Wednesday, November 10, 2010

Relax the atmoshere with CPS - LEE vs HEE - expressed emotion

CPS – collaborative problem solving helps parents to be more relaxed and in control of their emotions enabling them to be the source of joy , hope and happiness in their families. Families with challenging kids are very stressed out – see my posts – Welcome to Holland/ Beirut !! .

 Restoring the ' joys of life ' can be pretty difficult but very important. Parents have to be a THERMOSTAT for their kids and help them calm down and be happy , so they need to introduce plenty of song , dance and music into the homes.

Instead of following the advice of most therapists ' it is time that you show leadership and get back into control , be the captain of your ship ' which inevitably leads to WW3 - you are usually comforted that the situation will get worse and then get better , when you kids will see who is really the 'boss' – lower the rope , relax the atmosphere , use Plan C – prioritize challenging behaviors and put many as possible of the issues on the shelf . This helps to minimize conflict and create an atmosphere where parents and kids can bond and connect through general chatting, dialog and conversations. CPS is collaborative in nature , the child and the parent are on the same side , you don't need the ' united front' against your kid. You want to enter his world and reach out to him and help him come up with a better plan. You don't need to be assertive and show your power.

CPS is conducive to Low expressed emotion. Although most parenting approaches talk about speaking in a neutral tone and not screaming or yelling trying to impose your authority and still keep calm are really not a good fit, so most parents end up blaming, criticizing and yelling. ' Back in Control ' parenting is controlling , parents become over-involved trying to control the situation and find solutions without consulting or even taking into account the concerns of kids. This is highly conducive to High emotion expression HEE

Here is some info on "EE" and schizophrenia

Expressed Emotion (EE):

'It was obvious that families may be involved in the progress of the condition, but they are unlikely to have been the cause of it. However, the environment the schizophrenia sufferer returns to after treatment influences the likelihood of successful recovery. Homes where face-to-face interaction is characterized by intense emotional concern or criticism are less conducive to recovery than homes with more emotionally stable interactions. Relapse rates are highest where contact is most fraught.

Brown (1972) showed that patients who returned from hospital to homes where there was a high level of emotionality (High levels of Emotion were Expressed — HEE) were more likely to have a relapse, and would have it sooner than those with LEE (Low levels of Emotion Expressed) families. The kinds of emotions that were expressed were high levels of concern for the sufferers, leading to doing everything for them, being highly critical of their attempts to help themselves, and being very ‘strung out’ generally. These families were characterized by people (mothers usually) rushing around and driving themselves to exhaustion, looking after each other, fussing constantly and being overly possessive. Vaughn and Leff (1976) found 51 per cent of schizophrenic relapses in HEE families, compared to 13 per cent in LEE homes. The more contact the sufferer had with HEE relatives, the higher the relapse rate.

The evidence for the effect of other family members and their emotional responses on recovery from schizophrenia is now well established (and the care package for schizophrenia recovery usually includes some education and support for other family members).

Evidence for the importance of expressed emotion has been found in studies across different cultures so there can be little doubt of its importance in explaining relapse. Unfortunately for the EE explanation, there are also high relapse rates amongst those recovering from schizophrenia who are not in contact with any former family members, so the expressed emotion hypothesis may not be entirely true.' - Psychology notes

'Another example is research done in the area of "expressed emotions [EE]" and psychiatric illness. Years of research clearly show that a psychiatric patient released from the hospital to live with his or her high EE family is twice as likely to relapse and return to the hospital than the patient returning to a low EE family. As noted by a prominent researcher in this area (Hooley, 1998); "The term EE [expressed emotion] is rather misleading since EE is not a measure of how willing a relative is to express emotion or to vent feelings. Rather EE is a reflection of the extent to which the relative expresses critical, hostile, or emotionally over-involved attitudes toward the patient"(p. 631). Note the reluctance of researchers to be honest and open about the fact that they are speaking about a critical family. Instead, they camouflage this information behind the euphemism "expressed emotion."

The above-mentioned researcher, after noting the powerful effect of EE on the relapse rate of psychiatric patients, adds: "These data do not, of course, mean that families cause schizophrenia." I wrote to this researcher and asked if there was any research evidence, as implied by the term "of course," that high EE does not cause schizophrenia? She replied that "the appropriate studies have not been done." She did not explain why she assumes, as an obvious fact, that high EE doesn't cause schizophrenia, in the absence of research evidence. She did state however, that "because of the past tradition of blaming families for causing schizophrenia, it is important that researchers in this area don't go beyond the science in making any unwarranted inferences." It seems however, that when one is being politically correct, then it is quite acceptable to go beyond the science and state, as a proven fact, that EE doesn't cause schizophrenia. In addition, contrary to this researcher's assertion, there is evidence that children in high EE families are more likely to suffer from serious mental illness in adolescence, (see studies cited in Karon & Widener, 1994). ' Dr B Sorotzkin


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