Everyone Needs Therapy

Your Depression and Your Kids

2009-11-19T20:08:00.009-06:00

My mother always tells me, when I go back to the year my brother passed away, We acted like we were fine so we could have a life, so we could still have friends. We didn't want to lose them, too, our friends, being sad all the time, and we didn't want it to affect you. We still had other children.

And of course we, my younger brother and I, didn't want to upset them, our parents, who were so confused and aggrieved, so we didn't talk about it, either. As a result there was very little family grieving or overt depression.

The silver lining, if there can be such a thing, is that we did make some family resolutions about how we needed to interact with one another in the future. We upgraded the family intimacy with these rules, and held by them, honor them to this day. They're mostly about showing affection.

I think a lot of families handle loss the way we did, don't talk about it. I would venture to say, most.

Whenever I share personal things on the blog, there's a reason, and it's not so you should think you should do things my way. Any ersatz personal solutions you read about here (usually involving dinner) might have been right for me, the right way at the time, but maybe could have been the wrong way, let's talk. A family coping strategy is only as good as what follows the enactment.

We suggest coping strategies in therapy all the time, knowing that sometimes they work, sometimes they don't. Sometimes a therapist knows something will work (we just know), and sometimes we know that it's a long-shot and we'll tell you It's a long-shot. Or sometimes it's a sure thing, but something gets in the way, like life.

Let's move on, get away from grieving, move over to feeling sad, tired, teary, and withdrawn, typical symptoms of depression. What's a mother or a father to do, what's a a parent to do, when depression is crushing? Disabling? What do you do when active parenting becomes very, very hard?

Are you supposed to be honest with your kids about your feelings? Maybe. How honest? Answers are based upon the circumstances, and certainly upon the ages of the children. A five year old who sees his mother napping is likely to be good with

She's tired.

Spare the kid the details if you can get away with it.

But should we hide our tears indefinitely? Depression can go on and on and on and on. Even if we want to hide them, the problem, of course, is that hiding tears is rarely possible with children. Most of these creatures are empathic, can sniff the sadness of a turtle. This is why, frankly, the nap concept is a good one, and often does refresh, removes the tears, if soaks the pillow. If you can sleep, it's a gift, try to rest a little, if only to refresh the program.

I'm not trying to minimize the pain, as if to say a nap cures depression. I know how debilitating it is. Sometimes there are no tears at all, you know what I'm talking about. Sometimes the cloud is hanging overhead all day long, all week-long, and the burst never happens. There are coping strategies, like CBT, where you try to stay rational, try not to sink into despair and self-pity, and surely the support of a significant other, if one of these is around, is invaluable, as is a good friend. Therapy. Crying on an available shoulder.

But not the child's. The child will think about this, worry about this, find homework meaningless, and carry a parent's depression to school the next day. Or maybe not. But why take the risk?

Spare the kids your tears. Nothing makes one sadder than Mommy or Daddy's tears. And when the tears can't be helped, a quick recovery is best, for sure, a performance is in order, if a performance is possible. If this is a major affective disorder with depression, a 296.23, or .33, recurrent, severe, or a bi-polar disorder, a 296.89, acting may not be possible, minimizing the negativity may be impossible until medication begins to lift the brick off your head.

But if it's possible, when caught by your kid in the act of depression, a nod to Sometimes people just feel like crying, nothing's really wrong is a good nod. You will not always be able to get away with this, but if you can, by all means.

Isn't such emotional dishonesty wrong, you want to know? Shouldn't we be honest with our kids?

Not in my book, not if it's going to make them sad. What do they need this for, our sadness? They'll have their fair share, don't worry, in life.

That said, adult children can handle a lot of sadness from their parents. They feel esteemed, even, depending upon what we tell them, that we trust them with our honesty, our raw emotion. It is a compliment when I share with you. You are trustworthy.

And yet there's such a thing as emotional incest, mostly when it comes to the little ones. When the child is anxious because a parent has disclosed things prematurely, things that are difficult to forget, this can be considered emotional incest, invasive and traumatizing.

It is our job, some of us believe, to sanitize life, to make life feel okay for our children so that they can do their job, which is to play, without distraction, to learn how to make friends, to practice being a friend. (There is surely too much emphasis on academics these days, you know.) No childhood is worry-free, there will be upsets, but you control what you can.

I saw a movie last night on a DVD AWAY WE GO, starring John Krasinski and Maya Rudolph.

WARNING: SPOILERS RIGHT ABOUT NOW.

Although it's a little too sad for someone like me, I loved the people in this film, the young couples, friends and siblings of the protagonists, especially one couple who adopted a bunch of children and wouldn't let them watch the Sound of Music beyond the Good Night Song. They can learn about the Nazis when they're a little older, is the thinking.

John and Maya look for friends and relatives in different cities. They want to move somewhere, to settle down where they have connections, support. It is lonely, even in a loving, good relationship, without people.

The story (thanks to Sam Mendes, director, and writers Dave Eggers and Vendela Vida) lends us an answer to that question,

What do you do when parenting, active parenting, is very, very hard?

It really is all about the support system. Maybe Mommy ran away, or maybe she's just tired, but if she has this, social support, then there could be an aunt or an uncle, someone who doesn't mind filling in for her. Or a close friend, or a grandmother-- someone Mommy trusts, emphasis on the trusts.

A very social work-y solution, indeed. I'm open to others.

therapydoc

What Do You Do With a Drunken Pilot?

2009-11-14T17:18:00.014-06:00

The Wall Street Journal reminds us that the real terrorists are we.

We spend hours in line at security to reveal our weapons and gels, while a breath away from comatose, there in the cockpit of the airplane, the captain at the controls . . .

is snockered.

I don't know about you, but when I board a plane, I try to catch a glimpse of the pilot, try to reassure myself that this guy has had enough coffee for the flight. He tends to look like a marine, which is reassuring, and once in awhile he will be a she. Sometimes he'll have a drawl, sometimes will have that clip to his speech that says, "I'm all business. Get your laughs elsewhere."

In any case, you hear a lot as a therapist, so you worry about the shape of the captain. Pilots are people, too, and like everyone else, they work hard and some of them play hard. It can't be easy working hard if you've played hard the night before.

Maybe some of us are neurotic fliers and worry needlessly about dying in an airplane crash, especially because it's a quick and easy way to go. But that's not why we buy our tickets.

Susan Caray tells us the story.

The United Airlines pilot arrested this week in London for alleged drinking before taking the controls of a 767 jetliner to Chicago might have his pilot licenses revoked and could spend two years in jail.

And my kids wonder why I save all of my morning prayers, afternoon prayers, you name it prayers, for air travel. You need a lot of these, you know, if the pilot is going to be impaired.

Ms Caray continues:

The pilot, Erwin Vermont Washington, also could wind up back in the cockpit, through a rehabilitation program run by the Air Line Pilots Association union and a long but well-trod route to redemption blazed by a number of pilots over the years.

This is reassuring, it really is, that the union for the pilots offers rehab for substance-dependent pilots. Perhaps last week's latest wake-up call will wake someone up. All over the country, indeed, I hear pilots telling their loved ones,

"I'm going into rehab! Forget about the holidays. This is more important!"

My guess, however, is that no one will.

This is because a drunken pilot is a pilot in denial. Mr. Washington, last week's drunken pilot, had a swig of the hooch shortly before take-off. That's definitive denial, a pilot with a problem that won't ground him, no sirree.

Does anyone know this song?

"Drunken Sailor"

What do you do with a drunken sailor,
What do you do with a drunken sailor,
What do you do with a drunken sailor,
Earl-eye in the morning!

[Chorus:]

Way hay and up she rises
Way hay and up she rises
Way hay and up she rises
Earl-eye in the morning

The next verse is one from my tribe, I'm pretty sure, although my father denies singing it to me. I thought he learned it in the Navy in the Pacific:

Hit him in the head with a wet salami,
Hit him in the head with a wet salami,
Hit him in the head with a wet salami,
Earl-eye in the morning

Yeah!

Alcoholics at the helm of the family car typically tell their partners on any given night out,

"I drive just fine."

Which makes me think that more people need to buy salamis, and soak 'em well. Don't hit anyone, what responsible clinician could recommend that, for it is futile, but keep the salami around.

We don't want our pilots slowed down, retarded from alcohol, none of us want that. Should we revive this classic song, the salami could serve as an aversive stimulus. Hanging in the kitchen, perhaps the cockpit, too, the sausage might become a symbol of sobriety. Consider this an upgrade.

Rehab would be great, don't get me wrong, but since no one's racing to that solution, we really do need to come up with a better one, something a little more acceptable than deli. Vegans are insulted as we speak. A modest proposal coming right up.

Isn't there a little contraption, a breathalyzer that you can use for your car that won't let Old Red start-up if you have a level?* A level is a blood alcohol level above .08, but states vary. The car won't start until the driver takes the breathalyzer test and passes. Lose the test, lose the keys, or may as well, for they are useless.

The Air Line Pilots Association should consider lobbying management at UAL to install breathalyzers on every plane. They need to protect us, the consumers. We like living. We're not in denial.

Denial means that someone struggling with alcohol dependence may not think he's too drunk to operate a vehicle. Should that someone be a pilot, the vehicle an airplane, this makes him a terrorist, a time bomb.

The FAA ultimately has to do something about this; it's not unique to United Airlines. The industry has to do much more than offer rehab. Something has to bring these guys down to earth.

Oh, and most people avoid rehab, you know, until it's too late.**

therapydoc

*In random conversation I suggested that any official in the organization could administer a breathalyzer test to pilots prior to take-off, de rigeur. Then FD told me about these gizmos you attach to the dash. Much more elegant. Although obviously, it will ground us for who-knows-how- long while the airline scrambles to find a replacement. I, for one, won't mind the wait.

**And until they do, there are plenty of great recovery websites on the Internet.

I found it!

Wanting to Kill Yourself, But Not Wanting to Kill Yourself

2009-11-02T06:16:00.008-06:00

This is such a great topic and I've avoided it for too long. But a comment on an old post reminded me that you have to hear the other side of suicidal ideation. This is sanitized a bit. The bold font is mine.

I am a victim of a violent crime by a person in my family. Now I am planning on being a psychologist/counselor. I know that it will be difficult but I want to be there for those who have gone through this situation and I want to let them know that they don't have to let this ruin their lives. Depression is one out of many symptoms, I know, but is it normal to have the desire to kill yourself every time you remember your past? I have had trust issues because of this, so I sympathize with all the victims out there and only wish that I could bring forth justice in all their lives.

I'm not sure where, "Just shoot me," entered my particular vernacular. Some of us say this then put a cocked index finger to one ear, click, pretend to off ourselves, and everyone laughs.

Anyway, I've been saying it a lot when I hear about things in my personal life that leave me speechless, make me shake my head, as in, "What now? What next?" When I'm frustrated with people.

What's interesting about, "Just shoot me" is that the person who says it obviously doesn't mean it, is just signaling frustration with life's impossibilities. We can't control most of it, certainly not the behavior of other people. So we laugh it up, say, Shoot me.

I give up.

Which implies that someone else wins, but it's okay. We concede the victory with relief. Let it go.

I think this happens on a much deeper psychological level in trauma victims. If a person suffers a trauma, even secondary trauma (hears about someone's trauma and feels the pain), it can trigger suicidal wishes and fears.

Immediately after a trauma or during the trauma, the thought, I would be better off dead is seeded in some neuropathway. Then you get the emotion, the fear, the terror, or it's there first, doesn't matter. But the reasoning, the thought processing about the event becomes unconscious, and that happens rather quickly. All that remains for eternity is the conclusion, I want to die. Sort of stuck like a broken record. You can turn off the juice, but someone keeps turning it on when you least expect it.

And the fears remain, associated with the conclusion, better off dead. You never wanted to die, you never wanted to be raped, to use a common example, or sexually harassed, perhaps, but the thought and the fear originated at the same time, under heightened arousal, and became inextricably linked in the brain.

Our brains are simply out of control. You would think they would get a grip.

But no. Get a bad thought, link it with a negative event, and there's your negative thought, warmed over easy again and again with the thought of the event. And then, the evolved negative emotion, the depression that lingers beyond fear. Fear may have burnt itself out. Maybe not. Just shoot me.

If you grow up with someone who is suicidal you are literally fed this thought with every suicidal threat, wish. You could be a happy go lucky kid, someone with a fairly happy little neurotransmitter, and you listen to the gloym and doym and you think, Oh, for crying out loud. You don't get a corner on suicidal ideation, I have my own, damn it. And you do, not because you want it, because you breathed it.

Hard to be tough sometime, hard to have great boundaries, to know,in your heart,

This is not what I want, this is not who I am. This is merely something I thought once, under a great deal of stress.

Or

It's something someone else wanted, under stress. But it has nothing to do with reality, not mine. I really don't want to die, I certainly haven't the guts to kill myself even if I did.

But here are these stupid thoughts, coming home anyway.

So I wrote her back, said something like this:

Not to answer you personally, but hypothetically people do have what I call "normal" suicidal desires and fears, and these mean absolutely nothing, meaning, people who have these desires and fears would never in a million years kill themselves. You might be one of these people, probably are. That said, for sure, you gotta get therapy to work it out and you really can work it out. Reading about it on the Internet probably won't cut it.

So you want to know, don't you, what happens in a therapy that works it out?

You go over the trauma, for there usually is one, even if it is imagined. Some people have amazing imaginations and they make themselves upset with their own creativity. Doesn't matter if it's real or imagined, most of the time it's real. You go over it again and again, line by line, verse by verse, and examine your responses, how they were normal fear generated thoughts under stress and how wanting to kill yourself rather than face others in the shame of it all felt like a normal solution.

Then with your therapist you do a cognitive behavioral therapy. You challenge the date on the inserted thought.

Wait a minute. The date on that thought is August something, 2004! It's now November, 2009! That thought has expired!

And you let it expire, die a natural death.

You challenge your shame, you say,

And I did nothing to deserve this! Why should I kill myself over something that happened to me?

As my daughter is fond of saying, Most of the time things happen to us. And she's right. We can take responsibility, sure, and we should, and we should rectify whatever we can, make whatever amends are necessary, do whatever we can to right life, but owning things to the degree that they make us sick? Forget that.

Be charitable, pass them along.

therapydoc

Housekeeping

2009-10-30T07:48:00.003-05:00

I just cleaned the refrigerator because Michelle (not her real name) from Blue Cross Blue Shield called to inform me that because I am a "high volume" provider; they're coming over to audit my charts.

That will be the start 0f one of my upcoming posts.

And you want to know why I don't blog more often. You know I want to talk to you, and it kills me that there's not enough time. I'm not even responding to comments and am late in posting them, too, intend to do it, still plan to get back to them, for sure. But the road to hell is paved with good intentions, or something like that, and all I can say is that there's a lot of stuff on the proverbial plate, it's spinning madly, and

I'm sorry.

That said, please know that I read every comment and appreciate every one of them, and believe me, I learn more from you from this process than you could possibly realize. Indeed, one reason some therapists last in this field, don't totally burn out, get infected from so much pathology, is that we learn from every person we see, from everything we hear, everywhere. We might complain on occasion, but everyone does, you know.

It's been said before, this job is interesting, challenging. You have to stay on top of new knowledge, although you might rely on a foundation. Professionals have to keep learning, that's what differentiates them. Our WOW! really is a wow. It isn't placating, it isn't fake; there's no agenda. When the learning comes from others, it's illuminating. And a lot more fun.

So we're grateful that people share their lives with us, feel privileged. The first thing we tell patients as they button up their jackets to leave, maybe after the first visit, the second, third, fourth or fifth, etc.

Thank you for sharing all of that. It can't be easy, I know that it isn't. Thanks for trusting me.

When I started this blog, honestly, I did not know what to do with comments. They freaked me out.

Oh, no! This person thinks I'm her therapist! What will I do with this comment/email? What if she takes something the wrong way, uses it as personal advice, isn't seeing someone else, a real flesh and blood human being who can intervene and go,

Call 911! You need to be in a hospital!

Meaning, I could be responsible for something bad!

This blew me away, more-so than an occasional stalker threatening me and my family, or a BCBS auditor.

Which is why there are all those caveats in the margins that say,

I ain't your therapist, get one somehow, please, please, please. This is for your edification, is all, and it's fun for me, okay?

And you know I mean it, get therapy if you can, hence the title of the blog.

And yet, by all means, we can talk, we can share information. There's no one shutting us down, and why would there be? It's a mutual admiration society. So what I'm saying is No, to those of you who have asked if I'm giving it up.

And one day, no promises, I'll blog about it, tell you everything. You did sign that HIPAA form on the sidebar, right?

therapydoc

Being Right Part Two

2009-10-30T06:10:00.008-05:00

I thought there might be a Part Two when I posted Part One of Being Right. Sometimes there has to be a Part Two.

In Part One we find me hopeful about people changing. It takes time, but even people who have to be right all of the time can change, can yield the point with or without therapy, if you play them right. A family systems approach works better than CBT, a cognitive behavioral therapy that falls with defensiveness on deaf ears, as in, What do you know?

Part Two, I'm sorry, is more depressing. I find that I can't change some people, not without medication to chill them down. They'll never yield the point, never be wrong. They're simply too afraid. And they have a disorder, probably.

If it's Schizophrenia, Paranoid Type, an Axis I disorder, you can't blame a person for being quite sure that there are enemies out there, that people are persecuting him. He's right about this, absolutely sure; they're listening through the telephone, the computer. Voices and imagined events are real, no convincing otherwise.

These are delusions. Even with help, without medication delusions can be hard to dislodge. Try and convince people who suffer from them that they're wrong. Good luck.

Being right is also a feature of Paranoid Personality Disorder (PPD), an Axis II, and we can't blame people for personality, either.

Nowhere does the word "delusion" appear among the diagnostic indicators of PPD (listed below) but the features imply that sufferers are delusional by virtue of their unfounded distrust. Because they hear no voices they're not technically delusional. It is their faulty construction of reality that makes them suspicious of others, not voices in their heads.

You can have both, an Axis I disorder like depression, addiction, or anxiety, and an Axis II, a dysfunctional personality. The latter can cause the former. People can get depressed because others don't like them; they can't look in the mirror to see how difficult they are to love. Hospitalized for the whole gestalt, even CEO's billionaires, people ostensibly doing just fine, functioning at the top of their game, get mentally sick.

Personality develops in childhood as our genetic predispositions are slapped with reality, the world out there. Some traits lie dormant until challenged by the hand we get, our families, friends, teachers, our luck. Yes, you actually can blame the family, and you can blame others (try that boarding school, orphanage, the Nazis, or a father who liked your little brother better) for bringing out the worst in you.

The problem is there's no pointing any one finger at any one person. Everyone's a product of someone else's stress in transgenerational theory, people who victimize have probably been victims themselves. If you go genetic, you have to start with Adam and Eve and all those other mamas and papas.

Surely some features of personality, especially the cute ones, the positive ones, aren't snuffed out with negativity, and they're genetic, for sure, our cadence, how we talk, joke around. We see our mannerisms in our children and grandchildren, we know they haven't copied us intentionally. There's wiring in there. Yet we all talk like Seinfeld. Would I lie?

The environment gives the nod, the go-ahead to both the good and the bad.

In Part One we discussed how when childhood stress is bad, as it is under the roof of abuse and neglect, unconscious decisions to cope with it aren't always good. Without parental coaching, how's a kid supposed to know what to do? So children make decisions, as in, T

Trust no one.
Don't tell me, I'm wrong. You're clearly wrong, and you're scary, and
You're not the boss of me now.

We call attributing, or casting unwarranted negative aspersions to people paranoia, and we're not talking the pot smoking kind. You can change that by getting straight, you know.

When paranoia rules in an otherwise normal personality, as in Paranoid Personality Disorder, there's no yielding the point, no being wrong about people and their intentions. The person suffering from paranoia is sure, 100% sure that. . .

He stole that money!

She cheated me out of the property!

She has my ring and won't give it back.

He thinks I'm stupid. I'll show him!

Very difficult to convince people like this that they are wrong about this, no matter how much cajoling, flattering, affirming, validating, you do.

Okay. Maybe with a lot of sex. But even with physical affection, I don't know, the odds are that the paranoia will come back again under stressful conditions.

This is why, by the way, medications are helpful, they help people buffer stress. It is also why some people don't want to take them. They don't want to be left vulnerable to exploitation and harm, psychologically "buffered" from the pain.

Here are the features of this intractable disorder.

301.0 Paranoid Personality Disorder:

A. A pervasive distrust and suspicion of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by 4 or more of the following:

(1) suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her

(2) is preoccupied with unjustified doubts about the loyalty or trust-worthiness of friends or associates

(3) is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her

(4) reads hidden demeaning or threatening meanins into benign remarks or events

(5) persistently bears grudges, is unforgiving of insults, injuries, or slights

(6) perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack

(7) has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, or another Psychotic Disorder and is not due to the direct physiological effects of a general medical condition.

No fun. Partners, spouses and children are often accused of cheating, lying, having affairs, manipulation. Friends and children of friends, housekeepers, baby sitters, business associates, deliberately plotting behind their backs. People look at them the wrong way, people wrong them, think they're oblivious, stupid.

These are angry people. Suspicious. Not obviously, sometimes, they won't always tell you their suspicious, but surely. Telling you might give you an edge.

There is a strong association with child abuse, and you can see why. If you can't trust your own parents to take care of you and protect you, to show you that they love you, that they believe in you, who can you trust? Or if you lived in a concentration camp, and every authority was a killing authority, every uniform or bunk mate a possible snitch, you learn to read aggression in people, even when there isn't any. You misinterpret facial signals, body language, tone of voice.

You learn to trust only yourself. You become impenetrable, are perceived by others as tough. Deep down you want others to adore you, to tell you that you're wonderful, and you may behave as if you believe you really are, but you're really not sure. This thread of insecurity runs through most personality disorders, you know.

People who suffer from Paranoid Personality Disorder are often afraid to put themselves in situations that are intimate, it makes them feel vulnerable, weak. They won't initiate an intimate conversation, and have buried their issues deeply, don't participate, necessarily, or appear disconnected, laugh when they shouldn't. Makes sense, right? How can you let a potential enemy get close? That's just plain dumb.

You don't make yourself vulnerable, tell people your true feelings, your fears, your sadness, if there's a chance of being punished.

That's another reason you have to be right, too. So you don't get punished.

therapydoc

On Being Right

2009-10-22T22:00:00.006-05:00

You wonder, don't you, why it is that some people can never be wrong? Even caught, busted, backed into a corner, they'll lie to your face, tell you they didn't understand the question, or that you're interpreting what they said incorrectly. Never wrong, can't be.

It is everything to them, everything to be right. I'm sorry isn't in the vernacular. Nothing to be sorry for if you're always right.

If it's an acquaintance, you can let it go, maybe laugh it off privately, placate your friend. You intuit that this person needs validating, an emotional lift, an ego boost. Applause. So you give it. It's cheap.

If it's a colleague, someone on the team at work, or a fellow committeeman in an organization, a herd of industrial psychologists can't budge this person, will throw arms up in despair, slap together an agreement nobody likes. You just can't negotiate with some people.

When it's the boss, and it often is, well, you know who is right, and it isn't you.

Ditto, maybe, if it's family. History proves resistance futile, so you coach the kids,

Don't bother arguing with ___(Dad, Mom, Uncle Herb, etc.).

It's a waste of time.

Those of you coping with this emotional system come to therapy, usually, because someone else can't cope with this person. And the someone else won't let it go, insists upon arguing with the one who has to be right. Maybe it's a child or a teenager in charge of the revolution, or maybe it's you, finally fed up, sick of letting the baby have his bottle. Everyone in the family feels this negative emotion; it's palpable. Family and/or marital therapy is an attractive option.

Mainly because there's no sex in the marital relationship anymore, so changing this is an incentive for therapy. Anger's just not sexy. Or one of the kids is off "doing his own thing."

The ones stuck being wrong all the time are the ones who volunteer for individual therapy. The therapist is empathetic, knowing how difficult difficult people can be. It's not easy always yielding, always being wrong, for if you live with someone who is always right, and you disagree with that person, then you're always wrong.

Which feels bad. You might even come to believe it, too, that you really are more wrong than right, especially if you start out in the relationship a quart or three low in the self-esteem department. If you start out full, you'll find it runs out easily if you're always wrong. (This is systems thinking.) Like the Dementors in the Harry Potter books who whoosh down and sap happiness from others, steal it, make it theirs; you get sapped of self-esteem, happiness, no matter how well defended.

Generally we think you get this valuable commodity, self-esteem, maintain it or lose it, too, in a social process: direct communication or meta-messages, messages embedded in messages, body language, tone of voice, spacial positioning. These all communicate one's value, good or bad. Very little gray in most messages like these.

Such a humbling experience, too, being on the receiving end. Our partners, our parents, are supposed to be the home team. They are supposed to value us, validate us, tell us we're smart, we're good. People are supposed to be pleasant to one another in caring, intimate relationships.

Like FD will tell me, "You're not so bad."

It helps to have positive feedback, and the running hypothesis here, surprise surprise, is that people who have to be right all of the time didn't get positive feedback when they needed it most, during childhood. Those critical years, the formative years, really are critical, they are formative. And they can be wonderful, full of awe and wonder, or not.

The have-to-be rights never experienced wonder years. No happiness or wonder for them.

Those of us who adore our children, who praise and encourage them, who use reason when they're out of line, as opposed to beating on them in one way or another, believe children should stay in wonder for as long as possible. We know that the world is full of let-downs, disrespect, wallops, lumps. Nobody knows us out there, few care, really, how we feel. If we have three good friends, we are very, very lucky.

By and large, life's about taking the punches, coping with rejection. And our friends and family, people who care about us, buffer that.

You apply for a job and there's not so much as a rejection letter for non-candidates. We used to get these, Thank you for applying. . . but. . . letters. Now we know that if there's no call back, there's no job. No communication is communication.

Thus the Rodney Dangerfields are everywhere, getting NO respect. No "I value your opinion, your thoughts, your skills." That's why parents have to do it first, get a quart of three into us when we're little, hope it keeps. Value, validate. The words sound alike. A giving thing, this expression of someone's worth. We don't have to agree with our kids, with anyone necessarily, to say, Wow, now that you've explained it, I see why you feel the way you feel.

That's validation.

In the Chicago Public Schools there's a new program, the WOW program. Teachers are supposed to say WOW, no matter what a kid does.

"You didn't do your homework? WOW, I imagine you just didn't have time!"

Implicit respect. Wow, I see why you feel the way you feel.

No need to add the but; it's not a compound sentence. Validation means no qualifiers necessary. If I didn't ask for an alternative opinion, why give it to me? I may still be glowing in the Wow. The but can come later. And if there isn't any communicated respect, no validation, which takes some time, actually, in discussion, it's likely there's no interest in alternative thoughts and opinions.

This is the rationale behind the intervention you read on this blog relatively often, validating without regard for receiving validation in return, or unconditional validation in communication. Here the one who is always wrong (according to the one who is always right) patiently validates the one who clearly needs to be right.

To do this and not lose your mind, you actually need to know your subject, why he or she needs to be right, which can be very personal, very intimate information. But if it's a parent, or a partner, you have the right to know.*

So you snoop around and find, in all probability, that there's abuse in this person's background, shame and abuse, verbal, physical, emotional, psychological. This person has been labeled

stupid, retarded, fat, a wimp, a loser, maybe a fool.

Something. He or she may have been slapped silly for being so dumb. Stupid and dumb are operative words. Children should be seen, not heard, you can assume this, in families like these.
A child learns to stay invisible, is afraid to venture an opinion, knowing that the opinion isn't wanted, commands no respect.

You would think parents would naturally know, would simply have the empathy necessary to know that kids need to be asked an opinion now and again, that they need to feel important, to have a say in their lives, that this is how they emerge from the Petree dish of family with some self-esteem, a modicum of self-worth. We all need the You are important message. You are someone very capable. Without this type of messaging a person suffers a hunger, a growling in the tummy that won't quiet down.

Although I like to think that a corrective relationship feeds the beast.

Childhood abuse and emotional neglect is transgenerational, zips right past go, starts somewhere in the lower branches of the family tree and grows, like ivy, up. Subsequent generations might copy the behaviors of aggressive parents, identify with the aggressor. But it is not so simple as this. More likely, if one has been muted, called stupid often enough, shut down, there is still a thinking brain, a healthy vector of self that whispers, mouths silently to the aggressor, on more than one occasion during childhood,

"Actually, I'm not always stupid. You're stupid. You know?"

This voice grows louder inside, this shoot of a child's budding identity, this personality in progress, and grows very rebellious, even, over time.

I call it the Survivor Ego. Maybe others have other names for it. I've never read this in a book, to be quite honest.

The silent scream volleys hard,

"I am not always wrong, I am not always stupid, and damn it, one day, you'll all have to listen to me because I am not going away. You will contend with me when I am older. I live!"

The beginning of the oppositional personality.

Having been shut down for so long, the Survivor Ego lives to revel in expression, thrives in the countering of opinions, thrills with the power of final say.

"I live, okay? They didn't kill me. Won't somebody please notice?"

It is a micro-decision of youth, to respond this way, rather than cower every time, yield every point. It is the black/white of borderline. And the decision is unconscious by adulthood, that decision that turned the key, for evermore, the one that cheers the adult child on. "I'm right!" It's like a drug.

So you see why there has to be some psychotherapy, some good old fashioned psychodynamic therapy, to end the reign of terror, and the one who needs it is in no hurry, feels no need to get it. But when it happens, a person can change.

The change, albeit unstable at first, maybe forever, yields the point, many points, to significant others. The changed individual feels compassion for others, even empathy. This is possible for the memory of his history empowers him, substitutes for the other drug, having to be right all of the time. They believe me. They get it. They know I'm not stupid.

And when being right feels irresistible, when Mr/Ms Has-to-be-Right slips?

A raised eyebrow is enough, assuming you've agreed on that signal. In family therapy we're big on such things, signals.

therapydoc

*Just my opinion here, as usual, what you pay for when you read this blog.

Human/Animal Rights

2009-10-14T11:07:00.046-05:00

National Network to End Domestic Violence Hands down, one of the best resources on the web.

A personal fave, the chocolate Labrador retirever.

Short story:

A patient, someone who is weighing whether or not to leave an abusive spouse, a spouse who will not get help, tells me, "No human being has the right to hurt another."

Uh, huh. Go on.

Then she asks, "Don't you agree? Does anyone have the right to hurt anyone else?"

Probably not, probably not. And yet, it happens. And you have to get out of that when it does, even if it means abandoning, hurting the one who hurts you. Hurting that someone else, the one who has been hurting you, has to happen, it's a part of the process, and most people would agree that even if it's going to hurt, even if there's risk, you might have to go anyway.

You're not punishing, you're just going, I like to say. Nobody's punishing anyone.

And there are risks, safety risks, which is why support is so, so important. So many qualifiers when it comes to these things.

October is Domestic Violence Awareness Month.

The month is really brought to you by the National Network to End Domestic Violence, and if we reach way back, the Family Violence Prevention and Service Act of 1984. But when I searched "domestic violence awareness", surprise surprise, the NNEDV didn't show at all.

Somebody did their SEO* homework, that's for sure, and a collaboration between PAWS and the American Humane Association grabbed the top spot with a feature on the Pets and Women's Shelters Program. Social service providers are matching up pets and abused women to alleviate stress for both, kill two birds with one stone. Not the best metaphor, admittedly.

At first I was confused. The whole idea, really, throwing women and pets into the same sentence. But pets are vulnerable, and women and children are vulnerable, too. Almost anyone, male or female, can find himself at the end of someone's boot now and again.

This is really pet therapy, using pets as therapeutic agents. Animals have healing powers, provide comfort to humans. There's even a genre of specially trained Therapy Dogs that pad into nursing homes and residential treatment centers. These uncomplicated creatures are only in the biz to give and to take love. They haven't much else to do, really, and they're furry. So why wouldn't victims of violence love to love them?

Some might prefer to have the rent paid, or a fur coat, maybe, but then the PETA people would be on them about that. There you are, recovering from an abusive relationship, hugging your fur coat, and someone throws paint on it.

The PAWS idea makes sense to me, however. PAWS stands for Progressive Animal Welfare Society, by the way. I've suggested to parents, on occasion, referring to an occasional very, very sad kid,

"This kid needs a dog."

Or maybe a cat. Or a bird. Or a fish tank. But the dog, well, a dog is (wo)man's best friend, proof positive, everyone knows. You've seen Lassie, Rin Tin Tin. I'll take that chocolate lab, if you don't mind.

It's amazing how fickle we can be, some of us, after burying a faithful pet. You would think that replacing him is the next step. But service complete, we sometimes let them go, decide that taking care of a dog is too much work, too big a commitment, come to think of it. And have you seen the price of heart worm medication lately? I hope the Pets and Women's Shelter Program is going to pick up the tab.

Let's move on. There's so much to know about domestic violence, like one out of four of us will fall victim in our lifetimes. Check out what the President of the United States says.

And the National Coalition Against Domestic Violence

and the US Department of Justice.

Don't miss the Domestic Violence Awareness Project (DVAP)

I like their mission statement a lot:

The Domestic Violence Awareness Project (DVAP) supports the rights of all women and girls to live in peace and dignity. Violence and all other forms of oppression against all communities of women and their children must be eliminated. To change belief systems and practices that support violence against all women, the DVAP recognizes and promotes the participation of the entire community in building social intolerance towards domestic violence.

And they have resources, things a person with heart could do to work towards eradicating domestic violence, give it a shove out the door, make it one of those zero tolerance things.

The idea that we should work toward eliminating violence and all other forms of oppression against all communities of women and children, fantastic. I would add, toward men and pets, too.

It's all very much like, "No human being has the right to hurt another."

No?

therapydoc

SEO, as in search engine optimization, the science of getting a website to the top of a Google, Yahoo, or Bing search. See my sidebar.

The Mamas and the Papas Indeed

2009-10-01T08:20:00.074-05:00

California Dreaming?

I'm not feeling sorry for myself, but it's been four months since I've seen my West Coast kids and grandkids and that's a little long, even with Google-vid and chat, texting and email. Even with those pictures that pop up everywhere. Nothing helps when I get like this.

Although talking, especially about things that are intimate, helps tremendously.

Over the phone my daughter tells the story about my five year-old grandson,

"Mommy! I put a birthmark in my book!"

Undoubtedly, the stuff of the Mommy Blogs, and you can laugh at the telling, but I would have loved to have been there. I understand his Mommy had a hard time keeping a straight face.

We can talk about our marvelous virtual world, how we keep in touch and all that, but there's nothing like the real thing, the real humans. The touch of your children, the smiles of their spouses, the hugs of your grandchildren.

We'll get to Papa John in a minute.

It cost me a few bucks in gifts, not bad at all, especially since Southwest takes the bite out of baggage, doesn't charge. They're so funny at Southwest, so laid back. None of the attitude:

You're dirt, why should we even let you stand-by.

It's all:

Chill out. We'll get you there.

And there are plenty of places to plug in devices.

So I filled a nylon duffel with various throwing things cuz the kids like to play catch with me, and real kid toys-- puzzles, Disney-Rummy, nothing too expensive. September, birthday month, passed uneventfully so there had to be a few cards, too. Cards are a big deal in our family. You can forget the present, but it's unforgivable to forget a card. I didn't forget, just didn't get to it.

I always freeze, too, when it comes to what to write in them. Maybe everyone does. My solution is to edit the Hallmark text, flip it to get it right.

A favorite pen in hand, I went at it at the airport, two hours to kill. My chauffeur had to make it to a class.

I wanted to buy a magazine, too.

When I told my chauffeur that this was the plan, a latte and a New Yorker, he asked me why we canceled the magazine subscription.

"I couldn't get a good waiting room rate. One thing about The New Yorker. It's going to cost you."

But the cover, all about Iran and the economy, did nothing for me. Not the story about the gangs of Rio, either. Must be a plot to ensure that Chicago gets the Olympics. Chicago and Rio are the top two contenders. And the winner is. . .

We find out tomorrow. Apparently the city that hosts the games will suffer from a plethora of special, but empty new warehouses and big buildings when it's all over.

I picked a different magazine altogether, US, all about fashion and celebrity gossip. Wouldn't you rather look at models and movie stars? The boasting front page:

Mackenzie Phillips' Horrifying Confession.

Who could resist such a thing? And a buck cheaper.

If you haven't been paying attention, Mackenzie Phillips, born to John Phillips of the Mamas and the Papas and socialite Susan Adams (one of John's many marriages), tells all in a memoir of her wild and crazy days behind the set of One Day at a Time.

For most of us, starring in a hit television show would be wild enough, but Mackenzie's drug addled, depraved father seduced her, made things even wilder for his daughter. He made her his lover and the affair lasted ten years. I've heard it several times,

I'll teach you how to love someone.

This is the family child molester's favorite line.

I haven't read the book, but Ms. Phillips was all of 17 at the beginning of the sexual relationship, so we can say he seduced her. Even if she was head over heels in love with her father, that she was a minor is reason enough to rule out informed consent. That alone makes the act criminal. Minors can't consent to sex, not legally.

The Mamas and the Papas. California Dreaming. I Saw Her Again. Be careful who you worship when it comes to rock stars.

Mackenzie confesses to cocaine and heroin addiction, and we know that under the influence informed consent isn't possible either.

But let's get real. This is incest, internationally taboo.

John Phillips isn't around to talk about it, so for all we know the book is a pack of lies. If I hadn't heard more than a few handfuls of these stories first hand, I might think so, too. Ultimately Mr. Phillips passed away a victim of his own vices, heart failure at 65, eight years ago. Gave Mckenzie some time to write a book.

Now the question is,

Is this a good thing, to write a memoir? Maybe it hurts innocent people.

And the answer is,

Maybe yes, maybe no.

I read that her sister Chynna wasn't thrilled when she heard about the publication of the book and that it came as a surprise, not that she doubted the veracity of her sister's work. Chynna uses one of my favorite phrases, These things affect other people to explain her feelings. She has kids. Mr. Phillips had grandchildren.

Publicizing secrets comes at a cost, usually. It has to hurt innocent people, airing the dirty family laundry. In family therapy we talk about this as a process, especially when it comes to exposing incest, and suggest discretion.

Timing is everything when telling the kids, especially. They want the people they love to be infallible, perfect. (Who wants a predator for a grandfather?) This is why these confessions are frequently limited to a best friend, a trusted clergyman, surely a therapist. Therapists generally will work up a plan, make it thoughtful, considerate of everyone.

It has to be hard to break it to youngsters when a previously trustworthy family member can't be trusted anymore. So we might suggest tabling the discussion until they can understand what it's all about, if at all possible. Of course, if your aunt writes a book, it's hard not to hear about it.

Some secrets can be toxic, is the truth, they hurt people who hold them in. We have to talk about what has happened to us in life. We have to talk to someone. And exposing them ultimately might protect others from making the same mistakes. Awareness of danger is a good thing. We can learn from others and we like the details. Those of us in this business are traumatized hearing them first hand, but for others, the juice quenches a certain prurient curiosity.

The US interview goes on to say that Mr. Phillips also did time in a penitentiary for dealing drugs, and one of his sons calls him things I won't publish.

Living perpetrators of sexual crimes can get better. No one has to stay a creep forever. We have them on their knees in therapy, some of us, have them beg forgiveness. That helps a lot.

Hopefully Mackenzie did some healing writing her book. We wish her well. Sister Chynna's apparently a popular vocalist (I'm not always up on this stuff). I'm going to check out her work, see if it will help me get over the thought that I won't be listening to the Mamas and the Papas anytime soon.

Thanks to all of you who commented below, who recommended songs, movies, books and websites about this topic. It's clear that many of you already know that when we talk about sexual abuse, we're talking emotional scars, social isolation, and psychological/physical reminders of this kind of "love".

The whole thing makes me, personally, want to avoid the 'zines, the expose's, the memoirs. I'll stick to chick lit, maybe.

therapydoc

What is Borderline Personality Disorder

2009-09-25T07:53:00.005-05:00

One of my favorite critics told me that the post below isn't clear, that people don't realize how hard it is to have this disorder, and how hard it is, sometimes, maybe even most of the time, to live with someone who has the disorder.

Rather than go through the DSM checklist (I think it's in a post in a link at the end of yesterday's post) let me quote Randi Kreger. She defines Borderline Personality Disorder as follows in her book, The Essential Family Guide to Borderline Personality Disorder (italics are mine):

Borderline Personality Disorder is a serious mental illness that causes those who have it to see people and situations as all good or all bad; to feel empty and without an identity; and to have extreme, blink-of-an-eye mood swings. People with BPD act impulsively; their self-loathing and extreme fear of abandonment can cause them to lash out at others with baseless criticism and blame. Some practice self-harm or see no other option than suicide as a way to end their pain.

People with BPD experience the world much differently than most people. For reasons we don't entirely understand, the disorder distorts critical thought processes, resulting in emotions and actions that are out of the norm.

There you go. Now maybe the post below will make more sense :)

Thanks for your opinion, MK.

therapydoc

Borderline Personality Disorder and The Fake

2009-09-24T07:50:00.007-05:00

Originally I just wanted to tell the story about the stand underneath my fish tank, how I found it at Bed Bath and Beyond while shopping for a gift for a shower (yes, I had the coupon), shlepped it to the office myself, borrowed a screwdriver, for mine is never where it's supposed to be, and put it together in little under two hours. Of course I knew the secret about the cam screws. Put them in, tighten them up, last.

I see this sort of behavior as fairly normal, if a little impulsive, sure, because ordinarily I'd ask FD to put it together for me. But doing something physical and challenging is a nice way to distract a person from thinking, and sometimes we just think too much. So I'm always telling people to do something. You feel better if you can distract.

And the computer desk that supported the tank just didn't cut it.

Then I found myself talking about Borderline Personality Disorder, BPD. This disorder is very much about impulsivity, which substantiates the rule that things that are thought to be pathological can be perfectly normal in a different context.

Impulsively buying a bookcase that matches your furniture, even if it weighs more than you do, and putting it together yourself, even if your best tools are a hole puncher and a nail file, beats impulsively getting drunk to feel less edgy (a "borderline" thing to do), impulsively cutting one's self (another "borderline" thing to do), or impulsively whacking someone across the face because you're jealous or in a bad mood. You get the idea.

And if the impulsive act also functions to build your self-esteem, as opposed to, say, lowering it, then it's a good thing to be impulsive, right?

But people who suffer from BPD have a helluva time trying to reign in their impulsivity, and the folks who try to love them, who want to help them, get worn out by the drama.

It's easy enough to start to write something, quite another to finish, and that's what happened to this post. Then then something cool happened. Retriever wrote to me to ask what I thought about something going on at Dr. Helen's Blog and Dr. Bliss's blog over at Maggie's Farm. Both docs are writing about BPD, and lo and behold, Doc Helen has a video interview with my new favorite self-help guru, Randi Kreger.

Randi Kreger (Walking on Eggshells) has a fairly new book, The Essential Family Guide to Borderline Personality Disorder. I read it cover to cover in a night only a few weeks ago, found it a terrific resource, funny, easy to read, and full of information that everyone should know. Especially if you have someone in your family who is "impossible", who can't regulate his or her emotions, who acts impulsively to dampen heightened negative arousal, like anger.

And she has a great section called Tools in the back of the book.

I'll throw one at you right now, a favorite I've suggested many times to people in therapy. Randi would call this intervention an incompatible behavior. I've always called it The Fake.

The idea is that a person can't be obsessing and angry about something if something else is a more attractive option. It's no different than distracting a whining three year old with a shiny yo-yo. All of a sudden the icecream he wants isn't important anymore.

With kids it's always,

Outsmart them. You're older. You can do it.

With older people who simply can't let something go, who are stuck on abusing you or raging about something or someone, who really will not stop to listen to anyone else's point of view or entertain other positions, it has to be,

Did you hear the one about. . .

Did you hear what happened to So and So?

Good gossip is sheer genius. Gets 'em every time.*

My favorite fake is laughter. You laughing at your tormentor.

This person is tormenting you, criticizing you, ranting, and you break into hysterics, literal belly-bending, on the floor, doubled over with laughter hysterics. You do it respectfully, though, for you are complimenting the person who is clearly trying to upset you. But now the abuser sees himself, herself, as a good person, someone who can make you laugh, not just laugh, but laugh hard, and that fleeting self-esteem returns with your praise. Now we're all comedians, should work stand-up.

If you throw someone off like this, anger and blame are impossible.

And the truth is, most people with this disorder are smart, and they can really be very funny.

Traditionally with people who have Borderline Personality Disorder, once they're flying, meaning angry, there's no stopping them. The anger is a manifestation of pain. If you can't see that, then there's no helping your spouse, your child, your friend, your mother, whoever it is who is unable to regulate emotion. When the plate needs shattering, it will shatter. When they need love, they'll find someone to sleep with. When a car needs to be keyed, it will be keyed.

When it's all over, it's What's for Dinner? As if nothing happened. So in therapy we're forever working on strategies that will work, that will distract, end an episode.

If you think of this as an episode of true psychopathology and pain, then it's a lot easier to swallow the negative behavior.

And you have to see them as capable of seeing life differently, seeing themselves as their greatest allies, capable of rational, laudable behavior. Good lives.

I work dialectically with suicidal, self-destructive people who have BPD , for you have to do this, dialogue in an empathic way, one that reaches them, meets that place in the ego that wants to live. Typical questions from me include:

(1) Would you want your niece to cut herself? No? Then why are you setting an example? You think she doesn't respect you, look to you as a role model?

(2) Do people deserve to have quality lives?

(3) Aren't you a person?

People tend to agree. They deserve better. They are capable of better. They want more out of life. They want quality lives.

Then the question becomes how to get it.

And it isn't an impossible quest, an impossible, reprehensible therapy. I've referred to ACT, Acceptance and Commitment Therapy here in this blog, and it helps to know DBT, Dialectical Behavioral Therapy, and Schema Therapy. There is progress and people do get better, so I'm a little miffed, frankly, at all the negativity I read on the Internet about BPD, avoiding BPD patients.

Yes, people can be difficult. They can be high maintenance, and yes, group therapy surely helps, and for sure, without a team it is so, so hard to work a successful therapy. I get it that people with Borderline Personality Disorder can be more than difficult, that they can and will make your life a living hell without help. And yes, therapists try to avoid treating the disorder, need help for ourselves to cope with all the drama.

But with help? With time? (lots of this, endurance is the essence)

There's no greater therapy, no greater pleasure, no greater success than helping someone with this disorder get well.

That's all I'm gonna' say. I have some algae to scrape off my tank here at home, and spilled some sugar behind a cabinet. There's a lot to do, basically.

therapydoc

*Okay, not every time. Go ahead, talk about it.
See the Second Road on Self-Pity.
Other posts by me about BPD

Humble Request

2009-09-16T08:04:00.004-05:00

If you can think of names of songs, movies, Youtube clips, anything that relates to sexual assault,harassment, or otherwise asserting sexual power with coercion in relationships (a form of sexual assault) would you let me know?

Thanks in advance,

therapydoc

Anyone's Kid

2009-09-16T07:12:00.044-05:00

That's my helmet, my bike path.

Two relatively short stories coming up. There have been complaints from the peanut gallery that my posts are too long. For the record, in my defense, I did not write President Obama's speech.

Okay. You should know, before we begin, that if there were an avatar of me right this minute, it would be Therapydoc, Sad. News has it that an SUV rolled over a neighborhood five year-old on a bike crossing an alley. Now she's gone, going on two weeks now, an innocent little girl.

Three young mothers, all patients, called me the week it happened, distraught. Another parent spent twenty minutes of appointed therapy time discussing the tragedy.

"It could have been my kid, my five year-old."

And,

"What do I tell her?" Meaning what do you tell a mother who has lost a child?

You say nothing, is what you say, when you visit a mother who has just lost her child, but hold her hand if she's amenable, sensitive to the fact that she might not want to be touched.

And we're not even to the stories.

STORY ONE:

I'm riding home from work last night at dusk along the Chicago River. The path and surrounding greenery are all park district, the only real dangers--

an occasional Chicago cougar, the feline type, not the human
head-pecking birds
people who don't understand that On your left! is a warning about an on-coming bicyclist,

and kids on tricycles.

If you wear a helmet, the birds don't bother you. And if you're a nice person, you don't mind slowing down for children. Nor do you mind shouting, YO! instead of On your left! to get the attention of folks who don't speak much English, people who also have a right to the path, even if they're just walking.

Of course, if you're all about you and aggressive at that, then these things, especially people in your way, bother you a lot.

Let's break for a rant:

People everywhere are riding bikes without helmets. Gorgeous, slick, young people who should know better, windblown and smiling. It bothers me, this carelessness, because I picture them fallen to brain trauma or worse, death.

This has nothing to do with that little five year-old girl, by the way, something altogether different, you can't hold a child accountable. But it seems fairly obvious that accidental death and morbidity are not reserved for reckless automobile drivers, luckless pedestrians, and motorcyclists. Some call the latter organ donors.

So readers, help me on this one. What's with the denial? Is vanity that important? Is it? Am I missing something? Because the ugly truth is that if you're going to ride, you're going to fall. It has to happen.

There. I feel better.

So I'm riding along and coming toward me is a little girl on a little two-wheeler. Her blond hair is sneaking out of a white helmet and her eyes lock on mine. She's talking to me with defiant, proud, six year-old girl eyes that say,

"See? I can ride. I can ride this. And this is my bike and there is nothing like it, me on my bike, nothing stopping me. I'm free."

Me, fifty years ago. And probably many of you, too.

STORY TWO:

You have to give credit where credit is due, when you learn something from someone. So I'm glad for that incident with Professor Gates and Sgt. James Crowley this summer. Especially for that delicious use of language, The Teaching Moment.

Sgt. Crowley, if you recall, arrested Professor Henry Louis Gates for breaking into his own home. Generally white people aren't arrested for suspicious behavior like breaking into their own homes. But people of color are suspicious for breathing, even now, depending upon the zip code. (Check out a good novel about racism, Mudbound by Hillary Jordan. You're always asking me for book recommendations, and the truth is I don't read as much as I'd like. But Mudbound is worth the trip on many levels. I especially like the marital relationship and women's issues).

Anyway, Professor Gates is a man determined to use everything that happens to him as class material. He's the master of the teaching moment and referred to the incident with Sgt. Crowley as a way to educate people, in this case a very, very, very large number of people, the entire intercontinental news guzzling public.

Professor Gate teaches about race relations. And hate. Hate is about scape-goating, triangling really, marginalizing others to feel better about one's self. In therapy we sometimes use a psychological defense to describe this process, displacement. She's the problem. He's the problem. They're the problem. Blame them. Couldn't be me.

Unfortunately, President Obama inadvertently ratcheted things up, made a bad situation worse by saying that Sgt. Crowley "acted stupidly." But he took it back right away with this marvelous syntax

". . . I could have calibrated those words differently.”

Calibrated.

President Obama and Vice President Biden (almost forgot his name!) sat the professor and the officer down for a beer in the White House gardens to make amends, to desensitize them. The VP drank a non-alcoholic beer and the President drank the most popular beer in America, what else, Budweiser. Thus the incident became the administration's teaching moment: (1) don't drink, (2) if you do, drink like your brother, and (3) for heaven's sake, get to know your neighbors.

And that very day, I had my own teaching moment.*

I'm riding the bike to work; it's a little muggy, but we'll take it, no rain, and a diminutive fellow from southeast Asia passes me on his bicycle, one that he surely threw onto the boat to America. The bike has the wide tires and baskets that allow for balance, lend it to tricks like, Look Mom! No hands!

Anyway, he sees me riding behind him and flirtatiously throws his arms out, does that trick we used to do as kids, rides with no hands, arms out to the side. He's clearly enjoying showing off and I'm enjoying the show. Except it bothers me, you know. No helmet.

Being me, when he turns the corner and peeks back, I smile and shout,

"Where's your helmet?"

He doesn't get it, smiles incomprehensibly. I tap mine and he nods a universal, if exasperated, I know. I know.

therapydoc

President Obama to Children on their first day of School

2009-09-08T15:51:00.007-05:00

This is not a political post. I am not a political blogger. But still.

It one falls under,

I'm proud to be an American. People don't say that as much, lately.

And we don't even have that on the sidebar.

Our President's speech to young people who might not feel like trying hard in school.

Prepared Remarks of President Barack Obama
Back to School Event

Arlington, Virginia
September 8, 2009

Hello everyone -- how's everybody doing today? I'm here with students at Wakefield High School in Arlington, Virginia. And we've got students tuning in from all across America, kindergarten through twelfth grade. I'm glad you all could join us today.

I know that for many of you, today is the first day of school. And for those of you in kindergarten, or starting middle or high school, it's your first day in a new school, so it's understandable if you're a little nervous. I imagine there are some seniors out there who are feeling pretty good right now, with just one more year to go. And no matter what grade you're in, some of you are probably wishing it were still summer, and you could've stayed in bed just a little longer this morning.

I know that feeling. When I was young, my family lived in Indonesia for a few years, and my mother didn't have the money to send me where all the American kids went to school. So she decided to teach me extra lessons herself, Monday through Friday -- at 4:30 in the morning.

Now I wasn't too happy about getting up that early. A lot of times, I'd fall asleep right there at the kitchen table. But whenever I'd complain, my mother would just give me one of those looks and say, "This is no picnic for me either, buster."

So I know some of you are still adjusting to being back at school. But I'm here today because I have something important to discuss with you. I'm here because I want to talk with you about your education and what's expected of all of you in this new school year.

Now I've given a lot of speeches about education. And I've talked a lot about responsibility.

I've talked about your teachers' responsibility for inspiring you, and pushing you to learn.

I've talked about your parents' responsibility for making sure you stay on track, and get your homework done, and don't spend every waking hour in front of the TV or with that Xbox.
I've talked a lot about your government's responsibility for setting high standards, supporting teachers and principals, and turning around schools that aren't working where students aren't getting the opportunities they deserve.

But at the end of the day, we can have the most dedicated teachers, the most supportive parents, and the best schools in the world -- and none of it will matter unless all of you fulfill your responsibilities. Unless you show up to those schools; pay attention to those teachers; listen to your parents, grandparents and other adults; and put in the hard work it takes to succeed.

And that's what I want to focus on today: the responsibility each of you has for your education. I want to start with the responsibility you have to yourself.

Every single one of you has something you're good at. Every single one of you has something to offer. And you have a responsibility to yourself to discover what that is. That's the opportunity an education can provide.

Maybe you could be a good writer -- maybe even good enough to write a book or articles in a newspaper -- but you might not know it until you write a paper for your English class. Maybe you could be an innovator or an inventor -- maybe even good enough to come up with the next iPhone or a new medicine or vaccine -- but you might not know it until you do a project for your science class. Maybe you could be a mayor or a Senator or a Supreme Court Justice, but you might not know that until you join student government or the debate team.

And no matter what you want to do with your life -- I guarantee that you'll need an education to do it. You want to be a doctor, or a teacher, or a police officer? You want to be a nurse or an architect, a lawyer or a member of our military? You're going to need a good education for every single one of those careers. You can't drop out of school and just drop into a good job. You've got to work for it and train for it and learn for it.

And this isn't just important for your own life and your own future. What you make of your education will decide nothing less than the future of this country. What you're learning in school today will determine whether we as a nation can meet our greatest challenges in the future.

You'll need the knowledge and problem-solving skills you learn in science and math to cure diseases like cancer and AIDS, and to develop new energy technologies and protect our environment. You'll need the insights and critical thinking skills you gain in history and social studies to fight poverty and homelessness, crime and discrimination, and make our nation more fair and more free. You'll need the creativity and ingenuity you develop in all your classes to build new companies that will create new jobs and boost our economy.

We need every single one of you to develop your talents, skills and intellect so you can help solve our most difficult problems. If you don't do that -- if you quit on school -- you're not just quitting on yourself, you're quitting on your country.

Now I know it's not always easy to do well in school. I know a lot of you have challenges in your lives right now that can make it hard to focus on your schoolwork.

I get it. I know what that's like. My father left my family when I was two years old, and I was raised by a single mother who struggled at times to pay the bills and wasn't always able to give us things the other kids had. There were times when I missed having a father in my life. There were times when I was lonely and felt like I didn't fit in.

So I wasn't always as focused as I should have been. I did some things I'm not proud of, and got in more trouble than I should have. And my life could have easily taken a turn for the worse.

But I was fortunate. I got a lot of second chances and had the opportunity to go to college, and law school, and follow my dreams. My wife, our First Lady Michelle Obama, has a similar story. Neither of her parents had gone to college, and they didn't have much. But they worked hard, and she worked hard, so that she could go to the best schools in this country.

Some of you might not have those advantages. Maybe you don't have adults in your life who give you the support that you need. Maybe someone in your family has lost their job, and there's not enough money to go around. Maybe you live in a neighborhood where you don't feel safe, or have friends who are pressuring you to do things you know aren't right.

But at the end of the day, the circumstances of your life -- what you look like, where you come from, how much money you have, what you've got going on at home -- that's no excuse for neglecting your homework or having a bad attitude. That's no excuse for talking back to your teacher, or cutting class, or dropping out of school. That's no excuse for not trying.

Where you are right now doesn't have to determine where you'll end up. No one's written your destiny for you. Here in America, you write your own destiny. You make your own future.

That's what young people like you are doing every day, all across America.

Young people like Jazmin Perez, from Roma, Texas. Jazmin didn't speak English when she first started school. Hardly anyone in her hometown went to college, and neither of her parents had gone either. But she worked hard, earned good grades, got a scholarship to Brown University, and is now in graduate school, studying public health, on her way to being Dr. Jazmin Perez.

I'm thinking about Andoni Schultz, from Los Altos, California, who's fought brain cancer since he was three. He's endured all sorts of treatments and surgeries, one of which affected his memory, so it took him much longer -- hundreds of extra hours -- to do his schoolwork. But he never fell behind, and he's headed to college this fall.

And then there's Shantell Steve, from my hometown of Chicago, Illinois. Even when bouncing from foster home to foster home in the toughest neighborhoods, she managed to get a job at a local health center; start a program to keep young people out of gangs; and she's on track to graduate high school with honors and go on to college.

Jazmin, Andoni and Shantell aren't any different from any of you. They faced challenges in their lives just like you do. But they refused to give up. They chose to take responsibility for their education and set goals for themselves. And I expect all of you to do the same.

That's why today, I'm calling on each of you to set your own goals for your education -- and to do everything you can to meet them. Your goal can be something as simple as doing all your homework, paying attention in class, or spending time each day reading a book. Maybe you'll decide to get involved in an extracurricular activity, or volunteer in your community. Maybe you'll decide to stand up for kids who are being teased or bullied because of who they are or how they look, because you believe, like I do, that all kids deserve a safe environment to study and learn. Maybe you'll decide to take better care of yourself so you can be more ready to learn. And along those lines, I hope you'll all wash your hands a lot, and stay home from school when you don't feel well, so we can keep people from getting the flu this fall and winter.

Whatever you resolve to do, I want you to commit to it. I want you to really work at it.

I know that sometimes, you get the sense from TV that you can be rich and successful without any hard work -- that your ticket to success is through rapping or basketball or being a reality TV star, when chances are, you're not going to be any of those things.

But the truth is, being successful is hard. You won't love every subject you study. You won't click with every teacher. Not every homework assignment will seem completely relevant to your life right this minute. And you won't necessarily succeed at everything the first time you try.

That's OK. Some of the most successful people in the world are the ones who've had the most failures. JK Rowling's first Harry Potter book was rejected twelve times before it was finally published. Michael Jordan was cut from his high school basketball team, and he lost hundreds of games and missed thousands of shots during his career. But he once said, "I have failed over and over and over again in my life. And that is why I succeed."

These people succeeded because they understand that you can't let your failures define you -- you have to let them teach you. You have to let them show you what to do differently next time. If you get in trouble, that doesn't mean you're a troublemaker, it means you need to try harder to behave. If you get a bad grade, that doesn't mean you're stupid, it just means you need to spend more time studying.

No one's born being good at things, you become good at things through hard work. You're not a varsity athlete the first time you play a new sport. You don't hit every note the first time you sing a song. You've got to practice. It's the same with your schoolwork. You might have to do a math problem a few times before you get it right, or read something a few times before you understand it, or do a few drafts of a paper before it's good enough to hand in.

Don't be afraid to ask questions. Don't be afraid to ask for help when you need it. I do that every day. Asking for help isn't a sign of weakness, it's a sign of strength. It shows you have the courage to admit when you don't know something, and to learn something new. So find an adult you trust -- a parent, grandparent or teacher; a coach or counselor -- and ask them to help you stay on track to meet your goals.

And even when you're struggling, even when you're discouraged, and you feel like other people have given up on you -- don't ever give up on yourself. Because when you give up on yourself, you give up on your country.

The story of America isn't about people who quit when things got tough. It's about people who kept going, who tried harder, who loved their country too much to do anything less than their best.

It's the story of students who sat where you sit 250 years ago, and went on to wage a revolution and found this nation. Students who sat where you sit 75 years ago who overcame a Depression and won a world war; who fought for civil rights and put a man on the moon. Students who sat where you sit 20 years ago who founded Google, Twitter and Facebook and changed the way we communicate with each other.

So today, I want to ask you, what's your contribution going to be? What problems are you going to solve? What discoveries will you make? What will a president who comes here in twenty or fifty or one hundred years say about what all of you did for this country?

Your families, your teachers, and I are doing everything we can to make sure you have the education you need to answer these questions. I'm working hard to fix up your classrooms and get you the books, equipment and computers you need to learn. But you've got to do your part too. So I expect you to get serious this year. I expect you to put your best effort into everything you do. I expect great things from each of you. So don't let us down -- don't let your family or your country or yourself down. Make us all proud. I know you can do it.

Thank you, God bless you, and God bless America.

Thank you, Mr. President.
therapydoc

Will Treating Depression Treat Heart Disease?

2009-09-08T10:07:00.003-05:00

That's the title on page 8, WSJ, thanks Shirley S. Wang.

I wondered when this would become news. It is true, or so it seems in my practice and clinical sense, that having a cardiac event puts a person at risk for depression. And being depressed puts us at risk for a cardiac event, given the genetics, probably, or self-abuse, like smoking and drinking, and let's not forget, stress.

It makes sense to treat it, obviously, because what could be more life-threatening than suffering times two from life-threatening illnesses? They both kill, depression and heart disease, or they can, without treatment.

Exercise, keep your cholesterol low, watch your blood pressure, take your heart medication if it's indicated, and talk to people about your fears, if you have heart disease. It has to be very scary, having this condition. And depressing when your activities are restricted, when you can't add a little salt.

And we know people who would die rather than give up that sirloin.

Anyway. WSJ tells us that patients who develop depression after heart attacks fare worse in the long term than those who don’t. A recent article in the Archives of General Psychiatry found that patients who develop severe depression post hospitalization for a cardiac event remain depressed for at least 6 months. They have double the risk of dying over the next seven years.

Thus cardiologists and behavioral scientists are wondering if treatment will improve prognoses, and if early screening is necessary. We already know that 6.7% of the general population gets depressed in any given year (National Institute of Mental Health).

Research is inconclusive regarding the effectiveness of treatment and screening, but I think most family physicians, probably internists, too, are sensitive to depression, ask about it as a matter of course. They know people kill themselves, and no one wants this on their conscience. Family physicians have always used us, the mental health professionals of the medical network, to treat this, depression. Tweak a bit with the meds and the psychotherapy, and voila, a better quality of life.

It's about time the cardiologists caught on. We've always been here.

therapydoc

Your Worst Nightmare

2009-09-03T06:06:00.004-05:00

Some of you who have read old posts might remember that I have had recurrent home invader dreams once or twice a year for as far back as I can remember. Always the same thing. Some big, unshaven, muscle-bound criminal-looking type, sometimes more than one, pushing against the front door to my family home. Me alone, pushing to keep it closed from the inside, trying to keep him out.

Poor FD. I always lost the struggle and woke him up.

Then, for no apparent reason, they stopped. The nightmares just stopped.

As much as I like doing anger management with people, there’s anger management and there’s anger management. I generally don't work with people who are court-ordered, very few hardened criminals. An occasional sex offender, is all.

And if a patient has a psychosis that is disinhibiting, or is ruled by voices in his head and doesn't like the medicine they tell him to take, it's likely I'll punt him along to someone who likes this kind of challenge. An ER doc, even. I won't be discussing identity or teaching any muscle tension and breathing.

Most people who have anger problems aren’t in it to hurt anyone. They’re just poor emotional regulators, and tend to have trouble with very strong emotions. We all have them, you know, strong emotions. And they can make some of us feel like hurting ourselves, or hurting someone else.

Even telling someone off reduces tension, sarcasm, too. People who suffer from Borderline Personality Disorder are particularly vulnerable to this solution, hurting themselves, hurting others, in any kind of way, and we see this disorder present quite often in therapy. We’re getting better at helping people with BPD, and in the process, recognize how difficult it can be, emotional regulation.

Therapists have weeks in which this is all we work on, above all else, it seems, emotional regulation, behavioral blunting. Stop signs.

I think it's what makes this a dangerous profession, that which Freud called id, the very human drive for aggression. We’re not an endangered species, but therapists are at risk for harm.

And we take in a lot of verbal abuse. We either don't take it, won't see a verbally violent individual, or learn to address it dialectically.

"You can get away with talking to me that way," I will tell a patient, "but it won't make you popular at parties."

Some of us get good at this kind of challenge, even welcome it, say, bring it on, even, to change the behavior. We won't debate facts, won't get into it like they want us to, just talk about quality of life.

"Is this what you want to do, put other people down, yell and scream and distance people from you? Or would you rather try to get a tennis date?"

That's DBT, Dialectical Behavioral Therapy, changing the meaning of a person's behavior. Some people do it naturally. We call them masters of the paradox. But ultimately what it is, is getting through. If a therapist never learns how to do this, get through, then there will be no therapy, no changing anyone suffering from Borderline Personality Disorder.

Very occasionally, for it has to happen if you work with people, a therapist will encounter someone in the throes of a psychotic episode. That person might be on the brink of hurting himself or others, might be paranoid or psychotically depressed, or flying manically, not in control of thoughts or behaviors. Out of reality times three might be an apt description, unaware of person-place-time. And this can get violent. People do get killed.

I've been lucky. My only encounter with one of these individuals who actually lost it with me was with a psychotic ten-year old. Never saw him before, but you don’t easily forget the brute strength of a psychotic ten-year old throwing table lamps. Not that I was really at risk. Truth be told, I’m pretty strong when my adrenaline's pumping. FD doesn't sneak up on me anymore.

So yesterday, I’m working with a kid on anger problems, no less, and we’re talking about how it's worse when you don't have parents who want to help with this thing we call emotional management. At least her parents are into the process, we agree, want to learn about it themselves. We finish and she goes out to the waiting room. Her mother takes her place. Mom and I are talking about how in her family there were eight kids and her mother, like her, couldn't control the aggression between her many siblings, and how powerless she feels when everyone totally ignores her efforts at Time Out. Can you imagine that? Time Out doesn't always work. When suddenly . . .

We hear banging on the sliding door of my office (the door for my bike, not people). I jump up and open the usual other door, the one with a handle. I see her. She’s my height, my build, in dirty jeans and a man’s shirt, tennis shoes. I don’t know her, but I know psychosis when I see it, glaring at me with fury. She scowls at me as if I'm dirt, snarls loudly,

“You a doctor?”

I’m sure I blanch. But she's not well, I get my cap on (the therapy cap) and respond in the most quiet, gentle, compassionate voice I can muster, a clinical voice.

“What can I do to help you?”

She pulls up her shirt sleeve, rips off a flimsy Bandaid to show me a freshly wounded, bloody forearm. The blood has already dried, doesn't seem to need any stitches. “You can fix this!”

Now I’ll be honest. I don’t want blood on my carpet, so I’m getting nervous. And I don’t want to turn to my desk to call the police, because I’m afraid that if I turn my back on her she’ll attack me from behind. She’s flying. This is anger. That other stuff we talk about is frustration, powerlessness, aggravation, the other words.

“Oh, that needs a doctor’s attention," I suggest, concerned. "I think we have a doctor downstairs.”

She furrows the brow, lowers an eyelid, then backs out of my office slowly, never taking her eyes off of me, like a bank robber in the Wild West holding a gun to the people in the saloon. The crazy part of this is that if I had to pick her out of a line-up, I’m not sure I could. I'm not thinking, look for birthmarks, eye color.

She’s backing out to the waiting room from my suite, past the door that should never have been left unlocked. I follow her. She points down stairs. “Down there?” she asks skeptically. "There's a doctor down there?"

“Uh, huh,” I reply gently. “Down there.”

My patient is in the waiting room now, too, has followed me out and is with her daughter. "It's okay," I tell them. "Please come back into my office. I'm pretty sure nobody's working downstairs today." They join me and I lock the outer door to the suite after them. Inside we process what happened, they hadn't felt threatened, particularly, didn't realize what was going on.

They're my last patients of the day. I lock up after them. Locked doors make me happy, the one time I forget to lock up, this happens.

I realize I hadn't called 911. Should have called the police.

Moments later, calm, I hear a loud bang on the door to the suite. I shiver, ignore it.

Then the phone rings. It’s my patient. “You have to see this,” she insists, breathless. “You have to come outside and see this.”

"Was that you banging?"

"Uh, huh."

Okay, okay.

Out on the street, about a half block away, three big policemen are working to subdue her. They’re having trouble, too. Arms and legs are flailing.

I feel absolutely terrible, as if I could have talked her into waiting for them, convinced her to surrender peacefully. She would have had a free ride to the ER for her wrist. Instead it seems likely that someone hit a panic button. And she’s treated as a savage.

My patients are spellbound. “How did you know?” the mother asks me. “How did you know she was crazy?”

“I never used that word,” I object. “I said she has a mental illness, isn’t a well person.”

“But how did you know,” she insists that I tell her, “that she was dangerous?”

“You just know, is all.”

therapydoc

FYO, all of the details of the story have been changed to make it fiction. But I think you get the gist of it. The truth is, truth is better than fiction, but sometimes you go with fiction.

Really Good Tissues

2009-08-28T09:51:00.010-05:00

When I was in graduate school they told me that you shouldn't hand people the tissues when they're crying because you want them to know that it's okay to do that, cry, and if you hand over the tissues then you're giving the message that you want them to stop.

I thought that was powerful but dumb, because you could hand over the tissues, which might make some people more comfortable, blowing their noses into a tissue, as opposed to say, on a sleeve, and you say,

"This is not to tell you to stop crying, cry away, please. Crying is good for you. In moderation, obviously, to a degree, for sure, but with me, it's always good."

Anyway.

We've joked about me wanting a sponsor for the blog, mainly Puffs or Kleenex.

But who has time to really pursue this? I did go after one of the tissue companies, actually, maybe both, and remember a resounding rejection. Life hurts, is the truth.

Generally, when I shop, it's a guerrilla mission, no time to go through all of the aisles. I know, however, when I'm getting low on tissues at the office, that this will be on my grocery list-- KLEENEX.

Because Kleenex is another word for tissues, right?

As a c0-parent of five, and a person who likes to eat, I save a few cents if possible, buy the generics. So the cart fills up with generic tissues, off-brands if they look okay, especially if they come in a pretty box. You have to buy in bulk if you're a therapist because they go, as we say, in a good week. A good week is a good cry or fifteen.

Anyway, in over the years, very occasionally, someone will say,

"You need better tissues. Buy Kleenex or Puffs. People don't want to think they're using up all of your tissues."

Pretty amazing, but it happens, and of course I say thank you for the advice, because you have to thank a person for asserting, for trying to get the needs met.

I might even say, "Thanks, I don't hear this much, but I'm not going to take it personally." This makes the event an intervention. People take way too much personally and it gets them into trouble emotionally. Something to talk about.

"No problem, Glad to oblige," my clientele will say. People are nice like this.

So this morning I go to the grocery store, and buy several brands of tissues thinking, "We'll give this a whirl, see which one really is the best, which is the best for the money, which makes a person feel worse, might make a person think, My life is so bad, I even get a cheap therapist! Everything is bad! I'm born under a dark star.

We'll see what happens.

therapydoc

Shame

2009-08-24T08:44:00.001-05:00

What we didn't say in the last post, The Disappearing Act, not specifically, is that shame has a huge impact upon personality. Although we talked about fear of exposure in the comments, it is shame that muzzles us, keeps us in the closet, limits our capacity for intimacy, scratches at our vulnerabilities and tickles our fears of abandonment. We think, if we're honest with people, we'll be rejected if they know the truth about us.

We assume there's a huge stain on our shirt, that even if we don't talk about it, they know. Like we're the only ones who ever did it, whatever it is we did.

Add to this our Judeo-Christian-Moslem-Confuscian--who knows what upbringing-- the sense that we imbue from our parents, teachers, or other significant care-takers, that we're horrible if we stray from the tenets of goodness, all in the interest of raising us right, you know, and we're toast. It isn't unusual that parents and teachers will over-dramatize the wrongfulness of experimenting, acting out, and as kids we're vulnerable to drama and blame.

Spare us young and we can take it when we're old.

Survivors of childhood shame can get the sense of okayness from someone, if they're lucky, some angel, the one who gives us the nod that we're actually good. It's okay, says our angel. You're human. To err is human.

We could talk about this all day, but there's a story I want to tell, a story in a story about embarrassment. Embarrassment has to be a sister of shame, I'm thinking, and if at all possible, if we're talking about functional behavior, we do our best to avoid doing this, embarrassing people, because we know how that sense of shame might stick, like the effects of most relatives.

THE STORY:

One night FD and I are at a party for a bride and groom, not the kind that you stand around and drink and talk, but the kind specifically designed to bless the newly married couple during the celebratory week following their marriage. This means these parties are food-centric.

Nobody runs off to Hawaii right after the wedding, not in my crowd. Following the expensive (usually) gala event, the couple celebrates with friends and family for an entire week, then maybe takes off, maybe not. They may not because they haven't lived together before marriage (not in my hood), so staying home and getting used to one another tends to feel pretty good.

You would think people would leave a young couple alone, but no. That's not how we operate. We have to lavish them with good wishes, because basically we assume that if we lavish these on the couple, that the odds are better that our well-wishes will come true. We send them off to independent living with an insurance policy.

Would that it were that simple, but in any case, we don't change traditions that are really, really old just because they're inconvenient or seem fattening. And the Jewish tradition is that wherever the bride and groom sit down and break bread that first week, they're entitled to seven blessings, assuming they can gather the crowd of people necessary to say them. If there's food, you see, you increase your odds.

Jews basically eat because inherent in eating are food related blessings, and since praising Her is an inherently Jewish thing (although some mix it up, refer to Him), if old fashioned perhaps, whenever observant Jews have an opportunity to do this, eat and praise, they jump to it, praise before eating, praise after eating, praise the carrot, the bread, the wine, everything but the tablecloth. You name it, we praise it and are thankful for it. You would think we're starving. Oh yes, in our history, there was starvation. So this makes sense. But as long as we're eating, we'll add a few extra praises for the divine idea of coupling, for the newly married couple.

Enough said. This particular party happened to be a dessert party. I made two strawberry pies, for the record, and they turned out well enough, although between you and me, were lame excuses for pies, compared to my mother-in-law's, for she's from the south, and they know how to pie in the south, like nobody else; not even my mother, although as a yankee, her blueberry is incomparable; as is my machetainista's* apple. So my pies are generally not as good, not as rich, not as sweet, but if you cook for people you love, your odds are better that whatever it is you are making will turn out well, despite your fallibility. This is the thinking of my mother-in-law and I think she's right.

So we're sitting around a very, very long table, just the thirty of us, the hosts and the families of the young couple, and a lot of little kids. There's no alcohol, for the record, but enough sweets to put anyone into a coma.

The speeches begin, and it is thanks to the speeches that you get this post.

Rabbi Azose, the Sephardic rabbi of Chicago, perhaps the Chief Sephardic Rabbi of the Midwest, tells this story, one that dates back to 180 AD, I imagine, and the Roman occupation of Jerusalem. Forgive my interpretation, the rabbi did not use the word "idiot" in his speech.

Rabbi Yehuda HaNasi, or Judah the Prince, a descendant of King David, had a serious revulsion to garlic.

Sensitive to the smell, he started a class one day and had to stop teaching. Sensing the garlic on a student, the rabbi asked politely that whoever had been eating garlic please leave, because he didn't feel well, he had this allergy.

As a therapist this takes me to people who take off their shoes, and sometimes I must politely ask, Would you mind. . .put 'em back on . . .the ventilation in this place just isn't good enough and I am cursed with a sensitive nose. But this is not about me, who could do not even share the same room with the good Rebbe, certainly not when it comes to manners, although perhaps have some of those queasy genetics, it's true.

Anyway, Reb Yehuda asked the class in a generic way, "Would whoever had garlic for lunch kindly leave, I'm so sorry, I feel dizzy. . ."

And a group of men got up to leave.

After they had vacated the classroom together, the guilty student, the one who had spiced up his chicken salad, asked the others, for they did not smell of garlic,

"Why did you guys leave? I'm clearly the idiot who didn't know about the Rebbe's sensitivity!"

They told him that they had learned it is better to embarrass yourself than to let someone else be embarrassed, and you should do whatever you can do to prevent your fellow's embarrassment. The men had learned this from their rabbis.

Most likely they had learned it from Reb Yehuda who knew that they would do this, get up to leave with their fellow, therefore enabling him to make the request.

Good lesson, right? These are the kinds of stories they tell after you quit Hebrew school.

therapydoc

A machetainista is the mother of your daughter-in-law or son-in-law. Machetainista rhymes with Bach-eh-rain-vista

The Disappearing Act

2009-08-20T16:48:00.000-05:00

Maybe, instead of lovers, you start out as best friends. Or maybe there has always been chemistry. Maybe someone fixed the two up, thought you would work well together, and you did.

In each case things start out swimmingly, perfectly, and for awhile, maybe even a long while, it's magic, and there's attention and love, and that face I see on the leather sofa two feet away from me is pretty happy.

And the cynic in me waits for the other shoe to drop. Far be it from me to burst anyone's bubble. I'm not your mother. Let the fantasy last. We all need a little hope, and when someone is kind, when someone is attentive, when someone is flirtatious, well, it feels pretty good.

This is the new relationship paradigm, you know, love without commitment. With a divorce rate holding steady at one out of two, what is the point of the crystal and china? Why register at all? Surely weddings are expensive, and happiness a toss of the dice. I'd prefer to think, actually, that it's not. But that's something to talk about another day, not now.

So you're in this relationship and your lover is extremely attentive initially, professes adoration and ever-lasting love, and this feels ever-so-good, and the sex, whoa, is amazing, and you're thinking, I Could Live Like This, and your lover has told you that no one has ever made him/her feel this way before, no one has touched this part of him/her before, and as the song goes,

This May Be an Ever Lasting Love.

I've Finally Found Someone.

And then it disappears. No fights, no drama. No calls. No response.

"I text him. I call him. I leave voicemail. I email. Nada."

There are so many ways to do this, communicate.

"Nothing?"

"Nothing."

There's no such thing as nothing. Nothing is something. We have this phrase, "You can't not communicate. No communication is communication."

From the Life Stinks, department, that's for sure. So unfair. It was so good. Where did it go? Where did he go? She?

It's called the disappearing act, and if you know anything about behavior modification, then you know that some people actually are masters at this thing, modifying the behavior of others to accommodate long absences. They can stretch the rubberband, as we family therapists like to say, like nobody's business. They have an uncanny sense of knowing how long a relationship can linger in nomans land, before sparking it up again, lighting up life, just to disappear again.

Read that post on rubberband, if you haven't already, on emotional distancing and psychological space. Meanwhile, a short if not complete list of where people go when they take an intermission.

(a) back to his/her committed partner, aka, wife/husband

(b) back to life before you, shooting pool, arguing cases, building bridges, whatever a person with a life does

(c) is dating someone else, carrying on more than one relationship at a time.

(d) is getting stoned.

(e) is really angry about something you said, the way you said it

(f) is beginning to see you as much less than perfect, and wants perfect

(g) is doing just fine, actually.

(Help me here. Add to the list)

You, however, are the problem, assuming you're uncomfortable with the situation. You signed up for the problem, friends with benefits it's called. You're a giving person. More-so than your friend. You want more, you have greater intimacy needs. But there never was any kind of deal that referred to intimacy needs when you hooked up. The two of you didn't go over that part of your collective psychologies before becoming involved, before one of you unconsciously committed to the other.

And you can't say they didn't warn you.

So how does a person avoid the manipulation, the bad deal? Is it so outrageous to have this talk about intimacy, about needs, about sharing, about time, about the triggers we have, things that make us angry, all that before we get totally lovey dovey and out of control? Or maybe just get used to being rejected. Maybe that's the ticket. Haven't found that this works, gotta' say.

But since I'm on a roll, can't we talk about having missed someone to talk to as a kid, or having had to share a room with six siblings? These ditties about our upbringing makes us either reticent or more communicative, depending.

Can't people talk about what it meant, being verbally abused, or physically abused, and how that experience likely affected how they interpret things that happen to them, things that are communicated by a partner, i.e., criticism? Probably not, because all that is likely to be unconscious without therapy. We aren't all that in touch with how we distance, why we check out, or why we take things personally.

These are the things that really matter in relationships, you know, intimacy needs, our sensitivities. Just putting it out there. Something to think about.

therapydoc

Doubt

2009-08-13T17:27:00.002-05:00

Warning: There may be spoilers. If you haven't seen John Patrick Shanley's film but intend to, no question this will ruin it.

You probably know that it is about the Catholic Church cover up of clergy who molested and raped children. This is not something reserved for this faith, by the way, covering the tracks of those who are supposed to be protecting, yet who are endangering our children. Cover-ups in schools, governments, work-places, and houses of worship. . . happen.

They shouldn't, but they do, sometimes because of denial

it's not so bad what he did, or,
just a minute. . .he couldn't have done that

Sometimes, maybe usually, a cover-up is about not wanting to make an institution liable for hiring a certain someone. Schools especially are liable for child endangerment, for hiring criminals. They do background checks and have insurance policies to protect against this sort of thing, due to exposure of the problem. Awareness of childhood sexual abuse is higher, thanks, in part, to films like Doubt.

As I learned in an excellent workshop about reintegrating the offender into the community,

Where there are children, there are people who will abuse them, who want to use them sexually in one way or another.

Lovely thought.

The one way or another refers to either contact or non-contact crimes. When we think predators, we think about those who coerce children to participate in sexual acts. But far more common are those who make their money as non-contact offenders. I think of a beautiful girl or was it that good-looking boy, I treated many years ago, who vacillated between religion and a desire to make money. A man offered to make the child a film star. I lost the patient, who disappeared from treatment unfortunately, and never followed up about that career.

Non-contact offenders, those who photograph and film children, and those who expose themselves to little girls out walking their dogs, people who stalk, and many who plan contact crimes, are sometimes reaping the benefits of a trillion dollar industry. There's a good deal of money to be made swapping pictures, films, and names on the internet.

Contact offenders seduce children or coerce or force children to perform sexual acts. These are the people at the pool, at camp, in the rectory.

One in ten children who spend a fair amount of time on the internet will be contacted by one one type of offender or another, another lovely thought.

Rehabilitation is certainly possible for sexual predators, or so we learn from the experts. The pie chart (sorry, you'll have to trust my reference) tells us that 27% of all sex offenders keep it in the family. They also have the lowest recidivism rates following restorative justice, meaning legally enforced accountability and treatment. Thus they are reintegrated into the family after a nice, long separation, lots of time in therapy.

I won't quote you every statistic, but 15 years post-arrest, according to a Canadian study--they're way ahead of us in the USA on this one--only

13% of incest perpetrators were caught doing it again
16% of extrafamilial offenders of girls recidivated,
35% of extrafamilial offenders of boys,
and 24% of rapists of adults.

A person has to stay rational about this, not leap to the thinking that what this actually means is that sixteen of every one hundred offenders of girls who are not in the family really do recidivate. If you think this way then your mind might wander to the possibility that it might be your daughter who is likely to be irresistible.

That's where all that doubt about rehabilitation comes in. But lets not get so negative. Our parish priest, the fellow in trouble in the film, is likely to get better with therapy, and we can see why. Bare with me.

Let's review the film. (I could talk about Harry Potter and the Half Blood Prince, you know, it was so good, that treatment of drugs. But I'll save that for the SecondRoad. My post is called, of course, Harry Potter and Drugs).

But more to the point, there are many poignant, wonderful scenes in Doubt and the costumes (hey, not all of us went to Catholic school) and direction of the film, for those of us who love sensory, not sexual visuals, captivate. And there's Meryl, who never, ever fails, our greatest living actress. And Philip Seymour Hoffman as Father Flynn, in a poignant portrayal of a bad guy, brilliant.

We're swallowed up with emotion for supporting cast, too, especially Amy Adams as the idealistic young nun. We all know people like this, the ones with stars in their eyes, so naive, so positive, just like children before they learn that there is no tooth fairy; they grab me every time. I want us to be friends.

Viola Davis is especially complicated as Mrs. Miller, the protective mother of the vulnerable little boy, who is gay, of course, and is coerced into sexual acts with Father Flynn, who sees himself as mentoring the poor child into the world of male love. Mrs. Miller tells Meryl, Sister Aloysius, that the boy's father beats him, and all she wants is for her son to graduate, for this is a good school. The young man's future will be bright. The principal should leave this alone.

Positively rich.

Among the more memorable scenes, the first sermon. Flynn asks his flock (marvelously lower to middle class, a People's flock), in his Sunday morning sermon, with a delivery that real clergy people could work at emulating, meaning it is short and sweet and has a parable,

What do you do when you're not sure?

He is speaking of a crisis of faith, something that happens when our world is shattered, when we wonder,

Who is running this place?

I hear this quite often in therapy. Being affiliated, often labeled as a person of faith, people feel comfortable talking with me about their anger, their doubts about their religion.

It's not unusual to hear a patient say, "I'm so angry at Him. (Never Her, for some reason.) How could He let ____ happen?" Fill in the blank. Heart attack, cancer, job loss, job stress, earthquake, death, treachery, imprisonment. Rather than my usual pregnant pause, I'll talk about being angry with someone you don't believe exists, what that means. This is about doubt, and doubt is painful, wondering if what you do is a sham, a big joke, a waste of time, this is painful. As if not following the rules, not being observant, is so not a waste of time.

Flynn goes on to tell his flock that when we have a secret, something we cannot share with others, our loneliness feels unbearable, excruciating, as opposed to when a community suffers a catastrophe, when multitudes experience a crisis of faith together. He points to the assassination of the first Catholic US President, John F. Kennedy.

Doubting as a community tests the community, but it is a test that is shared, an open (outed) existential crisis. Doubting alone (closeted) is torturous.

Why would anyone doubt alone if it is so torturous? Shame, of course. And doubt, fear of reprisals. If you're Freudian you can see how regressive this makes people feel.* But in his defense, how do you tell people who depend upon you for spiritual guidance that you think they are all misguided, and that you, too, might be misguided, but you have chosen to pursue what you pursue anyway.

Doubt is the theme of the film, and for Father Flynn, a man who has seduced a young boy, a boy who is marginalized from his class for various reasons, including race and sexual orientation, vulnerable-- as the perpetrator, the pastor rationalizes. Just as the boy's mother rationalizes.

He tells himself that he can love this boy in the way that he loves this boy because children need love. Where else will this particular child find so much love, so much positive communication (sure, it's my language, but were we to ask certain perpetrators, they might agree, sex is communication).

And this, you should know, this rationalization is nothing new. If you have done any reading about gays and lesbians, gay men in particular, then you know that there is history, there is cultural validation of this way of thinking, that older men feel they are mentoring younger men, and younger men are on board with it. Safe men, loving boys. The boys are gay, the men are gay, and the boys know nothing of the ways of men. Not yet.

(You could start your education if you're in unfamiliar territory, with Gay New York, Gender, Urban Culture, and the Making of the Gay Male World, 1890-1940 by George Chauncey, a tome.)

Doubt, Father Flynn tells us, can be a bond as powerful and sustaining as certainty. We are lost. But we are not alone. Sounds good to the congregation, most of whom have no idea what he's talking about.

We, the ones who understand the reality of a sexual predator, don't buy it. We think,

Sure, most of us are lost; we know we're all lost to a degree, but we put our faith in some things, certain people especially. We suspend our doubt to feel good about life, to feel better, to have hope.

We don't expect our leaders to fail us, unable to hold fast to their own teachings.

therapydoc

*According to Freud, toilet training is the age of shame and doubt.

Back a' cha'

2009-08-13T15:48:00.006-05:00

It's been awhile since I did this, and of course feel guilty because people have been linking over here and there's been no time to link back, life's pretty crazy.

On the other hand, I just told my brother that when we want to make time, when we want to do something, there really quite a bit of it. Just last night it took me three tries to beat my Spider Solitaire game. To waste less time at this, I only allow myself one game and won't play every day, not even every week, but I replay the game until I beat it unless it's obviously going to be a losing battle. Apropos of nothing.

Anyway, there are some wonderful new and old bloggers that have yet to see the spotlight on this blog, and some who have but should be getting even more attention, so let's begin with. . . .

Samurai Scientist!, always setting me straight, no puns intended. Thanks, Sam.

Enlightening Darkness. Someone has to, seriously.

Cardiogirl takes all of her readers to other people's blogs on a train. (I love trains). Visit her blog and get something of a work-out, a pleasant work-out.

Uppity-crip (a very smart, or better, intellectual to use her words, crip) rails against the Pres and the Disabilities Act and how we really aren't doing enough to help this community. This should be a priority, Mr. President, if you're listening, and I know you are.

Massage Therapy has assembled a huge list of help sources, inspirational, no less, and included you know who, thanks.

Coming out of the Trees has been journaling, which inspired a post on that, thanks.

Dr. Deb (in my top faves on the blogosphere, if not my phone, and what's with that company that only gives you like five faves for free)) writes about all kinds of things, but when she writes about the amygdalla, I'm inspired again. That post on over-eating, if I didn't put it out yet, inspired by her Thanks Doc.

Suzanne Reisman at BlogHer is on my team against poor Steve Harvey (he cannot win). She's not into faking it either, to have to raise a man's over-inflated even higher (not that we can't be esteeming, it's the way of doing it that bothers some people, like most feminists, for example.

And MoonMaid has a new baby! That can make a person want to get in touch with who they really are.

And there are probably lots of bloggers under the radar. I just found one that specializes in child abuse, one of my, Oh, yes LET'S talk about that faves. Check out the Columbia Child Psychologist.

I like One Angry Daughter, who writes about a narcissistic mother. Nothing like the personality disorders to boggle the mind. And as long as we're at war, Trench Warfare.

Wait, What just makes me happy to be her friend.

And The Retriever is always worth the ride.

BlogSocial Worker, a foodie, is married to a writer for a food and wine zine. What a match. I have to see Julia and Julia.

Then there's Anti-social Social Worker, of course.

Now That's Nifty is as what it says it is, check 'em out.

Interesting Pile included my list of famous bi-polar personalities. Thanks, Pile, for reminding me to post more lists.
Everyone loves a post with a number in front of it. Five Ways to . . .

Of course I link to myself, from The Second Road. Talk about narcissistic, self-serving, self-indulgent, oh, drop it.

And The Modulator has a huge assortment of modules to choose from. You're probably in there, too.

My buddy Jack has been busy. If you have a little time, check it out. Jack generally blogs at Random Thoughts.

If you like good photography and art, and who doesn't, check out Leora in HP.

And I get great chizuk (strength) from one of our rabbi bloggers, this time kvetching about aging. Oy. As old as you feel, dude.

This Time, This Space, well, how great a name is that for a blog?

Visit Isle Dance, get away. I do.

More Mindless Rambling keeps it short and sweet, not an easy task, you all know it if you like to write.

Subdural Flow put up a Dancing in the Streets vid, Martha (she's stunning, and check out the pant suit)and the Vandellas, tells us where she's at, this is a good place.

Technobabe tells a mother-daughter saga, lots of us like these.

Wendy lost her son and leaves a tribute for us.

Can't forget Bird on a Wire or Laura's psychology blog.

Harriet, To Meat or Not to Meet, has some great recipes. Oh, you foodies. I aspire to even trying, and you just put it out.

Marie isn't shying away from trauma. Read her at Coming out of the Trees.

Dreaming Again posts at Wanda's Wings, is definitely depending upon a higher power.

Shades of Ivory found an even better Come Back to Me song, and tells a really sad story, but it's a goodie.

Cardiogirl gives a nice account of getting over some social insecurity stuff. Gotta' love that.

Sandy, PhD is Bloggin' Behavioral. I love her post on "shoulds". And that pic from the Sopranos, priceless.

Lola's Diner is a definite must. I've got to find time to get over there for real.

I've not told too many people about my obsession with those little rubber yellow ducks that you put in the bath for little kids, mainly so they don't notice you're giving them a bath. So how could I not love Duck and Wheel with String?

Kewie and Smithie are moving, maybe this is why they're not blogging much.

SYD is my first blogger friend to works an Al Anon program, so I stop by at his blog to get chizuk (strength, rhymes with me-too, soft "ch") when I need it. Thanks, Syd. Everyone should work a 12-Step program, I feel. Addiction has nothing to do with it (well, that's debatable, I guess).

And I LOVE A Quarter Life Crisis.

Battle Weary and Mercury in Pisces took off for the summer, or so it seems. Not that's a novel concept.

Chris is a coach, and since trainers and coaches make our lives more manageable, check him out. I imagine a coach is a trainer, right Chris?

And Mark, my buddy at the Naked Soul, is about as soulful as it gets. You have to read him.

April the Optimist, over at Thriver, never fails, either.

White Trash Academic is awesome, always throwing it around, that phrase, white trash, which I love.

Imagineamaste is working on focus. Good luck, bubbala.

Lisa Marie's occasionally in a Dysfunctional Daze, but like, who isn't? Check her out.

Positively Present has hit the six month mark in blogging. Don't leave us! Going great!

Transitions and New Beginnings is getting good at transitions and new beginnings, a lesson, here.

Jim, of the water method, doesn't mind telling us that he played with GI Joe.

SocialWorker24/7, at Eyes Opened Wider, tells it like it is. 24-7.

Cate, at Project Subrosa, is, well, still expecting. b'shaah tovah (meaning, in the right time)

A Midianite Mama isn't something to miss, and she's blogging that he's just not into you, which he might not be, unfortunately.

And the link I missed somehow, Uppity. Sorry, C. and Third Time's a Charm.

Maybe best of all, Motherhood is Not for Wimps. Read DaMomma, she don' disappoint. And she agrees with me about the therapy thing, too.

Okay, who else did I miss? Let me know. No problem adding you.

therapydoc

Separation

2009-08-05T19:46:00.003-05:00

This morning I wake up really early with a plaintive OneRepublic song in my head,

Come Home.

Lyrics :

Hello world
Hope you're listening
Forgive me if I'm young
For speaking out of turn
There's someone I've been missing
I think that they could be
The better half of me
They're in the wrong place
trying to make it right
But I'm tired of
justifying
So I say you'll..

Come home
Come home
Cause I've been waiting for you
For so long
For so long
And right now there's a war between the vanities
But all I see is you and me
The fight for you is all I've ever known
So come home

Oh

Everything I can't be
Is everything you should be
And that's why I need you here
Everything I can't be
Is everything you should be
And that's why I need you here
So hear this now

Come home
Come home
Cause I've been waiting for you
For so long
For so long
And right now there's a war between the vanities
But all I see is you and me
The fight for you is all I've ever known
Ever known
So come home
Come home

It's an anti-war song, is the truth, or so I learned on YouTube trying to find you a link. Watch it after you read this.

This isn't a political blog, but I do have an American flag drooping over our front-room window, and I'm thinking I should bring Old Glory to the cleaners, but don't want to take it down, not even for a day. The song has nothing to do with my personal politics, fyi, I just like it. There's a love song in there somewhere. Has to be.

This post is about marital separation, and the feeling that characterizes this stage of marriage. It isn't the same as wishing someone home from a war, but usually there's missing. Emptiness defines separation, and loneliness.

With separation one of two partners has to leave home. Someone has to pack up and go or it isn't a real separation. Sometimes a spouse will leave voluntarily, walk out, close the door, and that's it, game over. Too little, too late. Therapy didn't work. The love is gone, the relationship dead, the formal beginning of the end. From here we go to dissolve the marriage, dissolution, another D word, a softer word, as in dissolve into water. Means divorce.

Feels harsh, divorce, and it is. Also lonely. Dissolution-- soft, like water.

Yet there is no limit to the cheer-leaders, family, friends, colleagues who encourage the divorce option, who have been there and profess to be quite happy about it; and so many others who have suffered abuse in marriage, who see everything in terms of abuse, who support the leaving, toast to it. Bring on the party. Here's to a new life. The old one is over. Move it along, jump to the chase; what is this no man's land, anyway. Make a decision, please; it's been three weeks.

Relationship therapists don't see separation this way, actually. We don't see it as an entre' to divorce.

First of all, we know that no matter how you label a relationship, it is never over. These reside in our heads for years and years and years, no matter how we label them, even relationships of our youth. So what is the rush to finalize the ending of a committed relationship? It isn't over until the ink is dry. Boyfriend, fiance, lover, friend, spouse, partner; what happened there, in the relationship, the meaning of that person, will not disappear with a signature.

Therapists see all kinds of separations, you should know. So we snuff out the panic when a couple nervously asks, Might it help, a little space, some time apart? This one quotes the statistic that 3 out of 4 married couples endure a separation, generally not due to abuse or neglect or even a marital problem.

Normalizes it, doesn't it, that 3 out of 4 couples separate? That's well over a majority.

When separation is not about the relationship, it is usually due to a work transfer, or the needs of a sick family member, perhaps a change in status, like having to attend to the estate of a lost loved one, executorship, maybe. When crises happen, togetherness is the expected outcome of the separation--as soon as possible, if you don't mind. Fix whatever this is so we can so we can be together again soon. There is stress, being apart is stressful, but ways of communication transcend geography mainly because a couple wants to transcend geography. There is no discord.

Come home.

When separation is due to marital distress, however, therapists are in less of a hurry (depending upon one's treatment perspective) to push a couple back to the same home. We entertain objections, surely, from one of the two partners, but might advise :

Take a break.
get some space,
give yourself a chance to heal, to think.
Rearrange priorities,
see your own behavior, own your part of these problems, don't minimize.
Understand your significant other in a more rational way.

A little distance and we gain perspective. Of course this is within the context of therapy, for sure. If your time is spent at the bars crying in your beer looking for sympathy, it's unlikely any light bulbs, epiphanies, will be going off any time soon.

Thoughtful separations like these are healing for older couples, but for people new to marriage I tend not to recommend them, although there are certainly exceptions. But young people do well in marital therapy living together, not apart. The therapeutic mission will be to test new behaviors with one another in-house.

Young marriages are still in the test tube, the laboratory phase, everything is an experiment. The therapist can add a twist of this or that, present new perspectives, but the successful couple, with a little therapeutic insight, will comes up with the ideas that work independently, will finesse the experiment. And voila, it's back to being in love again.

Therapy is more complicated for older couples with history and emotional inventories . Negative emotions associated with a partner's misdeeds feel hard-wired to the victim, intractable. So many memories, so many disappointments, repeated enactments of dysfunctional behaviors, reactions. We can change these in therapy, work to understand one another, but the love won't catch up with the intellect, not so quickly. Not usually.

Time. But did you say you want to know how long you should be apart?

This depends upon each of the partners, how committed they each are to change, and how disassociated they feel from one another. Can we predict it? Can we predict how long a couple will stay separated?

Some of us take pot shots, guesses. I have a short but open-ended list of questions that make mine feel educated.

(1) How huge is the inventory, the list of pain, the wrongdoing?
(2) How deep is the anger, the hurt? Is this really immeasurable?
I actually measure it in terms of days, then hours, number of tears, holes in the plaster.

Every therapy for separated couples will be a designer therapy, by necessity, with a designer treatment plan. Objectives and goals are discussed, as well as an exhaustive investigation of each partner's emotional life. That certain responses are predictable, based upon that history, unfolds over time, and this is the insight we're looking for.

Thus there can be no textbook treatment for any particular marriage, which is why the work itself is as much an art as a science. We have our methodology, but procedural order will depend not only upon the broken dish of the day, but the way the therapist determines it to fit back together.

Is it time to block that metaphor yet?

Not to beat a dead horse, for those of you who read me, but there are three patients, three patients, remember, to every marital therapy-- the two partners and the marriage. That's a lot of therapy, a big treatment plan, so sorry. And the emotions don't just heal up overnight. People forgive, but they really can't forget. That memory thing will get you every time.

It would be nice if there were a switch, if we could will ourselves into loving again. Hypnosis, maybe.

Sorry.

That's why, if the rabbi or the priest, or the mullah, etc., has one thing to advise a young couple, it should be that they should stay out of denial, not brush any problem aside, look to the family of origin, the roots to the tree, the reasons people do what they do, the reasons they don't do things they should do. Attend to this right away, don't ignore "issues" let them build up inside until you have reached the point of no return.

Cuz that's a very, very bad place.

The Anti-Relationship drug, the thing that will ruin you is denial. You lull yourself into thinking, If I don't discuss this it will resolve on its own and I will love my partner again. These problems will go away in time.

Right.

Think again.

therapydoc

I Confess

2009-08-03T09:31:00.008-05:00

Okay, I confess. The reason you don’t see me blogging so much anymore is that there are other things to write (like you, am poking at a book that will never see the light of day) and am super busy at work and find that this and putting out on the blog is really hard to do.

For me there's an optimal time to do this, write, and only so many of these, optimal hours, in the early morning. So be patient with me.

Once I learned that ancient Japanese fine artists only produced, only approached their brushes and ink for an hour or two a day. Perhaps they lacked caffeine, is my thinking.

Anyway. In the process of writing this thing I am forced to re-read (this is so painful, you have no idea) many of my earlier posts, and have to rewrite them, for it’s a shame to take them down when the essence is still there, but the medium, the writing, like I said, atrocious.

Nevertheless, the first and perhaps only post on Bipolar Disorder has changed somewhat, and includes an inspiring embedded YouTube video of Kay R Jamison, author of the classic book on the subject, An Unquiet Mind.

Apologies to those of you who read the first draft. Probably none of you did, though, because in 2006 I didn’t even know about things like, tags, the traffic signals we bloggers use to draw attention to ourselves. But like I said, maybe that’s for the best in this case.

Anyway, here’s the edited version of

Bipolar Disorder, Not Everyone Has it, Actually.

therapydoc

Traffic and Weather

2009-07-16T20:05:00.016-05:00

I’m taking a 7th inning stretch, moseying into my colleague’s office to say hi. She’s aggravated because patients aren’t showing up.

“Do I charge them?” she asks.

“For sure! Charge ‘em!”

I’m in a take-no-prisoners mood, who knows, why, but have spent a good deal of the day working without a break. And the day started at the hospital, checking on my father. Every morning this week is at the hospital, which I don't mind, but I've been driving there, which is bad enough, and hate the parking lot, going around and around and around and around and around.

And there's no time to get home after the visit to change clothes to ride my bike to the office. There just isn’t time to waste.

So in general, I’m a little out of sorts. And some of the crank, for sure, is my father’s because he’s the helpless one lying around in a hospital bed.

I haven’t even told my colleague this, none of it, because (a) there hasn't been a lot of time to talk, and (b) I don’t want to talk about it. That’s what a blog is for anyway.

She says, “Charge them? How do I charge them? Should I call them up on the phone right now?”

“Don’t be silly! When you can talk to me? You'll get a call for another appointment and will say, ‘By the way, you know you owe me for the last visit. You didn’t show.’

And your patient will say, 'Oh, drat! I forgot!' or will spill out some excuse. Then you'll give that little speech we give." (Most professionals have a variation of this one.)

Sure, I understand, but you're supposed to at least call, we had a deal, even if you're sick, or have a funeral you have to go to, and you stole another patient’s time, because there's always someone who wants a cancellation. But no one could take your spot because it wasn't open cuz that didn't happen. That's why we charge, it's why I charge. Makes people more sensitive to other people the next time.

"You deliver the lecture," I tell her, "get paid and are no longer resentful and grumpy. The world is beautiful again."

“I’ll try it,” she says.

She might, but she probably won't charge. We social workers can be all mush.

ANOTHER STORY

So today I say to FD, “I’ve had it with driving. I’m riding my bike to the hospital and from there I’ll ride it to work. I’ll leave early so there's plenty of time.”

He’s skeptical, “Uh, that adds 11 miles to your bike ride.”

“No way,” I say. “And anyway, it’s all bike trail.”

For the most part it is bike trail by the river, meaning easy riding, and the only real danger is urban cougar, the feline species, and an occasional tricyclist. (By this we mean child on a tricycle, not someone on an antidepressant).

“You’ll see how far it is. It’s going to be tough. I can drive you, do what I have to do, then pick you up at the hospital. Then you can drop me off at work and have the car,” he continues.

“Senseless. It’s a beautiful day. Birds gotta’ sing, girl’s gotta’ fly.”

And it is fine, it truly is, for the first mile and a half. I’m very out of shape, have had no time this summer to get on my bike most days, and when I have done it, it’s been slow going. I’m not the person I was even a year ago. Enjoy your youth, my friends.

But I get to the hospital, no worse for the wear, and lock up my bike, take off my helmet and take a deep breath. I’m a half an hour late and for sure have missed the doctors. I want to talk to one of them, at least. Anyone on the team will do.

I get up to my father’s room and he’s rearranging the hoses and tubes that are sticking out of his arms so that he can sit down comfortably in his recliner. The drips are full of diuretics to get the excess water out of his body. The kidneys aren’t working, the heart’s not working, nothing’s exactly doing what it’s supposed to do. He’s braced himself for disaster and has been very philosophical.

“The food here is good, but I’m not hungry.”

“You’re sick,” I say.

“Yeah.”

“And it’s sickening, right, being sick, so how could you have an appetite? It would be weird to have an appetite, I feel.”

He laughs and shows me the paper and pencil review he’s given the nurses and the doctors so far. He has been very positive, very happy with his care-givers.

“I love it," I say. "You know, there are people who won’t give a positive review. No matter what, they will find something wrong with the people who are just trying to get through their day, trying to be helpful.”

“And those people are wrong!“ he confirms quietly. “They should write a good review anyway.” He would tip even the worst waitress. “Even if they’re terrible you tell their bosses how good they are. Then they’re not so terrible. They get better.”

Right, Dad.

We banter about nothing, and I realize that if I don’t get back on my bike I’ll be late for work and can’t let this happen. Mom will take the next shift pretty soon, anyway. I buy a bottle of water at the snack bar before leaving.

The ride to the office is LONG (about seven miles, FD is right on the money) and I have a sandwich in my backpack and I’m thinking maybe I should stop and eat or have a drink. There are plenty of park benches calling my name, but worry that if I do, and something happens, maybe a flat tire, I’ve wasted time eating and drinking. I hate being late. And I’m not hungry, anyway.

But I get to work in plenty of time and my fish (2 baby maroon clowns) are thrilled to see me. I feed them and they think they've died and gone to heaven. There are patients who have been calling all morning long on the office line, my cell phone, too, that I should call back, so I get to that. Eeeny, meeny, minee moe.

By 5:30 my back hurts and I reach for the Advil, pop open some email, too. One says in the subject line, 'I'm venting.' Why not? What's a therapist for?

There’s one more appointment to go, a 5:45. I get the call.

“Doc?”

“Yup, where are you? Caught in traffic?”

“Yes, how did you know?”

“I’m a genius.” (I don’t say this)

The city has been impossible, one of the allures of biking. Chicago has a short summer and construction begins and we end, so to speak, with the good weather. It is possible to spend the best hours of the day behind the wheel.

“Oh, a little birdie told me.”

“By the time I get to your office our time will be up,” he moans, remorsefully.

“We can talk on the phone,” I tentatively suggest.

“Okay!”

“But you’re in traffic, I just remembered, and I want you to pay attention to the road.” And I’m thinking, I can leave! I can go home!

“Can we reschedule?” he asks.

"Lemme look."

I find him a spot next week, knowing there's money lost here. I tell him, “I’m not charging you.”

“Thanks!” He’s so happy.

“Have a great night.”

Fact is, I could have charged him, and he would have gladly paid me. But he is powerless here and I am happy here and why would we punish either of us for either of those things? Hey, and he's called.

I pack it up and am out the door. It’s threatening rain, but you know, it’s that light summer rain that doesn’t bother you, the kind that sort of wakes you up, reminds you what it’s like to be a kid again, not worried about things like rain.

therapydoc

Termination

2009-07-08T22:07:00.003-05:00

I think-- gold watches, retirement parties. Cake.

Or the divorce party. Gonna' wash that man right out of my hair (a real oldie, you're not expected to know it).

The due a person gets for surviving a long association with an institution, sometimes trying, sometimes rewarding. Like marriage or work, or any serious social commitment that’s lasted long enough to feel. . .important.

Endings that beg formality.

Graduations, for example. FD hates going to them. He says, "What's to celebrate? You're just going to have to go back to school in September. There’s always another school."

He’s of the opinion that you learn more on field trips and reading encyclopedias. So he doesn’t get it. Would you ever stop learning, he asks? In his world there’s always something more, something new.*

But for some of us, our relationships are the most exciting something new in our lives. We don't just exchange phone numbers to say, “We’ll keep in touch!” and then not keep in touch. But it's harder, we know, once we've moved on, followed different paths. We become relationship-lazy, perhaps one of the reasons graduations are the perfect places for goodbyes. Give the work, the relationships, their due. And move on.

Then once we've settled down, established some roots, we find we're on the move again. In this economy some of us are moving back to our families of origin.

Where else am I going to go, now that I have no job?!

And some of us are moving away, taking the only jobs available, leaving extended family behind.

A friend of mine has a daughter who is being transferred a continent away, taking her spouse and children with her, the chutzpah, seriously. My friend, isn’t going to be hopping on planes to see her kid, she can’t afford it. This is a separation, not a termination, but it sure feels like a termination. Try convincing her otherwise. I wouldn’t begin. Sometimes people just need to spleen anyway, you know, let the tears roll.

When family moves away, it can hurt pretty bad.**

When it's friends, it might hurt, but the impact has to be different, less intense. We have to be happy for them, stay positive and profess, “We'll still get together, we'll visit. Now we have a good excuse to travel. A free hotel in a new city!” Like this is so easy, traveling. So pleasant, And so affordable.

Years ago, when my best friend (we had one of our kids on the same day, different hospitals) told me she was moving to Miami, I looked at her and without a trace of sadness sighed, “Nice knowing you. I’m terrible at keeping up, just being realistic here.” She wasn't pleased. But some of us get used to separations, terminations, young.

In our case, our time together was regimented, limited really, to one day a week, Saturday. The Jewish Sabbath consists of 25 free hours of not answering the phone, not turning on the television, not traveling, definitely not working. It's more like eating and drinking most of those 24 hours, singing, visiting friends, learning, and going to the synagogue to pray. I know, it's a tough life.

But once she moved I knew she wouldn't be a part of that anymore, that we would have to find time during the work week to talk on the phone, and that wouldn't happen. As it turned out, soon after she moved, my parents bought a condo in Miami. So now, when I visit them, my friend and I either get together for dinner or we talk about getting together, and that’s fun, too. It's like the proverbial call from the cousin at the airport between flights. "I'm here in town! Just called to say hello!"

All this before email, you know, all this drama. Now, we say,

"We'll email!”

Cause we have so much time for this, time to write back and forth about what happened today, yesterday, the past six weeks, six months. But some of us do pull it off, and we know how special it can be. But it’s not easy to keep up, is the truth.

So it can be tough, terminating, facing the reality that what we had together has to change, will go bye bye forever, lost to the past. Those of us who accept it don’t mind calling it what it is, termination. We say, “Goodbye, for now!” and celebrate the relationship we’ve had, redefine one for the future, try not to drop off the face of the earth, and when we do see one another again, try to pick up where we left off.

Negotiating a termination, saying goodbye well, means communicating what to expect from one another. What we would like, optimally from one another in the future. We'll expect more or less communication, depending upon the relationship. We say in therapy that there is no such thing as no communication and that may be true. But people over-diagnose no communication, tend to assume too much. They think,

"Where did you go? You haven't called. You must not like me."

Oy. Maybe nothing could be further from the truth. The squeaky wheel gets the oil. Our time isn't our own. There may be none. There is so much to do. And depending upon our histories, it may be hard not to take it personally. No call back, no letters. We'll perceive that as abandonment, an absence of emotional attachment, not enough, surely, to get the pencils writing, the telephones to ring.

But each of us has probably rejected more than we know, terminated relationships without a thought to those we've left behind. We only notice it when someone disappears on us.

So it can be touchy, this leaving others behind us, doing it well.

None of us wants to hurt anyone's feelings. Some of us can't walk away from a conversation until we're sure we haven't upset anyone. We can't terminate a conversation!

My tribe is particularly neurotic this way. Saying goodbye at a party takes two hours, seriously. Maybe this is a universal, for sure you don't have to be Jewish to worry about hurting peoples' feelings. As you turn to leave the party you can hear, in your head, the accusatory thinking. . . She didn't even say goodbye!

Long way around to talk about termination in therapy.

It symbolizes the death of an important relationship.

So we have to ask the question: Can a relationship really die?

We know our memories are buried in the hippocampus of our brains, probably wrapped in cozy blankets, stuffed into crowded, but air conditioned storage units. We pay by the year. If the memories are there, tucked in a tiny address in our brains, can a relationship, a metaphysical bundle of memories, really die?

They're all in our heads, somewhere, these relationships.

We used to say in family therapy, that there are invisible rubber bands around relationships, that it doesn’t matter what we call them-- married, divorced, separated. It is the relationship that defines the couple. And if they haven’t got a decent rubber band around that, if they don’t feel intimately connected, then guess what? They are already separated, even in a committed, married relationship, they may even be emotionally divorced.

The relationship between the therapist and her patient is also a metaphysical, cognitive entity, also bound by a rubber band. It can be very close, actually, intimate in some ways. But it isn’t marriage. The commitment of therapy is to treatment goals and objectives. It is the work we're committed to, and the intimacy is work intimacy, with no promise of ever-lasting, never-ending love. When the work is done, it is time to pack up our skill sets and go home. The imaginary rubber band becomes very thin, very, very large. You're gone, but not forgotten.

That’s the ultimate message the therapist has to convey to the patient in the process of letting go.

You are unforgettable. Your story is unique and you are amazing. I have learned from you. I’ll miss you, and if you need to come back, just give a shout. Thank you for trusting me, for sharing with me. I hope it helped, our time together.

They used to teach an entire course on termination, thirty years ago, in graduate schools, but I don't remember hearing this, that it is the therapist's obligation to convey these things to the patient, the meaning of the relationship.

What we do learn is that every one of us has or will have so many cut-offs in our lives, so many disappointments in relationships, so many deaths, both real and imagined, that a professional should be the last person to add to that class of aggravation.

Leave people miserable about the termination, unsatisfied, and unfulfilled, and they’ll bad talk you for years. I think that’s how they put it at the University of Illinois. They may even sue you.

And we can’t let that happen.

But you can’t please everyone all of the time, can you? And sometimes a therapist knows that a patient needs something more, someone else. It’s not easy sometimes to hear

We're not meeting your goals, and that's not good; it’s time for you to move on. You’re not getting better under my watch.

We make this call, by the way, not the patient. If we believe this to be true, then we have to insist upon another opinion, at the fatal six month mark, at least social workers do.

Am I helping this person? Should I get a consult? Should I punt?

We have to think this way. If we feel that punting will be detrimental, we need to get a consult, discuss the case with someone else, get a fresh opinion. And our consultant might say, punt. Each time I've done this, by the way, referred out, it has always been a positive thing to do. People need permission to move on, and we have to give it to them.

Sometimes we know that we're just exhausted, or we have exhausted our bag of tricks, and we're sure that a new perspective has to be better for the patient than to rehash the same old themes every week. Easing this human, our patient, down gently, feels next to impossible at first, especially if he or she has learned a certain amount of dependency in the therapy. First you crawl, then you walk, but a good mama wants her kid up and running, exercising.

The booby prize of therapy, surely, is a very quiet voice in the head, one that directs emotional wellness, fights off panic, and keeps you rational.

Up and running, exercising in the playground, no longer looking back, you hear, "Been nice to know ya'! Drop me a line!"

Because in this virtual world of ours, termination might just be a thing of the past.

therapydoc

*A complete exaggeration about FD to embellish the post. He does keep up with a few friends and some of his hundreds of cousins, and he never misses a barbecue.

** If you're my kid, and you're reading too much into this, CUT IT OUT! (cut it out is American English slang for Please stop! I assume everyone knows by now the meaning of chuzpah. (Let me know if you don't.)

***See Cat's post (I fired my first sponsor) about changing sponsors, one that prompted me to write Changing Sponsors, Changing Therapists on the Second Road

Top Ten Excuses: Governor Sanford

2009-06-25T07:35:00.009-05:00

No, I'm not finished with it.

Last night I had the house to myself (the remote) so I settled down to a warm teev to see what the world has to say about Governor Sanford.

What a nice looking guy, seriously. You can see why we're all so upset. He seems so presidential, has a little of the Lincoln jaw.

Anyway, the media is brutal and I'm pretty worried about the Gov's mental health. A sensitive man like him could get suicidal listening to what I heard last night, pundits and comics blasting him to smithereens. So we won't blast here, not much.

On the other hand, there's so much to blast.

You play you pay, Governor. And we learn all kinds of things, do we not, from our elected officials.

David Letterman feels sorry for not only the first family, but also the good people of South Carolina who have to endure this embarrassment. The governor, facing television cameras tells us:

(a) he went hiking
(b) he was exhausted
(c) he needed to get away
(d) he's really, really sorry--the list went on like the thank you speeches at the Academy Awards, and
(e) oh yeah, he had an affair.

He should have come clean, continues Letterman, should have told us straight up: I was taking care of business. You don't say, I was hiking on the Appalachian Trail. Say, I had s a board of trade meeting in South America. I'm looking at silos.

Letterman's top ten excuses. We'll add our own in a second.

10. Did I say hiking? I meant, cheating!
9. I had to do something after the devastating news about Jon and Kate!
8. I learned everything I know from Governor Spitzer.
7. Let's talk about more important things, like the Nestle Tollhouse cookie recall.
6. I learned everything I know from Governor McGreevey (apparently McG had an affair with his limo driver)
5. It's Ahminadajab's fault.
4. If you met my wife, you'd leave the country, too.
3. I'm auditioning for the Amazing Race (whatever that is)
2. If you run the state and have to leave the country for a week, since when do you need to tell someone?
1. It wasn't me, it was my alter ego, Bruno.

So let's add a few!

10. I can't communicate well with my wife, can't tell or show her what I need or want, it's too embarrassing to talk that way.

9. After all, she's really scary. Have you met her?

(She looks like the nicest person you'll ever want to meet, and she doesn't need him, by the way, her family owns the Skill tool company and has an MBA).

8. I have no imagination, zero.

7. I believe that it is women who are responsible for keeping their men interested, and that means they should be tan, preferably show tan lines.

6. If you have a close friend then how are you supposed to be able to stop that friendship from becoming sexual? Especially if you share so many of the same things, like you both have children? And why wouldn't you ask her for her email address?

5. I have an honest face, the people love me, I can get away with this. I think I can, I think I can, I think I can.

4. Denial is just a river in Egypt. Maybe I'll go there, too, check out some silos.

3. I'm in politics. What do you want?

2. I have a spiritual adviser so I'm working on it. Love the sinner, hate the sin.

1. And as Bob and Ray, that famous radio comedy team used to say, paraphrasing Nixon

NUTS! I'll never run again!

therapydoc