O'Grady Psychology Associates

Psychotherapy, Marriage Counseling, Neuropsychological Assessment

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Psychotherapy and Choice: The Journey to the Self

I often hike the trails below Mt. Diablo and am not a stranger to seeing snakes on the path, and have been told that in stretches of certain trails, rattlesnakes peer out from under the rocks. But on a recent hike, I was startled to actually make eye contact with a rattler! It was hiding in the hole underneath this gnarled tree trunk.

While snakes themselves have a rich symbolic history, today I want to talk more about the scary underground place it comes from.

I was reminded of a story I read to my daughters when they were young. The fable inspired lots of discussion in our home, and I believe it was formative for them.

The story was originally told to Rumi, the 13th-century Persian poet.

A caravan of men and camels crossed a desert and reached a place where they expected to find water. Instead they found only a hole going deep into the earth. They lowered bucket after bucket into the hole, but the rope each time came back empty—no bucket and no water. They then began to lower men into the hole but the men, too, disappeared from the end of the rope. Finally a wise man among the party volunteered to go down into the hole in search of water.

When the wise man reached the bottom of the hole, he found himself face to face with a horrible monster. The wise man thought to himself, “I can’t hope to escape from this place, but I can at least remain aware of everything I am experiencing.”

The monster said to him, “I will let you go only if you answer my question.”

The wise man replied, “Ask your question.”The monster said, “Where is the best place to be?”

The wise man thought to himself, “I don’t want to hurt his feelings. If I name some beautiful city, he may think I’m disparaging his hometown. Or maybe his hole is the place he thinks is best.”

So he said to the monster, “The best place to be is wherever you feel at home—even if it’s a hole in the ground.”

The monster said, “You are so wise that I will not only let you go, but I will also free the foolish men who came down before you. And I will release the water in this well.”

Wisdom and Choice

What made the wise man wise? He had a choice. He could go down into the darkness or not. He chose to descend into the hole even though it was doubtful that he would come back up again. He also chose to remain aware. He said, “I can at least remain aware of everything I am experiencing.” He showed kindness and compassion, without an agenda to beat the monster at his riddle. Through awareness and courtesy, he sets free his companions and releases the water.

Healing Comes from Confronting our Difficult, Dark Sides

Symbolically, this story illustrates a path to healing. In psychotherapy, we are often confronted with feelings that come from deep in the unconscious. By taking the difficult route into the darker places within, we can come back with deeper self-knowledge. When people begin individual therapy, they are often hesitant to look at the dark, secret places they keep tucked away. Psychotherapy is an opportunity to dig deeper and to face the darkness within, to remain aware and open to experience in the search for insight.

When we start down the path of self-understanding, we must choose to look at the discarded parts of ourselves. In this process, we can free ourselves from the things that hold us back from being truly alive. No one is without stain—without what seems like a monster inside. It is by entering the darkness that we can release the water, the substance of life, thereby slaking our thirst for wholeness.

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The Fourth Horseman: Stonewalling

"The Great Wall"During lectures about marriage, I have used this photo of the Great Wall of China to illustrate Gottman’s fourth horseman of the apocalypse: Stonewalling.

When we were in China a few years ago, we had the good fortune to see this magnificent stone wall when there were no other people around. It helped that our driver got hopelessly lost, and we ended up going several hours out of our way. But happily, we ended up at this stretch of the Great Wall that was not on the typical tourist path.

Putting up Walls

Walking up the steep steps gave me a view of the entire countryside, but scaling a partner’s emotional wall isn’t that easy. I reflected on why we put up walls and how these walls get maintained over the years. Walls are built for protection—to keep others out—and to keep control. In marriage, partners who have trouble with emotional self-regulation get overwhelmed emotionally, but also physiologically, even if they’re unaware of the raised heart rate and adrenaline that are making them feel literally attacked.  That’s why they put up walls.

Learning to Self-Soothe During Difficult Conversations

Emotionally checking out of the conversation creates the illusion of safety. Ignoring the difficult discussion, looking or turning away, or even leaving the room, puts the overwhelmed person back in control, but doesn’t solve anything. Learning to be aware of uncomfortable feelings, then how to self-soothe and maintain composure, helps partners stay in a heated conversation and also to listen and respond. That way, the discussion can move ahead without getting gridlocked.

A good technique for self-soothing to manage anxiety is Mindfulness-Based Relaxation Training, something I often recommend to clients who want to stop stonewalling. Learning this form of meditation is very useful in helping stay in control, calmly, without having to create a distancing wall—even when discussing the most upsetting topics. 

 

 

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The Four Horsemen of the Apocalypse: Shortcutting Criticism

In the biblical Book of Revelations, the Four Horsemen of the Apocalypse signal the end of the world through conquest, war, famine, and death. The Four Horsemen that Dr. John Gottman’s research has identified as signaling the end of a relationship are criticism, contempt, defensiveness, and stonewalling—communication styles that threaten a marriage’s health and longevity.

When I first see a couple for relationship counseling, I assess their communication behaviors by using a set of questionnaires developed from the research of Dr. Gottman. To evaluate criticism, for example, each client answers yes or no to statements such as “I feel attacked or criticized when we talk about our disagreements” or “My partner uses phrases like ’you always’ or ’you never’ when complaining.”

Defensiveness is seen in statements like “Many of our issues are just not my problem” or “I have to defend myself because the charges against me are so unfair.” Statements such as “I try to point out the flaws in my partner’s personality that need improvement” or “I feel disgusted by some of my partner’s attitudes” assess contempt. Stonewalling is when one partner just tunes out and ignores the other, usually after a barrage of criticism. Putting up a wall of silence is an attempt to protect the stonewaller from getting flooded by physical and emotional over- reactivity. Of all the Horsemen, Dr. Gottman says this is the most likely to end a relationship.

The good news is that each of these Horsemen has an antidote. The first step is recognizing these interactions when they occur. Often when couples are stuck in a cycle of negative communication, each person is unable to see his or her own part in the problem. But with gentle coaching, clients learn to notice when they are criticizing, being contemptuous, on the defensive, or stonewalling.

Next, I show couples alternative ways to expressing themselves by using a specific antidote to each Horseman. Today, let’s talk about the antidote to criticism.

Learning to complain without blame is key to short-circuiting criticism. Any relationship may give rise to legitimate complaints. But the key to avoiding defensiveness in your partner is to complain in a way that does not place blame.

The formula is pretty simple: “When _________ happens, it makes me feel____________. What I would like from you is_________________.” For instance, when Judy says to Mark, “You’re always putting your parents’ needs before mine. You’re such an inconsiderate jerk,” the likely response from Mark might be, “I do not! And if I do, it’s because you don’t take any time to connect with them, so I have to do it all!” Placing blame just engenders defensiveness, continuing the cycle of criticism.

Helping Judy to find a different way to express her feelings might sound something like this: “Mark, I miss feeling connected to you when we are with your family. Do you think that this weekend when we see them, we can stay close? It would help me if you’d check in with me every once in a while.”  In this version, Judy takes responsibility for her feelings and then asks directly for what she wants without making Mark out to be the bad guy. Mark, in turn, can listen to Judy’s request without feeling he has to justify and defend.

Antidotes to the other three Horsemen will be taken up in another post. But understanding how these concepts affect communication in marriage goes a long way to helping couples manage conflict.

 

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How Dyslexic Students Learn to Read

How Dyslexic Students Learn to Read

Researchers have discovered that children learn to read successfully when instruction includes certain basic elements.  For dyslexic students, it is essential that students receive instruction tailored to their particular needs.  Instruction must be at their level (not too advanced), and it must be intensive (at least 90 minutes per day), and systematic (not loose or inconsistent).  It must be offered in small groups (1 to 3 students per teacher).  Instruction must focus on reading practice (not vision training or movement therapy).  The particular method of instruction is probably less important than the level of experience of the teacher. 

Because each dyslexic student is unique, everyone requires a different strategy. An individual education plan (IEP) should be created for each child with the condition.

The following may be recommended:

  • Extra learning assistance, called remedial instruction;
  • Private, individual tutoring;
  • Special day class or pull-out resource class;
  • Enrollment full-time in a school designed for children with learning disabilities.

Effective instruction must include the following:

  • Specific focus on phonemic awareness—identifying and manipulating the individual sounds in words (like rhyming sounds, ending sounds, and breaking words into syllables);
  • Phonics instruction—teaching relationships between the letters and individual sounds of language—which must be systematic and explicit;
  • Provide students ample opportunity to apply what they are learning about letters and sounds to the reading of words, sentences and stories;
  • Fluency instruction—to get better at reading accurately and quickly, which leads to better comprehension.  For example, reading aloud the same passage repeatedly, while being monitored by a teacher or parent, improves reading fluency and overall achievement more than silent independent reading;
  • Vocabulary instruction;
  • Text comprehension instruction—teaching students to be aware of what they do understand, what they don’t understand, and use appropriate strategies to fix problems in comprehension.

How parents can help.  In my experience, parents are especially hungry to know what they can do themselves to help their child get better at reading.  They want to know what techniques help the most, what they can do to build motivation and interest, and what they can do to decrease frustration.  Here are a few suggestions for reading practice at home with young children (1st -3rd grade):

  • Reading practice should occur daily for 20-30 minutes.
  • Sit together and have the child read aloud to you.  “Shadow” your child, that is, prompt your child with help whenever the child stalls or stumbles, so you keep up a good pace.  Here and there make your child work a bit to sound out hard words, but don’t make your child labor too much.  Keep it moving.
  • Build fluency by re-reading passages several times.  Do this every day.
  • Take some time to read aloud to your child while he or she follows along with the text.
  • Build comprehension by pausing to ask questions, review, and anticipate what will happen next.
  • Select books that are interesting and engaging.
  • Watch your tone of voice—it sets the tone for the reading practice.  Stay upbeat.  Avoid conveying impatience, even when your child struggles or gets discouraged.  If you feel like it’s becoming a battle, take a break; try again later.
  • Give audiobooks a try.  In my family, listening to audiobooks on long car trips became a beloved tradition and ignited in my daughters a fiery passion for books.  Audiobooks strengthen attention span and comprehension.  The library has free books on tape/CD, and you can buy titles through iTunes and audible.com.

It’s not easy, but dyslexic students can learn to read and go on to become successful students.  Research clearly shows that systematic programs can significantly improve core reading skills in the weakest readers in first and second grade. It is more challenging to bring older children (after second grade) up to expected grade levels once they fall behind, although significant improvements in reading can still occur.  Improvements are much easier to achieve for accuracy than for fluency. One clear conclusion from educational research is that intensive intervention is best started when the child is young.  Waiting is costly.

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How is a neuropsychological assessment different from an assessment done by the school district?

How is a neuropsychological assessment different from an assessment done by the school district?

I have been contracted by nearby school districts to conduct independent assessments of students, and I have provided training and consultation to many local school psychologists and counselors, so I have a solid understanding of how the special education process works.   School districts are required by law to evaluate children for special education services if a child’s academic progress is significantly below grade level.  The school psychologist may administer intelligence tests (IQ), and tests of other cognitive skills.  A speech therapist might assess the child’s speech fluency as well as other aspects of language expression and comprehension. A learning specialist administers standardized tests of academic skills—reading, written language, and math.

The neuropsychological assessment is similar to the school assessment, but more detailed.  Typically, it covers everything the school assessment does (except speech articulation), but it goes into greater depth in examining various aspects of cognitive processing.  It is more “brain oriented,” in the sense that it starts with a fundamental understanding of how children’s brains work when they are learning and processing information.  The neuropsychological assessment aims to create a picture of how the child learns best and identify the specific areas of weakness that lead to problems in learning. We closely examine many different kinds of thinking skills, from very simple, elementary skills to very complex, high-level skills.

For example, the assessment will evaluate the child’s abilities in auditory attention, visual-spatial processing, visual-motor integration, phonemic processing, memory, attention span, and executive functioning (planning, organization and inhibition).  The results of this evaluation are then applied to an analysis of the child’s skills in reading (and other academic skills).  This way, a comprehensive set of recommendations can be made to help the child succeed in school.

Some other differences:

  • The neuropsychological assessment is usually more extensive and detailed than the school assessment.  The neuropsychologist can diagnose ADHD and related mental health conditions; the school psychologist cannot make these diagnoses.
  • The neuropsychologist can evaluate any child with learning problems—mild or severe—but the school often refuses to evaluate the student unless the student has already fallen significantly behind typical classmates.  So, the neuropsychologist is able to catch learning problems earlier.
  • The neuropsychologist works independently of the school district and is free of budgetary considerations.  The neuropsychologist can also make recommendations for services or treatment not offered by the school, or even recommend a private school placement, but the school psychologist is limited to recommending services offered by the school.  For these reasons, some parents feel that the neuropsychological assessment offers a more independent opinion about the child’s learning needs.
  • The school district assessment is done at no cost to the parents.  The neuropsychological assessment is paid for by the parents. It is sometimes covered by insurance if there is a suspicion of an underlying medical disorder, but health insurance usually does not cover “learning disability” assessments.

Parents can submit the results of an independent neuropsychological assessment to the school district as part of an IEP process to determine whether a child is eligible to receive special education services.  The school can rely upon the neuropsychologist’s findings to make decisions about the child’s placement and instruction.

Continue to my next post to learn about the interventions that can help dyslexic students learn to read.