Wednesday, November 29, 2006

Relationships and Recovery

You’ve hit bottom. You know who you are. You’ve made the decision.

I will not use. I will not use. I will not use. I will not use. I will not use. I will not use. I will not use. I will not use.

You’re cool with that. You know you have no place else to go, you have to stop or die.

And for a reason you can not explain, your significant other has let you come home. You lucky guy.

But your significant other, your S-O, is furious. She's always down on you. She's not letting you off easy, even though you're sober, even though you're going to Cocaine Anonymous, or Alcoholics Anonymous, or Narcotics Anonymous. Even though you SAY you're straight and sober, she's distant. She won't have sex. She'll barely let you hug her. She acts like she'll never let you in, like she has an inventory a mile long.

And she does. Her memory is FULL of things you've done and not done.

And she's yelling at you ALL OF THE TIME!

All you have to do is look guilty (and you always look guilty) and she’s on top of you like butter on toast. She's mad.


Or you're late. YOU WERE WITH HER!

Must be.

Or you bump into an old friend. YOU'RE USING AGAIN. YOU MUST BE. But you're not.

You say, I bought a book.

But BECAUSE my therapist told me that reading is better than snorting coke somehow doesn't cut it.

I was late because I had to work late.

I saw an old friend at a C.A. meeting!!!


Tell her she’s right. You'll return the book. You'll take books out of the library from now on. You'll try to be on time. You will NOT see that friend outside of meetings and you will NOT be using drugs with him.

Repeat after me. She wants no BECAUSE. SHE WANTS NO BECAUSE.

You can’t defend yourself anymore. You don’t WANT to defend yourself anymore. Even if you have an excellent answer to her questions, even if you think you’re a hundred percent in the right and she’s way off track and she doesn’t get you and she’s unfairly maligning you and she’s exaggerating.

YOU’RE NOT TO DEFEND YOURSELF. Probably not for a few years, make it two years, best case scenario.


You want her. You want your kids. There will be no next time. There will be no more chances. So you’re going to work your program. You won't use. You'll hear her criticism, her anger, her sadness.

You’re going to let her tear you to pieces, beat the living emotional daylights out of you if that’s what she has to do, if that’s what feels good to her.

Should she get therapy?

Heck yeah.

Will therapy help her anger?

That all depends upon how angry she is AND whether or not you own what she’s talking about. But again, don’t think of conning her. She’s not letting you in so fast this time. You’re in the house, but there’s no way she’s letting you into her heart. She’s not stupid.

I’ve talked to partners of users who have been angry for so many years that there is no hope of them getting over it. They do not make it through the guy’s recovery marriage in tact. They have to leave. Oh, and sometimes, another guy has already taken your place.

What did you think?

So there’s no saying that you can really keep her, just because she said, “You can come home.” There’s no assurance in this post that even if you follow all that I’m about to tell you to do that she will not kick you out of her life. She might do it tomorrow, and honestly? Who could blame her? She’s been through so much more than you know.

That’s why you’re going to listen to every word she tells you.

Here’s the short list, the very least you can do to try to salvage your relationship.

1. You should not expect sex. Forget about it. Take care of yourself, do not cheat on her. Try to share a bed with the both of you fully dressed. Work on having a friendly relationship. See if at some point you can get kissed. Enjoy the kiss. Pretend it is the first kiss you have ever had in your life. Don’t make it a sexual kiss. Don’t make it passionate. Express your love softly. If she’ll let you.

2. When she’s yelling at you listen and own every word that comes out of her mouth. Do not argue. Validate what she says. Repeat what she says. Ask her if she minds if you write it down. Say things like, “I’ve been such a jerk, such a selfish person. I don’t want to be that person anymore. I don’t want to hurt you anymore.” And mean it.

3. If she’s repeating the same rant over and over again it is because you haven’t responded to her complaint in a way that makes her feel you HAVE heard her. You’re probably responding defensively, telling her facts you think she’s missing and should know. This is not what she needs. She doesn’t care at all about your excuses. She needs you to hear what she’s saying and to grieve, as she is grieving, the insensitive, selfish, out of control human being you have been for as long as you have using, and perhaps before you ever started.

4. Do not hang onto that, “I’ve got a disease,” excuse. I love A.A. as much as the next doc, for sure more (since I like the religious/spiritual intervention, whereas not every doc does). But “It’s my disease” makes it seem so irrevocable, like a death sentence. It may very well be true that you will be an addict until you die, even many years after your sobriety has begun, but she doesn’t need to be reminded of that. It’s so negative. This is not about you, okay? It’s about the person you need to be to be in a relationship with HER.

5. You can’t ever, ever, ever, ever be in denial and think that indeed, you have this licked, that you can control your drinking, using, sexing, spending, whatever. Your mantra for the rest of your life is that you really can’t do it on your own. You will always need friends to help you, a community, probably A.A. , C.A., N.A, or a similar support group to keep your coping strategies operational. Getting a therapist and going to therapy once every couple of months for the rest of your life is a fine idea.

6. If she’s given you the chance to live with her during your recovery, you owe it to her (and to yourself) to become her MAN. You have to take care of HER. I’ve focused in this post upon you letting her vent. You’re to take in her anger, HEAR her words, VALIDATE her feelings, OWN the error of your ways. That's taking care of her.

This is all very hard. But it’s what a woman wants in a relationship with a significant other. She needs and deserves honesty. This means that you have to take a good look at yourself and match what she sees to what you see. She deserves to be heard. The anger you hear is her pain.

I know that when you listen to her vent that you want to shout back, WELL, WHAT ABOUT ME? I’M THE ONE WHO HAS TO COPE WITHOUT MY DRUGS AND IT IS SO FREAKING HARD, BABE, YOU HAVE NO IDEA HOW HARD.

She doesn’t want to hear it. She doesn’t care, honey. She just doesn’t care. She might have wanted to hear it at some point while you were using, maybe after your first relapse, but after a few years, after you’ve squandered good money after bad, after she’s slept alone knowing you’ve slept with others, and that you’ve lied a million times, deceived her in a million ways? She doesn’t care.

And you’re going to tell me that having to take that kind of beating makes you want to get high. I know it does. That’s why you have a sponsor, right? That’s why you go to meetings, maybe every day in the beginning, maybe many times a day. That’s why you see someone like me.

When you get those thoughts, especially the ones that tell you that you can’t stand it anymore (her attitude) and that you simply HAVE to use; if you’ve lost your sponsor, if you’re not in A.A., if you have no sober friends, then stop and think about why you’re really using.

She wasn’t there when you started. You’ve probably been using since you were a little kid. Maybe you were rebellious, maybe depressed. Maybe you wanted to fit in and had no idea how susceptible you’d be to substance abuse and dependency.

At the end of all those maybes is the simple truth that you needed something to do, something to change the way you were feeling, something to fill in your emptiness, loneliness, or bad to horrible sense of self.

Your using was never about her and it is STILL not about her.

You want her back? Shut up and listen to what she says and take it like a man. Take care of her. And don’t ever lie to her again. Oh, yeah. And don’t forget your next appointment.

P.S. After I posted this I saw an alcoholic in recovery. He goes to A.A. meetings twice a week. He would go three times a week but SHE wants him home (I told her, since it's a marital therapy, that she should kick him off to meetings as often as possible, but okay.) ANYWAY, he said that if he attended a meeting and complained that his wife was yelling at him too much that his group would say, DUDE. YOU DESERVE THAT AND SO, SO, MUCH MORE. JUST LISTEN.

'nuf said.

Copyright 2006, TherapyDoc

Monday, November 27, 2006

About Affection: Part Three Behavioral Therapy

Sometimes my mom, who turned eighty last year, will read my blog and she'll ask, a little shy, "I wonder if your father and I were bad parents?"

Are you kidding, Mom? You were great. The two of you teamed up very well together, still do, and I tell the following story in therapy, when people really need to change and don’t have the courage to do it, of how you two changed the way we operated one cold day in February, 1970.

I tell the story because there are families that lack affection or lose it somehow, and have no idea how to get it back.

Take this very typical example. I’ve seen dozens of variations of cases like this.

About a year ago, a lovely Hispanic woman, we’ll call her Mrs. X., brought her 15 year old daughter in to see me for therapy. The kid had taken the family car in the early hours of the morning to hang out with her boyfriend.

Her older brother happened to have been up around 3:30 a.m. He was looking out the window and saw his sister slam the car door upon returning home. This upset him on many levels, especially since he knew she had a boyfriend. He woke their father, told on his sister right then and there.

Mr. X. got up and beat the living blank out of her. He had never done that before. By the time the young girl saw me for her first visit there were no physical scars. But she was very upset and swore she would never speak to Mr. X again. Her mother wanted to know what they should do with the girl since she seemed so angry and out of control. Mom was also worried about the potential for more violence in the home.

There were many things happening in this family, but the thing that was driving the kid's need to drive the family car was feeling unloved. The boys in the family were valued, but she felt that she was not. She received no physical affection from her father.

I said, “Bring in Dad. We go no farther until I talk to Dad.”

Mr X, a very handsome, well-groomed middle-aged man, came in with his daughter and sat opposite to her. He said that he was very disappointed, had no idea that she would ever be the type of girl to do that, steal a car, go out in the middle of the night, ride with boys.

He was defensive. He had raised her properly. He didn’t understand. He worked so hard. He gave her everything she needed.

Do you ever talk to her?

Sure, sure, sometime.

No, really talk to her. Do you know who her friends are?

Sure, I know some of her friends.


Some, not all. She is in high school. There are many kids there.

At the end of the work day what do you do?

I come home late sometimes. I go to bed.

She tells me that you like her brother more than you like her.

Oh, that’s not true. That’s ridiculous. I love my daughter. I love her so much. (He steals a sad glance at her.)

And you tell her this, that you love her so much?

I have. Sometime.


Not much. But she knows.

I turn to the kid. You know, I ask, that he loves you so much?

I don’t know. I for sure don’t know. And now that he’s beating me up, why would I think he loves me. He loves my brothers. Ever since my little brother was born I have taken a back seat to him. Before that he was nicer.

How old were you before that ?


Do you come to him to talk to him? I asked.

I’m scared of him. He only gives orders. Do this, do that. He doesn’t ask me about me. He lied. He never asks me about my friends, or about what I like, don’t like. He couldn’t tell you what classes I’m taking in school. He doesn’t know the color of my eyes.

Brown! he shouts.

Yes, they’re brown, she agrees. But you know you don’t know what classes I’m taking in school.

The name of her boyfriend? I asked him hopefully. Do you know the name of her boyfriend?

No. I don’t know the name of her boyfriend. She can’t have boyfriends. She’s only a little girl.

Sure, sure. But what if she liked a boy. Girls do look at boys, boys look at girls. Let’s say she had her eye on a boy, and that he liked her, too. Wouldn’t you want to know that? Wouldn’t you want to know his name?

She can’t be with boys. We don’t let her be with boys.

But let’s say she liked him enough that she wanted to be with him, anyway. Even knowing you disapproved, and didn’t tell you about him. It is hard to know where teenagers are every minute of the day, isn’t it? Wouldn’t that be a problem for you?

Yes, yes.

So wouldn’t you be feel safer asking her, on occasion, if she liked any particular boy, and if so, what did she like about him? Wouldn’t you think it’s safer to tell her what boys are really all about, what boys want to do to girls, and how she should be very careful when she falls in love? I’m sorry, but I think fathers are supposed to warn their daughters that boys can break their hearts. Men understand men. Women only think they do.

He is quiet. He looks at her. The doctor is right. Boys are after one thing.

End of lecture.

Keep going, I say.

He goes on awhile about boys being boys.

Maybe it is time to start talking at home, I suggest. (I turn to the kid) If your father came into your room in the evening to talk, would you talk to him?

Mr. X interrupts. Oh, I don’t go in her room.



Why not?

It’s not respectful. A man does not go into a woman’s room. She is a woman.

But I thought you said she was a little girl?

He laughs. She is too young to take the car and drive around with boys. She is only 14

Fifteen, corrects his daughter.

Why would she want to do that, drive around with boys, I ask.

I don’t know. He sighs.

Ask her.

Why you do that? Mr. X asks.

I don’t know, she sighs.

Sure you do, I say.

I want to be with my boyfriend.

Ask her why.

Why Mr X asks his daugher.

I like him.

Ask her if they kiss.

He asks.

(His daughter, shy) Well, sometimes.

Me to her father: Do you ever kiss your daughter?


Have you ever?

Sure. Especially when she was small.

Do you ever touch her, say, arm or shoulder affectionately?


No you don’t she barks.

Of course I do.

You never hug me. Never touch me.

I can’t he says.

Sure you can, I say. You love her.

Of course I love her.

So why not show it?

I don’t know.

You hug my brother, kid blurts. You kiss my little brother.

He squirms uncomfortably in his chair.

True? I ask.


I kick the kid out of the office, ask her to wait for us in the waiting room nearby. I want to talk with her father alone. She leaves and I launch into one of my canned lectures with him.

Listen, Mr. X. I'm going to let you in on a little secret. You, as this kid’s father, ideally should be the only one who gives her physical attention and love at this age. You are IT. You’re HER DAD. You’re the man. She doesn’t need this boyfriend. Warm up to her.

I don’t know. I don’t think I can.

Put your arm around her while you're watching T.V. once in awhile. Smile at her when you see her. Ask her to tell you about her day. Stroke her chin. I know guys like you don't want to be accused of anything bad. You’re aware that there are men who touch their daughters inappropriately. But you’re not that kind of person.

I was told never to touch my daughter. I would never hurt my daughter. I want her to be happy.

Sure, which is why you were so upset when she went out with her boyfriend.

You know, of course, that you can never hit her again. She will call the police again next time. Or me. And I won’t help you. It's amazing they let you off this time.

I know. I won’t hit her again. But she can’t do this. She can't be taking the car in the middle of the night to be with a boy.

You need to start to talk to her, and you need to show her that you love her. You can't act like you love her brothers, but not her.

I don’t know. I can try. But I don't know. He looks at me helplessly, blank, lost.

That’s when I told him the story I’m going to tell you now. It’s a hard one for me to share.

But this time of year, when the weather gets cold, and my thoughts turn to winter (I hate winter) I think of this story and how it changed my family forever.

I’ll give you the introduction I don't give my patients. I didn’t tell this to Mr. X. He’s a patient, he doesn’t need to know all this detail. Maybe you don't either.

However, if you remember from the first post on affection, mine was not a gooey family. We were relatively disengaged. My parents allowed us our own personal space as kids, and although we didn’t communicate all that much with one another, we were allowed to do our own thing, to develop independence. This has served me well all my life.

But we were a little light on physical affection. Mom says I rejected her at age 13 when she took my hand while we were crossing the street and I shrugged her off. (Not all that weird, right?). The fact is, that soon thereafter, at fourteen, I experienced a real hormonal emotional drop and got pretty depressed. For sure I deliberately distanced from the family.

And my Dad was never physically demonstrative or affectionate to me. He was more like Mr. X. Maybe he worried that affection towards a girl might be inappropriate. He didn’t have sisters, and he had his own childhood issues with my grandfather. Affection can be transgenerational. If he didn’t get it, it might have been harder to give it, right?

Yet when I look at baby pictures, there he is, holding me, clearly happy, laughing, and AFFECTIONATE.

And he was so nice to my friends and everyone else. My guess is that he got uncomfortable when I started to show the first signs of being a girl.

What did a guy with no sisters know from girls? Anyway, I was a happy kid regardless, if not a little on the anxious side, until adolescence. High school was a tough time for my Little Bro, too, who barely remembers those years.

But Big Bro who was used to having actual physical health issues, was the one to come into his own as a teenager. He got tall and handsome, and let his beautiful Indian jet black hair grow out (this was the sixties). By seventeen he’d scored exceedingly well on the all those important achievement tests and got into the top medical schools. He was a happy older teenager and a year later, when I matured a bit we became closer, the two of us. We saw the potential for a warm, fuzzy, future family relationship.

Then in a flash, he disappeared in late January, 1970. It was one of those horrible family tragedies in which a child, a just turned twenty year-old child, can simply disappear.

I can tell you how it affected me as an adult. I don’t watch Without a Trace. I avoid all kinds of things about missing kids on television, and that milk carton campaign blew me away a few years ago. On very rare occasions, when patients tell me a story about missing persons I focus like crazy on them for that 45 minutes, get through the day, then zone out for who knows how long.

Anyway, when I talk to patients about affection, I don’t tell them all that I’ve just told you. My hands tremble at the keyboard even now, just thinking about sharing it.

But I do tell them the rest of the story, which of course, you deserve.

We left off with, Mr. X feeling incapable of showing his daughter the affection I thought she needed from him, and me saying,

Mr X., let me tell you a story:

When I was a kid my father was a lot like you. He was very careful about affection, and he never came into my room or sat on my bed, that sort of thing. I think that it is all about respect, honestly, and that you, too, are the kind of father who respects your daughter.

Am I right?


I know. I know you. You are a good man.

Well, here’s what happened in my family. One day we had a tragedy. My brother was 20 years old and he lived downtown in a dormitory for school. He disappeared. It was winter and we later learned, a month later, that he had drowned in Lake Michigan. It was a terrible thing, a terrible blow to everyone. I lost a brother. My parents lost a son. You don’t get over that.

(I let the pause get really pregnant here, then continue)

And as parents, I think mine said to themselves: We only have two children left. We have to make every day count. Every day has to matter with our two children.

So they called a family meeting, my parents, my younger brother, and me. We sat down at the kitchen table about a week or two after we had buried my big brother, and we talked about how we were going to make changes in the family.

I think my father might have said, and I’m not exactly sure he said this, but he might have said, “I don’t know if your brother knew how much I loved him.”

Maybe I said, “I’m sure he knew you loved him.”

And he said, “We have to be sure we all know that we love each other. How do we do that?”

I believe it was me who suggested that I kiss him, my father, when he came home from work from then on. I would do that.

The suggestion passed. He thought it was good. Everyone thought it was a good idea. Maybe it wasn’t even my idea. I don’t know. But the meeting ended.

And I did that.

My father would ring the doorbell. I’d run to answer it (I was 18). And I’d kiss him hello. And he’d kiss me back. It was wonderful.

It was very stiff at first, and weird. But it was wonderful and heartfelt and after awhile, felt very natural. And we are affectionate and loving with each other to this day. He is 86 and I love him very much. It is the same with my mother, who is going on 81.

You can do this, too, I told Mr. X, and have told so many other fathers. You can do this too. You can start this affection thing going with your daughters, and you should.

If not now, when?

What are you waiting for?

Copyright 2006, TherapyDoc

Friday, November 24, 2006

Keeping Expectations Low: Office Mail

The guy who delivers my mail at the office is a fit-looking fellow, probably around 58-59, wears a woolen cap in the winter, baseball cap in the summer, and his postal uniform every day. That is, when I see him.

I wait for him everyday with high hopes. After all, he’s the one who delivers the envelopes with checks from insurance companies.

I could complain about how when I buy a pair of shoes, I fork over seventy dollars immediately, that DSW does not have to wait for the money, whereas when my patients see me, they complain about their co-payment, usually between $10-$25 and have no idea how I sometimes have to haggle with their insurance to get paid the rest.

Yet if I want to buy a new scarf or even a box of TIDE, retailers expect the full amount right then and there. I won’t get away with a co-payment of twenty bucks. This is, by the way, the psychology behind charging up your credit cards. It's all about denial and not wanting to pay for anything.

Anyway, patients want to think that their medical providers are very rich, as money is the generic symbol of success, and they don’t want to be seeing an unsuccessful professional. So you thinking that I’m actually worried about getting paid probably worries you.

Yet this is how it is.

Like people in business who wait for the mail to see what’s inside, professionals wait, too.

I can remember, years ago, HMO’s had pulled the rug out from primary care and S. and I owned a medical building in the city. Eventually property taxes drove us out of there, but when things got really, really horrible S would take the mail from his receptionist and pace with it as he leafed through letters and junk, chanting, “No money. No money. No money.”

Those were fun days, let me tell you.

We’re both in new places now, but like I said, the mail is one of those things we approach from different building, now, with anticipation and a little dread. That post on keeping expectations low? I LIVE IT, BABY.

One year, the week before Thanksgiving, for some reason we were particularly broke. I don’t go to the office on Friday and Saturday, usually, so I wasn't going to be taking in any mail until Sunday.

On Sunday there was nothing in the mail box from Friday and Saturday.

This happens, no biggie, no cause for alarm. I’m all about low expectations.

But on Monday I was on the look out.

There’s a window in my office from which I can see the front door to the building and the row of metal mailboxes, and since the front door to the building is glass, encased in a glass wall of picture windows, I get to see the sunshine and the trees and the park across the street, too.

Sort of a room with a view.

If I’m not looking out for the mailman, I’m still close enough to hear the clang of his keys as he opens the box. So on Monday, I assumed I’d hear him, if not see him. But he never came.

Monday? No mail

Tuesday, same thing.

Wednesday, same thing. No mail.

Thursday? Thanksgiving. Okay, I understand, a holiday.

Friday, even though I had some visitors in from out of town, I made a quick trip over to the office to see if I might be able to make a deposit before 5 p.m. Making a trip in the city on the day after Thanksgiving in the late afternoon is a joke. Traffic is murder. The weather, in November, isn't usually conducive to riding a bike. (Have I talked about riding my bike to work?)

But I said to myself: Sure, this is ridiculous, but it’s a short day, certainly he’ll come later, and on Sunday, this Sunday for sure, there will be mail.

Sunday there was no mail.

And Monday? A week and a half since the last mail delivery from the United States Postal Service? No mail. And I was swamped with patients and there was no way to make a dash over to the station, but you can believe it, the next day, bright and early, I waited in line to talk about this situation with someone who might know something.

Me: So what’s up with the mail delivery to the 2650 building?

Clerk: What do you mean, what’s up?

Me: I don’t get mail anymore. Neither does anyone else in the building. There are ten offices in that place. Nobody gets mail anymore.

Clerk: Let me check it out.

I waited, and waited. Eventually he came back, this dapper clerk with a mustache.

Clerk: Who’s your mail carrier?

Me: Not sure, Smith maybe.

Clerk (big smile): Smith.

Me: That’s right, Smith.

Clerk (self-satisfied, he’s solved the mystery): Well Smith’s been on vacation. He should be back this week.

Me: What! So you don’t put someone in his place? Smith’s on vacation so I don’t get my mail?

Clerk: Looks like he forgot to put in for a substitute.

Me: That makes no sense.

Clerk: Or the sub didn’t show.

Me (worried, thinking my mail’s in someone’s living room, or worse, in the back of a postal truck they don’t use anymore): Where’s my mail?

Clerk: Oh, it’s in the back.

Me: I want it. Now.

Clerk: You want it? Do you want the mail for the whole building?

Me: No, I just want my mail.

Clerk (looking doubtful): Well, I’ll see.

Me: Please do.

He returned with one of those big plastic mail crates FULL of mail. No junk mail, either, just mail, bills, checks, authorizations for treatment, reports from other doctors, lawyers, employers, certifications from insurance companies, all kinds of good things.

Clerk: You can take that with you. The crate, I mean, but could you move aside so that I can take care of the next customer?

Me: Wait a minute. I really think I deserve an explanation. This is unacceptable.

Clerk: Maybe your building was locked. Maybe they tried to deliver the mail and you weren’t there. (Then, as an after thought). Or maybe it’s because he’s a union steward.

Me: Maybe it’s because my mailperson is a union steward?

Clerk (guilty look for having said it): I don’t know. Maybe. I never said that.

Well that explains it. Sure. Wait a minute. That doesn’t explain anything!

The follow-up?

We’ve never had to wait a week and a half for the mail since. I pushed the downtown office to keep an eye on our building (me being assertive). Mr. Smith had to scan some kind of an electronic device by 2:00 everyday for a couple of weeks, and occasionally I saw someone come into the building, playing with this thing, probably clocking him in.

It wasn’t like he apologized, okay? But for all I know it wasn’t his fault at all. I'd like to give him the benefit of the doubt.

Once an officious postal person stopped by to ask if I was the person who complained about the service to the building, or if I knew who might have registered the complaint. I got pretty nervous, like I do with anyone in a uniform (I hate being stopped by police for anything.)

Me: Uh, me? Complain about the United States Postal Service? Do you think I want someone to go postal because I didn’t get my mail, or worse, perhaps take it out on me by simply forgetting to deliver, say, only MY mail? Do I look like I’m crazy?

Official postal person: Did you? Complain?

Me: Uh, no, but I know everyone here in the building is pretty upset about the service.

Official postal person: Thank you, doctor.


No, things are pretty much the same, nothing’s changed all that much, except I’ve never gone AS LONG without mail. Smith comes before 7 p.m., assuming he’s going to deliver the mail at all, and I’ve stopped complaining. Something tells me he knows it’s me who did complain, but we’re very cordial, talk weather, etc. I never ask him, "Where've you BEEN?!?"

And don’t you worry. On Xmas? I’ll tip him, just like I’ll tip the guy who delivers the Wall Street Journal. I’m not stupid.

Copyright 2006, TherapyDoc

Thursday, November 23, 2006

Being vulnerable

The other day I was talking to a friend of mine and asked, “So honestly, what else do I need to do with this blog, aside from hiring someone to completely reformat it so that a person doesn’t have to scroll up after they click to read the stuff on the sidebar.”

Without skipping a beat she said: You need more dirty jokes, Lin.

Huh? What do you mean, more. Are there ANY dirty jokes here?


Could be.

So I delved deep into my old AOL account (153 messages) and looked for Sarelle’s jokes.

My friend Sarelle is an amazing food artist and very religious, yet she has this cache of jokes, generally Jewish, many about being elderly, all pretty funny.

But I have to be in the mood, you know? I hate it when someone says to me, “Did Sarelle send you that joke about the. . .Wasn’t it funny?” and I didn’t find it funny, and feel like I have to say that I did just so I won’t have to answer the next question, “Well, why didn't you think it was funny?”

Anyway, this morning I saw her, the joke-miester herself in the parking lot at Jewel. She was loading dozens of bags of groceries into the back of her 20-seater van, straddling a puddle of milk. I guess she’d dropped her milk, but I didn’t ask. I pretended it was normal to be straddling a big puddle of milk.

When women see each other they big hugs, so I gave her a big hug and told her a quick story about S.

Remember S? We dropped G.D., short for Genius Doc, in favor of S, Such a Good Doc, then yesterday he told me preferred C.D., short for Cranky Doc. But I don’t want him confused with a plastic disk. He's much more than a plastic disk.

When I rolled over this morning S was singing. I don’t know if this was hip hop or rock or what, but I know the song he was singing and I HATE this song.

S has a classical music background so he doesn't even realize how bad it is. That the song is bad is just my opinion, probably a minority opinion, as usual. And the only reason he has this deriviative hip hop song droning endlessly through his hi-jacked brain is that Rac, one of my talented daughters-in-law asked him to transpose some music for a show she's working on for her sister Meira.

Rac, btw, came up with the Jason Fortuny handle, Cyberspace Super Hero.

Anyway, I don't care what Meira says, I hate this song:

Everybody Loves the Fool.

Remember it?

Everybody loves a fool. Ain’t no exception to the rule. Maybe factual may be cruel, sometiiiiime, but everybody loves the fool.

As much as I hate the tune, the words actually prove my bias that there’s no rush to get better in therapy because our friends love us when we’re screwed up, when we play the fool, do stupid things. When you’re a psychological wreck it makes everyone else feel less screwed up. More normal.

See? Being a mess serves a valuable societal purpose.

I’ve said it before, people love us vulnerable so take your time getting your act together, and no, this is not about me making more money at your expense while you luxuriate in therapy. Sheesh.

On the other hand, why do other people get to feel good at your expense when you're vulnerable? Let THEM be screwed up for a change. Get working on changing those negative thoughts, raising that serotonin!

Anyway, back to the story.

S. was getting dressed to go to the synagogue (shul) and he thought it would be funny to give that horrible song to ME.

He sings, “Everybody goes to shul. I'm no exception to the rule.”

“No, no, no!” I cry out. “Do NOT give me that song!”

But it was too late.

So when I saw Sarelle in the parking lot I told her that story and gave her the song, and now you all have it, too. It should be out of my head. I'm cured. And I know. You hate me.

To make up for doing this to you on this Thanksgiving Day I’m giving you one of my friend’s jokes. Maybe it will inspire her to find some better dirty jokes that are not really dirty, or really funny, but gently distract us from what we should be doing, like cooking for Thanksgiving. Don’t expect me to do the joke thing very often, though. I get panic attacks just signing onto that AOL account.

Oh, and Sarelle? Tell me again the one that you know I like, the one about the old guy who got married and sees his friend the next day, and the friend asks, So how did it go, did you, you know? And he says, Sure we did, we. . .

How’s it go again?

Anyway, this was all I could find that didn’t make me want to throw up.

A man standing in line at a check out counter of a grocery store was very surprised when a very attractive woman behind him said,"Hello!" Her face was beaming.

He gave her that "who are you look," and couldn't remember ever having seen her before.

Then, noticing his look, she figured she had made a mistake and apologized. "Look," she said "I'm really sorry but when I first saw you, I thought you were the father of one of my children," and walked out of the store.

The guy was dumbfounded and thought to himself, "What the hell is the world coming to? Here is an attractive woman who can't keep track of who fathers her children!"

Then he got a little panicky. "I don't remember her," he thought but, MAYBE..during one of the wild parties he had been to when he was in college, perhaps he did father her child!

He ran from the store and caught her in the parking lot and asked, "Are you the girl I met at a party in college and then we got really drunk and had that wild crazy night in the back of dorm?"

"No", she said with a horrified look on her face. "I'm your son's Hebrew teacher!"

Groan, groan, groan.

Ah, it wasn’t that bad. I could have told you the one about the hypnotist.

Wednesday, November 22, 2006

28 Days

28 Days is just the Sandra Bullock movie that made me a fan. Spoilers, beware.

If you have any kind of substance abuse addiction and you haven't seen this movie, well, see it.

Sandra (Gwen) is in a 28 day rehab. Her mother drank herself to death. Gwen has lots of issues and is poly-addicted. She resists rehab but finally figures it out. This is a good place. People don't want to leave, in fact.

When someone does graduate and leaves this very cozy, ideal environment, the rest of the inpatients sing a rendition of Happy Trails.

Happy trails to you, until we meet again.
Happy trails to you, keep smiling until then.
Happy trails to you, till we meet again.

The launching is clearly stressful for Gwen. In one case a guy is leaving rehab and the other patients in the lobby see him with his packed bags, about to go. They sing the song.

Gwen (to another inpatient): I hope he makes it.
Other patient: Only three out of ten of us does. Maybe it's better for us if he doesn't.

The joke, of course, is that he doesn't quite get statistics. Three out of ten has no bearing upon any ONE person in particular. It's a group stat.

What's sad is that the statistic is probably true. Recidivism, repeating old habits, what we call "slipping", falling off the wagon, is much more common than not.

What I teach clients is that if that happens to you, if you start using again, well, you brush yourself off, pick yourself up, and start all over again. You have to love lines like these. They're so perfect for getting sober.

Slipping is just that, nothing more, nothing less, not a failure, not the end of the world. It's not so bad. It's just another challenge, no different than getting back to business when you've been on vacation for awhile.

Oh, and you're supposed to ask for help. People need people to be happy, not drugs or alcohol. And call people a lot, just to say hi, be a human being, care.

I know many people resist 12 Step programs for so many reasons, but in the process of getting sober following an egregious, life-changing, usually tragic event, millions of people are introduced to them. This film saves you a lot of trouble. Assuming you watch the whole thing.

Copyright 2006, TherapyDoc

Tuesday, November 21, 2006

Keeping expectations low

You've heard the expression, keep your expectations low.

Why? Because it saves you from too much disappointment when things don't work out.

Domeena Renshaw, MD, one of my mentors, liked to put this in mathematical terms. I can't remember exactly how she worked out the equation, but I've since made up my own, based on what I remember from hers.

Achievement divided by Expectations equals Satisfaction.

We shoot for a whole number.

So let's say there are 10 items on a spelling test. I haven't studied for the test,(aw) but I still expect to get a 10 because in the past, my spelling's been pretty good.

Unfortunately, there are lots of hard words.

I only achieve (A) 5 out of 10 (E). A/E = S. 5/10 = 1/2 (S). I end up with a freaking fraction for S, Satisfaction.

A FRACTION! This doc wanted a whole number. In life we want at least a whole number plus a tiny fraction, if necessary. Never a mere fraction, okay?

If I had gone into that test expecting only a 5, as opposed to a 10, then it would have looked like this. 5/5 = 1. The 1, the Satisfaction Quotient, is a whole number. yay.

So if you're starting therapy with a new therapist? Keep the E low.

If you're going on a first date with a cute guy? Expect the worst. The absolute worst. Make that E a 2.

If you told a neighbor you'll dog sit while she's out of town? It's not too late to change your mind. Expect gnawed shoes.

If you spent $300 on a couple of opera tickets based on a great C.D.? Expect the music will be fine, but the sets and costumes will be lame.

If you buy a hundred lottery tickets thinking you'll win? Expect to lose the whole enchilada.

If you expect something fabulous for your birthday? Expect everyone to forget about it altogether.

You get the idea. Hedge your bets, play it safe, and may all of your numbers be whole.

Oh, and be happy with whacha' got, right?

Copyright 2006, TherapyDoc

Saturday, November 18, 2006

Holiday Post # 1- Bananas and Video Games

Holiday Post # 1 Bananas and Video Games

The Thanksgiving holiday marks the season of joy for some, but for others it can be very depressing. As a matter of fact, you may know that for TherapyDocs all over the world, it’s BUSY SEASON.

Because of the Holiday Blues.

This Doc starts getting busier as soon as the leaves begin to fall and the days get shorter.

In Chicago, if we have a decent Indian Summer, meaning if there are a few weeks in late October and early November with sun and high temperatures, it seems there’s less of an onset of SADS (seasonal affective disorder).

I forgot to add someting about the holiday blues to that post on SADS, but I should have.

Going out of town last week for a vacation, a mere two weeks before Thanksgiving? Sheer sacrilege.

Why are people such emotional wrecks before the holidays?

Lots of reasons. One of 'em's money.

But first, a quick story about S. and bananas.

Who is S.?

S. used to be referred to in this blog as G.D., Genius Doc, writer of BUNK, Medical Myths and Misinformation. The problem is that he’s always hated being referred to as G.D. and I hate to upset him. So from now on we'll refer to him as S. short for Such a Good Doc.

Thursday night S. went to the Jewel, the local Albertson’s grocery store, to buy bananas. He’ll do that, go to the store to buy ONE thing. This is not something women ever do and it boggles my mind, but I admire it, like everything else about him.

The Jewel is in a strip mall within walking distance from our house. S. returned home with bananas that were a little green, but okay. I’m not going to make an issue over green bananas.

S: You would not believe what’s going on at the Best Buy! (Best Buy's right next door to Jewel). They’re queued up to get inside for tomorrow’s sale. Do you want to know what’s going to be on sale?

Me: Uh, sure.

S: The new Play Station. People will be waiting in line all night to get in early tomorrow morning to buy Play Stations for their kids for Xmas. They will be camped out all night long to buy these things.

Me: I see.

S: Crazy, right?

Me: Oh, yeah.

My friends, I have to tell you. We do not live in California. We do not live in Florida. We do not live in Georgia, Mississippi, New Mexico, South Carolina or Texas. We live in friggin’ Chicago, Illinois, and we are not having an Indian summer. It is COLD here at night. In November it gets into the 30’s by 10 p.m.

I have my thermostat set at 75 degrees.

Immediately I understood that this was going to be a very good season for me.

Except that people start canceling their appointments around this time of year (you DO give me 24 hours notice, right?). They’re saving their money, co-payments, co-insurance, what-ever, to buy things like . . .

Play Stations.

They short change S., too, this time of year.

But we’re getting away from the point:

Why do people suffer from Holiday Blues? The holidays are supposed to be happy times.

Money's big here. No question depression's also related to other things, LOSS in particular, missing people who are not here and having problems with people who are. But money certainly factors in heavily to the blues.

The Wall Street Journal made it perfectly clear.

In Friday’s WSJ (November 17) there’s an article in the Marketplace section entitled: It’s the Publicity that Counts.

Vanessa O’Connell writes an ingenious piece about holiday marketing to consumers. She says that in 1959 Neiman Marcus began to pitch gifts to those who could afford excess with the first one-of-a-kind luxury item. Neiman’s convinced the well-heeled that they could not possibly do without a . . .

Black Angus Steer.

Ever since, high end retail stores have been introducing fantasy items this time of year with exorbitant price tags. We too can buy them if we can get our hands on thousands, upon thousands, sometimes even millions of dollars.

A space travel venture, meaning a ride on a spaceship, the Virgin Galactic? Only 1.5 million. They’re booked solid, I understand. Sorry, you're too late.

A walk-on roll at the American Ballet? A mere $3,000 is the starting bid. Good G-d, TAKE it!

A day at the Super Bowl, accompanied by a National Football League player? Only $100, 000.00. How can anyone resist this?

Ms. O’Connell brilliantly remarks, “. . . even customers who can’t afford fantasy gifts will want to be associated with such luxury.

She continues: Retailers know that luxury is largely an emotional state, and during the holidays, people are most prone to acting on emotions.”

Bing, bing, bing.

Hear that friends? You’re most prone to acting on emotion (as opposed to logic)during the holiday season. And I’m telling you that your serotonin is likely to get locked up in those neurons this time of year. Thus you may be more vulnerable to impulse buying than you would be under normal circumstances, and you may be likely to regret your purchasing later, which will add to your depression.

The journalist is 100% correct. People act upon the need to spend money they don’t have: (1) to make others happy, (2) to save face among friends and family, (3) because it makes them feel rich, and 4) they want to be perceived as rich so that they’re treated as if they’re rich. The saying goes, image is everything.

So everyone rips out the plastic and goes to town beginning the day after Thanksgiving. And it depresses the blank out of ‘em to do it, too.

What a world.

Which brings us back to bananas and video games.

Bananas aren’t exactly a gift, it’s true, but we can consume them. I maintain that a banana, because it is food, is closer to a symbol of love than is a Play Station.

Food for sure represents love. When people eat they are commonly happy. They often eat with others and talk, discuss problems or fantasize about dreams. Women lunch. Couples make plans for the future over dinner. They communicate about intimate things.

Whereas a Play Station represents staring into a media device.

My grandparents (and my father) were immigrants and came to this country in the twenties. When I was a kid I remember only getting two toys for special occasions: a Ken doll with a bald spot (why Ken, not Barbie, I’m not sure), and a Sheri Lewis hand puppet, Lamb Chop. At some point Mom got us all a Monopoly Game to share which was a tremendous thrill. These were great toys.

But that generation wouldn't have dreamed of throwing out money on things they could not afford. Their concept of fun was any state that was the absense of work. Work for folks like my parents and their parents meant picking feathers off of chickens or holding eggs up to a candle to see if there was anything moving around inside the shell.

Fun was something you did outside, using imagination, preferably. It meant moving around, tossing pennies, having contests to see how far or high a kid could jump.

I'm thinking that the best gifts you can give your kid are imagination, a back yard, or both. I am sure that one can live without a back yard. But imagination? So necessary.

It can lie dormant unless it is watered, for sure. Parents have to water a child’s imagination, and seed it.

Another great gift is teaching children to love learning. Learning is also fun Good parenting, parenting with care, as I’ve said before, is the greatest gift.

And it’s not expensive.

Am I saying that I would have accepted a banana for Chanukah? Uh, no.

But a new sweater or a little cash? Well, what do you think?!

What would I suggest to parents who feel they MUST spend more money than they have in order for their children to have happy holidays?

Well, actually? I’d say don’t do it, don’t spend the money. Use your imagination to figure out something else, anything else.

Talk to your children about values. Spending money on things that don’t last is self-destructive for you and doesn't really enhance your child's life very much in the long run.

You being mentally healthy is a gift to them, too. Getting upset about something that really is within your power to control isn't necessary.

You can tell your children as much if they have the audacity to ask, "Where's My Play Station?"

You really can say, “You know, it makes me a little crazy to spend all that money when I don’t have it to spend.”

Believe it or not, they’ll understand.

Copyright 2006, TherapyDoc

Friday, November 17, 2006

The Paper and the U.S. Postal Service

THIS is not to be believed.

I intimated yesterday that I only sort of attended the conference. Let's just say I was in and out, so to speak.

Here's the deal. I got lost in downtown L.A. driving around aimlessly, looking for the Sheraton. The Sheratons that I remember have big S's on top of them. Now they're tucked into shopping malls. This one's in a Macy's.

So who knew?

When I MapQuested it, frankly, I was a little wiped out from traveling and more than a little hungry. So my photographic memory, which usually serves me quite well when it comes to maps, was completely on the fritz.

And to make matters worse, I couldn't get Margo's printer to print.

I finally found the hotel by nose after a good 45 minutes of hunting around and listening to other drivers swear at the way I made very swift 180 degree turns on 3rd Street, or was that 4th Street or Flowers or Hope, can't remember.

When I pulled into a parking garage it turned out to be a tight a double helix that it made me want to vomit all the way up to LEVEL 4. It's good thing I'm not a breakfast person.

Hit the elevator down to the lobby (they have a happy lobby over there at Macy's). I was all set to blow off the conference right then and there and SHOP but it was only 9:00. So I ducked into the hotel (elegant but no computing stations, come on), and descended to the conference rooms to register.

So dreary. The atmosphere was so dreary. And outside, I remembered, the sun was shining. Real sunshine.

I signed in and hunted for an interesting paper presentation. The plenary speeches were scheduled for the afternoon, an outrage, in my opinion. They're supposed to be the main attractions of any conference, and they're supposed to kick them off. If there's one thing I go to these things for it's the plenary speeches.

The so-called interesting paper presentation eluded me. I'd tip-toe to the back of a room, listen as long as it took to KNOW that the speaker wasn't going to hold my interest, then pretend that I had an important call that I had to take. I'd put the phone up to my ear, and book.

At worst I could get a cup of coffee. At best I could find a Kinko's and copy the paper to send it out to that editor in Milwaukee.

I chose to go to my old home away from home, Kinko's.

Turns out that Fed-Ex Kinko's is only two blocks away from the Sheraton! And they were so cheerful, so pleasant! Free paperclips, as always. I took this opportunity to take out my contacs so that I could read the map that I had shlepped along, heretofore useless since I can't read anything with small print wearing my contacs.

And I called G.D.

Me: So, Dear, whacha' doin'?

G.D.: I've got the boys. We're heading for the Kid Space Museum in Pasadena.

Me: Oh, I'm going. Pick me up. But I have to mail my paper. I saw a post office in the Macy's mall.

G.D.: Great. I'll be there in 15 minutes.

Me: (thinking, How much shopping can I do in 15 minutes). Okay, call me when you're outside. I'll hustle.

And I did. I mailed the paper at the post office in the Macy's Mall. Actually, I had already put about $2.90 on it in stamps. I asked the clerk to make sure it was enough. She weighed it and smiled. I'd overpaid twenty cents. Not bad.

This terrific person stamped the manilla envelope with a cool red circle stamp and tossed it to a cart. I said a quick goodbye, kind of proud that I'd finished the task, thinking the paper still wouldn't make it to Milwaukee until after the Veterans Day weekend.

Who actually knows when the U. S. postal service mails stuff on Federal holidays?

Got to Macy's, managed to score something rather personal in record time. G.D. was calling from outside, saying HURRY UP, the kids are getting antsy. He was getting antsy.

I rushed out and we had a GREAT DAY, which you read about yesterday.

But here's the upshot. Before I left town I complained to you about Mr. Smith, not his real name, the guy who delivers my mail to my office in Chicago.

Complaining about a postman is probably dangerous business if you think about it. What if they go postal? What if your mail gets stuffed in the trunk of the guy's car and you never see it again, all because you complained?

Since it's unlikely that Mr. Smith reads blogs so I ranted here about what I considered his lackadaisical attitude towards delivering the U. S. mail.

But the postal service at Macy's? Unbelievable. Listen to this!

We had had a long day, packed it in with those kids, did the museum thing, trudged through a rather wet Rancho Park, took the family out to dinner, met Cousin Roz and b-i-l Scott at Nagila, too, and finally landed back in the Valley, said good night and had a chance to log on.

There was email from the editor of the paper. And I quote:
Dear Professor Freedman,

We are in receipt of your revised manuscript, "Accepting the Unacceptable. . ." Both the mailed hard copies and electronic copies have reached our office, and have been forwarded to our editor for further review.

Same day.

The paper got there that day, the same day I mailed it. The paper flew from Los Angeles to Milwaukee, hopped on a U.S.Postal truck and made it to the editor's desk in less than 8 hours for $2.90.

It was not marked Express Mail. It was not even 2-Day Priority Mail. It was simple first class mail. United States Postal Service. Same day service. Under three bucks.

Now that's unbelievable, isn't it? I sure think so.

And another cool thing? I surfed my favorite blogs (I think it was that same day, can't remember, but it was that week) and Citizen of the Month had favorited this blog with a crush. Now if that isn't Los Angeles hospitality, I don't know what is.

Thanks, N.K.

Copyright 2006, TherapyDoc

Tuesday, November 14, 2006

What do Borat, Sexual Assault, and Informed Consent Have in Common?

I was in L.A. and I looked for Sacha Baron Cohen, A.K.A. Borat, who apparently dined at Pat's a really good kosher restaurant.

Not that I was at Pat's, but I couldn’t have been all that far away.

Who is Sacha Baron Cohen ? He's a comedian and has a hit television show in London and now stars in one of the biggest movies in America, Borat: Cultural Learnings of America for Make Benefit Glorious Nation of Kazakhstan, supposedly hilarious.

The film is a "documentary" about American culture, which is not a documentary. Rather he duped people into thinking he was interviewing them for a documentary, playing Borat from Kazakhstan, a film-maker with an interest in American life.

Borat Cohen did not let on that he is really a comedian intent upon embarrassing anti-Semites, racists, and misogynists.

In the process, people made complete fools out of themselves and signed away their right to refuse to be in the movie. According to one film review, unsuspecting interviewees were promised that the release of the movie would not be in the U.S. and that they would not be identified.

Promises, promises. Interviewees were made out to be the biggest morons in the movie according to one reviewer, James Berardinelli.

People don’t like being made out to be misogynists and racists in movies. Especially when they've been promised the movies would not be released in the United States. At least two Americans, fraternity boys from North Carolina University, who participated in the “documentary” signed releases while under the influence of alcohol.

Borat (Sacha Baron Cohen) picked them up, got them drunk, showed them a lude film starring Pamela Anderson. He filmed their racist and misogynist jokes. The interviews will be seen by millions of people all over the world. The children and grandchildren of these kids (not to mention their mothers and fathers) will not be pleased.

So they sued for lots and lots of money. Why not?

It is the issue of INFORMED CONSENT that grabs this doc.

Jason Fortuny may have been guilty of the same thing, duping shady people. But Jason says that he wasn't out to deliberately humiliate anyone. He told me that he did his Craig’s List experiment because he was curious to see what would happen. That’s what he said. He was curious.

Sacha Baron Cohen is accused of deliberately humiliating people and contextualizing a situation in which they would make racist and anti-Semitic remarks. He was out to make racists and anti-Semites look bad, and he succeeded.

Theoretically, we should give him a prize.

But this is America, and in America consent must be INFORMED CONSENT.


See, I don’t like sexual assault or rape. These are acts of violence that more often than not occur to women when they are under the influence of alcohol. Under the influence they can not give a perpetrator informed consent. In 90% of all rapes, the perpetrator is an acquaintance of the victim.

So it IS possible to obtain informed consent for sex if you know the woman you want to have sex with. You just ask. By law, if one or both of you are under the influence, you risk the whistle blowing bit with rape.

Informed consent vis a vis sexual relationships means that the woman is able to tell a man that it is okay to have sexual relations. If a woman is under the influence, she’s impaired. It’s almost always a woman who is raped, by the way. Seven out of ten victims are women.

Similarly, Sacha Baron Cohen got these idiot frat boys (their names haven't been released) drunk. They made morons out of themselves then signed releases (informed consent) so that Mr.Baron Cohen could use them in his film. Since they were impaired, they have a case.

Seems to me, but I'm not a lawyer.

Seems to me that Mr. Baron Cohen will end up settling. The precedent for informed consent is established as I’ve described above in most United States regarding sexual relations.

So as much as I would love to support you on this, Sacha, and would have given anything to have been at Pat’s to have interviewed YOU while you wined and dined on the town, I can’t do it. I can't support 'cha. (Unless you give a lot of money to Israel, then maybe).

Seriously, you could have got the same footage with informed consent. There are plenty of racists and anti-Semites in this country. I guess that was your point.

Copyright 2006, TherapyDoc

Friday, November 10, 2006

About affection- Part One Engaged vs Disengaged Families

Wednesday, November 8, 2006

We’re on an airplane, flying into Burbank. I hadn’t wanted to shlep the Thinkpad, if you have one you know why, it's so heavy, but FD said Bring it.

I hate it that he’s right about so many things. So much.

And yet, it’s good that he is because two brains really are better than one.
P.S. If you think like this in marital therapy, you'll do okay.

So here we are the two of us. He’s charting out some music. Composing I think is the word for it. Being in a band, one has responsibilities. I take his hand in mine every once in awhile, am kind of happy.

But boy do I have a headache, one of those I forgot to eat today headaches. With all the tumult, the packing, the last minute errands and calls, then there was The Paper.

Which is finished, by the way.

Submitted it electronically in a flurry, and printed it out, just one copy. But I need two hard copies to mail to the editors at the journal. These academic things get long with all those stodgy sources, four pages of references on this one. So instead of wasting ink at home, the precious thing’s with me in a carry on, ready to copy and mail from L.A., not because I needed this extra hassle, believe me, but because there wasn’t time to get over to Kinko’s.

There was a time, not that many years ago, when they knew me by name over there at Kinko’s. If you ever go to graduate school, it could happen to you.

So I’m pretty relaxed right now, looking forward to feasting my eyes on my family. I closed them a couple of times, too, my eyes and one of those times I started writing in my head the story you're about to read.

This is the story about affection in my family, my family of origin. For the record, the family of origin refers to a person’s parents and siblings. I don’t think my family of origin will mind my telling the story.

We’re a relatively small one, just the parents and three kids, me sandwiched between two brothers. As the girl I was afforded plenty of privacy, had my own room. The two boys shared theirs, a boy room in soft greens and blues. I liked oranges, pinks, and hot pinks. Crazy, right?

Basically we kids were raised in one of those traditional families where you listened to your parents. Your mom was nice and you could wriggle out of things with her, but if your father told you to do something, well, you just did it.

My dad had an amazingly effective way of scaring the living . .. out of us (love you, Dad). When we three kids were little we bonded properly, according to him, US AGAINST THEM, kids against the parents. Dad always took credit for this alliance against him. He felt it was the right way to build a strong sib-ship (my word, his idea).

If you've read anything by Sal Minuchin (students, paying attention?), one of the real fathers of family therapy, you know that having the generations in alliance is really a fantastic thing in a family.

After all, goes the rationale, parents will be gone one day, we think, hopefully we will outlive them, and it would be nice if the kids all got along. As you well know, this is not a given in many families.

But I would like to suggest that what we had as children in my family, our US AGAINST THEM alliance was really pseudo-intimacy, feeling you’re being intimate in the process of talking about others, now ourselves.

It doesn’t have to be that way exclusively. We could have talked about our parents AND talked about ourselves, but I don’t remember that happening. There weren’t many discussions about personal feelings or thoughts, I don’t think (correct me if I’m wrong, Mom or Dave, maybe I am). We were studious kids and when we could, we played sports.

Like most families we had good times and bad. Somehow, I don’t know exactly why, but I have my theories, maybe the spacing of the kids, maybe it was just our personalities or genetics, maybe it was a million things, maybe I’m too hung up on sharing lately, in general, but there wasn’t much intimacy.

On the enmeshment versus disengagement continuum that I haven’t yet talked about, we were probably on the disengaged side, although mom pushed pretty hard to engage us. That's why I sometimes wonder (am actually sure there is some correlation) to genetics and social interaction But let's not go there now.

Disengaged ____My family______________________enmeshed

A disengaged family doesn’t communicate at all about feelings, thoughts, what they want to do, particularly, either. If a kid wants to do something, he has permission, he's pretty sure, to just do it. There’s a sense that it’s okay to do your own thing, that no one cares, and that can truly be the case, but usually not.

Disengagement can be about benign neglect, but it can also be about being afraid of intimacy. Parents themselves are afraid to talk about their histories and feelings can also be afraid to express opinions, or G-d forbid, to interfere.

Their fear of intimacy is rooted in fears of rejection, their own antipathy and discomfort with closeness/suffocation, fear of exposure or ridicule, and finally, fear of fusion, losing one’s sense of self in a relationship, melting into the other’s personality.

Easy stuff, I’m sure you’re getting it.

The other reason for disengagement is pure and simple child neglect.

Enmeshed is the exact opposite. A kid gets no psychological space, isn’t allowed his or her own thoughts. Parents have to know not only what kids are thinking, but where they’re going all of the time, and with whom, not really to protect the child, but out of psychotic fear that the child will be swept away, seduced into being different by others who are different, and then will reject his parents.

True enmeshment makes it virtually impossible to develop any kind of confidence or cogent sense of self. True enmeshment means there’s no YOU, rather you’re an extension of THEM. The family is a collective psyche. I write a bit about this in SEPARATION AND SELF: THE ANTI-ENMESHMENT VARIABLE
Big words, but I think you get it.

Oh, and no matter the pathological pole, whether a family is disengaged or enmeshed, LOVE may have nothing to do with it.

Love, a certain kind of love, insecure, needy love, courses through the veins of the families at the ends of the continuum. Those of us in the middle probably turn out okay with a little therapy and luck. As you probably know, I feel everyone needs both.

But it's late and G.D. is looking at me like he wants to tell me something about how the cross-winds won't help us or there's a fault somewhere down there or did I know that the speed of an airplane. . . And he thinks I don't listen.

I had wanted to tell you a story about affection, a personal story. It’s my favorite thing, affection. But my battery power's running low, too. Plus I knew from the start that this story is going to have to be in 2 parts. That would make 3 parts if we include this one.

And face it, I'm on vacation.

It can wait, right? At least you learned about disengagement versus enmeshment. Gotta' go.

Copyright 2006, Therapydoc

Saturday, November 04, 2006

Falling Asleep in Shul

What happens to me is probably very common, but I haven’t read about it anywhere. I know it happens to a lot of people. Maybe it happens to you, too.

I can’t explain it, but it happens when I’m in the synagogue. (Shul is Yiddish for synagogue). When the room is warm and a hush falls over the crowd, and the rabbi gets up to speak, pretty soon he has this nice, lilting drone going. Well, when that happens. . .

I fall asleep.

So today we had a scholar in residence. A very nice rabbi, Rabbi K. He wrote a great book which I was supposed to read but stubbornly neglected to read, but will get to, eventually, with no promises. So Rabbi K. was in our shul to be our scholar in residence for this Shabbas, our day of rest.

He had already spoken to a packed crowd on Friday night, and he spoke when I was there this morning when all this happened. He spoke again this afternoon, and he’ll be speaking again tonight. It’s not easy being a scholar in residence. You need several different speeches.

Anyway, when our regular rabbi speaks I might catch a few zzzz’s, I’m not going to lie. But I love him and there are no hard feelings. He can't see way up into the balcony, anyway. I’m sure he’d fall asleep listening to me, too, and it’s not like I ALWAYS fall asleep when he speaks. I try to listen. It’s probably a statistically significant bet that I do, however, for the reasons I stated above.

But today Rabbi C. (mine) introduced Rabbi K. (our scholar), who started off quietly, which put me in that space, you know, within perhaps 50 seconds. Last I heard he was saying that he was going to talk about a Get Rich quick Scheme, the best way to become rich which wasn’t going to have anything remotely to do with money. Soon he was off to the races talking about Marital Relationships and I was down for the count.

Suddenly, a tremendous racket outside awoke me, jolted me in a very big way. I jumped up and it seemed that everyone was talking, but no one was really talking, some were simply explaining what the commotion was and others were asking, What’s the commotion?

I asked my friend Amy, sitting on my left, who does catch every word (yo, Aim) What’s the commotion?

Apparently there were about a hundred people standing outside the sanctuary in the hallway, and when one of them opened the door the noise of one hundred people whooshed in, rudely waking me and probably others.

Things quickly settled down, but these are moments when one has to make a major decision:

(1) Do I go back to sleep? Or

(2) Do I try to hear the rest of what the scholar has to say?

I opted for staying awake, as I usually try to do when I wake up somewhere during anyone’s speech. It’s not like I’m avoiding what the rabbi has to say, it’s just that strange confluence of variables that have the soporific effect. Those soothing intellectual words from the pulpit.

This is why, by the way, many clergy people scream at their congregants, I’m convinced.

When I woke up Rabbi K. was speaking to the men. I could tell because he never looked up to where the women sat in the balcony (for reasons of modesty). He looked directly at the men who were in front of him on the main floor of the sanctuary and said things, like, “When you come home from work, you should compliment your wives.”

So he was talking to the men, who, face it, need to know these things.

He told the men that the secret to being rich had to do with respecting their wives, listening to them, praising them, appreciating them, complimenting them, letting them speak first, always.

I agreed with him a hundred percent, except for the last five words. LET THEM SPEAK FIRST ALWAYS. Always? Clearly he did not read my posts on listening.

In Listen One and probably in Listen Two, I divulge the secrets of shutting up.

Shutting one’s mouth is the essence of communicating well, clearly, because it is in that void that one hears what others are trying to say and learns something. That is unless one is thinking of the next thing to say, which is not what one is supposed to do in active listening.

But forget about active listening for a second. We were talking about Who Gets to Speak First at the End of the Day, one of my favorite topics. The rabbi had suggested that if a man lets his wife speak first it would be good for the marriage.

But I disagree. The ikur (meaning, main thing, Hebrish, a mix of Yiddish and Hebrew) is that one need not automatically shut up and listen. That would be stuffing feelings and emotions that really, perhaps might need to be uncorked in order to proceed in the listening process. (this talking thing beats uncorking a bottle and is cheaper).

What works emotionally for the couple is when BOTH partners are sensitive to one another, each gauging the other's need to talk.

SHE or HE should be checking HIM or HER out at the end of the day (change these pronouns as you wish), sensing whether or not the world has trashed the other like a sack of garbage. Some days are like that, okay?

If I were the rabbi, and believe me, this is with all due respect because I like his message, for the most part, but I would have told you:

You should be checking out Your partner and vice versa.

This is not necessarily a verbal examination. It is not a, “So how was your day?” thing.

At the end of the day BOTH of you should LOOK at each other to see if there are any new gray hairs, any new wrinkles. You have to look for the sadness, the worry, or the gladness (preferably) in the other’s eyes. This is not a passive process.

Then. . . the one with the better looking face, the one who has not got a furrow of brow, a turned down mouth, that tenseness of the body, the shoulders, the one who’s in a better place needs to invite the one who is not in the best place to speak, saying, “Tell me about it. Talk to me.”

I know, I know, sometimes, perhaps usually, it’s not an easy call, determining which of you is in a better place. But you have to make it.

That’s love, friends. It’s not a gender thing at all.

Thanks Rabbi, for reminding me to say that again, to reinforce one of those definitions of love. If you said it while I was asleep, forgive me.

Copyright 2006, TherapyDoc

Friday, November 03, 2006

Blogger Burn-Out

You know, therapists burn out. This is a well-known phenomenon. They work for years to get this fabulous education, and about six years into it can't stand the work anymore.

Sometimes it's too much of one diagnosis or another, like seeing too many depressed people in a day can (HAS TO) make a doc a little depressed.

Or maybe there are simply too many borderlines out there, or too many traumatizing stories. Borderlines can have therapists all up in arms, worried about themselves, their families and personal harm, worried about others who have to deal with them, still more worries about suicide gestures and occasional success.

So real estate has tremendous appeal, okay? Not for me, frankly, but it does seem to be the choice for lots of other therapy docs. I kind of love my job, you know that, and I balance the types of folks I see every day, lay lots of responsibility for their welfare back on them.

But what about BLOGGERS? Do BLOGGERS burn out? They write day after day, week after week. They go nuts when they go on vacation, terrified their ratings will drop in Technorati, have others blog for them in their place!

So do they? Do they burn out, writing, writing, writing, day and night, organizing, editing, re-editing, reading other blogs, redesigning their websites, losing precious template symbols that trash the site (temporarily), commenting to others and to those who write to them, deep into the early hours of the morning, bleary-eyed, half awake the next day, manic, full of words, crazy.

Do they burn out? Do they?


Copyright, 2006 TherapyDoc

Thursday, November 02, 2006

Seasonal Affective Disorder--I'm Sharing about SADS

Yes, it’s that time of year. The days are shorter, they’re getting colder. The holidays are coming and the memories. . .

Oh man, the memories. . .

So a lot of people get depressed. It’s called the Holiday Season Blues, but professionals call it Seasonal Affective Disorder.

It’s a real thing. Some people literally only get episodic, meaning they suffer an episode of a major affective disorder, depression. Sometimes it’s mild, sometimes moderate, sometimes severe.

Sure, get therapy, right?

But also, get light. The studies on light indicate that if you light up your house, you’ll feel better.

Time for Therapy Doc to share.

About eight or nine years ago I got really down in late October. It was a truly irrational thing, and like usual I blamed it on anything I could think of (hormones rule, in my case), and tried to patch things up wherever I could, followed all of my own rules. Still felt like a ton of bricks hit me and walked around in a daze.

In mid-November Science Fair began. For those of you who know what that means, it’s pretty intense for the little buggers who have to come up with a project. Occasionally my kids would do projects that were psychological and I’d get involved, which was fun. G.D. helped when things got more scientific and I’d lay back and chill. I rarely got into the homework thing with the kids on the best of days.

One of the kids was doing a botany project for Science Fair. He’d lit up the family room, basically, with fluorescent lights 24 hours a day. I hadn’t even noticed it, pretty much was wrapped up in work and survival, making dinner and getting laundry into drawers. Opening mail.

But when I’d come home at the end of the day, no matter how late, there was light. And I didn’t really notice. But there WAS light screaming from the family room, streaming into the kitchen. The whole place was lighter. And without even noticing, I felt better.

NOW. Is this hocus pocus?

I’ll let you decide (sure, it’s anecdotal and it is not a representative study or empirically valid or whatever, but pay attention anyway).

Science Fair ended. I hardly noticed except the child we’re talking about PLACED. He did really well, so well in fact that the school awarded him a savings bond that we found stuck in a file many years later.

But when it ended, he turned off the lights. Once again, I didn’t notice that he’d turned off the lights. I could have been a better mom, I’m sure.

But when I got home at night, after he’d turned off the lights, I would walk into the family room searching for something. I’d stop and wonder what I was looking for, seriously. I thought it odd that I was doing this, but at some point I started getting depressed.

I’d be depressed and standing in the family room with it’s regular lame soft bulb fixtures, looking around, feeling SOMETHING was missing.

When it hit me that it was the fluorescent lights, I dug them out of the closet and turned them on again, and oh, oh, oh. What a difference a Watt makes!

This is a totally true story. My recommendation for SADS? Why suffer in the darkness, seriously? Fluorescent bulbs are cheaper and last longer. Talk to your hardware person and lighten up.

Copyright 2006, TherapyDoc

Wednesday, November 01, 2006

Anti-depressants, suicide, and teen-agers

I first posted about a teen and suicide a few months ago.

The subject never really disappears for therapy docs, but it’s back in the news again. So I’ll be hearing about it at the office today. People will be asking me questions.

Not to digress too far, but it is the elderly, not ironically, that is the population most at risk for suicide. One becomes less newsworthy after 65.

But back to teens. The research flips back and forth, but my understanding of the problem is as follows:

Teenagers are at risk for suicide in general, primarily due to pressure about academics. Pressure about school and grades underlies most teenage suicide. This is the reason that I emphasize that parents NOT pressure their children about grades.

Pressure them about curfew, pressure them about relationships, pressure them about morals. When I say pressure I mean talk. Talking to teens is often interpreted as pressure. They already know where we stand on most things, so they put us in the category of white noise.


You don't have to pressure if you make your child’s academic progress one of his or her first big decisions. You can offer to pay for tutoring. You can intervene if a teacher is too hard on your kid. You can help with the homework if you're really, really helping.

But make the child do the work himself and make it okay not to do SO well. You had your chance to go to school.


Teenagers do express suicidal ideation, some for attention, others to be cool, some because they are really depressed and do think they would be better off dead. Caring parents bring these young people to therapy and participate in it themselves. They’ll do anything to be sure their child is safe.

A busy adolescent-centered practice draws a few dozen cases like this a year. Many therapy docs won’t see adolescents because teens are tempted to try on different behaviors in their search for identity, some of them really dangerous. They’ll explore risky deviant sexual behaviors like pillow sex (suffocation). They’ll experiment with drugs, cut themselves, etc. Docs are afraid of being sued if anything happens.

So those of us who do see wily teenagers watch them carefully. And if we refer for medication, we make sure that the prescribing physician doesn't just put a child on anti-depressants and say, Have a nice day.

That's what they found in the original studies of teenagers on anti-depressants. They were usually prescribed "harmless" SSRI’s, a class of anti-depressant medication. But once they felt better, they were set free and some did kill themselves (between visits). Their doctors had let up, stopped seeing them weekly after the symptoms of depression abated. The decision may have been based upon the economics of medicine and managed care that managed too tightly.

We have known for a long time that some of the SSRI’s (Prozac was the devil) could trigger a psychotic episode in people with bi-polar disorder. The mania and Prozac didn't jive. But now Paxil is commonly used, often as a "life-saver" in the treatment of bi-polar disorder. Patients are watched closely, of course.

I am not a medical doctor and cannot prescribe medication for my patients. But I will tell you that I feel that I have to recommend medication evaluations for very depressed patients at all ages. It's simply the rule. Not doing a med eval is like washing the floor without sweeping.

If a medical doctor says that no, the patient does not need medication, then fine.

We insist upon a med eval because empirical study by the National Institute of Mental Health has consistently indicated that anti-depressants relieve the symptoms of depression. Once the physiological symptoms are gone (see more on this on another post), it’s much easier to change the dynamics that are contributing to the disorder.

The very best treatment, proven time and time again, is a cocktail of cognitive therapy AND medication.

Depression is a physiological condition.

And everything psychological is also biological. Thus medical intervention will effect negative symptoms, i.e., lethargy, lack of focus, confusion, etc. (see other posts on depression on this blog).

When a patient is really depressed, just participating in talk therapy, or working on reversing negative thoughts, changing behavioral patterns, can be futile, more painful because it may not work.

The quick and dirty? Don’t be afraid to see a physician about medication. But don’t walk away with a prescription and avoid real treatment. Treatment implies therapy, at least weekly in the beginning, sometimes more often. Sometimes I'll know that a patient needs to be in the hospital right away.

Unless your family physician is going to follow your child closely (or has someone like me doing that), get a psychiatrist to do the medication evaluation. The primary care doctors need to be informed, obviously.

And by the way. If your therapist is like me, he or she may see a tremendous amount of latitude here, may see cognitive, behavioral, family treatments, etc. as better options than medication in many, many cases. But if we say you need a medication evaluation? You do.

Copyright 2006, TherapyDoc