Narrative family therapy with depressed adolescents: The family as a place for Social Sharing of. Emotion. Jan De Mol. Professor Clinical Psychology & Family ...
Narrative family therapy with depressed adolescents: The family as a place for Social Sharing of Emotion Jan De Mol Professor Clinical Psychology & Family Therapy Bernard Rimé Professor Social Psychology University of Louvain (Belgium)
Rimé, B. (2009). Emo0on elicits the social sharing of emo0on: Theory and empirical review. Emo$on Review, 1, 60-85. DOI: 10.1177/1754073908097189
Adolescents and “emerging adults” depression Some figures: • Prevalence: 3% - 9% • Teenage life0me incidence : 20% • An0depressant medica0on Flanders – Brussels within the age range 0 – 25 in 2013: 29.385 children/youngsters
% gebruikers (0-25 jaar, Vlaanderen + Brussel) van antidepressiva (min. 1 aflevering): per leeftijd in 2013 5,0%
4,0% 3,5%
4,5%
% gebruikers
4,5%
4,1% 3,7%3,7% 3,2%
3,0%
2,8% 2,4% 2,2%
2,5%
1,9%
2,0%
1,4%
1,5% 1,0% 0,5% 0,0%
0,8% 0,6% 0,3%0,3% 0,1%0,2%0,2% 0,1% 0,1% 0,1% 0,0%0,0%0,0%0,0%0,0%0,0%
Leeftijd
1,3%
Features of depression • • • • • • • • •
Depressed mood Diminished interest or pleasure in most ac0vi0es Significant change in appe0te or weight Insomnia or hypersomnia Psychomotor agita0on or retarda0on Loss of energy and fa0gue Feelings of worthlessness or guilt + RUMINATION Thought and concentra0on problems Recurrent thoughts of death and suicide
è Problems with EMOTION REGULATION
Why family therapy? • Eco-systemic approach: Focus on emo0on regula0on as an INTERPERSONAL PROCESS embedded within broader SOCIAL and CULTURAL CONTEXTS Ø Most interven0ons regarding adolescent depression focus on the individual (CBT, IPT-A) Ø Most family interven0ons regarding adolescent depression do not include broader social and cultural context
Why family therapy? • Major theme of adolescence = Ø Process of separa&on – individua&on, including ambivalence of adolescent and other family members, and mee=ng the social complexi=es outside the family Ø Construc0ve separa0on and individua0on (iden0ty construc0on) is only possible when the persons involved have a sense and feelings that they had good moments together
Why family therapy? • Main assump0ons: Ø By addressing in family therapy complexi0es for adolescents within the broader social discourse, the family is approached as a resource to facilitate interpersonal processes of emo0on regula0on, for the adolescent and the other family members Ø Adolescent depression has a huge impact on the family, and this massive engagement is construc0ve when also (like the other family members) the depressed adolescent is approached as a full agent (what he/she feels-thinks-says is not mentally deficient), which facilitates the process of separa0on – individua0on
Why family therapy? • “Agency means considering individuals as actors with the ability to make sense of the environment, initiate change, make choices, and resist” Kuczynski, L., & De Mol, J. (2015). Dialec0cal models of socializa0on. In R.M. Lerner, W.F. Overton, & P. Molenaar (Eds.), Handbook of child psychology and developmental science, 7th edi$on: Volume 1: Theory and Method. New York: Wiley.
• Externalizing
Theore0cal framework: SSE = SOCIAL SHARING OF EMOTION (Rimé) • Emo0on elicits the social sharing of emo0on: emo0on regula0on is an interpersonal interdependent process Ø Nega0ve and posi0ve emo0ons Ø Cross-cultural phenomenon Ø Each SES
• Paradox of SSE: Ø During social sharing the nega0ve emo0on is reac0vated, but people report that this social sharing is good for them, not an aversive experience Ø Falsify the “catharsis”-idea: just talking does not change the emo0on
SOCIAL SHARING OF EMOTION • Difference between SOCIO-AFFECTIVE and COGNITIVE-SYMBOLIC modes: Ø Socio-affec0ve mode: support, comfort, consola0on, legi0miza0on, apen0on, bonding, apachment, empathy è Social recogni=on, valida=on, understanding of the narrator’s inside = perceived partner RESPONSIVENESS (Reis) Ø Cogni0ve-symbolic mode: EMOTION FUELS COGNITIVE WORK: accommoda0ng models and schemas, recrea0ng meaning, social reframing è Social comparison, narra=on, reconnec=ng to social representa=ons
• Socio-affec0ve modes of SSE: only temporary effects, no emo=onal recovery
SOCIAL SHARING OF EMOTION • No or less SSE (people who visit our prac0ce): Ø Shame Ø Guilt Ø Social constraint (also reason why socio-affec0ve modes do not work at the long term)
• Conclusion: Ø Emo0onal recovery demands cogni0ve-symbolic modes of SSE, i.e., a cogni0ve – social process that reconnects people to social representa0ons Ø But, ini0ally necessity of socio-affec0ve modes, then possibility of cogni0ve-symbolic modes
SSE partners for youngsters
First research: Dominant social representa0ons for depressed adolescents • In-depth individual interviews with 18 hospitalized adolescents (age range 14 – 19) Ø Interpreta0ve Phenomenological Analysis
• Three master themes emerged out of the data: Ø Impossibility to fail: - Failure is personal responsibility - Correct approach produces correct outcome - Proper social skills are normal Ø Obliga=on to have an in=mate rela=onship: - You can feel with whom it clicks - You know what an in0mate rela0onship is Ø Feeling bad is not allowed and not normal: - Feeling good is normal and self-evident
Therapeu0c principles 1. Main therapeu0c objec0ve: Facilita0ng the process of separa0on-individua0on in the family by facilita0ng a process of SSE for the adolescent within the social context of the adolescent, not only within the family, but in par0cular within the social context outside the family. Ø Integra0ng in the social context outside the family is possible when processes of emo0on regula0on are possible in those contexts
Therapeu0c principles 2. Mee0ng the family (star0ng point) MASSIVE mutual engagement-commitment-concern in families with depressed adolescents (suicide apempts, self-injury,…) Taking a family focus
Ø by searching for and giving words to this engagement: facilita0ng the socio-affec0ve modes within the family Ø not by focusing immediately on the problem but on the agency of the family: parents want to help and consequently take too fast a cogni0ve mode Ø but also “between the lines” as a therapist giving the message to the family that you know depression (not psychoeduca0on), also important for the construc0on of a therapeu0c alliance.
Therapeu0c principles 3. Moving to the adolescent Addressing the agency of the adolescent by exploring the social complexi0es with her/him, using a SOCIOGRAM, in the presence of the parents
Ø Star0ng with socio-affec0ve modes Ø But, by addressing the agency of the adolescent: “For whom you can/will (some0mes, a liple bit,…) be a resource?”: SSE is a BIDIRECTIONAL process Ø Then “To whom you can/will tell something (some0mes, a liple bit,…) about yourself?” Ø Moving to the cogni0ve-symbolic modes Ø First, addressing the agency of the adolescent by asking his point of view regarding social complexi0es Ø Then discussing what and how others might think (research into social representa0ons gives the therapist ideas): reconnec0ng to the social discourse
Therapeu0c principles 4. Moving to the parents Addressing the agency of the parents Ø By recognizing their difficulty for keeping distance Ø By asking what the narra0ve of their adolescent mean for them: facilita0ng socio-affec0ve and cogni0ve-symbolic modes of SSE within the family (some0mes parents are surprised and learn something from their adolescent regarding social complexi0es) Ø By exploring with the parents their social complexi0es in the presence of the adolescent (sociogram) “We haven’t failed as a family, and we can learn things from each other”
Therapeu0c principles 5. …and the therapist Addressing the agency of yourself Ø By exploring and understanding the social representa0ons by which you are influenced Ø By allowing yourself not to understand the adolescent and the parents too quickly, in fact some0mes not to understand them at all.
