Resilience Spotlight: Ronald Cohen, MD, Family Psychotherapist, Part 1

Posted on: June 27, 2013
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Questions for Ronald Cohen, MD, Family Psychotherapist.
 
 
 
 
 
 
WMB (Watch Me Bounce): Please tell us a little about what you do.
 
RC (Ronald Cohen): I am an Board Certified Psychiatrist turned Systemic Family Therapist  trained at Family Institute of Westchester in the multicultural, multicontextual extension of Bowen Theory, who specializes in helping families adapt and heal from unexpected crises and stressful life-cycle challenges, especially those caused by severe and chronic medical and psychiatric illness, trauma, and disability. I provide diagnostic, therapeutic, and educational services to help families resolve relationship difficulties and live happier, healthier and more fulfilling lives. As a consultant specialist I provide clinical supervision and help other health care professionals and organizations to consider how adding family therapy sessions to the treatment program can be both healing and protective of future generations.

Multigenerational Family Healing helps improve human relationships and solve major complex, challenging family life problems in less time and with less expense than multiple individual therapies. Healing current relationships avoids leaving a damaging legacy for our descendants.
 
 
 
 
WMB: What got you interested in resilience?

RC: In her book Normal Family Process, Froma Walsh wrote a chapter entitled “Family Resilience: Strengths Forged Through Adversity” in which she aspires to create a family resilience framework that “extends our understanding of healthy family functioning to situations of adversity”. From this I’ve developed goals for my practice including:

 

1.    Working from a competency based, health oriented paradigm to support resilience in the midst of crisis.

2.    Working to promote well-being by focusing on and actualizing the positive adaptive potential of each individual person.

3.    Working from a person centered, non-pathologizing, holistic treatment approach.

 

Family Systems Therapy has a positive view of both the individual and the family.

An approach that incorporates “the normative crises of the family life cycle” provides numerous opportunities for preventative mental health care. A senior founding clinician famously stated:  “When families come to me for help, I assume they have problems not because there is something inherently wrong with them, but because they’ve gotten stuck — stuck with a structure whose time has passed, and stuck with a story that doesn’t work.”

 
 
 
 
WMB: What does ‘resilience’ mean to you?
 
RC:
 

The ability to withstand and rebound from disruptive life challenges.

The ability to maintain healthy family functioning in situation of adversity

The ability to foster positive adaptation within the context of significant adversity and to recover and grow from these experiences.

The ability to live well despite illness and disability.

The ability to respond successfully to stressful crises and persistent challenges.

The ability to increase self-directedness, make connections, and lead loving and productive lives.

The ability to acknowledge suffering, restore dignity and make meaning of adversity.

 

 

 

WMB: On your website you talk about Family Resilience. If you had thirty seconds, how would you pitch your approach?

 

RC: A family-resilience approach is positive, competency and strength based, health oriented, and non-pathologizing. It helps foster positive adaptation within the context of significant adversity so families can acknowledge suffering, restore dignity, recover and grow. Family therapy is concerned with the resolution of problems, what is going on right now and how we can change things for the better, not with the why of the past. The process engages distressed families with compassion and respect to enhance their best qualities and reparative potential thereby helping families emerge strengthened, more resourceful, able to love fully and raise their children well.

 

Whether it’s David Miklowitz’ Family Focused Therapy for families struggling with bipolar disorder, Marc Galanter’s network therapy approach for maintaining a sober life style, the psychoeducation paradigm for addressing expressed emotion in families with schizophrenia, Constance Ahrons’ work with divorced, remarried and blended families or John Rolland’s Family Systems-Illness Model among many others, Family Systems Therapy is the treatment of choice for relationship difficulties, intergenerational conflict, and other problems endemic to the family life cycle. These collaborative, resilience-promoting approaches focus on strengths and resources to heal from painful experiences and recover from life crises in order to enhance the functioning and well-being of families, couples and individuals.

 

A family resilience approach is a very positive and constructive way that we can use to teach families how to make sense of what has happened and how to move forward, as difficult as that may currently seem to be.”

(Alison M. Heru, MD on Dr. Forma Walsh’s Family Resilience Framework)

 
 
 
 
WMB: What do you think makes someone resilient?

RC: Resilience arises from the interplay of multiple risk and protective factors over time involving one’s relationship with self, family and the larger social context in which one grows and develops. In focusing systemically on families and communities, Froma Walsh highlights the intrinsic value of extended kin and non-digital social networks to meet challenges, make meaning and define a future purpose. The goal is to thrive and not just survive in the domains of personal well-being, relationships and productivity. A positive outlook, hope, optimism, mutual support, empathy and collaborative problem solving expand the universe of accomplishable positive outcomes.

 

Resilience is enhanced by significant attachments and relationships with parents, siblings, extended family members, intimate partners, and mentors. Understanding the interactions between family structure, function and process enhances “the art of the possible,” and furthers dialogue to help families get safely through turbulent waters. Acknowledgement of the reality and shared experience of loss facilitates family reorganization and reinvestment in other relationships and life goals. Focusing on strengths and resource helps families develop the ability to struggle well and empowers families to overcome persistent adversity.

From another commentator in a LinkedIn discussion group, “The idea of being one car on a multigenerational train on a track that has been there for generations helps remove some of the shame and blame for the client and for other family members. It helps to provide a source of positive feedback for even small changes and helps to give a broader perspective. It helps a family be more forgiving and compassionate towards each other.”

 

 
 
 

WMB: Do you think there is a difference between how different health providers (i.e. psychiatrists compared with clinical psychologists and social workers) approach resilience?

 

RC: Absolutely! The difference arises more from one’s training and theoretical orientation than from the disciple one belongs to. Psychiatrists, as physicians, tend to work within the “medical model” of disease. Marital and Family Therapists work from a strength based orientation to help couples and families identify and use their existing skills, resources and abilities to assist in developing and maintaining healthy communication skills. I am not aware of the training curriculums for psychologists and social workers.

It is unfortunately perversely true that of all branches of medicine, psychiatry is the only one that actively works to separate the writing of prescriptions from the talking to people. Indeed no other medical specialty has carved out a separate “pharmacology” subspecialty. Our current system of financing health care delivery has led to fragmentation of care that is unnecessarily duplicative and not in the best interest of the patient. Furthermore, these approaches restrict access to the highest quality care to the wealthy while allowing insurance carriers to make treatment decisions for the majority of Americans that should be made by appropriately trained physicians.

The biopsychosocial model is the current dominant paradigm for psychiatric case formulation and treatment planning. Unfortunately this model is honored more in the breach than in actual clinical practice as both professional and economic constraints continue to increase the difficulties of integrating psychosocial services with biomedical care. Rolland has developed a treatment model that adds consideration of family and illness life cycles to the integration of biomedical, psychosocial, and behavioral dimensions in work with individuals with chronic illnesses.

Those of us trained in the Systemic Family therapy model act as coaches and collaborators to help families develop skills and strategies for dealing with relationship concerns. Family Systems Theory has a positive view of both the individual and the family. Working with the whole family is both healing and protective. Family Systems Therapy is the treatment of choice for relationship difficulties, intergenerational conflict, and other problems endemic to the family life cycle. The treatment focus is on direct assessment and modification of the relationships between individuals. Active problem solving improves communication and enhances quality of life while contributing to the emotional well being of future generations. It is healing on a higher level.

 

To become an adult, every person faces the task of the differentiation of self. The process of differentiating focuses on developing personal, authentic relationship with each member of the family, and changing one’s part in old, repetitive, dysfunctional emotional patterns so that one is able to speak one’s personal views calmly and nonreactively regardless of who is for or against them. Therapeutic coaching or family therapy with one person focuses on understanding the rules and roles of one’s family of origin and developing the freedom to make one’s own decisions.
 
 
 
 
 
WMB: Why, in your opinion and experience, is resilience important?

 

RC: The ability to struggle well, to make meaning out of adversity and to make loss matter is fundamental to emotional well being and stability in family adaptation to both predictable, normative transitional events in the developmental life cycle and unexpected, unscheduled crises that interrupt developmental tasks. Strengthening the foundation of love and affection helps to curtail repetitive negative cycles of anger and despair thereby promoting a secure base from which to reduce vulnerability, diminish conflict and repair attachment injuries. Be it problems with children, intimate partner conflicts and complaints, family feuds or disruption from major family life-cycle transitions, bringing family members together to help transform their interactions and learn to solve the problems in their relationships has a power to achieve the full range of emotional health that is almost magical.

Understanding the interactions between family structure, function and process enhances “the art of the possible,” and furthers dialogue to help families get safely through turbulent waters. Acknowledgement of the reality and shared experience of loss facilitates family reorganization and reinvestment in other relationships and life goals. Focusing on strengths and resource helps families develop the ability to struggle well and empowers families to overcome persistent adversity.
 
 
 
 
 
WMB: Do you think resilience is an inborn trait, or something that can be learned?

RC: Both/and. As with individuals, some families are more resilient than others. Resilience can facilitated by:

 

  • Hope, optimism and confidence
  • “Transcendence and Spirituality”, defined as (1) a sense of larger values and purpose, (2) healing rituals, congregational support and a faith based community, (3) inspiration and (4) transformation, is one of the key processes in family resilience
  • Mutual support, collaboration and commitment
  • Open emotional expression, empathy and pleasure
  • Cooperation, flexibility and proactive problem solving

 

So how do you do that?  That comes back to basic Bowenian what’s called family of origin or differentiation work.  The theory is we all bring a backpack into our relationships.  Some of it is good stuff; some of it is bad stuff.  A colleague of mine says, “Just ‘cause you have a lot of baggage doesn’t mean you have to open every piece.”

 

And where we get in trouble is that most of us are not aware of a lot of the stuff that is in that backpack.  Our family had rules of how you deal with conflict, how you deal with relationships, what you talk about, what you don’t talk about, what boundaries and limits are, how involved you are in everybody else’s life.  We think that the whole world lives that way because it is the family we grew up in and then we meet somebody who has a completely different way of doing things.  And we don’t even get, initially, what the conflict is.

 

 

 

 

WMB: Do you think your any of your personal experiences gives you a unique perspective on the topic? How?

RC: The gift of the life of my paternal grandfather was a richly rewarding experience of the beauty and power of resilience. His story of life in the shtetl, Satanov, Podolia Gubernia where he was born, emigrating to the US, pushcarts on the Lower East Side, wholesale fruit, trucks, parking garages, financial success, the Great Depression and bankruptcy, restarting and reinvestment, commitment, fortitude, perseverance and a loving family is still my ideal of a life well lived.

 
 

Dr. Ronald Cohen, MD, Family Psychotherapist

Dr. Ronald Cohen, MD, Family Psychotherapist

 
 

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