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Monday, June 11, 2007

Staying Connected

I'm not going to get too wordy here because it's Monday and the implications are scary, so much to do. But the lesson here is worth a quick post.

The "he" in the story could be a female or a Martian, there are no true identifying features in this post.

Several years ago I had a professional acquaintance who called to give me a head's up that she had referred her father to me for therapy. Her father's sister committed suicide and she worried her father was at risk.

He called that day, and I couldn't get him in immediately, told him it would have to wait a couple of weeks (!). Could he wait? Sure. I've waited this long.

He presented with two Axis I disorders, severe anxiety and dysthymia (ever-present depression, the low-grade fever thing). You would think the two can't co-exist, but they can. You're never depressed ALL of the time. You're never anxious ALL of the time.

His sister had just committed suicide. I should have done that a long time ago, he whispered

Would you want this case?

Past retirement age, our guy still worked, very responsibly, even though each day he felt inadequate.

He had been in and out of therapy for over thirty years.

His crippling anxiety, which surely did come from severe childhood emotional abuse, made parenting (and partnering) very difficult. His wife left him while the children were small (she took them with her), and he never had any meaningful contact with the kids after that, even though they begged him to talk to them, to be a part of their lives. He just didn't have the social skill to listen or to talk. There were four children. Four children, no contact. It really does happen.

Never had anyone discussed repairing his cut-offs with his children. The therapies, according to him, all addressed his relationships with his parents, his marriage, and his childhood problems, his lack of sexual/relationship attachment.

See, it's not that difficult, this case. There is a universal need to be loved by one's parents, and a universal need to be loved by one's children, and that can be repressed, of course. But it's there. And it has to be addressed if meaning in life is at all important.

Tiny steps, of course, he had to make the first moves, the calls, the visits, the toys for the grandchildren, the birthday cards and gifts. He didn't have to really talk very much at all to anyone in this therapy, but he eventually did, all on his own. It's a behavioral family therapy. Say hi, visit, go to the grandkid's baseball games. Quick guerrilla visits. Hi, Bye.

Put yourself on the map. You don't need to be a star.

No idea what those other therapies were about. Don't care. He did so well.

It's just an example, right? Anyone could see the need for that kind of intervention.

Was he still at risk? I thought so. You know how it is when people feel a little better. They have the strength to hurt themselves, whereas they hadn't before. But the thought of hurting the little ones like that, the grandkids, served as a deterrent. He said as much. And I lay on guilt big-time when it's deserved.

But I kept an eye on him over the years.

What's lovely is that I never even had to bring any of his children into my office to do that family therapy. The family system was in the room, everyone was in his head.

That's how you need to think.

Copyright 2007, therapydoc

10 comments:

Curiosity.Killer said...

This is seriously too complex for my brain to digest. So is his problems all in his head? Did he really been abused? I'm so confused.

Jay said...

>>The family system was in the room, everyone was in his head<<

This makes so much sense I may needlepoint it on a pillow. I'm a primary care doc, not a therapist, and not even a family doc, so I have no "official" training in family systems, but it's so clear to me that when I talk with one patient I am seeing a piece of the family, and when I intervene I am pulling on one thread of that tapestry.

I see a lot of women in my practice who are expressing the symptoms of the family stress and it's always a challenge to manage - I want to respect and relieve her suffering when I can, but I don't want to necessarily support the idea that she's the one with the problem. It's helpful to keep in mind that I can be treating the whole family even if she's the only one in the room with me.

therapydoc said...

Thankds Jay,

and CK?

I'll write more, flesh this out for you later, but can't do it right now.

No, the problem isn't exactly in his head, but his thoughts did drive his anxiety, his depression, his behavior, etc., and that paralyzed him.

So in a sense, much of all of our "stuff" IS in our heads. And those people, wow, they never leave.

Anonymous said...

Thirty years of therapy until he found a therapy doc who could help him??? OUCH! The system really is broken!!!

He is lucky to have found you and gotten the help he needed before it was too late.

therapydoc said...

Thanks Anon, but I honestly don't write this stuff to show off. It's the approach I'm trying to show off, and if it sounds like I'm dissing other kinds of therapies, specifically individual therapies that don't push correcting family relationships when it's very clear there should be a correction, well, that's not the intention, exactly, but yes, perhaps it is.

So Sioux Me said...

Curiosity Killer,

I totally get what Therapydoc is onto. I wrote an article about The Voice In My Head http://traceesioux.blogspot.com/2007/03/voice-in-my-head_22.html at So Sioux Me that this totally reminds me of.

The woman I hear in my head is my mother, but it's who she was when I was a kid. And that's the woman I have to make peace with in order for me to get over MY issues. But, that voice in my head isn't my mother's whole identity or self. The woman she is now is different than the one that exists in my head, because all of my interpretations are attached to it.

Making peace with the woman who raised me doesn't have all the much to do with my relationship with her in the current situtation. And the peace can't really be made between she and I it can only be made within ME. Cause that's where the woman she WAS still lives.

It's complicated unless you get it and I think I get it.

Tracee

So Sioux Me said...

therapydoc,

Tracee Sioux at So Sioux Me has tagged you for a meme, its a blogger game to make you share 7 interesting thing about yourself and then tag seven other bloggers. The rules and my 7 things are here: http://traceesioux.blogspot.com/

Tracee

therapydoc said...

So Sioux, We're newly acquainted, so you can't possibly know this, but I'm already VERY challenged, giving as much away about me as I do on this blog in the name of providing readers a more exciting learning environment.

I save myself thinking that as much as readers read into me? There's so little they know about me, really. This totally works for me.

Anyway, I'm not very interesting.

daedalus2u said...

Curiosity, All mental health issues are "in your head", in that there isn't any other place that they can be located.

Some things are habits that perhaps at one time were adaptive. For example, some of the symptoms of PTSD are "adaptive" (anxiety, not sleeping, hair trigger invoking of fight or flight, avoiding things, paranoia) if you happen to be living in a war-zone. If you are not living in a war-zone, then they are "problems" not features.

I was abused as a child, and am hypersensitive to people being abusive. When my children were of a certain age, I could tell from the next room when they started to escalate with each other even though I couldn't hear a word they were saying. I felt compelled to respond even though they were far from being abusive with each other.

therapydoc said...

And your kids, DAEDALUS2U, were better off for your intervention, I am sure. Sibling on sibling abuse is nasty stuff and it happens all the time because parents don't intervene, thinking, Oh, they need to learn how to handle this themselves.

NO! Kids need to know their parents will protect them and talk to them about safety and dignity and respecting others.

Thanks for a great comment.