This is my first time to blog at Mad in America and so I think it might be helpful for me to just share my pathways to where I am now in terms of how I view mental health treatment and human change.
I am always fascinated by what make people change. I first realized the anguish as well as hope of life when I was still in my high school and was a mentor to a special class of visually impaired students who were junior to me. By the way, I grew up in Hong Kong. All twelve students were visually impaired but several of them were also mentally or physically challenged. I grew up with them for four years with laughter and tears. Life is not equal for everyone but I find that we can make life better if we all work together. I decided to choose social work as my major in my university years.
Being curious, I went to India for a 6-week study tour after my graduation and prior to my first job at a family service agency. In the slum area and particularly the House for the Dying in Calcutta, I had another unforgettable understanding of life that lasts with me for a long time. I served lunch for people who only know how to receive food by kneeling. I stood quietly besides the bed of a person who had just came to the House in the morning and died within 3 hours because of extreme starvation and illness. I also saw families who brushed their teeth and cooked their food using water from the street ditches. Meanwhile, I witnessed a Brother who gave a big hug to a man with leprosy while I was appalled by the disfiguration of his hands and face and quietly debating whether to drink the sweet tea that this man has just prepared for me. Problems of living can happen at so many levels: the individual, family, and society level. Life can be drastically different for people but there are always ways to make life better.
As a young and novice therapist, I worked with a wide range of clients’ problems, ranging from depression, anxiety disorder, bipolar disorder, suicidal attempts, parent-child problems, marital problems, teenage pregnancy, child neglect, child abuse, just to name a few. Needless to say, it is emotionally overwhelming for a twenty some social worker. I relentlessly sought for more training in working with clients and families hoping to discover, learn, and master some “miracle” techniques to effectively help clients and families to address their diverse, and sometimes, dizzying problems of living. Of course, in my twenties, I probably do not realize that creating change in life requires more than techniques. Life is far more complex and fascinating than that.
I finally decided to pursue my master’s degree at the University of California, Los Angeles (UCLA) and then PhD at the University of Toronto in search for some answers to a simple question that has inspired me since a young age, i.e.; how to create beneficial changes in peoples’ lives. Meanwhile, I received clinical training at the Hincks Institute, Toronto, and later Brief Family Therapy Center in Milwaukee. At the same time, I continued my clinical practice primarily with children and families during these years.
Like many social work professionals, my earlier practice was more influenced by a problem-focused approach to social work treatment. Attending UCLA for my master’s degree surely means I have received lot of training regarding the DSM. I actually interned at the Neuropsychiatric Institute at UCLA and practiced as an outpatient mental health professional after graduation. A significant shift in my clinical practice happened when I was exposed to Solution-focused brief therapy when I was receiving my post-graduate Clinical Fellowship at the Hincks Institute in Toronto while I was doing my PhD. We all learn from our clients and they are our best teachers. I still vividly remember my client who was a single mother with a 6-year-old boy. The school referred her for treatment. The presenting problems as mentioned by my client included: difficulty in handling her child who never listened and destroyed almost anything.
In her own words, most children are angels after they fall asleep. However, Tom kicked her even when he fell asleep. He, further, had a history of setting fire, and touching a young girl who was two years younger than him. Tom was also having problems at school and had just been suspended. My client lost her job and she was on welfare since then. Like a lot of these stories, my client also had a diagnosis of bipolar disorder and had been struggling with her mental health problems since her late teens. In the first session, she appeared to be very guarded, blunt, and vigilant. She was totally negative about any possibility of a positive change in her life or in her boy’s behaviors.
Later I found out that I was the fourth therapist that my client had contacted. She appeared to have a history of dropping out from therapy after the first two or three sessions. For some reason, she continued to see me and by the fourth session, she shared with me something that I still remember unto today. She said that she dropped out from treatment not because she did not need it. She realized that she needed help. However, she usually cried desperately after sessions with previous therapists because what they discussed in sessions was mostly about her problems in handling Tom, Tom’s behavioral problems, and her own problems. She felt so depressed and helpless after these sessions and cried so badly that she did not want to come back again.
I “notice” the power of language in creating and sustaining change. Problem-talk, with the best intention, can still reinforce the problem reality just because clients recite it over and over again. I realize that it is more helpful to focus on what clients do well than what they are lacking. These are simple things, but it takes a lot of discipline for professionals to stay focused, stay simple, respect clients as the expert on their life and listen intensely for their strengths and resources. I think I am drawn to solution-focused brief therapy because its beliefs and assumptions match with how I see people and life. Anyhow, my first book published by The Oxford University Press is “Solution-focused treatment with domestic violence offenders: Accountability for solutions.” It is a rewarding collaborative effort with Adriana Uken and John Sebold at the Plumas Project in California that serves domestic violence offenders using a solution-focused approach since 1991.
Meanwhile, my search for answers to the question “how to create beneficial changes in people’s life” does not stop. Professor Cecilia Chan, a long time acquaintance, invited me to participate in the work of the Center on Behavioral Health at the University of Hong Kong to explore and develop a treatment approach that cross fertilize western techniques and eastern philosophies and practices in creating changes in clients and families. Such collaboration proves to instigate another significant shift in my vision and practice with clients. Working with the clients at the Center affords our team the opportunity to develop an integrative approach that addresses body-mind-spirit in a holistic manner. The eastern philosophies and practices of a yin-yang perspective, Daoism, Buddhism, and Traditional Chinese medicine (TCM) allow me to personally revisit conventional mental health treatment especially in terms of our view of problems, the process of change, and the role of bodywork and spirituality in the healing process. Involvement with this project does not only result in publication such as another book by The Oxford University Press in 2009 or papers in journals. More importantly, I personally witness amazing changes in people when we are able to approach treatment from a more holistic perspective that respects and utilizes the resources and inherent strengths in people. At CBH, they have used IBMSW for cancer survivors, clients with depression, anxiety, patients with chronic fatigue syndrome, just to name a few.
Inspired by the work in Hong Kong, in collaboration with Amy Zaharlick and Deborah Akers from anthropology, we pursued a study that uses meditation for treating female trauma survivors of interpersonal violence. The study was conducted at a treatment facility for homeless women and their children who had substance abuse problems. The study was funded by The Ohio Department of Mental Health to examine the effects of meditation practice on the mental health outcomes of trauma survivors. We are very fortunate to have Geshe Kalsang Damdul, at that time the Deputy Director of The Institute of Buddhist Dialectics at Dharamsala, India, who developed and provided the instruction of the meditation curriculum. I heard inspiring stories from the ladies. One lady shared, two weeks into the meditation curriculum, that she was able to stop cutting herself. She had this cutting problem since she was a teenager and has not been able to stop despite medication and other treatment. Two weeks into meditation, she was able to not cut herself.
I think there are still many things that we do not understand about what helps people make desirable changes. While not undermining the advancement of conventional treatment, one thing for sure is that there are many ways for people to get well that do not require them to continuously rely on professional help nor using medication.
While I am writing this, I am in the process of putting together a study that seeks to compare Integrative Family and Systems Therapy (I-FAST) with drug treatment for treating children and adolescents who have DSM diagnoses. I am fortunate to have the opportunity to work with another group of colleagues in developing and evaluating I-FAST since early 2000s. The Ohio Department of Mental Health supports the evaluation component of I-FAST. Each one of us firmly believes that there are alternative or complementary behavioral interventions to help family who have a child with DSM diagnosis. As a team, we are wary of the understudied long-term consequences of psychotropic drug treatment on health and mental health outcomes of children. We also believe there are effective ways to work with the family to successfully helping these children and adolescent.
The Resilience Study that is posted on my blog is in fact outside my usual research program, which mostly focuses on intervention research. Robert Whitaker has inspired me to conduct this study. He came to the OSU College of Social Work earlier in May and spoke about his work. I see a link between his work and my passion about solution-focused, strengths-based mental health interventions. I think it is important for us to listen to and learn from people who have walked the path so that whatever mental health treatment models being developed will fully embrace, respect, and utilize the inherent strengths and resources of us. Please feel free to check out the link of the Resilience Study or forward to people who might be interested in it.
This is an evolving journey and I am pretty sure that there will be no finite answer to my question about how to create beneficial changes in people’s life. However, I find myself being privileged to be part of this process and journey.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.