eNewsletter - March 2015

Behavioral Health Partners

Lessons from The Glass Menagerie: The Dialectic of Fragility in Patients with High-Risk Behaviors
Sara Rusk, M.S., Pre-doctoral Intern, Linden Oaks at Edward Hospital

Working with patients in mental health settings who present with intense symptoms and high-risk behaviors often leave a therapist wondering how carefully to tread. In group and individual treatment settings, therapists and other mental health professionals may find themselves cherry-picking their words or changing their own behavior in order to accommodate the “sick” or “fragile” patient. While this may appear to be in the patient’s best interest, the possibility to do more harm than good arises when the therapist reinforces the patient’s own sense of fragility and illness.

One of the most harrowing literary examples of fragility defining what a person can and cannot do is that of Laura Wingfield, the self-proclaimed “cripple” in Tennessee Williams’ The Glass Menagerie (Williams, 1945). Early in the play, Laura learns to identify herself as delicate and unable to survive on her own, leaving the entire household to change their behaviors in order to protect her. Laura’s mother devotes her time to finding her a suitor, someone to rescue them from a life she is convinced they cannot survive on their own.

As the play progresses, the audience sees Laura engage with reality less, retreating into her collection of glass figurines. Only when Laura interacts with a non-family member do we see her desire to be seen as capable, accepting the reality of one of her figures breaking and choosing not to break along with it. Her attempt to survive this moment, however, goes unrecognized as her mother continues to treat her daughter as incapable and doomed to fail. In the end, Laura remains tied to the fate assigned her by the world, never improving and moving past the fragility pinned to her at the beginning of the play.

The urge to treat patients like Laura can feel overwhelming when the therapist interprets their ‘glass figurines’ as too dangerous to handle. However, by recognizing that each patient has both fragile and non-fragile parts, the therapist can begin working within this dialectic to accept how much the patient is suffering and move him/her toward meaningful life changes. Marsha Linehan, psychologist and creator of Dialectical Behavior Therapy (DBT), describes this dialectic through using a solid therapeutic and collaborative relationship to validate his/her feelings while addressing the claim that he/she cannot handle it (Linehan, 1993).

Described as a type of irreverence, Linehan encourages the therapist to tackle behaviors in a matter-of-fact tone that neither encourages nor avoids addressing that behavior (1993). An example of this would be if Laura were in treatment discussing her desire to avoid school because she vomited there. If Laura’s therapist were to go along with her claims that she could not tolerate facing her classmates and instructors it is likely Laura would never return.

However, the therapist might instead call attention to Laura that continued avoidance serves as a way to reinforce her identification that she is too sick to function in the real world. Knowing that Laura is capable of adapting, much like when she reinterprets her glass unicorn breaking as an opportunity for it to become a horse, the therapist would then help Laura recognize her avoidance and encourage her to go back to school while providing her with the skills to succeed there. Only when the therapist adopts the dialectic of fragility and pushing the patient to walk the tightrope, does the patient learn to recognize his own sense of what he can accomplish.

In turn, therapists must be mindful of their own need to protect and rescue their patients. Had Laura worked with a DBT therapist, she may have started to appreciate her glass figurines as something to admire rather than a means to retreat and avoid reality. By receiving validation from her therapist with the encouragement to explore change, Laura may have developed the skills to recognize her desire to avoid and find the willingness to engage with reality as it is. She may have also finished her education and become a secretary. This would happen only if her therapist had the courage to accept her pain, acknowledge her perception as being too sick to function, and willingly accept the challenge of walking the tightrope with her.

Encouraging patients to manage even their most high-risk behaviors through DBT skills training and practice tends to generate productive therapy and patients leave feeling capable of managing their symptoms and living a life worth living.

References

• Linehan, M.M. (1993). Cognitive Behavioral Treatment of Borderline Personality Disorder. New York NY. Guilford Press.
• Williams, T. (1945) The Glass Menagerie. New York NY. Penguin Books.

Sara Rusk, M.S. – Pre-Doctoral Intern
Sara Rusk is a pre-Doctoral intern in the Discoveries Self-Injury Program. Sara is currently completing her doctorate in clinical psychology at The Illinois School of Professional Psychology at Argosy University, Chicago. Sara graduated with her master’s in counseling psychology in 2006 from the University at Albany, State University of New York and has nearly eight years of professional practice and clinical training experience. Outside of clinical practice, Sara has worked as a research fellow and adjunct professor. Sara is particularly passionate about program development and is currently completing her clinical research project where she designed and implemented a qualitative pilot study to train residential childcare workers to recognize and work with attachment-related behaviors.

CE Webinar: Anxiety Within Schools: The Hidden Consequences of Being Over-Accommodating

Linden Oaks is proud to announce our a free continuing education Webinar for behavioral health professionals. This online educational opportunity, which can be done from your own office or home, will discuss student anxiety. The presentation, Anxiety Within Schools: The Hidden Consequences of Being Over-Accommodating, features, Megan Schmitz, PsyD, Clinical Psychologist and anxiety specialist.

The presentation will examine school anxiety/avoidance in students and focus on how continual avoidance lowers tolerance level. She will also discuss practical tips for school support staff including social workers, counselors, and teachers.

This event is scheduled for Wednesday, April 15, 2015 from 12:00-1:00pm. Continuing education credit will be available for CADC/IAODAPCA, LCPC/LPC, LCSW/ MSW, LMFT, and Psychologist (note at registration).

Registration is required as spots are limited. Access to the Webinar will be granted upon registration.

Register online

Questions? Contact us at: jcole2@edward.org.