Sunday, December 31, 2006

The Stooge

I'm so proud of this blogger. Just have to share.

An interview with The Stooge.

We should all shep nachas. (I can't translate that, sorry, I'd guess, "gather happiness?")

His blog: StarWarsJoke of the Day

Anybody who can create a joke a day deserves our respect.

Streaming, literally and Eating kid-food

So you know I like tropical fish, which means of course I liked that movie, Finding Nemo.

I never did want to be a stream of consciousness blogger, but it's late and I'm tired, and I just have to tell this story before I go to sleep and get up in a couple of hours to have coffee before the fast (it's the 10th of Teves, if you really want to know, shortest fast of the year, but still I have to get some coffee in me before it begins at 5:30).

Anyway, on with the story.

I was cruising the blogosphere and found Life, Everything, and the Universe and the blogger had a pic from Nemo. She quoted Nemo (boy, I hope I have this right, I think it was Nemo) the clownfish who said,

Just keep swimming. Just keep swimming.

And you know that's great advice, although I'd add that occasionally floating is fine, too.

For those of you who want to communicate to little children, it's PRETTY important that you watch these movies. Chicken Little was a big one in it's time, and Babe is a classic. But THE LITTLE MERMAID saved me on a case about 10 years ago.

The little girl I saw back then is probably a teenager now, hopefully talking up a storm and giving her parents grief about her cell minutes. But when she was 5 she had a disorder we call Selective Mutism (313.23 is the DSM code).

It's just what it sounds like, a person consistently fails to speak in specific social situations and this interferes with educational or occupational achievement despite knowing the language and not having a psychotic disorder.

So the kid might talk at home, but not at school or to a piano teacher.

It's like the four-year old kid, we'll call him Eddie, who hasn't ever said a word in his life and finally blurts out, "Uh, Dad, would you pass the ketchup please?"

The family looks at him in shock and says, "Eddie! You speak! What took you so long?"

And Eddie says, "I didn't think I liked ketchup."

So you get the joke.

But the disorder isn't funny and can be very frustrating. It's basically an anxiety disorder.

My little patient, call her Tillie, couldn't squeak a word out in kindergarten. Her mom brought her in and Tillie didn't want to talk to me, either.

But I have toys and naturally like to play, so kids always like playing with me and within a few minutes they're usually chatting up a storm.

Well, Tillie didn't chat up a storm. She played with me and with my toys, but her anxiety was palpable that first visit. Second visit, however, she loosened up and could answer a few questions. She was very into the toybox and had found some toys from THE LITTLE MERMAID that seemed to satisfy her quite nicely.

Then I remembered.

Someone in that movie can't talk, right? I asked. It was Ariel, right?

Tillie smiled and batted her dark eye-lashes. Maybe.

It was, wasn't it! Ariel didn't talk. I almost shouted, I remember thinking, Gotcha'!

Play along with me, friends, I can't remember if it was Ariel or not, let's assume it was.

Uh, huh, she said.

Then I included her mother in the conversation. Mrs. L., I asked, Was it Ariel who couldn't talk in that movie?

Mrs. L. shrugged. She couldn't remember.

But you did see the movie, right? I asked them both, seriously.

Oh, yes, Mrs. L. said. We have the movie on tape. She watches it all the time!

Me: Then you have to sit down and watch it with her and get the details on how Ariel learns to talk, then Tillie will know what to do so that she can talk in school. Or do you already know what to do, Til?

Tillie didn't answer. She got pretty coy.

So do you want to watch the movie with your Mommie?

Yes, she smiled, I want to watch The Little Mermaid with my Mommie.

Great. See you next week.

The next week, when they came back the kid was already talking a blue streak at school.

End of therapy.

I have no recollection of the story behind the movie or what Mrs. L. did to get Tillie to talk. But I do think my story about Tillie demonstrates how children's minds work.

They're scared, just like you and me, of new situations, especially when they're really little. Yet they're looking for good strategies all of the time. They soak up stuff from the media, literally absorb what they see and incorporate media coping strategies into their personalities and psychology. They're on the look-out for defenses that work for them.

Selective mutism seemed like a great idea to Tillie, probably consciously. I'm guessing that during the intervention, Mrs. L. focused on showing her how much better life was for Ariel once the little mermaid started to speak.

So if a kid's acting weird, we can assume it's the emotional defense system rallying to protect the child from unspecified dangers. Kids are basically little and scared and who can blame them, face it. They absorb our anxiety, too.

But to help children build more functional defenses, parents have to do a little detective work. They have to find out where their kids learned the defenses they're using. This is true at all ages, by the way. Then they have to revisit the source literally, if possible, or talk about it, offer an explanation and devise better coping strategies.

No, of course most of life is not this easy and this "investigating" can be frustrating, especially as the years pile on. Like understanding your spouse of many years might mean asking a LOT of questions about his or her life and there's no saying you'll get a straight answer.

Try asking an octogenarian why he is the way he is.

I'm just suggesting people eat the stuff they feed their kids, not SO hard to do when they're little. Gets harder.

Copyright 2006, TherapyDoc

Friday, December 29, 2006

Acute and Post-Traumatic Stress

This is a quickie on differential diagnosis, but I think it's important. It's sometimes nice to know what you have and the prognosis for symptom alleviation.

I had a deposition a few weeks ago, did an expert witness thing for about four hours in my little office with a court stenographer and two lawyers.

It was just like on TV.

Towards the end of the deposition (4 hours later, not 2 as promised), the defense lawyer asked me how long I could expect my client to need therapy.

I said that he'd be over the really serious psychological stuff in a couple of years.

But I regretted that statement later on because the DSM-IV really doesn't specify the two years. I said that based upon reading the research on rape and recovery.

The DSM is correct, however, in that although the severe symptoms of post traumatic stress usually resolve within two years, many people have PTSD and other Axis I disorders which are related to the trauma and stress for many years following an initial trauma. They also are prone to avoidant behaviors, too, that change their lives, along with irrational anxiety in safe contexts.

I call it the trauma to the trauma.

A person who (a) has severe nightmares, flashbacks, recurring thoughts, avoidance, and a host of related symptoms (b) following a very stressful event that persist longer than 2 months is diagnosed with PTSD, POST TRAUMATIC STRESS DISORDER. Recurrence of symptoms becomes less frequent and less intense over the years.

ACUTE STRESS DISORDER only lasts 2 months, same symptoms.

So if you see a terrible car crash or a murder from a distance, you'll probably have flashbacks or recurring thoughts about it for only a few months. If you are mistakenly thrown into jail but aren't raped, yet feel humiliated and angry,and can't get it out of your head initially, the intensity of these symptoms, too, will probably actually resolve in under 8 weeks no matter what you do, with or without therapy.

But go and talk about it with a therapy doc anyway. Exposure therapies (and talking is a form of exposure) really can speed things along and are the way to go with acute and post traumatic stress. We have all kinds of tools in our toolboxes for these disorders. By the way, they are considered anxiety disorders.

Copyright 2006, TherapyDoc
Well, yeah, he's really cobalt, powder and royal, all rolled into one. F.D. brought him home in a paper bag and said, "I got fish." I assumed we were having sandwiches for dinner. Named him Viver (rhymes with diver) because he survived tank initiation, only because the Grouper (above) is now in solitary. I hear that they make a mean grouper at a certain restaurant. Dare I?

Wednesday, December 27, 2006

Enmeshed versus so-NOT-enmeshed

Terms of Endearment


The Forty Year Old Virgin?

You have to understand. For me, like just for about every other softy on the planet, watching Terms again is like sticking a knife way deep into my little heart and turning it.

a) the movie's really sad, ala Beaches, and b) it's a mother-daughter flick and it's been many weeks since I've seen M. or Y. Worse still,they keep my grandchildren hostage and it will be yet another couple of weeks before I zip back to L.A. for a few days of R. and R. and drop by. They have a new home.

I am told that SOMEONE has to help prune the rose bushes, as if I actually know how. Any advice, friends, would be appreciated.

Still, I had to write this post so I had to see the movie over again. Got half way through it and still think it's Debra Winger’s best performance. It was made for her.

And Shirley MacClaine? Sheer genious.

The movie starts out with Baby Emma in her crib, sound asleep. Aurora Greenway (Shirley), a fifties mom is terrified the baby may not be breathing. She practically climbs into the crib to check it out, isn’t satisfied until she’s wakened Emma who cries. Satisfied, Aurora leaves the room, baby crying.

Emma's father passes away, she's about five, and in the next scene they return home from the funeral. Her dad's distinguished boss helps little Emma out of the car and tells her, "Sorry about your Dad. He was a great worker. Take good care of yer momma."

Aurora hears this and shoots Emma a look as if to say, DID YOU HEAR WHAT THE MAN SAID? YOU BETTER (TAKE CARE OF YOUR MOMMA) !

That night Aurora can’t sleep. She wakes up Little Emma.

Em : "What's wrong?”

Aur: I can’t sleep. I'm tense. (She's telling a 5-year old this). Do you want to sleep in my room?

Em: No thanks.

(silence) Aurora backs off angrily. Emma caves.

Em: Would you like to sleep in my bed again?”

Aurora gladly jumps in with her.

Emma's best friend Patsy? Someone to resent. Flap, the fiance? Aurora totally hates him, doesn't show up for the wedding. She calls Emma non-stop throughout her wedding night and doesn't let up the following day.

When Emma gets pregnant Aurora is beside herself. Each time. Recommends abortion.

We get it, right? MOM can't stand the thought of anyone replacing her in CHILD's life.

Then, Emma's husband Flap lands a job in Iowa, miles and miles from Texas.
It's time to say goodbye.

Child is ready, Mom is not.

They hug and it's real sad, and then Emma breaks into that big, beautiful Debra Winger smile and says, "Momma? I think that's the first time I pulled away first."

Aurora grimmaces. This means the girl's finally left home psychologically and she doesn't like it.

Although Mom's needs clearly dominated Emma's emotional life during childhood, Emma fought for independence and ultimately won. Emma's got a very special spirit, too, and that's what makes this a REAL HOLLYWOOD FILM.

In REAL LIFE, Emma would most likely have an anxiety disorder,an affective disorder(depression) or a drug problem. In fact, if Aurora hadn't been so rich, so healthy, so cocky and full of herself then Emma would have been at risk to be a co-dependent, a care-taker.

But Aurora had means, full-time help and a big house, and Emma didn't feel compelled to stay home and hold her hand.

Plus Emma had that fabulous personality,a deep love of all things fun, like sex and song.

Real enmeshment should make you emotionally sick.

That's the definition. So Emma wasn't all that enmeshed in the end. But another kid under the same circumstances with different genetics, growing up under a different roof might have been. Variables, variables. Life is so complicated.

Emma's cancer at the end of the movie wasn't about Aurora, (although some people make these kind of associations, I don't). Emma actually bucked the usual consequences of suffocating enmeshment, the ones that are socially debilitating.

Enmeshment AND detachment are the ultimate socio-psychological retardants of life. I made up that term. You won't find it in a book (until you read mine).

Still, there are no absolutes in mental health. These big human brains we have are most resilient features.

If we really picked apart Terms (and we really could go on and on) we'd see a child whose raison d'etre COULD have been care-taking her mom, being what we call a parental child.

Or if Aurora had successfully socially restricted Emma (which she tried to do but failed) then Emma would have been set-up to deceive Aurora about her relationships. She'd have had to sneak around. There is some sneaking around in their relationship as it is. The very process of deception isn't healthy, usually.

It's about that little matter of psychological space that we've talked about before. Kids who have to fight for their psychological space and friendships outside the family often get high. Emma does do that, too.

On to the Forty Year Old Virgin. Andy, played brilliantly by Steve Carell is the polar opposite, so-NOT-enmeshed. Yet the Forty Year Old Virgin doesn't initially appear to be sick at all. He gets up, cooks a good breakfast, exercises, rides a bike to work. Works.

He has many, many toys and hobbies, the building blocks of SELF, and like Emma, he has a love of life and fun (Go Hollywood. We do like happy movies). Were it not for the fact that he's forty and has no relationships, we would think he's just fine.

But he's VERY socially ill at ease.

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We see very little of a family of origin except for a couple of pictures on a nightstand. They are nowhere to be found in this film, which says something, because although it's vulgar, it's not a stupid film.

Andy lives a very solitary life, not atypical of the people who grow up in disengaged families. These folks are perfectly happy not talking to anyone. Their spouses and children are the ones who have the problems, if indeed they marry. The family feels abandoned by the detachment of individuals who either have so much ELSE to do, or have absolutely little or no social skill.

Although guys like Andy feel perfectly fine, they're socially anxious and avoid others. Andy originally works behind the scenes at a big electronics store. As his social skill improves, he becomes a salesman and ultimately manages the store. But until someone had pointed out that he might just LIKE having a relationship, he was fine without one. Without any of them.

When Andy's coworkers find out he's a virgin the movie gets going. They befriend him and push him to find someone, anyone, to get laid.

And wow, does he bumble around. The movie is vulgar so I don't recommend it, but it has it's funny moments and the ending is great (you CAN fast-forward, you know). In the end Andy doesn't have to do it their way, he manages to have a relationship and take it slow, the way people should, and is ultimately very happy with a terrific gal that he MARRIES before losing his virginity.

I'm guessing a guy like Andy who never learned to drive a car (he's a heck-of-a bike rider) didn't get much one-on-one with his parents. Even though he KNOWS he's a nice guy, he's terrified to make the call for a date and he has no platonic relationships. It's not that he's a virgin that's a problem, really. It's that he has no friends.

We develop our capacity for intimacy in friendship. The petrie dish for sharing and learning to have an interest in others is the family of origin, the place you grow up. If the family of origin is an intimate place, one that shares yet is still mindful of privacy and personal space, then having friends and intimate relationships comes more naturally.

The family that raises you has an awesome responsibility. In healthy families of origin people talk, share, laugh, and they're reliable. They care. Parents ask their kids at the end of the day, and kids ask one another, "Did anyone pick on you today? Did the world give you a beating? Come on, TELL ME and I'll tell you about me."

Good parents teach their children that our social eco-system is not always a safe place, but that those who consistently prove accountable and keep their word may be worthy of our trust.

There is much to teach kids. Gently coaching them into the world of relationships is probably the most important of all.

It is an awesome task.

Copyright 2006, TherapyDoc

Sunday, December 24, 2006

Recreational Intimacy

Yeah, it's a repeat, but because so many of you are on vacation I thought perhaps you could use this one.

The 5 Types of Intimacy. People tend to have very fixed ideas on the subject of intimacy, but there are at least five types. It’s not all touchy feely, which is good, because many people are very uncomfortable with direct, romantic expressions of love.

But because there are five kinds, relationships that are light on one, two, or perhaps even more of these varieties suffer. You sort of have to have it all, to have it all
. Lacking any one of them can be the reason a committed relationship bites the dust. And unfortunately, it's not at all easy to have them all.

We'll start with recreational intimacy. Counselors sometimes suggest that couples go out and find something they like to do together. Not bad advice, but it's not good, either. It's like saying, You guys go out and find a movie you both like .

Maybe your tastes are so different that you can’t even find a movie that both of you can tolerate. Then you try, but the next time that you can go out is on a Saturday night and you've already missed the 7:45. You’re don’t know how to get tickets on-line. The two of you fight the crowds, get frustrated and bored. You can do it, maybe, but why?

What these counselors should suggest is that you work less at finding something you both want to do and more at doing something together. Anything. The catch is having fun. The rule on an assignment like that is to keep it light, try to make it fun. You can still go to a depressing movie, but only if it’s good.

I tell people not to worry about both of you liking an activity. Whatever you choose to do, it can be something one of you likes and the other totally hates, as long as it's not morally objectionable, disgusting or distasteful.

Games, sports, or the arts work nicely. Even pinball at a bowling alley. This is a personal bias, I'm going to admit. It could be that I'm showing my age, but video games don't seem to be as interactive as pinball used to be. Pinball was a whole body experience (a little more sexy, I think), the visual field more expansive. You had a whole machine to look at, not a simple screen.

Regardless of the game, the partner who doesn't like the activity still has to have fun for a couple of hours, make himself have fun. Two hours is plenty of fun. It won't kill you.

Another misconception about intimacy is that you have to spend a lot of time at it. It isn’t a quantitative thing. Spending six hours trying to enjoy a Saturday night might be less worthwhile than a half an hour a night every night during the week. We really are talking quality time.

But you hate Gin Rummy? Too bad. You have to either make it fun somehow or pretend to be having fun. Pretending is one of life's most unselfish challenges. Don’t think of it as being someone you're not. Think of it as becoming someone you want to be. If it’s okay for your spouse, it’s okay for you. Of course if it's morally objectionable, then it's not okay for either of you.

Pretend you're Gerry of Ricky and Gerry (gender nonspecific). Ricky has picked an activity that Gerry hates, golf. Gerry has the hard part-- not-- bursting Ricky's bubble.

Gerry has to think, Ricky wants me to do this. Ricky wants us to have fun together doing this. How can I make it happen? The answer is:

By not complaining. By laughing as much as possible. By letting go of thinking how dumb you look when you miss the ball. By thinking of how funny you look—it's good to laugh at yourself! Try to remember how happy Ricky is that you are there, just chasing after a little ball. Complement Ricky on how well he plays. Let Ricky teach you and don’t get defensive.

Ricky, has a big responsibility here, too. Ricky can't make you feel like a clod. Ricky has to ingratiate him/herself because Gerry is doing what Ricky wants. Gerry is sucking it up, and Ricky will have to do that next time. Sorry, Rick.

Thinking like this is a challenge, no doubt. But it is just this sort of (1) empathy and (2) fake it 'til you make it that is the key to intimacy. It's hard to be happy doing something that doesn't naturally make us happy. It's unnatural by definition and yet. the pay back is amazing.

Recreational intimacy can be hard even when you're doing something you both love to do, too, primarily because the other types of intimacy interfere with the process of your interactions with one another.

That’s why all five plates, all five types of intimacy, have to be twirling at the same time..

Copyright 2006, Therapy Doc

Friday, December 22, 2006

Puccini's Birthday

Forget that you don't like opera.

Find a classical music radio station in your town and LISTEN.

On WFTM in Chicago they're playing "Puccini's Best" and I'm in tears it's so beautiful. Just try it.

Thursday, December 21, 2006

You're Not Alone on a Bike

Have we talked at all about social ecosystems? I don’t think so.

Original running title for the academic paper reads:

Living the Cultural Ecosystem

A social ecosystem is your world. That includes the media and the world you are in right now.

1. There's you.

2. There's your immediate family, the one you live with, could be friends or just your cat. Could be just you and your partner, spouse or significant other.

3. There's the family of origin, the people who raised you and your siblings, it’s possible you don’t live with them any more.

4. There's extended family, includes all blood relatives.

5. There are your close friends, both near and far, some on the other side of the world, perhaps.

6. There are acquaintances you see in your neighborhood. This would include that little subculture that you see hanging around in Starbucks or Borders.

7. There are the people you know from work, school, or place of worship.

8. There are people from the bar, sports center, work-out club, church, local government. You might call them “acquaintances.”

9. There are the people you connect with directly via your computer or telephone.
Even telemarketers are a part of your ecosystem, as is the barking dog next door.

10. There's all of the information you get from television, newspaper, and radio. You might include books, too, since they expand your experience.

11. If you're an astronaut, then space might be part of your eco-system.

12. There your “higher power,” perhaps.

Maybe I left someone out, hope not. You get the idea. The ecosystem consists of all of the people and all of the information that has a direct influence on how you feel, think, and behave.

Sometimes people feel very alone, even when their entire world is very big. They don't feel connected to their ecosystem, not intimately.


FD and I make a big deal about riding our bikes. Getting around the city this way has worked for us on a lot of levels, but these days when I personally talk about my bike it's generally to complain about how people in cars seem to have to swear at me or blast me with their horns.

They act as if I should MOVE OFF THE (expletive) ROAD. Like roads are for cars, not transportation.

Truth is, I’d have given up riding my bicycle years ago were it not for F.D.'s nagging. I’d have succumbed to the lure of potato chips and television, effectively, perhaps permanently, locking the serotonin in my neurons forever, wondering if I should start Paxil or Zoloft, knowing I'd hate them both.

The bikes, our original bikes, are a common thread with us. They’re a link between us, one of those historical reminders reaching back to the first day we met. We were buying bus tickets at the student union to go home before a Jewish holiday.

“Come out with me for a Pre-pesach beer?” he asked. Beer has malt, so you can’t drink it on Passover, the fast-approaching eight-day holiday.

“I’m in.”

That day, or was it the next, he won his Raleigh ten-speed in a raffle for the North American Indians, I think that was the cause.

I didn’t have a bike at the time. My original red ten-speed, a bike I had used to explore my world throughout high school, had been stolen freshman year, first week of school, and I didn't have the money to replace it. 
The bike I ride today was our first "big" pre-marital purchase at a little under a hundred bucks. So you could say it’s a piece of our marital history.

He would say we keep the stupid bikes because we’re too cheap to get the newer more fancy ones with 36  thousand speeds. I would say we're sentimental. But the truth is we've kept them because they feel good and we don’t trust the new ones. And they remind us of a very romantic time. Keeping stuff like that alive is key in marriage, in case you're wondering.  Creating those kinds of things.

Oh, and the new generation, now an old generation, the mountain bikes, were always just plain silly for Chicago, a very flat town.

So before we even had children, we were that young couple that took out the bikes at the first sign of spring, shaking the lead out, feeling better about having had cheese cake or ice-cream when we got home.

But even during pregnancy F.D. would nag me to go out riding with him. “Come on,” he’d say. “You know you’ve never fallen off a bike in your life; let’s go, you need the exercise.” He needed the exercise.

Being a doc he was also afraid I’d throw an emboli and have a stroke during pregnancy. He was always afraid of things he wouldn’t tell me about but I could tell from that far away look in his eyes that he was thinking something scary.

So I’d go with him well into the pregnancies, nauseous, fat, get on the bike and tool around in the suburbs late at night when everyone else was tucked away in bed or watching a warm TV.

Because he felt the need to exercise. Face it. I could have done yoga if it was about emboli. There are simply some things one does for a relationship.

When my excuses started to mount (the seat feels too hard, the handle bars are too narrow, I’m bored, bored, bored and want to throw up) he’d work on my bike and make it friendlier. The wide seat, wide handle bars, the perfect high stem that gave me the leg length and stretch that I needed-- all thanks to F.D.

So he'd have someone to ride around with late at night.

But at the end of the day I got pretty addicted to the feeling I’d get from riding, much more than he did. I had the longer ride to work. The fresh air, the visuals, the sounds woke me up. I liked that it was me who knew the geese were back in the city in the early winter. Because we talked. “Yo geese.” “Yo back, watch what’s on the bike path. Don’t look up so much.”

Well, one day a group of dog people were out enjoying a summer evening and their dogs were off their leashes. The dogs saw me, a red speeding bullet flying through their park (they had marked it) and of the same mind this pack of dogs thought, “Deer.” They were off to the chase. A pack of dogs. Domestic dogs.

I saw them coming and got an adrenaline rush that helped me out-distance them in seconds. But it was thoroughly terrifying. I shook for days after thinking about it.

The next night, as I approached the park, I stopped, looked around, saw the dog people and their dogs way ahead of me. I slowed it down to a crawl until I was close enough to get their attention and explained that it wasn’t safe, letting their dogs run around unleashed. This wasn’t an official dog park.

What if I hadn’t been able to out-distance the dogs the night before? What then?

“It’s because you have that flashing light in the back of your bike,” I was told.

Thanks. In other words you’re not leashing them?

“No, turn off your light when you pass through.”

I don’t think so.

I wrote a letter to the Chicago Tribune and the editors published it! But still, the dogs sniffed and roamed and I was stuck slowing down to a halt whenever I passed through. Didn’t seem fair. It's at least a half-mile of park we're talking about.

Then one night I saw a police car parked at the very end of the park. I pulled over to him, casually mentioned the problem.

He cruised on in and fined them all $500 bucks a pop. That's what it'll cost you if you don't leash your dog in Chicago, unless you're in a designated "dog park".

Should I have felt bad that they were fined? I didn’t, still don’t. I worked that ecosystem to my advantage and in the end it worked well, even for the dogs who will never be impounded for eating the flesh of the bikers or pedestrians in their world. The dog people have leashed their dogs.

The interesting thing is that now when I see them? Things are different. The dogs have been on 30 foot leashes since that day, and when they see me they're very friendly. We have this strange genuine bond going. We smile and wave. Sometimes I’ll even stop and talk for a couple of minutes, just comment on construction or the weather.

It’s like I’m a Park Person, if not a Dog Person, I'm a part of the culture.

They must not know it was me who worked my ecosystem, right, to get them in trouble?

But I've become a part of their world, the person on the red bike. I’m ONE OF THEM.

People like familiarity, being in the same place at the same time with the same people. This is why I tell single people to become a part of a mini-culture, a system within the ecosystem. Become a regular at the library, or at a bookstore or a coffee shop. Go to a church or join a political organization. Meet people or not, if they see you they get comfortable at the thought of you, like you are comfortable with certain checkers or baggers at your local grocery store.

Being lonely is a state of mind, you know. You’re never really alone.

Copyright 2006, TherapyDoc

Monday, December 18, 2006

Getting Good Grades, Plagiarism and Copyright

Okay, kids, I know it’s important to get good grades. Once I taught an A.P. class in a high school and I couldn’t believe how students went crazy if I gave them a “B” or G-d forbid, a “C”. An A.P. “B” is really good, too!

And I know I’ve blogged about pressure and am on record stating that the reason young people will try and often complete a suicide is that they feel way too much pressure to make GOOD GRADES. They can’t handle the sense of failure.

But let me let you in on a little secret. If you steal from someone else’s work on line, it’s very possible that your teacher will know that it isn’t your work. You’ll be busted. Here’s how I know.

Bloggers have ways of checking statistics. We can find out where our “hits” come from with various services that track Internet traffic.

Tonight I happened to find something unusual. I’m getting hits from a website that enables parents and teachers to check homework for plagiarism. Your parents and teachers can copy your reports (they’re not stupid) and paste them into a rectangle on the website. The site scours the Internet for quotes that may have been taken from someone else. Not even necessarily quotes, just key words that run on near one another.

I tested this, copying from a post that I wouldn’t expect any of you to use for your homework. Wow! Up came the link to my blog.

Your teacher can show you the exact source for your homework. She can show you word for word.

I suppose it’s not plagiarism if you quote a blogger directly, if you cite properly. In professional journals we have a protocol for sourcing on-line material.

But that word at the end of each post? Copyright? Last I checked it’s a legal term. So be careful about claiming work that isn't your own. Everyone has a lawyer or three in the family.

And finally, last I checked, plagiarism will get a kid expelled from most schools.

Get off line and go do your homework. Learning is fun, don’t you know? Some of us like it. Especially THIS STUFF. WHAT COULD BE MORE INTERESTING, RIGHT?

Copyright 2006, TherapyDoc

Sunday, December 17, 2006

Take the gift, Just take it

Gifting, especially holiday gift giving does make people crazy.
And taking isn't so easy, either.

I've already posted about this once (bananas and video games) but before we get to how NOT to deal with your family during the holidays, we have to talk about accepting presents.

And then we'll do Things you'd like to put in your Xmas cards.

Here's the dilemna. You KNOW that so and so is going to spend a lot more on you than you want to spend on her. You're stretched to the max, broke or nearly broke. And she's the last person you would dish out this much money on.

The stress is compounded by "the reciprocity law." That's the one that goes something like this:

If Ellen buys you a $500 sweater, you have to spend $500 on her, too.

And if you don't, you feel guilty. And if you do, you feel depressed. What do you do?

This time of year I'm prone to say,

Who needs the guilt? Who needs the depression? Isn’t there a way to run off to Jamaica for the holidays?

No? Okay, so we modify your thinking on the reciprocity law. It's not a law, see? Not really. Just take the sweater. Here's why.

1) Ellen's going to spend $500 on your gift, but she really WANTS to spend it. You're doing her a favor by taking it graciously.

If you try to make a stupid rule, like, let's only spend a hundred, max, each, then you're running the risk of depressing her. You're bursting her bubble. You have to have a little heart, okay? It's the holiday season.

2) She truly doesn't care what you give her in return. If she's spending money like water she can buy herself whatever she wants.

3) Most of the Ellens of the world do not see gift giving as an even exchange. They're not looking at it like, if I give you X, you have to give me something comparable to X. Their reason for giving isn't to get something back. They're not children.

Children are always thinking reciprocity, but adults are a lot more complicated. A lot of adults actually give from the heart.

Not that kids don't give from the heart, but you're more likely to hear this conversation in a school yard than a comparable one at the office.

Kid 1: I'll give you my tuna fish sandwich AND my pickle if you'll give me your brownie.
Kid 2: Throw in the chips and we have a deal.

At the office it's more like,

Grown person 1: Can I borrow your stapler?
Grown person 2: Sure, just remember to return it, okay? I lose so many (expletive) staplers this way.
Grown person 1: I know. I'll return it, honest.
Grown person 2: It's okay. No pressure.

Attitude's more generous.

4) If the Ellens of the world are the ones with the resources to give, and they truly enjoy the gift of giving, then they're not sitting around wondering why you're not giving as much in return.

They're not really thinking you're the low life you think you are. They'd be insulted at the very idea that you think that they think you're a low-life cheapskate. They KNOW why you give a little less dollar-wise and they love you anyway.

5) For many people, Xmas is the TIME TO GIVE BACK. People with means are tickled pink to give back. Your boss, for example, might give you a bonus because you’ve WORKED for it. He/she is grateful and showing it. You don’t feel guilty when you get your bonus, right?

So why feel guilty when other people show appreciation by lavishing big, expensive gifts on you? NOT TO GET TOO SOPPY, BUT it's entirely possible that the intangibles you give them are priceless, especially if you're a co-dependent (see previous posts). Maybe you’re there when others need favors. Maybe you’re a good friend. Maybe you listen. Maybe you call and check up on others.

Not you? Never mind.

So rather than get soft and shmaltzy which is informative but boring, we get to what you can write in the Xmas card attached to your less-than gift..

Dear (Friend or Family Member),

I know this is a small token, but I want you to have the happiest Xmas ever and know that I am thinking of you this holiday season. I am hoping, if not quite sure, that one day in the future I’m going to probably come into A LOT of money, maybe the lottery, maybe the Reader’s Digest Sweepstakes, I don’t know, but I guarantee that when I do, you’ll get better presents from me on the holidays. And if I don’t? Can we still be friends?

Love, Me

Happy Holidays.

Copyright 2006, TherapyDoc

Friday, December 15, 2006


This is the same as the first post, but because my server, Blogger, has changed over to a new format, that post, along with several others, seems to have entirely disappeared! So have all of the comments. Am I upset? Well, sure.

You feel better.

I take it home with me (to a point).

You've left it in my office (to a point). If I’m in the “right” place, I've left it there, too.

That is the ticket for therapy docs. This is the best way to go.

I used to tell people that this is also the essence of therapy, this is why it works. The process sounds very simple and it is.

But as a systems thinker, and one who doesn't like to feel bad, I prefer to take the process a step farther, higher, if you will. If a person has suffered a trauma and a therapist can help just by listening, how much more powerful to bring in family members, to extend the dilution of anxiety, anger and angst.

I even hung up a homemade poster (Margo made it before the days when I’d have to pay her serious money to design something for me-- just kidding, honey, you're the best),

Share the Anxiety

That was based upon the idea that if you give over some of your negative emotion, then you’ll lose a little and your partner, or the sharee, will get some. It is one of the reasons that family therapy is therapeutic.

Theoretically, if a patient shares the anxiety or sadness with someone else, then a therapy doc will ultimately feel less of the angst. Yeah, I know, you're paying me to feel it, but that's not the point, not at all.

Not everyone has that kind of support, someone ELSE to listen, of course, so individual therapy will never go out of style and will always serve a valuable function in society, even if one day it is all done somehow with a web cam.

But this suggestion, that the patient also share with another, can fall flat because the "other" may not WANT to feel bad. That "other" may be tired of listening to sad, bad thoughts and emotions.

So I tell the "other" that like a therapist, when we hear other people's problems (OPP) that we really only hold onto them for a little while. The problem holder is still stuck with most of it.

"Others", partners, parents, friends, therapists who do hold onto stuff too long end up seeing a therapy doc to work on “boundary issues.”

Where do you begin and where do you end, where do I begin and where do I end? Always a crazy hard question.

If I have really good empathy skills, meaning I’m good at putting myself in your proverbial shoes, then I not only feel your pain, but I transcend the feeling thing and even enter your thoughts, your explanations, your visualizations, your defenses.

Ensign Troy of Star Trek fame, move over.

So having good empathy skill is being able to connect with others. But it’s not ANALYZING others at all. It's not intellectualizing in order to fix something.

My mother, for example, might think that I didn’t call her one night because I found her uninteresting. She’d be analyzing my behavior from her own self-doubt. (It’s just an example, friends, absolutely nothing to do with reality, she knows she's cool, at least we hope so.)

Empathy in such an example would be her really knowing that I’m tired of talking and listening to others, am involved in my writing, might be watching television or downloading songs, playing around with film editing or whatever, and Time just zipped away from me. She’d be seeing me in her head doing these things, based upon real data, empirical information about my habits.

That’s the boundary we’re talking about here. Empathy is leaving your own self behind. It’s all about the other. She wouldn't be adding things like her own self-doubts. It's just an example, people.

So to review.

You dish out the graphic details.

My brain incorporates them, is traumatized by them, meaning I get the picture. I feel the picture.

You have shared images. Now we both have them. Yours is a teeny, tiny bit less emotionally upsetting, less clear even. Mine could never be as upsetting or as clear as yours, not ever. I wasn’t there when your trauma occurred in real time. I have no sensory data other than the visual imagery I created based upon your narrative.

So you will always win out if you share your trauma (especially since the research indicates that the brain does have a better chance of desensitizing if a person repeatedly revisits traumatic events).

Bottom line? If you’re going to be a therapist then you had better have a certain type of cable television working in the brain. You’d better have lots of channels and the ability to switch channels. You’ll also need a good sense of self, too, good boundaries. You have to know where you leave off and others begin. That means that you are able to say to yourself, what’s in my mind now is really not my stuff; I don’t really need to think about it now, and turn it off.

Meaning you’ll have to leave people’s troubles at the office, as best you can.

But you don’t get to have the most interesting job in the world without paying a price. You’re going to get dirty in this job and you won’t like it.

But if you remember that what you’re feeling is only a fraction of what your patient is feeling, is only a hint of the patient’s pain, then connecting like that with people not only does them good, but it enhances your worth as a “helping” professional.

You won’t burn out, either, and have to go into real estate, which may be fun but can never, ever be as cool.

Thanks. I just had to get that off my chest.

Copyright 2006, TherapyDoc

On Being Late for Appointments

Did I run late today? Is that what's going on here? Well...

That'd be pretty rude, right?

But it does happen to everyone, and when it happens, those of us who respect others and their time, who sees time as a valuable commodity, will feel some stress, even distress when running behind the clock.

Anxiety disordered patients have the most trouble when this happens, when they're running late. People with anxiety disorders can feel highly anxious, even have panic attacks at the very thought of inconveniencing others.

But anyone, really, can be late.

Once you're late it's a little too late to have started out earlier. I tell people who are chronically late that they need to either set their clocks ahead or start out an hour (a full hour!) earlier for appointments. Both systems tend to work.

But say it's too late for preventive strategies, too late to test out new behaviors. It's too late, you're late. What do you do?

How do you control your anxiety? How do you keep that pulse down?

Like today, since I know you're wondering, I was running late for my 11:45 appointment. AND I was riding my bike to the office, meaning I'd have to compensate for things like wind. Plus I'd have to add time to change my clothes upon arrival. The wind, as luck would not have it, was in my face, slowing me down.

What I'll do in this case is damage control, of course. I call the person I'm inconveniencing. They can power trip me all they want about it, I don't care, I've screwed up. I'm at a disadvantage.

Once a person runs late, everything shifts in the power tripping. I always respect people who don't hold it against me, you know? Those who don't take advantage of an advantage.

But I've found that when I'm running late, calling makes a big difference. It says I care and gives me a chance to apologize profusely, also allows the other person to use the time more productively.

If you adopt that strategy call as soon as you realize you're not going to make it on time. And apologize a lot.

You do it before you get into the car and have to fumble for a cell phone in traffic, or in cases like mine, before you hop on a bike and look like a person with schizophrenia in the winter.

(Listen. The bike paths were clear, the sun was shining. What was I to do, drive?)

So calling ahead is a good thing, even if it opens up the possibility of more anxiety if you don't connect. But that's the price you pay, isn't it, for screwing up? (poor time management could have been avoided, face it, if I just hadn't. . .)

I'm thinking if you're like me and anxious when running late, it's because you don't want to hurt that person's feelings. You don't want the person you're keeping in limbo to feel rejected, angry, resentful, slighted, narcissistically injured, like you placed him low on your list.

If you're late for an appointment, lunch date, job interview, sales meeting, birthday party, just about anything, it's possible you'll ruffle a few feathers. And who needs that. I hate ruffling. People have it tough enough as it is.

Anyway, I picture the person waiting for me feeling mixed emotions, none of them good, maybe even feeling relief at the thought of me not making it. Some people don't even care when I'm late, I'm convinced. Therapy can be hard.

But if you try to let yourself off the hook by focusing on positive thoughts, like people will be relieved if you don't show or won't care, be aware that the other thoughts, the more negatative ones about how badly you've hurt their feelings, or how unprofessional or callous you look, will creep in and pollute those nifty rationalizations.

That's the problem with intellectualizing. You can't get away from so many possibilities and variables once you start thinking.

Lucky for you, there IS a quick and easy solution, a tried and true TherapyDoc Intervention that has worked for almost everyone in my sample, i.e., those in my practice for whom anxiety over lateness had been a problem, probably a tiny fraction of a few thousand patients spread over 25 years, and me.

It's denial.

Now I know I've said that denial is the most immature, primative of our defenses, and it's true. But it does work here up to the moment of truth.

You say to yourself, I am not late until I'm late.

What does that mean?

If it is 11:30 and you think it will take you yet another 30 minutes to get to an 11:45 appointment, rationally, you're late. But in my world, in real time, you are not yet late. It is only 11:30. The appointment is at 11:45. You really are not late, not yet. For all you know the person you are to meet will call within the next fifteen minutes to tell you that he or she is running late. Or cancelling.

Get it? You're not late until you're late.

If the appointment is for 11:45 and it is 11:46, then you're late. THEN you have to begin to worry about your relationship. You have just stolen a minute of that person's time. You're a thief.

This is not a good feeling, and obviously can be avoided with a little planning and less puttering, eating, or Spider Solitaire.


Yup. I was. Anticipating that, I left that message on the patient's cell phone apologizing. I was indeed, 4 minutes late. We had a deal, however. All of my patients know that I'll wait 15 minutes for them if they're late, and they have agreed to extend me the same courtesy. But it's not something I make a habit of doing and I discourage lateness.

The crazy thing is that it seems that whenever I'm late, the patient is late, too! The patient can be later than me! Then I have to make the moral/ethical decision: Do I lie and say I'd been waiting for them when I haven't? That's that power tripping thing I referred to above.

I'm a social worker, so no, I wouldn't do that. We're a pretty honest bunch. I'll for sure say, Oh, I was late, too. It worked out just fine, right? (smile). That's so intimate, by the way, being honest.

Today? I was blown off altogether, which is why you get to see this post. It's why that mantra works so well, too. Saying "I'm not late until I'm late" may feel like denial, but psychologically I feel that beating myself up over an event that hasn't happened yet is a waste of emotional energy. It's silly. Being late won't matter if the other person isn't waiting for you. Other variables do affect most outcomes. Others are often late, too.

This whole rationale, by the way, applies to all anticipatory anxiety. Why worry about an event that hasn't and very well may not happen?

I'm not saying you should be late intentionally or shouldn't worry at all. We have to stoke the fires of arousal SOMEHOW.

But you shouldn't ignore punctuality assuming that others will be late, or that they will blow you off, or that they keep what is often affectionately referred to as "Jewish time" or "Irish time". In these cultural "times" the thinking is that being fifteen minutes to a half hour late is normal and okay, which it might be in some crowds where everyone knows the rules. The idea there is that everyone should be adapting to an unwritten, covert rule about punctuality being over-rated and abnormal, culturally awry.

To me, fighting anticipatory anxiety, quieting yourself down by staying rational is the key. And quit the early self-flagellation. You'll have time, believe me, to regret the error or your ways later on, at show time.

Repeat after me.

I'm not late until I'm late. I'm not late until I'm late. I'm not late until I'm late. I'm not late until I'm late.

Then check your watch and get moving. Maybe you can salvage the relationship. Maybe not.

Copyright 2006, Therapy Doc

Thursday, December 14, 2006

Sex Addictions

There are many things I haven’t talked about yet, anger, primarily, probably since I’m an anger-phobe, but I’ll get to that when the time is right.

Sex addictions is another.

I’m going to loosely define a sex addiction as a compulsion to seek out sexual relationships with strangers, knowing that the relationship will in all likelihood never be more than a sexual relationship.

Like the other addictions, sex with strangers is self-medicating and compulsive in nature. The high people get from the excitement of new relationships, the hope against hope that the sexual relationship will become much more, and the act of physically connecting to another human being fill voids in the psyche, emptiness.

Docs who are more psychoanalytic than me will pontificate about replacing lost love objects in childhood, meeting unmet dependency needs, and the like.

You know that’s a bit abstract to be practical.

Oh, and it doesn’t explain our example.

Here’s a story I’ve heard a dozen times (probably, which isn’t bad over 25 years, is it?).

A guy comes in with a broken marriage. He knows it’s over. She knows about the sexual abuse he suffered as a child, but hasn’t a clue that he seeks out relationships with men and never refuses sex when propositioned. The marriage is conflictual and unaffectionate.

He considers himself a hopeless case. He’s a nice looking man who thinks he’s unattractive. He showers twice, even three times a day. He’s sweet, soft-spoken, non-violent. In his marriage this type of patient has been exploited in some way or another by his spouse. Perhaps she married him to gain citizenship or because she knew she could get him to pay off her Visa. He’s the one who does EVERYTHING in the family, including the carpool, the laundry, the work outside the home that brings in the money. Inevitably, he hands over his paycheck to her.

His self-esteem is trash, of course. He hates himself and has never recovered from the stain of childhood sexual abuse. He’ll always remember how he “performed sexual acts” on his abuser and was sworn to secrecy. He’ll describe these acts in therapy and he will feel a little better having shared this (he’s not told anyone else). But at the end of the session he goes home, self-esteem no better than it was the day before, looking for love.

These are tough cases and a doc like me can work with a guy like this for a year and it will help. No question, therapy really will help. ANY therapy that does not exploit him will probably help.

But remember, those of you either with this problem or those of you who are going to become therapy docs, there are OTHER RESOURCES out in the world that can be extremely effective, that can provide EVEN MORE SUPPORT THAN INDIVIDUAL THERAPY.

I’m talking, of course, once again, about the 12-Step programs. The one for sex addictions in the Chicagoland area is called Sex and Love Anonymous. There are dozens of local chapters all over the U.S. Sex Addicts Anonymous is great, too.

If you’re on-line, you can use a search engine to find the nearest chapter. If you’re a social worker with a client and you have Internet access in your office (and if you don’t, you should) then go there while you are with your patient and don’t let him leave without a piece of paper and a chapter meeting time and place in hand.

Here, I’m giving you the link, saving you the work. Bookmark it or put it in your Favorites. Welcome to my world. I cannot vouch for the effectiveness of any particular group, and watch out for the For Profit websites using similar names.

The word on groups is that if you don't like one, look for another. Try up to 6 different groups before you give up.

Sex Addicts Anonymous

Sex and Love Anonymous

Hopeless just doesn’t make it into the vocab, okay?

Copyright 2006, TherapyDoc

Tuesday, December 12, 2006

Blurting it out

Sometimes, just when I'm thinking that my patients aren't hearing a word I'm saying, something great like this happens.

Let's call her Alice. (all the names are made up names in all of my posts, except for mine). Alice suffers from some pretty serious depression. She's tried to take her life a zillion times. But when I got the referral, knowing that she had a strong history of that, she sounded so cheerful that I HAD to meet her.

And Alice is everything I want her to be and more. She's totally trying to enjoy living and has made a commitment to staying alive by following the advice of her doctors, myself and the psychiatrist who referred her to me.

Not surprisingly, she's never really had any decent psychotherapy. Lots of drug trials. Little therapy, virtually none.

So when she told me what happened while she was on vacation, and how she handled it so well, I asked if I could use the story and she said, FOR SURE.

Alice and her husband Joe are retirees in their sixties. They recently went to visit Joe's brother Al in Miami. It wasn't a pleasure trip. Al had back surgery and was having trouble with his rehabilitation. He had a live-in girlfriend, Lisa, who needed some time off from care-taking to work on some business in another state. So Alice and Joe had decided to give them Al a hand while she was gone.

Lisa returned the day before Alice was scheduled to return to Chicago. Al was joking around, playing with his walker and almost fell. This scared all four of them, but Lisa lost her temper and scolded Al for joking around, almost reversing whatever good would come of the surgery.

She shouted, If you fall and hurt yourself again, then you're HER problem.. (pointing to Alice) . I'll be finished with you. I can't believe how you've done this to me. I'm so angry at you!

Alice said that at that moment she heard me in her head telling her that her depression was related to being passive and that she had to stand up to people and tell them what she was thinking. She had to tell just the facts with no emotion, like she was reading a newspaper out loud.

So Alice shook her head slowly at Lisa, narrowed her eyes and said, No way. Your brother and I are retired and we have a life. I am NOT taking care of Al. We are not going to be there for him if you go.

After she told me the story Alice said, You have no idea how good that felt, just opening my mouth and saying No.

You're amazing, Alice. Here's to feeling good.

Copyright, 2006 TherapyDoc

It May Take a Woman to Clean Up the House

Enough about me. It was fun having a birthday on the Internet.

But tonight ABC replaced Boston Legal with Barbara Walters, so while jogging on the treadmill I watched the special about the Year's Most Interesting People. I watched the whole thing.

The most interesting person on the show in my book, without a doubt, was Jay Z, the rapper.

But Barbara chose Nancy Pelosi, as her Year's VERY Most Interesting Person, the Democratic minority leader to be sworn in as Speaker of the United States House of Representatives in January. And Nancy looked absolutely gorgeous on the show-- trim, well-dressed, sparkling as she spoke about her life and her political goals.

Her greatest accomplishments? (I'm loosely quoting, here)

"I'm a wife, mother, and grandmother. These are my most important roles. But it is a very fine thing to be able to add, Speaker of the House."

Speaker of the House! The first woman ever!

A nice girl from a very protective Italian family is two heart-beats away from the Presidency.

You realize, because you passed that Constitution test in 8th grade, that the executive chain of command is as follows:

We have a Commander in Chief, the President, George Bush.

He's followed by his #2 man, the Vice-President, Dick Cheney.

If anything happens to George, Dick Cheney, as Vice-President, becomes President. If anything anything happens to the Vice President, then the Speaker of the House, (Nancy Pelosi, becomes the President of the United States.

A woman who is first and foremost a Wife, Mother, and a Grandmother.

Barbara asked, "Nancy? Let's talk about you as a politician."

Nancy, "I don't mind the word politician. Politicians can change things and Washington needs change. Washington is a swamp that needs to be drained."

(again, I'm quoting loosely. I was jogging.)

Barbara, "You mean it's a swamp?"

Nancy, "You might say that it needs cleaning up. I want to break the liaison between lobbiests and congressmen."

Barbara, "With all due respect, many a politician has promised to come to Washington to make sweeping changes."

Nancy (without skipping a beat), "Well, Barbara, It May Take a Woman to Clean Up the House."

How I love America. I'll bet they didn't have to spend more than five minutes coming up with that one.

And on THAT note, if you haven't seen Of Fish and Family, read the post from December 11, 2006. I laughed, and laughed, and laughed. It's on the same theme.

Therapy Doc

Saturday, December 09, 2006

Holiday Post 3: Remembering and Xmas

I was thinking about my grandfather and how we used to write letters back and forth when I was in college. If he were alive today he would be 112.

But he's been gone 32 years.

The story goes that Fam Doc, my spouse (a.k.a. "G.D." or "S." in previous posts, here-to-fore "F.D" or Fam Doc) had never been to a funeral until the year he asked me to marry him. F.D. had a high fever that day, the day we were walking in the rain and he asked me, and he claims that he was delirious. But since I accepted the proposal he felt he couldn't take it back. At the time he was a funeral virgin.

Until six months into our engagement when Zaide' (my grandfather) passed away. The wedding had been planned for the following summer just so that he and Bubbie could come in from Florida during a warm month in Chicago. There were other plans.

I always thought it cute that my Zaide' referred to the Almighty as the Old Mighty. I had never heard this expression before we started our correspondence, and on occasion, generally when I'm thinking of him, it comes to mind and I use it.

Why he called the Master of the Universe the Old Mighty is unclear to me. It could have been that he was hard of hearing, which he was, but most probably this was a pun, his idea of a joke. Old guys like him mainly made little jokes and hummed when they weren't walking around in tallis and tephillin (prayer shawl and phylacteries) or feeding cats.

So one of the ways I keep Zaide' current is to refer to Him as the Old Mighty. Doing that sort of thing is


a deliberate reminder that the parents of my parents had much to do with the person that I am today.

So what we're going to talk about today is keeping memories current. Keeping them live.

I've talked a bit about loss in previous posts, but this time of year the subject comes back in spades.

It is really why therapy docs are so busy at holiday time. In practice we're dealing with loss, primarily, thoughts of others who are no longer with us, and then there's the ultimate misery, dealing with people who are. This busy season for therapy docs is why people who are close to me hear from me a little less often. Birthday presents, anniversaries, cards, all kinds of things aren't shelved, but might get post-poned until after Xmas.

I could have titled the post, Passing On or Coping with the End of Life as We Know It. Loss is something that rallies the stuff of coping. No matter how old a person is at the time of death, those who survive have to integrate the change into a new way of seeing things. One less present, one less card, one less plate on the table, one less everything.

So patients come to see me this time of year to make sense out of it and to shore up. They come back if they haven’t been around during the year. We family therapists tell people that your therapist is the person you hook back into when the family moves into a new developmental stage (read that, crisis) that rocks the senses. So I get people before the weddings, after the births of babies, launching children to preschool or college, etc. all year long. Events spawn crises.

Holidays can feel like crises.

Last week, one of my favorite people came by and told me about four (read that four) losses she suffered this year. I’ll change the events so that you can’t possibly identify her. She could be a He for all you know, too.

Let’s call her Elizabeth. In January Elizabeth she lost her father. In March she lost a child. In July the dog was hit by a car, and in August her husband, who was only in his forties and had minimal health problems, keeled over behind his desk on the job.

Elizabeth was doing very well in spite of it, but felt a little down. That was why she reconnected. Her past therapy was about childhood issues and we had done a little family therapy to clean up some blended family issues. I couldn’t believe she waited this long, truthfully, to reconnect, considering. Any two of those losses would have knocked the wind out of most people who had previously suffered from major depression.

She said she hadn’t called sooner because she was doing all right and had lots of family support (always therapeutic, friends, be there if you can for others). Now she wanted to touch base because she was feeling very sad. She was still able to work and take care of the little things in life like shopping, hygiene, the things that slide when folks are really depressed.

We talked about a half hour, neither of us wanting to take away the umbrella before it stopped raining. Thank you Baruch Levine, wherever you are, for that metaphor about defenses. The metaphor means that unless a person can handle feeling bad, therapists shouldn’t MAKE them feel bad by deliberately drawing out things that make them sad. The umbrella is a defense. (Make a note, budding therapy docs, please.)

Rather than wrap up the visit prematurely I asked, innocently (not so innocently), “And what about Christmas?”

The floodgates let loose, but I knew she had a decent dam (her umbrella is pretty good, in other words, so I could risk asking the question), not that many tears, just a few, because she has a good dam. We looked at one another with understanding.
“I haven’t put up the tree,” she said. “It’s a lot of work, you
know. It’s emotional and it’s physical and I only have my one daughter at
home with me to help.”

Uh, huh, I concurred.

“But he would have wanted one. He loved Xmas trees.”

Uh, huh.

Pregnant pause. I’m waiting. I know she has to do this. She has to put up the tree. She looks at me, guilty. Then, with determination:

“So I’m going to do it. I’m going to get it up. I’ll have some of my nephews help me.”
She brightened.

That’s what you do, friends. That’s exactly what you do to remember someone. You do things they would have wanted you to do, or you talk about things they would have talked about. Or you talk in the language that they used (which is why if there is any yiddish still spoken these days, the language still exists).

The job this time of year is to make a memory a living memory.

That’s what you do. Way to go "Elizabeth". Get up the tree.

Links to previous holiday posts:

Holiday Post #1: About feeling bad about the SPENDING it takes to spread holiday cheer.

Holiday Post #2 A first narrative on remembering.

Copyright 2006, TherapyDoc

Thursday, December 07, 2006

Being assertive: The postman and Direct Communication

When we last heard about Mr. Smith (not his real name) it was because I didn't get my mail one year, several years ago, for an entire week. I posted about that because when I was on vacation I had miraculous service in downtown Los Angeles and the comparison spoke to me.

The L.A. postal service mailed a paper to Milwaukee, Wisconsin SAME DAY, without any special postage or services or anything. And the lady was very nice.

When Mr. Smith went on vacation about five years ago, the Chicago post office (or perhaps Mr. Smith) forgot to arrange for a replacement to deliver the mail in my building.
So I told the story.

Readers gave me the feedback that I was not assertive enough, that I should have raised the roof at the local office at the very least, at most gone Downtown to see whomever it was who supervised union stewards. That was the other variable. Mr. Smith was a union steward. Union stewards are untouchable on the local level.

As unwilling as I was to file a formal complaint for fear of NEVER seeing my mail (or other repercussions) my neighborhood branch did get the message and installed a scanner in our building. Smith had to "clock-in" around noon.

An officious US postal service person stopped in and queried me, too. Did you complain about the time of your mail delivery?

Heck no, I said.

I could have, of course, because it came between 5 and 7 p.m. or not at all. Most of us were either gone by the time it got here.

I was afraid if they knew it was me that I'd NEVER see my mail again.

Knowing when to fold 'em is in the TherapyDoc world view, ala' the Kenny Rogers song about poker, I think it's The Gambler. You have to know when to hold 'em, know when to fold 'em, know when the counting's good, know when to run).

So although I encourage assertiveness aggressively on this blog, I'll never tell you to be assertive with someone who appears to be ready to beat the living daylights out of you. A postal carrier probably wouldn’t do that though, right?

On the other hand the expression, going postal, has real meaning to those of us who recall the true story about a mail carrier’s psychotic rage and violent episode several years ago.

There IS a Jewish adage, by the way, not to speak to a person when he is angry. Although this may not yet be empirically validated anywhere in the anger management literature (help me here, psychology students, I don’t have time right now, it makes sense on many levels, especially that of self-preservation.)

So Smith got back to work after vacation and we had the following conversation. See, I WAS trying to be assertive at the first level of intervention, DIRECT COMMUNICATION.

Direct communication is speaking directly with the person with whom you have an issue. Angry at your boss? Talk to him, don't come home and yell at your wife (partner) and kids or slam the door.

Me: Hey, Mr. Smith, how ya' doing? Beautiful day.

Mr. Smith: Sure is, Doc.

Me: Nice day to be delivering mail.

Mr. Smith: Uh, huh. (not looking up, sorting mail, putting envelopes into boxes).

Me: You can just hand me my mail. You don't have to put it in the box. I always like to see it as soon as it gets here, like to see what's in there.

Mr. Smith silently passes me an envelope, never looks up.

Me: I don't get any junk mail, it seems. Only bills or money.

Mr. Smith: (not a word).

Me: So a lot of times you must come in the evening, huh? Cuz I don't see you during the day.

I can see whoever walks into the building from my chair while I'm with patients. My chair faces the mail boxes that are set up perpendicular to the huge glass picture windows framing the door. I get a great view of the park across the street, too.

Mr. Smith: Uh, huh.

Me: So you come in after 6:30 sometimes, right? I know because I'm here that late quite often.

Mr. Smith: You're the last stop on my route.

Me: My, you work late.

Mr. Smith: (nothing).

Me: Most business people could use their mail earlier in the day. Is it possible to change our time?

Mr. Smith: No.

Me: You're sure.

Mr. Smith: That's the way it's set up.

Me: Of course. Well what about Saturdays? Why is it I don't seem to get any mail on Saturdays?

Mr. Smith: Sometimes this building is locked. I can't deliver the mail if the building is locked.

Me: Funny, I know there are therapists working here in the morning, at least until one. You must come a little late.

Mr. Smith: (nothing).

Me: Well, it's been great seeing you. Have a wonderful Xmas Mr. Smith.

Mr. Smith: You, too.

So nothing changed immediately. I certainly wasn’t going to complain. Instead of being assertive I had my third party payers (insurance companies) mail my payments to my other office. That worked quite nicely, except in those cases where the clerical people working in those companies just couldn’t pull it off.

But we think that because there are new tenants in the building who got together and complained that

I now get the mail between 3 and 4:30!

Using an entire system is an intervention that I always recommend. An assertive GROUP of people is much more powerful than as assertive individual. I hadn’t arranged this intervention because I was so busy catching up on my mail. And who can organize any kind of formal complaint during the holiday season? It's just not right.

But somehow it seems to have happened, four years later. I knew you'd be happy to hear about it.

Thanks Mr. Smith, if you're out there. You know it was never anything personal. I understand that the wheels of change, like the wheels of justice, work slowly.

Copyright 2006, TherapyDoc

Wednesday, December 06, 2006

The Dinner and Domestic Violence

It’s not like me to go to many charitable functions, although I know I should. Working into the evening has always been my excuse for avoiding formal dinners, and sending money to worthwhile organizations is what it’s all about anyway.

But tonight one of my colleagues, Hadassah Goodman, LCSW, was honored at a dinner for her work with SHALVA, a Chicago based Jewish agency that services victims of domestic violence. So I grabbed my friend Chani and went downtown to hear a few speeches and have a bite to eat.

The keynote speaker told over a captivating, moving story of how she suffered her entire childhood witnessing her mother beaten and abused at the hands of her father. It’s a story that social workers know by heart. Only a few details, like was she the driver or the passenger when thrown from the speeding car, change.

It is never any easy to hear this stuff, no matter how many times. And knowing that the victim is still screaming inside, still a victim of unresolved secondary trauma for having watched (if not received) the torture of a loved one, makes it worse.

Social service organizations like SHALVA help women get out of abusive relationships. These organizations deserve all the financial support we can give them.

Interestingly, the table favors at this dinner were greeting cards packaged in cellophane. The hot-pink label on the package in not so fine print was psycho-educational. I don’t think that SHALVA will mind my sharing. The blurbs underscore the importance of our taking childhood bullying seriously.

1. Children who display bullying behaviors are more likely to become perpetrators of violence (specifically domestic violence), child abuse, sexual assault and hate crimes as adults. (Brentro and Long)

2. It is estimated that 160,000 children miss school every day due to fear of intimidation and/or verbal/physical attacks by other children. (National Educational Association).

3. Bullying is so widespread and so common that the “rite of passage” myth has blinded us to its extensive harm and is seen as a minor issue on the horizon of adult crises.” (Suellen Fried and Paul Fried, Bullies and Victims, M. Evans and Co, 1996.)

4. It does not matter if it is mild, moderate, or severe: bullying is not normal. It is antisocial and needs to be addressed as such. (Barbara Coloroso)

According to this, a child who watches one parent bullying another is more likely to become a bully, too, ultimately perpetrating a cycle of violence in marriage.

SO. If women don't get out of those relationships then their kids might grow up believing that the normal thing to do is beat or be beaten. I've always found it incredulous, but people often do believe that what they experienced in their family is the norm. There is also a phenomenon called identifying with the aggressor that I wrote about in my post on humiliation, a very worthwhile read, by the way.

But this might be a good time for readers who haven’t been to the archives to read the story that I wrote for a young patient who had been verbally bullied throughout most of his elementary and high school years by his peers. It’s a hopeful story in a way.

The Kid with the Funny Laugh demonstrates how you can work with your children if they are being subjected to peer taunting and rejection. You can help your child take back his or her self-esteem and command respect within an abusive peer milieu.

It’s not easy to take on one bully, let alone an entire culture, but one bully can have so much influence that he/she has the power to ferment an entire culture of mean kids.

It’s not easy to confront group-think but it is within the realm of possibility, and probably easier than playing doormat. Accepting the role of victim tends to beg more violence from borderlines. Most people don't accept the role of victim consciously, but do just the same.

Passivity almost always underlies depression.

Once again, I make the humble suggestion, there’s no better time to work at changing a system, than now. Here's the link to the story about The Kid with the Funny Laugh.

Copyright 2006, TherapyDoc

Monday, December 04, 2006


Towards the end of the summer everyone cleared out. All of my adult children and their little ones had added to their frequent flyer miles.

F.D. and I were settling into ourselves, very much enjoying the quiet late summer nights. We envisioned the little ones tucked into their own beds in the west, had a certain satisfied feel that the time we had together was quality time.

The two of us returned home together one night to find that our spider had made a new start. The rain and wind in Chicago had been challenging and had previously knocked out this guy's iterations of three-foot webs on our front porch several times. We hadn't seen Spider in awhile and thought that certainly he had scouted better digs.

Those of you with spiders understand. We let it go.

And there he was! The epitome of If At First You Don't Succeed, Try, Try, Again.

Click on this link for the video. Wait just a few seconds for the audio.

In case you're wondering, No, I won't quit my day job.

Saturday, December 02, 2006

Denial and the Predator

I was so upset about this I almost wasn’t going to tell you about it. Embarrassed and upset.

Sometimes when you get something new, you neglect the old, or maybe you just don’t give it it’s due, the respect that it deserves.

If you look carefully in the photos in a previous post, Fish, Stress, Pets and Shoes, you’ll see that there is another fish in the tank with Velvet. In that post I went on and on about the loss of Velvet, a probably fine fish in his day.

But if you look at the center photo and you’ll find the grouper, a guy I never named. We just call him The Grouper. He's never had much attention from people because he's extremely shy and hides behind rocks or in a conche.

The fact that The Grouper was a little less good looking than Velvet shouldn’t have had anything to do with him not getting attention. He’s a fine looking fish in his own right, with amazing eyes that move sideways and wind around like a disk. His markings are extraordinary, if not colorful,(see photo below) and we have an excellent relationship.

I guess because I feed him, I'm as close to Mom as it gets. When I wear my polka dot shirt he goes absolutely nuts. He’s a spotted grouper, a predator fish.

When I bought this guy the man at the store warned me, As long as you only buy fish that are his size or larger, he should do well with any other fish you throw in that tank.

It’s a 30 gallon tank. Lots of room. That’s why I didn’t hesitate to buy Velvet, a bigger, if not very healthy, friend for him to pal around with, play cards, whatever it is they do.

And as you know, Velvet passed on to that big aquarium in the sky. I told myself to stay away from fish stores for awhile since this was locking up endorphins, losing fish.

Dovid and Chammie, my son and d-i-l, came to visit for Thanksgiving. Dovid and I went out to buy some shoes the Friday after. Chammie had better things to do with her time, brainy things. You gotta' respect that.

Dovid is a true aquarist and when I’m with him we always stop in to look at fish if there’s a pet store nearby. Well, there’s a Petco a stone’s throw from the DSW in Skokie.

A maroon clown caught my eye and he was only fifteen bucks. In my head I was measuring him, putting him up against the grouper, and in my head he matched. In reality he did not. It is this skewed lens we're talking about in this post.

Sure, I bought him. I sort of forgot that little piece of advice,

As long as you only buy fish that are his size or larger, he should do well with any other fish you throw in that tank.

It was early in the day, so I dropped Dovid off and plunked the maroon Nemo into the tank. The grouper emerged, looking bigger than Nemo but not angry. He gently tapped Nemo out of the way. Nemo hid behind a rock. The grouper retreated to his shell. I ran downstairs to shlep up a new tank just in case they really didn’t get along, prepared to flip Nemo into a safer home.

It took me about 10 minutes to get the 5 gallon salt water hospital tank ready. A record, honestly, although I hadn’t tested the water yet. I checked to see how the guys were doing. The maroon clown was literally in the jaws of the grouper.

Stinking predator!

S. came home and noticed that I had set up the other tank, but we were ships passing in the day, hustling around trying to get Friday night dinner ready. He didn’t say anything about the little tank, usually considered the hospital tank, a place to quaranteen a sick fish.

The kids came over for dinner, and Dovid apparently showed Chammie what was going on in the big tank. The clown wasn't that small, obviously. Four hours in The Grouper's tonsils, and still he struggled to swallow or would that be chew a large fin sticking out of teh side of his mouth. I have never seen teeth on this fish, but he has an enormous mouth.

Cham was majorly grossed out. I was upstairs getting dressed.

Dovid said to his father, “So, you lost a fish?”

S., assuming that Dovid was referring to Velvet, said, “Oh yeah, old news. Mom’s over it, I think.”

Dovid didn’t tell him.

I came downstairs and Chammie paid condolences right away. “WOW, MOM, THIS IS REALLY HORRIBLE.

S. seemed confused, so we explained the whole thing.

He said to me, “Didn’t you read my comment on your blog?” He was referring to the one on Thanksgiving and loss, the loss of Velvet, who passed away I'm pretty sure of natural causes. I spoke of his loved ones perhaps missing him.

In fact I had read that comment. He had written: . . .fish, as far as I know, don't have any "loved ones” -- except the ones they love to eat.

Thanks for that.

I had been warned, after all.

So embarrassing.

So why, if I’m so embarrassed and upset (and I’m still upset a week later) am I sharing this with you?

Sometimes people ask me to define denial. Denial, my friends, is not wanting to look at reality, Being in denial is ignoring the negative consequences of what you do.

Denial is considered the most immature of all of our defenses. LITTLE KIDS are great at denial. It is their primary defense.

I do NOT need a new diaper (funny smell)

I did NOT take a cookie. (crumbs are on the mouth)

I did NOT wake up my baby brother (baby’s screaming).

That fish is NOT too small for the tank. The Grouper eats so well, he doesn't need to do that, eat a fish just a little smaller than himself

All I can say in my defence is, I’ll work on it.

Here's our not so little predator. I have to tell you. He's looking pretty guilty at feeding time. No joke. He acts like he's not hungry, then, as soon as I leave the room? Food disappears miraculously. All gone.

Copyright 2006, TherapyDoc

What's Going to Be with Our Kids?