CCAF Event 9/28/16 Supporting Transgender Young Adults: Working Collaboratively with Family and Individual Treatment

Join colleagues at Penn Medicine and CHOP for this exciting panel, lead by transgender activist and family therapist, DR. ELIJAH NEALY.  They will address the importance of family therapy in the treatment of transgender young adults.

Dr. Nealy will be joined by Jacqueline HUDAK, PhD., LMFT, The Center for Couples and Adult Families, Perelman School of Medicine, Linda HAWKINS, Ph.D., Gender and Sexuality Development Clinic, CHOP, and Benoit DUBÉ, MD, Perelman School of Medicine.

 Wednesday, September 28th, 2016

6-8PM

16th Fl., 3535 Market Street

Philadelphia, PA 19104

A light dinner will be served

 RSVP sean.smith@uphs.upenn.edu

For the past 25 years, Elijah C. Nealy, PhD, M.Div., LCSW has worked extensively with LGBTQ adolescents and adults in both pastoral and social service capacities. Currently an assistant professor of social work at the University of Saint Joseph, West Hartford, CT, his clinical practice has focused on transgender and gender diverse youth and their families. Ordained with Metropolitan Community Church, Dr. Nealy regularly preaches and provides trainings for clinicians, faith communities, and organizations. An openly identified transgender man, Dr. Nealy lives in West Hartford with his partner and is the proud father of three amazing young people. He is the author of Transgender Children and Youth: Cultivating Pride and Joy with Families in Transition [Norton, February 2017].

 

 

Emotional Cutoffs in Families

I had a wonderful time presenting to physicians, nurses, social workers and psychologists at The Reading Hospital this spring.

The audience wanted to understand the meaning of emotional cutoff and the impact of this process on development and family relationships over the course of the life cycle.

Always true to my training as a family therapist, I began with my family genogram, and a story about my father’s cutoff from his family of origin. This happened when I was two years old and shaped the events in our family for many years to come. His alienation from his own family became the landscape of our life; it was always present. At certain times, like holidays, or life cycle events, like death, the impact was more acute. This relational rupture shaped how he was viewed by us, his immediate family members, influenced decisions, and had a grave impact on his health.

Father and daughter

Emotional cutoffs are the natural mechanisms people use to counter high anxiety or high emotional fusion, also known as ‘too much closeness.’ A cutoff can look like physical or emotional withdrawal, avoidance of sensitive topics, physically moving away from family members or rarely going home.

Relationships may look “better” if people cutoff to manage them, but the problems remain, and are dormant.

Although people reduce the tensions of family relationships by cutting off, they risk making their new relationships too important. For example, the more a man cuts off from his family of origin, the more he may look to his spouse, children, and friends to meet his needs. This makes him vulnerable to pressuring them to be certain ways for him or accommodating too much to their expectations of him out of fear of jeopardizing the relationship.

Not all cutoffs are unwarranted, however.  In some cases they are necessary, or preferred, as in the case of emotional or physical abuse.

There are circumstances when someone may be coached to ‘cut off.’ For example, consider the concept of ‘tough love’ or ‘letting someone hit bottom’ that is often suggested when a loved one is suffering with addiction. Post divorce families also struggle with physical and emotional cutoffs as issues of loyalty are prominent.

The words “cut off” imply a static state – a lack of motion or movement.   However, to remain angry or to hold a grudge are in fact, actions.

Consider these verbs: to harbor bitter feelings, resent, brood, or stew.  

Indeed, it is possible to become so wrapped up in the wrong that’s been done to you that you can’t enjoy the present. And there are significant health consequences. Anger, frustration and sadness increase the stress hormone, cortisol.

Experiencing these negative emotions instinctually prepares the body to fight.  A prolonged state of fight increases levels of protein in the bloodstream which promote cardiovascular disease and stroke. But here’s the good news: Studies have found that the act of forgiveness can reap huge rewards for your health, lowering the risk of heart attack, improving cholesterol levels and sleep, reducing pain, blood pressure, and levels of anxiety, depression and stress. And research points to an increase in the forgiveness-health connection as you age.

Chronic anger puts you into a fight or flight mode, which results in numerous changes in heart rate, blood pressure and immune response.  Those changes then increase the risk of depression, heart disease and diabetes, among other conditions.  Forgiveness, however, calms stress levels, and leads to improved health.

Perhaps in the next post I’ll write about the work of forgiveness and repair.  But for now, a return to my own family story.

About ten years into the cutoff, around the death of my paternal grandparents, my father’s siblings began to contact him.  These vaguely familiar men, my uncles, were welcomed into our home, and celebrated.

My father’s expansive capacity for forgiveness has stayed with me, and brought valuable lessons which I apply in clinical work with families: that despite dire circumstances, change can happen, and usually does.

We just need to take the long view – that is, a family life cycle perspective. We are constantly negotiating closeness and distance in our relationships over time; we readjust   according to the phase of the life cycle.  The warmth and closeness around the time of birth is juxtaposed with the ‘letting go’ required for launching into young adulthood.

The practice of compassion and forgiveness, for ourselves as well as those we love, will enhance our health and nourish our spirits as we face the challenges that will inevitably come.

 

Dr. Ellen Berman with Marty Moss-Coane and Ron Lieber: “Families and Money”

326aMoskowStudio    CCAF Founder, Dr. Ellen Berman was a guest on WHYY’s Fresh Air  with author Ron Lieber yesterday.  They had a lively and informative conversation about Families and Money.  Ellen and Ron  answer some of the more vexing questions about this important, delicate, and often very difficult to discuss topic.

“Money is all about values,” says Dr. Berman, who draws upon 30+ years of clinical experience with couples and families.  She talks specifically about the cultural shifts that impact ‘adult’ children, and offers clear, specific advice about how to avoid pitfalls and seize opportunities when dealing with the thorny issue of money and the family.

 

 

Welcome to our new CCAF Clinical Faculty Member, Michelle Jackson, MSS, LCSW

Welcome to our new CCAF Clinical Faculty Member, Michelle Jackson, MSS, LCSW

The Center for Couples and Adult Families extends a warm welcome to Michelle Jackson, a seasoned Couple and Family therapist who joined our Clinical Faculty last month.

There are many reasons I’m thrilled to have Ms. Jackson aboard, not the least of which is our ability to serve more couples and families at CCAF. Her arrival is evidence of our growth; clearly the word is out that there is couple and family therapy available at Penn.

Ms. Jackson’s sensitivity to issues of diversity in clinical work is in concert with the CCAF mission, as well as our curriculum in Culture and the Family that takes place across all four years of residency training in psychiatry.

Ms. Jackson’s life trajectory informs her fluency with individuals who have chosen or invisible identities, or who are part of biracial/bicultural couples, and multi-racial families. Her work provides a context in which to normalize alternative developmental pathways and strengthen resilience in the absence of cultural validation.

Welcome to CCAF, Michelle!

I’m so happy to have you as part of our team, and know that couples and families will be enriched through their work with you.  I look forward to a long collaboration together at CCAF.

To schedule a meeting with Ms. Jackson, please call Bryn Farrelly, 215-746-5900.

Read Ms. Jackson’s full bio

Research shows what Family Therapists Know: Memories can Pass between Generations

Research findings from a team at Emory University Medical School provide evidence of “transgenerational epigenetic inheritance” – that environment can affect an individual’s genetics and then be passed on.

As a family therapist I have intuited this often in my consulting room. There are times when a young adult with severe sadness sits with me, and I can sense that the sorrow is somehow lager that she is; it is too big a sorrow for someone that age.  When together we craft a genogram, we can find the relative, sometimes generations back, that bore the original wound.  History, culture, and family intersect to create a transgenerational  pattern – for dealing with fear, or loss,  and even what one dares to hope.  These patterns are born of the narratives that pass from one generation to the next.

For the full BBC article: http://www.bbc.com/news/health-25156510?SThisFB

The Family Life Cycle: Gear Shifts and Spirals, with Dr. Geri Fox

The Family Life Cycle: Gear Shifts and Spirals, with Dr. Geri Fox

Last month, CCAF faculty, residents and fellows were treated to a wonderful lecture by family psychiatrist Dr. Geri Fox.   “Gear Shifts and Spirals”  was an interactive discussion of video taken by Dr. Fox of her own family filmed over 25 years.  

Dr. Fox began her filming long before the now ubiquitous culture of self documentation.  She is a pioneer ethnographer, recording the turning points and challenges of everyday family life through the lens of her video camera.

She dedicated her talk to Dr. Lee Combrick-Graham, colleague and mentor who encouraged and nurtured this project.  

The images of gears and spirals were apt descriptions of the family life cycle.  Three dimensional, always in motion, the family is envisioned as  a system moving through time.  Dr. Fox described gear shifts as the ‘biobehavioral’ changes that are biologically driven – such as puberty.  These are times when the family’s world gets reordered, priorities shift, and boundaries diffuse.

As we know,  those changes, though anticipated,  can feel as sudden as accidentally shifting the car into reverse.

iStock_000023141413_MediumThe spiral conveys an image of coming together and then moving out again over time.   These forces are ever present in the family life cycle: the centripetal force that draws family together for the birth of a child, or a marriage; the centrifugal force that propels outward as children are launched into college and their young adult years.

iStock_000005779890_Medium

It’s one thing to describe a case of normal sibling rivalry, but quite another to watch Dr. Fox’s daughter poke and prod her newborn baby brother as residents and faculty laughed in recognition of this utterly familiar family scene.  We follow her along with husband and children through the small daily life events that, taken together, tell the story of family development over time: bemoaning the adolescent who’s ‘never home anymore,’  a daughter uttering fears about those first days at college.  Perhaps it’s the combination of voice and image that combine to keep the audience rapt; the empty place at the table, the boxes stacked by the door, so powerful in their familiarity, and so expressive of the experience of family.

Dr. Fox’s Life-Span Development Video Curriculum is utilized by the majority of US medical schools as well as abroad. She has won multiple awards for film-making, including two INTERCOM Chicago International Film Festival Certificates of Merit: in 2010, for Normal Development Video Series: A Longitudinal Stimulus Video Curricular Resource for Educators; and in 2013, for Saying Goodbye: A Personal Documentary about Attachment and Loss at End-of-Life.

Geri Fox, MD, MHPE is Professor of Clinical Psychiatry at University of Illinois at Chicago College of Medicine. She currently serves as the Assistant Dean for Graduate Medical Education, as well as the Director of Medical Student Education in Psychiatry.

“When Families Feud:” Dr. Ellen Berman on Voices in the Family

Silences, grudges and cutoffs between family members that can last for decades. How does this happen, what’s the price everyone pays and why is it so difficult to let go of resentment? Let’s talk about what we don’t talk about—family rifts and estrangement. Dr. Ellen Berman, founder of the Center for Couples and Adult Families  discusses ways to re-establish communication and review when that might not be possible.  Listen to her conversation with Dr. Dan Gottlieb:

http://whyy.org/cms/voicesinthefamily/