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Friday, March 30, 2007

That Carnival

The Carnival of Alcohol and Relationships really will be posted on Saturday, April 1, as promised (sort of) but it won't be until late Saturday evening.

We're still friends, right?

Sorry for the confusion. Then in May we'll do a Carnival of All Substances (great and small). Only posts that serve as deterrent to abuse and dependence, of course, would be appropriate. Anything that relates is fine, relationships, recovery, experiences.
I'll announce it soon as I get my act together.

Thanks to all,

Therapydoc

Awards

Accepting for TherapyDoc is her alter-ego. . .

There's this marvelous thing going on in the blogosphere, and it is flying in the face of the some of the terrible things happening (death threats to bloggers, oy vey, and boycotts of blogosphere, that sort of thing). But alternatively, other bloggers are reinforcing one another's work by bestowing pleasant awards.

Since so many people are anonymous, I wonder if Holly is actually several other people, too. She just gave me a Thinking Blogger award, my third actual award, which is truly touching, and flattering because although I think I think, I'm not really sure.

Just the other day I got the Blog of the Day award. It is exciting and titillating, especially since the last ribbon I've received was in 6th grade for the high jump.

So to truly accept this, I'd first like to thank my producers (mom, dad, take a bow), and my director (F.D., you rock), the cast (all of you nuts who comment, especially you, Holly), the set (could be better, have to get a better chair and occasionally take one of these cups back downstairs to the kitchen), the make-up crew (huh?), oh, heck, I could go on, and on, and on, and on. I mean, who is the best boy, anyway?

And as long as I'm accepting, I have to share that this is really my second Thinking Blogger Award! Karen gave it to me either last week or the week before. Must be going around. If I weren't such a lazy blogging bum I'd have passed the torch along to one or more of you deserving writers.

But it is what it is. Perhaps there's still time!

This means, regardless, that I will have to make room on the trophy shelf next to the many other trophies in the bathroom as did one of this year's 2-time Oscar winners (read it in InStyle Magazine, so it must be true).

Love this crowd, you're all out of your minds. Thanks a trillion to anyone who voted* for me.

uh, hugs

*nobody votes

All kidding aside, I'm really very flattered and think this is a wonderful tradition and will try to think up a new award while on vacation next week for Passover. Thanks to anyone who reads me (double entendre intended), and to those of you who take the trouble to make other people (like me) feel good, I'm forever grateful.

TherapyDoc

Wednesday, March 28, 2007

Work !

Let's get to something lighter.

One of these dreaded, but necessary decisions, going back to work, was a strategically planned option for me when my first progeny (twins) would hit the nine month mark. Fresh out of graduate school (MSW, don't know how anyone has a baby without one) knew enough to know that since the boys would have something called "object constancy" at 9 mos., that that was the magical age.

I could leave when the twins were 9 mos. old and they'd REMEMBER me. The babysitter wouldn't be a preferable surrogate. Maybe boring and unoriginal, but a source of real anxiety at the time.

But these days the 9 month theory is probably out of favor (I'd love some feedback, having been out of the psycho-dynamic loop now for many years). And there are so many parent magazines and so many women who have DONE IT and so many advice columns and now television shows and even MOMMY BLOGS, that I am sure the strategies and rationalizations are legend and the subject is beaten to fine baby powder.

Whaddaya need me for?

There are even DADDY BLOGS on how to do it.

Speaking of which, it always galled me that women had to have this angst but men were supposed to chirpily head off to work every day. Kiss the wife, pat the baby on the head and out you go. Chirpily anything, really. Chirp. Just chirp, guys.

In couple therapy it hurts me when I hear women complaining to men about not second shifting hard enough (change genders if you're gay where applicable). Both of you, don't you know, are supposed to get home from work, shoo out the baby sitter, and HIT THE FLOOR RUNNING. Get to work, d(expletive) it.

Six months ago, when Empath Daught went to work the boys were 4 and 2. It was hard leaving them, but she was pumped. And she was sick of free-lancing, having to beg people to pay her and having to redesign a perfectly wonderful web-sight because, it's great, but can't you just tweak this page right here, because I really, really think you've missed what I'm trying to do here.

She was valued by a high end store with high expectations and she fully intended to meet them and eventually make high end money.

She knew we were proud, but she called me and asked me honestly, How did I do it? How did I handle my separation anxiety? Wasn't it horrible handling their tears and their fears? Kids can make you feel so so guilty.

Flattered I was, Yoda said, that she asked.

And so happy, too. I don't like giving unsolicited advice to my kids or anyone else. Even when someone asks me straight out for advice I'll think about it and say to myself: this is an ego trap. beware. ego trap. do not step in. get more information. don't bite. trap.

That is, when I have my head on straight.

But I did have a system, and Empath Daught was interested. I'd stop the car in front of the house and brace myself for a second, hear the end of a song. Then gather my things, click that key in the door, hang up my coat, kick off the shoes and nylons (first thing), sit down on the floor with them, and play. Just play. For as long as I had until those guys tuckered out and went down for the night, I played. (I supposed there was some feeding and changing and bathing going on, too, but I can tell you for sure, there was no television.) And so many, many books. So many books.

The phone? Ignored it.

Tomorrow? Who cared.

The mess? Again. Gave it over to the sheer powerlessness of it all.

I remember this now because yesterday I heard that song on the radio by Kenny Loggins, the Christopher Robin song.

You'd be surprised
There's so much to be done
Count all the bees in the hive
Chase all the clouds from the sky
Back to the days of Christopher Robin and Pooh


It's an old song and I so love it. It got me back to thinking about those days. One of the things I remembered was that I needed to let go of the need to CLEAN. It wasn't that hard when I got into it, and of course, I was very into it, reconnecting with those kids. As I told my friend Mimi in an email the other day:

i liked it when the kids were little, giving into disorder and just watching them when i got home from work, sort of marveled. let the leggos take over.

best story

got burgled once. cop said, uh, lady, hate to ask, but was it this way before you left the house, or did the burglars do this to the bedroom?

uh, actually..


Giving into the disorder. I'd be terrified when people came over but didn't show it, or tried not to. Did say, if I recall, hold him while I clear away a place for you to sit down :)

So it's nice to know that Empath Daught is following in my footsteps. But I gotta' tell you. Somehow she gets those toys put away. I don't know how she does it.


Copyright 2007, Therapydoc

By Kenny Loggins (© 1969,1994 MCA Music Publishing, a division of MCA Inc.c 1969,1994)
Christopher Robin and I walked along
Under branches lit up by the moon
Posing our questions to Owl and Eeyore
As our days disappeared all too soon
But I've wandered much further today than I should
And I can't seem to find my way back to the Wood

So help me if you can
I've got to get back
To the House at Pooh Corner by one
You'd be surprised
There's so much to be done
Count all the bees in the hive
Chase all the clouds from the sky
Back to the days of Christopher Robin and Pooh

Winnie the Pooh doesn't know what to do
Got a honey jar stuck on his nose
He came to me asking for help and advice
And from here no one knows where he goes
So I sent him to ask of the Owl if he's there
How to loosen a jar from the nose of a bear

It's hard to explain how a few precious things
Seem to follow throughout all our lives
After all's said and done I was watching my son
Sleeping there with my bear by his side
So I tucked him in, I kissed him and as I was going
I swear that the old bear whispered
"Boy welcome home"

Believe me if you can
I've finally come back
To the House at Pooh Corner by one
What do you know
There's so much to be done
Count all the bees in the hive
Chase all the clouds from the sky
Back to the days of Christopher Robin
Back to the ways of Christopher Robin
Back to the days of Pooh


Alternate Version -- House at Pooh Corner- Christopher Robin and I walked along under branches lit up by the moon. Posing our questions to owl and eeyore as our days disappeared all too soon. But I've wandered much further today than I should and I can't seeem to find my way back to the wood. So, help me if you can I've got to get back to the house at Pooh corner by one. You;d be surprized there's so much to be done, count all the bees in the hive, chase all the clouds from the sky. Back to the days of Christopher Robin and Pooh. Winnie the Pooh doesn't know what to do, got a honey jar stuck on his nose. He came to me asking help and advice and from here no one knows where he goes. So I sent him to ask of te Owl if he's there, how to loosen a jar from the nose of a bear So, help me if you can I've got to get back to the house at Pooh corner by one You'd be surprized there's so much to be done, count all the bees in the hive, chase all the clouds from the sky . Back to the days of Christopher Robin and Pooh, back to the days of Christopher Robin, back to the ways of Pooh

Tuesday, March 27, 2007

Head spin

That story in WSJ on Chuck Mahoney did that, triggered me, maybe it triggered some of you, too. For me it was less the outrage about nobody saving Chuck's life than it was the sadness I felt for his parents and his brother. Elizabeth Bernstein wrote:
About once a week, the elder Mr. Mahoney opens the closet and buries his head in a sweatshirt that belonged to his son, trying to detect the fading scent.
I read the story on Saturday, looked up from my newspaper, stared through an open window to the backyard and tranced back over thirty years ago, saw myself putting on my brother's clothes, picking out a jacket (way too big for me), burying my head in it. My mother found me and I turned to her, This is mine, okay?

I almost started my post (3-24-07) on Chuck Mahoney like this: If you're easily triggered, meaning if you get depressed and stay depressed for a long time and can't bring yourself out of it, YOU MIGHT NOT WANT TO READ THIS.

So Elizabeth Bernstein's article made me. . . pause. For quite awhile. A good four hours, and my brother didn't kill himself. Journalists can do that to you. This blog is journalistic in that way too, sometimes. Maybe now.

Emotionally manipulative-- intentionally. I'll let you in on a little secret. You already know it, probably. Feeling badly for most of us, soaking up a little sadness, relating to the pain of others or even feeling our very own pain isn't so bad. In fact, it's a good stretch. Almost sublime. Expands our sensory perception of reality.

In my world view if a day goes by and I haven't squirted out at least one tear then I've been out of touch with reality, the suffering around me. It's around you, too, of course.

There are triggers and there are triggers, and there are the triggered and there are the triggered. My warning on that post would have been to those individuals who wouldn't bounce back within the hour or the day. The warning would have been for people who could really lose their cognitive functioning and maybe wouldn't be able to work for a couple of days after that. It can happen.

Being unable to function when depressed means there's no capacity to think. That's why making decisions is so hard. When a person can't "think straight" then there can be an added feeling of panic. That's why you'll sometimes describe to me waking up with a horrific fear, crippling fear mixed with tears and sadness, all interwoven at the same time, severe, severe panic and pain. And you haven't even started your day! You haven't brushed your teeth yet!

Not a nice disorder, depression.

So therapydocs tell people who suffer from it to avoid triggers. Although in some types of depression (probably the severe one I just described above) triggers may have nothing whatsoever to do with the onset, meaning an episode can seemingly come from out of the air.

Bi-polar disorder can be this way, although bi-polars can be triggered too. They will usually cycle, however, and there are seasons and months that are more likely to be more severe in one direction or another. They jump around on the continuum below in every which way with no say so in the matter. Usually it's physiology is all.Sometimes that depression on the left can hit like a ton of bricks with no warning.

For most other types of depression, however, like adjustment disorders, the onset is a little slower, and things do get gradually more and more gray and horrible.

We tell patients recovering from depressions of all kinds to avoid stimuli that they know will make them sad, the thoughts that will stick with them, affect their thinking, send them back down again.

Here's my short list of how to avoid triggers that can either cause an episode or make it difficult to recover:
don't read the newspaper
don't watch t.v. (unless you're sure it's comedy)
don't follow the war
don't go to funerals or wakes unless you KNOW you'll be okay
don't talk to people who upset you
that might mean, don't answer the phone or the doorbell
do protect yourself from stress of all kinds
do try to live in a bubble (although you can't, really, but try)
do make your own emotionally safe, restful environment (don't accept visitors, don't do extra community work to make people happy until you're really better)

that's basically what being in the hospital is like, you know, protective


And of course, my advice is based upon empirical data vis a vis the things that trigger psychotic reactions Let's segue there because it's so interesting.

The psychotic fear, depression and paranoia of schizophrenia and schizo-affective disorder can be triggered by something called expressed emotion.

Expressed emotion is really anger/criticism expressed at anyone at all by anyone within the family or on the job. Families who have a member who suffers from schizophrenia are taught to keep the anger and the criticism, ANY anger/criticism to anyone to a minimum.

Best to lose it entirely from the family's range of emotions.

That's the best thing you can do for a mentally ill person in your family. Be really gentle and nice all of the time. That will reduce your vulnerable family member's screaming anxiety and depressive outbursts.

Now. I think we could take a leap, here. Maybe, just maybe, if anger and criticism are bad for people with severe mental disorders, then perhaps they're also bad for the rest of us?

Hmmm.


Copyright 2007, TherapyDoc

Saturday, March 24, 2007

Chuck Mahoney and a preventable waste

This is why I blog. You have to know this stuff. People have to know. Especially kids who have friends who want to die. They need to know what to do.

What not to do is alluded to, if not spelled out in today's Wall Street Journal. The link may not be good for very long, WSJ may update it daily, so I'll tell the story over in the words of the journalist, Elizabeth Bernstein, whose eloquent story is on the front page of the only newspaper in town, no matter where you live.

Chuck Mahoney's parents sued Allegheny College in Meadville, PA, for his wrongful death in 2003. They alleged that the school had not taken enough action to prevent his suicide at the age of 20. Chuck's fraternity brothers and ex-girlfriend had alerted school officials that something was terribly wrong and they knew he needed help.

The school ultimately claimed there was no imminent cause to breach confidentiality and that the parents should have had better communication with their son who had been previously hospitalized as a suicide risk.

Chuck was a star athlete, tall and good-looking. He emotionally crashed immediately upon hitting campus: difficulty sleeping, anxiety, panic, fits of tears, the shakes. His parents helped arrange therapy and the therapist recommended a psychiatrist who prescribed medication.

Chuck was diagnosed with major depression, I'm assuming a 296.33, major affective depression, recurrent, severe, since court records revealed that he had a known history of depression (thus this was a recurrence) which included cutting and drinking alone.

He was treated and could study hard freshman year, maintain a relationship with a new girlfriend. He pledged Sigma Alpha Epsilon and got in but felt like a failure. He showed his therapist his writing. (he wrote well, by the way) :
It seems there is not a night, before I go to bed that I do not plead to God to please not let tomorrow come, but it comes and it comes.
The summer before sophomore year the therapist called his parents to tell them that their son wanted to take all of his medications and cut his wrists. (we call that a plan). Chuck had a five day stay in a hospital and felt better, like a weight had lifted. He did well that year academically.

But the following year he broke down, quit the football team in tears. He rescued a dog from a pound, took it home and carried the dog with him where-ever he went. But his mood was down. He broke up with the girlfriend and she told many others that he told her he wished he was dead. She told the therapist, too.

The therapist consulted with several people, other psychiatrists and administrators, about whom to tell and confidentiality issues were key, ultimately they became the substance of the case against the school.

In January, when he returned after winter break, Chuck spent much time alone in his room drinking heavily. He planned to give away his dog (a clue), in case
anything happens to me
He told his therapist that he had regular thoughts of suicide and a plan to kill himself with sleeping pills (another plan).

When he heard that a fraternity brother was dating his ex-girlfriend, Chuck threatened to kill him. School administrators were contacted. The dean and associate dean of students were contacted. The students didn't call Chuck's parents because they assumed the school would help him.

At 3:18 a.m. Feb. 11 Chuck wrote his therapist an email:
i hate living and i hate the prospect of going through another day.
At noon the next day she got another one:
I am sad and angry and alone, alone, alone, alone.
At what point do people who know these things think to say,

WOW, MAYBE WE SHOULD SOMEHOW FORCE A HOSPITALIZATION ON THIS KID!

Yes, the caps mean I'm shouting. SO MANY PEOPLE knew he was so very sick. No one knew what to do. I'm not blaming anyone, I'm really not. People just don't know. But they're much more powerful than they think.

You're much more powerful than you think.

Anyone can, you can:

Call the police, tell them that you suspect someone is going to kill himself. I have done this a few times, but a lay person can do it just as well.

As a friend/lay person, be there to substantiate your case when the police arrive. The police then will bring this person into an E.R. for an evaluation. The police would rather be safe than sorry. The docs in the E.R. will probably recognize suicidality and admit/treat the person at risk. Let them try their hand. They're good at this. It's their job. End of story.

But no, that's not how it ended. Around 6:45 that evening Chuck's friends found him asphyxiated by the dog's leash, hanging from the door in his room. The suicide note said,
To my parents, this is not your fault by no means, you were fantastic people and the world should worship you.
The jury voted 11-1 for the defense. They concurred with the school that since Chuck had not signed a waiver allowing the school to break his confidentiality, there was no way they could contact his parents. His parents who I suppose the school deemed responsible, were a 2 hour's drive away and didn't know how sick he was. The administration did know. But the administration somehow was not responsible because protecting the boy's confidentiality was more important than protecting his life.

Law is interesting like that. The case hinged on confidentiality, not responsibility. The school was not held responsible because responsibility wasn't the issue in the case.

So.

Once a week now, according to Elizabeth Bernstein's article, a father opens a closet and buries his head in his son's sweatshirt to remember him.

The therapist says she used a cognitive therapy.

I don't want to diss her, honestly, but when a person is this sick, cognitive therapy won't cut it. People can't "cognate" when they're this depressed. When a doc can sense that a patient can't think, a "thinking therapy" is inappropriate.

You meet him heart to heart. The goal is to ensure trust, trust not only in the therapy, but in the patient's own capacity to get well--with help, with support, and lots of it. The doc communicates that it may take a village to heal a child. The doc insists upon, doesn't suggest, hospitalization. Safety is the key word.

When a person is sick enough to dread tomorrow, as Chuck indicated in his journal? Plunk him in. TODAY. Keep him safe.

20/20 hindsight, doc?

No. Chuck had a psychotic depression, not an unusual presentation, either, and at the right age, 18-20 years old. Many therapydocs don't see it as such, not initially. They see the depression, but they miss the psychosis. They get stuck on the medical facts, the "times three" orientation rule. If a person is oriented times three (X-3), knows person, place and time, usually we can rule out psychosis.

But that criterion dismisses the most important criterion of all! Wanting to die can be enough to diagnose psychosis (rule out schizo-affective disorder, too, delusions/hallucinations).

Psychotic depression means that the hole is so deep (the one they can't crawl out of) the fog is so thick (the one they can't see through), the world is so horrible and painful (the one they live in) that life really is NOT worth living anymore.

The permanent solution to the temporary problem looks good. They think they are better off dead. They believe that, they say these things aloud. We've heard these words, MANY of us, not only therapydocs and health-care professionals.

Yet people still don't know what to do when someone says they want to die.

This is what you need to know. You don't give up on getting people help. If at first you don't succeed, you try, try again.

If, say, you did the police intervention and the E.R. sent a person like Chuck home, you have to be more creative next time. I'm not suggesting you do this, but in a case like Chuck's, I picture fraternity brothers planting an open bottle of spilled sleeping pills in the room, then calling police. They tell the police to come when they knew their friend will be in a stupor; they tell law enforcement that their friend wants to kill himself and they know he has the means to do it. They show the police the pills if the police don't see them.

The way those writer's think on Desperate Housewives, that conniving, out-thinking- the- status- quo- way of thinking is good, really. It is good to think creatively, but I'm not saying you should ever deceive law enforcement. I just can't resist the opportunity to make you think. It is a rare, extremely rare event, that would require such creativity.

One might think outside the box, but you should go with less drama. The truth socks enough punch, it really does. But it has to be told. Someone has to take a risk and stop the insanity.

The bottom line is that we're no longer powerless against mental illness. There is a an arsenal of medications at our disposal that grows larger every day, and if those don't work, electro-shock therapy really does work. We're not afraid of electro-shock therapy anymore. The professionals know how to manage it so that it doesn't make people into zombies forever after. We're not in the 1950's anymore.

If I were to look at the way this case was handled? I would honestly think that we were. A waste of life. Go to WSJ and see that video. Wall Street Journal

TherapyDoc

Thursday, March 22, 2007

Reading real books

Last night I didn't go straight home after work. It's not that I'm so old, but generally, unless I stop at the fruit store, I go straight home after work to whip up some dinner, sink into a warm computer or television, make some calls and maybe work out in the basement. The fun never stops.

But last night I stopped at a place called the Book Cellar on Lincoln Avenue in a trendy neighborhood not far from my office, as luck would have it, to hear a couple of blogger friends read from their published novels. I had never done this, attended a book reading. And I had never met a blogger friend, which is considered a Big Thing, something to blog about.

Mine is a sedentary job so luckily I could browse the books while Rick Karlin (Show Biz Kids), whom I hope to really meet one day, so funny, Amy Guth and Elaine Solloway read excerpts from Three Fallen Women and The Division Street Princess. I had no idea how charming, gorgeous, and talented they'd be.

Okay, I confess. I was so late for this event that I missed Amy's reading, and she's a performance artist. She's the one I really wanted to see (I'd already read Elaine's book, good reading, btw, but I'd read that Amy performs and am a sucker for a performance by a performer any day). So missing Amy perform/read (not sure what she really did) ruined an already perfectly bad day. But she did sign my book with love and kisses and what could be better than that?

Oh, oh you want to know why I had a bad day? Try bathtub leaking, electricity simply failing in the basement, meaning a bad wire somewhere (F.D. had fixed it by the time I got home). Rain, rain, rain. Stupid things I should be grateful for since in the end, they're LITTLE things. Think relativistic, stay rational, and very few things are actually bad and there are very few bad days. So this was not a perfectly bad day at the end of the day. It was a good day.

Anyway, I also got to meet Leah, who is another blogger and author of Shebrew, and at least got within 6 inches of her because she wasn't reading. Gave Leah a big hug and waved to Amy, couldn't even catch Elaine's eye since she was reading from the Division Street Princess about her brother's Bar Mitzvah and her mother bothering her father about eating and drinking too much.

And then, in my usual style, I had to go.

Get there late, leave early. Trademark. One day I'll change.

But last night, when I went to bed, I had shiny new novels at my side and I have to tell you. They put you to sleep faster than this blogging thing does. Not that the books are boring! Amy's is scaring the heck out of me!

But being in bed, with a book. Delicious. Soporific. It's that or I was tired and it was late. I'm recommending it, seriously, the soft cover thing. Or was that the cover thing. Will I ever stop writing about sex? Well, both, both are good, and the earlier in the evening, the better.


TherapyDoc

Wednesday, March 21, 2007

Sex and the Metaphor

I jumped at the chance to drive my son to the train, not that he couldn't have taken a bus, but I wanted to talk awhile. He's home for spring break.

We talked about blogging and how satisfying this kind of writing can be. He's very funny and sweet at the same time. Anyway, D, said, "Well, you know, YOUR blog is really for therapists, and the posts are kind of . . .uh. . .long."

Such a nice way of saying he doesn't read mine. Which is good 'cause now I can write about him and he won't even know!

Still, he's made some good points that should be addressed right away before we can stop talking about him and get back to talking about sex.

(1) In the interest of clarity, NO, THIS BLOG ISN'T ONLY FOR THERAPISTS. It's for anyone with an interest in the stuff on the sidebar

(2) In the interest of keeping things short I'll try to post more short posts. Like this one would have been shorter if I'd left off, "In the interest."

But the long ones with the stories stay. That or I save them for another kind of publication. (Leave feed back in the comments if you want me to quit writing the long ones.)

Here we go: SEX AND THE METAPHOR

Problems with sex reflect problems in a relationship. The core problem in a relationship will be played out in the bedroom-- under the covers, or over the covers, whichever the case may be; there will be covers.

A metaphor is a symbolic representation. Sex problems are symbolic of marital relationships and visa versa. I specify marital relationships here only because they're more likely to be long-term and if a relationship doesn't last very long it's hard to see the metaphor.

A common sex problem mirrors the marital problem in the example below, which is: Assuming you know what your partner likes without asking :

Sometimes we think we know what our partner likes so we don't bother asking or checking it out. We assume we're right. Our partner might enable this so as not to hurt our feelings.
"Enable" in this case means
not objecting or correcting us. This lack of feedback enables a dysfunctional situation to happen over and over again.

For example, Jack assumes Jill prefers a down coat to a fur coat because she's always been an environmentalist. She actually has always wanted a fur coat, preferably, mink. He buys her the down coat because he assumes it's what she prefers. She doesn't want to hurt his feelings so she acts really happy with the down coat.

Jill will never get that mink unless she tells him the truth, which she won't. Of course, Jack should never have assumed that she'd like down over mink (come on, Jack!)

And Jill assumes Jack that Jack likes it when she gives his muscles a hard massage. She likes it when he massages her like that, so she assumes he would like it as well. He HATES this but he doesn't tell her. (It might hurt her feelings? Does this make sense? At the time, it actually does.)

The metaphor, the symbolic representation in the marriage is mind-reading. They both assume rather than ask.

You can see how it would play out in the bedroom.
Change genders where appropriate if you're a sexual minority, but he gives her, or she gives him what is assumed to be wanted without really checking it out, verbally or otherwise. And all they really want to do is make one another happy. That's the irony.

This is what the faking orgasm thing is all about, by the way.

Any questions? Short enough, D.? Hey, did I say you could read this?

Copyright 2007, TherapyDoc

Tuesday, March 20, 2007

When I fall in love: Libido and people pleasing

Caveats, warnings, (1) it's written in code. (2) this isn't about people who live with abusive spouses. (3) some people do change for the worse and it may not be possible to love them forever. (4) that's okay, (5) yes, you will find permission to think about sex in this post, so if you have a problem with that, use your own discretion about reading on.

Now can I write already without everyone getting all upset?

The song, written by Edward Heyman and Victor Young, came out in 1952. Doris Day sang it in the movie One Minute to Zero. I wasn't born, not yet, but would be soon. Others re-recorded it, most memorable, Nat King Cole and Johnny Mathis, crooners of the highest order.

Woke up with it yesterday for some crazy reason, and didn't want to lose it:

When I fall in love it will be forever
Or I'll never fall in love
In a restless world like this is
Love is ended before it began
And too many moonlight kisses
Seem to cool in the warmth of the sun

When I give my heart it will be completely
Or I'll never, never, never give my heart
And the moment I can feel that you feel that way too
Is when I give my heart to you


Boy, he's going to hate me for this.

F.D. bursts through the door, purposefully strides through the hallway to the kitchen for his second cup of the day. I've been looking at him carefully recently, admiring his features, seeing through the gray, thinking he hasn't changed very much over a couple of decades or more. His basic personality, the guy I married is still very much there.

Change, you should know, comes up all the time in therapy. A patient had said to me just the other day, The things I loved about him when we first met I can't stand anymore. I said to the patient, Let me take you back there. Let's get a better look.

We change, but we don't change all that much. Change is not all that predictable and not usually permanent.

For many of us, for sure, our libido changes, sometimes a lot. When I trained in sex therapy at the Loyola Sexual Dysfunction Clinic in Maywood, Illinois, Domeena Renshaw, one of my doc/psychiatrist mentors, said many things that made sense at the time and make even more sense to me now. She talked quite a bit about something called "focus." Focusing on one's own sexual arousal is key in sex therapy. Quit thinking about everything, eveyone else. Think about what you like. Pay attention to yourself.

This is hard for some people. Especially when we're conditioned to thinking of the other person. We want HIM/HER to be happy. (or we'll get rejected?!)

Some people are so out of touch with their own needs and wants that they'll deny even having them.

Ironically it can lead to conflict. A person tries to please a partner but assumes too much and ends up doing the wrong thing. Not only is he upset because of the energy wasted, but his dissatisfied partner isn't happy, either.

You can see how the marital problem would get played out in the bedroom. He's thinking he knows what she wants, she's thinking she knows what he wants (or if they're gay/lesbian, etc., you can change the genders). But in fact, the guess work is just that. Thinking only about the other person isn't necessarily good for marriage, or for sex!

You have to focus on yourself.

Domeena really pushed the idea that a person's arousal, one's libido (in this case
drive for sex) is one's own responsibility. This was a super big concept in the early 80's and should be even now, but our popular culture persists in selling the notion that arousal is what happens when one is lucky enough to have scored an experienced lover. He'll (she'll) take you there, so to speak.

I read this all over the blogs.

But think back. When you fell in love? When I fell in love? How was that libido? Perfectly marvelous, I think. The object of our desire didn't have to do anything. All he or she had to do was cast a glance in the right direction. You had me at hello, we say.

Now it takes an hour and a half.

It's his fault? It's her fault? My fault? Your fault? We've changed so much?

That libido. We had it, remember. It was a natural thing, like breathing, an "awakeness". Food, unimportant. Sleep, who cared. But play, share feelings, gaze, flirt, make-out for hours? Now we're talking. I'm in love.

Libido is technically "drive." Freud said we were born with 2 of them, one for aggression, one for sex, love. This is probably the best thing we can learn from Freud. The rest is commentary.

So how do we get back a drive for making love? We want that physical desire but it's elusive, feels like it's gone forever. We weren't supposed to have lost it in the first place, you know.

But we do, of course we do. Over time it's easy to get tired and cranky and out of touch with being a sexual person. Stress, depression, anxiety, too many substances (legal or otherwise), and certainly, certainly anger derail our attention. We defocus. And our coping strategies, especially eating too much, will likely steal it away.

Add to that relationship problems.

And add to that, What you don't use, you lose. Those neurological pathways need travel or they atrophy.

And the guys aren't all that different. Women often complain to me that their male partners are always ready to go, always in the mood, still. After twenty or thirty years of marriage, sometimes, they'll be complaining about this. They're wrong, of course. Young guys, sure. They should be ready. But as men get into their 30's, 40's, 50's and above, they need a lot of touch and attention. And touch and more attention. Physical attention.

But they were born with an organ to look at and play with, whereas some women, MANY women don't know where their sexual organ, the clitoris, is (is this a bad word? in some cultures it's removed surgically, like a circumcision).

So women will say that they aren't instantly aroused like men because they can't see their arousal and really don't even feel anything close to arousal. A healthy guy wakes up with a morning erection. Normal physiology. A woman, unless she has trained herself to pay attention to her body probably won't wake up and go, hmmm, my body's surely aroused. We're in a fog, most of us, I think. We don't see anything different about ourselves in the shower, either, except perhaps more cellulite.

A guy's arousal (think code) is pretty obvious and it can turn him on, make him feel sexual. He wants to share that information and we're likely going to say, "Shut up, go away, I just woke up." But he's just being friendly. Childish sometimes, but friendly. (This depends on context, of course, we're not talking about meetings in a bar, we're talking about meetings in your closet).

Sometimes you might see a little girl who is obviously very in touch with her sexual feelings, maybe she's rocking or being demonstrative in some other way. Parents will discourage that behavior instead of saying to her, take it under the covers. We're embarrassed by it.

Then as adult women we wonder where our libido went. We sublimated it for many years, woke it up with romantic love, then let it go back to sleep. We then continue the tradition by encouraging our daughters to sublimate theirs, too.

De-sublimating isn't so easy.

I'm not going to even try to minimalize this, but within the context of a committed, tepid to warm relationship, add love, affection, communication and caring, and a person's libido can be coaxed back to life. It can be coaxed back to life with no relationship at all, actually, with a little personal attention.

Satisfying sex with a partner for sure requires good-excellent communication about what is pleasing, what feels good. Mind reading (can't stress this enough) fails in the bedroom, as it fails everywhere else. Everyone's different. What pleases one person is ticklish to another. Words are good. Demonstrations, better.

So it's all about that, in the end, when we're talking about resurrecting a libido in the context of a relationship. It's about polishing the relationship. A few tweaks of change, a few actions and words, and a libido can literally spring to life.

But even if you live alone, a little attention to yourself is a good thing. A lot of attention is better. It's like watering an almost dead plant.

But it's there. The drive is there (although it might be latent) . We're born with it. As long as we're breathing, even in menopause, it's there. Different, perhaps. Oprah had a show on this topic recently, so it must be true, with Nora Ephron who wrote a book. Maybe check out her book. I haven't read it.

As a therapydoc, however, I push the good sexual relationship in marriage as a good thing, because it's marital glue. And it's fun. It's supposed to be fun. It's one of those things, maybe the only thing that a couple does exclusively together, and nobody else needs to hear about it, except perhaps a local sex therapist, who is going to tell both of them, by the way, that it is not only their relationship they have to improve, but their focus. Especially her focus, most likely. It starts with people focusing upon themselves and where they're at to get where they want to go.

So if a woman wants that kind of relationship, the one she sees on television where the guy flirts with his wife and she flirts back and we just KNOW they're going to skip dinner and probably go right to bed, well, that woman has to find her libido, her sexuality. That feeling.

It's within her reach, literally. I'll tell you to begin the search early in the day, be more like he is in that way, more focused on yourself and your physiology, your physical feeling of arousal. And keep it all day long. It's okay. When you're hungry for food, wait a few minutes, don't eat so fast. Think of that other drive. Less fattening, more fun. In some ways, more satisfying.

Oh, and one more thing. Sure, he can be a part of the search committee. Why not? But you had best direct him. Guys need a LOT of direction.

And maybe sing to him, When I fall in love, it will be forever. He may need some encouragement, too, if it's been awhile. You could get scary.

Copyright 2007, TherapyDoc

A Hollywood Purim Shpiel

Not everyone knows, outside of the Jewish velt, that A Purim shpiel is a skit that's supposed to make you laugh. That holiday's over, and we're deep into preparations for the next one, Passover (labor intensive).

But in my family, laughing is something you're supposed to do every day, and preparing for Passover should not conflict with this.

So in that spirit, this skit's still funny. I don't think you have to be Jewish, after all, television is universal. But it might help.

Click below.

http://www.youtube.com/watch?v=0c1NKpuJ3RA

Sunday, March 18, 2007

Grading the Parents, Damage Control

Imagine the scene. I've seen dozens like it. Names have changed to protect the innocent:

TherapyDoc works with a boy (10) and his dad. This is a blended family and Dad and his new wife have "Johnny" every other weekend in the suburbs.

Johnny's getting really comfortable with them on his visits. Dad and Step-mom let him run around and play. He gets more fresh air out there. Bio-Mom lives in the city in a small apartment and she's afraid to let him go out alone.

Dad and Johnny are spending valuable time on a particular Sunday morning with me, the tail end of their weekend together. Dad's the one who initially brought Johnny into treatment for, let's say, shyness and poor grades. The kid's doing just great. Grades have improved; he's more outgoing.

And the "executive committee" is working well together. To a point.

What's that? Have we talked about the Executive Committee?

The executive committee looks like this. The executive committee has the big, poorly drawn, ellipse circling around it. Johnny's the only one not in there.

In the best of all possible worlds, these adults are going to periodically be alone with Johnny. If they have a basic understanding of the child and they can all agree about what the child needs and how they can best provide that, then the way they handle matters like limits and discipline will be relatively simple. A co-parenting visit regimen can accomplish that, although not handily.

If Johnny can split them, then discipline matters can be hard to negotiate. The goal is that the committee hang together. Anyone who has worked on a committee knows that simply working towards the same goal can be excruciatingly difficult, especially one in which one person might have been "chosen" over another (a step-mom over a mom, for example, by a cheating dad)

That said, when things go bad in therapy, they sometimes go very bad. A family therapist usually doesn't see EVERYONE together. That's so hard to arrange. I'll work with dyads to help them through their own particular issues, usually, with the committee's recommendations in mind. There has been a full meeting(s) and the rules have been established.

But when it's just one parent and one child, the parent might find it irresistible to "dis" another Executive Committee member on occasion, often in front of the child, even knowing that's unacceptable.

We've discussed it before, it's one of the rules, and everyone understand how "dissing" another committee member stresses a child. Nevertheless, when there's been conflict vis-a-vis individual/couple needs, a snag somewhere in communication, and the committee hasn't been working quite as well as it should, the complaints will fly. Disagreements aren't simply resolved.

As Roseanne Rosannadanna (o"s) would have said, When it's a blended family, there's always something.

She'd be wrong, actually. Some blended families blend beautifully, but usually it takes tremendous patience, maturity, suspension of ill-feeling, and work.

When that's not possible and things fall apart, one of the executives is likely to say something negative. The bashing can be done overtly or in a very gentle fashion, subtle and quiet, almost a whisper. Then I know the basher feels a bit guilty.

What's a therapist to do?

IF THE PERSON WHO IS BASHING FEELS A LITTLE GUILTY,THEN THE FOLLOWING INTERVENTION MIGHT WORK.

IF, HOWEVER, THE PARENT WHO HAS BASHED THE ABSENT PARENT HAS AN AXIS I OR AXIS II DISORDER THEN DON'T DO THIS (you really do need to know your DSM-IV to do well with some of my interventions, especially if you intend to be a therapy doc) .

BUT . . .IF THE BASHER HAS A HEALTHY PERSONALITY AND CAN TAKE A LITTLE CRITICISM AND DOESN'T MIND BEING POKED AT WITH GOOD HUMOR, THEN GO FOR IT (and be ready to do some damage control).

AND ANOTHER THING:

This is a middle-stage treatment intervention, meaning you have been working with the family awhile, agree on treatment goals and objectives, and have good relationships with everyone. (don't get too complacent about the relationship part, it can change).

If that's all happening you might have a shot at getting away with something like this.

TherapyDoc (addressing the complaint Dad has mentioned about Bio-Mom)
None of us are perfect parents. We all can improve somehow. But sure, Dad, I'll call Johnny's mom, hear her side of it.

Now. Johnny. (I look at the kid) As long as we're rating parents, how's dad doing anyway? Anything you're not getting out of him? He's right here. You can tell him. I'll protect you. (smile, glance at Dad) For example, is he spending enough time with you when you're at his house? It's great that you can go out to play. But do you talk? Is he keeping an eye on you? And what about that new step-mom of yours? How's that going. Do the two of 'em ever seem to gang up on you? Ever want to just punch them?
His sheepish look will give it all away. He'll look at Dad for permission to talk. Dad will give him the green light. He knows he has to. He knows the drill.

Therapy works, doesn't it, when everyone's honest about issues and feelings*? That's when you get the real work done.

But you as a therapist had better have that relationship before you potentially embarrass or put anyone on the defensive. Unless, that is, you don't care if you never see the family again.

As one of my mentors once told me,
Remember. Whatever you do. You want them to come back.
Usually you do, usually.

*Again. This caveat, that you have to have the relationship with the parent and the parent can't be too mentally vulnerable is crucial. You'd best not upset people in general as a therapydoc. That's not what we do.

If you do upset a parent in this example you might be endangering the child, forget about your relationship.

As long as we're talking about damage control. It's sometimes inevitable. If you do think you have crossed a line and upset a parent, or any other patient for that matter, take the patient aside immediately. Stop the session to talk alone as soon as you get bad vibes or you'll be there all day. You will have had a BAD day.

Is the intervention worth it if there seems to be such a risk?

It can't be a risk. You have to KNOW. If you know your patient, and know that he or she will not be insulted and will be able to go with the flow. When you're sure, when it's not a risk, or when your family really does trust you and is grateful to you so far for having patched them together up until now, then YES, this is a very powerful intervention. It makes the parent think twice before dissing another executive committee member again, and it does get at some of those underlying issues the child has been afraid to bring up before.

As a family therapist, however, you're not into taking risks. Any cool, strategic intervention that a master has used in a book or demonstrated on a video only worked because that doc KNEW that it would.

The first rule of therapy? Be therapeutic.

Copyright 2007, TherapyDoc

One more thing on mirrors

This is the third post in a series, so you might want to scroll down a couple of posts. It's up to you.

Today F.D. sat me down and said, "Let's talk about that Rashi you're obsessed with."

For the uninitiated, I had quoted a midrash (story) that Rashi, a revered 12th century commentator on Torah and Talmud (I hope I have that century right) brought down. To say that Rashi was a genius is an understatement, and to say that he was inspired, not even a question.

In his commentary Rashi brings down many midrashim, stories with messages that are as old as the Jewish people, and as I've said, we're talking over 5,000 years old by our calendar. So of course he tells the story of the mirrors and how the Jewish women convinced their men that they should join them in their tents to. . .
uh, to take a nap.

(This is what I mean by speaking in code, people. now isn't it more romantic than spelling every single thing out?)

F.D. went over the Rashi with me and he added something. He said that the women sat with the men under the apple trees and took out their copper washing basins and said, "Look, I'm prettier than you are." They weren't really mirrors they were copper basins. I knew that, actually, I just didn't think it mattered.

But we both thought the language a little odd.

Now how that was a turn on is a little obscure, but apparently it was. Maybe there was more to it. I suggested that as a woman said this she'd be tracing her guy's features, perhaps his forehead, his lips, and complementing them. Maybe she'd say, "I like how your chin juts out so strong, I like how your eyes look at me. I like the stubble on your cheeks."

But maybe she really did just say, "Hey look at us, we're a cute couple."

Fine, F.D. said, Let's have lunch.

Then we went to a birthday party last night and somehow the subject of these copper washing basin mirrors came up again (Maybe it was F.D. who was obsessed with the story).

Our good friend Heshy explained it. The Hebrew letter mem that we had thought meant THAN in this case, I'm more pretty THAN you are, really didn't mean THAN at all. She wasn't comparing herself to him. She said, I get my beauty FROM you. The mem means FROM in this case.

Isn't that fabulously romantic? Of course Heshy, you're right. Thanks. And no, this is not the last word on the subject, I just don't know how to tell you the rest. Another day.

Friday, March 16, 2007

Explanation about Foreplay

Okay, you deserve an explanation.

Maybe the last post, Why the Mirror: Passover, and Sex, was a little obtuse. Let me flesh it out.

1. About foreplay to foreplay--

When people are new to a relationship they talk first, usually, and try to get to know one another. They flirt.

Heck, some people get married before they begin to kiss, hug, and physically enjoy/pleasure each other.

First there's getting in the mood psychologically, the getting to know one another and flirting. That's the "foreplay to foreplay."

Then many couples proceed to waking up their bodies, the physical arousal, looking for a signal, I call it. The kissing, hugging, and pleasuring prior to intercourse is the "foreplay."

Sure, not everyone needs foreplay to get aroused sexually, and surely not everyone needs foreplay to foreplay.

But there's so much sexual dysfunction in our society (on so many levels, but I'm not going there) that I feel that respecting the continuum is a good way for couples to proceed.

Start with no physical touch. Start with the minds touching. Then two people can decide if they wish to move on from there. Moving on implies mutual consent, by the way, at every move.

2. When I say that a famous Jewish personality was in Egypt and was freed along with the rest of the Jewish slaves, it is a reference to the belief that in fact every Jewish soul is thought to have been there at the exodus.

How this makes any sense is hard for me, also, to understand, but I don't question theology very much, I just enjoy it and suspend my disbelief. I do this in the world I live in, as well, suspend my disbelief/belief at times. When I am criticized, I try to believe it. When I hear gossip, bad stuff, I try not to believe it.

3. When I say that people think that Jewish women are sometimes erroneously thought to have these also ran roles in Judaism, I refer to the ideas of egalitarians who think that this religion revolves around men. The men get to do all the fun stuff.

In fact, women in Judaism are thought to be on a higher spiritual level than men. Created second they're a new improved version, less likely to act out sexually and aggressively.

Men have many more direct commandments in Judaism, more things they have to do, like put on a prayer shawl and phylacteries when they pray. These behavioral tasks, which sometimes become dear, sometimes are surely drudgery (like having to go to a synagogue to pray with at least 9 other men 3 times a day) keep them straight. Theoretically, they'll act out less with the sex and aggression if they're kept busy doing what they're told to do.

I personally prefer that the men have to run around performing time related commandments and I don't.

4. The line in the Gemora, Oy vey we're all gonna' die is a very loose translation of a line that a rabbi said during a toast at a wedding. There's more on that story on the post about my birthday, click here to subject yourself to that.

5. The story about the mirrors is an example of flirtation, women flirting with their men to entice them to have sex. The men had lost interest.

Either the guys were tired out from slavery or they didn't want to bring children into a society that would enslave a young child to hard labor. The women in Egypt believed in the promised redemption, however.

Jewish history goes back over 5000 years, and pre-Egyptian slavery tradition had dictated that indeed, G-d had it in mind (why is discussed sometimes when people talk about the Messiah) to let the Jewish people descend into slavery in a foreign land. But He would bring them out. These overworked fellows were exhausted, lost hope, and stopped believing this, but Jewish women had faith. It is for this reason, too, that women are praised so highly. Proof of their metal.

Hope that helps. I'm not a rabbi. (But I do know sex therapy.) Rabbis tell people who ask them questions to ask their local rabbi since customs vary from place to place. So ask around on the Jewish stuff if you didn't get it in Hebrew school or never had the benefit of a parochial education.

And many people, even now, haven't formally learned nearly enough about human sexuality and/or relationships. That's why there are people like me, maybe, to fill in the blanks.

So I'm going to humbly try to continue to do that.

Copyright 2007, TherapyDoc

Monday, March 12, 2007

Answering Questions: New Feature #1

You send me really great questions and when I feel I can answer in a couple of sentences, I'll usually write back.

Actually, I'll write back in any case, but sometimes just to say, This is a little involved. When I get around to this I'll write you back, which you should know, won't ever happen.

So the New Feature goes like this.

You can count on me answering your questions if I can do it in one word. Or maybe in a couple of sentences.

Let's start.

Question About Therapy #1

TherapyDoc, SHOULD I WALK OUT OF THERAPY FEELING WORSE THAN I FELT WHEN I WALKED IN?

No. You should not.

And that wasn't even a trick question.

Friday, March 09, 2007

More on alcohol

So what I decided, after thinking about the post below, is that I'll host a carnival on alcohol and relationships at the end of March. Go to the following link to post your stories, okay?

The Alcohol and Relationships Carniva

Thanks. They can be happy, sad, funny, bittersweet, educational, I don't care. But we're not talking wine tasting, okay?

Danielle Baker

I was in traffic this morning and listening to National Public Radio's Eight Forty-Eight. Steve Edwards paid tribute to a former intern Danielle Baker, who was killed earlier this week in a drunk driving accident.

He broke down telling the story, which made me cry, too, and I wondered how many listeners at that very moment had the same reaction, how many Chicagoans were sitting in their cars crying for this talented 22-year old woman who won't be coming into work anymore, who won't parent her two-year old daughter, who won't take care of her parents as they get old.

It's Friday, friends. That's a signal for people who drink to start drinking, just because it's Friday. Drunk driving accidents total over one hundred billion dollars a year in this country. Only 1.5 million drunk drivers are arrested and it's thought that only 1 of 200 drivers will be pulled over by police while under the influence. (Thank you, 848, for the stats)

So to some people that means they should go ahead and drive while under the influence because the chances are VERY slim that they'll be arrested.

It's always someone else that gets arrested, someone else that's in an accident, someone else's sister, mother, daughter, who is killed.

Maybe I'll dedicate Fridays to the joys of alcohol.

Thursday, March 08, 2007

OCD versus OCPD

Obsessive-Compulsive Disorder versus
Obsessive-Compulsive Personality Disorder

I, for one, feel uncomfortable walking anywhere, except sometimes on the beach, without slippers. Or shoes. Or sandals. You know what I mean. And I really like socks on the inside of these foot coverings, too. If at all possible.

Does that make me O-C?

When I posted on bi-polar disorder I told you that none of the disorders are romantic. You don't WANT these disorders. No matter what you see on television or in the movies, having a real diagnosable mental disorder is a serious drag.

No question we like our symptoms, and many of you may even claim you're "married" to a symptom, say, depression. But what you really mean is that you like that nice little lull you get when your attention focuses inward and your body says, Stop. Oh why on earth would you want to treat that? (I can think of a few reasons, actually)

ALL of us have suffered from the symptoms of multiple mental or behavioral disorders. You know I don't use the word "ALL" all that lightly. But it's an "ALL." This one's an absolute. You can't live and not feel anxious. You can't live and not get depressed. Find me one person without an "addiction" of some kind.

These people are lying.

But to be diagnosed with a disorder is a whole other level of dis-order. It means that you have a cluster of symptoms that meet a cluster determined by real social scientists who have done research to find that indeed, symptoms cluster together and define recognizable syndromes, or disorders.

A list of symptom clusters helps therapydocs explain to people who don't believe in mental illness that if one has that particular cluster of symptoms, then that person has what we believe to be a particular mental disorder.

Even your grandfather, who doesn't believe in all this therapy nonsense gets it when he can read the symptoms on a list.

Now.

What's the difference between Obsessive-Compulsive Disorder and Obsessive-Compulsive Personality Disorder?

The first, OCD, is an Axis I disorder, meaning the symptoms of the disorder can make the person who has them feel sick. The second, OCPD, is an Axis II disorder, a Personality Disorder, meaning the symptoms make EVERYONE ELSE sick, especially the people who live with the person who has the symptoms. But the symptom bearer can be relatively comfortable.  Not always.  Perhaps not usually.


Obsessive-Compulsive Disorder, 300.3, belongs to a family of anxiety disorders that are classified in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

Sufferers are sick with many of the following symptoms. This is almost straight out of the book. For a better explanation go to the library or Google OCD. The "bold" in the descriptions below is my attempt to get you to pay attention. If words are in bold then you should stop for a second, and think. Here are the symptoms of OCD. All of the categories, A through E, have to apply.

Obsessive-Compulsive Disorder

A) Either obsessions or compulsions:
Obsessions include:
1) recurrent and persistent thoughts, impulses, or images that are intrusive and cause marked anxiety and distress
2) the thoughts, impulses, or images are not simply excessive worries about real-life problems
3) the person attempts to ignore, suppress, or neutralize them with some other thought or action
4) the person recognizes that they are a product of his or her own mind (not imposed from without as in thought insertion*)

Compulsions include:
1) repetitive behaviors (hand washing, ordering, checking) or mental acts (praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
2) the behaviors or mental acts are aimed at preventing or reducing the distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.
B. At some point the individual recognizes that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children.

C. The obsessions or compulsions cause marked distress, are time consuming (1 hour or more a day) or significantly interfere with normal routine, work, academics, social life or relationships.

D. If another Axis I disorder, the content of the obsessions or compulsions is not limited to that (i.e., preoccupation with drugs in the presence of substances, food for anorexics)

E. The disturbance is not due to the physiological effects of a substance or general medical condition.

That's a lot to remember, right? Now don't you have more respect for your therapists? They know (or should know) ALL of the DSM-IV-TR.

There's more to say on OCD, but let's move along to OCPD.

Obsessive-Compulsive Personality Disorder, 301.4

A pervasive (doesn't go away) pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by FOUR or more of the following:

1) is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost

2) shows perfectionism that interferes with task completion (unable to complete a project because his or her own overly strict standards are not met)

3) is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity)

4) is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)

5) is unable to discard worn-out or worthless objects even when they have no sentimental value

6) is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things

7) adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes

8) shows rigidity and stubbornness

NOW

If you have either of these disorders you might consider getting therapy. Usually we see people with 300.3, the Axis I anxiety disorder in therapy because they're miserable.

Those of you with the Axis II disorder 301. 4 might be unhappy, and for sure your behavior is causing others more stress and discomfort than you realize. But you're not going to part with those moldy National Geographics form 1945 that are stacked up in the basement. You'll be yanked (against your will) into marriage or relationship therapy at some point or you'll lose the best thing you ever had. But you generally won't volunteer for it.

That's it for now. Any questions?

This obsessive blogging has GOT to stop, by the way, don't you agree?

*Thought insertion is a symptom of schizophrenia. One who suffers from this disorder actually hears a voice that does not exist that is inserting thoughts into his or her mind, i.e., the FBI is listening to this phone call, watch what you say.

Copyright 2007, TherapyDoc

Wednesday, March 07, 2007

Popularity

Being popular is a family value. Well, it was in mine.

No small order.
Friend of my mother to my mother: You look at her cross-eyed and she cries.
Mom: So don't.

Being shy is usually trans-generational. Mother faked it til she made it, but she'll tell you today that she's shy.

So the popularity thing was a tall order, anxiety aside, and my parents, as I've discussed earlier, did teach the course on working the room, ala, Go kiss Aunt Goldie and make your cousins feel comfortable in our home. I had that down.

Proof that I am not making this up. One of my eldest sons (28) repeated this very recent conversation with his grandmother.
Y: Booba (rhymes with tuba), how're you?
B: Just great, Lenore and Sammy are visiting us.
Y: That's nice.
B: Do you want to say hello to Sammy?
Y: Who's Sammy?
It just seemed natural to my mom that her grandson should want to chat with one of my dad's cousins. In truth Y has met Sammy & Lenore, probably at his bris.

Anyway, I learned at some point that I could make kids in school laugh. But this was much later, perhaps I was already 10, so I think the socially challenged years were from 0-10, then from 14-present.

Blogging, of course, you can’t shut me up. Am told I have more words than G-d.
But popular? I don’t know. Let me tell you what it takes to be popular.

Source: Being Popular 101.

Axiom: Being popular means being nice.

This is a tall order for a lot of people, even if they have been hypnotized like I was.
You have to be nice to everyone. You have to be nice to everyone. You have to be nice to everyone. You have to be nice to everyone. You have to be nice to everyone.
My parents as luck would have it made popularity a conceivable concept because they themselves were popular. They were always playing cards or noshing and visiting with friends. Here's how I suffered as a result:

Mom or Dad (interchangeable on this one): Come out of your room and say hello to Helen and Shirley, Sid or Sidney.

All the men were named Sid, Sidney, or Sydney. No one knows why.

The come on out of your room thing was a way of making me into a social creature. Social creatures, people who love other people, are called Ohave Breiyot. According to my tradition, if you love His creatures, He'll love you for it. It's a good idea. So they tried to get me out of my room. Usually it translated into a piece of cake.

But since I've been in practice, I've learned that STAYING IN YOUR ROOM, NOT SOCIALIZING WITHIN THE CONTEXT OF THE HOME (if you're not a sulky adolescent)can be the harbinger of problems in adulthood.

If a person doesn't interact with his or her family of origin, then the social lubricant, the ability to empathize, to sense how others feel, might lie fallow. True empathy and consequently caring, although there surely might be some genetic marker, is probably not so much innate as it is fostered by family interaction.

Empathy can be learned. It can be learned in adulthood, but like learning a foreign language, it's much harder to learn in adulthood. So you have to teach it to your children. This is one of the most important parenting tasks.

I can't believe it's taken me this long to post this.

Empathy is an amazing quality, and makes it easier to be nice to others. You get them so you give them the benefit of the doubt. But...once you have that default inclination to feel how others are feeling, once you've determined that it's better to be nice, you have responsibility. You can't circumscribe that behavior. You can't just be nice to a couple of people. It's your responsibility to be a social person.

Corollary to Being Popular: Being nice to everyone may mean resisting the urge to join a popular “clique.”

Impossible. Or so it seems. Even if a person really does find everyone pretty fascinating (like I do), not joining a clique at certain ages (all ages?) is hard.

But it's necessary. It's that or you have to make everyone feel included in a special secret relationship. You're a person of many cliques, indeed, unlimited cliques. Cliques of 2, 3, 4, 5, . .any number of people who are cliqued together. I want to say, because you actually know how to click, or communicate well.

Having an exclusive clique without many other special cliques can really work against you. You can lose your soul. I almost did.

A couple of years ago I went to a high school class reunion I ran into someone who looked exactly as she had in 4th grade. But she dressed more like Paula Abdul.
Me: Hey, M., How are ya’?
M. glares at me.

Me: S’up? You’re looking great. (I didn’t feel this way, but it’s one of those things you say if you want to be popular).

M. glares some more. She's at a table, surrounded by others. I'm with two other women who were geeky like me in high school. M. is acting like, Well, look who's popular Now. My two friends are looking at me like, She hates you.

Me: What’s wrong, M., seriously. Do you recognize me? (Everyone recognizes me, I still look like I did at 11. Same build, too.)

M. sneers: You were mean to me. You were so mean to me. You wouldn’t let me into your clique. You and . . .


Take the knife OUT of my heart. Ouch.

Me: What are you talking about?
M (I wish I were making this up): Third grade.

Me: No way. I was too terrified of people at that age to have had a clique. I was the kid afraid to ask the teacher if I could go to the bathroom! (Something of an exaggeration, but these days they’d have had me on Prozac or something similar for the nail-biting).

M.: You were mean. Your friends were mean.

Me: Please forgive me. We were kids. I’m so sorry.
M makes some sort of Feh! gesture, brushes me off as if to say,
You blank.
This humbled and upset me quite a bit, her not accepting my apology. And it was a bad way to go into the holiest day of the year, Yom Kippur, which was coming right up, two days away. On Yom Kippur we're supposed to ask people to forgive us for the jerky things we did during the year. If people forgive us, we have half a chance that the Old Mighty will, too. Maybe we'll get another year of life.

Well, I said I was sorry.

So cliques can be deadly. See?

Now. If it's true that to be popular one must be nice to everyone, then what do we do about the people in own families? They're SO annoying. Do we have to be nice to them, too?

Yeah. All Of The Time.

What's interesting to me as a family therapist is that some people think that they can get away with being nice to everyone OUTSIDE of the family, but the people WITHIN the family they can treat like blank, like dogs. Rather than kick the dog (which isn't right either) they "kick" a spouse or the kids or both. This makes no sense.

When we're talking about being inconsiderate, bullying, or being overly critical to an adult partner I use the following intervention:

Treat her/him like you would treat your boss.

When it's beating on the kids I say:

Treat them like you'll want them to treat you when you're in a wheelchair.

So what does it really take to be popular? In the blogger community, and who knew this when I started blogging, and who has time for it, being popular means being funny AND validating other bloggers. Commenting on someone else’s blog is tantamount to publicly hugging a stranger. Emailing someone you only know through his or her essays or posts is the equivalent of calling up someone and inviting them to your Bat Mitzvah.

Communication in cyberspace is what it's all about, face it, and FRIENDLY communication is rewarding. Rejecting ANYONE is so not right, and yet, it is difficult to go full strength in virtual relationships since half the people who comment on blogs seem to be named ANONYMOUS.

The popular bloggers pull it off, however. They are terrifically social animals (yes, but we are all social animals, okay, most of us just aren’t terrific at it.)

I could name a dozen of you, but since I was invited to a virtual birthday party for Neil Kramer, let's name him. He's a very popular blogger and gets a lot of mileage about subjects that make me blush, but okay, nothing new there (even sex therapists can blush, dudes). If you are not interested in this kind of humor, skip the more prurient looking posts. The sweet ones concern Neil and his wife, Sophia, who is without a doubt Citizen of the Month. And very nice.

When I started blogging last May it was to disseminate research and practice findings (teach). I was hunting around Technorati, searching for Jewish blogs, thinking I’d find people who got my jokes.

Not that you have to be Jewish, G-d forbid, to get my jokes.

Anyway, there was Citizen of the Month, with a post he’d done on beds. Different beds. Made beds. I think it was called, Beds You’ve Shared With Me, or something like that. His cyberfriends had emailed him pics of their bedrooms.

The pictures were very nice and I liked the presentation. F.D. and I used to spend good money to see OPBs, Other People’s Beds at nice bed and breakfasts when we were running away from community/family life, well before our children left Chicago and all of our vacations became. . .visiting vacations. Some of these B. and B. owners had nothing on Neil’s friends. Others, I have to tell you, are SO much better than the best of you, sorry.

Anyway. I dropped him a comment. Nice beds. Actually, I have no idea what I wrote. But he emailed me back! This absolutely amazed me! I was so happy. Somebody out there said hello. He took it seriously, validating other people.

He listened to his mom and dad.

Well done, Mr. and Mrs. Kramer, and Happy Birthday, Neil.

Post Script: I think Y did get on the phone with Sammy. I'm really very proud.

Copyright 2007, TherapyDoc

Tuesday, March 06, 2007

Night at the Museum

Can TherapyDoc review a movie if she didn't see the end?

Blame American Airlines for catching those tailwinds, starting the movie too late, landing early! What was I supposed to do? There had to be at least another half hour to go before the movie ended when we landed at Ohare when the captain turned off the buckle your seat belt light.

Should I have rented it or do you think you can just trust me on this?

Directed by Shawn Levy, writing credits by Ben Garant & Thomas Lennon (thank you IMDB.COM) this one delighted me and yes, I'll buy the DVD when it's at Blockbusters for ten bucks or less.

Why?

Dick Van Dyke, Mickey Rooney, and Robin Williams, of course.

But, you say, you don't like Robin Williams under any circumstances. As Teddie Roosevelt I can like Robin Williams, and so should you.

Are there great Therapy Truths we can take out of a movie about yet another dead-beat guy whose wife has left him for a successful stockbroker-type person? (see that football movie about the Philadelphia Eagles for a real feel-good along the same heroic lines)

There are three lessons but first a quick plot summary. Ben Stiller plays Larry Daley, a single guy, probably 35, still finding himself. His schemes to make money haven't worked and his 11 year old kid Nick (Jake Cherry, so cute, btw) is beginning to identify with ex-wife's second husband, yes, a stockbroker.

Nick says to his dad, "What if you're wrong (about finding the "right" break) and you're just an ordinary guy who should get a job?"

ouch

But that's what he does. Larry finds a job as a guard in the Museum of Natural History. At night the displays come to life for the museum has acquired a golden Egyptian tablet with a "curse". Larry has to fight off Octavius, Attila the Hun, T-rex, and African jungle beasts. The diorama miniatures from the Wild Wild West come alive (Owen Wilson as Jedidaya, never better), along with hundreds of Roman soldiers, critters, beasts, and warriors battling like crazy, having a good old time at Larry's expense since he can not seem to restore order after sundown.

He's about to get fired by Dr. McPhee (a hysterical Monty Pythonesque "British" performance by Ricky Gervais), since there's always a tiny bit of evidence left in the morning, a Roman soldier's head under a Wild West guillotine, for example.

Larry begs one more chance at the job from Dr. McPhee. That night the elderly guards he's replaced are in the museum raking it clean of relics to enhance their retirements. Larry's son is there, watching him work out deals with Teddy Roosevelt who admits he's really only wax, which is why he can't seem to make a play for the beautiful Sacajawea, (Mizuo Peck).

So the lessons, briefly, are:

1. As Teddy Roosevelt must have said, Some men are born great, for others, greatness is thrust upon them.

Seize your moment.

2. History IS interesting when it's presented as biographical, when historic figures become people. (kids need to know this)

3. Your children will love you if you spend time with them, engage their imaginations, and teach them cool things, not all that hard to do since they want to do all of the above.

So rent this one and watch it with them.

At least I didn't give away the end, right?

Copyright 2007, TherapyDoc