Thursday, March 31, 2011

Participants Needed for a Study on the Experiences of Legally Married Same-Sex Couples in California

Hello, my name is Erin C. Falvey, and I am a student at San Diego State University and Claremont Graduate University completing my doctorate in education. I am conducting a qualitative study which focuses upon the experiences of same-sex couples who are legally married in California. The results will be reported in a publication that I am completing as a requirement of my graduate program.

If you and your same-sex partner are legally married in California, I would like to invite you to be a research participant in this study. The purpose of this study is to construct a greater understanding of how legally married same-sex couples describe and navigate their experiences as a married couple. I will interview you and ask questions related to your experiences. This may include questions about your family, friends, and community. The interview should take approximately 1 to 1.5 hours to complete. Interviews will take place at my office located in Mission Valley. The address is 2835 Camino del Rio South, Suite 120-C, San Diego, CA 92108.

I will be videotaping the conversation as well as taking notes to ensure that I have accurately documented your story. In order to ensure the accuracy of my report, I will provide you with a draft for you to review and provide feedback or corrections to the content prior to its completion.

You will also be invited to participate in a follow-up focus group with other participants in the study. The follow-up focus group will be approximately 1.5 hours in duration and will take place a few weeks after the completion of your interview. The purpose of this meeting will be to share and discuss the themes which emerged from the interviews in order to get a more in depth understanding of your experiences. Participation in the follow-up focus group is not a mandatory component of your participation in the study and one or both of you may choose to participate in this portion of the study. I will also be videotaping the follow-up focus group conversation as well as taking notes to ensure that I have accurately documented the meeting.

The study will also include a brief demographic survey which will ask questions regarding your history and background. Space will also be provided for you to include any further demographic information that you would like to include about yourself. This survey will take about 10 minutes to complete.

Participants will not be paid for their participation in this study.

Your participation in this study is voluntary. If you decide to participate, your responses will be confidential- that is, recorded without any identifying information that is linked to you. Your confidentiality will be maintained to the extent allowed by law. I will use a pseudonym in my final report when referring to your responses.

Risks and Benefits to Your Participation:
Risks: It is possible that some areas of the interviews related to your personal experiences may generate some discomfort. If you begin to feel uncomfortable during your participation, you may discontinue participation either temporarily or permanently.

Benefits: A potential benefit of your participation in this research is that this study may further mental health professional’s understandings of the experiences and strengths of same-sex couples and enhance their ability to work with lesbian, gay, and bisexual individuals, couples, and families.

Erin C. Falvey, MA MFT
Doctoral Candidate, SDSU & CGU Phone # (619) 261-4221

Thursday, February 24, 2011

Diagnosis and Identity – Who Am I Now?

Guest Blogger: Tammy Fletcher

This article builds on the discussion in my last Topic Expert article where we explored the experience of new diagnosis and its effect on emotional wellbeing. Another way in which receiving a diagnosis, either psychological or medical, impacts us is in terms of identity.

Coming to terms with identity can be challenging for anyone. Developing an understanding of “who we are” is a lifelong process. Our sense of self solidifies as we age and gain life experience, however, that same life experience brings fluidity to identity. For example, a young girl struggles through her teenage years to become a young woman. A man in his 20’s goes from student to husband to father. An elderly couple moves from long-term relationship to widowhood. Cocktail party information looks like “Hi, I’m Jane. I’m a _______” – filling in the blank with your occupation, your family or marital status, your project du jour. All little pieces of what make up your identity.

Life is a series of changes, and as we move and adapt through what life brings us, our sense of who we are in the world shifts as well. Twenty-two years ago, I was a wife, a friend, a daughter. In a heartbeat (plus 13 hours of labor), I became something entirely new – a mom. I welcomed this identity shift, and while it was certainly new and sometimes even scary, there was support and advice everywhere I turned. It was an expected and celebrated change. I was still me, but this new life experience permanently altered my sense of self.

A few years later, I had another instant identity shift. A grim-faced neurologist sat down and told me, “You have multiple sclerosis.” Me? But I had things to do, a daughter to raise, a book ready to publish. This unwelcome verdict and whatever the heck it had in store for me was not in the plan. Right. Try telling that to a diagnosis. “Um….hi. I have other plans. Can you come back later? Or better yet, not at all?”

Sometimes life thrusts upon us the mother of all life changes – a serious medical or psychological diagnosis. As both a patient myself and a mental health clinician, I have seen the impact of diagnostic conclusions, and how we struggle to regain our footing. My last article outlined the logistics of a new diagnosis, including how to talk to your doctor and where to find more information to help you become an informed consumer. Now, let’s talk about the impact of a diagnosis after the calls have been made, the treatments scheduled, and the news begun to sink in.

“Who am I now? I was Mark. Now I am Mark, the-guy-who-just-had-a-heart attack. People treat me differently. My life changed, and of course I changed. But I am still Mark. Right?”

“I knew I had some problems with depression, but hearing ‘It’s Bipolar II Disorder’…wow. Now I’m officially a ‘psych patient.’ I stopped trying to explain it to people when I saw the look on their faces. Like I’m contagious. My therapist tells me to accept it and move on, make the best of it. How do I do that?”

“I’m an addict. I get that. Sometimes I want to be just ME again. I am not sure who that is now.”

Sometimes, receiving a diagnosis can feel like the person you were prior to the news doesn’t exist anymore. Or exists in such an altered state that you have trouble recognizing yourself. Friends, family, co-workers, and even your clinical support team have their own ideas about your diagnosis. Cancer, Major Depression, Lupus, Schizophrenia, Traumatic Brain Injury….the list is endless and the perceptions about each vary widely, influenced by each person’s personal experience, culture, exposure in the media, and personal beliefs about illness in general. It can be a challenge to dig yourself out of a mountain of perceptions, labels, and misinformation to re-connect again with people in your life, and with yourself.

Some suggestions that may help you through the process of physical or psychological illness:

1) Stages of Grief – Dr. Elisabeth Kubler-Ross outlined five stages that many people experience after loss. These stages can apply to any major life change, as well. From job loss to divorce to learning you are facing physical or mental illness, you may go through Denial, Anger, Bargaining, Depression, and finally, Acceptance. The stages do not always appear in order, and reaching the Acceptance stage doesn’t mean that you may not slip back into Anger or another stage. Those feelings are part of the process.

2) Find support – Whether you join a support group of others facing similar circumstances, or seek individual therapy, bolster yourself with support in whatever way works for you. Patients need emotional support after receiving serious health news. Family and friends may be dealing with the diagnosis in their own ways. Before worry, isolation, or depression take hold, reach out to others for support.

3) Find ways to still be you – Treatments, lab tests, hospitalization, appointments, side effects…all these can crowd into your reality and leave little time or energy left. You are still you. If you love music, take your iPod with you to an appointment. If reading relaxes you, visit the library or ask a friend to bring you some reading material. Books on CDs are available if reading is difficult. Stay connected to what matters in your life.

4) When loved ones offer to help, let them - People often don’t know what to say or do when a friend is ill, but they would like to help. Sitting and talking, driving you to an appointment, throwing in a load of laundry or bringing a meal – all are little ways to stay connected to others who are important in your life.

It would be false to assure you that everything stays exactly the same after you have been handed a significant medical or psychological diagnosis. Every piece of information we take in changes us somehow, and this one is a doozy. You may feel overwhelmed with information about what to expect. Remember, this is your journey. No one else’s will be exactly the same. The diagnosis impacts you; however, you also impact the disease or condition. You come to the table with your own set of strengths, experiences, and goals.

Dealing with mental or physical illness changes us. What we do with that is up to us. I chose to grow and find the life lessons hidden underneath the label of illness. However, I refuse to be the label. I have multiple sclerosis. It does not have me. That part of my journey involved conscious choice, and yours can too. Be kind to yourself as you go through any disease process. Allow it to teach you about yourself, others, and what matters most in your life. It’s okay to feel overwhelmed, angry, and to wish sometimes it would just go away. Stay anchored through those feelings and know that you are a person, not a diagnosis.

Chronic Pain – All in Your Head?

Guest Blogger, Tammy Fletcher, MA

According to Carmen Green, M.D., a pain specialist at the University of Michigan’s Health System Center for Interventional Pain Medicine, as many as one-fifth to one-third of Americans live with some form of chronic pain (Gazella, 2005). Let’s say there are about 300 million people living in the United States right now, that means that as many as ninety-nine million people may be experiencing physical pain, many on an ongoing basis.

Why so many? And why do the numbers seem to be increasing? A few reasons come to mind. One, on average we are living longer. Conditions that used to result in death are now more treatable, extending our lifetimes. With increased longevity may come chronic pain related to these conditions or simply to the aging process. Another reason for the increase in our pain is the increase in obesity in the United States. According to the Centers for Disease Control (CDC), as of 2009 only two states had an obesity rate of less than 20%: the District of Columbia and Colorado (Centers for Disease Control and Prevention, 2009). The CDC reports that obesity may lead to diseases that may include chronic pain.

With chronic pain intruding on so many millions of lives, you might imagine that the practice of medicine has kept up with these trends, and that a patient experiencing moderate to severe pain on a daily basis might have an array of effective, cost-efficient choices in care to assist in enhancing quality of life and restoring a desired level of activity and function to the patient’s life. There are a growing number of specialists in the effective treatment of pain, including medical doctors and osteopathic physicians who complete specialized education and certification in this area.

Given this information, why do so many patients report difficulty in finding adequate medical care for their pain? I hear again and again from clients who feel they are not taken seriously, seen as drug seekers, or told their pain is “all in their head.” So in addition to living with a condition like diabetes or fibromyalgia, they experience the added stress of feeling no one understands their chronic pain. Chronic pain patients often feel as if their doctors don’t believe them, or see them as malingering.

This is not to say that patients don’t abuse health care systems. There is such a thing as “drug seeking behavior” as well as patients who embellish their symptoms or concoct stories of illness for various reasons. This article is not about those people. This article is for those who experience severe or intractable pain on a regular basis. Their lives have been disrupted. Their relationships have bent under the stress of their pain. Their careers may be on hold, or greatly hampered. These people want nothing more than to function. They want to be believed.

As I mentioned in my last blog, I am a chronic pain patient as well as a therapist. I was diagnosed with Multiple Sclerosis in 1996. Prior to my diagnosis, even I was told it was “all in my head” by my primary care physician. Guess what? It was. I had lesions on the nerves in my brain. After a very satisfying moment of firing that doctor, I set out to find one who knew what pain was and how to treat it. It took me several more years, but I found her. As patients become more educated and empowered, the medical field is going to have to keep up with us – even those of us with chronic pain.

Speaking of my own pain specialist, she reminded me to add here that there are a number of pain-causing conditions that simply defy definition or clear diagnosis. A patient wakes up, sneezes, and ends up with a ruptured cervical disc. Those cases are even more likely to be undertreated, as they don’t necessarily show up on an x-ray or a blood test. A confusing or hard-to-pinpoint diagnosis can complicate the patient’s ability to have his or her pain symptoms treated.

There is no question that chronic pain has emotional repercussions. Depression and anxiety are common among pain patients, especially those whose pain is not managed adequately. I have noticed that in therapy sessions, often just allowing the client who experiences chronic pain to talk about what it is like is a catharsis in itself. Respect, acceptance, and the ability to hear the person’s story with empathy are all healing tools that any therapist can use for the chronic pain client.

Cognitive behavioral therapy has been shown to positively effect chronic pain, while providing clients with techniques to control pain in whatever ways they are able (Keefe, 1996). Narrative therapy is making strides in supporting clients in developing a different relationship with pain, as well as coping with feelings like anger and depression. Whatever your theoretical orientation, I encourage you to learn as much as you can about chronic pain, treatment options, and the ways in which pain impacts our clients’ daily lives. Keep in mind that your client may have been told that his or her pain is unfounded, imagined, or otherwise minimized by health care providers. Your caring, professional support can be a vital part of a chronic pain patient’s health care team.

Here are some helpful resources for anyone seeking additional information about chronic pain:

* The American Academy of Pain Medicine:
* The American Chronic Pain Association:
* The American Pain Foundation:

Works Cited:
Centers for Disease Control and Prevention. (2009). U.S. Obesity Trends.
Gazella, K. (2005). Enduring chronic pain. University of Michigan Health Minute .
Keefe, F. J. (1996). Cognitive Behavioral Therapy for managing pain. The Clinical Psychologist .

Wednesday, November 10, 2010


Guest Blogger: Tammy Fletcher, MA

“When my husband and I went through this process, it was like a roller coaster. We had no one to talk to.”

“I had a miscarriage after months of trying to conceive. My family says I am young, I can try again. No one understands how I feel.”

“As a lesbian single woman trying to conceive, I had little support. I longed for a child, always had. I keep trying but it’s not easy.”

“My wife is going through so much right now. Every month she goes into a depression when she gets her period. Is it worth all this?”

When doing a search for “Infertility and Counseling,” most resources offer information on in vitro fertilization, genetic counseling, surrogacy, egg/sperm donors, and even financial planning for the process. All of this information is valuable for anyone trying to conceive (TTC). What is often missing is support for dealing with the emotional side of the TTC process. Infertility can affect your self-esteem and your outlook on life and your relationship.

TTC and infertility are much more than physical processes. Most people experience a variety of emotional issues after a diagnosis of infertility. Medical treatments involving hormones, lab tests, and procedures like semen analysis and egg transfer can add to feelings of stress, confusion, anxiety, and sadness. Each month, you may be holding your breath for a positive outcome, but feel uncertain it will come. It is no wonder individuals and couples trying to conceive express the need for support and understanding.

Some things to remember if you are trying to conceive, or you or your partner have been diagnosed with infertility:

* This can be a trying time; self-care is vital to help you cope with emotional and physical stress.
* Become as educated as you can about options in treatment. Your health care professional should be your partner in the process, able to answer your questions and help you know what to expect.
* Couples: don’t lose touch with each other or your relationship. Communication and mutual support are vital right now – for both of you.
* Don’t forget that sex is about intimacy, too. While this can be challenging when you are monitoring your ovulation cycle, for example, take time to connect with your partner and maintain your bond of intimacy.
* Not everyone will understand what you are going through, and some may even make thoughtless remarks in their efforts to offer comfort. You may find support from others in the same situation, such as support groups or therapy.
* There can be feelings of grief and loss, too, particularly you experience miscarriage. Honor these feelings and be gentle with yourself.
* Make time for other areas in your life that will help you stay balanced: work, friends and family, hobbies, exercise, and relaxation.

Working through this process with a professional therapist can help provide the support and empowerment you need during this time. Do not overlook the importance of your emotional wellbeing while facing fertility issues. Professional therapy can help you feel more positive about the process, as well as strengthening your bond as a couple.

At Narrative Contemporary Therapy, we welcome your call to learn more about how we can help, or to schedule an appointment. We can provide supportive therapy throughout all stages of the experience of TTC and infertility treatment, for individuals, couples, and families. Contact us at (619) 261-4221 for information. My direct line is (619) 252-9811.

Monday, November 1, 2010

Grief and the Holidays

Guest Blogger: Tammy Fletcher, MA

Holidays can be stressful times. Everywhere we look, we see commercials, store displays, and reminders that this is supposed to be a time of joy. Families and friends gather together to celebrate and enjoy each others company, exchange gifts, and share meals. For those who are experiencing illness, loss, or grief, however, the holidays may feel anything but merry. Feelings of sadness, depression, or anger are not unusual when living with the process of grief. How can you cope, then, when it feels like everyone around you is overflowing with happiness while your own heart is breaking? Here are some tips to help you through the holidays and beyond.

* Do away with the “shoulds.” There is no one way to celebrate the holidays, and frankly, most families are not like the ones depicted on greeting cards or television shows. When you are feeling down, it is easy to fall into the “how things should be” trap. Instead, find what things in your life you can embrace, and let go of comparing or feeling you “should” be feeling a certain way.
* Show yourself extra kindness. Many people easily demonstrate loving kindness to others, but when it comes to caring for themselves it can feel difficult. Make sure you are getting enough sleep, nutrition, and self-care. Do something nice for yourself every chance you get.
* Don’t isolate. Isolation is different from alone time, which we all need from time to time. If you find yourself avoiding others completely, not wanting to leave the house, or feeling like no one can relate to you, take some small steps to reach out and connect. Have coffee with a friend, make a phone call to say hello, or attend a workshop on something of interest to you.
* Set boundaries. Don’t take on more than you can handle. It is okay to say no sometimes; there is no need to prove your resilience and strength right now. Pace yourself with activities and tasks if you need to.
* Finally, accept the support of others. If you feel emotional or sad, lean on your loved ones and allow them to be there for you. If signs of depression and grief are troubling you, you can also seek the help of a qualified counselor – preferably one trained in the grief process. There are likely to be support groups in your area as well to support those struggling with loss during the holiday season.

Grief is a process. It ebbs and flows, and it takes time to move through. Be gentle with yourself, and allow others to assist you. Above all, know that you are not alone in your pain. Grief and loss turn our worlds upside down. There is hope and help to get you through to the other side.

Wednesday, October 6, 2010

Elderly Parents

Guest Blogger: Tammy Fletcher, MA

Most of us in the Baby Boomer generation have witnessed our parents’ aging process. We may notice them tiring more easily, or experiencing chronic aches and pains. More serious concerns include memory loss or confusion, falls, or struggling to get through activities of daily living like cooking and personal hygiene. I recall during the last years of both my parents’ lives how startled I felt each time the phone rang late at night, fearful of bad news. They had moved to a tiny town in the south, idyllic during their active retirement years. As they moved into their 80’s, their distance and isolation from the big city became more and more of a worry.

What are some signs to watch for with your aging parents? What questions should you ask in order to help them stay safe and as healthy as possible?

* Unsteadiness, dizziness, falls: A fall in an elderly person can be troublesome and even dangerous. Might your parents benefit from grab bars, shower chairs, or other devices designed to prevent falls and injuries? Or is the family home with stairs and slippery floors no longer the best option?

* Confusion, loss of memory, wandering: This might be as simple as those “senior moments” we all have after a certain age, or can be early signs of dementia. Keep communication open with your parents, and encourage regular medical care.

* Inconsistent use of medication: Whether due to forgetfulness, depression, or lack of funds to pay for medicine, consistent use of medication can be a major factor in overall physical and mental health. Inexpensive pill dispensers and notes or reminders of medication dosage are a couple of simple ways to help keep organized.

* Depression or other changes in mood: Life transitions are often stressful periods in a person’s life. One elderly client in her mid-80’s told me “All my friends are passing away. It’s lonely. I can’t be as active as I used to.” The loss of a spouse or friends can create deep sadness and even depression. Keep communication open with your elderly parent and help him or her find support if needed.

If you are nearby, staying aware of your parents’ wellbeing is obviously easier. If you live farther away, another family member, neighbor, friend, or professional caregiver can help keep you actively involved. It may be helpful to learn about resources in your parents’ community for the elderly – exercise classes, social groups, church activities, or other ways they can be as active as they would like to be. Additionally, some elderly people may eventually benefit from living in a retirement community, or require the higher level of care available in facilities such as skilled nursing homes. It may be time to discuss what may be some difficult topics, such as healthcare decisions, safe living arrangements, and financial issues. These subjects may

One last thing to be aware of, this time for you. This can be a stressful time for you as well. Take care of yourself to avoid caregiver burnout. Ask for help when needed, talk to a trusted friend, family member, or counselor, and don’t forget your own needs. It may be a time of transition and change for your parents and family, but with open communication and ample support, it can be a time that enriches your lives.

Friday, September 10, 2010

Children of Gay and Lesbian Parents Series: Resilience

In the evaluation of a child’s development, educators and mental health professionals have traditionally utilized standardized developmental preconceptions which arrive at reductionistic conclusions and impose dominant cultural assumptions (Smith & Nylund, 1997). This often leads both the service provider and his or her client(s) to construct an identity characterized by deficit. When service providers deflect human problems to the mental domain the social and political antecedents of problems remain unchallenged. For example, in discussing the Martin’s 1998 publication, Litovich and Langhout (2004) posit:

One of the arguments against children being raised by lesbian or gay parents is that the experience will cause undue social difficulties because of heterosexism resulting in homophobia, stigmatization, and discrimination. This argument seems ironic as sexual-minority parents are not to blame for society’s prejudice and yet, their parenting abilities are questioned on the grounds that their children will experience difficulties as a result of this prejudice (pp. 411-412).

Further, in their review of literature related to the developmental outcomes of children raised by lesbian parents, Litovich and Langhout (2004) found that the most significant differences between children of lesbian parents and children of heterosexual parents pointed to positive developmental outcomes for children with lesbian parents including an increased capacity for empathy, appreciation of difference, and awareness of inequality and prejudice.

A growing body of literature that challenges much of the deficit language prevalent within the child development literature is largely concerned with the construct of resilience. While very little of this literature specifically addresses the experiences of gay and lesbian parents and their children, the construct of resiliency does offer us another paradigm with which to understand the experiences of these families. This is particularly poignant in that although children raised in same-sex headed households must contend with the day to day reality of living in a heterosexist and homophobic context, their development has not been shown to be negatively affected according the empirical research (American Academy of Child and Adolescent Psychiatry, 1999; Anderssen, Amlie, & Ytter√ły, 2002; Litovich & Langhout, 2004; McCann & Delamonte, 2005; Meezan & Rauch, 2005; Patterson, 2006)

In their interviews with lesbian families, Litovich and Langhout (2004) traced several themes related to resiliencies present within these families. These included open discourse on sexual orientation from a young age and discussion and invitations to future dialogue about the possibility of heterosexist incidents that the children might experience. Examples of coping strategies which frame experiences of heterosexism as outside of the personal worth of the child and which teach the child compassion, even for those who are intolerant of them are understood within the resiliency paradigm. In this way, the family becomes a major source of support for the child, resiliently fostering the development of positive self esteem.