Tony Madril Therapy - Issues and Insights

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ISSUES
In this section, Tony reviews relevant topics.

ISSUE: Practical Tips for Lesbian and Gay Parents Raising Teenagers

No doubt adolescence is tough. And for teens growing-up in lesbian and gay households, it can be even tougher. Nevertheless, lesbian and gay parents who are aware of the particular challenges their teens are likely to face can respond with a set of interventions that are meaningful as they are practical. Delivered thoughtfully, these focused actions can help lesbian and gay parents ease the stress of a sometimes burdensome period of family life.

Lesbian and gay parents can expect that their teens will face some challenging issues related to their entry into adolescence; they might also expect the possibility of their teens encountering the social stigmas often associated with children who are raised within non-traditional families. Therefore, setting a foundation of sound preparation, support and instruction can enable lesbian and gay parents to increase positive developmental outcomes for their adolescent sons and daughters.

Who am I? Do I fit in? Will someone else love me besides my parents? Can I make it on my own? Am I straight or gay? These are just a few of the questions many teenagers will pose to themselves and others during the adolescent time of their lives. Discovering the answers to these questions is, in the simplest of terms, the winning goal every teenager must score before moving on to a fully integrated adult life.

In fact, every teenager is uniquely positioned to respond to various issues of personal growth and development. Adolescence is the very time for this. The following is a list of generally accepted principles of adolescence; identifiable tasks created to help explain what it is a teenager must address during this stage of their personal development:

To achieve a new level of closeness and trust with peers
To gain independence from parents and to develop a new status within the family
To develop a sense of personal identity
To address issues of sexuality
To acquire a set of values and ethics to guide behavior
To move toward autonomy in the world

Accomplishment of these monumental tasks settles upon the teenager’s development of an unwavering sense of identity, a stable sense of who they are in relationship to the rest of the world. Once they accomplish this, they are better equipped to begin addressing what will be the responsibilities and freedoms of their adult lives.

For the teen being raised by lesbian or gay parents, this process may be complicated by a fear of discrimination brought about by social stigma. Although the body of research on the psychological well-being of children raised by lesbian and gay parents is favorable (it reports no notable differences between children raised by lesbian and gay parents and those raised by heterosexuals), some teens within this group choose to hide, delay or selectively disclose the details of their family’s gender characteristics. While doing so may elicit some temporary gain, such as allowing the teenager an adequate amount of time to “come out” to peers, it also suggests that some teens raised by lesbian and gay parents are struggling with coming out to peers about their families, on the one hand, and avoiding discrimination on the other.

How can lesbian and gay parents help their teenagers resolve this conflict? That is the question. Simply put, lesbian and gay parents can help by educating themselves about the number of practical tools available to them to counteract the effects of homophobia and discrimination. For example, the following table includes several things I recommend to parents who are worried about their child being teased about having “two mommies” or “two daddies.” These interventions were adapted from research studies on lesbian and gay parenting, and from my own clinical experience working with lesbian and gay families. Together, I refer to them as the “Tasks of Adolescence for Queer Parents.” They are simply practical ways that lesbian and gay parents can proactively guide their teenagers through the complexities of adolescence.

Parental Task: To establish a pattern of warm and open communication

Helpful Tips:

Schedule time each week for you and your teen to talk and do fun things together
Model the use of active listening skills, such as summarizing what you heard your teen say. This is especially important to remember during times of conflict
Set the ground rule that your teen has permission to talk to you about anything without fear of consequence, as long as the information is not used inappropriately; to punish or manipulate, for example
Let your teen know that you are aware of the possibility that, at times, she may feel uncomfortable with the idea of disclosing particular information about the family. Let her know that this is “okay,” and that you would welcome hearing about these instances should they arise. This may help to increase the likelihood that your teen will use you as a resource for dealing with a number of issues, including how to manage social stigma

Parental Task: To create a supportive social system

Helpful Tips:

As appropriate, include your teen in social settings in which your sexual orientation is affirmed by significant adults, straight and lesbian/gay alike. For example, you might introduce your teen to a straight colleague whom demonstrates strong support of lesbian and gay families. You could also invite your teen to have lunch with a group of your friends
Create opportunities for your teen to have regular contact with other teenagers who are being raised by lesbian or gay parents, or whom live within other types of non-traditional families
Engage your teen in the process of learning about racial and ethnic cultures and other groups of diversity different than your own

Parental Task: To teach effective coping skills and decision-making strategies

Helpful Tips:

Spend some time with your teen identifying various problematic situations that could arise, which are directly related to the family’s gender makeup. This may help them to prepare for, address and/or avoid stressful situations, which may occur outside of the home
Engage your teen in a process of identifying and prioritizing the options and resources available to them to address these situations in the moment. Teach them to weigh the “pros and cons” of each potential decision as a means of increasing their ability to problem-solve
Practice role playing how, in particular, your teen would go about applying these decision-making strategies to “real life” situations that involve discriminatory behavior
As appropriate, ask your teen for his opinion about how you might go about solving some of your own mundane day-to-day problems, such as how to deal with a difficult co-worker. This will keep him in the practice of thinking strategically about the tools he can use to resolve interpersonal problems at moment’s notice

Parental Task: To consider the best time to come out to the children

Helpful Tip:

If possible, consider coming out to your children during their childhood or late adolescent years. Because younger adolescents are often preoccupied with issues of their own emerging sexuality, early and middle adolescence, (generally accepted as ages 10 – 16) may be a particularly difficult time for them to learn about the sexual orientations of their parents

Parental Task: To consider being out to the larger community

Helpful Tip:

Being out to others is generally correlated with a greater sense of psychological well-being. This also seems to be the case for lesbian and gay parents. If you are not out to the larger community, it may, therefore, be helpful to consider the implications of doing so. You would, of course want to consider the level of social stigma that exists in your community and the fact that there may be separate “pros and cons” of coming out for your children that do not exist for you

No doubt raising teenagers can be challenging for any parent. Nevertheless, lesbian and gay parents who are confronted with the vicarious effects of social stigma may, understandably, find the task even harder. At the same time, there are ways to help. First, lesbian and gay parents can equip themselves with an active awareness of the issues their child will need to address as they enter into a new realm of personal development. Second, lesbian and gay parents can study and apply various helping strategies and techniques to support their teens through the season of adolescence; including how to address the problem of social stigma should it arise.

In short, hope for healthy adolescent development for teenagers of lesbian and gay parents lies within the creation of a family environment in which communication is open and warm; parents make thoughtful and informed decisions about family matters; and teenagers are supported and taught effective coping strategies to prepare for and respond to the problem of social stigma.

ISSUE: Weighing the Importance of Getting a Quick and Accurate Psychiatric Diagnosis for Your Child

I have been approached many times by parents who have been anxious about “getting the right diagnosis” for their child. Their worry seems to stem from the fear of getting the “wrong treatment” for their child or that their child may not “get better” without a quick and accurate diagnosis of their child’s psychological issues. These are usually parents who have been battling with their child’s mental illness for a number of years and whose children exhibit a myriad of psychiatric symptoms that do not fit nicely into the criteria for one specific mental disorder. While there is considerable foundation for their concern, having an exact diagnosis, at least at the beginning stages of treatment, is generally not the most important part of the work to be done.

On the one hand, having a readily available and accurate diagnosis can help to relieve the family’s anxiety about what it is their child is facing. A clear diagnosis can be extremely helpful in aiding the therapist and parent in obtaining specialized services for the child, such as special education, speech or occupational therapy. It can also help certain children qualify for admission to various publicly funded mental health and child welfare programs unavailable to most.

On the other hand, having a quick and accurate diagnosis will neither reduce the child’s troublesome symptoms, nor create the environment necessary for the therapeutic interventions to begin taking hold. Only the careful and steady development of the therapeutic rapport and a thorough assessment of child’s mental health symptoms can accomplish these most critical clinical tasks.

A strong therapeutic alliance can provide a child with the sense of psychological safety necessary to for him or her to begin disclosing much-feared topics, such as past experiences of physical or sexual abuse. It becomes the primary protective element as it begins to buffer the child from the full force of painful emotions that inevitably arise throughout the process of facing one’s problems. In fact, careful research in the field of mental health has indicated that it is the quality of the relationship between the therapist and client, not the particular interventions employed, which holds the greatest potential to create positive, progressive change in the life of the individual receiving therapy.

Similarly, a careful examination of the child’s psychiatric symptoms by the therapist can become a good measure of how quickly and to what extent the child’s symptoms will improve. A proficient psychiatric evaluation can provide some very important answers to questions such as: What triggers the onset of the child’s symptoms? How do these symptoms function for the child? Do they distress the child—or are they somehow advantageous to him or her? How do others respond to the child symptoms? Do they act to reinforce or extinguish these symptoms? What else in the child’s environment influences the nature and function of the child’s symptoms? Equipped with suitable answers to these questions, the therapist can then proceed to develop the most effective treatment plan for the child, which, when implemented, will begin to alleviate the child’s symptoms in the quickest time possible.

Although getting a timely and accurate diagnosis for your child is an important part of any prudent treatment process, it falls second to the initial tasks of allowing the therapist to conduct a sound evaluation of the child’s mental health symptoms and allowing him the time to establish a genuine relationship with him or her. Clarification of the psychiatric diagnosis can always happen later, by way of further evaluation by the therapist or through a referral for formal psychological testing. It may help to remember that a psychiatric diagnosis is ultimately a guide to the treatment process as well as a tool to obtain resources on behalf of the child.

INSIGHTS
In this section, Tony defines relevant key words.

Play Therapy
Play therapy is a therapeutic approach used to assist children, usually between the ages of 3 and 8, to literally act-out internal conflicts and distress regarding a variety of problems through the therapist’s purposeful engagement of the child in a variety of play activities. Play therapy is often the recommended treatment modality for this age, as younger children in particular do not have the cognitive, developmental or verbal skills to discuss issues and communicate directly with words like adults.

Cognitive Behavior Therapy
Cognitive Behavior Therapy is a type of talk therapy that has been demonstrated by many research studies to be the most effective approach for resolving a variety of psychological problems. The therapeutic relationship between the therapist and client is highly collaborative and goal-directed; the focus of treatment is changing those irrational thoughts, beliefs and assumptions that typically lead to poor behavioral choices and negative emotional states. Specific techniques are taught to help people improve their mood, relationships and general life outcomes.

Behavior Therapy
Behavior Therapy helps you to change your habitual responses to certain situations through the guided application of various therapeutic techniques. Goals of behavior therapy are situationally specific, depending on the client’s desired behavior change. Behavior therapists use a variety of techniques, such as systematic desensitization, to help clients reduce problematic reactions, such as fear and anxiety, to specific stimuli.

Humanistic Therapy
Humanistic Therapy emphasizes the personal growth and self-fulfillment of the client through the process of honest self-examination, self-mastery and creative expression. The goals of therapy come from the client, not the therapist; as such, therapeutic goals are client-focused, being primarily concerned with what the client foresees will contribute to his or her greater personal growth. The ideal description of a humanistic therapist is someone who is “genuine,” “non-judgmental,” and “empathic.” The humanistic therapist assists in the development of a therapeutic atmosphere that will increase the client’s positive self-regard and self-confidence in the world.

Reality Therapy
Reality Therapy is designed to help individuals take control over their behavior and make choices, often new and difficult ones, that will increase the likelihood that their psychological and emotional needs will be satisfied. It is based on control theory, which assumes that all people are responsible for their lives, for what they do, feel and think; it purports that people have a significant amount of influence over their lives in relationship to the external environment. The therapist works with the client to assess how well their needs are being met and what personal changes should take place to meet those needs. The client determines what they want in therapy, not the therapist.

Structural Family Therapy
Structural Family Therapy provides both the therapist and the client with a model for optimal family functioning; it suggests that families function best when certain family structures prevail. For example, families do well when parents hold the executive power within the family and use it responsibly to see that important interpersonal boundaries are maintained and that the responsibilities of individual family members are consistently upheld. When family structures are dysfunctional, the therapist joins with the family and uses himself or herself to transform it to a higher level of functioning.

Multisystemic Therapy
Multisystemic Therapy is an intensive family- and community-based treatment program specifically designed for adolescents who exhibit serious antisocial behaviors, such as breaking-the-law. The aim of the MST therapist is to create positive and lasting changes in and between the various social systems in the child’s life that contribute to the maintenance of various antisocial behaviors. Ultimately, the program should assist in the resolution of antisocial behavior and prevent out-of-home placement for those adolescents at-risk for such an intervention.

Systems Theory
Systems Theory is a theory generated from the biological sciences that is often applied by clinical social workers as a tool to understand and influence the form and function of complex human systems, such as groups, families, and communities. This theory is based upon the premise that systems are flexible and respond to new input with growth and that changing one part of a system will change all corresponding parts. Careful analysis and modification of the function of the component parts of social systems are, therefore, essential techniques used to effect positive social change.

Imago Therapy
Imago Therapy is a specific type of therapy used to help couples experience greater satisfaction in their relationship by attending to their partner’s developmental needs. It teaches that romantic love is the key to healing past wounds through the development of a “conscious relationship” with a partner who embodies both the positive and negative personality traits of his or her primary caretakers of childhood. The therapist engages the couple in a number of developmentally exploratory exercises to increase the couple’s insight into the dynamics of the relationship; he or she also teaches the skills of effective communication and how to directly identify and express what is often unconscious and unspoken within the relationship: the emotional and psychological needs of each partner in the present moment.

Self-defeating Thoughts
Self-defeating thoughts are any thoughts a person has about themselves which act to impair his or her functioning and self-confidence in the world. They are usually irrational because they hold no consistent basis in reality. Many times people are unaware of these types of thoughts because they are often unconscious and automatic. “I’m not good enough” and “There must be something wrong with me” are two examples of self-defeating thoughts.

Behavioral Experiments
Some therapists, to assist their clients with the resolution of various troublesome thoughts, feelings and behaviors use behavioral experiments. For example, in the practice of Cognitive Behavior Therapy, the therapist may request that their client complete homework assignments between therapy sessions. These may consist of real-life "behavioral experiments" where patients are encouraged to try out new responses to situations discussed in therapy sessions.

Negative Belief Systems
Negative belief systems are a culmination of irrational beliefs or self-defeating thoughts which can operate, individually, within a person’s mind or, collectively, within the group consciousness of a family or community. Negative belief systems are “negative” because they are largely false and work to impair the individual or group’s ability to meet their respective goals. Negative belief systems may act generally within a person’s life or they may be ordered around a specific idea or situation. For example, a single heterosexual male may experience great success in his career and financial life, but fail to find a partner because of his belief that he is not desirable to women.

Acting-out
Acting-out is the process wherein a person expresses their psychological conflicts through actions. This is an ineffective means of resolving internal conflicts because the actions taken do not directly address the problem. For example, a man has an extramarital affair because he cannot verbalize his feelings of frustration or helplessness within the marriage.