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June 2014 SVC-CAMFT Newsletter.

  June 2014  


 Sacramento Valley Chapter

California Association of Marriage & Family Therapists

Newsletter Editor:  Heather Blessing, MFT Registered Intern

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Letter from the Board

June 1, 2014

Dear Members,

                June! Six months into our year and it is time to look back and see what we have accomplished and what still needs to be done.


                The 3000 Club is blooming and we are having a repeat performance for about 40 Sacramento State students who would like to go over one of our Prelicensed Presentations. Over half of our members are trainees and interns and this response is very heartening as they carry our future with them.


In appreciation for their response we are going to raffle off two seats that have been donated for the Law and Ethics Event at our June 20th Breakfast Meeting! This Meeting is about “Working with Latino/Hispanic Clients.”  It will be presented by Guillermo Alvarez, LMFT. (Please see Events on our webpage for more information.) Carol and Sterling are really reaching out to our futures in the colleges and their efforts to support, guide, and education our new members is greatly appreciated.


     Again we want to thank Carol, Heather and many others for all their help with the Directory. We also give our thanks to our many Sponsors who supported the expense of the Directory.


     Marti and Kari with Heather’s support are working very hard to bring you a comprehensive and educational Law and Ethics Meeting.  Remember there will be 6 ceu’s towards your annual requirement. This is also a wonderful opportunity to network and bond with other members. Let’s have a great day. 


     We are beginning our Sponsorship Program (which still needs a volunteer to be Program Chair of our New Business Development that already has three sponsors!) Each has been exceedingly generous and we are very grateful. Future funds will go to support the new events for the 3000 Club, the morning meetings and two more programs that we want to start before the year is up. One is the Therapists Get-Togethers to discuss new interventions, education, “insurance”, and other concerns we have around practicing therapy. The Second is a workshop we would like to develop for therapists going into private practice for the first time. Please send any questions you may have so that we can include everything you need to start a successful private practice.


Again, thank you all so much for your continued support.


Jill P. Lawler, LMFT #51392


  This issue:

· Letter From the Board
· Legal Beagle

· Volunteers for Board Needed
· April Presentation Summary
Upcoming Meeting Information
· NAMI Walk
· Upcoming Board Meetings
· Special Feature
· Letters to the Editor
· Psyched about Books and Movies
· Advertising and Announcements
· Advertising Policy for the Newsletter


Jill P. Lawler, LMFT
Mike McDonald, LMFT
Past President:

Chad Thompson, MFT
Secretary: Maria Wiese, LMFT


Beverly Baldwin, MFT Intern

Terri Johnson, MFT Intern Program Co-Chairs:
"Marti" McClellan-Morehouse, LMFT
Kari Deitrich, Trainee
Hospitality Co-Chairs:

Kimberlie Flowers, MFT
Pre-License Chair:

Betty Knight, LMFT
Sterling Evison, LMFT
Volunteer Chair:

Membership Co-Chairs:
Carol Nelson, LMFT

Newsletter Editor:

Heather Blessing, MFT Intern


Legal Beagle

dectective.pngWelcome to the section of the SVC-CAMFT newsletter, Legal Beagle written by Darlene Davis, LMFT. The chapter thought it would be helpful to keep you updated on new laws, legislative pursuits or actions, as well as ongoing legal and ethical dilemmas we all face in our career as Licensed Marriage and Family Therapists, Interns, and Trainees. Please feel free to ask questions that you have and I will do my best to investigate and post your answer in the newsletter. Please note that articles are based on information from CAMFT and/or the BBS and have been researched to the best of my ability. This is not meant to be legal advice.  Please contact CAMFT or Board of Behavioral Sciences for any legal matters you need assistance for.

I attended the BBS meeting (via webcast) on Thursday, May 22nd and thought I’d share some of the discussion and updates. This article does not cover every topic discussed at the meeting. For more information visit www.bbs.ca.gov under board meetings

The BBS is continuing to fill their vacant positions and now has hired 5 out of the 8 expected. This has dramatically reduced the time for processing applications for licensure. Although it’s not to the time that is expected it has gone from 8.5 mths to 5.5 mths to process applications for licensure. The time reduction should continue as they hire and train additional staff although they anticipate a year before normal processing times occur.

Proposed legislations:

SB 909 Dependent Children:  Health Screenings This bill proposes that a social worker may authorize a noninvasive initial medical, dental, and mental health screening for a child taken into temporary custody by a county welfare agency due to an immediate danger. The board supports the bill.

SB 578 (formerly SB 1148) MFT:  Record Retention This bill would require a licensed marriage and family therapist (LMFT) to retain patient records for a minimum of seven years from the date therapy is terminated.

Most of us probably follow the seven year protocol but there is no actual law in place for LMFT’s. This would make it clear what our obligation is. For children we would keep records for 7 years after the child turns 18. It will not require us to destroy records after the 7 years. The board supports the bill with an amendment to add other disciplinaries (LPCC, LCSW, etc). If the bill passes it would apply to records of a patient whose therapy is terminated after January 1, 2015. 

AB 809– Healing Arts: Tele Health This bill corrects the problem of requiring consent prior to every session of telehealth. Current law also states that the health care provider needs to be at the originating site (site of the patient) when consent is obtained. This defeats the purpose of telehealth. This bill will allow verbal or written consent that can then be transmitted to a distant site where the health care provider would be performing the telehealth services. The bill does not solve or answer all of the questions that were brought up but because it is an urgency bill the board will support the changes and will then begin advocating for other changes.

AB 1775 Child Abuse and Neglect Reporting Act: Sexual Abuse  This CAMFT sponsored bill adds “downloading” or “streaming” or “accessing through any electronic or digital media” a film, photograph, videotape or recording, negative or slide of a child engaged in an obscene sexual act to the definition of sexual exploitation for purposes of mandated reporting under CANRA.  While the law mandates a mandated report for printing or copying of these materials, the law does not specifically mention “downloading”. The Board voted to support the bill.

SB 1012 MFT: Trainees supervision– This is a CAMFT sponsored bill that would increase the limitation of 5 hours of supervision gained per week to 6 hours of supervision gained per week  toward the 3000 hours of experience required for licensure.

This bill will allow interns and trainees who work in multiple settings simultaneously to receive up to 6hrs of supervision instead of the current law that only allows 5hrs of supervision. The BBS is proposing language that would have this bill be retroactive back six years that allows interns and trainees to apply hours of supervision up to six hours to count beginning 2009. There is also a supervision committee currently underway that is looking at many aspects of supervision needs. See the BBS website for dates. The board supported the bill with an amendment to include LPCC’s. NASW would like to study the change before supporting inclusion.

Lastly once again random people have died at the hands of someone that was mentally ill. This tragedy has brought up much discussion (again) on how to change gun laws and/or improve mental health services. A bill has been introduced! I have inserted it here in its entirety.


 Assemblymembers Nancy Skinner, Das Williams Announce

Legislation in Wake of the Santa Barbara Shooting

SACRAMENTO undefined Today, California State Assemblymembers Nancy Skinner (D-Berkeley) and Das Williams (D-Santa Barbara) announced legislation to help prevent mass killings like this weekend’s tragic Isla Vista rampage near UC Santa Barbara that claimed the lives of six students.

The proposed legislation would create a gun violence restraining order, establishing a system where concerned family members, intimate partners or friends can notify law enforcement of someone who is demonstrating a propensity to commit violence toward themselves or others. 

“When someone is in crisis, the people closest to them are often the first to spot the warning signs but almost nothing can now be done to get back their guns or prevent them from buying more," Skinner said. “Parents, like the mother who tried to intervene, deserve an effective tool they can act on to help prevent these tragedies."

Under current law, therapists can notify law enforcement that their client is at risk of committing a violent act allowing authorities to investigate the individual. Law enforcement can prevent the person from buying or owning firearms.  

“The tragic incident in my hometown of Isla Vista is not a result of gun laws failing. Rather, it is a horrific example of how our mental health laws and gun control laws are not working together,” said Williams.  

The proposed legislation would grant this authority to concerned family members, friends and intimate partners, creating a mechanism to intervene and potentially prohibit the purchase of firearms and/or remove the firearms already in possession. Law enforcement would have the ability to investigate threats and ask a judge to grant an order prohibiting firearms purchase or possession. 

In most cases involving an individual in crisis there is no mechanism to limit firearm access while the individual is seeking or receiving needed help (e.g., mental health counseling, substance abuse treatment, anger management) 

Family members may call law enforcement to intervene. However, as evidenced by law enforcement's response to the mother's call regarding her concerns about the shooter in the Santa Barbara incident, if no crime has been committed, or the individual does not meet the criteria for an involuntary civil commitment to mental health treatment, there is essentially nothing that can be done to prevent that individual from purchasing firearms or to temporarily remove firearms from their possession during the crisis.

Senator Hannah Beth Jackson will be joining Williams and Skinner as a principal co-author of the legislation.


Elected in 2008, Assemblymember Nancy Skinner (D-Berkeley) represents the 15th Assembly District, which includes Hercules, Pinole, El Sobrante, San Pablo, Richmond, El Cerrito, Kensington, Albany, Berkeley, Emeryville, Piedmont and parts of Oakland. Skinner serves as Chair of the Assembly Budget Committee.



Darlene Davis, LMFT
Executive Director HOPE; Healthy Outcomes for Personal Enrichment
MFT Stipend Coordinator for Greater Sacramento
Instructor of University of Phoenix




Mike McDonald who most of you know as a Hospitality Co-Chair has stepped up to become our President Elect.
This leaves a Hospitality Co-Chair vacant.
We also need another Membership Co-Chair, another Member at Large and a Volunteer Chair.

Also I, Heather Blessing, will step down at the end of the year as Newsletter Editor and am looking for a replacement.  If you are interested in learning about the newsletter feel free to contact me at newslettereditor@sacramentovalleycamft.org

Please contact Jill about the other positions
at jilllawler@hotmail.com


  May Presentation Summary
Experiential Sand Tray Training (2 CEUs)

Don't forget to sign up for the June meeting!

SVC-CAMFT Monthly Meeting:
How to Work Effectively with Latino/Hispanic Clients Sierra Vista Hospital
8001 Bruceville Road Sacramento, CA 95823
Date: Fri, June 20, 2014 9:30 AM PDT

Ixel from Sierra Vista Hospital asked attendees to feel free to provide feedback to the hospital in regards to the SVC CAMFT meetings.  Any feedback - about what is going well and any suggestions for improvement, etc - are welcome!  He also informed attendees that the hospital is gearing up to introduce a new program for patients: Adolescent Life Skills Training as part of the Adolescent Outpatient Services.  The Adolescent Outpatient Services Open House occurred on May 20th at Sierra Vista Hospital for anyone interested in learning more about the program and touring the outpatient facility.  The Adolescent Life Skills Training is an afterschool program that lasts for 8 weeks, consisting of two 4 week modules beginning on June 2nd.  For more information, contact Barbara Thomas at barbara.thomas2@uhsinc.com or 916-288-0420.

Attendees were then immersed in the Sandtray Worldplay Experiential Workshop, led by Yvonne Sinclair M.A., MFCC.  According to Yvonne, "Sandtray Worldplay is a unique, dramatic, multi-dimensional form of individualized creativity.  Its purpose is to provide access to the innate healing and growth functions that are present in the human psyche.  It may be used as the primary method of therapy or in addition to verbal therapy" (from handout courtesy of Yvonne).  Yvonne introduced attendees to sand tray world play and its origins, identified limitations to sand tray therapy, explained the sand tray world play format including suggestions for sand and miniatures, and systematically laid out the phases of sand tray world play.  Yvonne explained that trays need to represent the four elements of Earth, Wind, Air, and Fire; real sand works best for tactile reasons.  A good variety of miniatures, displayed on shelves in categories, works best.  It's important that the therapist utilize Directive Non-Directive techniques - have clients build their world and then be invited in.  It's important that the therapist get proper training, let it be the client's world, and understand their own countertransference and limitations.  Items need to be processed in the order of placement.  Attendees were then invited to complete sand trays themselves.  Individual worlds and group worlds were created, and instructors helped attendees process what they had created.

For more information about Sand Tray Therapy and Yvonne's continuing education workshops, please go to www.yvonnesinclair.com, call 916-434-2877, or visit 898 5th Street in Lincoln.

Written by Brianne Durkin, MFT Registered Intern #77288


Upcoming Meeting Information

(Remember we are at Sierra Vista Now)

June Monthly Training
Topic: How to Work Effectively with Latino / Hispanic Clients
Guillermo Alvarez, LMFT
Date:  Friday, June 20, 2014 
Time: 9:30 AM to 12:00PM

Sierra Vista Hospital
8001 Bruceville Road
Sacramento, CA 95823

Workshop Information:
When we are able to express awareness of client’s needs and interest and demonstrate genuine empathy in regards to their unique, sometimes culturally sensitive issues and concerns, the therapeutic relationship is more dynamic and beneficial for all parties involved. Guillermo Alvarez, LMFT, has provided mental health services for the Latino / Hispanic community in the East Bay area for over 13-years. And one of his goals has been to raise awareness about some specific issues that mental health providers can benefit from in regards to providing effective mental health care for Latino / Hispanic clients. He also aims to improve access to mental health treatment for individuals, couples and families in need. The tools and strategies that Guillermo will share are based upon many years of experience and a personal commitment to a population dear to his heart.

In this meeting we will address the following objectives:

* Identification of common diagnoses among Latinos

* Examining indicators for acculturation

* Exploring clinician biases and personal beliefs and their implication on service delivery

* Discussing barriers to services

* Identification of best practices when working with Latinos

Guillermo Alvarez, LMFT, has been an active leader in the CAMFT community for the past 12 years, including the 2013-2014 CAMFT Board of Directors, President. The SVC-CAMFT is honored to provide a forum for this very important presentation on Friday, June 20, 2014. Guillermo will present at the pre-licensed group meeting and the general meeting.

Includes continental breakfast and 2 CEUs
Register and pay online or register and pay cash/check at the door. Early registration ends Tuesday, June 17th
Early registration rates*:
2014 Licensed Member of SVC-CAMFT, AAMFT-Sacramento, and all local chapters of CAMFT: $20
2014 Pre-Licensed Member of SVC-CAMFT, AAMFT-Sacramento, and all local chapters of CAMFT: $15
Non-Member: $30
For information on joining SVC-CAMFT or renewing your membership for 2014 please email: info@sacramentovalleycamft.org
*Add $5 for late or "at-door" registration
Register and pay online, register online and pay at the door, or register via email and pay at the door: info@sacramentovalleycamft.org 

Free June Pre-Licensed Meeting
Date: Friday, June 20, 2014
Time: 8:30AM-9:20AM
Location: Sierra Vista Hospital - 8001 Bruceville Road, Sacramento, CA 95823

Speaker: Guillermo Alvarez, LMFT
Note: Registration and membership are not required for the pre-license meeting

Law and Ethics (6 CEUs) will be on Saturday, July 19, 2014
Topic: In What Does the Law Expect of Me? Part IV
Dave Jensen, JD, CAMFT Staff Attorney
Date:  Saturday, July 19, 2014 
Time: 9:00AM to 4:00PM (check-in begins at 8:30)
Location:  Trinity Cathedral 2620 Chapel Ave
Sacramento, CA 95816 (map)

Workshop Information:
Dave Jensen, JD, CAMFT Staff Attorney is returning to Sacramento on to provide the annual Law and Ethics Training. He will be presenting the topic “In What Does the Law Expect of Me? Part IV” This course is described as a review of the ten things the psychotherapy profession comes down to. The presentation includes the following subjects:
* Standard of care

* The difference between one’s right to privacy and the therapist’s duty to maintain confidentiality of patient information, including both mandated and permitted exceptions to confidentiality

* The fundamentals of reporting elder and dependent adult abuse

Dave has found a way to make this continue education requirement interesting and sometimes fun. So don’t hesitate to reserve your spot immediately because you don’t want to miss the presentation.

Check-in 8:30 A.M.
Training- 9:00am-4:00pm Includes  Snacks, Lunch, and 6 CEUs

Special:  $50 for licensed members / $35 for pre-licensed members until Monday, May 19th. Members: Make sure you sign in to get this special option.

Register and pay online or register and pay cash/check at the door. Early registration ends Thursday, July 17th.

2014 Licensed Member of SVC-CAMFT or another local chapter of CAMFT: $75 2014 Pre-Licensed Member of SVC-CAMFT or another local chapter of CAMFT: $50
Non-Member: $85 Add $5 for late or "at-door" registration. Secure Parking $5 all day across the street from the venue
For information on joining SVC-CAMFT or renewing your membership for 2014 please email: info@sacramentovalleycamft.org
Register and pay online, register online and pay at the door, or register via email and pay at the door: info@sacramentovalleycamft.org 

Upcoming Board Meetings
Board Meetings are FREE for anyone to attend BUT we do ask you register so we have an accurate headcount.
To Register click on the board meeting(s) you wish to attend.

Friday, June 20, 2014- Sierra Vista 12:15pm-2:00pm

Friday, September 19, 2014 - Sierra Vista 12:15pm-2:00pm (Election Focused)

Friday, November 14, 2014 - Sierra Vista 12:15pm-2:00pm (Election & Budget Focused)



Picture from 2014 Nami Walk

Our team, "Sacramento Marriage and Family Therapists", raised $840 for NAMI this year.    Pictured below from left to right are team members Catherine Zanzi,  Kitrice Rosa, and Gia Herndon. Thank you to everyone who donated and/or walked!

Special Feature

What Drives Addiction?  What Drives Codependency is the Real Question?
There is more to it than you might think.

Jon Daily, LCSW, CADC II

The term “codependency” has always been tethered to addiction. It is used to describe a person in a relationship with someone who is active in an addiction. In the 1940’s the term given for the addict was “alcoholic.” As a result, the label given for the person in a relationship with the alcoholic was the “co-alcoholic.” Years later, society and the clinical community at large realized that chemical addiction was not limited to only alcohol. While the sixties era was in full swing, many people were using a variety of drugs ranging from marijuana to LSD. During this time, the people using were viewed as “addicts” and the people who were in relationships with them were called the “co-addicts.” Eventually, the clinical community moved away from referring to someone as "addicted", instead referring to them as “chemically dependent."  It was then the term “Codependent” emerged.

What is codependency?
Codependency is defined as a psychological condition or a relationship in which a person is controlled or manipulated by another who is affected with a pathological condition (typically narcissism or drug addiction). In broader terms, it refers to the dependence on the needs of, or control of, another.[a] It also often involves placing a lower priority on one's own needs, while being excessively preoccupied with the needs of others.[b] Codependency can occur in any type of relationship, including family, work, friendship, as well as romantic, peer or community relationships.[b] Codependency may also be characterized by denial, low self-esteem, excessive compliance, or control patterns.[b] Narcissists are often considered to be natural magnets for the codependent.

How is codependency developed?
We are born inherently vulnerable and totally dependent on our caregivers for food, safety, and regulation, thus making an infant’s attachment-bonding to one or more caregivers critical for physical and emotional survival (1). Because the infant must attach, the infant adapts for better or for worse to the needs and vulnerabilities of the caregiver. Infants integrate behaviors, feelings, and desires that can be contained within the caregiving relationship, but they defensively exclude, dissociate, and disown behaviors that threaten the attachment bond (2). When caregivers lack the capacity to help children feel safe, loved, lovable, and validated for their uniqueness, the development of codependency may then serve the defenses these children adopt.

During early years of life, the personality and uniqueness of a child blossoms within the space created by the relationship between the child and the caregivers. When infants experience the stomach pains of hunger they cry out to be fed. If their caregivers respond promptly with food, then the infants learn that they can trust their biological experiences and emotions. They also learn that along with their power to cry out for help, they can trust that help will be provided.  Over time, when attuned caregivers respond predictably, consistently, and warmly in response to an infant's needs, a sense of trust within the self and others builds. 

For example, a child might want to be physically close, held, and touched in play or in comforting. If caregivers have the capacity to meet these needs, this reinforces the child’s sense of self-trust. From infancy children begin to integrate the notion that it’s okay to approach others to have their needs met. In addition, children learn to recognize both their own needs as well as what others offer to meet those needs. This ongoing stream of information and feedback are therefore integrated into the attachment relationship, which in turn underpins the development of the self.

This attachment process becomes even more sophisticated as children develop a broader range of needs, interests, and personality traits. It is at this point that a child's attachments play out in behavior. This can be seen in a curious child becoming interested in something new and having a need for a parent with the capacity to engage with her, or conversely, a child becoming distressed or sad and having a need for a consistently warm and attuned caregiver to sooth him. We see this process throughout early development as children begin to discover their unique interests, traits, and gifts. Children may be artistic, prone to intellectual pursuits or emotionally sensitive. They may be relationally oriented, mechanically inclined, and/or right- or left-brain dominant. It is when caregivers have the capacity to meet, validate, and attune to these needs, that it becomes more likely that those individual traits and gifts will be integrated into the child's sense of self and learn that it is safe to be who they are.

When validated, children recognize and honor their own needs, experiences, and interests. In addition, they build an ability to recognize others who are affirming, soothing, stimulating, and regulating. This in turn, allows children to feel safe approaching others and forming relationships that will regulate both their needs and emotional states.

It is essential that children are able to integrate a consistent sense that their needs and traits will be warmly acknowledged and met by their caregivers. When this integration does not occur, it is then that children are more likely to split off from the parts of themselves they perceive are unacceptable to caregivers and others. A lack of integration may manifest in a mistrust of others as well as a lack of trust of their own thoughts, feelings, desires and traits.

It is clear that the development of the bond, along with the process of integration, is important for general wellbeing (3). It is important to also note however that this bond also builds the template and expectation for all relationships throughout one's life (4). Beginning in infancy, children mentally represent their attachment figures and construct ideas and expectations for relationships with both these original figures and others. Bowlby called this the internal working modelundefinedIWMundefinedof attachment. While still in infancy a child internalizes patterns of relating to people, and most generally the parents, and therefore forms ideas about ways to relate to others based on these representations (5). These representations also are thought of as the underlying structure that shapes the nature of sensation, perception, memory, feeling, thought, and behavior, and are likely to become consolidated as personality and/or personality disorders. In other words, children understand their range of relationships based on early interactions with caregivers, which they have internalized and organized (6). Each attachment relationship shapes the child’s mental schema, which then shapes expectations for future relationships and interactions.
In the first 18 months of life, the brain is blooming and pruning billions of neurons. It is during this stage of neurological development, that the brain is right-hemisphere dominant (7). In addition, we have twice as many neurons in the brain during the first year of life than we do as adults. In this early stage of development, the brain builds neural networks that serve as memory, representations, and routes to process the flow of information received both from the body and the external environment.

To some degree, genetic inheritance is a predetermined blueprint of neurobiology; however, the environment is responsible contributing or inhibiting neurons in forming neural networks. Moreover, during the period of right-hemisphere dominance, which is an experience-dependent stage of brain development, these neural networks shape what we now know to be our unconscious. The right hemisphere of the brain involves creativity and the development of language, visual perception, patterns, and impressions. In these early years, impressions and perceptions are not guided by capacities for reason and logic, which later attempt to explain behavior and allow us to understand and interpret the nuances and complexity of relationships. During our first 18 months, within the regions of the right brain, we build a significant piece of the way we see ourselves, how we feel about ourselves, approach or avoid others, and regulate our affective states, which we then play out unconsciously in our daily lives (8) (9) (10).

To some degree, the explanation of the neurological process, the forming of and dying off of neurons, matches Bowlby’s statement: "Those behaviors, feelings, desires which can be contained in the relationship of the infant to the caregiver will be integrated by the infant; those that threaten the attachment bond will be defensively excluded, dissociated, disowned" (11). Perhaps without knowing it at the time, Bowlby used psychological language to describe the biological development of neural networks through which personality, affect regulation, and the mind emerges and becomes structured.

Unfortunately, not all caregivers have a broad capacity to nurture a child's blossoming self and encourage the development of a favorable IWM. We know for certain that when caregivers do not respond to a child's needs appropriately or the response is inconsistent, this lack of an appropriate response impedes the development of a positive sense of self and a healthy internal regulatory system within the child.  As a result, a child may learn to both mistrust internal experiences and mistrust others as a resource for co-regulation. Sadly, children in negative or inconsistent circumstances often split off from aspects of themselves and mistrust others. Further, they may overly rely on themselves and experience avoidance for regulation which sadly, inhibits their psychological and neurobiological regulatory systems to be properly built.

Two Case Studies:
In the first case study, the present, but passive and distant father says little and doesn’t shoulder responsibility for being uninvolved and incapable of attunement. In the second case study the father was not around for me to question, let alone enlist in helping his child.  
We cannot know for sure how either of the children discussed below would have fared in infancy and early childhood if a father or grandparent had been either a primary or co-primary caregiver. However, with more and more fathers becoming actively involved with their children during infancy and early childhood, new research may reflect the more equal roles of parents in society.

Case #1: Jason (Insecure Attachment: Dismissive-Avoidant)
Parents Who Avoid the Developing Self in their Child Leads to a Child Who Avoids his own Internal Self and Avoids Others: "I'm okay, you're not okay"

Fifteen-year-old Jason was a quiet, shy, and passive adolescent, but was also an original thinker and a mechanically gifted young man. Always ready to take on the challenge of fixing things others couldn't, Jason preferred being by himself while he worked on motorcycles, go-carts, and other creative mechanical projects in his garage. Introverted, strong-willed, and stubborn, Jason's behavior left his parents confused about how to direct him after he started sneaking out, skipping school, using drugs, and ultimately, becoming expelled from school for selling drugs on campus. Jason violated every limit his parents set, and continued doing as he pleased despite his parents’ attempts to implement boundaries. As an introverted, quiet person, and socially inept in many ways, using drugs served as his social lubricant and selling drugs reinforced his sense of belonging to an accepting group.

When I evaluated Jason, I was struck by his preoccupation with trying to figure out the therapeutic process in order to avoid engaging. Instead, of cooperating, he searched for the path of least resistance out the door. With each question I asked, he became quiet as he looked away and stared at his lap, the couch, the walls, and back to his lap. He looked anywhere but at me. After these long silences, he would glance up at me as if he forgot what I  just asked him. When I reiterated the question, he came up with one or two word answers and started looking around the room again.

During early treatment, I thought Jason was simply expressing his resistance and frustration about being forced into counseling, hence, the passive-aggressive silence and slow, minimal responses. I believed that as counseling progressed Jason would soften up, as others do, and see our sessions as a safe place to explore his life, thus being able to grow and find relief. However, because Jason wasn’t verbally skilled and insightful, I moved away from the typical talk therapy. Instead, we went for walks along the river or played ping-pong or checkers. However, it soon became clear that he wasn’t actually walking or playing checkers with me, but rather, was absorbed within himself and just happened to be next to me, much as toddlers might "parallel play." In contrast with early treatment, where he resisted and showed frustration through non-engagement, I now saw his lack of capacity to engage in and negotiate relationships as the result of his early childhood experiences. It accounted for what could be called “odd” social relationships.

Left brain dominant, Jason might have been viewed as anxious or depressed, or suffering from schizoid personality disorder or having Asperger’s.  Perhaps he was simply a very resistant teenage boy. Although I could have easily put him into any of those categories, those labels would have limited my understanding of Jason and wouldn't effectively inform the direction of his treatment. To discover what he needed, I had to understand what it felt like to be Jason, including what it felt like to be Jason as a child growing up in his family. I needed to know what was it like to be nurtured and guided by his father? How had he experienced his mother's affection, care-giving, love, and nurturance? Why was Jason avoidant of others and his own internal experiences? What purpose has his substance abuse served?

I asked Jason's parents, Patty and Rick, to meet with me so that I could gather Jason's developmental history. Patty was an educated, professional woman, who was dressed to fit her role as a university professor. She appeared assertive, but at the same time I sensed weariness in her. Rick, a blue-collar, hardworking contractor, came to the appointment in his work jeans and a T-shirt. Like Jason, he presented as quiet, shy, and passive. Rick wore his sunglasses during the first half of the session, as if hiding behind them for safety.

I asked Patty and Rick about what their life was like when Jason was born: stresses and supports, unexpected events, such as the deaths of friends or family or job losses. With each question, Patty first glanced at Rick to see if he wanted to answer, but he passively shrugged as if he didn't care who responded or as if he didn't have a ready answer. Patty then turned to me and answered the questions. 

Perhaps she was tired, I speculated, because she was doing all of the interpersonal and emotional work in their family. When Patty answered questions about Jason's first year, she immediately looked even more tired. Then she mentioned that Jason and his older brother were only 17 months apart, so she had been exhausted by caring for an infant and a toddler.

Patty had spent much of her life climbing the academic ladder as a university professor and researcher, ultimately having her children in her mid-30s, a situation that proved more difficult than she’d anticipated. Already worn out from parenting her first child, she became depressed when Jason was born. 

I asked about family and community support and learned that Patty’s family lived about 1500 miles away. As a private person, and admittedly socially anxious, she didn’t like to share her personal life with professional friends. In the early years of her children’s lives, Patty received only minimal emotional support from Rick, who also did not share in the care of the two young boys. She was forced to become overly reliant on her own exhausted internal resources to cope with life's ongoing and new demands. Viewing her job as a source of emotional respite from the family demands, Patty longed to go back to work when Jason was three months old.

When I asked how she responded to Jason when he was upset or hungry, she was candid in her answer: “I know there were times when he needed soothing and I just let him cry, and there were times he was hungry and I just didn't care to respond right away."

Jason's developmental history provides a plethora of information about the course of his development. Jason certainly carries the genes of his father's shy, quiet, and avoidant personality; Jason’s receptive mirror neurons might have picked up his father's affective state and avoidant behavior and integrated it into his own neural networks. I also believe more telling variables exist. In actuality, Jason grew up with tired and avoidant parents. As a result, he did not experience others as a source of consistent, warm, and predictable soothing or attunement. Rather, he experienced inconsistency at best, and more commonly, his life was a place in which he received no response, leaving him to go inward and to overly rely on himself to get his needs met. When turning to others, Jason found that they didn't acknowledge and nurture his developing self and meet his dependency needs. This meant that Jason’s affect regulation system never fully developed. His internal working model, his IWM, of himself and others left him feeling unworthy of nurturance and support from others. This then becomes a pattern of mistrusting others to be sources of help to stimulate and soothe affective states. 

Jason grew up believing that he needed to stay out his mother’s hair. In addition, his father only engaged with him when a mechanical issue was involved. No room existed for Jason to connect to his own internal emotions; when he expressed them in his early years, he was left alone with the unregulated emotional state. With no one attuned to him, shame was created and therefore a strong need to be "unseen."

Over time, the negative experience repeated, leaving Jason's opiate and dopaminergic systems contracted and unable to thrive (12) (13). However, when Jason used street drugs, these deficient systems are activated to fire. Moreover, because others did not attune to his emotional states, Jason was left believing, "Others don't feel what I feel. Because they don't feel it and only I do, then something must be wrong with me." This belief system is core to codependency.

Jason’s expression of affective states did not promote attachment. Instead, he seemed to be a source of his mother’s stress, which led him to think he had to disown his internal experiences and distrust them when he felt these experiences physically and mentally. It became clear that his father Rick lacked the capacity to attune, and his passivity indicated a missing component in his own development that left him unable to connect with his own internal processes and emotions.
Consequently, Jason had learned not to trust others as a source of support, soothing, and safety. Because his affect regulation system was not fully built, he had a limited range of affect and limited capacity to cope emotionally (14). His personality was narrow, turned inward, and brittle because of his parents’ lack of capacity to nurture and develop their son’s full range of self in his early years.

Finally, Jason learned that relief came from avoidance and over-reliance on himself to get his needs met. As a teen he found that street drugs and alcohol reliably and consistently served to medicate his emotional states. Furthermore, his drug dealer and drug culture responded to him every time he called out to them. 
As stated earlier, caregivers with a limited capacity to nurture their children’s developing self can lead children to split off from parts of the self. They suffer from insecure attachment and avoidance, but they may also take on characteristics of another insecure attachment type, such as anxious-preoccupied children. These children effectively become the caregiver and must attune to their parents’ emotional state and needs, making this situation again a set up for codependency. 

Case Study #2: Sarah (Insecure Attachment: Anxious-Preoccupied-Hyper-vigilant)
A Child Who Must Attune to the Caregiver and Loses her Self in her Preoccupation With Others’ Emotional States: Codependency: "I'm not okay, you're okay"

Fashionably dressed, but anxious and depressed, Sarah was 19-years-old, and a straight-A college student with a passion for snowboarding, at least when she wasn't busy studying, volunteering in the community, and tutoring the youth in her church. In other words, Sarah appeared to be quiet, respectful, non-confrontational and compliant - overall, the perfect kid, student, and member of her community and church. Referred to my program from the psychiatric hospital where she had been hospitalized for a week, Sarah had stopped eating and had begun cutting her arms, thus leaving self-inflicting wounds. During that hospitalization her psychiatrist also discovered that she had a history of using vicodin, marijuana, alcohol, and Ecstasy.

Sarah had been using drugs on and off for five years, although her mother had just discovered she was using. During our initial evaluation with Sarah and her mother, Kate, I was struck by how quiet and withdrawn Kate appeared, as if we were in the same office, but she was actually somewhere else.

"Kate, can you tell me a little bit about what is going on for you right now?" I asked in a gentle voice.
As I asked the question, Kate became withdrawn and her head and upper body collapsed forward, allowing her to hide her face in her lap as she began to cry.
"It’s all my fault that she’s using drugs,” Kate said. “I’m not a good enough mother for Sarah. Her father was never in the picture and I tried to do it all myself. I never knew that she was depressed or cutting herself. I’m overwhelmed, so depressed and confused.”  

I realized immediately what just occurred. We’d started out focusing on exploring and understanding Sarah's issues and needs, but within minutes, the focus shifted to containing Kate's emotional state. This likely had been happening in their home for years. I then turned to Sarah. "Can you talk a little bit about what’s going on for you right now?" 
In a soft voice, Sarah said, "I don't know..."

I then said, "You look like you might be feeling depressed or sad.”
She lifted her shoulders in a helpless shrug. "My mom is depressed and that makes me depressed."

To the world, Sarah appeared as the perfect girl - nice looking, excelling academically, giving back to her community, and overall, hard working. However, underneath her "I am doing great" veneer she struggled with feeling depressed, empty, exhausted, and alone. Like most experienced clinicians, I knew that diagnoses of codependency, depression, anxiety, or a substance use disorder by themselves would not be adequate to help me to understand Sarah. These diagnoses would not allow me to fully gain insights into her development, how her mind works, and the reasons for her anxiety and depression, along with her drug use. I needed a developmental history to understand her and help her feel understood. 

When I met with Kate alone she described growing up with an alcoholic mother and abusive father as “hell.” With a mixture of sadness and anger, Kate told me that she hated her father and referred to her mother as a bitch. “I worked my ass off to get out of that life and leave it behind me,” she said with a defiant tone, “and I don't ever want to see them or revisit those memories again." 

I asked how she thought her childhood influenced her development and the way she interacts with Sarah, and she instantly looked deflated and defeated, but just as quickly began crying in a desperate, animated way. From this hypo-manic place she kept talking about how hard she’d worked to give Sarah what she needed. During the interview I observed her complete exhaustion. It took considerable energy to contain her emotions - it was always a fight, always a struggle, yet the emotions continued to hijack her in extreme ways. 

Kate also had a history alcohol and marijuana abuse, but she thought she’d hidden it well from Sarah. "Sarah is the love of my life,” she said.  “Since the day she was born, we would cuddle and she was the one thing that made me happy. I was severely depressed for the first year of her life, and Sarah was and still is my teddy bear."

Later that week, I met with Sarah so I could gain a better understanding of her childhood. Right away, she mentioned that her mom had always been depressed, moody, and unpredictable, which led to Sarah’s constant fear that her mother might leave or hurt herself. According to Sarah, Kate becomes angry when she drinks, although she doesn’t hit Sarah. Still, these moods and angry talk frighten Sarah, making it impossible to relax when her mom is upset. As Sarah had said before, when her mom is depressed, she’s depressed, too. 

“With such an intense connection to your mother's inconsistent moods, how are you able to do so well in school,” I asked, “and find time to help out in the community and your church?” 
"I feel alone at home,” Sarah replied. “My mom doesn’t understand how depressed I’ve been, but when I do well in school and in my activities, it makes her happy. It puts a smile on her face and other people give me a lot of love for what I do.”

With Jason, his caregivers lacked the capacity to help him reach his full range of self, which damaged his development. In Sarah’s case, the full range of her developing self was not only unmet, but she had to attune to her mother's emotional needs. This led to her preoccupation with her mother's moods in the moment, while also anticipating the moods to come. Hyper-vigilance, needed at times for emotional survival, was repeated so often that over time it became more of a state than a trait. She built her life around doing what others needed or wanted her to do. Whereas the avoidant-dismissive person is hyper-vigilant, as if it’s not safe to rest, codependent Sarah, with what Mary Main would classify as insecure-anxious-preoccupied attachment, expended a great deal of psychic and emotional energy to constantly scan the environment and ensure it was emotionally safe to meet others’ needs and expectations. Over time, that outflow of energy left her empty, tired, and depressed.

Sarah ended up caring for and fixing her mother's emotional state so that Kate could “return the favor” and take care of Sarah’s emotional state, or, put another way, "I need to fix you so that you can fix me." This dynamic trapped and exhausted Sarah; ultimately, it damaged her affect regulation development and gave her a tattered sense of self. This left her vulnerable to peer pressure and subsequent drug abuse. Her drug use served her need to relax and for once, let go of expectations to please others.

Sarah’s codependency fueled her drug use. When immersed in the drug culture, Sarah experienced others emotionally giving to her rather than taking. Sarah also met more and more people in the drug culture and spent time at their parties and gatherings. Consequently, this emotional and social attachment to the drug culture became part of her hook to drugs. The drugs were intoxicating and soothing; the drug culture came close to meeting her interpersonal needs. This setup proved to be the most significant challenge in addressing the addiction part of her treatment. She was enmeshed with her drug using friends, and despite recognizing how damaging they were for her, she resisted letting go of that part of the experience. It was within that culture that she was allowed to not get an A in every class or be involved in community, nor was she expected to fix others’ emotional states in order to find approval, acceptance, and belonging.

As previously described, a child experiences arrested development when caregivers have limited capacity to connect, validate, nurture, and respond to the full range of a child’s blossoming self. Lacking consistent, responsive attunement, a child may split off from those aspects of the self that the caregiver is unable to help develop.  In the concept of good fit/bad fit, when the parent can attune or match a child in temperament and learning styles, there’s a good fit that serves positive development. However, when caregivers lack the capacity to attune or express emotion, then the good fit isn’t achieved. In these situations, developing children may split off from disowned-parts of themselves that are not within their caregivers’ ability to match.

Looking at the above examples, it also appears that codependency/insecure attachment can be a trans-generational issue. In other words, children might adopt the attachment inadequacies of the parents.  In these cases, the young people used drugs to sooth their insecurity but their drug use was a consequence of and a solution for failed relationships. If it wasn’t drugs, it may have been enmeshed relationships, workaholic tendencies, eating disorders, gambling, etc. to sooth and avoid.


Neurobiology of Codependency

I remember years ago telling a group of addictions counselors, “codependency is a brain disease.”They looked at me as if I was trying to be tricky but I wasn’t at all. I meant it.  Simply put, everything mentioned about early childhood experiences hitherto is not only about the development of the self, relationships and the mind, it is also about neurobiology. Schema, beliefs, learned behaviors; adaptive defenses are neurobiologically networked for better or for worse. When relationships shape our minds they are also shaping our neural networks in our brain.

Siegel (1999) states, that when we are “feeling felt” in early childhood, our dopamine system (pleasure/motivation) expands, and the psychological correlate tethered to this relationship experience is the allowing or wanting to “be seen.” Conversely, he defines shame as simply the absence of attunement. Sadly, most clinicians understand that shame can be an even more explicit weapon in families.  Siegel goes on to purport that shame contracts the dopamine system and the tethered psychological experience is a person who wants to be “unseen.”

In addition, Schore’s (2003) research has shown that in the attuned moment between child and caregiver, both have the biological experience of the opiate system firing.  These systems serve to reinforce the attachment and bond within the relationship. When people have healthy relationships both the dopamine and opiate regulatory systems are built and sustained.

This leads me to some final points, in 2007 William Harbaugh  set out to pinpoint what exactly would happen within the brains of people who are given money and a choice to keep it or donate it to charity. In 2007, with his psychologist colleague Ulrich Mayr, he placed subjects in an fMRI scanner, while a computer monitor in front of them presented them with opportunities to donate to a food bank from a fund of $100 in real cash they'd received at the beginning of the experiment. The suggested donations could be as low as $15 or as high as $45. The subjects' donation decisions had meaning, since they would be allowed to keep whatever money was left over. What he found was that when people donated to charity the part of the brain that was firing was the Nucleus Accumbens (NAC). The NAC is the epicenter of dopamine in our brain.  Evolution may have hardwired us this way in order to keep our DNA passed on, and certainly we are biologically hardwired to attach to others. 

Connecting the dots, if lack of attunement and growing up having to take care of your caregivers so that they can take care of you, or experiencing toxic shame contracts dopamine, it makes sense then that codependents are driven to give of themselves as it helps put their dopamine back in balance. In essence, it helps them, for a moment, feel they are loveable. Finally the hole in the self for the codependent is not a food hole, not a drug hole, or a gambling hole. It is a deep relational hole in relationship to self and others. Unlike other addictions, codependent behaviors actually come the closest to filling the relational hole. It is a complex issue with many layers, and is a subject in which it is essential that the dialogue continues.


a"Codependency - Medical Definition and More from". Merriam-Webster. Retrieved
b Codependents Anonymous: Patterns and Characteristics
Wallin J.D. Attachment in Psychotherapy (The Guilford Press 2007).
Wallin J. D. (2007).
Kreppner, K., Ullrich, M. (1998). Talk to mom and dad and listen to what is in between: A differential approach to family communication and its impact on adolescent development. In M. Hoffer, J. Youniss, & P. Noack (Eds.), Verbal interaction and development in families with adolescents (pp. 83-108). Westport, CT: Ablex Publishing.
Waters, E., Merrick, S., Treboux, D., Crowell, J., & Albershein, L. (2000). Attachment security in infancy and early adulthood: A twenty-year longitudinal study. Child Development, 71, 684-689.
Bowlby, J. (1988). “The Role of Attachment in Personality Development” (from A Secure Base: Parent-Child Attachment and Healthy Human Development [Basic], Lecture 7, pp. 119-136).
Laursen, B., & Collins, W. A. (2004). Parent-child communication during adolescence. In A. L. Vangelistsi (Ed.), Handbook of family communication (pp. 333-348). Mahwah, NJ: Lawrence Erlbaum Associates.
Cozolino. The Neuroscience of Human Relationships: Attachment and the Developing Social Brain. (W.W. Norton & Company, 2006).
Schore, A.N. Affect Dysregulation and Disorders of the Self. (New York:
W.W. Norton, 2003).
Siegel, D. J. The Developing Mind: Toward a Neurobiology of Interpersonal Experience. (New York, The Guilford Press, 1999).
Cozolino (2006).
Wallin J. D. (2007).
Seigel, D.J. 1999.
Schore, A.N. (2003).
Schore, A.N. (2003).
Hegel, G. The Phenomenology of Spirit. (Oxford: Oxford University Press, 1807).
Fonagy, P., Steele, M., Steele, H., Leigh, T., Kennedy, R., Mattoon, G., & Target, M. (1995a). Attachment, the reflective self, and borderline states: The predictive specificity of the Adult Attachment Interview and pathological emotional development. In S. Goldberg, R. Muir, & J. Kerr (Eds.), Attachment theory: Social, developmental and clinical perspectives (pp. 233-278). New York: Analytic Press.
Neural Responses to Taxation and Voluntary Giving Reveal Motives for Charitable Donations. William Harbaugh, Ulrich Mayr, Dan Burghart. Science. June 15, 2007

(2014) By Jon Daily, LCSW, CADC II
Founder & Clinical Director for Recovery Happens Counseling Services, graduate school instructor for USF and author of (2012) Adolescent and Young Adult Addiction: The Pathological Relationship to Intoxication and the Interpersonal Neurobiology Underpinnings. (Most of the information in this article is from chapter 6)

That article is also available in print and PDF: Click Here

The views expressed in the Special Feature Articles do not necessarily reflect the Sacramento Valley Chapter of CAMFT or CAMFT. They should be understood as the personal opinions of the author. No information in this articles will be understood as official.  Other views and commentary are welcome and will be published as long as they are respectful and stick to the topic.


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Title:  Mr. Magorium's Wonder Emporium
Directr : Zach Helm
Released: 2007
Reviewer:  Heather Cassandra Blessing, MFT Intern

  This movie is a great way to help a child (older than 7 or 8) understand the concept of death and dying and grief.  Very appropriate in cases of losing a grandparent.  There is magic, laughter, and lots of love and acceptance that help you connect with the characters but it is this monolog towards the end of the movie describes it all. 

When King Lear dies in Act V, do you know what Shakespeare has written? He's written "He dies." That's all, nothing more. No fanfare, no metaphor, no brilliant final words. The culmination of the most influential work of dramatic literature is "He dies." It takes Shakespeare, a genius, to come up with "He dies." And yet every time I read those two words, I find myself overwhelmed with dysphoria. And I know it's only natural to be sad, but not because of the words "He dies." but because of the life we saw prior to the words.

I've lived all five of my acts, Mahoney, and I am not asking you to be happy that I must go. I'm only asking that you turn the page, continue reading... and let the next story begin. And if anyone asks what became of me, you relate my life in all its wonder, and end it with a simple and modest "He died."

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