Something's got a hold on me....

Something's got a hold on me

I can't let it go

Out of fear I won't be free

-J. Cole

I was very impressed with the recent album release from artist/rapper J. Cole. That something he is speaking of, that something holding him, that something he can’t let go of, is trauma.  Rarely discussed among African Americans is the topic of mental health and even less scarce is a conversation on the impact of Adverse Childhood Experiences (ACES). The ACES Study[1]  was published over 20 years ago, a landmark study, with findings indicating a connection between 10 childhood experiences and many of the leading causes of death in adults. These 10 adverse childhood experiences include physical, emotion, or sexual abuse, having a parent in jail, having parents who are separated or divorced, living with a parent or household member who has a mental health or substance use disorder, emotion, and physical neglect. The study found the higher your ACE score, the greater risk you have for developing or experiencing a number of diseases, disorders, and consequences such as alcoholism, unintended pregnancies, liver disease, heart health related diseased, poor academic performance, and pulmonary disease. Your ACE score is calculated by counting the number of adverse experiences occurring during childhood. Cole breaches the topic of adverse childhood experiences by sharing his own experience. If you listen closely to the lyrics in J. Cole’s “Once an Addict,” he shares:

Step-daddy just had a daughter with another woman

Cole discusses here, his biological parents were separated and then his step-father and mother separated due to infidelity. Cole goes on to illustrate:

Growin' up I used to always see her up

Late as shit, cigarette smoke and greatest hits from Marvin Gaye

She kill a whole bottle of some cheap chardonnay

In reflecting on his childhood, Cole has the realization that his mother struggled with alcoholism or  at the very least her drinking was problematic. He continues reflecting on his childhood experience:

Mama cursing me out

Depression's such a villainous state

Lastly, Cole shares knowing his mother was depressed and enduring the consequences of that depression, verbal abuse. By my count, J. Cole has an ACE score of at least four. Now I am by no means diagnosing Cole, a true diagnosis can only be done through a thorough assessment. However, by his own account, these childhood experiences impact him as he shares:

Too young to deal with pain

I'd rather run the streets than see her kill herself

If you’re reading this and attempting to rationalize out the realization you too may have experienced adverse childhood experiences, the prevalence of ACES is fairly high with 63.9% of study participants having experienced at least one ACE. The study was limited by its diversity in that only 4.5% of the study participants were African American. If having a parent in jail or prison counts as one ACE and coupled with what is known about the disproportionate number of African American males who are incarcerated, the impact of ACES among African Americans should be a hot topic. If a study such as this was conducted with larger samples of African Americans, what might we find? What has a hold of us? What can we not let go of? How will these experiences manifest themselves in our lives and overall health?

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[1]   Felitti, Vincent J et al. “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults.” American Journal of Preventive Medicine, Volume 14, Issue 4 , 245 - 258.

Learning from your clients--

How many of us has this happened to? You sign up for a continuing education course only to arrive a find that one of the presenters is currently your client. More than likely, very few of us have had this experience. Should you encounter this situation, I'd encourage you to reflect on the ethical principles of your chosen profession as well as any policies your current employer has, if you are not in private practice. For social workers, the National Association of Social Workers (NASW) code of ethics simply discourages dual relationships that present risk of harm or exploitation. The code of ethics also advises social workers to engage in appropriate boundary settings in situations where the dual relationship is simply unavoidable. 

Now that I have covered all your liability concerns, here is where I believe allowing your clients to assist you in enhancing your clinical skills can be beneficial. Consider that one of the most prominent psychologist, author, and developer of Dialectical Behavioral Therapy (DBT) has struggled with mental health. Whom better to teach you then an individual who has had lived an experience. This very principle has been researched in the use of peer recovery specialist to engage and retain individuals in treatment. One study found individuals were significantly more likely to return to treatment with the use of peer coaching (Simon et al.). The reality check here is that the individual who’s been in the chair before is doing a better job at client engagement than degrees on the wall. We as clinicians and/or social workers may want to consider asking our clients, what can be done differently to help. Imagine what your client’s insights can do to enhance your ability to engage and retain them in treatment. 

While your client's may not be functioning at a level where they can host CEUs any time soon, do not pass up the opportunity to learn from them as they sit in the chair across the room from you. As you continue to grow as a clinician, also consider adding literature to your library from authors with lived experience (I have added a few references below). 

https://www.nytimes.com/video/health/100000000877082/the-power-of-rescuing-others.html

Linehan, M. M. (1993). Cognitive behavioral therapy of borderline personality disorder (Vol. 51). New York: Guilford Press.

Saks, E. R. (2007). The center cannot hold: My journey through madness. Hachette UK.

Simon, G. E., Ludman, E. J., Goodale, L. C., Dykstra, D. M., Stone, E., Cutsogeorge, D., ... & Pabiniak, C. (2011). An online recovery plan program: can peer coaching increase participation?. Psychiatric services, 62(6), 666-669.

Workers, N. A. (2008). NASW code of ethics (Guide to the everyday professional conduct of social workers). Washington, DC: NASW.

Workers, N. A. (2008). NASW code of ethics (Guide to the everyday professional conduct of social workers). Washington, DC: NASW.