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July 10, 2019

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The Corrective Relational Experience: Improving Family Functioning with Emerging Adults

Dr. John Souza, Jr., LMFT, DMFT

Introduction
Outcomes studies on wilderness therapy/outdoor behavioral healthcare (WT/OBH) programs serving youth ages 12-17 have demonstrated that family involvement in treatment increases the likelihood of long-term maintenance of individual students’ gains from such programs. This same body of research has linked caregiver participation in family activities to an increase in trust and empathy between caregivers and students. However, as some researchers have uncovered, these gains may not necessarily generalize to improvements in family functioning. Moreover, when considering family involvement in the treatment of young adults (herein referred to as emerging adults or EAs; ages 18-25) there remains the historical remnants of a socially constructed bias against such involvement; based on the presupposition that the paragon of EA development is “independence” from caregivers.

Pacific Quest’s Family Program for Emerging Adults
At Pacific Quest (PQ) we have considered the above research findings and social constructions, and in response have developed our Family Program for Emerging Adults based on a practice-based evidence/research model. Data from our practice suggests not only is family work with EAs appropriate, it can often be a critical element of their treatment process as caregivers report a correlation between our Family Program and an improvement in family functioning. This has led us to conclude that the ultimate aim in the treatment of EAs may not necessarily be to only encourage greater independence, but also to cultivate intentional interdependence.

Clinical and Theoretical Foundations
PQ’s Family Program for EAs is embedded within an integrative WT/OBH model designed to treat a variety of emotional and behavioral problems by way of horticultural therapy and other experiential modalities. Our Family Program for EAs builds on this model by creating opportunities for corrective relational experiences (CREs); unexpected moments when caregivers and EAs are able to attune with one another and are therefore transformed. During these CREs caregivers and students learn in what ways they mutually influence one another and thus how to be intentional with that influence. The nature of human nature is that we are not independent, but rather are reliant upon each other. Through intentionally designed CREs, family’s at PQ become more cognizant, and thus able to influence this reality.

The Corrective Relational Experience
Over several years of observing Pacific Quest’s Family Program for EAs, we have come to understand that while there are a number of smaller CREs throughout the two-day intensive program (consisting of caregiver-only meetings, family therapy with primary therapists, and multi-family therapy groups) the overall Family Program is itself a CRE. We have found this CRE to consist of two primary clinical dynamics: Differentiation and congruence (see Figure 1): Development of one positively influences development of the other. Moreover, these processes mediate the establishment of accurate empathy and trust, which in turn can encourage the maintenance of differentiation and congruence.

Improvements in Family Functioning
PQ’s Family Program for EAs has been correlated with improvements in family functioning. This has been measured through a pre/post-test design employing the psychometrically supported Global Assessment of Relational Functioning (GARF). The GARF consists of three subdomains:

• Interactional/Problem Solving Skills
• Hierarchy and Organization
• Emotional Climate

Of 161 caregiver respondents, all reported improvements in the three GARF subdomains (see Chart 1). Overall, the subdomain reported most positively impacted during Family Program was Emotional Climate. Communication (an aspect of the subdomain Interactional/Problem-Solving Skills) was identified by 85.7% of respondents as the specific aspect of family functioning most positively impacted by the Family Program.

Conclusion
At Pacific Quest we have answered the call from researchers to improve family engagement in WT/OBH. We have also recognized the interdependent nature of human nature and used this as the impetus for our work with EAs and their families. By employing a practice-based evidence/research model we have correlated our Family Program’s CRE approach with improvements in the emotional climate and communication aspects of family functioning. Future practice/research with EAs might consider how to generalize such improvements in family functioning by creating CREs with others (e.g., siblings or families-of-creation) and in other environments (e.g., a transitional program or a caregiver’s home).

April 11, 2019

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The Art of Empathic Listening- Bill Miller

Dr. Bill Miller, expert in empathy, listening, and motivational interviewing, hosted a full-day workshop in Oahu this winter.  Six members of the Pacific Quest clinical team were able to attend. His presentation, titled “Listening Well: The Art of Empathic Listening,” focused on the interpersonal skill of accurate empathy, and captivated a sold-out audience at the University of Hawaii-Hilo.  Mental health counselors, substance abuse counselors, nurses, hospice workers, and other island residents all came together for this phenomenal event.   Below are the perspectives of three members of the Pacific Quest clinical team who were in attendance.

Mike McGee, CSAC

As the Adolescent Family Program Manager and Substance Abuse and Addictions Recovery Specialist, and having recently received the internationally recognized credential of Certified Substance Abuse Counselor (CSAC) from the state of Hawaii, I first heard about Dr. Miller’s workshop when I was invited to be part of the board organizing the event.  It was an incredible honor to receive such invitation, and to meet Dr. Miller in person.  I was especially struck by his patience, humbleness, and overwhelming sense of serenity and kindness.  I thought that I understood Motivational Interviewing well before this event, but I really appreciated the primary focus on empathic listening.  It seems well understood that listening is one of the most important components of therapy, yet it is easy to see how we can sometimes get in our client’s way with our agendas and definitions of growth.  I think we can easily focus on the technicalities of a therapeutic approach and miss what actually makes it work- compassion and understanding.

Dr. Elnur Gajiev, Psy.D.
Dr. Miller, a pioneer in his own right, highlighted the work of the late Carl Rogers and spoke to the tremendous therapeutic power of empathic listening and responding in kind. Though Rogers’ work is sometimes thought of as structureless in it’s advocacy of unconditional positive regard, Dr. Miller asserted just the opposite, noting how “Accurate Empathy” is as much a scientific and clinical approach as it is an art, and cited several empirical studies to support this point. He also noted how Empathic Listening is far more than simply a technique to utilize in sessions in order to build rapport or shift towards some predesignated therapeutic aim, but more so a way of being – a practice founded upon the principles of partnership, acceptance, compassion, and evocation – which changes us in seemingly all aspects of our lives as we continue to enact and embody it. To prove this notion, he led us through a number of experiential exercises in which his instructions fine-tuned our use of our empathic faculties (verbal and nonverbal alike) and understandings of one another. There were many moments of laughter, in which we noticed how often we may trip ourselves up through “doing too much” rather than tuning into what is already there; as well as moments of deep understanding and shared insights.

Dr. Miller’s lessons rippled far beyond the domains of Motivational Interviewing to connect to a foundational element within the art and the craft of what we practice on a daily basis. He imparted a greater appreciation for the role of Empathic Listening in our work and in our lives, and we are incredibly grateful for his visit to our wonderful home here in the Pacific Ocean.

Dr. John Souza, Jr., LMFT, DMFT

I first became aware of Dr. Miller when I was approached by one of his close friends and colleagues here on the Big Island of Hawaii, who invited me to form a committee with the goal of offering this workshop. I had no idea who Bill Miller was, nor did I necessarily think that a workshop on listening would be well received; I mean, who doesn’t know how to listen?! After 11-months of committee meetings, reading Dr. Miller’s book (Listening Well), and realizing how much research Dr. Miller had done on the subject of listening and empathy (including his work on Motivational Interviewing) I came to appreciate what this conference was offering: An opportunity to counterbalance the over-emphasis on specific models of clinical practice; to implement our outcomes data that overwhelmingly speaks to the importance of relationships in improving client’s mental health; and to learn that the art of listening well and accurate empathy can be learned if one is willing to first practice the discipline.

As part of the workshop committee, it was difficult to actually participate in the same way as my colleagues. However, seeing so many PQ therapists in the context of a much broader community of local practitioners, I appreciated that what we had done was bridged our PQ world with that of the larger population of providers in Hawai’i. We were all there to learn to improve our relationships. My hope is that this workshop will continue to inspire improved relationships across work environments, professions, and cultures, particularly here on the Big Island.

February 2, 2018

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Breathing Life Into Relationships

Pacific Quest’s Young Adult Family Program: Breathing Life Into Relationships

By: Dr. John Souza, Young Adult Family Program Therapist

Ohana

In Hawaiian culture the taro plant symbolizes family or “Ohana”.  The word Ohana itself comes from the taro.  The “Oha” are the new growth emerging from the corm, an underground storage organ that is the foundation of the taro.  Adding the word “na” pluralizes the Oha, thereby creating a group growing together or an “Ohana”.

Dr. John Souza

Within the word Ohana are the words “Ha” and “Hana”.  “Ha” is the sacred breath of life carried by all and which joins us.  “Hana” is the work into which we breathe our life; and in which we engage with joy knowing it is through our shared work that we make our family relationships healthy and vibrant.

Breathing Life Into Families

Pacific Quest’s Young Adult Family Program has become a haven in which families come to practice joyfully breathing life into their relationships. In 2017, our Family Program had the privilege of hosting 316 students and caregivers. With over 90% of our students participating in Family Program, PQ is an Outdoor Behavioral Healthcare (OBH) program that continues to emphasize integration and diversity, something the garden teaches us is essential for resiliency.  In a time of environmental and social stress, the opportunity for families to have such a place of respite is essential for them to engage in what we call the Corrective Relational Experience.

The Corrective Relational Experience

The Corrective Relational Experience (CRE) is about rebuilding trust and increasing mutual empathy. During Family Program the CRE is achieved by students, parents, and staff embracing two main responsibilities: Practicing Differentiation and Congruence.

Differentiation is being able to separate one’s own thoughts and feelings, both intra-personally (i.e., within one’s self) and interpersonally (i.e., between one’s self and someone else). Additionally, differentiation involves the ability to enter into or exit from a given emotional relationship by choice. Differentiation means not losing one’s emotional self in a relationship, yet also not cutting one’s emotional self off from a relationship: to stay flexibly connected, yet separate.

Congruence is how reflective your values/beliefs (intra-personal) are in a given relationship (interpersonal). That is to say how closely does what you say reflect what you actually want, need,, and feel in a given relationship? For example, if you don’t like a behavior, do you say, “I don’t really like that” or do you only think that, but actually verbalize, “That’s great!”? To be congruent increases authenticity, a critical component of trust and accurate empathy, the heart of the Corrective Relational Experience.

Professional to Personal: Being Part of a Larger Change Process

As a research-informed clinician, I often wonder about the application of research in practice and practice in research. What I’ve found is that the research on Wilderness Therapy and OBH that continues to point to the importance of family involvement in the development and maintenance of gains made by youth in such programs is spot-on. These gains are being supported by the development of mutual trust and empathy between parents and their sons and daughters. Moreover, for me as a clinician, being able to work with entire families in person only enhances the sense of shared trust and empathy within the therapeutic/clinical relationship (between therapist, student, and parents), itself a major predictor of successful therapeutic outcomes.. This mutual influence between clinician and client becomes the nucleus of a much larger change process.  As I the professional, experience greater trust and empathy, it becomes part of my personal experience, which I take home to my family and to my community. As parents experience this CRE, they too take it back to their families and communities. In this way we become like the taro or Ohana, breathing life into our relationships, born of the same source of trust and empathy.

Having Your Own Corrective Relational Experience: Breathing Life Into Your Relationships

There are many ways to have a Corrective Relational Experience. Below are just a few suggestions of specific skills PQ families have used to foster their own CRE’s. Feel free to modify these or make up your own!

  • Breath: It sounds simple, but this rhythmic, sensory-based activity will help keep you regulated and better able to relate to another person. I like to inhale for four counts, pause for one, exhale for eight, pause for one, and repeat. Feels great!
  • Listen: Again, it sounds simple, but really listening to someone with total openness and suspension of judgment or an agenda is challenging. Try inviting someone to share with you for five minutes while you listen; fully open yourself up to hearing whatever they have to share. Be sure to thank them for sharing!
  • Reflect: This is a great skill to use in tandem with listening. However, try to limit your reflections to only those words used by the speaker. Not only will this minimize you inadvertently inserting your own opinions or judgments about what the speaker was sharing, but will also let the speaker know the correct message was conveyed and received.
  • Share: Related to listening and reflecting (and essential for building trust and empathy) is the art of sharing your own struggles. This involves knowing if you need to share more or if you need to share less. If you need to share, be sure that what you share is focused on the relationship in the present moment and involves feeling words such as happy, mad, scared, confused, etc. If you need to share less, let the listener know that you’re practicing creating more space for them to share.
  • Ask for Feedback: A great way to not only practice vulnerability, but also truly honor your relationship with another person, is to ask them for feedback on the relationship. Ask them to share how they feel in the relationship, if there are realistic ways they see that you could more effectively support the relationship, if they have ways that they want to better support the relationship. The key is to remain curious and focused on improving your bond with the other person. Should you find yourself struggling to do either of these two things, repeat the above skills, beginning with breathing or simply request to take a break and return to the conversation at an agreed upon time in the not-too-distant future.

The most important element in any CRE is a genuine desire to improve the relationship. This includes listening, sharing struggles, and setting clear boundaries.

I wish you and your relationships all the best.

A Hui Hou (until we meet again)!

For more information on Pacific Quest’s Young Adult Family Program, please email drjohn@pacficquest.org.

February 3, 2017

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PQ Success Story: Creating a Path in Life

By:  Dr. John Souza & Janna Pate

Linus came to Pacific Quest as a 25-year-old who struggled with four college failures, anxiety, and symptoms of depression. He often referred to himself as “lazy” and believed he could not finish anything.

At Pacific Quest, Linus received a 391-page curriculum consisting of 242 assignments in English, environmental literacy, fitness, health, Hawaiian culture, horticulture, and psychology. One of those assignments was a project called a Discernible Difference (DD) that requires students to spend at least 3 days creating a lasting, positive impact on the land.

PQ Alumni Success Story: Creating a Path - in the Garden and in Life

Student with his final project

Per his pattern, Linus took on a project that was far bigger and more anxiety-producing than necessary, opting to cut a long and difficult path through the cane grass (a “noxious weed” that grows in clumps over 10 feet high) to a meditative section of the camp known as Ocean View. At the time, students could not access Ocean View independently because it wasn’t visible to staff over the cane grass.

To start, Linus felt his familiar pattern of anxiety while working in the cane grass and at times suggested quitting. However, as he continued to work and reflect, he began to feel empowered.

Most notable was the day when Linus began to redefine his past failures as not resulting from “laziness,” but rather from a “paralysis of analysis” — anxiety from over-thinking and not “doing” something. By “doing” something every day, Linus learned how to break down large tasks into smaller ones, take breaks, ask for help, and take ownership of his own wants and needs.

When project completion was in sight, Linus began to ask: Wouldn’t the cane grass simply grow back? But finally he said, “It doesn’t matter if the DD gets maintained after I leave, the real work is for me. And if it does get taken care of, all the better.”

PQ Alumni Success Story: Creating a Path - in the Garden and in Life

Over a year later – continued progress!

Almost a year and a half later, we are happy to report that Linus’s DD has inspired generations of PQ students not only to maintain the Ocean View path to but to expand it. A vast new area for gardening and other projects now exists: a pumpkin patch, a meditation mandala, a memorial garden, and a secondary path to a space used for graduation ceremonies. And students can access Ocean View independently.

Not only did Linus complete all of his work at PQ, but since leaving, Linus has successfully completed a transitional program, started taking university classes, and is living independently, continuing to create his own path.

September 27, 2016

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PQ Students Attend “Embrace” Screening: Documentary on Body Image + Positivity

By: Dr. John Souza, Jr
Primary Therapist

At 7:30 pm on a Monday evening, the movie theater in Hilo, Hawai’i was nearly filled to capacity as over 100 souls gathered to screen the documentary film Embrace: One Women’s Journey to Inspire EveryBODY. Of those souls, nearly 40 were from Pacific Quest and included young adult students, staff, and therapists.

Three months prior my wife (Deepa Ram-Souza, MA) had asked if I would be willing to help her bring a screening of the movie to our local theater. She believed the documentary focusing on what film director Taryn Brumfitt calls the “global epidemic” of poor body image would be well-received on our little Big Island.

At first we struggled to garner interest, selling only a few tickets. Then Pacific Quest’s Clinical Director Dr. Lorraine Freedle, Ph.D., caught wind of the effort, kicking it up to Co-Executive Director Mark Agosto, MBA. Next thing I knew PQ had purchased 40 tickets! This shouldn’t have surprised me, given that the year prior PQ’s leadership had helped champion an effort to take several young adult female students to a showing of The Vagina Monologues at the University of Hilo’s Performing Arts Center.

PQ Students Attend "Embrace": Documentary on Body Image + Positivity

Indeed, the documentary itself was truly eye opening and inspiring. In lucid and compassionate filmmaking, Brumfitt tastefully shared what were sometimes very ugly realities about how women have been influenced to be hyper-focused on “youthfulness” and an “ideal” image of physical appearance. Through compelling interviews with courageous (and beautiful) women (and men), the film offered an assessment of the origins of poor body image and examples of how people have worked through their own personal struggles with body image; taking the viewer to the edge of some uncomfortable (and often extreme) examples of body image issues, but without exploiting the storytellers or losing focus of the larger issue of women’s body image.

After speaking with my wife, our 12-year old daughter (who with her friends, was also in attendance), and several PQ employees who attended the screening, the take away seemed to be that there are no “flawed” bodies because there is no ideal toward which to aspire. That is to say, the “idealized” images we may have about a woman’s (or a man’s) body are simply not real. And even for those idealized images that might actually exist (i.e., are not altered using Photoshop), the hyper-focus on “youthfulness” privileges only a small part of the larger human experience, obscuring the joy and beauty of the diversity of life, including aging and death. This Body Image Movement invites everyone to “redefine and rewrite the ideals of beauty.”

The message many seemed to take from the film is that in life the “beauty” of the body resides in its manifest diversity. This made me think of the garden, made of many plants which themselves are comprised of non-plant elements (e.g., water, soil, sunlight, etc.). When considered this way, no plant is “more” or “less” beautiful anymore than sunlight is more or less beautiful than water or air. All things are interrelated and therefore all things are uniquely beautiful. And this, I believe, is what I am taking from the film: The real beauty in life is not the thing (e.g., the body, the plant, the element, etc.) but the relationship between things. On a personal level, for me the real beauty of life is knowing that I am married to a woman that would care enough to take on such a project; that together we are raising a daughter who has the kind of friends, and who live in a community that cares enough to show up for such events. On a professional level the real beauty is knowing I work for a company that has the kind of leadership that in the spirit of better serving our students and our employees, is open to seizing such an opportunity and has resources to actualize it.

The next day, while visiting students at Reed’s Bay (PQ’s young adult program), one male student asked, “Hey Dr. John, I loved that movie, but what about one for men?!” I passed the message along to my wife, who said she would look into it. Beautiful.

March 30, 2016

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The Mango Twins from O’ahu

By: Dr. John Souza, Primary Therapist

Last year my wife and I visited the town where my Portuguese ancestors first lived and worked on the sugarcane plantations– Waimea, Hawai’i, on the island of O’ahu. There we discovered a fruiting mango tree with the most succulent mangoes. My wife suggested I bring a seed home to plant. At first I rebuffed the suggestion. But, with a little cajoling, I was soon toting home one of the seeds for planting on the Big Island of Hawai’i. From that moment I began to feel a sense of connection with the seed; it was both the symbolism of the seed as a part of my Portuguese heritage and also my worry about whether or not I could actually grow a tree from a seed I found in the wild. This is how horticulture therapy begins.

john_souza_450x566

When my wife and I returned home I was excited and anxious to plant my little bundle of joy. I hurried through online readings about how to grow a mango tree, to find the right container, and the right soil mixture. I was careful to find just the right spot in my yard for my little mango keiki (the Hawaiian word for “child”) to grow. I placed it near my front door so that everyday I would remember to check on it.

Horticulture Therapy and Seedlings of Hope

Each day I checked on my little seedling of hope, looking for any signs of life. Days became weeks, but alas nothing seemed to be happening. I began to lose hope and started preparing myself for the possibility that I had failed; either I wasn’t very good with plants or I hadn’t done enough. I felt pangs of disappointment in myself, a few times thinking I had let down my Portuguese kin.

Then, the following week, signs of life! I couldn’t believe the seed was actually sprouting! And what’s more, there were actually two sprouts showing. Twins! What joy! I was so relieved. Maybe I wasn’t such a bad gardener. I was after all, part Portuguese! I was beaming with joy as I talked to my twin keiki, showing them off to friends and family. I was a proud mango papa.

Months passed and my little mango keiki grew very well. Each had strong stems and bright almost fluorescent green leaves. All was going well, until I started to notice that their growth was slowing. At first I didn’t think much of it. But after another month of them looking relatively the same size, I wondered if it wasn’t time for them to move out of their comfortable little hale (Hawaiian word for home), into an environment where they could stretch out a bit. I knew this to be true, but subconsciously I put off actually doing anything about it. Two months went by and I was barely aware of the fears driving my procrastination: What if I hurt them? What if I killed them?! They looked so healthy; I didn’t want to do anything to cause them harm. Do they really need to be moved?

How a Mango Can Transform

But one day I woke up and knew it was time. I marched outside and gently picked up my mango twins. I began preparing two new pots for them, carefully placing in each another mixture of soil and tender loving care. Then, the moment of severance: I carefully pulled them out of their home. After a bit of clearing of some of the soil, I discovered they were still connected by the last remnants of the original seed casing! This meant having to physically pull them apart. I was aghast and worried as I pulled, hearing the snapping of little plant parts; heart-wrenching! I worked quickly to get each plant into it’s new home, offering a lot of love and several apologies for what seemed to me a cruel and unusual act of betrayal and plant butchery.

Then it was over. As I looked at my two beautiful twins, now in their own homes, separate, yet connected, I felt a bit of relief, but with a distinct undercurrent of anxiety and fear. Again, those pesky thoughts came to me: “What if they don’t make it? What if they die?!” However, I put these thoughts aside and went about my day, holding out hope that the twins would survive the transfer.

The next few days were nerve wracking. Each day I checked on my beautiful little keiki twins, and at first it looked like they were doing well. I knew that plants go through shock and that this could actually be a good thing for them to develop resilience. But as I looked at my twins, I noticed they were both starting to show signs of stress: Their leaves began to droop and on these leaves began to form dark spots. One of the twins was in really poor shape; it’s leaves beginning to brown. One day my wife noted that this particularly brown plant looked nearly dead. This hit me hard, as I had been in a bit of denial. But she was right. I had been blindly holding onto hope, not seeing what was happening right in front of me.

I began to panic. We’d had a few days of fairly heavy rain and my intuition had been telling me the twins were getting too much water. Why didn’t I put them under a shelter?! How could I have been so careless?! I texted a desperate plea for guidance along with a picture of the twins to my friend and Pacific Quest’s Horticultural Therapy Director Travis Slagle; no response. I looked online about what to do for a dying mango tree and websites offered the use of a weak sugar-water mixture. I jumped on the suggestion, but as I was about to pour the water, a little voice told me this was not the answer. They were already suffering from too much moisture. But I didn’t listen and poured the mixture onto the plants. Soon after, Travis replied texting, “They’re sensitive. Keep the faith and don’t over water.” Noooooo! Why didn’t I listen to that little voice in my head?! Why didn’t I wait until I heard back from Travis?! Why didn’t I do more reading ahead of time?! I was becoming overwhelmed with feelings, but not paying attention to the feelings; I was too busy trying to find a solution. I was in crisis mode.

Horticulture Therapy :: Life and Loss

Then my wife (clearly the level-headed one) noted that it seemed I was grieving something, and that it might be more than just the twins. This gave me pause and I considered the nature and source of my feelings. It turns out she was right (of course). In fact I was in the midst of a grief and loss response. The grief I was experiencing for the plants was interconnected with all the grief I had ever experienced throughout my life: The missingness of my father from my life subsequent to my parents’ divorce, moving to new towns and away from childhood friends, the deaths of loved ones, and on and on. All of it connected to the present sense of no longer being able to experience the joy of seeing my twins thriving. Moreover, I had imbued those mango twins with all myriad of meaning ranging from my ability to care for another living thing to my worthiness as the bearer of my ancestral heritage.

Again, I texted Travis, “I think one got too wet and may not make it.” Travis responded, “Namaste little mango.” And that was it; that was the correct answer. Namaste is the Sanskrit word for seeing the light in others. I interpreted that to mean to accept the good in all things, including life’s losses.

It remains to be seen if the twins will survive the transplant. Either way, I will accept that there is something good that will come from it, for they have already borne fruit by providing me insight into my own internal processes, compelling me to connect with friends and family, and most importantly, myself. And now it’s given me this story to share with you, which (hopefully) will inspire you to consider your own responses to life and loss. Then, be sure to share it with someone else. In this way, from a single mango seed from O’ahu, we will propagate connection with self and others.

Thanks for reading this far. Namaste.

June 29, 2015

Written by:

How Children Raise Their Parents

 

johnsouza_175x220John Souza Jr., D.MFT
Primary Therapist – Pacific Quest

Several weeks ago my niece and nephew were visiting from Minnesota. I was so excited to show them all that Hawai’i had to offer. One day we decided to visit downtown Hilo, pulling into a parking stall in the packed lot of the bustling business district and excitedly gathered in front of our vehicle to talk about what shops to visit first. As we did I noticed that the rather new-looking car next to ours had one very obvious flaw: a small, but deep dent on the driver’s-side door. I stopped mid-sentence and went to inspect, fearing the white paint filling the dent was from my white car’s door. Sure enough, it was a perfect match and I quickly pieced together the fact that my 9-year-old nephew had accidentally opened his door too quickly and inflicted some fairly significant damage to some stranger’s otherwise flawless vehicle.

I looked in this stranger’s car and then around the general area to see if anyone had as horrified a look on his or her face as I did. It seemed no one (including my entourage) were aware of the emerging scene and for a split second, I thought “I could get the kids back in the car, drive away, and no one would be the wiser.” As I considered this option, a little (and very annoying) voice said, “Wait a minute” and I imagined 10 or so years into the future, seeing my daughter and her cousins driving around Hilo together. I saw them in a similar situation as the present one, but speeding away from the scene in order to avoid the consequences of their actions, laughing and saying “Ha! We totally got away with that!” It was in that moment I realized that in order to increase the likelihood of these impressionable youth taking responsibility for their actions in the future I had to take some responsibility for my nephew’s actions now while the price tag was still relatively small and I could guide him through the process.

As I mentally returned to the present I took several deep breaths, reminding myself that my nephew was only 9 and that my intention was not to shame him, but rather to let him experience the steps involved in taking responsibility for his actions. Knowing I was about to enter into a process of teaching that might take several weeks I also had to remind myself to be patient and kind as this would only work if my nephew sensed I was not judging him, but rather helping him with a process of reparation.

I first asked him if he was aware of the damage; he was (as most kids would be) non-committal, saying he didn’t know about it. I reassured him that I was not angry (making sure my tone of voice and even my body posture were congruent with this), but rather wanted to help him figure out how to help this damaged car’s owner fix his or her car. After engaging in some Socratic questioning (e.g., What do you think we could do?) I offered the suggestion that we leave a note, offering help with wording only after asking if he wanted help. Soon he had composed a succinct note to the car owner offering to pay for the damage and leaving my telephone number. That was it: No yelling or lecturing. Just a note left on the owner’s windshield and we got back to our original conversation about what shops to visit first.

Fast-forward a few days and the owner of the damaged vehicle called me. I explained the situation, including that I was trying to teach my nephew about taking responsibility for his actions. The car owner seemed somewhat annoyed by the damage (stating it was the first damage to her otherwise new car), but was supportive of the lesson to be learned through the experience.

At this point I hadn’t shared this story with any other family. In my family, so often when a child makes a mistake it seems that each adult must take a turn giving the child feedback (some not always constructive). This can be overwhelming and confusing to a child. Therefore, my nephew and I would share the situation, but only when the time seemed right to do so.

Again, fast-forward a few weeks and I received a text from the car owner stating she had told her friend about the lesson I was trying to teach my nephew. This had inspired her friend to write about the experience in our local newspaper, stating it was how adults can inspire children to act with integrity, going so far as to say she hoped my nephew would someday run for president of the United States.

This was the opening I was looking for to share the story with the rest of the family. I gathered them all in the living room and asked my nephew to read aloud the newspaper clipping. The response was overwhelmingly positive as all laughed, hugged, kissed, and congratulated my nephew for acting with such integrity.

Throughout the years of parenting of my own children and practicing as a family therapist, I found that while certainly parents raise their children, children are equally responsible for raising their parents. While not every parenting experience need be as in-depth as the one with my nephew, it is important to remember that our children need us to teach them, but more importantly we need them to teach us.

 

October 17, 2014

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COMING HOME: A Conversation with Dr. John Souza, Primary Therapist

Please take a moment to share a bit about yourself…and what brought you to Pacific Quest?

Having been born on O’ahu and coming from several generations of Hawai’i-born Portuguese and Spanish, I’ve always had a connection to the islands. And while I was raised on the Mainland, including spending my formative years in California, Nevada, and Colorado, and the last 20 years enduring the harsh winters in Minnesota, I knew one day I would return to Hawai’i.

During one of the harshest Minnesota winters in 35 years, I recall sitting in my office, in a suit and tie thinking, “I don’t want to do this anymore.” Coming from a background in marriage and family therapy, I had considered ecological systems to be an excellent metaphor for how family systems function. I began to imagine that working with natural systems, such as those found in a garden, would be complementary to my family systems training; PQ was the missing link between my systems background and working with families ecologically. I knew it was what I was meant to do. Plus, not only did I get the benefit of returning to my birthplace, I never have to endure another Minnesota winter!

Can you share a bit about your clinical strengths and specific areas of expertise?

I would say my clinical strengths include being able to highlight other people’s strengths, including being able to view their perceived “weaknesses” as positives; I can draw a positive connotation on just about any way of being, partly because of my underlying philosophical worldview that we as humans are naturally driven to attempt to be loved, to love, and to be good at something. However, through the confluence of genetics and environment these predilections become obscured and come out “sideways” through what the mental health field might refer to as “maladaptive” or “dysfunctional” ways of being. I would offer that these ways of being are actually quite the opposite: They are very much about adaptation and attempting to function as best one can within a given set of circumstances. The question is more about how these adaptations fit within a larger social milieu. If the answer is “not well”, then the challenge becomes dichotomous: Change the person or change the environment. At PQ we have the opportunity to do both, while also being able to work with students’ families, who are also comprised of individuals attempting to do the best they can with what they have. This is not to say that dysfunction doesn’t exist-it does; but I am more interested in learning how something dysfunctional may at one point have been functional.

Placing a child outside of the home can be an emotionally daunting process for a parent. How do you assist parents with this transition?

As a parent I have such a deep sense of respect and empathy for the families who make the decision to place their child in a treatment environment, far from home. What I generally offer to these families is 1) whatever you’re feeling is okay, including a sense of relief that your child is out of the house; this is such an appropriate response to the situation, especially when you consider that most families have been living in a state of hyper-vigilance and anxiety for months, sometimes years; and 2) you now have a chance to press the “reset” button in order to redefine how your family functions and its “new normal”. To begin this reset process, I start with the Five Pillars of Health, including taking stock of your nutrition, your sleep, your exercise, your mental health, and your awareness of the mind-body connection. This not only parallels what your child is doing at PQ, it also gives parents something healthy on which to focus the emotionality of the situation.

Can you talk about your therapeutic approach in terms of integrating the family into the treatment process?

The first thought that comes to mind is “How could the family not be integrated?!” That would be like trying to bake a cake without flour. It just couldn’t happen; it wouldn’t be a cake. Similarly, you cannot affect the individual without the entire system being affected. To illustrate this I often use the analogy of a hanging mobile (the kind you might place above an infant’s crib). When you touch one part of the mobile, all the other pieces necessarily respond. Similarly, our students and their respective families are inextricably intertwined, sometimes too much and sometimes not enough. Part of my job is to help them find a sustainable balance between the mutual influence they have on each other by looking at the way they manage separateness and togetherness, two equally important and necessary elements in all relationships. I do this by encouraging each family member to take stock of his/her Five Pillars of Health and by beginning to separate their thoughts/feelings from their son or daughter’s thoughts/feelings. In this way individual family members move from being reactive to being “response-able”.

How do you define success as it relates to your work with students and families?

So often students and their families have been stuck in family patterns that limit their ability to be anything outside of the roles they play in those patterns. Therefore, I would define success with students and families as the development of a broader and more balanced awareness of themselves and each other; awareness that each family member is a whole person, not just the role they have been playing for the last umpteenth years. I also consider success to be a lifestyle change that includes the Five Pillars of Health. The more each family member lives well and develops congruence between their insides and their outsides, the more response-able they become, and the more likely they are to be successful in achieving their treatment goals.

How do you integrate referring professionals into the process?

A similar response to question #4 comes to mind “How could referring professionals not be integrated?!” Referring professionals not only help sustain our ability to provide our services through the actual referrals they make, they are a direct part of the treatment team. I cannot think of a single referring professional relationship that has not provided invaluable insight or support toward a family’s success at PQ. Therefore, I’m usually disappointed if a family does not have an Educational Consultant or similar referring professional because it means I may provide a less complete clinical assessment than I might have had there been a referring professional to use as a sounding board; someone to bounce ideas off of regarding various hypotheses or interventions and the best post-PQ options for students and their families.