National Day of Listening

This coming Friday is the National Day of Listening. The goal is to reserve one hour of the day to record a conversation with someone you find important: an older relative, friend, teacher, or someone you've noticed but have never taken the time to learn about.

Want to know more? Head to the National Day of Listening website to learn how to participate.

Twitter

It's interesting really. I consider myself a pretty tech-savvy person in my day-to-day life. I'm a fan of electronic gadgets and tend to be an early adopter of new technology.  Those of you know know me in my private practice would feel differently: according to some my little paper calendar makes me look like a dinosaur.

I'm making a slow crawl toward moving my psychotherapy practice into the 21st century. I've opened up a Twitter account. If you look to the toolbar on the right, there is a box in which you can click to follow my tweets.

For now, I'm going to use Twitter to make general annoncuments: updates to my website or blog, my vacation schedule, inclement weather or traffic calamity alerts, and notifications of being out sick. Twitter will not be my primary way of notifying current clients about changes in my schedule: I will always contact by phone and/or e-mail first. I will not utilize Twitter as a primary way to contact clients.

Twitter raises some privacy concerns that I'm working on sorting out. I believe that anyone can see who follows me on Twitter. If you choose to follow me on Twitter, you will need to agree that it is okay that other people know you are doing so. In that Twitter is not confidential and thus I cannot protect the privacy of such communications, I will not be using Twitter for any direct contact with individual clients.

Hang in there with me as I develop this tool. I also am working on the development of a revision of my privacy policy that will include Twitter, this blog, and communications in the electronic realm in general. When it is finalized, that privacy policy will be posted on this blog, on www.drjasonmihalko.com, and discussed in my office.

Animal Assisted Therapy

Since I've started bringing Maggie into the office on a regular basis I've been fielding a lot of questions about the benefits of animal assisted therapy. Here are a few interesting research articles. I found them to be interested and thought I'd share a few abstracts. I am particularly struck that even the presence of an aquarium in an ward of patients who have Alzheimer's has been shown to have a significant positive effect.

Barak, Y., Savorai, O., Mavashev, S., & Beni, A. (2001). Animal-Assisted Therapy for Elderly Schizophrenic Patients: A One-Year Control Trial. American Journal of Geriatric Psychiatry, 4, 439-442.

In a blind, controlled study, the effects of animal-assisted therapy were studied with elderly patients diagnosed with schizophrenia. The study indicated that there was a significant increase in mobility, interpersonal contact, communication, personal hygiene and self-care through the use of cats and dogs as modeling companions.

Barker, S. B., Pandurangi, A. K., & Best, A. M. (2003). Effects of Animal-Assisted Therapy onPatients' Anxiety, Fear, and Depression before ECT. The Journal of ECT, 19, 38-44.

This study was done to determine whether animal assisted therapy is associated with reductions in fear, anxiety, and depression in psychiatric patients before electroconvulsive therapy (ECT). The effect of AAT on fear was significant in the study and the conclusion was drawn that animal assisted therapy may have a useful role in psychiatric and medical therapies in which the procedure is inherently fear-inducing or has a negative societal perception.

Edwards, N. E. & Beck, A. M., (2002). Animal-Assisted Therapy and Nutrition in Alzheimer'sDisease. Western Journal of Nursing Research, 24, 697-712.

This study was really interesting to me. It examined the influence of animal-assisted therapy--this time fish aquariums--on the nutritional intake for individuals with Alzheimer's disease. The researcher's collected baseline nutritional date for two weeks before the study began and then every two weeks after the aquariums were introduced. Nutritional intake increased significantly when the fish were introduced and continued to do so over a 16-week period. They study also found that the participants required less nutritional supplementation (they were eating better) and thus had a net savings effect on their health care costs!

Filan, S. L., & Llewellyn-Jones, R. H., (2006). Animal-Assisted Therapy for Dementia: A Review of the Literature. International Psychogeriatrics, 18, 597-611.

This article reviewed several small studies that suggest the presence of a dog reduces aggression, agitation, and promotes social behavior in people with dementia.

Martin, F., (2002). Animal-Assisted Therapy for Children with Pervasive Developmental Disorders. Western Journal of Nursing Research, 24, 657-670.

This study evaluated the effects of interaction with dogs on children with pervasive developmental disorders. These disorders are characterized by a lack of social communications and abilities. While interacting with a therapist, children who were also exposed to a therapy dog exhibited a more playful mood, were more focused, and were more aware of their social environments.

Folse, E. B., Minder, C. C., Aycock, M. J., & Santana, R. T., (1994). Animal-Assisted Therapy and Depression in Adult College Students. Anthrozoos: A multidisciplinary Journal of the Interactions of People and Animals, 7, 188-194).

This study investigated the effects of animal assisted therapy on self-reported depression in college students. Students were randomly assigned to one of three groups: animal assisted therapy in conjunction with psychotherapy (directed group), animal assisted therapy only (non-directive), and a control group. They study demonstrated a significant difference between the control group and both the directive and non-directive group, suggesting that that just the presence of a therapy dog can have a positive effect on depressive symptoms.

You Make Me Mad

"No one can make you feel something. You choose to feel that way." How many of us have heard this from a school teacher or parent?

"You create your own reality." Have you heard that one a lot? I have. I've heard it in the context of self-help discussions, discussions about mindfulness, and from more than a few psychologists.

I did my postdoctoral training in Dialectal Behavior Therapy. At the clinic where I worked, most of the clients who sought help did so because they were no longer able to continue life overwhelmed by their feelings and emotional reactions. Most of my clients were diagnosed with borderline personality disorder and specifically came to the clinic to receive some of the best DBT therapy that was provided in the area.

I heard many excellent psychologists and psychiatrists say that no one could make us feel something. The gist of this way of approaching emotions is the following: Another person can't open us up and make the complicated series of reactions that cause anger, fear, shame, guilt, or joy. Our feelings are on in the inside and we are responsible for our own feelings and emotional reactions. As one of my mentors would say, another individual might make the situation optimal for an individual to create a particular feeling.

I've said this over and over again to clients. Recently, I said it again only to stop, apologize, and say that this is just a bunch of poppycock. Yes, each of us are completely responsible for how we respond to our emotions. However, our emotional experience is not necessarily under our control at all.

When a driver cuts in front of me during in Boston traffic, my heart beats a little faster and my rate of breathing increases. I am having a physiological response that is out of my immediate control.

From a cognitive perspective, I interpret these physiological cues. I might worry that I might get into an accident (fear) or I might be annoyed at the offending drivers' sense of entitlement (anger). I have agency over my interpretations and thus the popular statements of "you create your own reality" and "no one can make you feel something."

At this level of iterpretation I do not disagree with these statements. I do expect myself to have a degree of agency over how decode my physiological cues.

I might have a variety of behaviors. Perhaps I might duck and start to cry in fear (not likely), or maybe I might issue some sort of special hand signal to express my annoyance (more likely). Again, I agree with the notion that no one can make me cry or make me use special hand signals. At this level of interpretation, I again expect myself to have a degree of agency over how I behaviorally respond to my decoding my physiological cues.

You might be saying "Wait just a minute Jason, you started this off by disagreeing with the notion that we create our own reality."

That's true, I do. It's because these statements contain an a major invalidation of our physiological responses. That initial quickening of our sympathetic nervous system happens without our consent or control. The driver cuts me off and my body responds. I don't make my sympathetic nervous system turn on, it is designed to turn itself on and protect me. While the driver who cuts me off doesn't not have direct control of it either, his/her actions are the stimulus that causes the whole chain of events to start: physiological response, decoding of physiological cues, interpretation of cues, behavioral response.

I try hard to never invalidate another person's experience. If you fall, I don't tell you it doesn't hurt. If you tell me you've fallen and share that you were told it wasn't supposed to hurt, I make it a point to underline the essential invalidation of your experience. It's kills our humanity, a little bit at a time, to invalidate our experiences like this.

Now don't get me wrong. If you've fallen and stubbed your toe, collapse to the ground, and hide in your house in fear for several weeks I'll have a few things to say: you very well may be having difficulty decoding your physiological cues and selecting effective behaviors.

I try very hard, however, to never tell you that it didn't hurt, wasn't important, or didn't happen at all.

Therapy Dog

Magnolia the therapy dog had her first full day of work as a therapy dog. I had hoped to slowly start introducing her to work in January however due to some unexpected circumstances, she joined me for the day yesterday.

Maggie did extraordinarily well. She greeted clients at the door and said hello to them as they settled onto the couch or chair. She joined some up on the couch and settled into their laps. At other times, she curled up in her bed next to my chair and silently slept. Not bad for a 14 week old puppy.

Traditionally, a therapy dog is an animal that is trained to provide affection and comfort to people in hospitals, retirement homes, nursing homes, schools, people with learning difficulties, and even stressful situations like disaster areas. Any breed of dog has the potential of being a therapy animal. The temperament of the animal is what is important. Dogs working as therapy dogs need to be friendly and patient. They need to possess a sense of confidence and ease in all situations. Most importantly of all, they need to be gentle and enjoy interacting with humans--whether that be the gentle pet of someone in a nursing home or the clumsy roughhousing of a child in school.

There are several different organizations that sponsor certification of therapy dogs. Therapy Dog International is a group founded in New Jersey. Therapy Dogs Inc. is another similar organization based in Wyoming. The organization that I am choosing to work with is the Delta Society and their New England affiliate, New England Pet Partners Inc.

I've elected to work with Maggie toward certification with the Delta Society because I like that they differentiate between Animal Assisted Activities and Animal Assisted Therapy. On their website, they write that "Animal-assisted activities are basically the casual "meet and greet" activities tat involve pets visiting people. The same activity can be repeated with many people, unlike a therapy program that is tailored to a particular person or medical condition." Animal Assisted Therapy is defined as "a goal-directed intervention in which an animal that meets specific criteria is an integral part of the treatment process. AAT is directed and/or delivered by a health/human service professional with specialized expertise, and within the scope of practice of his/her profession."

While Maggie will certainly be engaged in Animal Assisted Activities in my office from time to time, I am also hoping she will be amenable, when needed, to becoming a more integral part of the therapy process and engage in activities that are more akin to Animal Assisted Therapy.

This I Believe

I've been listening to a podcast for the last several months that has captured my attention. This I Believe describes itself as "an international project engaging people in writing and sharing essays describing the core values that guide their daily lives." I have found most of them to be amazing and inspiring.

I've been reflecting upon one essay in particular for the last couple of weeks. Ann Heywood was a military wife and held more than 30 different jobs before she started her own business helping other people find the right job. Some consider her to be the precursor to the "follow your bliss" movement.

Her essay offered two things that stood out. Heywood wrote "I believe that every human being has a talent--something that he [or she] can do better than anyone else. And I believe that the distinction between so-called "create" talents and ordinary run-of-the-mill talents is an unnecessary and man-made distinction." She also wrote "I also believe that in the process of searching, no experience is ever wasted, unless we allow ourselves to run out of hope."

What an important lesson this essay offers in self-discovery and understanding. Each of us offers the world a gift that no one else can offer. Each person is valuable. None of our experiences are wasted--even the painful ones. They all drive us to a place that makes us uniquely ourselves, uniquely gifted, and uniquely valuable.

Is there a more powerful act that any one person can take other than transforming a difficult or traumatic experience into something that propels oneself toward finding one's unique gifts?

Neighborliness

I recently adopted a puppy. She and I are spending a lot of time together as I'm training her to be a therapy dog. Eventually she'll be joining me in the office. Part of Magnolia's training involves a lot of socialization. We go to parks, malls, and other places where she can encounter lots of different people. I have a list of experiences that she needs to be exposed to: older people, children, people using crutches, people in wheelchairs, etc.

I've heard people in the past joke about the best way to meet new people is to buy I dog. I had no idea how real that joke actually is. Admittedly, Magnolia is tiny and cute. Still, I didn't anticipate that people would actually stop their cars, roll down their windows, and start up a conversation. Since bringing Magnolia home on Saturday I've had no less than ten conversations with different people while I am out walking.

It got me thinking about why this is. I'm not doing anything different except walking with a prop--a cute dog on the leash. At least I didn't think I was doing anything different. After observing a little more I am realizing that I'm actually a lot more mindful of my surroundings. Sometimes big dogs come along and I need to snatch my eight week old pup off the ground. Sometimes little children come running to pet her, and I need to be ready to help negotiate the contact so neither party is afraid. Sometimes, I'm just making more eye contact with people. They notice me and what I'm doing. I notice them and what they are doing.

It made me wonder what other kinds of props people might use to start conversations and meet new people. Dogs and puppies help. Not everyone can have one. I've sent clients out in the past with homework assignments to hold the door open for people and make a few seconds of small talk, or comment on a pair of earrings that they notice and admire while in the check out line. Other clients, who spend lengthy amounts of time commuting on the T, get the homework assignment to make a comment or ask a question about a book they see someone reading.

The prop--or situation--really doesn't seem to matter. When people try out these homework assignments they are always successful: they have a brief conversation with a stranger. While it doesn't guarantee a new friendship is formed, it at least creates the opportunity for a moment of interpersonal contact.