Thursday, May 29, 2008

Psychological Services for China's Traumatized Quake Survivors in Full Swing

BBC Monitoring Asia Pacific - May 19, 2008

Text of report in English by official Chinese news agency Xinhua (New China News Agency)

["China Exclusive: Psychological Services for China's Traumatized quake Survivors in Full Swing" - Xinhua headline]

MIANYANG, Sichuan, May 19 (Xinhua) - China's largest ever psychological service operation for survivors of a natural disaster is in full swing, a week after an 8.0-magnitude earthquake rocked the southwestern Sichuan Province.

In a temporary residence site for earthquake victims in west China's Mianyang City, Dr Wang Ningxia, a psychologist faced an eight-year-old girl Qiao Xi, who was traumatized and unable to speak after experiencing the tragic disaster.

Qiao Xi's mother lost four of her family including her son, Qiao Xi's elder brother, in the earthquake. The voluble girl lost vitality after that.

"Do you still want to go to school? Would you want to go back to your school?" the doctor asked.

The question won the first one-word response from the traumatized girl a week after she lost speech.

"Want," whispered the girl, who had been communicating with simple body languages of nodding for "yes" or shaking head for "no".

Doctor Wang said that the session with the girl had had some success. But not all the cases she met in the quake zone progressed.

"I tried in vain to communicate with a mother who lost her daughter in the earthquake. She could not face the mishap that happened. She neither cried nor ate anything," said Wang.

The doctor from the South West University of Science and Technology led 10 teachers and 34 students to carry out psychological service work in Mianyang City.

Wang took out a questionnaire she drafted, and pleaded with Xinhua's reporters to help submit it to authorities, who have the power to hand out the questionnaire among quake victims.

"The questionnaire would help psychological counsellors to locate victims who urgently need psychological treatment," said Wang.

There are at least 300 professional psychologists working in the quake zone, according to Xinhua's tally of medical staff sent by the Ministry of Health and a dozen of medical institutes around the country.

A group of psychologists led by Zhang Yuqing, associate professor from the Psychological Institute of the Chinese Academy of Sciences has carried out counselling on 1,000 school children in Beichuan County, closest to the epicentre of the earthquake.

"We have taught the children some psychological knowledge and some methods to ease psychological stress," said Zhang, who also planned to meet injured victims and orphans.

Wang Ningxia said that most of psychologists working in the quake zone volunteered to join the task.

"This was the first time that we faced so many traumatized people. This is the first attempt at such a massive psychological operation in China. The work lacks overall coordination," said Wang.

She said that psychological therapy is urgently needed, since survivors are still gripped in horror, and by a sense of insecurity and solitude.

"They re-experienced the horrible scenes again and again in everyday nightmares or insomnia. The trauma may remain for two to 10 years," she said.

Zhang Kan, director of the Psychological Research Institute of the Chinese Academy of Social Sciences said that millions of quake victims, witnesses, rescuers and even reporters on the earthquake may suffer psychological trauma, and need counselling.

"Some people may not handle the helpless emotion, and suffer long- time panic, the feeling of setback and emotional dysphoria. Such patients may turn to liquor, cigarettes and drugs for comfort. Some may contemplate suicide or other extreme behaviour," said Zhang.

Thousands of volunteers from around the country have registered through local psychological service stations to go to the rescue front line. However, there is still a heavy shortage of professional psychologists, since the therapy is in an initial developing stage even in China's major cities.

(C) 2008 BBC Monitoring Asia Pacific. via ProQuest Information and Learning Company; All Rights Reserved

Friday, May 16, 2008

Soldier cries: "Please let me rescue one more!"

I read the following article that is being published in many Chinese news sites. It is a personal account of the earthquake in Sichuan, translated into English (article in Chinese here: 消防战士跪地落泪:求求你们让我再去救一个)

[Disclaimer: the following article may be disturbing to some readers, but it is meant to mobilize us to action.]

"I just received a call from a reporter who had recently interviewed me. She just returned from MianZhu. On the phone, she described a scene she personally witnessed. She used only four words to describe what she saw - "世界末日" (Armageddon). She could barely work, because while there her tears never stopped. There was ruin after ruin, and the void left by collapsed buildings was filled by the sounds of crying. Rescue teams frantically rushed from site to site, but often it was too late. The photographer that went along with her only took one picture before throwing away the camera to join in on the rescue effort. The surroundings made it impossible to just stand and watch.

She told me that at a school she saw a scene that she will never forget. Half of the school's main building had collapsed. When the quake happened, roughly 100 children had been buried by the debris. All of them were elementary school kids. Soldiers-turned-rescuers had already retrieved teens of live children and 30 some corpses from the site. Watching the miniscule children that will never be able to open their eyes again, she couldn't find enough strength to even speak.

But as the rescue effort escalated to an all out sprint against time, aftershocks and the instability of the building was threatening a further collapse. Anyone going into the rubbles again would only meet certain death. The rescue commander issued an order for all rescuers to immediately evacuate the scenes until further notice. But just at that time, some of the soldiers who had just left the ruins yelled that they had found more trapped children.

When some of soldiers heard the news, they lost it and immediately began to crawl back down the rubbles. At that very moment, the second collapse happened. A huge slab of concrete was falling right in front of everyone's eyes. Other soldiers attempted to restrain those who wanted to go back in. The two groups wrestled with each other, until people eventually moved them into a safe zone. A soldier that had just pulled a child from the rubbles, kneeled on the ground and sobbed, pleading to the people pulling him away.

"Just let me rescue one more."
"I am begging you, just let me rescue one more."
"I can rescue one more!"

Everyone who watched the scene unfold cried. But they could only stand helplessly, as the building collapsed for a second time. Later on, those children were retrieved from the rubbles, but only one was still alive. As the reporter watched the young soldiers carry the sole survivor to the rescue tent, she sobbed uncontrollably.

Even though the story was told to me through the phone, it touched me greatly. I can't imagine how emotional the scene would have been had it occurred right in front of my eyes. What I do know is that it is a true story, and that right now, in the heart of the quake disaster area, the same story is being repeated. Tonight, as I sat in the comforts of my room, I first became aware that I should do something. Even though it is not realistic for me to be at the disaster site, can I do something that is within my power?

With tears in my eyes, I decided to first publish this article. I know that this article won't bring about any real help in itself, but this is the fastest, most immediate thing I an do. One article doesn't have any real power, but at least I can let more people know what is happening. Only after finishing the first task, can there be a second or a third..."

Pray for China. Show your love. Friends, no matter what situation you are in, as long as it is one where you can help, I hope we move as fast as possible. Don't let the fact that your action has too small of an effect, deter you from doing it. One article, one dollar of donation, they are all forms of support."


I am going to do something.

Current death count exceeds 20,000; those buried under rubble estimated to exceed 25,000; total feared dead exceeds 50,000. Millions are homeless. [Source]

Wednesday, May 14, 2008

So You Want To Become A Psychotherapist!

Most undergraduate students in psychology or social work or some other “people-helping” field want to get into the field of mental health, but they don’t know how to go about it. Well, I don’t blame them. To begin with, there are so many different terms that seem to sound like the same thing (for example: psychotherapy, psychology, psychiatry) it can be quite confusing. To add to the confusion, there are different professions that all seem to do the same thing, and different educational pathways towards these professions.

The purpose of this post is to provide an introduction to the different psychotherapy professions and the educational pathways you can consider (and it will be from a biased perspective: my bias!). I will limit my discussion to psychotherapy as it is taught and practiced in North America. First, let us clarify some important terms.


Psychotherapy. Psychotherapy is a broad term that covers therapy that makes use of the psyche (or the mind) for treatment. A psychotherapist uses talk-therapy, cognitive therapy, behavior modification, etc. to treat a person while a medical doctor will tend to resort to pharmacotherapy (or drug therapy) to treat a person. In the USA and Canada, the psychotherapy is NOT a profession, but a description. A more official term to use than Psychotherapist is Mental Health Professional (see wikipedia link).

Profession. A profession is a paid occupation, esp. one that involves prolonged training and a formal qualification (e.g. lawyer, doctor, psychologist). The training tends to last at least 2 years, the formal qualification is often granted by an association after a formal exam, and the individual is licensed by the state and/or country. It is a crime to refer to yourself as a lawyer or a medical doctor, or a psychologist unless you have been trained and qualified as one. These professional titles are legally protected. Types of mental health professions include: Psychiatry (MD), Clinical/Counseling/School Psychology (LP), Marriage and Family Therapy (LMFT), Clinical Social Work (LCSW), Counseling (LPC).

Main Differences Between Mental Health Professions

PSYCHOLOGIST. There are many different kinds of psychologists, and not all are “mental health professionals” in the vein of a psychotherapist. For example, an Industrial/Organizational Psychologist will not see patients with depression. The psychotherapy oriented psychologists include: Clinical psych, School psych, Counseling psych. Nowadays, in order to become a Licensed Psychologist (LP), you need to have a doctorate, either a Ph.D. or a Psy.D.

Clinical psychologists tend to do a lot of mental health assessments from diagnosing depression to figuring out if you have a personality disorder, or even if you have learning disabilities. They can see people of all ages, but usually, will specify if they specialize in seeing children (because special training and skills are required to work with young children).

School psychologists also do a lot of mental health assessments, but they work in the school setting seeing children from K-12. If your child is having problems (learning difficulties or mental health issues), a teacher may likely have them be consulted by a school psychologist.

Counseling psychologists are what you see in movies and TV: the kind that sits on a nice comfy chair opposite their clients, ask questions, nod and look very empathetic. They mostly specialize in adult talk-therapy.

If you are having a simple problem with depression, all the above psychologists should be able to help you.

(See American Psychological Association and Wikipedia entry on Clinical Psychology)

MARRIAGE AND FAMILY THERAPIST. This is my profession, and so I understand this best compared to all the other mental health professions. It is a fairly young profession compared to psychology and social work, but in some states, it is a very strong profession (e.g. California, Minnesota). A marriage and family therapist who is trained through the AAMFT-accredited schools will have training in working with multiple relationships beyond any of the other professions. We are comfortable working with multiple family members at the same time (and I’ll admit that I find it more interesting when there is actual conflict in the room than when everything is going smoothly!)

To become an LMFT, you need to get a two-years masters in an accredited program, then get 1000 hours of face-to-face supervised therapy experience, and then sit for a national exam followed by state oral exam. The key difference between LMFTs and the other professions is that we specialize in working with marriage and family relationship problems.

(See American Association for Marriage and Family Therapy and Wikipedia entry on MFT)

COUNSELOR. The problem with the term counselor is that it is a very generic term, and so people don’t often realize that “going to see a counselor” could mean anything from getting credit counseling from a bank to receiving hypnotherapy at a hospital. And just to make things more complicated, both the American Psychological Association and the American Counseling Association both use the term “counselor” in their professional titles: an LP (licensed psychologist) specializing in counseling psychology or an LPC (licensed professional counselor). In this section, I’m referring to the Licensed Professional Counselor.

An LPC is a masters trained mental health professional that uses a variety of psychotherapy modalities to address people’s mental health concerns. The training received by LPCs is a lot less rigorous than LPs (which require a doctorate) and a little less rigorous than LMFTs (in terms of clinical face-to-face hours).

It is interesting to me that if you go to the CACREP website, you will find programs in career counseling, college counseling, community counseling, gerontological counseling, marital couple and family counseling, mental health counseling, etc.

In general, of the LP, LMFT, LCSW, and LPC licenses, the LPC license is considered the less well regarded (at least in California and Minnesota). But I have met a couple of LPCs whose work I respect very much.

(See American Counseling Association and Wikipedia entry on Licensed Professional Counselor)

CLINICAL SOCIAL WORKER. The main difference between social workers and other psychotherapists is that their field advocates going out into the field where the people are. If psychology is about seeing people in private offices, then social work is about going to the people where they are. Some social workers train to become clinicians, in that they are licensed to do psychotherapy. These are often referred to as Licensed Clinical Social Workers (LCSW, or LiCSW).

To become a LCSW, you go through a Masters Degree in Social Work, and do a few more psychotherapy-related coursework. Of all the psychotherapy training mentioned here, social workers are least trained to be “clinicians” (compared to psychology, counseling, or MFT). This does not mean that a LCSW is a bad psychotherapist—they may have obtained further training on their own to build up their competence as a clinician. I personally know some LiCSWs who are excellent clinicians.

(See National Association of Social Workers and Wikipedia entry on Social Work)

PSYCHIATRY. A psychiatrist is a medical doctor. Psychiatry is a specialty of medicine, and you need to have a medical degree in order to become a psychiatrist. It is the highest salaried of all the mental health professions. Psychiatrists often see patients to diagnose mental health disorders and to prescribe medication. At the same time, psychiatrists tend not to be very well trained in talk-therapy. They tend to see mental health problems as pathologies using the language of the DSM (Diagnostic and Statistical Manual of Mental Disorders), for example, Bipolar Disorder, Schizophrenia, Borderline Personality Disorder, etc.
Usually, a patient will go and see a psychiatrist through the referral of a counselor (LPC) or a clinical psychologist (LP). And usually, patients are referred to a psychiatrist for specific diagnosis of mental health disorders and to receive medication.

(See American Psychiatric Association or Wikipedia link on Psychiatry)


Sometimes, too much information can be more confusing than helpful. The reason why people give a lot of information is so that they can be accurate as to their representation. I’m sure many psychologists, social workers, and counselors will read my entry and offer corrections (you are welcome to do so, please leave me a comment). But for the student who wants a “big picture,” let me offer very some grossly exaggerated caricatures of what each of these professions do or are regarded (from my lens as an MFT). Here we go.

• The psychiatrist is a medical doctor. He (usually a man) is more interested in giving out drugs than in talking to patients. We psychotherapy types don’t usually consider him as one of us, unless we need his help for assessment and to have our clients get medicine when talk therapy is not working.

• The psychologist is the “ooh—aah” of the psychotherapy professions. We masters-level trained types think that they think too highly of themselves. But we secretly wish we were LPs too because they earn a lot more than we do (average $70k compared to our measly average of $40k). When we masters-trained types feel stuck with our clients or need specialized assessments, e.g. for learning disability, we will consult them.

• The marriage and family therapist is a snob. (Yes, we are!). We think that ours is the best field of all because we are systemically oriented—all “problems” stem from relationships. We are so snobbish that some of us will even refuse to use mental health disorder categories (like borderline personality disorder) because we think they come from an individually oriented medical model, and is not a helpful way to think of problems, for example, a woman who is depressed is not depressed by herself, but rather her depression is strongly associated with her poor marriage or family of origin problems, etc. We marriage and family therapists are a small profession, and unless we are loud and aggressive about our work, we may likely get squeezed out by psychology or social work in the future.

Social workers are not really clinicians. They are more advocates than anything else. And their training in psychotherapy is very poor. The only reason why they are well accepted as a license is because social work as a profession overall is very old (as old as psychology) and they are very loud and aggressive.

Licensed professional counselors are master’s level psychologist-wannabe’s. Comparatively speaking, it’s one of the easier of the mental health professions in which to get licensed

Ph.D. = the ticket! You can increase your salary to be at the same level as a psychologist if you obtained a Ph.D. in MFT, or Social Work, or Counseling. Not only will you be better reimbursed, you will also get the same level of respect that a psychologist gets. In fact, even a psychiatrist will respect you when you say that you are Dr. So-And-So with a Ph.D. in MFT or Social Work, etc. BUT, you pay for it through about 4-6 more years of schooling post Masters.

[This post was written for Avis and other people in her situation.]

Saturday, May 10, 2008

Thoughts On The Impartation of Knowledge

Sherman Kuek has written another gem of a quote:

"Knowledge must never be imparted out of insecurity or anxiety.

When knowledge is imparted out of insecurity, it causes one to project one’s self as the subject of knowledge. It makes one flaunt himself as the person who knows it all, while others are subtly implied to know nothing of equal value. In the thick of such insecurity, only the knower’s field of knowledge and realm of discourse are of vital consequence. Such a man knows nothing except his own loftiness.

When knowledge is imparted out of an anxiety that others might not know enough, it causes one to impose onto others the obligation to know as much as the knower does. It does not take into account the different capacities and efficiencies of people to absorb knowledge. Such a manner of imparting knowledge makes people into objects of information; it demeans the human spirit and belittles the learner."

I seem to find myself vacillating between one or the other. It is time to find a better way.

Friday, May 2, 2008

Youtube Has Everything!

A teenager I've been working with insisted that you can find *everything* in youtube. Youthful ardor, I thought to myself. As I was just clearing up emails tonight, I decided to youtube "Grounded Theory." Can you believe it? There is actually a youtube video on it!