Category Archives: Uncategorized

May 24, 2015 · 9:24 pm

The Roots of Prejudice

The scarier prejudices are those that don’t recognize themselves, followed closely by those that don’t apologize. The second category, if it is malleable, calls for individuals to see reason, be open to contrary experience, which is difficult enough; that is, hard work for anyone. But challenging such a blockade is still easier than calling out the prejudice that isn’t even understood as one.

There are plenty of words representing ideas that are invoked to protect prejudice. Take the word trauma for example. There’s a word which is used on a regular basis to explain reactions to a past event, or set of events. Look up the diagnosis of PTSD (Post Traumatic Stress Disorder) in the DSM (diagnostic standards manual of the American Psychiatric Association) and you’ll find reference to numerous symptoms, falling under three sub-headings: re-experience, avoidance, and increased arousal. When an individual is faced with a stressor, he or she experiences flashbacks, bad dreams, the desire to avoid certain places, people; hypervigilance and agitation in stressful situations. When the trigger is the pace of traffic for a car accident survivor, or the turmoil of a returning soldier, then the assessment of trauma seems appropriate, the prescription of avoidance seems natural, even common sense.

But what happens when fear of a stressful event is conflated with fear of the events’ principal figures, especially if those figures represent distinct social groups? Currently, I observe a disturbing trend in my work, as well as in my community: the prerogative to disparage police, lawyers; representatives of “broken” systems, medical and administrative. I notice that when threatened, individuals launch into fierce diatribes, reducing people in these professions to caricatures, while paying thin lip service to the possibility of error (“I know there are some good cops”, said a man I listened to recently). You might think this constitutes that small space for understanding, as I suggested earlier. But I don’t think so. At least, when there is such awareness, it seems fleeting, and more importantly, outwardly-directed—the worry about what others might think, but not so much an integration of feedback.

A broader understanding of trauma, or its cousin prejudice, lies beyond the medical dimension, within the theoretical realm of the unconscious. In asserting this, I am aware of leapfrogging the conscious derivatives of prejudice, that which is attributed to socialization over time. While I don’t dispute the impact of calculated teaching, or “modeling” as it is also dubbed, I rather think that the roots of prejudice lie in a capacity for splitting, as Melanie Klein first conceived (building upon the writings of Freud) in the 20s and 30s, and in the strange vicissitudes of psychic energy, which call for binding. Splitting is a primitive defense: a habitual impulse towards segregating love and hate that is innate, thus creating a template for good and bad, which provides humankind with both a moral lens, but also a harsh, distorting, discriminating eye. Latterly, modern theorists like Masterson devised maps of intrapsychic structure, which delineate the pathways taken as a result of splitting. Within such maps individuals can potentially see who is who (in terms of what is experienced affectively) in the equations of relationships, and begin to question a presumed reality.

Present-day mental health services addresses social prejudice in an oblique way: by urging separation, boundaries; “tools” for people to use, to enable calming, the quickest paths to safety. Ironically, the oblique path is more accessible for the average sufferer; the methods of choice are more utilitarian. They speak past the core traumas, prejudices, leaving well enough alone lest its practitioners offend those who have already fixated on truth. Therein lies some kind of cycle, I think, which is difficult to interrupt. That’s scary also.

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April 16, 2015 · 6:51 pm

Saving Thunder Road

In a recent article in the Contra Costa Times, journalist Malaika Fraley writes that Thunder Road Adolescent Treatment Center in Oakland is scrambling to stay open. She reports that TR’s longtime operator, Summit Medical Center, has been planning to sever ties with the program for two years, due to annual running costs of the residential drug rehab and plus facility in excess of $6 million, yearly deficits of $800,000, and declining admissions. Well, I think that conversation’s been happening for much longer, actually.

I worked at Thunder Road for fifteen years, between 1996 and 2011. I chronicled my time, what I observed, what I think treatment for substance abuse and teens entails, both from a research and personal perspective, in a book I published in 2013, entitled Working Through Rehab. Among other things, I remember that threats to the program’s viability started around 2004, and continued periodically thereafter. When I left TR in 2011, I’d worked most clinical positions in the program, seen various changes to program structure, tweaks of philosophy and methods, etcetera, and held the view that TR had been “scrambling” for some time. I am sympathetic to its latest bid for survival, and for the prospect of retaining “the only program of its kind” for Bay Area, and especially East Bay, Alameda residents.

But what is the meaning of this latest, perhaps most threatening of crises? If the community wants drug treatment for youth; if it believes that drug abuse, gang violence, physical and sexual abuse, child abandonment, are ills damaging the community, where is the ongoing support for programs like Thunder Road? Why were admissions declining? Where is the city leadership, the rally of business sponsorship that would spare a thirty year old institution from this desperate position? At the risk of disparaging efforts that may yet come to fruition, I wonder if there is enough conviction to save Thunder Road; if there exists a muted rejection of drug treatment in the community as a whole.

An overview survey from 2014 by the National Institute on Drug Abuse (NIDA) reveals some interesting trends. Use of illicit drugs has generally declined over the past two decades: decreasing use of alcohol, cigarettes, the misuse of prescription pain relievers; stable rates of marijuana use among teens, but perhaps more importantly, changing attitudes about the perceived risk of harm associated with marijuana use. 36% of adolescents say that regular use puts users at great risk compared to 52% just five years ago. In other words, a majority of teens no longer think marijuana use is significantly harmful, which begs the question: what becomes the pretext for treatment, especially a residential admission, if this attitude prevails? Aundrea Brown, who runs Alameda County’s public defender’s juvenile division, states that Thunder Road is an essential placement alternative to juvenile hall (according to the Times article). The Save Thunder Road petition site says something similar. But I suspect many citizens of Alameda, the county that TR now dominantly serves, might reject the implied dichotomy. They’d surely rebut that neither alternative should exist; that a society moving towards legalization of currently illicit drugs, and that deems K2/spice, painkillers, e-cigarettes (according to NIDA, the only major substance whose use is on the rise) as effective, acceptable mood-altering substances, should leave well enough alone.

I hope the county is able to broker financing for a provider (or coalition of providers) to take over care of Thunder Road from Sutter. On balance, I believe what the program brings is a valuable service to the community, though it undoubtedly needs reform. But a broader question needs to be aimed at the community, in schools, churches, within board meetings and without: what do you really want to do about drug use?

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April 7, 2015 · 9:04 pm

My not day in court

It was first supposed to happen on January 30th, but it was canceled the night before. My court appearance, my testimonial witnessing of percipient–that is, merely factual information–which had been compelled by a subpoena sent in the mail versus personally delivered, had been continued; that is, delayed. “Good news” exclaimed an unctuous junior prosecutor. “You can go about your day”. Thanks, I thought. So, the three or four appointments I’d canceled to make way for a hearing that might have happened at any point in a three hour window: I could call all those people back and re-instate their sessions could I? His name is/was Chad, and I never got a chance to pose this flippancy. I have history with guys named Chad. They tend to have girlfriends named Brittany or Saunders.

I hoped this was over, but knew it wasn’t. For the next subpoenaed appearance for the same case, I placed clients on stand-by, telling them I might make it the next day, or I might not. They were all nice and understanding, about which I felt lucky. After all, it doesn’t work in reverse. I have a cancellation policy and can’t operate on the basis of appointments that might happen. Anyway, my situation was unusual, so I deserved the benefit of the doubt, I think. Meanwhile, by this time, I had secured the services of a lawyer through my malpractice insurer, someone who would investigate the trifling details, the dense penal codes that would explain why subpoenas require personal service in some cases and not in others; why summons to some courts call for reimbursement of witness’ time, while others don’t. Above all, I wanted my lawyer to contact the public prosecutor (no longer Chad the second time around, due to a tag-team arrangement in their office, apparently), speak whatever dialect these people speak, and release me from an unnecessary “live” appearance.

It wasn’t that I didn’t care. The whole time this was happening I stayed mindful that my inconvenience would pale in comparison to the troubles of my client. I won’t go into details, partly because of confidentiality, and partly because the nature of his offense might prejudice the reader. Trust me that his incarceration, which continued in another sense throughout this period, was triggered by a technicality, though it stemmed originally, and inevitably, from matters relating to sex. So it was a criminal matter, and half-beknownst to me, criminal courts have more authority than civil ones. I was an unpaid servant at their beckon call, I guess, but it still didn’t make sense. I’d dealt with criminal courts in the past, in different contexts, often writing them letters which detailed the elements of treatment, percipient and not. But all the prosecutor wanted in this case was the basics of attendance; nothing else?

My lawyer didn’t buy it, but pledged to get to the bottom of the matter. She figured that live cross examination would begin with percipient questions, when and how often my client had attended therapy, but would then slip in questions calling for opinions, hoping to slide past the complications of an agreed upon expert testimony. However, much to my lawyer’s surprise, the DA stuck to the official position, insisting upon percipient information alone and adding that second hand information (reported by probation via my reports to them) was “unreliable”.

Interesting. Had a P.O. lost the reports? Were they shooting from the hip in response to questions? The competence of law enforcement was quietly in question, while I, and especially my client, would bear the burden, it seemed.

The second appearance was also continued. This time I got two hours notice, which was obviously too late for my clients to accommodate. On the back of this irrefutably unfair event, I was granted permission to write a more thorough letter, supplementing attendance reports with sign-in sheets, thus excusing me from court following a third subpoena for a hearing now past. My client’s still in jail, his program needlessly interrupted, which is a sadly common event for those mandated into care.

http://www.stopAB1775.org

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March 15, 2015 · 4:24 am

A Distrust of Heroes

I hadn’t expected Birdman to win best picture. Seriously, I thought American Sniper had a chance, plus the films about Stephen Hawking, Alan Turing, Martin Luther King. I thought Boyhood might win, partly because of its original idea: the filming of a child’s coming of age, shot intermittently over the actual period of growth for the child–12 years. The other reason had to do with heroism, the type of heroism assigned to parents contending with everyday realities, stressors, over time. The film seems to appeal to a mass audience looking for itself on the big screen; a validation of all that’s difficult in life. And this seems to me a prerequisite quality for widely accepted, as in successful popular art.

Not so much, according to the academy voters, much to my surprise. Of the best picture nominees, Birdman wasn’t the only film without a chance of winning as far as I was concerned. The others were Whiplash (my favorite film of the year, actually), and The Grand Budapest Hotel, which should have won all awards were a strict aesthetic criteria being applied. Prior to the ceremony, about which I had only passing interest, I did not fashion a particular reason for my prejudice, but afterwards observed the ground rules I’d summarily applied. Of all the films nominated, it occurred to me that none of my three non-contenders presented with conventional heroic themes. Grand Budapest Hotel is essentially a comedy and thus didn’t stand a chance of winning best picture. The protagonist of Whiplash appears potentially heroic at the outset of the story. Miles Teller’s manic drummer boy seems quiet and sweet, but soon betrays an obsessive, narcissistic edge which ultimately renders him the equal of his brutal teacher. We cheer for the Andrew Neiman character, but the drama is his own and no one else’s. Meaning, what he does he does for himself. The same is more or less true of Riggan Thomson, the protagonist of Birdman, who adapts a play for the Broadway stage, bravely invests all his money in the production; has left the comfy cash-cow of Hollywood, splitting from the gravy train of a bizarre superhero character. It all sounds winning, if eccentric, but as I watched Michael Keaton and director Inarritu collecting their award, I wondered what fans of the other films were thinking. After all, if your favorite film of the year was about America’s most celebrated civil rights leader, or the greatest scientific mind of his generation, or the man who supposedly cracked a Nazi code and won WWII, or if, more topically, your film recognized the plight of the embattled American soldier overseas fighting terrorism, then you might have looked upon Riggan Thomson and thought, so what.

I felt quietly refreshed, for as a film buff, I peruse the history of Oscar winners over the decades and observe that conventional hero figures usually win the day. But they’re often missing from my list of favorites, because I prefer unlikely heroes, or even protagonists who don’t even seem that way, because most of us don’t. This is why Bryan Tecco, my protagonist of The Situation, had to be a drug dealer and a slob. He had to seem self-absorbed, even callous. Because he goes about his life as most do–trying to get by–his gift to society is what the oligarchs of capitalism intend. It is preordained but stumbled upon, like Bryan’s near drowning at the outset of the novel. It is an accident.

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February 21, 2015 · 8:14 pm

Flight Of Icarus

Woke up feeling light, thought I could fly, went for a jog instead. Stay grounded, I thought. Am I the anti-R Kelly? He’s referenced in the film Birdman, which–it was suggested–I should write about. Therapists, I replied, should write more about films, art in general. So I will.

Riggan Thomson, played by Michael Keaton, sits in his room (levitating, actually), looking like he woke up on the right side, also feeling light, though he is yet to take off. Nor is he grounded exactly. The earth, his world,  seems too constrictive for that. Within moments, his meditation is broken and he is stomping through tight hallways, talking frenetically with anxious producers, a broadway debutante actress, as well as a second actress, his apparently pregnant girlfriend. He is less conversant with his recovering addict daughter Sam, played by cat-eyed Emma Stone, who brings serious chip to her chip-on-the-shoulder role. Thomson is a mess. He is washed up, an ex-superhero star (The Birdman) who now seeks respectability and depth in Hollywood’s darker sibling, the theater. And the culture of theater is less glamorous: it is dirty, claustrophobic, and peopled with either non-entities (the anonymous stage crew), or the impossibly self-absorbed. Thomson at once fits in and doesn’t, but he’s bought in. In fact, he’s invested all he’s got into this play which is an adaptation of a short story by his one-time idol, Raymond Carver. So committed is he that he’s willing to assault, perhaps even kill the mediocre actor who is fucking up rehearsals. In this respect, he is no less driven than the abusive Terrance Fletcher character from Whiplash, though he seems more transparently fragile–insecure, even psychotic.

The Hollywood past doesn’t leave him alone. It stalks him in the form of hallucinations, the Birdman alter-ego whose appearances bring to mind the imaginary friend character of Beautiful Mind, though unlike that film, it’s clear from the outset that Thomson is–what?–at least troubled. But he’s not alone in his craziness, which makes things very interesting. All of the support characters are fucked up also, to more or lesser degrees. One character who seems even crazier than Thomson is Mike Shiner, played by Ed Norton. Shiner is the man Thomson might have been ten years earlier: cocky, gifted, uncontrollable, exhibitionist in all ways, so out there that he disguises his underlying fears, of inadequacy and impotence. His act, both on and off stage, is ingenious, and in an oedipal/electra nod, Sam is of course  drawn to him.

Shiner’s addition to the play brings it to a new level. He is box office potential, but also hip, in with the critics, who seem to despise Thomson, especially a bitter, spinster-like figure who hangs out in a bar across from the theater, awaiting his opening night like a vulture. Meanwhile, the previews, as in that strange, half-price experimental stage of live production, are falling apart. But that’s okay according to Shiner, who schools the outsider Thomson on what is important, what is real. What evolves is a play that dissolves the fourth wall between artist and audience, just as Keaton and director Inarritu flirt with our wall with their Birdman/Batman parallel.  The climax of this path is an accident. In between scenes during the last preview, he heads outside for a smoke break, but locks himself out of the theater. Next, he is wandering through Times Square in his underwear, dodging onlookers and voyeurs in what becomes a serendipitous publicity sensation. This wasn’t what he wanted, however, and afterwards he confronts the hateful critic in the bar, appealing to her sense of fair play, her compassion for the struggling artist. But she’ll have none of it. Convinced he is a charlatan, she pledges to “kill” his play.

At this point everyone–Shiner, Sam, the producer, cast and crew–think he’s delusional, not dealing with reality, though they don’t know the half of it. With opening night upon them, Thomson has one more trick up his sleeve, one more flight of fancy: an on stage suicide that will blow everyone’s mind, even Shiner’s, as well as his brains out. It doesn’t come off (actually, only part of his nose comes off as a result of the on stage gunshot), but the play does, and even the hateful critic can’t resist the uberrealism, ultimately giving Thomson  a rave review. The following day, he is in hospital, recovering from his wounds; meanwhile, the press, the internet public, his producer, are all excited because the play is a triumph. Thomson is not excited, however. Ambiguously disappointed, he removes his bandages, inspects his face in the mirror, and steps out the high rise hospital window. This possibility, of Thomson’s suicide, persists throughout the film and remains until the last shot, wherein we see Sam gazing out the open window, first in frantic abandonment, then in wonder. She believes he can fly.

If you’ve ever felt like a poseur, a madman or woman, a capable person but sometimes a dufus, you should like what Birdman is about. Check it out.

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February 12, 2015 · 8:35 pm

Statement To The Recruits

In a recent statement to the membership of the California Marriage and Family Therapist Association (CAMFT), association lead counsel Cathy Atkins issued guidelines for members regarding the controversial new law AB1775. It’s an interesting report featuring answers to questions posed by members, numerous interpretations of intent, none of them explicated in the Penal code, but leaving therapists and other mandated reporters (not to mention our clients) still wading in ambiguous waters.

* Firstly, it’s good to read a (sort of) acknowledgement that AB1775 is much more than a legal addendum designed to keep us all in touch with advancing technology. It is in effect a re-definition of sexual exploitation, to include the viewing of child porn (CP) alongside a pre-existing definition that was previously  confined to its production and distribution.
*Cathy’s guidelines addresses what I’ve called the conflation of child porn viewing into a definition of sexual exploitation by pointing out that the words “downloading” and “accessing” could be interpreted as meaning the exchanging of files, and so the additional language is designed to reinforce the original Child Abuse and Neglect Reporting Act ( CANRA) laws. She suggests that police will not investigate the mere “downloading” or “streaming” of child porn, and implies that law enforcement will take into account a therapist’s opinion as to whether CP use is “stumbled upon”, whether there are  “factors to be weighed” (such as a spouse’s contrary characterization of CP use), or whether CP use will lead to direct harm of a child. In short, she suggests that therapists will have discretion  in their reporting and that social services/police will take into account our opinions about our clients, but warns that said discretion will not protect us from liability, or even prosecution.
*Hmm? Do we accept this explanation? I’m dubious, obviously. Firstly, I think it likely that police will think that therapists who dispute potential direct harm to children are merely advocating for their clients; that police will not think the viewing of porn is “accidental” simply because we think it is (and wouldn’t such reports be a nuisance?); that police will think the viewing entails (or has entailed) exchanging by virtue of the aforementioned technological advances/nuances related to the internet, and will thus have a pretext for investigation, plus the ensuing legal fall-out, leading to disruption of existing therapeutic episodes, not to mention child abuse prevention efforts,  via the hegemony of the CASOMB system (an issue not referenced by Cathy), as I have described in previous messages to the CAMFT e-tree. So much for therapist discretion, I think.
*Also, I think police are likely to agree with the 2012 US attorney general’s opinion that viewing CP alone does indeed constitute exploitation because the viewer is judged to be aware of the abuse depicted in the CP. And since a therapist becomes aware through client disclosure, then that knowledge of the abuse in turn triggers the obligation to report. The logic here is as follows: we are witness to someone who has witnessed abuse, and because we don’t know the victim we report the witness. Next, Cathy warns that if a therapist is aware that a client has accessed pornography, fails to report that use, and the client later abuses a child, then the therapist may be held criminally responsible for the failed report of possession (or viewing, I guess). BTW: unless a solid correlation exists between use of pornography and direct contact child abuse, then this argument validates the use of prejudice as tantamount to reasonable suspicion–another form of conflation. Otherwise, we should be making Tarasoff reports (pertaining to reports of threats made against others) if our clients report owning copies of American Psycho. More topically, perhaps, are we to infer risk to others if clients are enamored with 50 Shades Of Grey? This law, or the interpretation of it,  thus strikes at the heart of the “imminent risk” principle of exception (of when to break confidentiality), so central to an understanding of the original CANRA laws. Oblivious, AB1775 supporters promote an inference (which belies current research, actually): that viewing of porn will lead to child abuse, or might; and that “might” is sufficient to trigger a process that will leave those tentatively disclosing clients wondering what, if anything, they will ever again share with a therapist.
* So it seems like glibness to assuage members that all will be worked out, and that AB1775 “does not affect the standard of intent of the CANRA statute” . We are not investigators, Cathy reminds us. But we are encouraged to do due diligence to protect children which, as the tautological thinking unfolds, invariably connects the viewing of porn with actual harm to a child. The bill’s author, Melissa Melendez, and others, want police making the distinctions between the accidental users, the regular users, and those relative few who will use CP and also directly harm children. Not the lawyers at CAMFT. Not the researchers. Not any mental health professionals. Not us.
We are the recruited.

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February 1, 2015 · 9:23 pm

Four Star review of The Situation

Fewer words from me this week, more quiet satisfaction. And so, a guest blogger of sorts. I’ll read along

https://www.forewordreviews.com/reviews/the-situation/

Affirmation at last

 

Graeme Daniels, MFT

 

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January 17, 2015 · 9:57 pm

Why I don’t do free consultations

Recently I had a call from a prospective client looking for a therapist. He and I had one or two phone exchanges, discussing my approach, plus logistics like schedule, insurance matters and fee. At the end of the second call, which, like the first, lasted minutes, we agreed upon an appointment time and I indicated my fee for a first session. The caller balked, saying he’d hoped for a free consultation, and adding that he’d seen numerous therapists over the years, all of whom had offered an initial free session: a “screening” he called it; a “feeling out process”, seeing if we’d “connect” he added. I was dubious about his claims.

I replied that, contrary to his personal experience, free consultations are not a norm in psychotherapy, though some, perhaps many, do offer a free session at the outset. I added, pleasantly I hope, that the assumption of a free consultation was inappropriate for various reasons, not least of all because a therapist’s time, which is actually our only reimbursable commodity, is not free. The caller gently deferred on this point, but asked to call me back as to whether he’d make an in-person appointment. I sensed that his shopping had yielded other willing participants in the free service department, and that I’d not hear from him again.

Indeed, we did not meet. So, for those who have received free consultations from therapists, or who might think them appropriate, if not a standard of the profession, I will now explain why they are not.

Firstly, returning to the earlier point, a therapist’s time is his or her only reimbursable service. Meaning, there is no commission placed upon an individual’s mental health. That said, if anything, therapists might reasonably raise fees if a person’s circumstances improve, as they may be an indicator of a person’s growth and the therapist’s good work. To put it another way: why shouldn’t therapists, like everyone else, merit a raise from time to time?

Secondly, if a therapist doesn’t receive a fee, then he or she is simply giving away their time. If a private practitioner, there is no agency, hospital or other institution that will absorb the cost of the therapist’s time; not PTO that will pay for an un-reimbursed hour, and the opportunity cost of the “free” time cannot be written off taxes.

Well, what of the ideas tabled by that caller? You might ask. What’s wrong with the idea of “feeling out a therapist” as he put it; checking to see if a “connection”, a rapport, seems apparent before making a commitment to actually engage in therapy. My answer is as follows: an opening session may be a breezy, shopping encounter for a would-be client or mental health patient, but it is not and cannot be such for any mental health professional. From the outset of an episode, even during an initial telephone exchange, therapists incur responsibilities, legal and ethical–what’s called fiduciary terms–which are rivaled by few other professions. Take confidentiality, for example. That responsibility, to keep client material private, kicks in before therapists even meet their clients, when they are speaking by phone. Why? Because if I receive a later phone call from that caller’s girlfriend, for example, who wants to give background for a prospective therapy, contribute to the intake process, it’s not as though I can exchange information with that person. In a first session, in which a client may be deciding if there is a connection, a therapist must make certain assessments: is the person in danger? Is psychotherapy even appropriate for them? Are they suicidal, a danger to others, and what are the recommendations for other treatments that will best serve them? This is not a feeling out process. It is work; it requires years of education and training, and it’s not free.

Free consultations, a kind of coupon therapy, does occur in our business, and a therapist may ethically choose to work for a significantly low fee with someone of especially low means, or pro bono with someone who cannot pay at the outset of an episode. But, of course, we can’t do this with many people, and with most the practice is inappropriate, especially if done for business reasons: a teaser of free service, designed to entice customers; ideas borrowed from retail culture. Such gestures can contaminate therapy, creating tacit dependencies that likely undermine therapeutic goals, enabling false understandings as  to the nature of therapist-client relationships.

 

Graeme Daniels, MFT

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January 10, 2015 · 8:01 pm

New Changes to Child Abuse Reporting Law

Graeme Daniels, MFT 

            In August of 2014, the California legislature passed bill AB1775, which stipulates important changes to the Child Abuse Reporting Act, and was apparently sanctioned by CAMFT(and conveyed to CAMFT membership the same month), despite objections by the National Association of Social Workers, which reasonably argues that AB1775 will stymie therapeutic disclosures and hamper child abuse prevention efforts. This law went into effect on January 1st of 2015. Ostensibly, AB1775 calls for all mandated reporters to report instances of child pornography to authorities, social services or police. Legislative author and state assembly woman Melissa Melendez, who authored the bill (it was actually written by lawyers for CAMFT–The California Association of Marriage and Family Therapists in concert with law enforcement and child advocacy groups), pledges to crack down on child pornography, though the impact of the law is likely more far reaching.

To explain: pre-existing law dating back to 1980 (the once Child Abuse and Neglect Reporting Act, or CANRA law) stipulates that mandated reporters alert authorities to sexual exploitation, material that depicts minors engaging in obscene sexual conduct, through the mediums of film, videotape, negative or slide. The language of AB1775 is updated as followed: “sexual exploitation includes downloading, streaming, or accessing through any electronic or digital media, material in which a child is engaged in an act of obscene sexual conduct.” Meanwhile, Penal code 11165, subsection 311.4 defines obscene sexual conduct as, among other things, “exhibition of the genitals for the purpose of sexual stimulation of the viewer”, as well as lewd and lascivious acts, which are further defined in subsection  288.2 as that which depicts touching intimate parts of the body, including “buttocks of a person and the breasts of a female” (subdivision d). The law further removes the need to observe an “identifiable victim”, as is typically required by social service investigators. Thus, the idea is not to protect victims per se, but rather to capture those who view obscene material, and engage therapists as informants. **But if you work with adolescents in particular, note the word minor (meaning under age 18), the reference to “electronic or digital media” (i.e.: cell phones and computers), and the language of the penal codes, and understand why sexting, for example, is now reportable under the law.

Of course, the issue is bigger than that. A person who discloses to you that he or she looks at teen or preteen pornography, who is perhaps seeking help, afraid they might hurt minors more directly, must be reported to Child and Family Services, who will likely defer to law enforcement investigation due to lack of identifiable victims. As an experienced sex addiction/offender therapist, let me describe the likely fallout: arrest, incarceration, loss of job, estrangement from peers, family, possibly lifelong registry on a public sex offender list. Next, because sex offender treatment is under the exclusive authority of The California Sex Offender Management Board (CASOMB), which certifies providers, YOU WILL LOSE CLIENTS that you report if you’re not certified. Finally, for those who recall the CAMFT Bylaws debacle of 2013, observe that once again CAMFT has co-signed an initiative that will bind its vast membership without actively engaging that membership in the process. Don’t be taken for granted! Discover research by Dr. Karl Hanson, whose work distinguishes child pornography users from child predators (versus conflating them), become educated as to the implications of this short-sighted legislation, and learn through the website, www.stopAB1775.org, how we can block it.

Graeme Daniels, MFT

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December 28, 2014 · 2:38 am

Good Enough

It’s a holiday giveaway, these free books (almost, but not quite free if you click on the link). A year after it’s initial publication (actually, closer to a year and a half), I’m looking to stir interest in my non-fiction and memoirish work, Working Through Rehab: An Insider’s Look at Adolescent Drug Treatment. This latest giveaway comes upon the heels of a workshop I recently taught–an overview of the disorder of self model created by James Masterson, that I provided for interns at a community mental health setting. Masterson’s work, referenced minimally in most training programs these days, is referenced centrally in WTR, as a guiding set of principles for what might happen in community or residential treatment settings, especially those straining to incorporate psychodynamic perspectives.

The difficulty is outlined in one of Masterson’s final works, The Personality Disorders: A New Look (published in  2000), in which he reviews the various methods used to treat Borderline Personality Disorder, as well as concomitant conditions such as Bipolar d/o or PTSD, and bemoans the dilution of intrapsychic focus in favor of pragmatic and utilitarian approaches. Like many, Masterson points out that modern neurobiological research has determined that a child’s brain increases 2 and 1/2 times in size during the first year of life, suggesting an “experience-dependent” growth pattern tied to a dynamic between caregiver and child–that the role of a caregiver is that of regulation; regulating the immature psychological systems which influence biochemical growth.

Masterson’s contemporaries, Otto Kernberg and Heinz Kohut, suggested more or less competing models for the treatment of individuals who suffer from development dysfunctions such as BPD. Kernberg drew from ideas put forth by Melanie Klein by indicating a constitutional excess of aggression on the part of such patients, with maternal or caregiver interaction playing a less influential role in his model. Like Masterson, Kernberg recommended an expressive psychoanalytic psychotherapy in treatment, but one that favored a focus upon transference interpretations, with insight into such interactions promoting integration, and thus growth. Masterson disagreed, thinking that confrontation of ego defenses, particularly regressions designed to ward off what he termed “abandonment depression” (as in an abandonment by a primary object) was the central task of psychotherapy. In Masterson’s view, interpretations prior to containment of defenses, or the establishment of therapeutic alliances, were ineffective. Meanwhile, Heinz Kohut, in whose model I was initially trained in the nineties, recommended an approach that drew attention to patients’ so-called unmet needs. Focusing more upon Narcissism than Borderline pathology (once deemed interchangeable conditions, incidentally), Kohut taught a model which focused upon mirroring responses, with less emphasis upon transferential interaction (Kernberg), or defense analysis (Masterson). The differences are crucial, parallel to what are termed “enabling” versus “recovery-oriented” approaches in the lexicon of CD treatment. As Masterson would say, what we call defense they call the patient’s “efforts to repair”.

In  WTR, I describe the influence of Masterson in my growth as a therapist in a residential setting, as well as my movement away from the Kohut model I’d originally been taught. My rationale was as follows: the patients whom I saw repeatedly in treatment were mired in patterns of lying, self-destructive behavior, suicidal and violent tendencies, alongside a variety of other defensive habits, yet few of these patients were sociopathic. They were admitted for a treatment episode that was daily, intense,  would last over months, if not longer, and engender transferential bonds that were complex. The stage was set for a psychoanalytic treatment, yet over time, the prominence of such models diminished, in favor of derivative approaches, Dialectical Behavior Therapy, so-called Strength-based models, that focus upon symptomology versus intrapsychic, or internal change.

Change. Meaningful, lasting: everyone in the field claims to want it, and even resistant patients give it lip service.  Notions of it inform but also confound treatment plans. In dispute with Kohut, WTR mischievously contends that mirroring defenses tends to reinforce defenses. In dispute with Kernberg, I offer that a focus upon constitutional aggression ignores underlying pathology. In dispute with Masterson, I’d say that mandated referrals engender “compliance” defenses, which contaminates therapeutic alliance, enabling defenses. Such bonds, as well as defenses, are nonetheless fluid, predictable and not. But to work through rehab, as either a patient or a professional, you have to make a choice at some point as to what approach is right. Hopefully, your choice is good enough.

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