". . . or, you could practice compassion,
going toward, rather than away from, the suffering of others."
Norman Fischer, Buddhist Abbott,
Everyday Zen Center San Francisco, CA
"the way out of pain is through it. . ." Mark Epstein, M.D.
"follow your sorrows. they will teach you what you need to know."
Norman Fischer, zen priest and abbott of the Everyday Zen Sangha,
San Francisco Zen Center"universally and without logic, our pain connects us to the world on a more fundamental level."
Mark Epstein, M.D.
"diminishing sources of terror, despair, and suffering
promoting sources of connectedness, relationship & hope for children"
Teaching child/adolescent and family courses, including clinical biodevelopmental, theoretical. diagnosis and psychological conceptualization and assessment for many years at the doctoral level, she has also conducted psychological assessments with individuals across the lifespan and within amazing diverse contexts; for older adults, infant/parent, parent-child, Court-ordered and private evals, clinical and forensic, psycho-educational, trauma evaluations, parenting capacity, targeted, developmental evaluations; readiness, intelligence & aptitude, giftedness, psycho-diagnostic, personality, parenting, parent-child, domestic violence , Nexus assessments for Veterans from which personalized precision interventions are derived.
Providing Expert Testimony as needed.
Dr. Marileetaught many years at SF Bay Area doctoral institutions (primarily PGSP/now PAU) and continues to train and supervise doctoral students and licensed clinicians in assessment, trauma assessment and treatment, and empathic, mentalization, relational approaches to early childhood and parenting in the manner of Dr. Bruce Perry, MD., Peter Fonagy, Ph.D., UK.
Over the years, she has used relational assessment in a multitude of fascinating settings over the years, with interns in child/adolescent and adults in a psychiatric inpatient hospital, with asylum-seeking child, adolescent, and adult/elder survivors of political torture.
With Dr. Livingston, she uses assessment not merely diagnostically but as a critical means of understanding complex, painful traumatic events and accompanying distressing thoughts and feelings of child witnesses of horrific acts of violence and atrocity (to enhance testimony for refugees and asylum seekers who had been forced to observe torture and murder of family members, burning of entire villages, etc.), for children who have sustained poly-victimization, such as abduction, torture, and training as child soldiers; for those forcibly displaced, abandoned, left to wander without sustenance or protection toward country borders as a consequence of war/armed conflict: uprooted children of war. (See Assessment section regarding rationale for skilled clinical use of Performance (Rorschach) Testing: it has been an invaluable means of understanding the inner worlds of children who have witnessed parental suicides, been exposed to homicides, etc. -- events too overwhelming to speak of in direct interview.
By learning to see these overwhelming events, and their apparent meaning, through the eyes of a child or adolescent using symbolic work (art) or performance measures, "it is possible to understand a child's internal representations of him/herself, of others, relationships (connectedness/community), the wider world, and the future - the child-in-relationship, child-in-context, child in time, place, and emotional space, (and in constant interaction with others - who are also in transaction - Sameroff) in the world, generally."
This priceless clinical data could never be otherwise articulated by young children.
treating~
by Dr. Marilee
"children exposed" to and "affected by" violence (such as war/armed conflict affected globally, are addressed by our nonprofit, alwaysbelisteningglobal.com), and by interpersonal and interparental high perpetually unresolved conflict (have more recentely been researched by clinicians high-violence, marginalized, communities through school-based programs, and similar private patients, and explored through practice through clinical/forensic cases maintained through DFCS and our own Blue Canoe settings.
For example, nature, effects, and assessment of:longterm effects on children of high chronic unresolved interparentel conflict
(See E. Mark Cummings)
longterm effects on children of violence exposure (such as community violence, interpersonal violence)
and the specific longterm effects of exposure to DV (domestic violence).
*pediatric suicidality~ for twenty years, we have examined this issue through research, assessment, and treatment, looking at the potential of incipient (emerging) mood disorder and attentional issues (impulsivity) in latency age children (and preschoolers) which at times combine with a series of what may appear to be "nominal" (per adult standards) exit and entrance life events to profoundly effect the child's cognitive awareness, contributing to distortions of perception and appraisal.. . . . derailing their ability to assess reality without distortion, impairing their judgement, impeding their ability to develop expectable and healthy abilities to cope with stressors, manage emotions and impulses, build and sustain peer friendships, and otherwise function as healthy children.
these are the children/youth who appear to "suddenly snap" and attempt or complete suicide (recent news reports of latency children hanging themselves in their bedrooms) or have very serious "attempts". taking their lives often described by parents as occurring "out of the blue". Recent data also suggest that adhd may be the highest contributing factor to suicide in younger children (presumably because of impulsivity but perhaps also due to difficulties fitting in comfortably in varied contexts, struggling with adjustment, etc.
*we have been avid program developer, trainer and treatment providers for marginalized, underserved child/family populations, leading grant-funded no-fee school-based treatment programs staffed by doctoral practicum students and interns in low-income communities.
* as a refugee psychologist and asylum assessment provider for survivors of torture jointly trained by Gerald Gray, M.S., and Dr. Carlos Gonsalves, Ph.D., Center for Survivors of Torture, San Jose, CA & Physicians for Human Rights, HealthRight International, she specialized in unaccompanied, asylum-seeking children/adolescents and complex adult cases (women imprisoned/tortured as a consequence of membership in minority religious sects; immigrated adults living for decades in the US but in isolation, below poverty level, with no English acquisition or cultural assimilation, with severe, complicated, comorbid, untreated medical conditions; asylum-seeking young Central American adolescents who find their way to the US through extreme hardship, only to find their mothers missing or uninterested in connecting with them; unable to return to Central America for fear of incarceration, unable to attend school in the US for lack of requisite paperwork, lacking housing or funds, and worse, sometimes susceptible to recognition, exposure, potential execution by lethal US/Central America-connected trans-migrating gangs.
oppression, victimization, -- preventing the rise of helplessness
I provide treatment for targets of insidious partner intimidation, in particular, extremes of religiously embedded violence, child maltreatment, potential abduction (flight risk), gender-based harassment, bullying, coercion and oppression, punitive, terror-based child-rearing systems, oppressive systems of rule and their results -- all of which produce variations of internalized attitudes of severe self-blame, worthlessness, shame, helplessness in the presence of signals of danger, rendering the individual target repeatedly susceptible to preoccupying, exhausting hyper-vigilance, lethal assault, low self esteem and perpetual downward functioning, vulnerability to re-victimization.
Overall, working at the margins entails being sensitive to a wide range of individuals: children and adults with unique, neuro-developmental, neurolinguistic, situational (traumatic) challenges, lives intertwined with high risk and few protective buffers from adverse circumstance (at high antenatal vulnerability), some experiencing religious shunning by reason of divorce, ostracization, from cult-like systems of belief, many unrevealed victims and their children, or domestic violence.
children at risk: poly-risk histories intertwined w/current adverse circumstances, who have developed few protective buffers
Often not appearing for clinical attention until they enter the juvenile justice system as early teens, these children and adolescents-exposed are often characterized by histories of multiple (poly)-risk, multiple out of home placements, lives saturated with the effects of cumulative, adverse childhood experiences (ACEs) and few observable protective factors, -- their mothers tend to have had no or poor prenatal maternal health mental health, and sparse health/mental or health care. Often these youth have been born into poverty, substance use and criminal environments, crime and marginalization, and by default, they have had to live chaotic lives, have been frequently uprooted, multiply re-"homed' by social services, are chronically truant and acquire inadequate, substandard education due to the upheavals in their lives, but also a function of poor nutrition, exhaustion, lack of medical care, exposure - in many cases - to illicit substances; abandonment.
Over the years, the demographics of this patient population (the children) have changed, but the core need for those with multiple risk factors, complex, accumulated traumatization in the face of ignorance or disinterest, lack of awareness, little public understanding about their vulnerability and ever-present stigma, is much the same. A note to add here is that there is additional risk for children and youth who are transgender, who identify as LGBTG,, and/or who are confused or "gender-creative", in part due to the additional burdens of stigma, societal and familial rejection and rejection potential, and the very real, literal danger of violent assault and hate crime.
Teens who may be typically homeless may also be largely invisible as a result of couch-surfing, migrating through a disorganized set of highly exploiting child and youth underground settings in astonishing numbers. They may have been in and out of juvenile detention centers, have been frequently trafficked, constantly vulnerable to chronic, life-limiting illness and maltreatment, generalized exploitation. Some of them suicide, some are murdered (statistics, State of Nevada).
supporting both children's health and mental health care --
Psychological testing is often essential for accurate, effective need based & evidence based treatment planning:
In her US private practice, many of our individual pediatric and adult cases -- with their complexity of needs and shifting, unstable living contexts, present with a compelling level of challenge (some individuals have been considered refractory to treatment, passed from therapist to therapist, social worker to social worker, for years, accumulating lists of confusing, contradictory diagnoses, dozens of medications; often blamed or feeling blamed for their compromised psychiatric and functional status, considered hopeless. They are complicated cases involving involving a number of individuals, sensitive, confused and confusing, with a number of co-morbid diagnoses, child cases, often located at the edges of (symptom-based) diagnostic classification systems).
The clinical demands of organizing and ethically managing these cases, sorting out the many competing issues which attend them, and arriving at helpful, clarifying, working diagnoses, can be enormous, time-consuming, and stretch the limits of what can be obtained by skilled clinical interviewing, even at its best - however, the margins of diagnosis and treatment are where skillful use, interpretation, and application of psychological testing is most helpful, -- and that is one of our
Assessment based treatment is a tremendous strength, and foundational for the collaborative treatment planning in which she engages and trains others.
I have extensive experience working successfully with high school/college age individuals, graduate students, medical students, young professionals, silicon valley professionals and other adults who find themselves in places of frustration, perplexity, lack of direction or inertia, adults in crisis situations, compromised and painful relationships, reaching out for immediate, confidential support and assistance. Others are pondering life satisfaction and concerned with making meaningful changes.
transition and renewal
For these clients, highly uncomfortable transitional periods often signal potential positive change and renewal is at hand.
Such times suggest insightful, supportive deep listening may be beneficial in order for people to dare move toward clarity, begin utilizing therapeutic support they may not have experienced previously toward mobilization of internal resources, learning to engage trusted, predictable presence for movement toward a next phase of development and accomplishment.
collaborative approach/referrals
abbey is currently referring patients whose primary issues are longterm Substance Use/Abuse, those with Eating Disorders, and those with severe OCD to colleagues with expertise in those areas. When working with acutely, chronically depressed, actively suicidal individuals, we do so in conjunction with a treating psychiatrist, patient agreement to collaborative case management, and treatment as a team, with appropriate Releases of Information.
bio
An avid reader, teaching and performing musician (piano/harpsichord), Dr. Ruebsamen obtained a degree in Early English Literature from SFSU, then, inspired, with many contemporaries, by President John F. Kennedy to contribute to society by embracing children with exceptionalities, she obtained two generous federal Health, Education & Welfare Fellowships which supported two years of graduate work (M.S.) in Education of Exceptional Children, earned two LIFE Credentials, Regular Education, K - Secondary, Special Education/Visually Impaired Children, became proficient in Advanced Braille and Sign Language.
She taught toddlers and young blind children during the rubella epidemic of the 1970s; later, instructed children and teens with low vision in public schools for twelve years while progressing through clinical psychology doctoral studies. Working with low vision children, many of whom had many frustrating psychological struggles and losses to adjust to - intertwined with their actual visual conditions, stigma, and the consequences of being regarded and treated as "other" and "different", dealing with feelings of isolation and loneliness at times, was significant in propelling her toward the field of clinical psychology.
the power of being heard: pastoral care, hospital chaplaincy in the era of HIV/aids; jungian psychology
"he listened and never judged, and I began to live again . ." (C. Jung)
Dr. Marilee describes being transformed by the profound healing effects of masterful active listening and the skillful, sustained presence embodied by Chaplain Marvin Ruebsamen, Th. M., Good Samaritan Hospital. San Jose. There she trained in pastoral care and eventually co-instructed for twelve years in the volunteer chaplaincy program which emphasized Presence-oriented individual attentiveness. She participated in multiple, systematic trainings, studied Jungian psychology, and co-created Symposiums for the larger community. In the course of advanced training, she observed the work of the renowned interfaith AIDS Chaplaincy of 4th Floor SF General, fully functioning (to overflowing) at the height of the AIDS pandemic. At Good Samaritan Hospital, she assisted organizing Symposiums with speakers such as Fred Luskin - Stanford, (The Forgiveness Project), David Jacobson, (recently released hostage held in Tehran prison with Benjamin Weir, Father Jenko et al). As a Chaplain's assistant, Marilee worked primarily in Pediatrics, ICU, Medical Floor, End of life and Emergency Units.
clinical psychology
Dr. Ruebsamen earned a Ph.D. in Clinical Psychology at Pacific Graduate School of Psychology (now Palo Alto University), with concentrations in Psychodynamic, Jungian, and Child Psychology. Her pre and post doctoral internships were completed at Adult and Child Guidance Center SJ in order to work for extended time with acutely ill, terminal children, women and men with HIV/AIDS, worried and affected families. There were actually children being treated there for behavioral/medical issues who also required support for grieving the loss of each parent, in turn, to AIDS during that time.
aids: coping and bereavement -- ucsf aids bereavement (coping) project
She worked as a Senior Psychiatric Interviewer in the landmark UCSF San Francisco AIDS Bereavement (Coping) Project, collecting data by interviewing caregiving partners of young men dying of AIDS in the San Francisco Bay Area. This Health Psychology project investigated the coping strategies caregivers found most effective in managing the unpredictable, undulating course of intense, chronic stress they experienced while giving intense care to their partners, continuing data collection later during and after their bereavement (Drs. Susan Folkman and Margaret Chesney, Ph.D.s, UCSF, Principal Investigators). She was deeply impacted by the coping strategies employed by the (primarily young) men with AIDS who shared their "stressful events" as well as "happy events" shared in weekly interviews conducted for the Coping Project - most men were approaching their death at home, some in small apartments, where homemade buddhist altars glowed with candles, fresh flowers, photos, collected rocks - joy and generosity spilling over in the shadow of sadness and impending loss. The experience was sobering yet full of gratitude and joy.
pediatric aids: stigma, ignorance, rabid attitudes and rejection of vulnerable children dying of maternally vertically transmitted HIV/AIDS, and learning from those who gave them care
Dr. Ruebsamen had become a passionate supporter of the Pediatric AIDS Foundation in its formative years, and continues today. As a post-doc, a founding member of the first AIDS Committee of Santa Clara County, CA; and member of the first AIDS Committee of the California Psychological Association. She worked independently through agencies, faith-based organizations, and county medical facilities assisting parents of fostered infants and toddlers who had acquired AIDS and were were rapidly losing their developmental milestones as they died --in an era when maternal-child HIV transmission was not yet well-controlled in the US.
She conducted Dissertation research with college students living near SF, a major AIDS epicenter regarding their personal perception of risk regarding HIV/AIDS, and found their perception of risk of infection unrealistically and alarmingly, low.
professorship
faculty
associate professor, core part-time faculty, pacific graduate school of psychology
While a post-doc, and as she developed her private practice, Dr. Ruebsamen was recruited by PGSP to teach and clinically supervise a cohort of students and follow them through their required child clinical courses and practicums, teaching the Child sequence, Development, Psychopathology, Assessment and Treatment courses, later adding the Adult Assessment sequence and developing a Child Trauma Field (school-based) Track and Advanced Field Supervision. In following years, she taught as an adjunct at several other Bay Area doctoral programs.
consolidating theoretical and clinical issues
attachment theory: and the effects on children of exposure to high parental conflict which is unresolved; interpersonal and interparental violence
With Dr. Livingston, she attracted multiple grants from The Health Trust of Santa Clara County CA, creating the Advanced Trauma-Focused Field Assessment and Intervention Practica for students, serving at-risk, impoverished and underserved communities (East Palo Alto, East San Jose, Gilroy/South County, Central San Jose, Alum Rock School District; St. Elizabeth's School, Palo Alto). These projects afforded doctoral students profound trauma and chronic poverty-informed clinical opportunities, and support for presentation of their research at regional, national, and international conferences. Her instruction was grounded in Attachment Theory, Clinical Developmental/Psychodynamic Theory (Steiner), and contemporary Trauma Theory. It included the burgeoning research on the tremendous impact exposure to interpersonal and community violence has on children at various developmental stages - what that looks like clinically, how to assess and treat the children suffering from its impact in the field and in the clinic.
Much of Dr. Ruebsamen's clinical thinking derives from Bolby's Attachment Theory - (and modern variations, which recognize and value primary attachments which exist in the infant and child's relationships beyond sole the mother--proximity seeking and safety, secure base behavior, caring, predictable caregiving, infant parent psychotherapy, parent child therapy (Lieberman, Ph.D., Van Horn, Ph.D.). This included the bonds of love and protective nurturing that buffer secure attachment and sustain it in adulthood, even after loved ones have passed (the research results and eventually those results applied in the process of accompanying the months of illness and untimely death of close friend and colleague, brilliant researcher, Dr. Nigel Field.
consolidating and grounding contemplative spirituality, mindfulness, Buddhist thought, contemporary trauma theory,
and relationship-based treatment
Therapeutic work has been enriched by the study and integration of contemporary trauma theory and therapies, reflective parenting and supervision; a growing emphasis on self-compassion and treatment perspectives afforded by mindfulness, the deep contribution of the wisdom traditions, contemplative spirituality and Buddhist thought -- with the heart/affectivity as the relational home. This has resulted in providing treatment that is more clearly relationship based.
clarifying role of relational & depth interpretative approaches to psychological assessment
Many years of Roger Greene, Ph.D.'s rich faculty Assessment Seminars, Dr. John Briere's trauma research seminars and those of others, decades working with Phil Erdberg, Ph.D. and Dr. Livingston, Ph.D.'s relational and depth Interpretative approaches to performance-based (Rorschach) testing led Dr. Ruebsamen to develop exceptional skill in psychodiagnosis and rapid, accurate, assessment-informed intervention with children and adults who have endured extreme adversity, severe and complex trauma; frequently with complicated, comorbid health issues.
She has become adept at recognizing the interplay between inherent and environmental vulnerabilities with their personal, lived, experiences.
further clarifying mentalization, theory of mind, the inner world of internal mental representations
Her work with vulnerable, very young violence-exposed children and their parents is grounded in mental representation, effective executive functioning, empathy, mentalization/theory of mind as proposed by Dr. Peter Fonagy, UK,, in the attachment, caregiving and disordered attachment work of of Drs. J.H. Pawl, Mary Main, Eric Hesse, Alicia Lieberman and Patricia Van Horn, (Infant Parent Therapy and Parent Child Therapy), informal studies of attachment, loss, and Continuing Bonds of love and attachment after death with Nigel Field, Ph.D.
the importance of honoring context and transactional processes is rooted in Sammerof's work
conceptualizing parent to child abuse as, "failures in the expectable environment" proposed by Dante Cichetti, Ph.D., she immersed herself in early neuroscience studies of of infancy and adversity of Bruce Perry, MD; Daniel Stern, MD, and the Boston Group. The opportunity to teach Child Development at Pacific Graduate School of Psychology while a post doc was a tremendous opportunity for continued study and integration of concepts, led to richer understanding through teaching child and adult clinical courses and thoughtful application by means of supervising practicums and working a clinical private practice -- both largely composed of violence exposed children and families.
expanding theory and practice to a global perspective
children in time and place - and emotional space - children in relationship,
in families: a global perspective on "listening"
more recently, teaching Life-Span Development, she maximized the scope of the course by including contemporary globalization and health/mental issues impacting child/family wellbeing worldwide. Traditional domains of development were integrated with contemporary humanitarian assistance and protection, issues pertaining to education, spiritual care, and unencumbered, safe access to health and mental health care for the world's infants, children and youth, adults, elders, frail elderly, honoring "people in families", whatever the configuration.
integration of compassion, contemplative, psychodynamic thought
Clinically, she values the integration of meditation, contemplative compassion, Buddhist thought and psychoanalytic, psychodynamic perspectives presented by NYC psychiatrist Mark Epstein, MD, as well as the work of Norman Fischer, zen priest and abbott of the Everyday Zen Sangha, San Francisco Zen Center, known for his influence in bringing everyday buddhism to the west.
what suffering and pain can teach us: a lever for growth: caring, wise, kind, and joyous living . . . . According to Mark Epstein, MD, "if everyday trauma (loneliness, longing, and fear), common to everyone, doesn't destroy us, it is freeing -- it wakes us to both our minds' own capacity and to the suffering of others. It makes us more human, caring, and wise. It can keep us kind. It can bring us joy. Available to all of us, it can be our greatest teacher."
western psychology teaches that if we understand the cause of trauma, we might move past it,
while many drawn to Eastern practices see meditation as a means of rising above/distancing themselves from,
their most difficult emotions.
HOWEVER, both, Epstein argues, fail to recognize that "trauma is an indivisible part of life" and can be used as a lever
for growth and an ever deeper understanding of change. When we regard trauma with this perspective, understanding that suffering
is our greatest teacher."
In his 2014 book, The Trauma of Everyday Life, Epstein shares his belief that - universally and without logic,
our pain connects us to the world on a more fundamental level. He states, "The way out of pain is through it".
A Jungian might ask, "What is this experience asking of me?"
and a Buddhist, "Follow your sorrows. They will teach you what you need to know."
about maintaining an intentional spiritual practice in the face of adversity . . .
Dr. Ruebsamen practices engaged (feet on the street) spirituality, and the calm abiding
at the heart of the major interfaith wisdom traditions (contemplative Christian, Buddhist,
Jewish, Muslim integrating their major teachings - particularly those which emphasize affect,
the compassionate heart, and relational, communal caring.
She practices Lovingkindness (Metta) and Tonglen meditation, and supports others
in their own, meaningful spiritual practices, agnostic spirituality; secular orientations.
and so, although I know we're only small
In the time we have here, surely we have it all ,,,,,
so although I know we're only small
In the time we have here, ..... this time we have it all.
James Taylor
You, who are on the road Must have a code
That you can live by.
And so -- Become Yourself
Because the past Is just a good-bye
Teach your children well
Your father's hell did slowly go by
And feed them on your Dreams
The one they pick The one you'll know by
Don't you ever ask them why
If they told you you would cry
So just look at them and sigh
And know they love you.
And you of tender years Can't know the fears
That your elders grew by
And so please help them with your youth
They seek the truth before they can die
Teach your parents well.
The children's hell will slowly go by
And feed them on your dreams
The one they pick The one you'll know by
Don't you ever ask them why -
If they told you you would cry
So just look at them and sigh And know they love you.
Teach Your Children, Crosby, Stills, and Nash. Released, 19
That you can live by.
And so -- Become Yourself
Because the past Is just a good-bye
Teach your children well
Your father's hell did slowly go by
And feed them on your Dreams
The one they pick The one you'll know by
Don't you ever ask them why
If they told you you would cry
So just look at them and sigh
And know they love you.
And you of tender years Can't know the fears
That your elders grew by
And so please help them with your youth
They seek the truth before they can die
Teach your parents well.
The children's hell will slowly go by
And feed them on your dreams
The one they pick The one you'll know by
Don't you ever ask them why -
If they told you you would cry
So just look at them and sigh And know they love you.
Teach Your Children, Crosby, Stills, and Nash. Released, 19