The next Alumnae/i Association meeting is on Friday, March 6, when Richard Johnson, PhD, LCSW, will present Family Therapy with One Person: Coaching Individual Clients Toward Change in Family Relationships. Admission to Alumnae/i Association events is free for members who have paid their $50 annual dues. Admission is $10 per event for students and externs and $25 per event for other guests. Registration is available online at the Ackerman website.
The Kempner Award and Lecture are presented under the auspices of the Center for Families and Health. Dr. Evan Imber-Black, Director of the Center, introduced Dr. Loebl.
In his presentation entitled “An Integrated Psychiatric and Family Systems Approach to Caring for Our Elders,” Dr. Loebl noted the many ways in which medical and psychiatric problems, along with complex family dynamics, are intertwined in the care of older patients. The specific case Dr. Loebl used in his talk was that of a 75-year-old woman, Mrs. Smith, with several serious medical conditions, including hypertension and diabetes, pain and osteoporosis, urinary incontinence and memory loss.
Dr. Loebl said that hypertension and diabetes, both common conditions in the elderly, can have an impact on the delivery of blood throughout the body, including the brain. If a patient is not taking appropriate medication for one or both of these medical conditions, the damage to the blood vessels and consequent lack of adequate blood flow to the brain may cause behavior that appears symptomatic of dementia or even vascular dementia itself. This is best prevented with proper medication.
Just as not taking medication for a physical condition can affect symptoms of mental illness, taking medications also can affect mental health, Dr. Loebl commented. He explained that memory problems can be a side effect of many medications prescribed and commonly in medications used to treat urinary incontinence. Coordination of care is vitally important, especially in the elderly who often present with multiple problems for which they are given many different types of medication by a variety of doctors.
Dr. Loebl’s case study demonstrated clearly the importance of family members in caring for an older person as well as the powerful impact of family interaction. Mrs. Smith is a divorcee with four children, but only one daughter, Jenny, is actively involved in her care. Mrs. Smith also has a home health care worker, Cindy. Although Jenny and Cindy were working to coordinate Mrs. Smith’s care, several critical issues had emerged. Jenny was beginning to feel jealous of her mother’s attachment to Cindy. She also resented the fact that when her less involved brother and sisters came to visit, her mother seemed to appreciate them much more than she appreciated Jenny These family concerns surfaced at a time when Jenny was feeling increased pressure about her work and it became apparent that Jenny was beginning to spiral into depression, herself.
Dr. Loebl used circular questioning to address some of these issues. First, he asked Jenny to think why her mother thought the other children were not as involved as Jenny. Then he asked Mrs. Smith to speak about why she thought Jenny was feeling depressed and overburdened. This type of questioning calls up substantial amounts of relational information that may not be made available otherwise, Dr. Loebl said. It also opens the door to exploring intergenerational transmission of beliefs. In the case of the Smith family, Dr. Loebl explained, Jenny may have been repeating a pattern set by her mother, who lost her own mother as a young woman and stepped in to care for her father and siblings.
Dr.Loebl also said he worked with Cindy and Jenny to ease any tensions between them. Dr. Loebl’s approach was unusual in that he involved the caretaker as fully as the family members. As a result, the caretaker, Cindy, played an instrumental role in helping to mobilize the non-involved family members, which Jenny felt unable to do. This helped ease Jenny’s jealousy and sense of burden. Dr. Loebl’s attention to the home health aide’s position as an important member of the system is an innovation in family therapy with geriatric patients and their families.
Dr. Loebl said that recognizing the complex interactions between an illness and a family helps to clarify treatment planning because goal-setting then can be guided by an awareness of the components of family functioning, the phases of the illness and the family’s beliefs in ways that optimize care. Psychosocial factors, as well as biomedical interventions, become important influences in the healing process. Dr. Loebl said that by integrating psychiatric and family systems approaches we can better help families understand the nature of the illness and understand more fully the role of the family at different stages of illness.
The Carl Kempner Award is named in honor of the late Carl Loeb Kempner, husband of Doris Kempner, an active member of the Ackerman Board for many years. The Kempner family’s commitment to education and social services has been life long and, with the support of the Armand G. Erpf Fund, the Carl Kempner Award continues to enhance knowledge in the development of clinical intervention and in training therapists working with families coping with major health issues. Each year the Center for Families and Health at Ackerman selects an awardee from among our Ackerman trainees, alumni or young faculty members engaged in the most innovative research in the area of families and health. The award recipient delivers the Carl Kempner Memorial Lecture.
Dr. Noguera began by pointing out that unlike many speakers at the workshop series and many people in the audience, he is a sociologist and not a therapist. “We occupy the same kind of social world,” he observed, “but we approach it in different ways.”
Dr. Noguera said he did a lot of his work with schools and to understand schools, it was critically important to see them in a social context. He noted that although the United States has vast resources, it does not do the basics very well. By basics, Dr. Noguera said he meant such endeavors as teaching children from poor communities to read. He said that the schools often are the only safety net available to children.
“We have so many kids suffering from so many ailments,” Dr. Noguera said. “And it’s not just poor kids. In other communities, we have children suffering from substance abuse and eating disorders. It’s a mistake to see risk as only connected to poverty.”
Dr. Noguera noted that the U.S. has the highest teen pregnancy rate of all industrial nations, that the U.S. homicide rate is higher than the death rate of many countries at war, and that more people per capita are incarcerated in the U.S. than in any other country at any time in history.
Dr. Noguera said that the famous sociologist Emile Durkheim – the father of modern sociology – conducted a study of suicide years ago and found that suicide was closely tied to people’s sense of connection to their society. The more connected a person felt, the less likely he or she was to commit suicide. Dr. Noguera said that Emile Durkheim came to see suicide as a symptom of what he called anomie, a term that signifies an erosion, diminution or absence of personal norms, standards or values in an individual. The effect of this normlessness at both the personal or societal level is to introduce alienation, isolation, and desocialization because as norms become less binding for individuals, those individuals lose their sense of right and wrong.
According to Dr. Noguera, anomie grew in the U.S. as society changed from rural to urban and people became less attached to one another. “In other words,” Dr. Noguera said, “people need people.”
Dr. Noguera also cited the observations of Margaret Mead who, when she worked with groups in the 1960s, commented on the fragmentation of generations as a serious societal issue. In his opinion, both Durkehim and Mead were correct, Dr. Noguera commented, because we see in our society a breakdown of both institutions and families.
Social isolation and alienation can lead to mental illness and, in certain circumstances, even death, Dr. Noguera explained. To illustrate his point, he spoke about a heat wave that occurred in Chicago in which a number of elderly people who lived alone actually died because they were so disconnected from their families and communities that there was no one around to see how the extreme heat was harming them. “There was no one to open the window or get them out of their apartments,” he said. However, older people who lived with others or were still involved in a community did well in spite of the dangerous conditions brought about by the heat because another person looked in on them and helped them.
After September 11th, Dr. Noguera said, people experienced an increased sense of community and appreciated it. “There is real social benefit in social community,” Dr. Noguera said. What is needed, he explained, is to teach people emotional intelligence skills. These skills can be taught in schools, but one of the key questions facing society is how to teach them on an even larger scale.
This year’s graduating class was divided into three groups: Rachel Berezin, Andrea Blumenthal, Scott Hirose, Anita Mambo and Bonnie Siegel, supervised by Evan Imber-Black, PhD; Dana Greco, Jodi Harrison, Andrew Koncz, Keren Ludwig, Margaret T. Ngunang and Sarah Robinson, supervised by Miguel Hernandez, LCSW; and Wendy Bond, Kimberly Hope Andron, Karen Murphy, Genevieve Shineman, Orly Toren-Gabay and Jan Weiss, supervised by Fiona True, LMSW.
Lois Braverman, President of the Ackerman Institute, welcomed the graduates and their guests.
“Completing the Ackerman training program is not an easy task,” Ms. Braverman said. “It requires hard work, dedication and a major commitment of time over a period of years. I am so proud of all of you and I know your families and friends share that pride.”
Ms. Braverman also congratulated the externs’ families and friends.
“At Ackerman, we believe that families are the greatest resource available to individuals coping with the complexities of modern life. We know that individuals’ problems are best solved within the context of family, and we also know that individuals’ achievements also happen within the contexts of families and communities that support those accomplishments,” she explained.
Marcia Sheinberg, Director of Training, characterized the graduates as “an impressive group.”
“You have opened your hearts and your minds to expand your ability to help people,” she said. “You have done so based on a belief in the principles and practices of a relational perspective. While most of the mental health community continues to conceptualize problems as located in individuals whose context may or may not facilitate their well-being, you believe that the essence of one’s health is in the context of connection.”
“As a profession we are facing challenging times,” Ms. Sheinberg continued. “Never has the fork in the road been clearer and the consequences for our field, not to mention the world been greater. As you continue in your careers you will be both ambassadors of the Ackerman approach to human suffering and an advocate for the principles we ascribe, which values all perspective even those which we choose to challenge.”
Each of the three supervisors also congratulated the students. Evan Imber-Black said her externs had shown her they possessed the “authenticity, warmth and empathy” needed to be successful therapists.” She called on the externs to fulfill an ancient Hebrew imperative to “repair the world.”
Miguel Hernandez told his students that their dedication and hard work filled him with the same kind of pride parents feel in their children’s accomplishments.
“You are no longer my students,” he said as he presented each of his externs with flowers. “You are now my colleagues.”
Fiona True said she often uses the metaphor of a pond in family therapy, but that her extern group had really sailed on an ocean. There were storms, she noted, but the externs made their ship seaworthy and took it to an “incredible place.” She congratulated her students for their shared commitment to learn and grow, their dedication to the families they treated and their great intellectual curiosity.
Many of the students then spoke briefly, thanking the faculty and staff at Ackerman, as well as their own families and friends for their love and support.
Greg Rogers joined the Ackerman Institute Board in 2006 after participating in Ackerman’s Family Foundations and Live Clinical courses. He is a graduate of Brown University with a degree in Economics and Organizational Behavior, and earned an MBA in International Finance from New York University’s Stern School of Business. He is the Founder and current President of RayLign Advisory, a Greenwich, CT based family consulting firm with a focus on facilitating effective financial decisions in the context of family relationships. In addition, Greg is Founder and President of the RayLign Foundation, as well as advisory member of the Fairfield County Community Foundation, and board member of the Connecticut Council for Economic Education.
“Jane Donaldson, the current Board of Directors and a tremendous Faculty and Staff have put Ackerman on an extremely positive trajectory,” says Mr. Rogers. “I very much look forward to helping further apply Ackerman’s special capabilities toward strengthening families and communities worldwide.”
The Board also welcomed two new members, Diana Benzaquen and John Tyers. Ms. Benzaquen is the Vice President and Director at Brown Harris Stevens, the real estate brokerage firm. Mr. Tyers recently joined Merrill Lynch as Vice President of Broadcort, a leading provider of financial clearing services to investment advisory firms.