Facebook Like


Monday, July 31, 2006

Seeing spirits or psychosis?

One reader writes:

"As a therapist, how do you help someone distinguish between seeing "spirits" and psychosis? What are your thoughts on this?"

Of course, as a therapist I'd first want to know, Why do you ask?

But let's start with psychosis since I'm not as well-informed about spirits. We'll trust the American Psychiatric Association's Diagnostic Statistical Manual, the DSM IV-TR.

According to the DSM, the word psychotic historically has had many definitions, none of them universally accepted (figures). The most restrictive definition requires delusions or prominent hallucinations that the patient believes to be real.

Hallucinations are experienced as real events, things "sensed" by the body(visions, touches, words, smells,tastes) that are not sensed by anyone else. They can be perceived or sensed by any of the five senses.

Odd people on the street who are talking to themselves are probably talking to voices in their own heads, responding to auditory hallucinations. If the voices get threatening or command a person to violence they can trigger a homicide or more commonly, a suicide. Auditory hallucinations are signature symptoms of paranoid schizophrenia, never a funny illness.

Delusions are misinterpretations of experiences, erroneous beliefs. Persecutory delusions are most common. In these, people believe that they're being followed or spyed upon. (Having been identity thefted sometimes I really relate to this, but I wouldn't be considered psychotic).

Referential delusions are misperceptions that something or someone is trying to tell you something. So if you read an article in the newspaper and believe it had been put there for one reason only, to tell you something, then you have a referencial delusion. In the movie, A Beautiful Mind, John Nash (Russell Crowe) has ideas of reference every time he reads a magazine or a newspaper.

Less restrictive definitions of psychosis include delusions and hallucinations that you know are all in your head. But if you're going to say that you have them just before falling asleep, or upon waking, it doesn't count. Neither does hearing your name called occasionally when no one's around.

A definition of psychosis that is broader still, according to the DSM, is one that includes other symptoms such as grossly disorganized or catatonic (immobile) behavior. Some psychotic individuals have disorganized thinking. They can't keep to any one subject. They are thought disordered. A doctor would not use cognitive therapy approaches with such patients because their inability to "think straight" literally disables them. Making them think with a cognitive intervention would increase the patient's already very high anxiety, not lessen it.

A definition that is broader still is one that defines psychotic as a loss of ego boundaries. So if you think you're me, or vice versa, we both might think twice. On the other hand, if you took my identity, perhaps you are me.

Now, TO ANSWER THE SPIRITS QUESTION, or not. The DSM IV allows for hallucinations that are a normal part of religious experience in certain cultures.

The DSM continues (my commentary always parenthetical):

Illness is considered the body's response to distress, communicating a need for social support.

"Locura, " for example, is a term used by Latinos that refers to a severe form of chronic psychosis, including hallucinations. (Seeing SPIRITS might be an example, but the DSM doesn't specify).

"Zar" is a general term applied in Ethiopia, Somalia, Egypt, Sudan, Iran, and other North African and Middle Eastern societies. It refers to the experience of SPIRITS possessing an individual. Persons possessed by a spirit may experience shouting, laughing, hitting the head against a wall, singing, or weeping. They may withdraw, show apathy, refuse to eat and may develop a relationship with the possessing spirit. It's not considered pathological locally..

Zar is apparently about being possessed, not about seeing spirits. Unfortunately, nowhere does the DSM IV discuss seeing spirits, per se. The DSM, unless someone can tell me differently, does not include paranormal experience. Only empirically validated disorders make it in as diagnostic categories. If seeing spirits is a paranormal thing, and you have it, your insurance company won't pay to have you treated for it. I admittedly am no expert in this area.

Thinking with a culturally sensitive medical model, however, we might guess that some people want to see spirits so much that they convince themselves that they do.

Otherwise, this experience would be considered either a type of hysteria or a conversion disorder. In conversion disorders the body responds to stress by developing some rather bizarre symptoms. These could include visual hallucinations.

Asked to distinguish the difference between psychosis and seeing spirits, I'd ask culturally sensitive questions and go from there.

One thing's certain. Really seeing something that no one else agrees is visible can be a bad sign. At best, the person is very religious. At worst, he or she is severely distressed.

Copyright 2006, TherapyDoc

Sunday, July 30, 2006

My Cousin Vinnie and Conflict Resolution

Do you want to learn anything from the movies, or do you just want to use them like heroin? It's an exaggeration, but you know what I mean. I'm always looking for something, anything that will teach my patients/readers a sliver more about how and why the people who get along on screen get along. I'm in it for the relationship truths in film. Those entertain me.

Just one look at a scene from a top-notch film directed by Jonathan Lynn, written by Dale Launer-- My Cousin Vinnie -- and you'll understand. Two young men, Bill and Stan, are mistaken for murderers and Bill's cousin, Vincent 'Vinni' Gambini (Joe Pesci) is elected by the family to represent his first client.

Vinnie and his fiance, Mona Lisa Vito (Marisa Tomei) drive to a small town jail to interview the accused clients. The day is long and difficult. They're exhausted and have to rest up before Vinni will stand before the court the next day.

They end up in a third rate motel room and have an argument over a drip in the bathroom sink. They can't sleep.

They argue it out until they have both said everything conceivable, every possible side to an argument that one can have about water dripping from a bathroom sink. It is an argument full of words, rich with data, opinion, fact. It's a great argument.

It is surely one of the better, if not best arguments in movie history.

Why?

As she is telling him her thoughts, how she sees the problem, he is hearing her. He WANTS to here her so he listens hard and he gets it. He hears all of those words and a light bulb goes off in his head because he's LISTENING, a novel concept, I know, for most people who argue.

But he sees Mona Lisa's point and as this happens you can actually watch his love and admiration for her grow. Sure, Joe Pesci is a wonderful actor. But the "fight" has become less of a fight. There is no contest. The fight has become a vehicle for admiration and love.

The point is, they argue, they get closer.

That's what emotional intimacy is all about.

You argue to the point of hearing one another, really getting one another, and the power struggle, the need for control vaporizes. Not everyone really cares about power in relationships. True, some do. But couples in therapy talk about wanting to be heard, to be respected.

When couples remember how their relationships started out most will say (if I ask), Yeah. He/she totally listened to me, hung on my every word.

So why's that have to change, anyway?

Thanks Dale Launer for a great script. I'm assuming you've lived this one.

Copyright 2006, TherapyDoc

Wednesday, July 19, 2006

PANIC

First of all, no one ever died from a panic attack. Maybe, if you're elderly and have a heart condition it's possible, I'm not sure. But as far as I know, this is something that happens when arousal in the brain triggers the body to either fight, flight, or freak.

Freaking seems to be a combination of wanting to get the hell out of there but feeling unable to do so. You feel Trapped. Or thinking that you will be trapped.

Public speaking is a perfect example. Say a woman has a panic attack when she's about to get up and speak. The heart races, her breathing slows, she feels dizzy. If she's had a little therapy she'll try to remember to breathe, perhaps take the microphone and sit, grab a glass of water that she's strategically placed on the podium for that purpose.

If she's had public speaking lessons she WON'T tell her audience, "Uh, excuse me, I'm having a panic attack." Instead she'll have a canned sentence ready to go that will buy her some time, like, "Let's all think of a possible joke we can tell on this subject. Go ahead, take a minute, I'm going to look something up." And she'll sit down and chill.

But panic is simply unpredictable. That's why it's panic. A person can have this once or twice in a lifetime, or it can become a predictable response to stress or bad news.

If you've been identity thefted, then panic is routine when a strange credit card company calls to find out why you've not paid anything on a bill that you've never seen. This can happen frequently, yet the sense of panic will not diminish each time, in fact in can get worse.

Does this mean you need medication?

Not at all. If you think you do, ask a doctor. But self-relaxation exercises can bring back your equilibrium, as can working a cognitive therapy program. I really will try to writing more about these things in the future.

For now, know that you don't have to panic about a panic attack, and you really don't have to go to an E.R.

It will pass in a few long minutes, no matter what you do. (Although your level of anxiety may not!)

Copyright 2006, TherapyDoc

Monday, July 17, 2006

Addictions, Internet and Otherwise

Moving on regarding addictions and relationships. We can look at gambling, sex, or simply put, the Internet for enlightenment.

Addiction is all about being dependent. If you're an independent person and your partner is dependent, yet you don’t say anything to discourage your partner’s dependence, then you're co-dependent. You subtly contribute to the dependency by not confronting it.

There's got to be something wrong if you're afraid to discuss a situation that's bad for your partner, or bad for you.

The Internet has not become an "official" substance but certain kinds of "surfing" are dysfunctional, like frequenting chat-rooms with prurient intent that lures in kids.
Gambling sites are irresistible to pathological gamblers.

When a person has no power to resist certain sites it can cause shame, anxiety and distress, not only to the visitor, but to others in the family. It is social and occupational distress that mental health professionals hone in on when they assess dependent pathological behavior.

But what’s an addiction?

When it comes to alcohol and drugs, professionals don't use the word "addiction" to diagnose a dependency. We’re checking for compulsivity, a sign of dependency. We also check to see if using to excess is acute, meaning sporadic yet destructive, like wrapping onesself around a tree in a car while under the influence. Read the post on An Ordinary Guy.

Pathological gambling is a disorder (312.31 in your handy DSM-IV TR) in which a person is preoccupied with gambling and has repeated unsuccessful efforts to stop or control it.

There are many other possible symptoms, like the gambler needs to use increasing amounts of money to achieve the desired excitement, or is restless or irritable when trying to cut down. If it serves as a way of escaping from problems or relieving depression, or lies are necessary to conceal gambling from a significant other, then it’s pathological.

Sexual disorders can be compulsive. Exhibitionists can’t stop from exposing themselves to strangers or thinking about it. Their fantasies and behavior have the potential to cause social and occupational distress. Similarly, fetishism, involving fantasies, sexual urges, and behaviors with inanimate objects can also cause significant distress and social impairment. There are more of these disorders, including pedophilia, obsessing about and acting upon fantasies with children.

The word addiction is most relevant to people who follow 12-Step programs, each with distancing “addicts” from compulsive behavior and obsessive thoughts about anything from food to sex.

And now, there’s the Internet.

So if your spouse says, let’s go to bed, but you’re on-line and just CAN’T get off, you’re in trouble. Therapy Doc sees intimacy in relationships as key. Intimacy with a computer screen just doesn’t cut it.

Of course, if you’re an emotionally intimate couple, there’s no stopping you from talking about your feelings and what you thought of what you saw.

What to do instead? Next time.

Copyright 2006, TherapyDoc

Tuesday, July 11, 2006

Average Guy and a Tree

As long as we're on the subject of dependency, allow me to clarify something.

Professionals have to determine if substance use (excessive alcohol, pharmaceuticals, illicit drugs)is compulsive behavior, an indication of dependency, or sporadic but potentially destructive behavior abuse, like wrapping oneself around a tree in a car, stoned.

Take Bart (not his real name) an average guy. A college graduate, Bart works for the phone company, makes a decent living. He doesn't use illegal drugs. He's a very nice guy, has friends, helps his Mom. In fact he describes himself as an Average Guy.

Bart's out one night having a few drinks with his friends. He remembers he wants to visit someone else and leaves the bar. He's been there, he tells me, 2-3 hours and has only had four pints of beer. For him this isn't much.

He leaves the bar, walks to his car, drives to his friend's neighborhood. Driving through the suburbs he somehow doesn't see one of those raised circular islands in the middle of the street that have arrows indicating which direction he's supposed to go, right of left.

His car hops the curb, flies through the concrete roadblock with the sign, and smashes into a parked car. Miraculously, no one is hurt. Both cars are totaled.

"I wasn't even drunk," Bart tells me.

Ah, but he was.

This is an incident of alcohol abuse.

Professionals opine that any amount of alcohol, any amount of cocaine, any amount of any substance can and very well may contribute to a serious accident. Sure, senility can, too, and so can fatigue. But we're talking about what people think of as normal drinking-- an average guy drinking an average amount of probably average beer.

Could have killed someone, is the truth.



Copyright, 2006 TherapyDoc

Friday, July 07, 2006

Exceptions and another example of co-dependency

I re-read the post below and it sounds a little harsh. So keep in mind that there is a difference between chronic and acute dependency. Acute problems are new and generally short-lived. Chronic can mean forever dependent, or not, depending upon all of the variables affecting the situation. See my original post on As Long As He Needs Me, June 19, 2006

I was talking about people who are chronically dependent, who take much more than they give when they could give and do much more than they do. There is a great difference, of course, between an individual who cannot hold a spoon or a fork, and one who simply has to get high.

(By the way, if you ever feel that I'm exaggerating, because I do, or that I'm wrong, please comment.)

Anyway, all that stuff I say about care-taking does not count if the dependent behavior is acute, perhaps brought on by a severe depression that requires tedious adjustment of meds, or a serious medical illness. The process of GETTING FUNCTIONAL again can take a long time.

My rant is only about people for whom getting functional never seems to happen.
A good example is Selma's kid Rick (not their real names).

Rick is 37 and Selma, 57, is still paying his car payment. He's never really held down a full-time job and there's NOTHING physically wrong with him.

Selma knows that Rick smokes pot and hangs around with lowlifes. (Rick's not a lowlife, right??!!)

Selma can't get out much because she's too broke, helping her mom and her boy Rick. She would like to get out, however. She likes to dance.
Get the difference? See why I get emotional?

Copyright 2006, TherapyDoc

Co-dependent-Still (second post)

Okay, people. If you've been reading me thus far you probably get that the sort of thing I referred to in the last co-dependent post infuriates me (As Long as He Needs Me, June 12, 2006)).

You don't live your life because someone needs you. You have a life. You're worth something even though someone needs you. Your identity is made up of so many things: your job, your values, your position in your family and community, all the wonderful things that others say that you are, and much more.

You are much more than a care-taker.

And yet, sometimes it feels like taking care of one particular dependent is what life is all about.

Fine, if the dependent's a one-year old.

The big problem with care-taking capable but seemingly ef-ed - up individuals who (a) drink because they grew up in abusive homes, (b) are depressed for whatever reason, (c) have minor injuries or simple viruses that should require only a day or two off of the job at most, (d) seem to always get bad breaks at work, (e) just don't have good social skills, or (e) a million other irrational excuses, is this:

Because of your personality and because you CAN, you do a lot to pick up the slack. Mark my words, dear. You will tire out. You will, within five years, be so tired you'll be going to therapy (even though you've been TOTALLY FUNCTIONAL YOUR WHOLE LIFE!!!)and saying that you're depressed and exhausted and can't cope, and that you've been working since you were seven and all you want to do is sleep.

And I'll fill out those family leave papers in a heartbeat.

And you'll hate that, because you don't like being sick. So why is it that your partner does?

In this case we're saying the dependent person is a partner or spouse, but it could just as easily be a child, parent, or friend that you are CO-DEPENDENT upon.

You're real capable and work a LOT, probably at a 9-5 job then the second shift, laundry, cooking, cleaning. If your spouse has a physical disability, say a bad back, and is on some serious drugs, things can get even more fuzzy (note the double entendre).

The degree to which disability is truly physical versus a manifestation of sheer laziness and dependency is hard to determine. And if your partner is addicted to alcohol or drugs, even prescription drugs, then it's a certainty that you'll be the one doing JUST ABOUT EVERYTHING for the family.


Once I had a patient who was hit by an automobile and lost his legs and suffered multiple injuries. He was a wonderful, hard-working man who came to see me because he was severely depressed.

Why was he depressed? He had disability insurance. His bills were being paid. AND he was expecting a very large settlement from an insurance company.

He was depressed because he COULDN'T hang in there. He HATED taking medicines that helped his pain but made him fuzzy, tired, and less functional for his family. He HATED his kids to see him not jumping off to work in the morning. He HATED that his wife had to pull more weight than usual.

This kind of person, even when he's dependent can't be dependent.

To me, he's the role-model for adulthood. Mature adults don't like being dependent. They don't want to be a burden. And for some crazy reason, mature individuals, even when they've been hit by a car, they will still try to kick in and do the lawn and everything in their power to go to work as soon as they possibly can.

(The details of this story are fictional, of course.


So why are you taking care of an immature adult who should suck it up and do whatever is necessary to function as highly as possible in the family?

An educated guess is that it beats being lonely, is better than rejection, and makes you feel like a good person (Christian), builds our self-esteem. You can get dependent upon a person's dependency, hence the co-dependent thing. It gives you a warm and fuzzy feeling to help.

Or you feel you deserve this kind of life, that you are committed to this person for better or for worse, that you don't kick a guy (say it's a guy, just for the sake of convenience, okay?) when he's down.

News flash. Just so you should know, if you're cleaning up his vomit because he's an alcoholic and he's "sick," instead of leaving his sad blank and terminating his incompetent and disgusting parental example to your children, you're not doing him any favors.

Which is where we come to the concept of GIVING in co-dependent relationships and what that's all about, really.

But that's for another time. There's just so much to say.

Copyright 2006, TherapyDoc

Wednesday, July 05, 2006

Because of You

All right, I’ll admit. I’m a softie for sad songs.

So I Googled “Because of You” by Kelly Clarkson to get the lyrics. The music video's on the website, a must see for Therapy Doc readers.

Here are the lyrics to the song.

I will not make the same mistakes that you did
I will not let myself cause my heart so much misery
I will not break the way you did
You fell so hard
I've learned the hard way, to never let it get that far

Because of you
I never stray too far from the sidewalk
Because of you
I learned to play on the safe side
So I don't get hurt
Because of you
I find it hard to trust
Not only me, but everyone around me
Because of you
I am afraid

I lose my way
And it's not too long before you point it out
I cannot cry
Because I know that's weakness in your eyes
I'm forced to fake, a smile, a laugh
Every day of my life
My heart can't possibly break
When it wasn't even whole to start with

Because of you
I never stray too far from the sidewalk
Because of you
I learned to play on the safe side
So I don't get hurt
Because of you
I find it hard to trust
Not only me, but everyone around me
Because of you
I am afraid

I watched you die
I heard you cry
Every night in your sleep
I was so young
You should have known better than to lean on me
You never thought of anyone else
You just saw your pain
And now I cry
In the middle of the night
For the same damn thing

Because of you
I never stray too far from the sidewalk
Because of you
I learned to play on the safe side
So I don't get hurt
Because of you
I tried my hardest just to forget everything
Because of you
I don't know how to let anyone else in
Because of you
I'm ashamed of my life because it's empty
Because of you
I am afraid

Because of you
Because of you

Thank you, Kelly Clarkson, and to Ben Moody, and David Hodges.

To see the video click here: Because of You
http://www.youtube.com/watch?v=_lhXur9ca40&search=because%20of%20you

I want to go over what's important to take away from Ms. Clarkson's experience.

What Kelly learned was that her parents' marriage was dysfunctional and that she had it in her to repeat the same mean things that they said and did to one another in her own relationships. She could easily have become like her parents despite the fact that she hated the way they behaved towards one another. They weren't particularly nice to her, either.

But she thought hard on the subject and consciously changed what surely would have destroyed her already conflictual marriage, herself.

She could have acted out the family destiny, but she refused.
Yay Kelly for getting it.

What moves me, and perhaps you, too, is her life-long anxiety disorder and how it's so obviously rooted in the YOU of the song. Because of YOU. . . Her PARENTS. Parents are powerful. Most haven't a clue how powerful. It really was because of them.

Her parents made life seem scary and unpredictable.

But BIOLOGY had something to do with it, too, and not genetics in this case.

Here's where we get a little bit technical to explain how childhood trauma relates to generalized anxiety that can virtually cripple people.

A kid witnesses violence, either verbal, physical, or emotional in the home, perhaps often. Verbal violence, by the way, can be criticism that the parents believe is in the service of good parenting ( I have to say, I've never understood how they defend this behavior, but they do)

What happens to the kid who experiences this kind of distress?

Kid feels afraid.

How do we know that kids are afraid, and why can't they get a grip? Shouldn't Kelly have been okay by say, age 18?

Stressful events (like violence or bad news) trigger the physiological responses we interpret as fear and anxiety. The heart beats fast, adrenaline soars, arousal mechanisms of fight or flight are in over-drive.

Then after awhile, the body settles down, relaxes.

When a child is young, the capacity for denial takes over at some point and homework becomes a priority, or feel good activities like baseball, television, friends, and food become attractive options over anxiety and depression. Any distraction will do. Drugs work nicely for adolescents (it's what they say when they're using illegal substances to self-medicate-- we mental health professionals have better solutions, obviously).

But even after kids have reached homeostasis and are relaxed, that initial physical awareness of danger following a stressful episode-- -- the shaking, the shortness of breath, being "on edge"-- -- does not dissipate without leaving a neurological trace, a path, so to speak, in the brain. The brain remembers.

The arousal that follows stress is interpreted by the brain as anxiety. It is not the same type of arousal that you feel when you're cheering on your favorite baseball team. This time the alert, hyper feeling is an indication that something's wrong, and it doesn't feel good, (even though it may keep some people thin). Stressful events lead to hyper-vigilence. The pathway between trauma or anticipated trauma and fear has been sealed. An anxiety disorder is set when there is no buffer, nothing to offset the sense of powerlessness.

Kelly experienced anxiety as a little girl. She was young, vulnerable, small. Her brain repeatedly flashed: POWERLESS-- --YOU'RE POWERLESS -- -- AND YOU'RE SCREWED.

That sense of vulnerability would not magically dissipate as she grew up. In stressful, unpredictable families, children become literally wired, wound too tight. They don't stray too far from the sidewalk.

As luck would have it, if kids make it to adulthood they have more options and can control most things, make things all right. As adults we have much more power, more functional coping strategies, and resources. Sometimes we need help in identifying them.

One of the more powerful tools is focusing on the fact that you're not a kid anymore. At some point they can't hurt you. That's when it's time to cross the damn street.

Copyright 2006, Therapy Doc

Sunday, July 02, 2006

EVIL STEP-MOTHER 2nd Installment

The last we heard from Miranda, the Not So Evil-Step Mom, Eddie, age 14, was cussing her out. see Lessons from a Family Therapist

MIRANDA: Eddie, the car pool will be here in ten minutes! You better get dressed.

EDDIE: Go to hell.

MIRANDA: Seriously, Eddie. You'll miss your ride and your dad will be upset. Why not just get going?

Eddie ignores her.

MIRANDA: Eddie! GET GOING!

EDDIE'S SISTER #1: Miranda, don't yell at him, Jeez.

EDDIE'S SISTER #2: You're so mean, Miranda, honest.

What's a woman to do? Yell back, NO I'M NOT! I'M NOT MEAN!!???

Actually, saying, not yelling, No I'm Not is a good start. Miranda should never let those kids get under her skin. She should never lose it. They win if she loses it. Losing it just proves to them that she's a b…. .

Easy for you to say, Therapy Doc. We know you've been married to the same shlumf for 30 years. You don't have step-children pushing your buttons.

Perhaps. But I really do feel your pain. I know it's hard to keep your cool when little children who have been raised right, who have attended parochial schools that emphasized respectful behavior, are really mean (ching, ching, ching, goes the money, and for what!?). And when I was a young parent, I yelled puhlennnty, although the kids don't seem to remember it. It helps to stop yelling while they're still pretty young.

But talking, not yelling, is what assertiveness is all about. I push assertiveness in my relationship therapies for the obvious reason. It works.

Assertiveness, you'll hear me say on this blog over and over again, is JUST THE FACTS. NO EMOTION. Just the facts, ma'am.

So "No, I'm not," IS the proper response to a kid who calls you mean. But you have to say it quietly, and not defensively, speaking above a calm whisper, audible but not aggressive, as if you're saying, Please pass the cream. "No, I'm not. I'm not mean, actually. You're wrong. You have the facts wrong."

Then I would suggest you continue and say, "And I know you're really nice kids, too. You're not mean. You're just under a little (huge pregnant pause) . . . . . . . . . . . . . . . . . . stress."

Then you say nothing else, nod empathetically, sympathetically, like you really care, and fold the laundry while singing a happy tune (I'm suggesting Stevie Wonder's Don't You Worry 'Bout a Thing) these days, peppy, enthusiastic and happy.)

What should you NOT do? Don't go telling Dad on them. Keep it between you and the kids that they verbally abuse you. Let them know that you're a big girl, that you grew up on, STICKS AND STONES WILL BREAK MY BONES BUT WORDS WILL NEVER HARM ME. You don't need to run to their Dad and tell them what bratty kids he's got.

STICKS AND STONES WILL BREAK MY BONES BUT WORDS WILL NEVER HARM ME

Such a crock, right?

Let us digress.

In my office I have this marvelous bus poster. Maybe you've seen it if you ride busses. About twenty years ago a young patient of mine ripped it off a CTA bus and gave it to me, rolled up. I loved it too much to give it back to the CTA. It has a picture of the cutest, saddest little boy, maybe 3-4 years old. He has the biggest, saddest eyes I have ever seen on a child and long, blond hair, a big tear is splashed on a round cheek.

The poster says, WORDS HIT AS HARD AS A FIST—WATCH WHAT YOU SAY.

Hundreds of patients have seen that poster in my office and nodded in agreement. They all know how hurtful words can be, and so do you. But if I tell you that in all sincerity they are only words and that if you imagine them as text floating off the page and into space, you can take the power away from the person who said them. Or if you write them on a piece of paper and burn them they will, in fact, disintegrate, I am not lying. They are only words. The message, however, still has to be deciphered, understood, and reduced to meaninglessness.

So let's look at Eddie's mean words and decipher the message.

He said, GO TO HELL. Does he mean it? Or does he really mean that he wants his real biological mommy back and can't stand the thought of a substitute. It's the latter, of course. And he's angry. How dare you impose yourself and your likes and dislikes, thoughts and ideas, upon this family? Who freaking asked you?!? If I want to be late for school, says Eddie, I'll be late for school. What're you gonna' do, kill my mom? You can't hurt me.

Poor kid.

So angry and sad. Can you do anything to change that?

No. But you can accept it for what it is. It is not a personal attack against you. It is an expression of grief.

Should you acknowledge that? Should you say, "I know you'd rather I was your mommy and you hate me for taking her place?"

Maybe, but don't be surprised if it goes nowhere. Speaking to angry people rarely goes anywhere. They're in what I call emotional nuts-ness, in NO mood to listen to reason. When they calm down and can discuss things rationally, then we can talk. But by quietly saying, No, I'm not mean, at least Miranda sends a simple message about what is really going on. It's not her who is freaking out. She's not the emotional basket case. And she's there to help, not be mean.

Eddie may not be ready to really process what's happening for a year or two. But if Miranda doesn't freak out and scream, reflecting back her own insecurity and need for acceptance, she has a chance to play the hero, the one who isn't miserable.

See, at the end of the day, people don't like hanging with people who are miserable. They like happy people. So Miranda, you gotta' be happy. Kick up your Ipod. Wait it out. Things will get better. Time heals. Usually.

But wait, what did you mean DON'T TELL DAD. In the last blog on Step-Mom, you said that Dad and Mom are the primary dyad, the executive committee (I did say that, right?). Isn't Step-Mom taking the place of Mom? Isn't she now in the primary dyad?

Yes, of course. She can and perhaps should tell Dad, but not right away, and not when he's in a bad mood. He'll be much happier and more willing to help her shape the behavior of the little ones if she's not accusing him of raising miserable, mean children.

It's the old joke. I can say whatever I want about my mother. But you better not. You can substitute children for mother and you get the drift.

NEXT TIME: PSEUDO-INTIMACY, why everyone picks on step-parents, even when they KNOW it's not nice!

Copyright 2006, TherapyDoc