Tuesday, February 27, 2007

The Doc Worries

Here's me on Sunday morning, slight daze, 6:05, padding into the kitchen in old powder-blue terrycloth bathrobe, red slippers, can't explain the color. It's hard to sleep on Saturday nights if you've rested all day Saturday.

F.D. has made the coffee and am grateful for that, could smell it on the way downstairs. He's checking weather on teev.

F.D. What's wrong? You look worried.

Me: No, not worried.

F.D. You look worried.

Me: Worried. As in worried I'll fall asleep on one of my patients since i'm scheduled way too heavy, unless i drink a lot of THIS, of course, which i worry it will somehow give me cancer or a UTI or who knows what, in any case could make sleep difficult tonight. (deep breath) Worried we'll get killed in a car accident on the ice on the way over to work and by the way, why will the black ice not melt? Worried i over-stepped when one of our friends asked me for advice and i stupidly gave it to her; am also worried that i'll give the kids this virus that's coming back when we go there on Purim and that everyone will be mad at me. I'm worried that you look nothing like that Rubin guy on American Idol and your costume won't work. Worried i'll never get to cleaning up my mother's kitchen before she gets home and she'll be upset that there's a speck of dirt on her floor and that i made a serious mess watering the plants, and then she'll clean the floor and complain about her neuropathy and it'll be my fault i never got Helen in there to clean or did it myself because, after all, Helen will break her stuff dusting, i'm worried Blue The Fish will die. More?

F.D. That's enough, what time do you want to leave?

So the question is, At what age does a girl just become her mother, a guy his father, giving into the natural human condition of obsessive worrying? Is there a study on this? Is this a natural condition?

I'll answer all of the above.

No idea.

But. There's worrying and there's worrying, and there's variability, meaning every kind of worrying in between. Let's relabel (a great family therapy intervention, fools NO ONE) and say:

Where there's worry, there's motivation.

Yes! That's what we'll say, because it's true. Worrying is a GOOD thing. Fear, for sure, probably keeps us alive altogether, that whole fight or flight thing. But that's not exactly worry, really. Fight or flight happens when a guy jumps out of an alley and sticks a gun in your back and you fight or take flight. That's instinct as it should be.

Which leads us to post-traumatic stress, way worse than mere worry, and neither are the same as the abandonment anxieties or those simple fears like the fear of exposure we've been talking, i.e.,

If I don't get out of here they'll notice that
I'm wearing winter white in the summer, or I haven't combed my hair. Or: Yikes, I have no socks on.

Fear of exposure IS worry, but it's not necessarily conscious, we're not always aware of it. Worry is conscious anxiety. Take the worry of checking, for example:

I'll bet I left the oven on and now I'm fifteen minutes from home and if I turn around I'll be late, crud! I'm going to burn down the whole house! Had better go home and check, even if I will lose my job for being late again. It's still worth it!

And then again, checking, although it's anticipatory anxiety, isn't only anticipatory anxiety, it's not going to let up once the real anxiety sets in. This can really mess you up.

So much to worry about.

But worry does motivate people to do good things, right, I mean, who would study for school if it weren't the worry for grades? We do so many things ONLY because we worry. I see this as a Global Worry Problem.

Perhaps to reduce Global Worry, we should have a National Worry Day. Everyone spends the WHOLE DAY worrying. We get it out of our system. Can you imagine the energy?
This makes sense, seriously.

I am taking suggestions but leaning towards Thursday, November, 29,2007, the first National Worry Day. It'll be after Thanksgiving and people are already a little more worried than usual, yet it's not too late in the week to ruin the weekend, being a Thursday, giving us Friday to recover from the stress of having to worry. I just don't know.

What do you say?

Yes, this is a paradox, having a day during which you HAVE to worry. You can't worry if you have to worry. No one can make you worry, even you. In therapy I have you do this even if it's NOT National Worry Day. Go ahead, just worry, it's okay.

And yet, we should do it, the National Worry Day holiday. I mean it. Blog/politic burst worry out of this world as we know it.

Of course there will be a carnival*. Who wants to host the carnival?

*A carnival is a special blog on which
the blog host links readers to other bloggers who have all tried, with no success whatsoever, to write about the same theme. Ours would be National Worry Day, of course.

Fine, fine. I can do it. But what if it doesn't turn out well, what then?

Copyright 2007, TherapyDoc

Wednesday, February 21, 2007

Intimacy and Fear of Exposure

This is not about that dream you have where you're naked and everyone else is dressed.

But you can read it anyway.

It didn't seem fair to have exposed you to my short list of the Intimacy Fears That Can Wreak Havok on Your Relationship and then not describe them more in detail.

Today's your lucky day.

Keep in mind that the psychological mumbo-babble today is very down on you blaming your family of origin (parents) for all that is wrong with your life. These days we are told that we're to own our emotions and our behavior, take responsibility.

And yet. . .

Parents do have us in their care for a major chunk of our lives. The things they do and say have tremendous power. I'm not saying that they don't have their own reasons and traumas and right to be the way they are.

I'm just saying they affect us when we're kids. It's inevitable. We're little. They're big.

Let's take a look at the fear of exposure, one of the psychological fears that make emotional intimacy difficult in relationships.

Fear of exposure and fear of rejection work together to muzzle perfectly talkative people when they should be talking about themselves. They're self-muzzled because they're thinking, If people only knew the real me, they’d for sure not want to be my (pick one) friend, lover, employer, etc. So this fear of exposure, people knowing who we really are, naturally leads to the fear of rejection, those same people leaving us in the dust.

Abandonment fears rule, capture our psyche, paralyze our ability to act naturally in social situations. They're almost always underlying anxiety disorders, especially panic disorder.

But let's stick to the fear of exposure. Those of us who have this fear might talk eloquently about other things, work, school, politics, religion, but not about our own weaknesses or faults. We don’t expose ourselves and we surely don’t over-expose ourselves.

We never tell what we might think is TOO much, even if we do tell a little bit of the good stuff.

Funny, in the days before digital photography we worried about exposing the negative of the photograph to light. There was a danger that light would blanch out the picture, ruin it altogether. Overexposed, the details of the photo were gone, the pic was whited out, we had to throw it away. That's how people think. If they're over- exposed they'll be thrown away.

But we’re in a digital age, which only means that with a click we can discard a pic. Considering that so many of our relationships these days can be on-line, "virtual" relationships, perhaps the metaphor still works.

Fear of exposure, like every other psychological concept is multi-variate, meaning there is no one reason that people have it. Therapists, however, usually jump to thinking about shame.

For example, people are ashamed of things that they did in their past so they'll hide them. An alcoholic in recovery will remember having missed appointments, embarrassing the family, making a general fool of him or herself while under the influence and may not want the world to know what life was like before sobriety.

But a thief will fear exposure to avoid the consequences of his actions, prison, hardship, fines, etc., none of which have anything to do with feeling shame.

We’ll look at shame. It’s more interesting to me than sociopathy.

Take the case of an A.C.O.A., an Adult Child of an Alcoholic. We'll talk for a moment about people who are A.C.O.A. s, who grew up in homes where one or both parents drank too much. These parents were supposed to be engaged in the job of parenting, but they were drinking at the time or were drunk from having been drinking. It is hard to drink and parent at the same time. People do it, but not well. Not if they’re drinking alcoholically.

Social drinkers can do the same, neglect their children or embarrass them. They're fuzzier to source in therapy as a cause, a reason their children have intimacy fears.

As soon as a patient tells me that he or she is an A.C.O.A. (or has parents who just loved to party, social drinkers, mind you) my mind plays a game.

Have you ever seen computer animation that can zoom forward in time to make a person look older and also zoom backward to make that very same person look younger? I do this in my head, adding freckles, acne, braces and all. It’s not really that hard to see people as children if your brain has this function. If it doesn't, ask your patients for pictures of themselves as children. I do that as a matter of course which may be why I have that zoom lens thing pretty well down.

Depending upon how people in the family related to one another and the other details a patient tells me, I’ll visualize my patient in one of several different childhood videos.

Take Suzie. Suzie could just as easily be a Sam. In this scene Susie is about nine years old and comes home from school in a pretty good mood. She’s doing really well and she has an “A” on a paper she wants to show her mom.

Her mom, however, is passed out on the couch. This is something new. Susie has seen her mother asleep on the couch before, but usually later, after dinner. She's never depended upon her mother for help with her homework. Susie is scared and may even try to wake mom. But if she does, mom might get testy. This happens again and again, until Susie gets it that mom is quite drunk.

She figures it out that she can't bring friends home to this, can't risk waking up her mother, can't risk having to explain the sleep thing. Since alcohol dependency is a progressive disorder, her mom gets worse over time. She acts drunk when she is at social functions (if she makes it to them), slurring her words and saying things that are inappropriate, stumbling physically. Susie’s mom misses social cues, doesn’t know when the class trip is supposed to be, forgets names.

Susie is embarrassed about this. Even if her mother is a kind person and Susie loves and worries about her, having an alcoholic parent isn’t something she brags about to friends. Not usually. And underneath is this notion that her mother does love alcohol more than she loves her.

Mom would never admit to that, but her actions speak louder than words. She chooses (even though she’s powerless, by not getting help she chooses) drinking over parenting.

A kid who grows up like Susie may choose NOT to drink as a teenager or an adult, although some studies put her at an 80% risk of either becoming an alcoholic or marrying one. The Susie I’m talking about may end up marrying an alcoholic but is likely to fall in that 20% that neither becomes an alcoholic or marries one.

Our Susie will do everything in her power as a child and as an adult to project NORMAL to the rest of the world. She acts as if her family is NORMAL. Her grades, of course, were better than normal, they were fantastic. Her behavior was and is beyond reproach. Susie is perfect. She tries like crazy to be perfect. This woman is the nicest person in the world, the first to volunteer to help others, the hardest working person on the committee. The best employee.

When F.D. and I could afford employees I would beg him, “F.D., please. Find an A.C.O.A. I’ll make sure you don’t exploit her. You’ll never regret it. Find a woman who grew up with alcoholics who just wants to fit in and be normal.”

It’s true. An ACOA is likely to be the hardest working, most loyal human being in the world. She will do anything for a little praise and appreciation, a little love and respect. And you'll give it to her. She's fabulous.

Parents who are reading this might be thinking, How do I create a perfect child like that? You don’t have to be an alcoholic but it helps. Shaming your children will drive them to perfection. Or suicide. You pick. (I had to throw that in there somewhere.) Children in emotionally trying families can suffer a myriad of psychological "issues" beyond not communicating well in relationships.

But back to our girl, to Susie and others like her. The need to Fake Normal isn't just a risk for children who grow up in addicted families. Some people peddle really fast to excel so that no one will suspect other things about their families of origin. We might keep our families a secret if we want to hide: (a) alcoholic or drug addicted parents, (b) class distinctions and/or poverty, (c) serious mental illness in the family, (d) violence and rage, (e) sexual perversion, (f) physical illness.

I’m sure I forgot something.

This is not to say that every perfectionist comes from a family with big problems or that you have to suspect all of your perfect friends. But this self-protectiveness is a personality trait developed while very young and it's unconscious. The process of personality development is way below our conscious radar. We don’t set out to be perfectionists. We simply can’t afford not to be. It’s a matter of pride.

Is there anything wrong with this? What’s wrong with wanting things perfect?

If you’re a perfectionist because you’re naturally competitive and need admiration or simply enjoy doing things, well, perfectly, then perhaps there’s nothing wrong with this characteristic at all.

As long as your children don’t feel they’re inferior because they’re afraid they’ll never quite meet with your approval, will never reach your gold standard, or be as good as you are, you’re okay.

But if they do have this issue, or if your spouse has the same issue, then well, Yes, There’s Something Wrong With Your Being a Perfectionist.

The most interesting thing about all of this for family therapists is that perfectionists usually have no clue how painful it is to be them. They don’t see how having to struggle so hard to be perfect absolutely messes with their relationships and dilutes their intimacy.

We family/relationship therapists are nuts about emotional intimacy. It's one of those feel-good things.

Here’s how a fear of exposure worked to mess up Susie, in case you haven't got it by now.

Susie was always on guard to make sure that no one judged her based upon her alcoholic family. All her life she worked against mortification, embarrassment, and shame. She didn't just lose that defense, that need to hide things about herself just because she found herself (by the grace of Someone) in a safe relationship. She’s hardwired to outwardly show perfection.

It is likely, by the way, that she will not find herself in a safe relationship since she's not looking for real intimacy. She doesn't get real intimacy, emotional sharing.

But she's a really attractive person, you know, a high achiever and nice as can be, so it's very possible that she'll also find a really nice person, commit, get married, and think that she can pull it off. And she might, too. Not all marriages have to be emotionally intimate.

All a person has to do to be in a relationship is not drink, right?

But he says to her, "A penny for your thoughts," and there's nothing to say. She's totally out of touch with any negative emotions or thoughts. She's always defending and she does a great job at this. He doesn't really know her. She doesn't really know her.

Then at some point she crashes and needs therapy. She'll call it a “nervous breakdown” a “crash” a “burn out” that she can’t afford, she'll tell me. She has no time to be so emotionally exhausted. She won't be telling me about her self-doubts, her fears of abandonment, rejection. Not initially. She might get there, but it'll take awhile.

That kind of sharing only happens when she's totally depressed, brought down, usually from working too hard, it's true. It seems to me that if a person's been working triple time since the age of 12 for approval and love, that eventually there HAS to be a burn-out. Yet Susie won't take off work even though I'm begging her to do this, to take care of herself. Take the Family Leave, blank it. TAKE IT!

No. Then they'd know.
Indeed, Susie hasn't been able to tell me about her fears because they've been unconscious until now. She'll finally figure it out when she says,

No. No Family Leave. Then they'd know.

See, until that point, she's perhaps talked about her problems in her relationship, her unwillingness to ask her partner to meet her needs, her reluctance to tell her boss that she can't do EVERYTHING. She doesn't tell me or others the many salient, very important things about herself that function for self-preservation.

Until she gets sick, emotionally exhausted.

It's easy to talk to a therapist or even a friend about job stress and wanting to Just Quit. It's easy for a Susie to tell someone else that she's sick of doing everyone else’s work, and bored with her own. But our girl won’t complain, won’t draw negative attention to herself as a matter of course.

The shame thing runs so deep that even when it would feel great to drop the façade, it’s virtually impossible. Susie can’t look less than to others. She resists letting herself be seen as vulnerable, a wreck, alone.

She's a person who has never really depended upon anyone else but herself and her trust in others isn’t very high.

She trusts herself.

Such an insult to a significant other, to someone who adores you, cares about you, not to be let in on the secret of you.

So I’ll encourage Susie to be honest about her insecurities, to get in touch with that whole childhood issue, and sure, throw a little blame at the family of origin for neglecting her emotional needs. I'll push the Susies in therapy to be more real, to let down the mask.

At first they'll give me that deer in the headlight look like Are You Out of Your Mind?

But after awhile? It feels really, really good.

Like anyone would reject a person like her, seriously.

It's what those people who have real friends, really close relationships have got going, you know? They share about themselves.

I didn't say it's easy. But it can be done. Just a little oil, a little flexibility, a short stretch, slight risk, and bingo, there's the payback.

But a caveat, okay? This does NOT mean that you blab your life story to just any ol' e-date of any new friend. Intimacy is a slow, trust-validated process. Trust is the key word and you can't just TRUST anyone with your life, your secrets, your thoughts. People really can hurt you, they can use your words against you. They can tell the world. About you.

So take your time. Be discerning.

Just something to think about.

Copyright 2007, TherapyDoc

Monday, February 19, 2007


More on sandwiches.

Could have titled this Being a Baby Boomer, which means that I know where I was when I Wanna Hold Your Hand made the top ten. Think transistor radio at recess, blacktop.

But Baby Boomers are now the Sandwich Generation. Booming isn't exactly how you'd describe us. Squished, maybe. Or squashed.

The Sandwich Gen has divided loyalties. We're squeezed between (1) the needs of adult children and wanting to help them by spending time with our grandchildren, and (2) the needs of parents who may be aging gracefully, but by all accounts, like us, are aging nonetheless.

For some of us this situation feels truly hopeless. That's especially true during a "crisis." For example, my daughter lives on the West coast but I live in Chicago, not exactly next door.

So when I got a call telling me that by some miracle, she and her spouse were able to buy a house in L.A. and BOOM had even found one, this was exciting but weird since I couldn't hop on over to see it. We need not go into the details of the miracle, but perhaps both she and #1 working full time had something to do with it.

But moving is stressful, no matter how miraculous. Last I looked it rated # 8 on the Most Stressful Life Events list. My practice for sure validates this. I can look at a new patient sometimes and know that the good city is not being kind to transplants.

So of course when my kid called a week later to say,
I don't know HOW we're going to DO this. We have SO much stuff and I can't take off from work, I just GOT this job...
Well, you can imagine the guilt. Another mom would have hopped on the next plane. But I'm a professional and I can't always hop the next plane, and my kids know this and don't expect it. Most of the time professionals can't just hop on the next plane.

But we wish we could.

Then there's the SECOND SLICE OF BREAD, the fiercely independent more than admirable octogenarians. Both my parents and F.D.'s mother are beyond admirable. They're venerable, paragons of humans we all wish we'll be one day, working everything in their power to avoid dependency, even the need for an occasional software tweak.

Dad (86): I don't know what I did, but I can't find AOL.

Me: Lemme take a look. Hmm. Seems you uninstalled it.

Dad: Maybe. I might have. I was having trouble with something and I didn't want to bother anyone so I tried a few things.

Me: People make mistakes, anyone can do that, uninstall AOL. It's cool you're not afraid to try. This is no problem.

And of course it ISN'T. It's fun.
Then there's Mom.

Mom: I have a doctor's appointment and your father has a blood test and they're both at the same time, same hospital. It's okay, though, we'll take a cab.

Me: What time?

Mom: It's OKAY.


Mom: 9:00, Tuesday.

Me: Thanks for making it early. I'll pick you up at 8:30.

Mom: Well, I know you start work late in the morning. Can you make it 8:15? We don't want to be late. Oh, and we've got a ride home.

Of course.

Is this not enviable? Am I not lucky? If it seems I am publicly overly grateful (and I hope it does) it's because I am totally grateful and it is a Jewish thing to express gratitude.

Which brings me to the THIRD SLICE OF TOAST. Oh, you didn't know there would be a 3rd slice? I've always known.

Right now I'm in Israel, if only for a few more hours. A big tentacle of the family lives here. F.D.'s sister and brother-in-law who made the move, uprooted their young children many years ago. This is the ultimate move for a Jew, wandering back over to the Holy Land to settle forever.

Thus I have what are called k'rovim, literally, near ones, dear nieces, nephews, grandnephews, a grandniece, and of course, the wonderful parents/grandparents, all living very far away from the US of A. So the draw to see family in Israel is huge.

But here's the real truth about this draw, this 3rd slice that's pressing on the ol' jelly.

It's not just them. It's Israel, the people, the religiosity and the secularity (so Jewish), the land, the architecture, the ruins, the WALL, the ocean, the shells. Even the ocean is better (and you know I love Miami). The country gets way under your skin, the stones invade your identity. The plants take over if you've seen them often enough.

I wasn't going to even go, honest. I liked my denial. I was going to wait a little longer, even though it had been 3.5 years since I'd been there last, and that's a long time. The family, my s-i-l and various combinations of children, had visited Chicago more than twice since then.

But when squeeze came to shove I boarded an El Al plane last Monday night, alone.

F.D. had left an hour before me on British Air.

Why did we do it that way? Like I said, I wasn't going to go. When he made his plans, arranged his ticket, I said,
Honey. Go without me. It's too expensive, I have too much to do, it's Okay. You go. We'll save the money.
But it wasn't Okay. And one day in a fugue (ha! blame it on the fugue) I walked into that travel agent's office, the one who hadn't seen me in years and said,
Get me on a plane to Israel on February 12.
Funny how they can just DO that.

Flew El Al to hear the pilot speaking Hebrew and the flight crew with their heavily Hebrew accented English. I know these guys will get me there. They know the way.

And my fellow passengers were mostly Christians. It is a very common thing for Christians to arrange tours to Israel and this group from the South had a good deal of charm.

I could tell they weren't Jewish because no one pushed in line or complained about the wait at security. And they could tell that I was a yid by my looks I suppose or was it the confident way I did push through, until I realized that there was nowhere to go. It does get boring waiting.

Anyway, we all eventually settled into our seats on the plane and got pretty friendly. There was the obligatory video on a screen boasting Israel's scenery, birds, soldiers, hotels, Chassidim, wildlife, nightlife, shopping, artifacts and ruins, not necessarily in that order. A retired fellow in a golf shirt across the aisle asks me about the book I'm holding.

Retired fellow in golf shirt: Do you read that right to left or left to right?

Me: Oh, it's right to left. (I show him). See?

Retired fellow: Where you from little lady?

Me: Oh, I'm from Chicago.

Retired fellow: COLD! Ever been to IzRayEl before?

Me: Yes, many times.

Retired fellow: This is my first time. Where will you be? On vacation in Jerusalem?

Me: Oh, I don't take real vacations. I visit. Relatives.

Retired fellow: So this is a visit?

Me: Yes, this is a visit.

Retired fellow: Oh. But you're not from there, you're not from Israel?

Me: No.
But what I SHOULD have said, what was on the tip of my tongue, what I wanted to say was this:
The purpose of this trip? Same for me as for every Jew. It's why we go. It's why we should go more often.
I'm going home. That's why I'm going to Israel.
That's what I should have said. Talk about pressure. Even the stones can guilt a Jew.

Copyright 2007, TherapyDoc

Saturday, February 17, 2007

The company we keep

Sometimes I get lucky. I get tossed into good company!

There are all kinds of phrases that relate to the company we keep.

In fact, just the other day, no it wasn't just the other day, but a few weeks ago in my office, a dad totally chewed out his pot smoking, class-cutting, car stealing good-for-nothing teenage son. I, of course, totally disagreed with the good-for-nothing part. He's certainly going to turn around. He's in therapy!

Like all loyal fathers in denial, however, dad blamed the kid's friends. You want to know the measure of a man? he asked. Take a look at his friends. The nicknames of the friends said it all, but I'll spare you.

Anyway, before I left town last week two very interesting bloggers/writers asked me to share their company. Leah at Shebrew asked me a bunch of questions about 20-something relationships (I answered a couple of them, it was OVERWHELMING, LEAH!) and Elaine, the Division Street Princess, asked me to share a summer vacation story.

See, Elaine feels that thinking summer is somehow supposed to make you forget there's two feet of snow to shovel in the Chi-town. She has some of the nuance of hypnosis down, but honest, it wouldn't work for me if I were in the northeast or the central states.

The kid I mentioned? We're hoping he chooses better company, the plan so far. But surely there's much more to it than that. And honestly, even if their nicknames are a little weird, do you think it's so easy to drop your friends?

But take a look at Elaine and Leah's posts (they're highlighted above). Because, face it, if you're reading this, what else have you got to do? And like I said, they're good company. For sure.

Shebrew: http://www.shebrew.com/2007/02/mirror-mirror

Division Street Princess: http://thedivisionstreetprincess.blogspot.com

Saturday, February 10, 2007

Why Everyone Really Does Need Therapy

I'll qualify that. Why Everyone Really Does Need Therapy if they have any intention at all to be in a committed, long-term relationship.

Leah, over at Accidentally Jewish tapped me for an e-zine interview and I threw out a few couples/family therapy zingers, the short list below. I learned the short list at the Center for Family Studies/Family Institute of Chicago in 1981. The school is now in Evanston, IL under the auspices of Northwestern University.

If you really want to be a therapy doc, you should go there for awhile. Although the short list, condensed, is a la Bill Pinsoff (probably) the commentary below is mine.

Anyway, the 'zine is called SHEBREW and I'll let you know when it's on-line. In any case, it's not fair to you to hold back, I feel. So we'll take this slow, starting with the last question Leah asked me. She asked me a whole lot of questions but I only answered three, kind of like how I am with email and comments on a bad day.

But since question 3 triggered bad dreams for me on Friday night we'll start there. (We'll get to dreams, it was surely too much good food.)

3. What should people do to prepare themselves for relationships?

Somehow get to know yourself. Get therapy maybe, for sure do that if you can, even if you just focus on this one issue and this alone: Your intimacy fears.

Couples in trouble all have intimacy issues. We all do. We all have some kind of weirdness that makes communication (read closeness) harder than it should be.

My short list of reasons people fear intimacy includes fear of rejection/abandonment, fear of exposure, fear of suffocation, fear of merger (losing our sense of self, identity).

These fears are under our very own radar, unconscious. But they're not just issues for the books or "head cases." Everyone has them. Yet it's hard to talk about something you don't necessarily know you have.

So in my world, you get therapy, you know yourself, then and only then are you going to be ready to deal with your own intimacy issues and ultimately, those of your partner's

Oh, you want to know how intimacy issues can mess with your relationship? Those fears I mentioned interfere with our ability to talk, to express what we want and need, to say things with sensitivity, to think less about ourselves and more about our partners. They interfere with empathy, our willingness to focus on our partner, to get into his or her shoes.

So they’re huge, okay? You can't ignore them. They don't go away over night no matter what you do. They just make you cuter is all, and all the more interesting to get to know.

Copyright 2007, TherapyDoc

Thursday, February 08, 2007

Spanglish and Identity Formation

It's movie Friday and lucky for all of us, I could walk on the treadmill and watch Spanglish. The good part of doing this on DVD's is you can stretch out a movie that you like. That was the case for me with Spanglish.

It struck a chord because Tuesday was my youngest son's 18th birthday. And after watching this wonderful film I had to question whether or not his father and I had done enough to pass onto him our very strong cultural identity.

Don't get me wrong. The film speaks to different people in different ways. Not everyone is going to see this and think "Identity Formation." A teenager I know mainly saw that the suburban dad in the movie was falling in love with his Latin housekeeper. To me, that was a subtext, not even interesting, a more of the same kind of plot.

But back to me and my concern about my kid. Based on objective data, at this very moment birthday boy is studying in yeshiva in Israel, or drinking beer now that he's legal. (In that country kids can drink at 18). He's not drinking, I'm pretty sure. He's learning, so one might think: so far, so good.

For those of you who don’t know much about yeshivas, they’re like seminaries, schools of study and prayer that are relatively cut-off from secular culture. Birthday Boy told me yesterday that he is literally basking in sunshine when he’s not studying the holy books.

It is a tough life. I once visited this place he's "stuck" in. Basically? Nirvana.

Anyway, I birthed him, no let me correct that, Dr. Diamante delivered him from my abdomen while I slept peacefully under general anesthetic, long story, not necessary, eighteen years ago on this day.

F.D. and I named him a Hebrew name that he would hopefully grow into (means happy) and indeed, he has been a kick to our serotonin nearly every day of his life, a funny, lovely human being, he should only live and be well, as my grandmother who escaped pogroms used to say.

Oh, enough about him. Truth is I thought I could get out of buying him a new IPod by writing a nice post about him. But that ain't gonna' happen, so back to the movie. He’ll get his electronic something. Eventually.*

Spanglish drives home that just because a kid, like my kid, appears to be culturally in sync with his family, he can and may choose to become whoever he wants to be at any time in his life. He is his own man, or will be one day. She is her own woman, or will be one day.

Were I to talk the talk, the psychiatric rap of the day, well I’d say, “And that is how it should be.”

But oh, I don’t just talk the talk anymore without more than a little consideration, not on too many things, even though when I teach I'll surely present it to you as the textbooks do.

But every case is different. Every family is different. Generalities are well, so general.

The movie.

The beautiful Paz Vega plays Flor, a young single woman raising a sweet, lovely daughter alone. Flor immigrates to California, the Promised Land, and she touches our hearts. It is because she speaks no English for the first three quarters of the film that she has to communicate her confusion, her dislike, her surprise, her disdain, her dread, her disapproval, everything that is so real, all that we tend to have to express with expletives, she shows us by face alone.

And like Helen Mirren’s recent performance in The Queen, she's masterful and eminently watchable.

It's not only that she's so drop dead gorgeous. The film has to TELL us that over and over again. It's not a perfect film. I could have done without the selfish marital sex scene, too, which is emotionally painful to any sensitive human.

Flor exemplifies strength, values, courage, heart, and identity. She knows who she is and she's proud of it. She is the paradigm Latin woman who understands passion, love, and what it means to be a woman, parent, a mother and friend.

Employed as a house domestic by Deborah and John Clasky (Tea Leoni and Adam Sandler), as long as Flor is able to keep her home life and her work separate, she's okay. At some point, however, that has to change. Flor and her daughter Cristina must move into the Clasky home. Cristina will be influenced by her garish American role model co-parent, Deborah, as her mother, Flor, the Latin goddess, tiptoes around uncomfortably, powerless to compete against Deborah's glitz.

Flor’s quiet dignified manner shouts out silently against Deborah's shallow, empty, captured-on- the- fly ethics and whims. Deborah has the American dream and believes in it, the materialism, the emphasis upon physical strength, competition, sports, hedonism. She hasn’t a clue about giving, love, empathy or healthy relationships and is over-powering in her own home, confident that her way is the right way for everyone, her daughter, her husband, her son, her mother, even Cristina, Flor's child.

Flor watches as these American values creep into her daughter's soul like a hypnotic, changing Cristina from the sensitive Latin woman that she is supposed to be to a shallow culture-vapid American. Cristina has been seduced into attending the private school that Deb shamelessly presents to her as hers for the asking (with a prearranged scholarship). Poor Flor does a slow burn as she loses her daughter. Eventually she can no longer accept this. She has to leave this job.

The foils, John Clasky (Adam Sandler is absolutely charming) and his daughter Bernice (Sarah Steele, also a great teenage actress, I loved watching her every scene) are believable in their roles, but it is very hard to believe that a guy like John could have ever married Deb. But that's Hollywood. No explanations necessary.

John is sensitive and kind, whereas Deb is over-bearing and mean, never failing to hurt her daughter, overtly rejecting Bernie because of her weight. Flor would call Bernice womanly. Bernie, by the way, is the kind of overweight that this therapy doc would have suggested she not even worry about until her hormones begin to even out, perhaps seventeen even. (Go ahead, argue with me, I can take it.)

John notices that Cristina has the qualities his wife lacks. Hence the conflict and ultimate resolution. But Spanglish, in the end, presents a troubling lesson for therapy docs. It goes against the psychiatric grain. I, of course, loved it.

Psychiatry is VERY big on something we call differentiation and individuation.

This thread has been going for about thirty years, probably since Margaret Mahler presented the concept of symbiosis in the sixties, the idea that infants and mothers have a mutually needy relationship going. The baby needs mother's milk, and mother's breasts, engorged, need that baby to suck.

Infant symbiosis gradually morphs into differentiation, a child recognizes the difference between the two blobs of protoplasm, child versus mom, and child develops a sense of self, an "I."

As the "I" develops, so does one's sense of confidence and mastery over the world.

Before too long, the "I" is saying NO to parents and YES to peers and struggling with the many options for living that call out or sometimes whisper, Try me.

That, my friends, is child development and identity formation on one foot.

And we encourage this, we therapy docs do. We tell you, the talk, the party line to tell the kids is: Try on all those hats! Be a teenager who explores identity, who learns from all people, who has a world of choices and chooses wisely. Be the person you are inside.

Were I to walk that walk I would say to my dear son and really mean it, See the world, dear, experience what life has to offer, meet new people and choose for yourself who you want to be. Your identity is yours alone, not mine.

And I do. I've done that.

But Flor, who is smarter than most of us therapy docs, looks at her daughter's emerging identity and worries, just like many of the parents who come to see me worry about their children. Before Cristina takes the scholarship, a favor Deb so obviously wrangled out of the school to pay her back for all of her contributions, Flor complains to John. She is afraid.

Why is she afraid? She is afraid that Cristina will go in either one of two directions. She will be "odd" or she'll be "the same." And "odd" is surely better than "the same." But "the same" is a much more likely outcome, she feels, and she's upset.

Without giving away the ending (why not, you got everything else) Flor ultimately leaves her position in the Clasky house, taking her daughter back to the barrio. Cristina goes kicking and screaming, furious at her mother who ultimately asks her the question that has been nagging at her ever since she reluctantly exposed her daughter to the Clasky family:


We can take a lesson, honestly, from Spanglish. Is this what we want, to encourage our children, to become people so different from ourselves? How well individuated must one be, after all?

Happy Birthday, Sim. Be the best man you can be. And don't ever forget where you come from.

*He got a Zune, by the way.

Copyright 2007, TherapyDoc

P.S. There are wonderful performances in this film by both Victoria Luna and Shelbie Bruce, young women who play Cristina at 6 and 13. How Albert Brooks finds these kids, I don't know. And Tea Leoni's performance as Deborah Clasky is brilliant. I know this woman. She might seem like a comic book character to you, but I know her. I’ve treated her many times. She is the daughter of an alcoholic vainly searching for love and affirmation in all the wrong places, in all the wrong ways, competing, competing, competing, she doesn't know why. And because she has power to act (money) she makes mistake after mistake and doesn’t know it.

Wednesday, February 07, 2007

Gimme, gimme, gimme and Behavior Modification

You know I like Boston Legal. I just love to watch really, really insanely old people like William Shatner and James Spader aging gracefully (Candyce Bergin does not age) . We all have our ups and downs.

But to be honest, this season had been terrible until tonight. Yet I kept watching.

You know how it is when it seems a television season has really gone down the tubes and you're considering Just Not Watching That Show Anymore, but you do it anyway? It's like we're rats in a maze going for the cocaine.

You might do it too, keep turning on the same disappointingly bad show, hoping for a good one each time. And then, just when we can't hold out any longer for a good plot (or just plot), something to hold our interest they throw us a crumb, a really good show.

Fine. You don't do this? You're a better person. But for the rest of us drones,

You think the networks don't know this, that we'll watch anyway?

It is the essence of conditioning. Why should they have to put out a great show every week when they know we'll be back for more regardless?

What it should mean to young parents is that all you have to do is reward your kid on occasion for being good. If a kid can't predict when he'll get his candy, he'll keep at it (behaving) until he gets it.

Let's take the case of the grocery store.

Say you have an 18 month old. Start your kids really young, by the way, as soon as they're aware of the concept of GIMME. As in, gimme, gimme, gimme, buy me, buy me, buy me.

Surely you have heard that mantra.

You tell the kid:

When we go into Jewell (Albertson, Walmart, whatev) :

MAYBE if you're good, I'll buy you something.

MAYBE NOT. But you have to be good anyway. If you're bad FOR SURE you won't get anything. Not here, not now, not never.

If the kid is good this first time, he gets the toy. The next time you give the same rap. Emphasize the MAYBE part. Repeat it several times.

Probably the kid will be good. But DON'T reward every time. It's okay. Basic trust does not depend upon this.

Oh, sorry honey, I can't get you the toy this
time. Not enough money. But probably the next time, I will.

The next time comes around. The kid is good. You buy the toy.

Repeat again. And again. Until the kid is about 30. Don't buy just because he's good (like that's gonna' happen every time anyway). Buy to reinforce. Erratically. Shake it up, make it unpredictable.

Like the networks do.

Life isn't fair, okay? Best to learn young.

Copyright 2007, TherapyDoc

Saturday, February 03, 2007

Exercise Jones

People are pretty depressed lately. I know that the Bears are going to be in the SuperBowl tomorrow, and for many Chicagoans there is just that, nothing more. Chicago Bears fans, at least, are happy, and as we speak they're getting ready for SuperBowl parties.

I understand that chili is a very big thing for this, which makes sense.

So for those of you who are are high on football, this post may not apply.

But if you are seriously cold, very tired of an obvious LACK of greenery or any plant life outside,

If your house plants are dying because of the dryness of home heat,

If you keep asking whatever happened to Global Warming, anyway,

And you're waiting a VERY LONG time for your car to warm up, in fact you find you've reached your destination before the heat even kicks in,

then maybe this post will apply.

Maybe you'll be inspired. Someone inspired me.

Let me preface this by saying, I don't drive on Saturday. It's a religious thing, ala Joe Lieberman.

And you might have guessed by some of my earlier posts that I'm a regular shul-going Jew. (shul = synagogue)

I used to go all the time as a little kid, probably until I was 14, then skipped it altogether for a few years except for High Holidays. Got back into it again in young adulthood, but didn't make it regular habit until my 30's.

People go to the church and synagogue for different reasons, I know. My reason is a little psychotic, but maybe it's not all that different for all people who have a spirituality program running now and again in their heads.

I'm a regular shul go-er because once I learned that it is a nice thing for a Yid to re-accept the Torah every week during the formal reading on Shabbas.

We believe it was Moses who gave the original acceptance speech during that biblical episode of The Ten Commandments. Moses accepted the Torah for everyone else during that huge fire and lightning storm on the mountain. Some people believe that the Old Mighty picked up the mountain and held it over the heads of the Jewish people and said, You do want to accept this, right? Are we talking deal, or what? An offer we couldn't refuse.

We were ALL there tradition has it. You've seen the movie, the one with Charlton Heston. Every Jew was there.

Anyway, probably most people have less weird reasons to go to a house of worship and I can respect them. It's kind of amazed and annoyed me at the same time that my shul attendance is so compulsive. It's like there's a magnet, that's all I can say.

Observant Jews, the ones I admire, don't make anything big out of their spirituality or their synagogue attendance. To them it's about being a part of a community, following the letter and spirit of the law, the job that's been assigned. They understand that it is the good things they do in life that count.

Judaism is not a religion of meditators or kabbalists (mystics). Only certain stars think so.

But I can see a place for meditation and spirituality, anything that calms people down. And I don't tease anyone for being too absorbed relating to their Higher Power.

I'm very against teasing anyone unless I know that person will accept it good-naturedly.
Like my mother LOVES it when we tease her. "Are you making fun of me?" she'll ask, flashing this enormous smile that says, Please, please, just have a good time at my expense, I'm so good with it.

I feel this is the height of maturity in a personality.

Anyway, even though I compulsively go to shul to stand, inhale, and accept the Torah, if I'm sick and need to sleep I'll stay home.

And if it's really cold in Chicago and I'm just a little sick? I'll stay home with no guilt at all. Who needs the cold?

So last Friday night I said to F.D.,

"Honey. There is no way I'm going to shul tomorrow."

And he nodded, since we go to different services anyway, why should he care?

"'Course not. Too cold. Stay home."

I got up on Shabbas morning, threw a sweatshirt and robe over my flanell pajamas, mumbled a few things to the Old Mighty (Him, or do you prefer Her) and headed for the hot water, instant coffee, and the Wall Street Journal.

My mother-in-law had slept over. I've learned a million things from her over our many years together, and she knows me pretty well. We exchanged perfunctory greetings, how'd you sleeps, and retreated to our own thoughts. She hardly ever sleeps over but it seemed crazy for her to walk home in the cold the night before.

Minutes, hours passed. I dozed in and out, transcended the boundaries of early morning time. At some point I looked up and she was all dressed. She was going to the Sephardic synagogue (not ours) because they were going to have this fabulous Tu B'Shvat luncheon.

Tu B'Shvat is a day of celebrating the fruits on the trees in Israel. What it means in Chicago is that Jewish people buy out all the kosher dates, figs and nuts in the city. If you forget about the holiday until the day before, you'll probably have to settle for grapefruit.

I actually found some pretty lame dates at about 3:30 p.m. on Friday in one of the kosher stores. I've got a great recipe and will make this really nice bar someday before those dates are totally inedible.

So my m-i-l was dressed and bundled up and off to face the cold. As she opened the screen door she shouted, "OH! IT'S SO BLUSTERY!"

Well, uh, duh. I hadn't intended to leave the house anyway.

But I have to tell you. I've pretty much languished the past few weeks. You can't ride a bike in the throes of a Chicago winter, well, most don't. And my SDV (Some D-word Virus) zapped me from working out in the basement.

In my defense, I did try to use the treadmill once last week. But I ended up watching T.V. while standing still on the treadmill, leaning on the treadmill, stretching on the treadmill, everything but walking on the treadmill, eventually abandoning the treadmill, going upstairs to watch on our ancient family room set like normal couch potatoes do.

Watching my energetic octogenarian mother-in-law skip off to shul in the cold made me feel pretty wimpy. I got those funny feelings you get when you're going to seed. Your muscles feel slack, you have no pep, you stare into space a lot. At some point you know there's only yourself to blame.

Mine, as you know, is a sedentary, 5-6 day a week job. I have to MAKE myself exercise or it's not going to happen. Oh, you, too?

So I said to myself as m-i-l skipped off to the Sephardic shul, You boob. Get dressed.

But what to wear? It's not like anyone cares what you wear in my shul. Truthfully, you could wear purple and orange, fuchsia and green, all black, or all white. NO ONE CARES. We love this about one another.

So I put on a red thermal long-sleeved tee-shirt (purchased from Target for 4 bucks, still get complements like it's a Tommy Hilfiger) under a white crew-neck sweater. Threw on a warm skirt and boots.

Long coat, multiple scarves, multiple hats, ear muffs, mittens. Cough drops in my pocket.

I did it, left the house.

Wow was she right. It WAS blustery. A block into the walk, almost turned back. But instead did what I did as a kid--walked backwards to block the wind.

When that bone-chilling north wind finds a space you haven't covered, say between your sleeve and your glove, or your forehead, just above the eyes? It's like Voldemorte sucking the life-force out of Harry Potter.

But it was GREAT. Seriously. I survived and a few of my friends even showed up which is always remarkable, since they don't usually attend in good weather.

No, it didn't dent the need for a good work out. But as soon as I post this? I'm going to practice what I preach.

What's on on Saturday nights, anyway?

I seem to remember a song, a satirical spoof called Basketball Jones, jones meaning craving. Am I making this up? Does anyone else remember this song?

Copyright 2007, TherapyDoc

I wish you . . .

Just a wish for Super Bowl Sunday Bears fans who couldn't go to Miami.

Sung to I Wish You Love
English lyrics by Albert A. Beach
French lyrics and music by Charles L. Trenet
Best performed by Natalie Cole

Lyrics below by none of the above

No matter how this game turns out
Those in Miami, there's no doubt
Will bounce back soon, it's just like June
They've got an edge

But those of us who bundle up
To visit friends and have some 'sup
Will watch the game but first complain
That this is rough.

Our frozen hearts will all concur
That when it's cold we brrr and grrrr
But Bears show moxy, who cares if oxy
Is ten degrees?

I wish you shelter from the breeze
Some cheesey nachos
Lemon freeze
But most of all
If snowflakes fall,
I wish you gloves
No, I'm not in Florida gloating. What did you think?
And that's it. I'm finished complaining about the cold in this city, for awhile.

But I will take complaints if anyone wants to commiserate.
Baseball's right around the corner, right?

Copyright 2007, TherapyDoc

Friday, February 02, 2007

The Write the letter, Don't send it Post

You may have heard this TherapyDoc aphorism.

Write it. Don't send it.

See, we can be talking about something (you will, that is, while I nod) and at some point you'll say,

"Oh, man. I have to write the letter. I'll just write (that person) a letter and explain EXACTLY what I mean."

Which is my cue to say, Write it. Don't send it.

Or, Sure, sure write it, then let's take a look at it and maybe tweak it a little.

And we do.

We resist the temptation to immediately press "send" because you know that under the influence of emotion, empowered with a rise in seratonin, maybe the overall sense of well-being you get from working on things in therapy, that you're vulnerable to acting impulsively and screwing something up big time.

Empowerment is a dangerous thing. For example, did you know, there's a saying that when a suicidal person gets better, THAT'S when the danger of suicide is most likely. When a person feels better, the energy is available to accomplish the job.

Same with other impulsive, can't take 'em back behaviors, which is one of the reasons I thought long and hard before ever blogging.

But if all you ever get from this blog is the idea that you should watch out for your suicidal friends when they say they're feeling better, then it's been worth the trip.

It is true that when we feel those emotional surges, happy or sad, we're more likely to say or do something we'll regret in the morning. We regret sending the letter as soon as it's in the mailbox. We regret having pressed "send."

So slow it down when you feel good is all. Reread it. Letters can always get better.

Today was supposed to be Movie Friday but I looked back on the week and as usual I had seen No Movies. I considered maybe watching Return to Neverland, the Peter Pan movie which was on cable but didn't have the patience, and it had been an entertaining enough week what with the opera and all. AND on another night I ate out. Will the fun ever end.

As a last ditch media effort I squeezed in 30 minutes last night to watch The Office. This is a popular show as you probably know.

Even my favorite not-so-vanishing blogger Of Fish and Family, recently wrote about meeting Steve Carell, the star. Since I've already discussed one of Steve's movies, The Forty Year Old Virgin, imagine how all of that just came together tonight.

Happened to glance over at the muted teev and The Office was just on.

No, that's not how it went at all. Staring at the t.v. guide on the screen for who knows how long I finally settled on The Office.

I'd take a half hour and put up my feet.

After all, I'd been cooking at least 45 minutes and had a couple hours more to go, for sure, before clean-up time.

I watched the teaser (the first couple of minutes of a show before it breaks for commercials is called a teaser) and in the teaser the star of the show, Steve Carell, who plays Michael, did something that stopped me in my tracks.

What he did reminded me something I had done as a young mom.

Which is weird because the Michael character on the show has never been married or had any children. He's the office manager (I guess) and his life is pretty unexciting (I think).

Anyway, on the teaser Michael is in the process of making a video for the son he's never had because he's afraid that he'll die one day and he won't have had time to teach this son that he's never had many things. Things like

jumping a car to get it starte.

So it was cute. And it sent me into a bit of a reverie.

Here it is.

When I was a young therapy doc I had small children. They were babies, even, and for me, along with having babies and children came catastrophic fears. These are normal and pediatricians, or family practitioners like F.D. tell parents that it's normal to worry that anything and everything that might happen to their child, but that they shouldn't let themselves get overwhelmed by these fears since the odds of the realization of catastrophe are slim.

What the doc is NOT telling you is that he is worried about EVEN MORE terrible things that can happen to his kids and yours, too, because he knows about SO MANY MORE terrible illnesses and diseases than you do.

Now when I would think of a terrible thought about something unbelievably terrible, I'd tell F.D. about it and he would usually calm me down. His favorite thing was to say: Well, that's really unlikely. That won't happen. That makes no sense. You don't want to know about the stuff you really should be worried about. You're too anxious as it is.

And he wouldn't tell me any more.

That sure calmed me down.

Anyway, I remember, among other things, thinking this very normal parental thought:

-- If I die these kids are toast. They're finished. How will they make it without me? They LOVE me. They love me like CRAZY. I'm their MOM. Who will look at them like I do? Who will listen to them like I do? No one can love them like I do. But it's so possible. It CAN happen. It'll ruin them. But anything can happen. It can happen.

I can get into a car wreck.
A dissatisfied patient can come in with a gun and shoot me. Dead. Or stab me with a knife.
I could get cancer. I could HAVE cancer.
The house could blow up. It's possible.
I could get an infection that goes to my heart or my brain or someplace no one can find it.

These things happen.

So I wrote the kids a letter and folded it up with our will. The children weren't even all born yet, one was a per sterpes, and the others were all under six. Yeah, four under six.

In it I remember being concerned primarily with what kind of people they'd be, how they would make decisions. I remember naming the people I trusted, the ones they should go to for advice. I told them to stick with religious studies, never to forget who they were, be kind to everyone, that kind of stuff.

But now, when I think back on it, I remember it was really a whole lot of gobbledy-gook, a meaningless stream of words that would have undoubtedly confused them at any age. I know. I found it a few years ago, read it and tossed it in the garbage, relieved that no one had ever read it.

Thinking as a therapist now, not as a mother, writing that letter and sticking it in with the will was for sure therapeutic. It made me feel that I had some control, as if there ever is something that one can do that can somehow take away the pain in such an event, G-d forbid, parent loss. Talk to Holocaust survivors.

There is no such intervention.

Sure, set up your wills, your trusts, talk to your kids and make sure they know what you believe in. Make sure they know the kind of stuff they come from.

But when I say write it don't send it? I say it because the letter I wrote sounded terribly maudlin and overly-emotional on the re-read. It didn't represent the person I was then or the person I am now. It was just an exercise in control. I'd have changed EVERYTHING about it if I were to write it again today.

Parenting, unfortunately, and you all know this, is not about what you say as much as it's about what you do.

Sure, you SHOULD write things down if it makes you feel better, and better yet, talk to people about the things that are important to you. Do have those talks with your kids, with your spouse, your parents, your sibs.

But you never get the last word in anyway, you know, not even with letters.

Copyright 2006, TherapyDoc