What Is EMDR?
This article provides a brief history of EMDR and shares the way it works, and the general phase-model that is used. It explains the benefits of EMDR and how it is unique.
EMDR stands for Eye Movement Desensitization and Reprocessing. This type of therapy began in 1987 after a graduate student named Francine Shapiro became interested in exploring how distressing thoughts abated when she moved her eyes back and forth. Although that is the history, it is good to note that EMDR is more than eye movement and reprocessing, it is a trauma-informed treatment approach (Shapiro, 2018).
To boil it down to the basics, when someone engages in EMDR, they are guided by a trained therapist to focus on a highly distressing memory while following the therapist’s fingers move across the visual field, or sometimes by tapping the shoulders or hearing a sound on either side. After this, the client will talk about thoughts, images, and sensations that were elicited by the bilateral stimulation. This reprocessing component or the digestion of a traumatic memory, (focusing on the difficult memory) will come towards the end of building the groundwork of trust, emotional skills, and developing a treatment plan collaboratively between the client and therapist.
Benefits of EMDR
EMDR allows us to process a traumatic moment in small doses. In addition, the eye movement helps form new associations allowing the body and mind to reintegrate the trauma and adapt. The EMDR Institute, Inc. writes,
“These new associations [resulting from EMDR] are thought to result in complete information processing, new learning, elimination of emotional distress, and development of cognitive insights” (n.d.).
Another advantage of this method is that the client does not need to concentrate on the traumatic memory for long periods of time. Some therapists have found that clients have a higher tolerance for EMDR than other exposure therapies, and is therefore seen by many clients as more secure and without negative outcomes. It is important to practice EMDR with a trained professional because the best results come from systematically preparing the client to engage in reprocessing a traumatic memory.
EMDR therapy often follows three stages. In a snapshot, they are:
Take a history of the trauma and map out a treatment plan
Learn a way to cope with stress.
Throughout stages 3-6, the client will think about a negative thought or belief, locate bodily sensations, and explore a memory associated with the trauma.
7. Client keeps a log and revisits coping techniques from stage 2.
8. The therapist and client will review the progress made up to that point.
References
EMDR Institute, Inc. (n.d.). What is EMDR? https://www.emdr.com/what-is-emdr/
(Shapiro, F.) (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principals, protocols and procedures (3rd ed.). Gilford Press.New York.
Is Stress the Same As PTSD?
This article looks at the difference between stress and PTSD. Discusses symptoms and adjustment disorders.
What is a traumatic event?
First, it is important to identify what a stressor is and what a traumatic event is. Traumatic events that are covered by the term PTSD (Post-traumatic stress disorder) include
“exposure to serious physical injury, sexual violence, threatened death, and the sudden or violent death of another person. Car accidents, physical assault, rape, military combat, and natural disasters qualify as traumatic events” (Joy & Turk, 2018).
What is a stressor?
A stressor can be either traumatic or non-traumatic. For example, a stressor could include graduation, moving to a new city, losing a job, or having a child. Although it is true that when someone is under a state of stress, the brain may send signals of high levels of stress hormone cortisol throughout the body which could seem similar to the body’s response to a traumatic event. However, in the case of a stressful event, normally the highest level of the brain is still functioning letting the body know that everything will be ok.
The mind can talk the body through the situation. Many of us have been in stressful situations and have been our own best cheerleaders, saying, “You got this!” or, “Just two more hours!” This is because the stressor has not caused a trauma response. When someone is at a moment of bodily threat, the mind quickly sends signals to the brain to prepare for an attack, to fight, flee, or freeze. The higher functioning brain can’t even catch up, that’s why many people who have experienced grave harm recount like they were swimming, in slow motion, or looking down on the event from above.
So, what is meant by ‘stress?’
According to Van der Kolk (2015), when someone experiences a threat, the brain sends signals to the body that alert the fight, hide or flight response which produces an enormous amount of stress. When the threat is gone, sometimes the body stays on high alert. This is a hormonal and electrical state that impacts the entire nervous system and keeps it from “settling” or being calm even in safe situations.
Stressors might be a sign of an adjustment disorder and not PTSD
If you have severe difficulties in functioning and relationships and mood that seem to be excessive, within three months of experiencing a stressor, you could be facing an adjustment disorder. This is mostly shown in the inability to cope with the stressor or adapt to the changes presented. Often there is an unhealthy response, either characterized by problems in relationships, inability to carry out responsibilities, or changes in mood and conduct. Be aware that depending on one’s culture, responses to stressors may vary and may not constitute a disorder. The same is true for bereavement, which would not be categorized as an adjustment disorder.
Symptoms of an adjustment disorder
According to John Hopkins (n.d.), some of the signs of adjustment disorder include:
Depressed mood
Constant crying
Jumpiness
Breaking rules, recklessness
Nervousness
Worrying
Feeling hopeless
Suicidal thoughts and ideation or behaviors
These symptoms begin within 3 months of the stressor’s occurrence, and last no longer than 6 months after the event, although if the stressor continues, one could potentially have chronic adjustment disorder (Mayo Clinic, n.d.). According to the APA (2017), people with adjustment disorder could show other symptoms of anxiety, depressed mood, or conduct problems. In addition, adjustment disorder with anxiety and depressed mood are the most adjustment disorders diagnosed in clinical settings (Joy &Turk, 2018). In some cases, adjustment disorders can be precursors to other disorders such as PTSD or depression.
Resources
American Psychological Association. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. American Psychological Association.
John Hopkins Medicine. (n.d.). Adjustment disorders. https://www.hopkinsmedicine.org/health/conditions-and-diseases/adjustment-disorders#:~:text=An%20adjustment%20disorder%20is%20an,three%20months%20of%20it%20happening.
Joy, E.E., & Turk, C.L. (2018). The diagnosis and treatment of trauma and stressor related disorders. Continuing Education Article for Free State Social Work, LLC.
Mayo Clinic. (n.d.). Adjustment disorders. https://www.mayoclinic.org/diseases-conditions/adjustment-disorders/symptoms-causes/syc-20355224
Van der Kolk, B. (2015). The body keeps the score: Brain, Mind, and Body in the healing of trauma. Penguin Books.
I Want a Snickers Bar, I Don’t Want Dark Chocolate
This article discusses how Black children, especially boys, are usually the last to be adopted. Discusses systemic racism in social work, ethics, and racism.
Dark-skinned Black children last to be adopted
In the early 80s, a twenty-something-year-old White woman attended an informational session about adopting children in Oregon. During the meeting, a family seeking to adopt commented that adopting Black children was “different” and “hard.” The White woman said to herself that she was committed to adopting Black children. She adopted one, then two, three, and finally four Black and mixed-race Black children. How do I know this? She is my mother.
It turns out the royal family isn’t the only one concerned about the skin color of children ready to join the ranks. Let’s look at how dark-skinned children face discrimination in the adoption process, while lighter-skinned children jump right into the stork’s cloth carrier.
White child $35,000, Mixed child $25,000, Black child $18,000
Dark-skinned children cost less than White or mixed-race children because programs and agencies offer incentives to families reluctant to adopt them. Leeat Yariv (Oliwenstein, 2010) led a research team to explore adoptive parent’s race and gender preferences in adoption. A striking aspect of the study found that parents were willing to pay $38,000 more for a baby who is not African American.
While the Lanz family was looking into adoptions, they were surprised to hear how agencies made race-based cost calculations (NPR, 2013). The family was told that the cost to adopt a White child was around $35,000, a biracial child between $24,000-$26,000, and a Black child would be $18,000.
Some social workers discriminate based on skin color
Social workers favor White children in the adoption system as found by a report by the ACLU in 1999 to review 50 adoptions in the state of NY (Hall, 2019). This could mean that social workers portray White children in more positive terms, and highlight the skin color of light children leading to an increase in light-skin adoptions.
Hall notes that social workers facilitate discrimination against dark children by providing skin color information to parents, which is against the social work code of ethics. The NASW code of ethics explains “that social workers ‘should not practice, condone, facilitate, or collaborate with any form of discrimination’ on the basis of race, ethnicity or color, along with other factors” (Hall, 2019).
Positive biases towards light-skinned children
The Caltech research team found that a non-African American child is 7 times more likely to be attracted by potential adoptive parents than an African American child (Oliwenstein, 2010).
Caldwell, the founder of Lifetime Adoption, notes a similar preference for light-skinned or biracial children rather than dark-skinned children, remarking that prospective parents say,
“ 'I want a baby to look like a Snickers bar, not dark chocolate’ ” (Blake, 2009).
Caldwell also reported that a family turned down a dark-skinned child because they thought he would not look good in photographs.
The underlying assumption is that lighter skin children are more attractive, and more valuable simply for having lighter skin. This light preference or light bias shows up across parents of all races. A study at Black Parenting, an adoption agency in LA found that 40% of Black parents, regardless of their own skin color, preferred lighter-skinned children (Hall, 2019).
So, what is driving this dislike of dark skin?
Negative associations of dark skin go back to the one-drop rule. Historically, dark skin was synonymous with dirtiness, ugliness, and behavior problems. Some might say, “Oh, these are just preferences,” but how are preferences formed? Usually, preferences are reflexes, expressions of unexamined cultural values that operate sometimes unconsciously. You could say, “Well, couples are adopting Black children, they aren´t discriminating.” Yes, they adopt Black children, but they look for the lightest ones they can find.
Let’s get some facts out there. Dark-skinned Black people will face more discrimination in jobs, in finding romantic partners, in school, in housing, and in academic advancement. Dark-skinned Black people are overrepresented in the criminal justice system. These prejudices have been well studied, and many are described in the book Caste by Isabel Wilkerson (2020). The research lays it out, but we need to be saying the conclusions out loud and more often, which are the following:
There is no reason related to the actual child´s abilities, looks, or temperament that warrant this discrimination. Dark skin is just as beautiful, dark-skinned children are just like any other child, it's society that makes dark skin an undesirable trait. Adoptive parents and social workers should remember this.
In an interview, Nefertiti Austin, a Black adoptive mother who wrote the book Motherhood so White explains the negativity associated with Black children.
“[Black kids] are perceived as behavior problems. They are considered aggressive, but their White counterpart is considered rambunctious. And our girls are sexualized at an early age. They are thought to have attitudes. But if another girl, a White girl, says the same thing or responds in a like manner it's, 'Oh well, she was annoyed,' or it's excused” (Mosely, 2019).
These assumptions based on race about behavior are compounded even further if the child is of dark skin.
Results of discrimination in adoption
White children wait 23.5 months on average to be adopted out of foster care, while Black children wait for an average of 39.4 months, which is much longer than any other race (Hall, 2019).
As Yariv (2010) notes,
"Long-term foster care leads to bad outcomes” (Oliwenstein, 2010).
We all know what those outcomes could be. Increased mental health challenges and fewer support systems and a list of problems that go with that.
I know there are plenty of caring and loving foster care families, but we must remember that with stability and love, children can face many difficulties, this should be a right for all children. Let’s do our part to challenge adoption discrimination based on skin color.
Resources
Blake, J. (2009, July 20). Single black women choosing to adopt. http://edition.cnn.com/2009/LIVING/07/01/bia.single.black.women.adopt/
Hall, R. (2019, February 19). The US adoption system discriminates against darker-skinned children. The World. https://www.pri.org/stories/2019-02-21/us-adoption-system-discriminates-against-darker-skinned-children
Mosley, T. (2019, September 16). ‘Motherhood so white’ author finds race matters in adoption. WBUR. https://www.wbur.org/hereandnow/2019/09/16/motherhood-so-white-author
NPR. (2013, June 27). Six words: ‘Black babies cost less to adopt.’ NPR.
https://www.npr.org/2013/06/27/195967886/six-words-black-babies-cost-less-to-adopt
Oliwenstein, L. (2010, April 20). African-American babies and boys least likely to be adopted, studies show. Calteach. https://www.caltech.edu/about/news/african-american-babies-and-boys-least-likely-be-adopted-study-shows-1610
Wilkerson, I. (2020). Caste: The origins of our discontent. Random House.
What the Movie ‘Instant Family’ Got Right About Adoption
This article talks about basic do’s and don’ts by looking at the film Instant Family. Discusses positive ways to adopt children and some behaviors to avoid.
…And One Or Two Things It Got Wrong
I really enjoyed the movie “Instant Family,” based on the true story of a heterosexual, cisgender White couple of decent economic means and the family they created. They adopted three children from the foster care system, older children as well, who appear to be Latino/a. The movie gives a glimpse at the foster-to-adopt process, bonding, frustrations, humor, and love. It’s a nice movie in many ways, although some scenes sent a few unfavorable messages about adoption that should be addressed. Here are some things the movie did well.
Thumbs up
Siblings stayed together
The social workers did an activity where they explained the grief of displaced children. Social worker, “She is grieving the loss of connection with everything and everyone. But the one connection that can remain is between siblings. Sometimes it’s easier for sibs to adjust because they’re not going through it all alone.” Keeping children together helps with bonding, emotional regulation of all the children. Separation between siblings could be traumatic for adopted children.
Adoption of older children
At the adoption fair, Pete, the dad-to-be, sets his eye on the group of teenagers keeping to themselves far across the lawn. He says, “I’m going over there….look at them over there. I mean, everyone’s avoiding them like they’re dipped in sh*t.” A little extreme, but you get the point. Many people fear adopting older children, mainly because of fears that older children will adjust poorly. Adoption of older children could have different elements of difficulty than with younger children, however, all people who adopt should remember that no matter when a child is adopted, they take their past with them. This is something both to celebrate and to take into account.
Strengths of gay parents
During the training for adopting parents, the film showed a highly motivated gay couple in the foster care information session. You could say they were quite pro-adoption, as LGBTQ+ couples are four times as likely as straight couples to have adopted than their heterosexual counterparts (Adoption Network, n.d.). According to the US Department of Health and Services, often LGBTQ people choose adoption as their first choice for creating a family, making them a “highly motivated resource” (Turner, 1999). This could have psychologically positive outcomes on adopted children to know they were the “first choice” which is different for many heterosexual couples who often “end up” adopting (Reed, 2013).
Adoption of Black children
In the film, a White single woman October specifically wanted to adopt an African American boy. This is quite rare. Unfortunately, Leeat Yariv (Oliwenstein, 2010) led a research team to explore adoptive parent’s race and gender preferences in adoption. A striking aspect of the study found that parents were willing to pay $38,000 more for a baby who is not African American. Parents also preferred adopting girls to boys.
Thumbs down
Talked about “giving them back”
After a trying dinner where the youngest spilled the milk and dumped chips all over the dinner table, the middle child began to have a panic attack, and the oldest screamed at the parents for being too strict, the parents had a bedtime huddle.
Pete says to Ellie, “We can’t start turning on each other here. If we stay calm and work together, we can find a way to get the little a**holes out of our house.” Notice that he used the term “our house.” The kids are outsiders, intruders.
Elie looks at him with wide eyes, “That’s exactly what I was thinking. I hate them so much! They’re so ungrateful. We are doing everything for them, and they couldn’t give two sh*ts.” Side note, I have never seen a movie where supposedly good parents say they hate their kids so much.
Pete gives her a sly look. “They’re not adopted yet,” he grins.
Ellie leans in conspiratorily, “We could just give them back.”
Anyone who has been a parent knows that parenting is no easy task. But this scene was quite horrible, in my opinion. The parents showed absolutely zero empathy for the children’s adjustment and worried more about the kudos they receive for being “saints” for having put up with them, as they termed it. They complain that their kids aren’t “grateful.” This idea confirmed a previous worry they had brought up to the social worker, that they didn’t want to be white saviors adopting kids of color. Well, they stepped right into it.
Although they seemed to be joking, this kind of “give up” when the going gets tough is no laughing matter. It is the equivalent of talking about your biological child in this way, “We carried them to term, and they are so ungrateful! Let’s get rid of them.”
Many of us may remember with horror about the YouTubers who “rehomed” their adopted child Huxley after he was “too difficult” and coincidentally wasn’t hammy enough for the camera. Needless to say, such a decision shows a lack of maturity and empathy about the child’s needs. The decision to “rehome” also is a sign of poor preparation that could have had a traumatizing effect on Huxley.
Adoption of Black children
Pete and Ellie’s kids visit their birthmother four times in the movie, and each time they come back with dysregulated behaviors. At the foster care group, Ellie says, “We just feel so rejected. I know this makes me a really bad person, but I keep wishing that their mom would go back to prison.” It is understandable that Ellie is struggling with the aftereffects of the parent visits. On the other hand, her preference that the birth mother undergo a harmful situation for her own peace of mind seems to lack empathy. The social worker reframed Ellie to suggest that she is trying to protect the children, also painting the birth mother as the problem.
This is an unfortunate and common trend. I have seen this with YouTubers who post about foster adoptions. Often they hold disparaging and highly disrespectful views about the birthmothers. One YouTuber said, “I am glad I saved my children from a woman who was living in sin.” I wrote to her and reminded her that someday her children and likely the birthmother, would see that video. I told her it is better to hold a supportive stance towards the woman who allowed her to be a mother rather than to judge her harshly. Similarly, with children whose parents have divorced, it is recommended not to talk negatively about the other parent. This will help retain the children’s sense of integrity and self-worth.
In sum
To sum it up, as shown in the movie, it’s important to keep siblings together and to adopt older children who often are less likely to be adopted. The movie commented on how for many LGBTQ+ families, adoption is the first choice. Couples or individuals who adopt as a first choice is an area very seldom studied and the psychological benefits for children of this choice should be explored. Further, the film highlighted, albeit in a rather essentialist way, a white woman who sought to adopt a Black teenager. Further research shows that Black boys are the least likely to be adopted. It should go without saying that parents should not take adoption like a library…children should not be returned. In addition, parents who adopt children, whether transracially or not, should learn about their children’s culture of origin and integrate these aspects into their lives.
Resources
Adoption Network. (n.d.) Same-sex adoption. https://adoptionnetwork.com/types-of-adoption-options/same-sex-adoption/
Oliwenstein, L. (2010, April 20). African-American babies and boys least likely to be adopted, studies show. Calteach. https://www.caltech.edu/about/news/african-american-babies-and-boys-least-likely-be-adopted-study-shows-1610
Reed, K. (2013, October 22). Study finds couples who want children view adoption as a last resort. Nebraska Today.
Turner, C. S. (1999). Adoption journeys: Parents tell their stories. Ithaca, NY: McBooks Press.
What Is Cultural Competence?
Explores the building blocks of cultural competence including humilty, openness, and curiosity. Discusses how our language shapes our reality.
Most people, especially in the health and education fields are familiar with the term “cultural competence.” But, what is cultural competence composed of, and what are the often unstated suppositions that serve as the bedrock of cultural competence? First, what is cultural competence, or as my college professor of psychology of racism termed “cultural humility.” These two terms hold slightly different meanings, but I believe they get at the same thing.
What is cultural competence?
Cultural competence is made up of components that fall into three categories: 1) Self-awareness 2) Interpersonal connection 3) Attitudes.
Preemptive Love (2020) puts it simply,
“Cultural competence is the ability to understand and interact effectively with people from other cultures.”
Cultural competence requires us to build self-awareness around our biases, social position, and assumptions. Interpersonal connections include flexibility, true listening, dialogue, problem-solving, and working through misunderstandings. Attitudes include keeping an open mind and staying respectful.
You might be thinking, “Oh, right, this means I should just tolerate everyone.” Cultural competence or cultural humility invites people to look for authentic connection which comes from a shared understanding, rather than tolerance, which means you are putting up with a person or idea.
Humans literally see different things
Let’s take an example from neuroscience, in the South African language Xhosa. They don’t have a word for blue. So blue, in effect, does not exist in that culture. What English describes as blue, in Xhosa is luhlaza, or blue/green. Since language creates meaning, a large part of cultural competence must include an awareness of language. Language allows us to step into another worldview.
So, how does this translate to the mental health field? For example, in Andean communities in Peru, people use metaphors to describe what may be perceived in Western society as stress, anxiety, and tension (Pederson et al., 2010). Andean people in a focus group did not recognize ideas or words such as anxiety and tension, but instead used other Quechua words such as collective sorrow, melancholy, or pain such as headaches to express relational cut-offs and sadness, as expressed by the word pinsamientuwan. This means that language and meaning are inextricably linked. Mental health providers should remember that some words don't hold the same meaning in other cultures, or may even represent ideas that don't exist in other cultures.
But, what is culture?
So, you might be asking, “What does culture mean? I understand the competence part, listening, respecting, learning about the self and others. But, what exactly is a ‘culture?’” In the very literal world, culture embodies certain practices inhabited by a particular community. This could span linguistic, geographical and religious affiliations. Culture is encompassed by values and beliefs. You might then be asking, “Does that mean I have to accept everything any culture does?” One might say, for example, toxic masculinity is a cultural practice, as in, people from a particular group believe in its values and its practices. Does that mean if I am culturally competent, I must accept this practice? The answer is no. The reason is that the underlying aim of cultural competence is to share power.
Cultural understandings seek to share power
One understated piece of cultural competency is how it addresses power differences. The reason the health field, in particular, has made strides in training people about cultural competence is that marginalized groups often receive subpar care and inadequate attention which can result in increased mental stress, health complications, and even death. For example, most articles about cultural competence stress the lack of language interpreters in the mental health field. In the United States, the culturally dominant language is English, therefore the culturally competent response would be to provide quality services in Spanish, for example, since a large percentage of Spanish-speakers have been underserved in healthcare.
Social workers and cultural competence
Cultural competence aligns social workers to our code of ethics. In addition to attending to the mental health needs of our clients, we are tasked with encouraging social justice and non-harm. Our stance must be reflective, open, and respectful. Again, that does not mean that any act committed by any culture can be accepted. It does, however, mean that as professionals, we will do our due diligence to improve the mental health of our clients through respecting and understanding their cultural perspectives.
Resources
Pederson, D., Kienzler, H., & Gamarra, J. (2010). Llaki and ñakari: Idioms of distress and suffering among the highland Quechua in the Peruvian Andes.Cultural Medicine and Psychiatry. 34:279–300. DOI: 10.1007/s11013-010-9173-z
Preemptive Love. (2020, January 23). What is cultural competence? And why is it important?
Serving The Latino(a,x) Population In Massachusetts
This article discusses particular mental health and linguistic needs of the LatinX, Latino, Latina population in Massachusetts.
Implications for therapists
Languages in Massachusetts
I imagine that when people think of Massachusetts, their minds go to Salem and the witch trials or Plymouth Rock. But if you were paying attention, you will know that Massachusetts has a strong Native American population that is regaining stolen lands, that Sojourner Truth landed in Florence and made a home, and that abolitionists worked, wrote, and joined forces here. In addition, Massachusetts was a cultural and economic hub for migrant workers from Puerto Rico in the 1950s. This diversity is partially reflected in the 2018 Census Bureau, citing that nearly 25% of Massachusetts residents speak a language other than English, which is higher than the national average. Spanish was the language most spoken, at nearly 10%, followed by Portuguese at 3.14%, and then Mandarin and Cantonese Chinese at 2.8%.
The high percentage of Spanish-speaking people reflects the larger national pattern. By 2060, Latina people will reach 28% of the US population (Smith, 2018). So, with this in mind, let’s look at some barriers to Latino people seeking mental health services.
Language support in health and social services
The 2018 Census Bureau found that 63% of the Latino population reported limited English, with only 12% reporting levels of English proficiency. So, how is mental health keeping pace with this trend? Not so well. According to an APA survey, only 5.5% of psychologists can provide services in Spanish (Smith, 2018).
Like every state, Massachusetts requires an interpreter in hospitals for non-English speaking patients. Chapter 6 of the Acts of 2000 states,
“Every acute-care hospital, as defined by 25B, shall provide competent interpreter services in connection with all emergency room services provided to every non-English speaker who is a patient or who seeks appropriate emergency care or treatment “(del Mar Farina & Kirby, 2019).
Although laws require interpreters in health care facilities, in practice, interpretation is not offered or when offered, it is inadequate.
Opioid use amongst Latinos
SAMHSA reports that an epidemic of opioid use amongst Latinos has increased dramatically in recent years. Some of the reasons are that these drugs ameliorate the pain associated with trauma due to deportation and detention, fleeing from natural disasters and violence, injury from physically taxing service jobs, and psychological and physical injury from serving in the armed forces. Alarmingly,
“In 2018, Massachusetts had the highest opioid-related overdose death rate for Hispanics” (30.4 deaths per 100,000).
Unequal access to adequate drug treatment and diagnosis
Some studies found emergency departments are reluctant to prescribe opioids to Latino and Black patients even when presenting similar levels of pain intensity as white people. This pushes people to other options for pain relief.
Another structural hurdle is for heroin users in treatment. Latino individuals face barriers in receiving a less stigmatizing and more effective treatment such as naltrexone or buprenorphine. They are less likely to elect methadone since it is highly controlled and administered in a public setting and is more stigmatized. SAMHSA states,
“ ..a two-tiered treatment system exists where buprenorphine is accessed by Whites, higher-income, and privately insured individuals, while methadone is accessed by low-income and publicly insured people of color.”
Cultural competence
Social workers will need to have a firm understanding of the mental health effects related to the above social issues such as detention, immigration, and opioid misuse. In addition, social workers will need to remember the pillars of many Latino families include religion, and maintaining an insular and close-knit family structure.
Bilingual psychologist Pizzi underscores this point,
“Family is a priority, and one does not offend or put the family values or family unit at risk to pursue one’s own individual happiness” (Smith, 2018).
Final thoughts
Since Latino families tend to leave treatment more quickly than other groups, it is important that social workers continually reevaluate their methods to help Latino people get the best out of their treatment by offering a culturally responsive and a clinically and linguistically informed approach.
Resources
Census Bureau. (2018). https://datausa.io/profile/geo/massachusetts/demographics/languages#:~:text=24.3%25%20of%20Massachusetts%20citizens%20are,the%20national%20average%20of%2021.9%25.
Del Mar Farina, M. & Kirby, S.M. (2019, September). Use of interpreters in mental health encounters. In IBHC Training Modules. https://www.westfield.ma.edu/interdisciplinary-behavioral-health-collaboration/modules
Smith, B. (2018, June). Spanish-speaking psychologists in demand. APA.
https://www.apa.org/monitor/2018/06/spanish-speaking#:~:text=In%20a%20nationwide%20APA%20survey,making%20them%20a%20rare%20commodity.
SAMHSA. (2020). The opioid crisis and the hispanic/population: An urgent issue.
What Is PTSD?
Discusses the causes of PTSD, traumatic events, and symptoms of PTSD.
PTSD stands for Posttraumatic Stress Disorder, and as the name suggests, a person who has faced a traumatic event responds with a high level of stress that can pervade and disrupt everyday functioning, relationships, and mood. Some might be asking, well, what constitutes trauma, and why is stress such a bad thing to merit the category of a disorder?
What constitute ‘traumatic events?’
To begin with, almost everyone in the US has experienced a traumatic event in their lifetimes, about 90% (Kilpatrick, et al., 2013). A traumatic event could include a car accident, bullying, neglect, racism, homophobia, transphobia, ableism, xenophobia, sexism. But the distinction with the traumatic events that are covered by the term PTSD includes
“exposure to serious physical injury, sexual violence, threatened death, and the sudden or violent death of another person. Car accidents, physical assault, rape, military combat, and natural disasters qualify as traumatic events” (Joy & Turk, 2018).
Importantly, one need not directly experience the traumatic event to be affected by them. In other words, even hearing details of a traumatic event can cause someone to have a traumatic response. In addition, the reason an event becomes traumatic has as much or more to do with injurious ways we learn to think of ourselves and the world because of the event, rather than the horrific nature of the event (Maté, 2022).
Does everyone who experiences a traumatic event have PTSD?
It is very possible that people who have experienced trauma don’t ever develop PTSD symptoms. For some people, symptoms show up within a month of the traumatic event, in other situations the symptoms take years to manifest (Mayo Clinic, n.d.). In addition, there are many people who have processed the traumatic event, for whatever reason, that allows them to integrate the trauma, not in a way to mean that the trauma has been forgotten. Rather, the person has come to a point of acceptance about what happened to them, has empathized with response to the horror of the situation, and has decreased bodily the stress from the traumatic event. In other cases, the memory of the trauma pervades daily functioning, and takes over the body’s resting state, causing constant alertness, agitation, anger, difficulty sleeping.
So, what is meant by ‘stress?’
According to Van der Kolk (2015), when someone experiences a threat, the brain sends signals to the body that alert the fight, hide or flight response which produces an enormous amount of stress. When the threat is gone, sometimes the body stays on high alert. This is a hormonal and electrical state that impacts the entire nervous system and keeps it from “settling” or being calm even in safe situations.
What are the symptoms of PTSD?
Changes in mood. This could be anger, recklessness, sadness.
Changes in cognition. This could be forgetfulness, inability to concentrate, self-blame for the event, blanking out parts of the traumatic event, detachment from others, negative beliefs such as “I will always be in danger.”
Arousal. Jumpiness, difficulty sleeping, difficulty concentrating, angry outbursts, being in a state of constant alert.
Constant intrusive memories of the traumatic incident.
Nightmares about the event, flashbacks, or leaving one’s body so to speak.
Re-experiencing the traumatic event, as though the event were taking place again.
Avoidance symptoms such as trying to avoid objects, people, or places that remind them of the traumatic event.
Healing PTSD
As clinical as these symptoms sound, one must always remember that no one is ever at fault for damage that others have done to them. To reiterate Van der Kolk, trauma is horror. Even though we can list symptoms, we must acknowledge that the threat to one's integrity is an existential injury that goes into the depths of the soul. To heal from this life-shattering event, it truly takes trust in one’s own sense of being able to keep safe. This happens when the environment can guarantee safety. Further, when a person who has experienced trauma can find ways to connect with themselves, have empathy for their own suffering, and can listen to their own bodies and thoughts in a safe place they can build loving relationships towards the self and towards others.
Resources
Joy, E.E., & Turk, C.L. (2018). The Diagnosis and Treatment of Trauma and Stressor Related Disorders. Continuing Education Article for Free State Social Work, LLC.
Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, M. K., & Friedman, M. J. (2013). National estimates of exposure to traumatic events and PTSD prevalence using Trauma and Stressor Related Disorders DSM-IV and DSM-5 criteria. Journal of Traumatic Stress, 26(5), 537–547. https://doi.org/10.1002/jts.21848.National
Maté, G. (2022). The Myth of Normal. Avery.
Mayo Clinic. (n.d.). Adjustment disorders. https://www.mayoclinic.org/diseases-conditions/adjustment-disorders/symptoms-causes/syc-20355224
Van der Kolk, B. (2015). The body keeps the score: Brain, Mind, and Body in the healing of trauma. Penguin Books.
Adoption and LGBTQ+ Parents
This article looks at the many strengths LGBTQ+ parents bring to children they adopt. This includes high motivation and support navigating gender.
LGBTQ+ parents adopting children who are not LGBTQ+, and LGBTQ+ parents who adopt children who are LGBTQ+ is a very positive thing! Studies have shown particular strengths that LGBTQ+ parents bring to their children, whether or not they are LGBTQ+. In particular, though, LGBTQ+ parents can help bolster identity questions for LGBTQ+ youth.
High motivation to adopt
There are many positive qualities associated with LGBTQ+ parents that make them exemplary parents and candidates for adoption. You could say they are quite pro-adoption, as LGBTQ couples are four times as likely to have adopted than their heterosexual counterparts (Adoption Network, n.d.). According to the US Department of Health and Services, often LGBTQ people choose adoption as their first choice for creating a family, making them a “highly motivated resource (Turner, 1999).” This could have psychologically positive outcomes on adopted children to know they were the “first choice” which is different for most heterosexual couples who often “end up” adopting (Reed, 2013).
Help manage identity issues
According to the Adoption Network (n.d.), LGBTQ couples are four times as likely to have adopted than their heterosexual counterparts and tend to be more diverse in level socioeconomic status and ethnicity than straight couples who adopt (UCLA Williams Institute, 2018). This could help them relate more to children in foster care who often come from ethnically diverse backgrounds. In addition, LGBTQ parents who adopt out of the foster care system show strengths in the ability to relate to identity concerns children wrestle with from being in the foster care system.
Help support LGBTQ+ youth
Additionally, LGBTQ+ parents can help LGBTQ+ children through identity concerns related to their sexual orientation or gender expression, as many children in foster care express at least 7% express not identifying with being heterosexual (SAMSHA, 2014). Acceptance is crucially important as the level of family rejection can lead to LGBTQ+ children running away or committing suicide. According to the landmark report from the Family Acceptance Project (Ryan, 2009), LGBT youth who experienced high levels of family rejection were 8.4 times more likely to commit suicide than youth with low levels of family rejection. Similarly, LGBT youth who faced high family rejection were 3.4 times more likely to become infected by HIV than LGBT youth in low family rejection households. You can see the importance of affirming, loving households, especially given these staggering findings.
Agencies and providers must be LGBTQ+ affirming
Unfortunately, not all agencies hold affirming practices when it comes to LGBTQ+ parents. It is important that agencies take into account prejudice from staff, including heightened scrutiny during home visits, or lack of awareness regarding the use of proper pronouns. It is important that when adoptive families meet the biological families, the agency focuses on similarities between the parents, such as perhaps where they live, where they went to high school, and not talk about sexual orientation right at the beginning. Staff should remember that they cannot assume what types of parents the biological parents will consider for their child’s adoption (SAMHSA, 2014). Agencies can be more affirming by training their staff, making material LGBTQ+ inclusive, and remembering the many positive qualities of LGBTQ+ adoptive parents.
Resources
Adoption Network. (n.d.) Same-sex adoption. https://adoptionnetwork.com/types-of-adoption-options/same-sex-adoption/
GLAD (n.d.) Know your rights. https://www.glad.org/overview/second-parent-adoption/massachusetts/
Reed, K. (2013, October 22). Study finds couples who want children view adoption as a last resort. Nebraska Today.
Substance Abuse and Mental Health Services Administration. (2014). A Practitioner’s Resource Guide: Helping Families to Support Their LGBT Children. HHS Publication No. PEP14-LGBTKIDS. Rockville, MD: Substance Abuse and Mental Health Services Administration.https://familyproject.sfsu.edu/sites/default/files/FamilySupportForLGBTChildrenGuidance.pdf
Turner, C. S. (1999). Adoption journeys: Parents tell their stories. Ithaca, NY: McBooks Press.
UCLA Williams Institute. (2018). How many same-sex couples in the US are raising children? https://williamsinstitute.law.ucla.edu/publications/same-sex-parents-us/