TIPS and TOPICS from David Mee-Lee, M.D.
Volume 8, No. 6
October 2010

In this issue

-SAVVY:  Writing by hand engages the brain in learning

-SKILLS:  Words that can push people away

-SOUL:  Being imperfect, vulnerable and authentic

-SHAMELESS SELLING:  Brand new Journal on positive mental health

-Until Next Time

Welcome to the October edition of TIPS and TOPICS (TNT) a little late, the editor just got back from Australia.

SAVVY

In the Wall Street Journal this month, an interesting article caught my attention- especially since we live in an era when there is a push for health records to go paperless, and where our communication is dominated by text messages, tweets, voice mail and Facebook.  No more writing letters or essays these days.  The WSJ article was titled: “How Handwriting Trains the Brain.  Forming Letters is Key to Learning, Memory, Ideas.”  I excerpted some of Gwendolyn Bounds points in her article which have relevance to our clients.

Tip 1

Writing by hand is more than just communication. It engages the brain in learning.

”
Using advanced tools such as magnetic resonance imaging, researchers are finding that writing by hand is more than just a way to communicate. The practice helps with learning letters and shapes, can improve idea composition and expression, and may aid fine motor-skill development. .. Recent research illustrates how writing by hand engages the brain in learning.”

• Adults studying new symbols, such as Chinese characters, might enhance recognition by writing the characters by hand.

• Some physicians say handwriting could be a good cognitive exercise for baby boomers working to keep their minds sharp as they age.

• Studies suggest there’s real value in learning and maintaining this ancient skill of handwriting, even as we increasingly communicate electronically via keyboards, big and small. Indeed, technology often gets blamed for handwriting’s demise.

• But in an interesting twist, new software for touch-screen devices (such as the iPad) is starting to reinvigorate the practice.

“During one study at Indiana University published this year, researchers invited children to man a “spaceship,” actually an MRI machine using a specialized scan called “functional” MRI which spots neural activity in the brain. The kids were shown letters before and after receiving different letter-learning instruction. In children who had practiced printing by hand, the neural activity was far more enhanced and “adult-like” than in those who had simply looked at letters.”
“It seems there is something really important about manually manipulating and drawing out two-dimensional things we see all the time,” says Karin Harman James, assistant professor of psychology and neuroscience at Indiana University who led the study.

Clinical Implications:

• Individual and group therapy forms the backbone of much of our clinical work. Such verbal interaction can reshape cognitions and build relationships.  But that can be enhanced for all people by including writing exercises, narrative writing and journaling. This is especially true for those not verbally fluid or who are developmentally more kinesthetic in the ways they learn best.

• There is a strong literature on the power of written self-expression in behavior change.  Expressive writing therapy, journaling, bibliography and other reading and writing exercises are underutilized in behavioral health treatment. In future editions of TNT we’ll focus more on this neglected area of facilitated change.

Tip 2

Computers, keyboarding and the internet can facilitate learning. Writing by hand has a unique relationship with the brain in composing thoughts and ideas

Research highlights that the hand has a “unique relationship with the brain when it comes to composing thoughts and ideas. Virginia Berninger, a professor of educational psychology at the University of Washington, says handwriting differs from typing because it requires executing sequential strokes to form a letter, whereas keyboarding involves selecting a whole letter by touching a key.”

• Pictures of the brain have illustrated that sequential finger movements activated massive regions involved in thinking, language and working memory-the system for temporarily storing and managing information.

• A recent study of Dr. Berninger demonstrated that in grades two, four and six, children wrote more words, faster, and expressed more ideas when writing essays by hand versus with a keyboard.

• “Even in the digital age, people remain enthralled by handwriting for myriad reasons-the intimacy implied by a loved one’s script, or what the slant and shape of letters might reveal about personality.”

• Beyond identifying personality traits through handwriting, called graphology, some doctors treating neurological disorders say handwriting can be an early diagnostic tool.

“Some patients bring in journals from the years, and you can see dramatic change from when they were 55 and doing fine and now at 70,” says P. Murali Doraiswamy, a neuroscientist at Duke University. “As more people lose writing skills and migrate to the computer, retraining people in handwriting skills could be a useful cognitive exercise.”

Clinical Implications:

• Journaling provides a window into the past, the present and the future.  If clients have old journals or expressive writing in poetry, essays or diaries, these are just as legitimate “grist for the mill” as therapy sessions focused just on verbal exchange and recounting the past and present situations.

• The Change Companies’ core intervention tool is the Interactive Journal.  The Change Companies®’ Interactive Journaling® approach offers a change-focused, participant-driven resource for effectively guiding targeted populations through the process of life change. This approach enhances the therapeutic engagement between providers of service and participants while building consistency and confidence in the modality being used.

Reference:

Gwendolyn Bounds: “How Handwriting Trains the Brain Forming Letters Is Key to Learning, Memory, Ideas”. The Wall Street Journal. October 5, 2010

Write to Gwendolyn Bounds at wendy.bounds@wsj.com

SKILLS

Every now and then I like to highlight terminology our field uses which distances us from forming a working alliance with our clients. So I was most interested when I attended a session at the American Psychiatric Association’s recent Institute on Psychiatric Services in Boston.  Ronald J. Diamond, MD, Professor at the University of Wisconsin School of Medicine and Public Health in Madison presented thought-provoking ideas.  The title of his talk says it all: “From Bad-mouthing to Good-mouthing the Customers: Alternatives to pathologizing and put-down labeling of people.” I’ll share some of the nuggets of wisdom that impressed me.

Tip 1

When people are not skilled at getting their needs met, don’t call them names.

“Manipulative”, attention-seeking”, “entitled”, “acting-out” flow so easily from the clinical tongue. But if you reframe the person’s behavior as unskilled attempts to get their needs met, you can be empathic and help them develop more effective ways to get their needs met.

Take “manipulative” for example.  If you are skilled at asking for what you want, comfortable in persuading people to meet your needs, collaborate and cooperate with you, we call you “assertive”, an “effective leader”, or “a person of influence”. However if you are not skilful in asking for what you want…if you ask something from  someone and don’t get it …then you attempt to get yet another person to meet your need, we call you “manipulative”, especially if you go about it in an annoying persistent manner. 

Let’s look at this same process with the other terms.

“Attention seeking”

• We all have the need for attention to some extent.  Nobody wakes up every day and says to themselves: “I hope no-one notices I am around, ignores me and treats me as if I am a nobody.” So if you are skilled at getting noticed, are respected, and do that in ways that contribute positively to others’ lives, we call you a “celebrity” or “movie or rock star” or “politician” or “trainer and consultant”!

• If you are not skilled at getting noticed and regarded, and go about seeking that in annoying, intrusive ways, you are now then considered “attention seeking”. Such people are crying out to be respected and taken seriously. What they need from clinicians is skills training on how to get needs met effectively.  Don’t just call them names under your breath and shut them out.

“Entitled”

• We all have a need for fairness, to receive what is our right to have, to be acknowledged and appreciated for what we have done or deserve.  If you are skilled at achieving this recognition and what is rightfully yours, you are applauded you for knowing what you want and how to succeed.

• Sometimes individuals are not skilled at gaining respect.  They are not good at getting things that are rightfully theirs.  Perhaps they have not been taught the value of hard work and diligent effort to reach a goal. These individuals use counterproductive interpersonal skills which result in labels like “entitled” or “narcissistic”.

“Acting out”

• When a person has the skills to deal with frustration, disappointment and stress, then no one is offended by the person’s behavior and coping mechanisms.

• Someone may not be skilled at managing stress, frustration, and needs for love and acceptance. Therefore  their ineffective  attempts to cope with their troubling feelings and needs often ends up by being noticed and targeted as “acting-out” behaviors, which need to be subdued and controlled.

Tip 2

Technical psychological constructs and terms are just that, not code words to describe people you don’t like.

“Borderline”, “splitting”, “passive aggressive”, “Axis II” are some of the terms that have specific psychological meaning or are constructs with a defined meaning.  However, listen in on a team treatment planning meeting sometime.  See if you can distinguish when clinicians are using these terms to describe the specific psychological term or construct and when they are actually using these words as shortcuts to describe a client they find annoying or difficult to work with.

• “She is so borderline and manipulative!”

• “Look at all those admissions and how thick the chart is.  Must be a borderline.”

• A client is not getting along with his assigned therapist but lacks the assertiveness skills and self esteem to deal with that directly with his clinician. Unfortunately the therapist does not seek out feedback from the client on whether the methods used are a good fit for the client, therefore is unaware of the client’s dissatisfaction. When the therapist discovers that the client has talked to another clinician, seeking to be on her caseload, the client is accused of “splitting” and manipulating.

• A similar client is intimidated by the counselor and has some transference authority issues which prevent him from disagreeing with the counselor’s advice and directives.   Rather than deal directly with his concerns about the treatment plan, he simply doesn’t follow through, hoping the counselor won’t notice.  When the counselor does notice the non-adherence, the client is confronted for being “passive aggressive.”

• “Oh he is so Axis II. Can someone else take this case?”

• “Not another Axis II. Aren’t there any nice clients I can work with?”

Implications:

Dr. Diamond summarized the problems when we use words loosely, inaccurately and often judgmentally:

1. Incorrectly-used words and terminology create barriers that inhibit and even prevent joining therapeutically with people.
2. Using such words can give clinicians permission to not listen to clients and see their important feelings and needs: “She is so borderline and acting out, that you can’t believe a word she says.”
3. When we label clients in this way, it puts the problem within the client, instead of seeing that the problem is an interactive one, influenced by the clinicians’ attitudes, beliefs and behavior.

SOUL

This month I presented at the US Journal conference in Chicago and picked up some SOUL words of wisdom from Brene Brown, PhD. (www.brenebrown.com) who presented on “Shame, Vulnerability, Imperfection and Authenticity: The Quest for Our True Self”.

• She made a succinct distinction between shame and guilt.  Shame was summed up as “I am a mistake” and guilt as “I made a mistake.” Shame is crippling and paralyzing. Guilt however can be empowering if it is used to take on responsibility for our actions, make amends and move on.

• When there are so many demands for service and an impulse to run faster to address and meet those needs, it’s hard to practice compassion when people are running all over you.  Dr. Brown counseled it is better to choose temporary discomfort over ongoing resentment.  She elaborated: it is better to set boundaries and say “no” now and weather the discomfort of setting limits, rather than live with resentments that “they made me do something I didn’t really want to do”.

• In her book “The Gifts of Imperfection”, she speaks of authenticity as a daily practice of letting go of who we think we are supposed to be and embracing who we actually are.  Choosing authenticity means “cultivating the courage to be imperfect, to set boundaries, and to allow ourselves to be vulnerable.”  “Don’t shrink; don’t puff up; stay in your sacred ground,” she said. That’s authenticity.

We are in a fiercely competitive election season full of negative attack ads, attempts to exploit opponents’ vulnerabilities and marginalize candidates as extreme and out of touch.  Imagine a different perspective, one that banishes shame and imperfection,  replaced by values of vulnerability and authenticity.  Could leaders ever be allowed to be imperfect without ruining their careers? Could they ever admit mistakes, not project blame and still stay in office?

Imagine……

SHAMELESS SELLING

I am excited to introduce you to The Change Companies’ latest interactive journal just hot off the press. The principal author is Senior Advisor, William R Miller, PhD.  He and I developed this journal with the following goal in mind: “Our aim is to provide a very positive change focused resource that encourages and empowers clients to take an active role in their own recovery.”

We designed this journal to focus on facilitating self-management in mental health and addiction treatment.  As Bill Miller wisely said during the development process, we want to attract people into managing their mental and chemical health, not just coping with it!  Coping sounds like just surviving, but managing is empowering.

Take a look at this brand new clinical tool:

This 88-page Interactive Journal assists individuals in becoming active participants in the care and maintenance of their own psychological wellness. Participants are provided information and strategies that guide them in setting goals and managing their situations, thoughts, feelings, responses and consequences. The Journal helps participants develop a working alliance with their service providers in making life changes for mental and chemical health.

Find out more at www.changecompanies.net and call (888)-889-8866.

Until Next Time

Thanks for reading. See you in late November.
David

David Mee-Lee, M.D.