hotline. His model is grounded in humanistic counseling theory and the early crisis intervention theory laid out by Caplan and his contemporaries. Roberts’ seven sequential, often overlapping, stages are (a) assessment of biopsychosocial and lethality components presented by the client, (b) rapidly establish a collaborative relationship, (c) identify the major problems, including those that led to the client presenting at this time, (d) explore the client’s feelings and emotions related to the problem, (e) develop a set of options to respond to the problem situation, (f) take appropriate action to respond to the problem, and (g) create a follow-up plan.

Now I find that a one-session model is inadequate for deeper, multi-session work outside of the crisis intervention arena. Through teaching and practicing multi-session counseling, I am questioning how to evolve my counseling guidelines to fit a wider variety of counseling situations. A 4-task model of the counseling process is beginning to clarify in the muddy waters of helping people be their best version of themselves. Tasks is a better way to look at counseling than stages because change usually follows a winding path rather than the artificial linearity of stages.

The four tasks are information gathering and relationship building, application of clinical interventions (e.g., education, empowerment and encouragement, problem-solving options, behavioral experimentation), evaluation of the results of interventions, and termination.

During task 1, information gathering and relationship building, the client is encouraged to tell their story as it relates to their reasons for entering counseling. Through storytelling, the client presents their strengths and provides clues to the solutions they seek. This task is the basis for the working relationship and the tough emotional work that comes later.

Task 2, application of clinical interventions, the counselor does any number of intentional actions to shift the client’s thoughts and actions in the direction of a different way of being in the world. Through new thoughts and actions, the client tests possible solutions.

Task 3, evaluation of the interventions, is intermingled with Task 2. Try something and see what happens; if it works, try something else until there is an acceptable change and resolution to the problem. The stepping stone metaphor is useful here: to get to the other side of the river, there are many choices to be made about the path. Some choices lead to a quick crossing while some choices lead to deadends and backtracking to find another way. I also find playing Solitare helpful for learning patience for coping with dead ends.

Task 4, termination, although it sounds final, is a time for the client to live as a changed person. It is a time for some celebration, although sadness is often part of the hero’s journey, and harvest of the rewards.

If I can be of service to you or your family, please feel free to visit my PsychologyToday listing and contact me.


What I Learned at ACA

Sharing some thoughts about the 2019 American Counseling Association annual conference in New Orleans.

First, NOLA is such an interesting place. Full of variety in people and food and ways to live. A few days in this city is refreshing.

Picked up some information to share about social media as a process, or behavioral, addiction. The internet, social media especially, provides stimulation to our brains and some folks develop a compulsion to check their feeds that can be intrusive. The presenter stressed the role of self-awareness in both understanding and changing relationships with our connected devices.

Discussed the promotion, prevention, treatment, and recovery continuum of care for SUD treatment. This model starts with the normalization of responsible substance use; the key component is responsible use, which is how most people use. From this responsible use concept grows ideas about de-stigmatizing use and also the idea that not using is okay also.

We talked about the effect of use on families, across generations. Turns out, many people are not aware of how use affects their children and grandchildren. Some mentioned how hidden groups that support Adult Children of Alcoholics and minor children in substance involved homes have become. This supports my thoughts about the limits of education for counselors and the work still left to do.