It’s been more than a year since the 33 Chilean miners, trapped for over a month half a mile underground, emerged to worldwide celebration. But despite everyone’s best wishes and many efforts to help them, by all accounts, they’re doing poorly. It’s been reported that 29 of the 33 continue to suffer from such disabling symptoms that they’ve been unable to resume normal lives.
“They’re taking uppers, downers, and mood stabilizers,” says Jean Romagnoli, a physician who’s been involved with the miners since the rescue operation began. “They’re overprescribed. They don’t understand why they’re taking them, but they’re fed up with the pills.” Several are still having flashbacks. One miner, for reasons he can’t explain, has built a wall around his house. Raised in a culture that values toughness, several had predicted they’d go back to work in the mines, but only two have been able to return. One of them tried walking into a mine months after their rescue, and could last only two minutes. When Jonathan Franklin, a British journalist whose book 33 Men relates their ordeal from the initial cave-in to their post-rescue struggles, accompanied another to the mine entrance, the man started crying. Franklin asked him why, pointing out that he’d survived. “Yes,” the former miner replied, “but my happiness is still inside there.” Considering that mining is the only work most of them have ever done, and that they live in a poverty-stricken region where virtually no other work is available, most of the rescued miners have been reduced to poverty. Their monthly disability checks of $500 are about half of what they earned previously.
Despite all that’s been learned about PTSD and helping people recover from ordeals like those the miners experienced, how can so many of them still be in such bad shape? It’s been 30 years since PTSD was first recognized as a distinct diagnostic category and made it into DSM-III. Since then, millions of dollars and hundreds of studies have focused on how to treat it, and the miners have received six months worth of treatment, courtesy of the Chilean government.
Actually, recent research on PTSD provides a possible answer to why the miners are continuing to experience such difficulties. Increasingly, researchers are coming to realize that PTSD can be somewhat of an umbrella term, like depression. It’s not a single condition and, therefore, no one treatment is likely to be universally effective. In the January 2009 issue of Psychological Trauma: Theory, Research, Practice and Policy, Christine Courtois and Steven Gold explain the different kinds of traumatic reactions, some of which, like “betrayal-trauma,” are triggered by factors beyond the immediate trauma itself. For at least some of the miners, the experience of betrayal may be part of their ongoing problems.
The most common type of betrayal-trauma is abuse by a relative, but betrayal can be perpetrated by organizations as well. While there was massive support for the miners during the rescue operation, the explosion itself resulted from unsafe working conditions and unenforced safeguards that the mining company and government supervisors had overlooked. This may well have put the miners into a psychologically untenable conflict: the ones who victimized them are also the ones who rescued them—and celebrated their rescue.
An example of the unenforced safeguards is shown in the fact that the rescue chamber to which the miners struggled immediately after the explosion—that was supposed to be fully stocked to help in just such an emergency—contained only a two-day supply of food and water. Therefore, until the rescue shaft was opened wide enough to send down supplies 17 days later, each miner subsisted on two spoonfuls of tuna, a sip of milk, a bite of a cracker, and a small piece of peach every other day.
Trauma undermines a victim’s fundamental sense of safety and basic assumption that the world is orderly, fair, and secure, and much of the psychological healing that must take place necessitates restoring people’s sense of control and safety. “These guys have been on several roller coasters,” says Gold, adding his own powerful metaphor. “The ground’s been constantly shifting beneath their feet.” They went from believing they’d all die—they’d actually considered eating whoever died first—to being rescued. They went from the terrible, dark isolation of being trapped underground to the glare of worldwide attention. They were taken care of for six months, and then the psychological services were eased out. Increasingly they’ve gone from heroes to becoming objects of scorn: people who celebrated their rescue have since booed them, saying they’re greedy ingrates for attempting to sue the government. The President of Chile even publicly opined that “It’s time for them to return to their normal lives.”
The roller coaster likely has another wrenching twist ahead, adds Gold: the movie rights to their ordeal have just been sold, and a sudden infusion of cash will likely make things better for a while. But whatever the financial windfall, the emotional up-swell is likely to be short-lived, and they’ll still be struggling to make sense of what happened to them and trying to find a way to go on with their lives.
How to Train Good Therapists
As it’s become increasingly clear that the client–therapist alliance is probably the most important feature of effective therapy and positive outcome, the question arises of how well the field’s professional training does at providing graduates with the skills they need to establish the kind of relationships with their clients that are the hallmark of effective therapy. Critics contend that many graduate programs have a ways to go in that regard for a number of reasons, starting with the admissions process itself.
“The criteria that are used to get into grad school have nothing to do with therapeutic competence,” says L.A. psychologist Nicholas Ladany, director of Loyola Marymount University’s Counseling Program, who trains therapists and supervisors around the world. “Almost every graduate program uses grade point average, GRE test scores, and research experience as entrance criteria, and there’s not one bit of research that shows any relationship between these and therapeutic competence.”
Training programs typically assume that therapeutic skill will be acquired when the students do their internships and get on-the-job training, right? What isn’t widely recognized is that therapists with a limited capacity for developing solid clinical skills can easily slip through their field placements. Theoretically, field supervisors tell a school liaison how a student is doing, but how many supervisors have the awareness or courage to say to the school, “This student will never become a decent therapist”? And if they do, how should the school handle that information? Clinical acumen and skills, says Ladany, simply aren’t evaluated well. Most graduate schools, he says, “overload students with content-based knowledge, dabble in self-awareness, and give little attention to evaluating clinical experience.”
There are exceptions, of course. Some Ph.D. programs focus predominantly upon clinical work and include a strong supervisory evaluation component. But even at this level, there are seldom any reliable mechanisms in place to ensure that students who graduate have actually acquired the skills they need to practice therapy effectively. “Sometimes there are student clinicians who just don’t seem to grow or benefit enough from supervisory feedback,” says a faculty member at a Ph.D. clinical training institute. “In the beginning, you want to give people a chance, and you hope that through continued training and practice, they’ll get better. So the issue of whether they should be practicing never gets directly confronted, and all of a sudden they’ve graduated.” Ladany puts it more succinctly: “Basically, we pass people through if they can get good grades and don’t piss off a supervisor.”
A controversy at Webster University in St. Louis illustrates the problems that emerge when a school strays beyond the objective—albeit clinically irrelevant—criteria used to assess and graduate students. Earlier this year, a student who’d received all A’s and one C, was kicked out of the master’s program in Counseling Psychology on the grounds that several of his taped counseling sessions demonstrated that he “lacked empathy.” He’s now suing the university for $3 million in losses and damages.
Part of the lawsuit’s contention is that the code of ethics of the American Counseling Association stipulates that schools have an obligation to help students improve their deficiencies. Currently, there’s no objective way to determine whether the Webster University student really has enough empathy to become a competent clinician, and if he does lack empathy, what his training program could have done about that. Ladany thinks that part of the problem is that the qualities of empathy and the other clinical skills involved in being a good therapist aren’t defined well enough, making it impossible to evaluate students fairly. Beyond empathy, the skills in question are other hard-to-quantify talents, like interpersonal competence, curiosity about others, and sensitivity to multicultural issues, along with the ability to manage countertransference, tolerate ambiguity, and establish a working alliance. What’s needed in our graduate schools, claims Ladany, is a live-session exam that students have to pass. If they fail, they’d get more training and have to take other live exams that honed in on the skills in which they hadn’t demonstrated proficiency.
There’s another neglected component to students’ training that requires attention, Ladany adds: old-fashioned modeling by faculty. When faculty members exhibit strong qualities of interpersonal connection, empathy, and interest in and care for others, their students are likelier to develop those qualities, too. Unfortunately, says Ladany, too often such sterling models simply aren’t represented in training programs around the country.
Can We Stop School Bullies?
The suicide a little more than a year ago of Rutgers University freshman Tyler Clementi was the final impetus for New Jersey to pass the most comprehensive anti-bullying legislation in the country. The Anti-Bullying Bill of Rights, which supersedes a 2002 law already on the books, makes New Jersey one of five states to have adopted anti-bullying laws for their schools in the last year. But can the law make a dent in the growing incidence of bullying today? A 2011 report for the Centers for Disease Control estimated the number of students who reported being bullied more than once, and of students who admitted to bullying others, was around 20 percent of the school population in 2000; in 2009, the percentage had risen to 30 percent. While these figures indicate that bullying has become increasingly common in schools, they don’t take into account the virulent and growing phenomenon of cyberbullying.
Unlike playground or hallway bullying, cyberbullying can happen 24/7, even reaching into kids’ bedrooms. Smartphones, e-mail, and social media induce kids to discount any feelings of empathy and impulsively post nasty messages without thinking about the consequences. Cyber messages can be read by thousands, if not hundreds of thousands, of people, and remain visible for years. Clementi, a gay college freshman, committed suicide after his roommate posted a surreptitious video of him kissing with another male. At Oak Park River Forest High School in Illinois, a few boys recently rated their female classmates on the Internet on such things as their looks and sexual proclivities. Although these sorts of conversations have always been part of the locker-room scene, they have a completely different effect when shared with the world.
Early anti-bullying programs often ran into strong resistance from people who said that such programs went against human nature and prevented kids from learning how to defend themselves in the real world. But as bullying has increased and its role in student victims’ depression, suicide, and homicide has become clearer, that resistance has diminished. The opposition to New Jersey’s tough law focuses almost exclusively on whether schools can fund and implement its provisions.
In the past, anti-bullying efforts focused on building up students’ self-esteem, instituting zero tolerance, and meting out harsh punishments for infractions, based upon principles that sounded good but have proven ineffective. Newer programs are addressing the issue from different perspectives. Therapist Stan Davis, of Wayne, Maine, whose Stop Bullying Now! approach has gained international recognition, says that effective anti-bullying programs must first clearly define bullying, not just so that teachers and staff can identify and address it, but so students feel comfortable with the definition. This puts bullying into a common context, so that a sense of community—one of the strongest protectors against bullying—can be built among students, parents and educators. When there’s common agreement on what constitutes bullying, people who report bullying are less likely to be labeled as snitches. Davis, whose Youth Voice Research Project asked more than 13,000 young people in the United States what works and doesn’t work in bullying prevention, says that the best common definition of the problem boils down to whether a reasonable person would feel threatened or harmed by an action. That’s the definition New Jersey uses in its new law.
Davis also contends that while it’s important to have immediate consequences for aggressors, immediate, harsh punishments are counterproductive, unless the acts of bullying are particularly egregious. If students and staff know that the aggressor will suffer severe repercussions, they’ll be more reluctant to report it. When aggressors suffer harsh consequences for relatively minor incidents, those who report the bullying can seem like snitches, which sets them up for being targets again. The New Jersey law requires each school to institute a clear policy of progressive remediation and reeducation, with escalating penalties. Clearly defining bullying and meting out appropriate consequences helps create what for Davis is essential: an atmosphere in which all students feel supported. It also sharpens the focus on the real issue of bullying.
“If someone bullies,” says Davis, “everyone needs to realize that the aggressor, not the targeted person, is 100 percent responsible for the behavior. The worst effect of bullying is how it makes targeted people feel about themselves.” Most people who’ve been robbed or assaulted know the nagging feeling that somehow they’ve done something wrong—they weren’t vigilant enough, were in the wrong place at the wrong time, or made themselves look like an easy target. Only when everyone, including witnesses, adopts the perspective that the aggressor is completely to blame can schools reshape the culture that fosters the behavior.
Resources
Chilean Miners: Jonathan Franklin, “Chilean Miners Struggling with Financial and Psychological Problems,” The Guardian, August 4, 2011.
Bullying: For the complete New Jersey law, see http://njbullying.org/documents/Anti-BullyingBillofRights.pdf.
Garry Cooper
Garry Cooper, LCSW, is a therapist in Oak Park, Illinois.
