Monday, November 29, 2010

Thoughts on Developing Resiliency

As I begin to write about resiliency, I have to mention what Geoffrey Canada said when I heard him speak at a National Council conference. He said he was not that interesting in studying what helped people succeed despite bad situations; he was interested in creating fewer bad situations.

Still, when I heard Mark Katz, PhD speak at the Joint Commission Behavioral Management Conference I was struck by the overlap between his presentation and our training. Dr. Katz is the Director of Learning Development Services, a Clinical and Consulting Psychologist in San Diego, California, and author of the book On Playing a Poor Hand Well, published by W.W. Norton and Company (1997). In the book, Mark explores the lessons learned from those who've overcome adverse childhood experiences, and discusses ways of incorporating these lessons into our existing system of care.

In his presentation, Dr. Katz emphasized that the meaning people attribute to misfortune is a key factor in their ability to overcome it. He stated that: “The meaning we attach to adverse experiences can determine whether we view ourselves as resilient and courageous, or helpless and hopeless.”

Dr. Katz reported on a study that identified beliefs that interfere with the ability to overcome adversity. These are perceiving adversities to be permanent, pervasive and personal. (Seligman, 1992)

• Permanent – the perception that things will never change
• Pervasive – problems are evident not just in one life area, they’re pervasive
• Personal – It’s all your fault.

Seeing our adversities in these ways increases the likelihood of psychological problems; it may also weaken our immune system. Developing these beliefs when young may be especially impairing.

On the other hand, perceptions that foster resilience (Seligman, 1998; 1992) are that:

• Adversities are temporary – the perception that things will get better
• Adversities are limited – Things may not be going well in one area but they are going well in others areas
• Not personal – The person sees that he is doing the best he can under the circumstances and that it is not all his fault.

Dr. Katz identifies a key factor is resilience is fostering a sense of mastery. This includes highlighting, nurturing and expressing strengths and talents, and things you feel passionate about, feeling you’re making a contribution, and the belief that our actions can alter our destiny. So, people are able to rebound from a difficult past by learning to attach new meaning to adversities past and present, aided in large part by their ability to:

• Re-shape personal identities around longstanding strengths and talents,
• Re-frame personal limitations and vulnerabilities within the context of these strengths and talents, and
• Find or create social contexts where they felt valued for their contribution.

It is interesting to note that the three attitudes that Dr. Katz identifies as particularly harmful are exactly those that are created through trauma. His work highlights the importance of treatment programs deliberately organizing interventions to change these beliefs. The child who is experiencing abuse from his or her family does not see any hope, and thinks that their current situation is permanent. Because the neglect and abuse is so pervasive and repetitive, it affects every aspect of the child’s existence. And in our training we emphasize the role of shame. This child feels that the abuse is his fault, partly because that gives him some possibility of control, as well as to preserve his connection to his parents, and because he is told it is his fault.

What can we do in our programs to convey hope and to show the child that adversity is temporary? First and foremost we must create experiences in which the child is successful, is happy, and experiences joy. We must offer opportunities for the child to explore his strengths. We must coax the child to play. And then we must take care of ourselves and each other so that we can maintain our hope, and thus be able to show hope to the child.

If the child has these experiences of play and success, she can gradually experience that while some areas of her life may be troubled, other parts are not. The pain can be compartmentalized in an adaptive way.

Help a child to emerge from shame is a slow and meticulous process. We must be careful not to rush to reassure the child that whatever happened was not his fault. Instead, we must provide space for him to explore his thoughts and feelings, and share his secret fears and concerns. The antidote to shame is sharing and receiving and empathetic response.

It is important to note that Dr. Katz emphasized a sense of mastery as a key to resiliency. In our training we explore the concept of effective action. The essence of trauma is not being able to change it, control it, or have any power to influence what happens. In our treatment programs we must make sure we do not replicate a sense of powerlessness. Instead, we must offer children lots of ways to take effective action in their own lives. These can include having choices in activities, food and unit functioning; being involved in planning meetings for their lives and advocating for their own wishes; and participating in helping others, volunteer work, helping causes they care about, etc.

The overlap between the literature about beliefs that support resiliency and the evidence about healing from trauma strengthens our understanding of the importance of addressing these areas directly and planfully.

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