Welcome to Weinholds.org

Interview with Patricia Raskin - Healing Developmental Trauma

 Interview on Healing Developmental Trauma with Patricia Raskin on her Blogtalk Radio Positive Living Network. Click here:

A Prescription For True Reform

If you are like me, you have become both very bored and hugely disgusted with the current health care debate. Day after day we witness newscasters interviewing our leaders in Washington who continue to lie through their teeth about how hard they are working to bring health care reform to millions of uninsured and underinsured people.

The truth is that their agenda is totally political and not designed to fix the broken health care system. The Republicans just want Obama to fail and by stonewalling him on health care reform they think they can do that. They have used deliberate lies and misinformation to create doubts and fears about what will happen if health care reform passes. However, even with all their attempts to spread confusion and fear, they haven’t fooled a majority of the American people who still want meaningful health care reform that includes a public option.

Then there are members of both parties who are heavily subsidized by the insurance, pharmaceutical and health care industries and get their marching orders from lobbyists who are spending over $1.4 million a day to keep any meaningful reform from happening. They also use deliberate misinformation to shoot down even compromise suggestions such as a public option, saying it will force hospitals to close and the insurance industry to go bankrupt. Again, for what it is worth, a majority of the American people doesn’t seem to be buying these lies and half-truths, even though our representatives continue to mouth them.

The Betrayal of The American People

We elected a President whose mandate was to change Washington “politics as usual.” However, even before the debate began, Obama declared that the single payer plan was “off the table” for discussion. What? This is arguably the best way to fix the broken health care system and we can’t even discuss it? I thought he came to Washington to bring us “Change We Can Believe In.”  The only change these people are interested in seems to be the large chunk of change they are receiving from lobbyists and special interest groups that lines their pockets.           

How much money did health care lobbyists have to contribute to Obama’s election campaign and have to continue to offer him to get him to nix arguably the best solution to the problem?  As a result, Obama continues to give just lip service to compromises such as the public option and when pressed on the issue says that the public option isn’t even essential to health care reform. Without the single payer or the public option, whatever reform bill passes Congress and Obama signs will amount to just a huge give-away to the insurance, health care and pharmaceutical industries. 

It won’t be health care reform for the people who need it. It will be all about profits and very little about the promised reform. Sure they can point to eliminating pre-existing conditions, but no one mentions how much your insurance will cost you if you have a pre-existing condition.

The media outlets all owned by corporate America have conspired to spin this issue to drive up profits and ratings. Instead of doing the honest investigative reporting needed to expose the lies that are being told, they are busy creating an “us vs. them” drama between the various factions.

The Failed Grass-Roots Strategy

The grass-roots strategy has been to appeal to the consciences of our leaders by showing them how broken our health care system is and how it is creating endless personal and economic hardships for million of American people. People are sending our elected officials millions of letters telling of horrible personal tragedies that they have suffered because of either being denied coverage or not being able to afford to pay for health insurance and health care. To make sure they understand the seriousness of the problem we also present them with sobering statistics such as these:

• Over 46 million people are without health insurance. And millions more are underinsured.
• 62 percent of all bankruptcy filings are due to medical debts. In 2009 alone this amounts to roughly 2.4 million people. (No other country in the world that has a national health insurance system in place has ever heard of a medical bankruptcy)
• Almost 45,000 people die this year because they cannot afford the necessary medical treatment they needed.

Then to make sure they get it, we do studies that show the economic impact over the next ten years if they fail to act. A recent study by the Urban Institute shows what is likely to happen by 2019:

• A 30 percent increase of number of uninsured people.
• A 60 to 100 percent increase in premium costs for businesses.
• The number of people getting health insurance through their work would decrease by more than 10 percent.
• A 75 percent rise in the cost to states of the current SCHIP program for children.
• A 100 percent increase in uncompensated health care due to emergency room visits, etc.

The lead researcher on this study concluded: “ …if comprehensive health reform that reduces the rate of health care cost growth and provides affordable coverage options is not enacted, there will be serious economic strain on individual, businesses and governments in all 50 states and the District of Columbia.”

You would think with all this personal testimony, statistics and projections of the cost of doing nothing being thrown at them to get them to “vote their conscience,” would have the desired effect. How much more do they need to know in order to do what is morally the right thing to do?

Well folks, you and I both know that isn’t happening. Actually, everybody I know with a conscience is convinced, so why are they not convinced? Is it that these leaders don’t even have a conscience? It sure looks that way. How else could these elected officials who have pledged to work for the welfare of their constituents continue to ignore all these personal tragedies and appalling statistics and predictions?

The Political System Is Broken

This all points to a horribly broken system. However, this time I am not talking about the broken health care system, but the broken political system of greed, power, money and special interests in Washington and elsewhere. Until that system is reformed, there will not be any true health care reform enacted or actually any reform at all that would threaten the status quo.

By focusing all our energies on trying to fix the broken health care system, we actually have gotten a closer look at how broken our political system is and how it operates. Do we need to see any more? All we have to do is connect the dots between the amount of contribution money these elected officials are receiving from lobbyists and special interest groups and the words that come out of their mouths.

How To Fix A Broken System

Unless someone writes a prescription for members of Congress and the President to all receive a “conscience transplant,” our efforts need to be focused on the only true reform that is possible in Washington: Campaign Finance Reform. Let’s stop fooling ourselves into thinking that just because one political party controls the White House and both Houses of Congress we can have true reform that fixes what ails this country.

No matter what they tell us in order to get elected, it ain’t going to happen. In addition to not being able to pass true health care reform legislation, they will not be able to pass energy legislation that protects the environment and stops global warming or fixes our broken educational system or does any of the other things we need to do to take back this country from the money and power brokers. It will take radical action by all of us to prevent those highly invested in maintaining ‘business as usual” from continuing to call the shots in Washington.

If we all mobilized and brought our collective will to the task of reforming the sick and broken political system, this could be accomplished. In the next election cycle, we must demand practical proposals on implementing public financing for all elections from every candidate that is running either for election or re-election. Then we have to make sure they follow through. As Michael Moore suggests in his latest film, Capitalism: A Love Story, we have to replace capitalism, as it exists in this country, with democracy. In order to do that, we all have to be committed to making it happen.

Developmental Trauma

Janae B. Weinhold & Barry K. Weinhold

Developmental trauma is a breakthrough term with roots in both developmental psychology and traumatology. Developmental trauma is inflicted on infants and children unconsciously and most often without malicious intent by adult caregivers who are unaware of children’s social and emotional needs. Infants and children require energetic attunement, skin-to-skin and eye-to-eye contact, kind and comforting words, protection and safety from their mother during gestation, birth and the first years of life.

Unfortunately, most parents have not been educated about children’s social and emotional needs and lack skills for supporting their child emotionally when they become upset. They also never fully experienced emotional attunement with their parents when they were children. This makes it difficult for them to respond to their needs for nurturing, protection, safety and guidance in timely and appropriate ways. They also do not correlate their deficiencies in their own parenting experiences with their own day-to-day struggles to effectively parent their own children. 

Here is a word picture to help you understand what these terms look like in real time. The inspiration for this word picture comes from a 1986 NOVA film, “Life’s First Feelings,” illustrating the results of a research investigation into the important biological and social functions emotions serve in the early development of a child’s personality (NOVA, 2000).

Early in the film, chief investigator Dr. Edward Tronick describes an interactive dance of communication that he observes between an infant about the age of 5 months and his mother. In this dance, the infant is sitting in a carrying seat and the mother is standing in front of him. She is instructed to interact with her child for several minutes while being videotaped. Sometimes she puts her face too close to her son, and he fusses, looks stressed, withdraws, and looks at his hands.

Then she backs away and again comes in close several times. Sometimes she makes sounds, wipes the drool off his chin, and waves her hands close to his face. When the boy becomes overly stimulated and gets a little upset, he withdraws and soothes himself by breaking eye contact and looking at his hands. Then he looks back at his mother and smiles really big in an effort to reengage with her.

This part of Tronick’s experiment is an excellent illustration of the infant–mother dance of communication. The next part of the experiment, however, contains something that would not be done today because we now understand that it causes experiences of shock, trauma, and stress in infant research subjects.

Tronick does a short “cold mother” experiment in which he asks the mother to keep a blank face and not respond to her child’s attempts to engage with her. It is obvious after the previous playful exchanges with his mother that the infant does not anticipate her withdrawal. At first he looks surprised and then he smiles really big at her in an attempt to draw her in. When she stays stony-faced, he looks off to one side and again peers at his hands. Then he looks back at his disengaged mother’s face and smiles and tries to reengage with her.

When he sees she is still not responding to him, this causes a series of things to happen very fast—so quickly that they are almost invisible. First the pupils in the boy’s eyes dilate, then his eyes bulge, and his face becomes blank. Then he has what looks like a severe hiccup, and finally he vomits a little bit.

Tronick does not comment about the look of terror on the infant’s face, the change in his eyes, or his hiccup. He does remark about the child’s “loss of bodily fluids” and then shifts the focus. An announcer in the background asks the question, “If this response occurs in the laboratory, what happens when infants are emotionally deprived over long periods of time?”

This short video segment illustrates four important points. The first point is the difference between developmental shock, trauma and stress. This process begins in the first part of the experiment when the invasive mother over-stimulates her child. He shows signs of developmental stress and then flees his mother’s overstimulating behavior by looking at his hands and self-soothing, at which point he then attempts to reengage with his mother.

He first shows signs of disorientation during the cold mother experiment when he is unable to reengage her in their dance. Then he quickly drops into a state of developmental shock that is visible in the dilation of his pupils, his bulging eyes, his blank facial expression, his hiccupping, and finally his vomiting. The experiment becomes a shattering experience for this small boy who dissociates and becomes immobile.

The second point the video illustrates is the immense power of the interactive dance between the child and mother, and what happens to the child when the mother disengages from it. The third point it illustrates is how few resources this child has to cope with a mother’s disengagement and how rapidly this causes him to move from stress into trauma. Then he attempts to re-regulate himself by looking at his hands and then into shock when his mother does not respond to his efforts to engage.

The fourth point is that this video segment demonstrates is the sequences of state-shifting from developmental stress, into developmental trauma, and then into developmental shock; from higher-order brain functions to more primitive defensive responses contained in the limbic system and reptilian brain; and from newer parts of the autonomic nervous system to the older. These are the primary components of what we call the trauma continuum, which we describe briefly in the next section.

By definition, developmental shock, trauma, and stress are inflicted on infants and children unconsciously and most often without malicious intent by adult caregivers who are unaware of children’s social and emotional needs. Infants and children require energetic attunement; skin-to-skin, eye-to-eye, and right brain-to-right brain contact; kind and comforting words; and protection and safety during gestation, birth, and the first 3 years of life. Most adults, including many mental health professionals, have not been educated about these needs, and many lacked these personal experiences of emotional attunement when they were children. Adults also do not correlate these developmental deficits with the day-to-day struggles they experience in their lives. Consequently, they are unaware when they are shocking, traumatizing, or stressing their own children and are not able to recognize the symptoms of developmental shock, trauma, or stress in themselves, their children or others.

The authors of the new DSM-V edition, due for release in 2012, are considering the inclusion of Developmental Trauma Disorder as a new diagnostic category (van der Kolk, (2009).[1] Many traumatologists use the term “Complex Trauma” to describe experiences of multiple and/or chronic and prolonged experiences of chronic interpersonal trauma in the context of inadequate caregiving systems that delay development. This new diagnostic category would encapsulate diagnoses such as bipolar disorder, ADHD, PTSD, conduct disorder, phobic anxiety, reactive attachment disorder and separation anxiety.

Researchers in children's mental health have typically focused on more extreme traumatic events of an interpersonal nature that involve sexual or physical abuse, war, community violence that happen early in life. These experiences often occur within the child’s care giving system and include physical, emotional, and educational neglect and child maltreatment beginning in early childhood.

Developmental trauma is caused by seemingly “ordinary,” “normal” or “subtle” daily events that involve relational and energetic disconnects between children their mothers that are either too long or too frequent. Unfortunately, most adults do not recognize or perceive these relational disconnects as traumatic, but see them as “normal” because they “happen to everyone.” 

Early traumatic experiences, anchored in these “ordinary” events, hard-wire children’s brains and nervous systems for a life built around trauma. The primary goal becomes avoiding anything that might trigger the memory of an experience involving developmental trauma and the underlying emotional stress associated with it. When children are unable to avoid these triggers, they react by trying to flee or fight. This is the most common cause of hyperactive behavior in children.

Our definition ofdevelopmental trauma recognizes the chronic effects of subtle emotional events that draw no attention from adult caregivers and provide no relief for children’s symptoms. We believe that many who are using the term “developmental trauma” are actually referring to developmental shock and that they are not discriminating between shock and trauma. Events involving shock are much easier for mental health and medical professionals to recognize because the causative events associated with it are often extreme enough to draw their attention. 

[1] van der Kolk, B. & R. Pynoos (2009). “Proposal to include developmental trauma disorder diagnosis for children and adolescents in DSM-V” http://www.traumacenter.org/announcements/DTD_NCTSN_official_submission_to_DSM_V_Final_Version.pdf

[2] NOVA Video Series (2000). Life’s First Feelings. Boston, MA: WGBH.

 

  

Health Care Reform: Is the Public Option Too Good of a Deal?

With every day opposition mounts against the inclusion of a public option in any health care reform legislation. The single payer option isn’t even “on the table.” It sure looks as if there are a lot of Senators and Congresspersons who are scared of the competition that a public option or what a single payer system would do to the private insurance companies. Why I even heard some of them say they believe the public option or the single payer system would drive the private insurance companies into bankruptcy. Poor babies. You would think that these private insurance companies are on the verge of bankruptcy and are in need of a bailout. The truth is that these companies are making enormous profits and paying their CEOs millions of dollars.

They might have to make less profit on health insurance if there were a public option to compete with them or even a single payer system, but they would continue to sell other kinds of insurance and could still sell premium health insurance packages to those who could afford to pay for them. But going bankrupt is not one to the likely outcomes they face. 

Mind you I am not opposed to anybody making a profit. Heck, maybe the government could even make a profit off of the public option. The way I do the math, the public option or the single payer system would be totally paid for out of the premiums collected some subscribers, the same way the private insurance companies get paid. This would make it “deficit neutral” and “revenue neutral.”     Now here is the difference, the public option or single payer system would have administrative overhead of about 4-5 percent also paid from premiums while the private insurance companies have administrative overhead of around 30 percent that are also paid by the premiums they charge.

Do you know what this administrative overhead consists of? First of all, it covers the wages of the insurance companies employees who process claims and decide how to deny benefits to customers. Did you know there are 30 health insurance employees for every health care provider in this country? They also have to spend money to advertise their company’s products. They have to pay to build fancy buildings in the “high rent districts” to house their companies. They have to pay their top executives enormous salaries and benefits. Finally, they have to satisfy their stockholders and achieve hefty profits. 

Gee, why couldn’t the government pocket most of the differences between their 5 percent overhead and the 30 percent overhead of the private insurance companies? If we had a robust public option or better yet a single payer insurance system run by the government, this could be used to pay for the whole health care reform package without having to raise any taxes. What a deal!  

Maybe it would also level the “paying field” and bring down health care premiums and at the same time we as the stockholders would benefit as well. Health care reform is starting to look like a good deal after all, particularly if you factor in the public option or the single payer system. Oops, I forgot, the government cannot make a profit off of health care. Maybe the question is: “ Should anybody make a profit off of somebody’s illness.” In most developed countries of the world the answer is “no.” In this country, however, bottom line profits, greed, waste, fraud and abuse are what drive our health care costs to the highest per person level in the world. We can do better!

Stay healthy and be well.

Barry

Health Care Reform: Who Says Prevention and Wellness Costs More?

I have been involved almost daily in health care reform activism since Fall 2008 and now I am going to write a regular blog about what I have learned and how I see the health care reform debate unfolding in Washington and elsewhere. Much of my interest has been in researching ways to transform our current health care system from an emphasis on “sickness” into an emphasis on prevention and wellness.

             Currently, not much happens in this system until someone gets sick. That never made any sense to me. It is probably the least cost-effective way to run a health care system. As a result, we now have a sickness-oriented adult population with 2/3rds of us classified as obese.

            There are some signs of hope. The current legislation under consideration in Congress seeks to change this. HR3200 in the House has allocated $126 billion in funding for public health promotion over ten years to be used to support prevention and wellness. The Senate bill, out of the HELP Committee, has about $100 billion a year over ten years to promote prevention and wellness.

            What isn’t clear, however, is how this money will be spent. Some money will go to doing preventative screening tests on more people and this category is called “Clinical Prevention Services.”  The rest will go to building a foundation that can support a shift in consciousness in the entire population from “sickness” to “health” called “Community Prevention Services.” The former may actually increase health care costs, while the latter can significantly decrease health care costs over the long haul.

            There is also a problem of how to calculate the cost-savings from real community-based prevention and wellness programs. It is likely that it will remain a big part of any bill that gets hammered out in Committee after the Senate and House pass their versions of the health care reform bill because it has bi-partisan support.  If that does happen, it could mean enormous cost-savings over a ten-year period. However, the Congressional Budget Office, which is considered to be the “gold standard” on estimating the costs of legislation, says that these parts of the bills will not yield any cost-savings and might actually increase the cost of health care reform. How can they say that?

            Well, they are partially right. If they are only looking at the possible increased cost of more preventative screening tests, the most concrete variable they can measure, they will conclude that prevention means increased costs. Actually, this should not even be classified as prevention and should be called “early detection” and “early intervention.” There is even some recent evidence that the screenings for breast cancer with mammograms does not increase survival rates and neither does PSA screenings for prostate cancer. Wait a minute, that is the subject of another blog.

            Second, The CBO has no accurate way of measuring the potential cost-savings from the creation of “Community Prevention Services.” Their predictions work best when they can isolate a single variable such as the current cost of preventative screening tests and then estimate the cost of insuring an additional 50 million people and offering them screening tests they do not now get. They can easily predict increased health care reform costs from these additional screening tests. However, they cannot easily isolate the variables involved with creation of community prevention services because they are varied and cannot be easily grouped into a single variable. In addition, much of what is being proposed is new and there is no good base line information available to use for making predictions. So what happens?? They guess.           

Finally, it turns out that the Congressional Budget Office isn’t perfect, in fact far from it. On three occasions recently they grossly under estimated the cost-savings of various pieces of health care legislation. It appears that when they have to estimate more than one variable at a time, their accuracy goes down to almost zero.

            If the members of Congress rely solely on the cost-cutting estimates supplied to them by the CBO in making their decisions, it could result in  significantly reduced expenditures in the area of community prevention services. Please urge your representatives to use some plain common sense and help them see that we have to invest in community prevention services that promote health and teach people how to stay well. This is where the future of health care reform has to be. We simply cannot afford to pour more taxpayer money into a very expensive “sickness” oriented health care system and hope that we will be able to reduce the cost of health care, that is already the highest in the world. It ain’t going to happen.

 Stay healthy and keep well.

 Barry

Book Review by Stephen Burton Ph.D. Cand., UNCC, Charlotte, NC

A Review of Conflict Resolution: The Partnership Way

Paperback: 336 pages

Publisher: Love Publishing Company; 2nd Revised edition (January 2009)

Language: English

ISBN-10: 0891083391

ISBN-13: 978-0891083399

 The first step that can save us from a modern culture that over-emphasizes a belief in ourselves as autonomous and separate individuals is learning how to resolve interpersonal conflicts through empathic understanding and the willingness to respect the needs of others equal with our own. A mistaken belief of separateness allows individuals to navigate life without taking the risk to ask for help from others or considering that others might need their help.

 It may seem like a difficult task to educate an increasingly diverse society to be more aware of the need to cooperate with each other. However, consider the role of mental health professionals who are asked to relieve the psychological pain and fallout suffered by individuals coping with interpersonal and societal conflict. What tools do they have to bring to the table in order to effectively help clients resolve their conflicts in today’s increasingly conflictual world?

 From the perspective of master’s level students engaged in learning the craft of therapeutic counseling, they soon find that conflict resolution and mediation skills are essential components of an effective professional practice. Yet most university training programs spend very little time developing the theoretical literacy necessary to understand the concepts of conflict resolution. In addition, even less of their clinical training is devoted to creating competencies in the use of conflict resolution skills.

 When the majority of graduate students in counseling and psychology embark on their practicum and internships in clinical settings they often are surprised by how much conflict is present in the lives of those they are charged with helping. Conversely, they discover how little they have been taught that might enable them to actually help their clients resolve the painful conflicts they are experiencing in their personal and family relationships as well as those in their school and work environments.

 A new generation of counselors, social workers and psychologists can now benefit greatly from the work of counselor educators, Barry Weinhold, Ph.D. and Janae Weinhold, Ph.D. This breakthrough work in the field of conflict resolution, Conflict Resolution – The Partnership Way, represents a departure from the traditional texts that can be found on this subject. It lends itself well to developing theoretical literacy on this subject. More importantly, it places emphasis on creating clinical competencies through specific types of skill training, without which little can be accomplished in the area of mediation and conflict resolution. In this increasingly important area of therapeutic practice, professionals need to be able to walk the walk with clients seeking to resolve their conflicts more than just talking the talk of traditional talk-therapy. This is an area where a pill will not fix the problem and the competent use of a specific set of conflict resolution skills must come into play in order to effectively help their clients. 

 The Weinhold’s revised 2^nd edition text addresses the theoretical literacy needs of students’ for understanding conflict and its sources by presenting an integrative meta-theory titled, Developmental Systems Theory (DST). DST utilizes a four-stage developmental model to explain why conflicts occur in all human systems. This includes intimate relationships, family, schools, organizations, legal systems, and the larger social systems of communities, cultures and nation-states. They then present practical skills to show people how to resolve the three major kinds of conflict that occur in all human systems: (a) wants and needs, (b) values and beliefs, and (c) intractable conflicts.

 As alluded to above, just using a didactic approach to teaching conflict resolution will not work in producing professional competencies in this area of therapeutic practice.  What is needed is a constructivistic approach predicated upon student involvement in their own educational process of discovery and experience. The Weinhold’s new book provides the instructor with resources to utilize this approach, including student self-inventories and writing exercises in each chapter that provide insight and direction for understanding strengths and areas of needed skill development.  Finally, the book provides readers with a clear understanding of Developmental Systems Theory as it is applied to conflicts that occur in all human systems. Practical step-by-step processes for resolving the various types of conflict are presented throughout the book that include the development of dialogue and inquiry skills critical to helping practitioners work with clients and others in resolving conflicts.

 The content of the book is laid out in four parts:

 Part One

• Describes the Partnership Way and the Developmental Systems Theory that supports it.
• Illustrates why we need a new paradigm of conflict resolution.
• Introduces new research on unrecognized and unhealed developmental trauma as the primary cause of intractable conflicts.
• Helps readers examine their personal style of conflict resolution and to determine where it is and is not effective.

Part Two
• Focuses on resolving conflicts of wants and need and values and beliefs.
• Provides step-by-step skill building worksheets and skill practice exercises to help readers learn how to resolve their conflicts as well as how to help others do the same.
• Teaches readers how to identify your own wants and developmental needs.
• Shows how to distinguish between a conflict of wants and needs and a conflict of values and beliefs.
• Presents dialogue and inquiry skills to resolve conflicts involving values and beliefs.

Part Three
• Focuses on identifying the often unrecognized developmental sources of intractable conflicts and strategies for resolving them at their source.
• Shows how to resolve conflicts in individuals, couples and families.

Part Four
• Focuses on strategies for resolving conflicts in more complex social systems, such as the mental health profession, schools and churches, the legal profession, the workplace, and cultural, national and international organizations.
• The last chapter describes how the authors have utilized these skills in their own relationship.

 The fundamental principles and suggested teaching methods laid out by the Weinholds in their newly revised book can help colleges and universities better prepare students entering the helping professions to assist clients in resolving their interpersonal conflicts. The material presented by the authors can serve as the basis for engendering the understanding, values, beliefs, and conflict resolution skills necessary for those who are increasingly looked upon to heal the pain and frustration of those involved in interpersonal conflict. The book presents a path toward developing a higher level of consciousness about the need for conflict resolution that can foster more peaceful relations among all people. It provides the information necessary to understand and settle disputes that represent the artificial divisions that separate us as individuals and community members in an increasingly diverse and conflictual world.

 Information about the reviewer: Stephen Burton is currently a second year Doctoral student in the Counseling program at The University of North Carolina at Charlotte (UNCC). He is also an experienced mediator in the field of conflict resolution and dispute settlement. During the 2009 first summer session, he co-taught the Advanced Counseling Techniques course required for Master’s level students enrolled in UNCC Community and School Counseling graduate programs. As a part of the course, he taught the segment that focused on mediation and conflict resolution techniques using material from the book, Conflict Resolution: The Partnership Way, by Barry Weinhold, Ph.D., and Janae Weinhold, Ph.D.