Sunday, December 30, 2012

New Card about my Book

Here is a card I just made and ordered to hand out to people who are interested in my book:




What do you think of it?

Wednesday, December 26, 2012

Love Wins

Remembering Ana Grace Màrquez Greene

I am sure that all of you know about the horrible killings in Newtown CT. A 20 year old gunman shot 20 first graders and six adults in the Sandy Hook Elementary school. Prior to going there he shot his mother. Finally, he shot himself.
One of the children killed was the daughter of a Klingberg employee, Ana Grace Màrquez Greene. Her mother, Nelba Màrquez Greene, is the Director of our Family Therapy Institute. Her father, Jimmy Greene, is a jazz musician.

I spent much of the week helping our Klingberg community absorb this tragedy.
Staff and clients were deeply impacted by these deaths, Ana’s and the other 26. As an administration, we wanted to provide space for staff to discuss the events and to explore their feelings and reactions.

We transformed our former reception area into a Room of Reflection. We added soft lighting from lamps, plants, pictures and stuffed animals. We had a bulletin board. I originally thought that would be for staff messages, but instead people posted articles, poems, pictures, etc. AND copies of staff emails they felt were moving. We had a book to sign in and write a message, and a basket for cards. The newspaper article with the pictures of all 20 children was posted. All in all, it was a place where people could sit and reflect or talk with others.

We noticed that the room of reflection had a purpose far beyond its actual use. Often people looked in and said “I’m so glad you are doing this.” Whether or not they chose to hang out there, the room was a statement that we knew our staff were having deep feelings about this event, and that thinking and sharing were important and worthwhile activities.
Similarly, the discussion groups we organized had unanticipated results. We set up several times to accommodate the complex schedules of an agency like ours. During those times staff were encouraged to come to the Room of Reflection and discuss the way the killings in Newtown and our co-worker’s terrible loss were affecting them. My colleague Steve Brown joined me in facilitating the groups, and we had some ideas to get the discussions started. Not many people came, but those that did spoke thoughtfully and compassionately. They were impacted on many levels. The clients were having various reactions, and staff were creating space for them to explore their feelings. Some outpatient families had lost a child themselves, and were re-experiencing their own losses. In fact, everyone was experiencing their own losses, recent or distant. Many spoke of hugging their own children more. One father reported his child saying “Dad, will you stop hugging me!?” Concerns of personal safety were on everyone’s mind- what is our safety at Klingberg? We constantly deal with emotionally dysregulated people, are we doing enough to increase safety? People worried about the safety of their children and reported on how their children’s schools were responding. My colleague David Lawrence Hawley made the excellent point that “we are no less safe than we were last week, we are just feeling differently about it.” Our wall of denial has been pierced.

Another area of concern was ourselves as mental health providers. Could we have helped this shooter if we had treated him earlier in life? Do we know what to do? Many are not sure. Assessments that we are currently making assumed a greater importance that was scary to some. And it feels like there are so many constraints and so little we can do. People spoke of youth they had known who seemed dangerous, and how little they could get the community to respond because the youth hadn’t done anything serious yet. One therapist describes one such youth who had gone on to kill his girlfriend. So, our confidence in our interventions was shaken, and at the same time we felt the importance of what we do.
One unanticipated results of the Discussion Groups was that serious, thoughtful discussions were starting everywhere, outside the discussion group times. This may have been inevitable, but I think it helped that the administration gave permission and acknowledged how important it was to set aside time to share our reactions. As the quote that we posted in our Room of Reflection says:

“Grief wounds more deeply in solitude; tears are less bitter when mingled with other tears. “
                                                                                                     Agememnon Seneca

Throughout this process we were encouraged by occasional reports of communication with our beloved staff member, Nelba. Her strength, honesty and grace in this terrible situation inspired us all. The family began to sign all communication with the phrase: “Love wins.” So we adapted that slogan. The town also said “We are from Newtown and we choose love.” Even while wrenched with this desperate sadness, the families were reaching for the meaning of their children’s lives, and trying to bring some good from the horror.
Then on Saturday I attended Ana’s funeral. This was the most incredible event I have ever been to. Ana’s father is a jazz musician named Jimmy Greene. He plays the sax. He is very connected to the jazz community. The held the ceremony in this huge cathedral church and there were literally over a thousand people there, all races, ages and types, most dressed in purple. Prior to the ceremony the family sent out an email inviting people to wear purple and sparkles because that is what Ana loved.

The ceremony, which they called "A Celebration of Ana's Homegoing", included lots of music, jazz, choir singing, a classical string quartet, etc. The message of the powerful speakers was all positive- acknowledging the sadness and pain, but emphasizing our learning from Ana's short life and becoming more loving.

On every email and communication they have sent out they have ended with "Love wins." I now have a purple bracelet (one of those plastic bands) that says "Ana Grace: Love wins". That was the message of the ceremony. It was so incredibly inspiring.

Now, how do we go forward as the media retreat and the attention moves elsewhere? How do we do the hard work of actually creating the change that children like Ana deserve? It is clear that we must work together, that we must be inspired to fight for what is right. And our efforts will matter because LOVE WINS.

Sunday, December 16, 2012


The shootings in Newtown Connecticut are close to us geographically. And they have been brought even closer because one of the children shot was the daughter of one of our Klingberg employees. Nelba Marquez-Greene is the new Co-ordinator of our Family Therapy Institute, and a wonderful new addition to our staff. She and her husband, the jazz musician Jimmy Greene, lost their daughter Ana in the shooting.

I have been thinking about Newtown, Nelba and their family almost constantly, as I am sure many others have.
There have been many different clamors for many different solutions. More gun control! Easier access to mental health treatment! We wish so badly that there was a solution, something to do, a law to pass.

As a person who teaches others about treatment, I of course think of the shooter. Do we know what treatment would keep this from happening? I have read speculation that the shooter had Aspergers.  If he had received the most caring and skillful treatment possible, could we have presented this? We don’t know yet whether he ever had treatment. I do feel confident that any treatment that emphasized relationship, safety, caring and finding your voice would have had a better chance of reaching him than a  harsh, punitive approach would have.
But this is all speculation at this point. What is not speculation is the love and connection we are sending to Nelba and her family. We comfort each other by gathering and by sharing in an open hearted way. We can’t make sense of what has happened. But we can use our connection to each other to get through it and to strengthen our commitment to the work we do.

Please share your thoughts by clicking “comment”.

Sunday, December 09, 2012

Ruta Mazelis on the Experience of Self Inflicted Violence

This past week we held our annual Day of Learning and Sharing for Risking Connectionsâ trainers. My colleague Steve Brown gets credit for both the vision and the implementation of this event, which offers in-depth training on an important topic in trauma treatment. This is one of our most excellent achievements. The warmth in the room is obvious, as the community of trainers greet old friends and catch up on the latest events. This is a group of the clinical leaders in Connecticut, all of whom have attended Risking Connection training and an additional three days to become trainers. They have also attended Consult Groups and Recertifications to keep their knowledge current. They are seeped in a trauma-informed approach to their clients. They are our partners in changing the world.

This year our guest speaker was Ruta Mazelis. Ruta is a popular speaker and trainer who presents nationally on behalf of Sidran on issues surrounding self-inflicted violence, trauma, and trauma informed care. She frequently consults to SAMHSA's Center for Mental Health Services on topics related to trauma, including trauma-informed care, co-occurring disorders, re-traumatization in systems of care, self-injury, and criminal-justice involved survivors. She provided extensive technical assistance to the SAMHSA Women, Co-occurring Disorders and Violence Study, served as a program manager for the National Center for Trauma Informed Care, and is currently on the board of the National Trauma Consortium. Ms. Mazelis, herself a trauma survivor, has worked as a substance abuse and mental health care provider in inpatient and outpatient settings. She is the editor of The Cutting Edge newsletter which she founded in 1990, and edits the web site,, and she has published numerous books.

Ruta immediately sensed the skill and knowledge in the room, and realized that she did not have to teach this audience the basics about trauma. Instead, she used her personal experience to instruct us about the realities of being a trauma survivor who relies on self-inflicted violence to deal with unbearable pain.
I hope to write more about this training in a later blog. In this post I would like to convey some points that Ruta emphasized: The first is that self injury is not a distinct and uniquely horrible or dangerous symptom. It is just one more way people have found to deal with the unbearable pain that has been part of their lives. She emphasized that we all self harm, and that for all of us it is a method of coping with pain. It is adaptive, as are addiction, aggression, eating disorders, smoking, running away, sleeping all the time. It is actually not the most dangerous thing that many trauma survivors do. The long term harm to the body is considerably less than say alcoholism. Or smoking. It is not illegal, it can be kept hidden, and it does not hurt others. Ruta told us that she has learned from her newsletter that self-inflicted violence is part of the lives of people of all ages, sexes, socio-economic groups, professions, and statuses. She has known many treatment professionals who use this technique to manage their lives.

I was once again struck by the ways that the pressure to achieve change can so often interfere with change. Self harm is adaptive. The trauma survivor will stop doing it when they no longer need it. Therefore, if we immediately jump to methods to eliminate the self harm we are not respecting the survivor’s experience. If we start talking about replacement behaviors (writing on one’s self with red pen), it may seem naïve or insensitive to the client. If writing with red pen would accomplish what I need, I would have done that long ago. It may seem disrespectful: I am not interested in how you came to do this or what it means, I just want you to stop. Ruta said repeatedly that most trauma survivors stop self inflicted violence when they work on the trauma, are no longer in desperate pain, and do not need it any more.
This is such a hard stance to maintain with all the pressures surrounding us, both from our colleagues, from those outside our agencies who monitor our performance, sometimes from the client’s family, and certainly from inside ourselves. It is extraordinarily difficult to stay with such a painful symptom.

So all we have to do is work on the trauma. What exactly does that mean? And particularly what does it mean for those of our children (most) who are far from being ready to talk about the events in their lives? As Ruta presented it, it does not just mean teaching coping skills. It means interacting with the child at every possible moment from the understanding that their behavior comes from fear, shame and despair and is adaptive. If a treater expresses that conviction repeatedly the client may gradually question their own self blame. It means creating a safe enough space that the client can relax, play and sleep. It means engaging in rhythmic rewarding activities with engaged adults to begin rebuilding the brain and reshaping early templates of relationships. Most of all it means love and compassion, for the client, ourselves and each other.
So that’s all we have to do. And gradually the self inflicted violence will fade, along with the other extreme symptoms, as the client moves forward to a life worth living.

Ruta was intense, real, passionate, and at times uncomfortable. Just what we all need to counteract all the push towards shorter, more practical, symptom reduction quick fixes. Thank you Ruta for a reminder of the profound depth of the work we do.