Thursday, January 31, 2008

Obsessed, did you say?


Obsessed with stamps? Not hard to do.

People sometimes ask you, I'm sure, How do you have the time to read, write, post, link, blah, blah? And you reply, We make things for the things we like.

I would add, the people we like. For better or for worse. This second edition of Obsession! is better than the first, thank G-d. Yet I'm really surprised that no one has posted on relationship obsessions, with the exception of one serious crush on Zach Galifianakis.

Sure, I told you I'd censure obsessions about sex, but never people, presentations, a good casserole.

But before we begin. I have a dilemma and maybe someone can help me out here. I really love that scent, Obsession. But it's made by Calvin Klein. Since I object to the billboards and pictures on buses of scantily clothed children, I won't buy CK stuff. A person has to have principles, right?
But ALL the advertisers do this now. Should I give in?

Back to our usual programming. A great list.

PHIL! for humanity talks about the work-obsessed and 8 Ways to Tell You're Doing That (working too much). He mentions dogs no longer wagging tails. Makes sense.

And Madeleine writes a limerick about searching, searching, searching for the lost blog, something she calls web withdrawal. Mad's a short, happy read, if a little mad, of course.

Considering stamp collecting? Why not? Seems to me it beats a lot of other obsessions. Yes, we have stories, don't we, about stamps. And if you're interested in what the U.S. post office has put out over the past hundred years (I was) check out A Century of Stamps. You'll go nuts.

Career Counselor advises miserable souls who work and obsess about how they probably shouldn't.

Warren's obsessing about thoughts, and energy, and matter, and he's going to make himself sick about this, it's clear. Cut it out, Warren. Yet I like this post-modern thinking, if it's a little overly-complicated.

The Skinny on January tells us to eat it raw, like we need more obsession on food. Well, maybe we do.

And Personal Hack (I LOVE that blog title) is obsessed with losing weight. You know, don't you, PH, you have to love yourself no matter, okay?

Mark Riffey, Business is Personal, let's go regarding independent book sellers. Remind me to tell you a story.

And SarahSpy is the one with the serious crush on Zach Galifianakis.

Kevin, No Prodigal Son, is obsessing about batteries, and if you're looking for a new car, you should, too. But WHEN are they going to come down in price?

Margarita Moments obsesses about Paris, Nicole, and disses all kinds of bratty rich kid issues. But I have to tell you. Rich kids need therapy, too, and if any of them want to see this therapy doc, I'm available.

Whereas KEN is obsessing about how to make money, has no issues with rich people, rather has issues with people who have issues with rich people. You two duke it out.

Unlocked is into HGTV Dreamhouse. Move on in Un.

Whereas Lucinda's into witches and I'm warning you, it's NOT pretty.

Don Morrison is obsessed with business tools, and Total Well-being likes his bicycle, YAY! See you in the spring, TW. Mike is going to the gym working muscles you don't even know you have.

Obsessed with Marion Jones and Barry Bonds? Check into 200 Motels!

That's it for today. I think it's time for the post on how NOT to obsess. We're surely ready.

therapydoc

January 2008 Back a'cha


This is the post where we give a shout to the people who link over to ENT and say Thanks!

This is kind of fun, because I after I say thank you I get thank you's for thank you's and then the thank you for the thank you for thank you, and on it goes. Oh, let's quit goofing around.

The most moving blog of the month is hands down, The Other Side of Time, Joel Merchant's story of loss and remembering. Losing a child is considered the worst loss, and Joel's story poignantly reminds us that life has to go on, somehow.

The best social work blog I've found is WorkingSocial.com. Check her out, a former Chicagoan, gone south for her mental health.

For a decent rant...like you can't rant all on your own, try RantHere.com . They're the best rants Rant can scrounge up.

Sometimes a person just wants to get online to read a decent story. Writers, thankfully are posting their best wares virtually everywhere. For example, Just Write is just right and you can find links to stories there, ditto for Incurable Disease of Writing , Missy's best.
And Be The Story has stories about stories.

How to Stop Smoking is easy on the eyes and links to info posts. Check her out.

Angelawd escaped corporate and now lives the easy life of freelance. Easy?

Womens's Clothing, a post at Info News spins blurbs of all kinds, as does PopBlue at Thought Disorders. These blogmeisters don't quit.

Have you ever wondered: What Is It, exactly, that's going on in Gaza, Israel, and Egypt? Probably not, but if you do want to hear from Anglos on the state of things in that corner of the Middle East, check out Jack's collection of incredi-blogs. Jack, too, is a treat.

Coffee Yogurt has some quick posts with pics that make it worth the taste.

If you're a Chicagoan looking for work, stop by Jobaja's website, chock-full of interesting ideas and sure, editorial. Writers EVERYWHERE.

This one by Lillie, is sheer genius. She thanks people who have commented by aggregating the number of times they do. And who said social science is a lost art? Seeing is believing. This is, btw, a great example of behavior modification.

Anja Merret blogs on virtually everything.

At Oh, You're a Feminist you'll learn that insulting language such as fat fingering (making typos) is on its way out, if we bloggers have our say, and it's pretty obvious, we do.

If you're interested in entertainment for children (my hand's up) check out the links over at Veggie Tales.

Pink Holly hock has noticed that when she walks into a hardware store, a piece of her brain freezes in Buy It All mode.

Rabbi Without a Cause is thinking he'll take a break from blogging. Right, rabbi. Sure.

And WalkAbout is confiscating cell phones at the door. Nobody's going to catch her on video in a house-dress.

An Eclectic Blog features an eclectic blogger who blogs therapy, photography, and probably recipes. We relate.

Door Opens is in recovery in the suburbs. I love anyone in recovery, you guys know that. Dry Blog keeps a sense of humor about sobriety and offers advice about stoned pets, how to recognize them. I'm not joking.

Curiosity Killer won the thinking Blogger Award! Way to go, C.K. And Pajama Mama, not getting out of those PJ's, has no reason to go anywhere. FD and I dream of opening a store that only sells pajamas. We'll call it PJ's.

A politically healthy blog would be Back Across the Line. Back exposes the Kimkins diet scam, nasty stuff, starvation.
At Mariposa's Tales you can get good pics of the airport in Hong Kong. Sure, there's other stuff, but I happen to like airports.

RD Doctor, NOT to be confused with FD, hosts links to a dozen blogs on health and disease. Thanks, RD.

And there's a huge list of really good posts on positive thinking and successful thinking and all kinds of positive, successful Go Team thinking at, what else, the Carnival of Inspiration and Motivation, and I'm fairly positive this is good for you.

And Craig, always an inspiration, repeats Priscilla's list, if you've never seen that one. Is Priscilla the one that Jennifer Weiner refers to in her novel about the pregnant women? I think it's Little Earthquakes. Priscilla's the woman who does everything better than you, ala Sylvia. We must discuss Sylvia one day.

SuccessSystems directs us to health and well-being blogs, included ENT, thanks Success. You should go from strength to strength.

Liza's Eyeview eyeballs thoughts and words, primarily, and is surely gunning for President, at the very least key-note speaker. Good luck, L. You totally have my vote.

Maybe I should have taken a lesson from Dr. Sanity on how to limit submissions to carnivals that day that the material submitted to the Carnival of All Substances got the better of me. Sanity seems to have managed to do that at her carnival of the insanities. She's a real doc, you know.

January Back 'Acha means something else, too, you know.

Spring equinox is coming up. Only 7 more weeks of winter. Boy there's a lot of snow on the ground today!

therapydoc.





















Monday, January 28, 2008

Best of NPR: The Glad Game, the Aftermath of Abortion, and Candidate Theme Songs,

When NPR is good, you know, it's very good. It's been very good lately.

Just the other day, Liane Hansen (Weekend Edition, January 27, 2008) explored the roots of the Pollyanna story, written by Eleanor Porter in 1913. Talk about good.

Pollyanna, an orphan, takes up residence with her mean, but wealthy and powerful aunt, and has a magical affect upon an entire town due to her incurable optimism. Even her mean old aunt comes around, eventually.

It's one of my favorite stories. You can read the book or watch the Disney version (with Haley Mills); both are charming. If you do, however, you might want something to counteract the sugar, perhaps guacamole and salsa.

Can it get sickening, so much optimism? Oh, yes. But the positive psychology movement can, too. I've ranted a little that it's not so easy, nor is it necessary, to erase all sadness. On the other hand, lest you forget, Happy is Better. Hands down.

Whatever your psychological politics, learn to play Pollyanna's Glad Game.

Wickipedia sees it as an attitude more than a game, a way of dealing with adversity that our girl P learned from her father, not a wealthy man. To play, the challenge is to find something to be glad about. . . when a situation feels anything but gladful.

The game originated one Christmas at the charity barrel "grab bag." Pollyanna, hoping to get a doll, reaches into the barrel only to find a pair of crutches. Her father makes up the game on the spot. What's good about this situation? How can a girl be glad, here?
Be glad about the crutches because "we don't need 'em!"
Oh, what a winning suggestion.

To tell you more would surely ruin the story.


An NPR gem that I hate to have liked tells the bittersweet story of abortion. Women are asked to write into the NPR BlogOfTheNation with personal tales of life following the procedure.

Sure to bring tears to your eyes, should you need a good cry. Check out that post at NPR.org/blogofthenation.


Now you need a pick-me-up after that, so how about today's broadcast on candidate theme songs? I've not been particularly impressed with such things, but Bill Clinton's Don't Stop Thinking About Tomorrow still gets me foot tapping and I voted for him, so there probably is something to this. You can hear that story at NPR.org , as well.


My real thoughts on America and this year's campaign trail, tomorrow.


therapydoc

Sunday, January 27, 2008

It Never Rains in California


Every time I visit the kids and we hug goodbye, it breaks me up.

Last night I took a red-eye from Los Angeles to Chicago so I could see Sunday appointments as usual. FD stayed on a half day more because he hadn't joined me in L.A. in December when I ran away for a long weekend with the first degrees. So he needed a little more time to get his fill.

We were in Miami only a few short weeks ago for barely a weekend to see the other side of the sandwich, my parents. It's hard saying goodbye to them, too.

If you know me by now, then you know I like life uneventful. I'm not so big on excitement. I like things to happen on time, people to be accountable, and days to unfold as predicted, within reason. So yeah, I get disappointed a lot.

But do you remember that song about rain in California? It never rains in California, but girl, don't they warn ya'. It pours, man it pours. . .

I got off that plane Thursday afternoon and dragged my beat-up carry-on outside to the curb where FD would be pulling up any minute with my grandsons in a rented PT Cruiser (a funny looking car that reminds me of the old Pacers, if any of you remember those). He hadn't rented it. Empath Daught's car was in the shop.

And sure. It's drizzling.

In a couple of minutes I see my grandsons making faces at me from the windows of that funny-looking red Pacer wanna' be. I pile in with my stuff and contort those uncomfortable greetings you ply when you're in the front seat and the people you're dying to hug are in the back seat. (FD is all business when he's driving airport traffic, no hugging him).

Within minutes the boys, 3 and 5, decide to be thirsty. This is a state of being for little kids. It's one of those binomial things. They're either hungry or they're thirsty when in an automobile. With adults it's all about the bathroom.

I whip out my phone to call Rac to set up a time to see my granddaughter, another thing necessary to keep me whole.

OMG, Rac cries. It's POURING here. POURING.

Sigh.

This is an event in Los Angeles, pouring. Not on the order of an earthquake, but it's huge. Rain is still unusual. There aren't any basements to flood, so it's hard for some of us to be truly empathetic, but they do have mud-slides and no one seems to know quite how to drive. Can I take the canyon? Dare I take the canyon?

We swing over to the K-Mart to buy a bottle of water and some cups to hydrate the boys. And a package of Tupperware. I had a bunch of small gifts, plastic frogs, bugs, that sort of thing, and want to prevent Empath Daught from stepping on them for days on end if I don't supply the containers. And I can't bare to see them strewn around in a morass of toys in the toybox. The boys actually take care of their toys if they have a method. I find this true of most kids.

The bottle of water, of course, is too warm.

We pick up Empath Daught, and as always, I'm overwhelmed at how well she looks. She could have walked out of Vogue. I say as much and she says, Well, you know how it is. I look kind of young, so if I wear anything but a nice, tailored look, they don't take me seriously at work. They treat me like I'm sixteen.

She's not sixteen. So although every other designer in Los Angeles works in jeans, sweats, or pajamas, my kid does not. She's dressed. And yes, given the chance, she's dressing me, too.

We have a great weekend and the sun comes out on Saturday for about 3 hours. I see the whole thing. The kids play all kinds of games outside (in January!) despite my insistance that these are not appropriate games. They like games like Hit the Orange with the Baseball Bat, Smash the Orange on the Side-walk With Your Shoe, and Whack the Tangarine on the Tree. Let's not forget Putt the Lemon. (Sure, I exaggerate. They only smashed two juice oranges with their shoes on the sidewalk and whiffed at the ones on the trees, missing completely.)

By Saturday evening the boys are worn out and my granddaughter blissfully exhausted. My son has scored some Garth Brooks tickets (GARTH!) for Rac, his deeply Southern spouse, who simply can't wait to get their little girl to bed so that she can get ready to see the true love of her life. I can hardly hug Rac goodby since The Controller has those little arms clinging tightly to her neck.

And it has started to rain again.

Y, my son-in-law, asks if I mind if he takes me to the airport. Do I have any special need for E-Daught to make that run? The weather's SO bad. Or FD, perhaps? Do I want FD to drive me?

No, Y. Any time to talk with you is a good time. The plane's delayed. After all, it is RAINING. The kids are in bed, so the four of us eat our fifty-seventh snack of the day, moussaka and Parmesan, you can't have too much of that, and gradually wind down the visit. When it's time to go, I hug my daughter goodbye.

FD catches the mist in my eyes. She hugs hard and well, one of those amazingly satisfying hugs you get when you've been apart too long and you're not sure, really, when you'll hug again. FD asks me for the third time if I have my boarding pass and my driver's license, and why am I taking this red-eye flight, anyway, past midnight?

Y takes me to the airport and repeats, at least a dozen times, I've never had to drive in this much rain before. I'm so glad your daughter didn't drive you.

Me, too. She should get some special time with her daddy. I think of the two of them together, the boys asleep, and feel good.

The flight's really late, of course. How could a flight crew possibly find their way to the airport in this weather, and so late at night at that? I'm sitting at the gate typing away at something and I hear my name called over the loud speaker.

There's this mixture of excitement and fear when that happens, you know.

I gather my stuff. They want me to change seats so a child can sit with her mother. Sure, I say. What am I supposed to say, No? Then I correct myself. Uh, how far back, um, am I going?

You still have your window seat and you're moving up a couple of rows, actually.

Actually, I'm sitting behind a crying baby and am effectively blocked from ever leaving my freezing seat at the window because two enormous men in blue jeans from Oklahoma are in Seats C and D.

I smile at them and remind myself that I'm flying a red-eye to see the Big Dipper from the window of Row 8, and to catch a sunrise peaking over a sleeping, yet dazzlingly lit major metropolitan city. And I want to see my usual Sunday morning suspects-- on time.

Despite the crying baby I'm asleep within minutes and wake up only to catch a glimpse of those stars (you can touch them), then go back to sleep. But before I do that, I think back on that goodbye in the valley.

It wasn't always like this. No trouble saying goodbye when they left for summer camp. No trouble when they left for Israel straight out of high school for a year, or two, or three of seminary/yeshiva. We visited.

No trouble when they left for college, and not all that much, really, when they married. As long as one was around things were okay.

And now we have two, perhaps soon, even more. So why now?

Oh, who are we kidding? It's not a now thing. But as I age, it does seem that I'm getting a little more vulnerable, a little more emotionally reactive. I know I've seen the phenomenon in my practice with other people, patients, even colleagues. Especially colleagues! But nobody ever warned me about it, really. I don't think I read anything about it in a textbook or a journal, and it seems that I never needed to know about this, particularly.
Am I generalizing?

So I did a little research. It seems that older people are actually happy. As we age, we have to learn to regulate our emotions. It's that or feel totally out of control. Our social circles get smaller and smaller (attrition) and we value the relationships we've got. So we either (1) reappraise the situations that make us angry, anxious or depressed (the stuff of cognitive therapy minus the expense of professionals) OR we (2) suppress the thoughts that bring us down.

Suppression is thought to be the least optimal solution, and is associated with memory loss, something none of us even want to think about.

All of this emotional work begins in late-middle age, supposedly.

I'm supposed to be getting a grip on my emotional reactivity. On the other hand, what if I like it? What if I think it's rich? What then?

My guess is that those of you with small children don't have to worry about this stuff for quite awhile. But don't say I didn't warn you.

Tonight I picked up FD at Ohare, Terminal 3, Baggage Claim 6. We took off our coats and he looked at my sweater a little curiously, a sweater that our daughter had insisted I wear home.

It looks so GOOD on you, she said, But it needs a good cleaning. Do you ever wear the white jacket I gave you?

Wore it all the time in Miami.

Good. Take this sweater. Please.

Honey, I don't need it.

Take it, please. Just take it. Besides, you paid for it.

Huh?

Sure. When I lived in New York, remember how I bought all those clothes, just charged them to your credit card? You were so nice to let me do that. This is one of the sweaters I bought when I was away at college.

You never spent that much. You bought this while you were at Parsons?

Uh, huh! And it's perfect for you. Tell them to get those little fuzzy things off, those pills, at the cleaners. They can do that, you know.

See? Things do have a way of coming home again.


therapydoc

Thursday, January 24, 2008

What Faking it Til You Make It Really Means

I get that blank look from people when I assign the behavioral task, Fake It 'Til You Make It. The blank look is fear of confrontation, usually, fear of a situation you know you have to face.

You know that you have to rise to the occasion, that you really should face a problem, a person. And your therapist and everyone else is saying that you have to Just Do It.

But how can you just do it if you've never done it and you're afraid you'll look like an idiot if you do?

The classic example is making the call. Say someone owes you money. It's your employer. And you know he knows that he owes you money. But he's been getting away with it because you haven't been able to confront him on it.

So your therapist says, Just get on the phone and don't confront. No need to be angry.
Just assert, meaning explain the facts nicely and reiterate that you haven't been paid yet.

Then nag. (My spin on this intervention). Keep calling. Call every day until you're paid, perhaps twice a day, until someone in management says, "Would someone kindly get this guy off my back? Just PAY him!"

This is still very hard, even doing it without anger, for many people. It's still hard to pick up the phone, and especially hard to do it every day, to become a nag.

I'll say, try to make it like you're just repeating facts, like you're reciting multiplication tables. Rote, no emotion. But to you, bringing forward the facts feels impossible. You're a little shy. You don't like asserting. So how do you fake it 'til you make it THEN?

It's not easy, but I think you have to make it fun. You have to raise the serotonin in your brain by seeing this as play, not work. And the way to do that is finding the other you, the other person inside (you have MANY you hardly even KNOW). The one who can do it.

People like to focus on the people inside that they're more familiar with, the ones with the faults and deficits their parents introduced to them as children (yeah, I get to bashing parents sometimes, as unpoplar as that is; this is one of those times).

But there is a person inside who is probably very angry at the self for not asserting, and angry at the other person for taking advantage of the person who doesn't assert. This other self is someone we can call The Advocate.

Or the Hero. This person wants justice in the worst way. This person isn't known as you, not yet, since no one, not even you, has ever heard from him except in fantasies. But this advocate resides in the wish department of everyone's psyche. The advocate, the hero, really wants you to be that person who opens up that mouth and gets you what you want.

You also want to get to know the actor. Yes, another one of the people in us who occasionally gets trotted out to play, but not nearly often enough. There's a potential actor in everyone, and this actor needs attention. You have to let the actor flex a few muscles now and again. You need the actor here to help the hero do her stuff.

This ISN'T faking it. These are real selves tucked in your brain.

Think of any movie, any television show with a leading character who tells it like it is even if no one wants to hear it. Someone like Marie, on Everyone Loves Raymond. (A whole post in and of itself, right?) Or think of ANYONE else who asserts that you can relate to, especially if that person makes you laugh. You want to act like that person. Keep that person in front of you.

We all have a little Homer inside of us. (Maybe not the best example). Act like your role model would act in the situation. Pretend to be righteously indignant. Deserving.

Aren't you?

Larry David, on Curb Your Enthusiasm is a good example. He's always asserting himself, but to a fault. He would return a torn shoe that he wore for 11 months and 28 days to Nordstrom. If you try to be like Larry you'll fall short, most definitely, of being as obnoxious as he is. You're not made of the stuff of cringe.

If you try, however, to be indignant, you'll be heard.

You don't have to be a Martin Luther King, a holy man. But we can say he inspired the idea. It was his birthday this week, and you observed it, right, so you maybe can learn from him. Have a dream. Make it so.

Once you feel a little righteous indignation, the next step is to bring out the hero and behave as righteously indignant. There is nothing to lose here.

You say, "Hey, I think you forgot to pay me for those six hours that I worked on Thursday doing inventory. When do you think you'll get to that, anyway?"

And when you do that, do you know what that other person is thinking, feeling?

Busted.

Way to go. You just brought out The Cop. You'll make a great parent.

copyright 2008, therapydoc

Tuesday, January 22, 2008

Leave your religion at the door?

I'm only writing this because I've done it myself. I'm guilty of it (well, not all of it).

I've let patients feel closer to me, better understood because we share the same Judeo-Christian values. That's not bad per se, but I think when it comes at the expense of someone else, it is bad.

It's a very subtle form of triangling and I don't think we, as therapists, need to triangle anyone, least of all someone's partner or spouse, mother or sibling, to have a good therapeutic relationship. Yet it's such a temptation.

Almost anytime a therapist disses someone else this process is probably insidiously at work.

Occasionally I'll get a caller looking for a frum therapist. Frum, in my world is a reference to religious observance. In this case, Jewish and Orthodox. This kind of call is really about the importance of ethnic and ideological values in people's lives.

People want their therapist to validate, not confront, their religious values. We all want a cheer-leader sometimes. We want someone who is culturally sympathetic when we talk about what bothers us.

A religious parent with a gay child, for example, does not want or need to be told, Hey, you're out of touch. Get with reality. He's not going to get married to a nice Catholic (Jewish, Baptist, Christian) girl. Lose the dream.

I actually don't think most therapists ever talk that way.

But I can see how a person might be afraid that we would. It's no longer cool to be homophobic. Heterosexism (the assumption that everyone is a heterosexual until proven otherwise) is a program that the American Psychiatric Association, American Psychological Association, and the National Association of Social Workers have deleted.

So our professional dogma, our authority isn't religiously-orthodox-friendly, exactly, and patients from this perspective might tiptoe carefully when choosing a therapist who will be emotionally supportive. One might even prefer to choose a professional who waves his or her religion like a flag, wearing their own personal orthodoxy assuredly. An organization for parents and friends of "ex-gays", Exodus International, has support groups and therapists who hope to change the sexual orientation of the conflicted many with love and twelve step programs.

It's not so farfetched that religiously orthodox patients worry that secular therapists might emphasize a modern agenda, not empathize with the pain of a parent, for example, who has to adjust to a child/spouse's sexual minority orientation. Or sexuality in general.

People worry about therapy hurting, sometimes legitimately. Hence that joke,
therapist = the-rapist.

These fears pop up over other issues, as well.
Pre-marital sex.
Abortion.
Intermarriage.

But despite what people think, it's not true that therapists will necessarily lack empathy for religious values that they do not share. Indeed, more "secular" therapists try even harder to understand languages that are new to them.

A good therapist will not preach liberal values or anything else, for that matter. Psychoeducation is not thumping a bible. Nor is it thumping a text book.

So the best way to choose a therapist is not to seek cultural sameness and the hope of shared values. What people really need to look for in a therapist is someone well-trained in the craft.

(So sure, get even more training somehow along the way, go beyond that masters. You don't have to get a PhD to get certification in most subspecialties.)

Someone who is well-educated, who keeps up with the profession, who has empathy, good diagnostic skill, and heart will take you where you want to go.

A good therapist knows how to zero in on the pain and knows whether or not to discuss it. The patient isn't supposed to be zeroing in on anything about the therapist, particularly, not the doc's religion, not the doc's shoes. The patient should be looking inside.

(It's why I personally don't wear much jewelry or loud clothing, you know, always an excuse for people to skip topic. I love your sweater, a present? And it's why I don't want to talk about Chanukah or the other Jewish holidays. )

Let's talk about you, I say.

But if a person wants a therapist of a certain color or creed, that's all well and good, it really is. It can be hard to explain one's world view, one's religious thinking, to someone who is unclear on the concept. Religious concepts affect how we think, and how we think affects how we feel. Religious cognition can play a huge role in psychotherapy.

One's ideology, such as a religion or ethnic value system, is also a cognitive map. So a patient might prefer a therapist who already knows his or her way around town.

The problem with that, of course, is that a religious or ethnic map is not the only map in the patient's head. Using this map to the exclusion of others will surely circumvent a therapy doc's direction, reinforce the confusion.

If you need to know how to get to Albany from New York City, having a map of Manhattan is nice, but it's not enough.

And people of the same religion and race are indeed a heterogeneous lot, very different from one another. Most people interpret and see things differently, even with shared values. More importantly, we live very different lives.

So knowing about religion, race, and cultural differences, while important, is not going to crack a case or even necessarily be much use to a therapydoc.

And yet, we have a professional responsibility to learn about cultural differences. Cultural diversity is taught to professionals in graduate schools (social work and psychology for sure) and has been since the 1990's.

Don't take those classes lightly, friends. One's cultural toolbox should always be open at the office. Even a cursory understanding of ritual observance and cultural mores will serve mightily. You might learn in school, if you pay attention, the answers to questions like these:

Do African Americans really need to hear how your day has been so far to be comfortable enough to open up? (some do).

Does it matter if a patient is a DOS or an SOS (daughter of a survivor/son of a survivor)? (uh, huh).

What are the laws of family purity?

Should an Indian woman from India expect to move into her father-in-law's home after marriage?

Oy. There's so much to know. How can we possibly know it all?

Which is exactly why some prefer talking to their local clergy person or finding a frum therapist.

It's the training that will matter in the long run, however, not knowing the patient's world view before the first session. Patients will teach us their world view if we shut up and listen. If we let them.

This is not to judge therapydocs who carves a niche solely based upon their cloth. On HMO panel applications sometimes there's a question asking providers to check off specialties. One of them is "spiritual counseling." Once I accidentally checked it. (These applications take a lot out of a person).

That meant MANY rejections from first time callers.
Oh, I wanted a CHRISTIAN therapist.
Never mind.

No matter what the world view or ideology of the therapist, to get back on topic, we have to address this triangulation thing.

It's not okay to ally with one person in therapy by beating up on someone else using cultural or religious values as sticks. (We're talking beating with words, obviously, insinuating that another family member or perhaps even boss, friend, is bad). This isn't a good idea even if the one taking the beating isn't there in the office.

When it comes to first degree relatives, no matter how awful you, as a therapist, think another family member has behaved, it's not your job to meet out the judgment.

It's pretty hard not to do that, believe it or not, not to call someone who has sexually abused a patient a bad name. Deep breaths, sighs, slow turns of the head, nods. These communicate disapproval just as well. And yes, when it comes to abuse of all kinds, feeling disapproval is okay.
It has to be. Communicating it and how, deciding IF you should be communicating it, is the issue.

Sometimes yes. Sometimes no. It's a call that should be based upon context. It's a thoughtful call.
Remember your patient either has chosen, birthed, and may share quite of bit of that other person's DNA. So it's best not to join with the patient's anger. It's not your job to be righteously indignant.

Someone has to stay level.

A nice example of what I call beating on the sinner is when one partner/spouse presents as a victim of another's infidelity. This spurned partner comes to therapy and says something like:

"My wife (husband/partner) came on to a co-worker (friend, tennis pal)

And they did it in our living room (bedroom/dining room/car)."

Disgusting, you want to say.

But do you? Do you even dare judge the partner who cheated? Do you even know that it's true? Is your patient such a virgin? So many other possibilities going on here.

In such a case the patient clearly wants empathy for the pain, the rejection. That's the therapist's job. And the patient needs where to go from here. Although punitive fantasies (don't you want to just kill him/her?) can be therapeutic, they're not to come from you. You're a therapist, not a cheerleader--not a judge. You look at your patient and say, Tell me more. This must have hurt, this indiscretion.

Believe it. It hurt.

There's no beating up the partner, whether he or she is around or not. No thumping or pointing to the Bible, and no assumption of guilt or that the complainant is even telling half of the story. But we can't intimate our doubt, diminish the power of a patient's narrative, regardless. We stay empathetic.

And when the "errant" partner is in therapy with us, we can't say, not ever, What were you thinking?! People beat themselves up enough without our help. (Okay, you actually can ask that question, but NO attitude. )

For not being a rabbi, I preach pretty well, no?

Religious values can and should be part of therapeutic dialogue. The values we talk about matter because they are the patient's values. They are what drive many of the patient's thoughts, and as such are clinically invaluable data.

Our values are irrelevant. Our values aren't under discussion. When a patient asks us, Well, what do you think? we turn it back on them, What do YOU think? Seriously. Tell me.

Or:
And how did that make you feel?
What did you want to do about that?
What would it be like, doing that?
Do you want to work on it?
Do you want to talk to her/him about it?
Does he/she want to talk to me?
Why not save this relationship?
Should we work to save this? Is that a goal?

Sometimes people don't want to save it. And that's okay, too. I always suggest they wait awhile, however, before signing on the dotted line, dissolving the relationship for good. Work on it in therapy, try to get past the hurt and anger in any case.

Anger especially, is never easy. Yes, it can take many months, sometimes over a year to get past the indiscretions and hurt. But most of us have time. And just leaving the "problem" doesn't always make us feel better. (Sometimes it does. Sometimes it doesn't).

Best first to look him or her in the eye. Take a good look at the reality of the situation. Talk about it. At length. Change. Both of you change. Because you know, after all, that everyone needs therapy.

And you can always talk about where that soul is going with your clergyperson.

copyright 2008, therapydoc

Saturday, January 19, 2008

National Association of Computer Guys


You know your guy is one of them if:

You can't get ahold of him

He can always get you the same thing you just got online for 20% less

He has at least one other full time job

He just can't possibly explain what he's just done to get your computer working again; he's not even sure himself

It's always the fan

He's probably going to replace the fan

He says to you, "Where did you get THIS router?"

He tells you that AOL really will take over your computer and he's right. Skype, too. Norton, for sure. Get rid of all of it.

He always has an extra router/cable/modem/harddrive enclosure that you can borrow because he really doesn't need his.

Only HE knows the name of your computer

He's the only one who knows where your network key is saved

He's the only one who can restore anything if your computer has really crashed, including your network key.

He knows enough not to coach you through the motions over the phone.

Next to your significant other, your mom, your therapist, and your primary care physician, he's one of the most important people in your life.

He won't charge, but will accept money

He knows how much you need him but doesn't rub it in

He won't eat, but might take a cookie for the road

Both of you pray that one day he'll be able to send someone else out to fix your computer, but deep down you really enjoy your time together. So you dread that day.

He's always saying to someone on the phone, Soon. I'm almost done.

He'll be in your neighborhood next Thursday.

therapydoc

Thursday, January 17, 2008

Controlling Your World and Everyone Else's While You're at It

Two year olds are funny in that not only do they want to control their own worlds, but they want to control yours, too.

Rac called me and left me voicemail around 5:30 or 6:00 p.m.- prime therapy hours if you're uninformed. It's the end of my day, my last appointment, the phone's been ringing all day, not that I've answered it, and I see there's voice mail on my cell phone. I look at "Missed Calls" on the Treo and say to myself, G-d, I hope they didn't crash the car.

But instead of checking to find out, I avert my eyes from the phone, look at you, and nod.

FD and I are to babysit and I'm guessing Rac is too embarrassed to leave him the message. So she leaves it on my voice mail. We women understand.

Rac:


I know you've raised 5 children and you know what to do. But your granddaughter's a little crazy and she won't go to sleep unless you do the following:

You have to sit down with her and put her head on your shoulder and cover her with the blanket. She should have the bunny in one hand and another stuffed animal in another. She'll know which one.

Then you sing the songs. (I've told her earlier in the day that I printed up the words between patients).

Then you put her head on the bunny and lay her down, and cover her up. You walk away. She'll whimper a little, but that's okay.

Sure, Rac.

Since we're in No Bubbie! phase, I say to FD, "Knock yourself out. I wrote up the instructions and the words to The Song. Take them with you."

He takes the kid upstairs to her crib. I'm down in the kitchen, doing dishes. I hear my granddaugher screaming. I can't take it. I go up to see if No Bubbie really means, No Bubbie.

FD doesn't even have the instructions in his hands. He's lost them. The light in the room is on. He does not know the words of the song, nor the tune to the refrain. The kid is an emotional wreck, screaming for Rac.

I turn off the light, grab the words of the song (I've left them on the ironing board) and take the piece of paper to the doorway where there's a little light. I begin to sing. Why are there so many songs about rainbows?

It's not good.

NO BUBBIE SHING. NO BUBBIE SHING.
Well, we can't blame her for that, can we? I walk away, settle into doing something in the room next to hers, the one with the ironing board. She's screaming. FD is helpless. I grab the words to the song again, barking an order from the doorway at him.

"I'll say them. You sing them." (He's holding the kid in an armchair in the dark that Little One literally scored one day from someone's front yard after vending at Wrigley last summer. There's so much you don't know.)

We sing Rainbow Connection about seventy times.

Me: Why are there so many. . .

FD: Why are there so many. . .

Me: Songs about rainbows.

FD: Songs about rainbows

She finally falls asleep in FD's arms. The parents come home.

Great instructions, Rac, I say. Worked like a charm.

She went out? She's asleep!?! You're joking!

Well, of course. No problem. We sang the song.

I can't believe it!

Believe it, says FD.

Here are the words in case you need them, and sure, let's let Kermit sing it for us. This one's for you, Rac. SUCH a good mom.

She's got the rituals down. You should see bathtime.





Written by Paul Williams and used by Kermit the Frog, of The Muppets, Jim Henson Productions

Why are there so many songs about rainbows
And what's on the other side?
Rainbows are visions, but only illusions,
And rainbows have nothing to hide.

So we've been told and some choose to believe it
I know they're wrong, wait and see.
Someday we'll find it, the rainbow connection,
The lovers, the dreamers and me.

Who said that every wish would be heard and answered when wished on the morning star?Somebody thought of that and someone believed it, and look what it's done so far.
What's so amazing that keeps us stargazing?
And what do we think we might see?
Someday we'll find it, the rainbow connection,the lovers, the dreamers and me.

All of us under its spell, we know that it's probably magic....

Have you been half asleep and have you heard voices?
I've heard them calling my name.
Is this the sweet sound that calls the young sailors?
The voice might be one and the same.

I've heard it too many times to ignore it.
It's something that I'm supposed to be.
Someday we'll find it, the rainbow connection,
the lovers, the dreamers and me.

La, la la, La, la la la, La Laa, la la, La, La la laaaaaaa


therapydoc

Wednesday, January 16, 2008

Anxiety, Ethics, and Blogging

Mi emailed me after reading comments and said, "I think it's so nice that people see themselves in your blog."

Well, yes. And no.

FD brings home throw-away medical journals and will occasionally cut out an article of interest. "Read this," he says, tossing me a shiny, neatly-folded page. "Tell me what you think."

This one's from Family Practice News.
Point/Counterpoint: Do physician bloggers compromise patient privacy?

I'm not a physician, of course, but all mental health professionals have an obligation to protect patient privacy . So the article is of interest. And it's about blogging.

Two docs, one a neonatologist, (talesfromthewomb.blogspot.com) and one a psychiatrist with a private practice, face off.

The psychiatrist believes that physicians should not blog. She argues that when medical bloggers write, they swing the power to expose patients, breach confidentiality. She cites an extreme case, a blogger MD who tells of an 18 year old patient who birthed her third child on Xmas day. The tone of the post is heavy on the musar (criticism or value judgement in Yiddish).

She is right about that case, for sure. Clearly the age of the patient and date of birth of a third child are identifiers, and it is likely that the young mother, albeit blessed, would be embarrassed and distressed had she read the doctor's judgmental words about her on the Internet.

Closing argument?
Patients should not have to ask their doctors if they blog before they feel safe to agree to treatment.

The neonatolgist, Tales from the Womb, counters nicely, making the point that he blogs under his real name because being anonymous would dilute his authority. That implies, to me, that what he's teaching really is important, and blogging is a way of disseminating that information to the public for the public good. It's not so simple, physicians should not blog.

Authority, by the way, is something Psychotoddler, also an MD, told me I would lose when I took my name off this blog, fearing home-invaders more than anything else. It's an anxiety thing.

Tales feels that using methodology that carefully disguises detail in the enactment of a case adequately addresses the psychiatrist's complaints. Teaching begs examples and good teachers find them. So he takes snippets of old case material, changing every identifier including, but not limited to (a) biological sex, (b) time, (c) gender, (d) age, (e) race, (f) marital status, (g) political preferences (h) sexual preferences, (i) geographical region, (j) occupation, and (k) socioeconomic status. We have MANY demographic qualifiers to play with.

Family therapists can manufacture fictional demographics for everyone in an example, changing great-grandparents into adoptive gay uncles if necessary to make a point. It's not too hard to do a rewrite with a little imagination and still not sacrifice verisimilitude.

Writers enjoy this effort and professionals who blog, face it, are writers. We're professionals first, however. It's in our blood to protect you. Ethics are mother's milk. We spend hours of classtime digesting them.

So. You can see whose side I'm on. And to reiterate, when you read a case on this blog, it's never a real situation except perhaps when I talk about myself and my family, and even that can be hyperbole except for me liking a good sandwich. And who doesn't?

To teach a decent class about health or mental health, however, we need more than our families of origin in the credits. There's just so much pathology in any one clan.

The point though, is that you have and will continue to have many good professional blogs out there to choose from. But when it comes to this one

. . . even if a situation feels VERY familiar to you

. . .even if it feels I'm speaking TO you

. . . even if it feels that surely I have written a post BECAUSE of you . . .


It's not about you.

And on that note, can we please get back to work?

About six months ago a publicist sent me Dancing with Fear, a book by psychologist Paul Foxman. I agreed to post on it only if I liked it, but warned her that a book like this is at the very bottom of my list of things to read. Like I want to read another book on anxiety when I could be drooling over Vogue? Come on.

So for months the book occupied a place in a heap of journals and books on the floor next to my bed. And every time I looked at it I felt guiltier and guiltier. It got to the point that the guilt just got to me.

What could I do? What would you do? I sucked it up and gave it a good skim, enough to recommend DWF to those of you who need more on those cognitive-behavioral techniques that I feel are so key to emotional management.

Dr. Foxman has lovely discussions on anticipatory anxiety and the must have coping strategies that you need to cope with excruciating anxiety. And he's not afraid to talk about sex, the natural tranquilizer.

You'll find those shoulds and what ifs, the obsessive thoughts that undermine your rational thinking, and pages and pages on proper breathing, yoga, diet, and muscle contraction/relaxation. Some of these things (breathing and muscle contraction for sure) should be taught in elementary school. How are kids supposed to get through test anxiety without them?

Dr. Foxman takes on everything from the biological events that define our anxiety, to psychological defense mechanisms, sleep, food, and drugs. He may discuss visualization, too, but I could be imagining it. And if you like self-disclosure from your therapydoc, you'll like his candor about his own disorders.

I didn't see What Goes Up, Must Come Down, my theme song for anxiety, but maybe it's in there, too. Coasting through a panic attack, just breathing normally is the way to go, rather than fighting it. Knowing that you'll eventually resume your regular programming is the key.

But I'm pretty sure he does emphasize that therapydocs are not so into control, to quote the psychiatrist in the movie, Ordinary People, because needing control makes us more anxious, and it's elusive.

Enough about fear and the movies. Check out the book next time you're spilling coffee at Borders.

If you also want a book that's truly gripping, a page turner that scares you yet keeps you in it because you know it just has to have a happy ending, read Lori Schiller's biography about her struggle with schizophrenia, The Quiet Room, written with Amanda Bennett.

I couldn't put it down. Here's a link to a blurb from Lori that she wrote while working on the book.

Oh, wait. There's just one technique that Dr. Foxman's encyclopedic paperback forgets to mention. This coping strategy really does quiet the brain, requires no meds, but is quite psychologically addictive, caveat emptor, so I recommend it in small doses, one or two games at most (sure, start 'em over again until you win).

Yes, it's that computer game, Spider Solitaire. Before you reach for the stupid Tylenol PM or whatever garbagey over-the-counter sleep medication you use,

Go to the Start menu. Find Accessories. Click on Games.

OR go out and buy a couple of books. Go to bed, lie flat so the blood flows to the reticular formation in the back of your brain, and read.

You'll never look back.

therapydoc

Monday, January 14, 2008

One of the last Carnivals of All Substances


Ya' gotta' love it. I took these pictures (well, not the strawberries*) in the stairwell of a Winston Towers condo building in Miami Beach, median age resident 62, maybe higher. Yet there's a revolution going on. Can you imagine the condo association meetings? Someone plastered those signs from the 24th floor on down to the lobby.

This was going to be, and probably is the last carnival of all substances. Most of the submissions are either selling something like Hoodia Gordoni, botox, HGH, a new sleeping aid, or vitamins. Or they extol the benefits of herbs, organics, and alternative life styles.
Frankly, we were reaching here for recovery stories, the kind that make a person stop and think.

And I'm just not getting any of those. I did a little reach out to my buddies at the 12-Step blogs, asking for some help, but only got a couple of nibbles.

So it's time to move on for now. There's still Obsession! a blog carnival due to post at the end of January for those of you with obsessive thoughts, compulsions, or children.

One last time, let's go in the order received.

Tracee Sioux is still ranting against smoking. We're putting you on the board, Tracee.

And Erin, at What Winners Do, one of my favorite recovery bloggers, asks the proverbial question, is a jones for a substance an addiction or a mental disorder of those weak of will? We therapydocs usually hold by two diagnoses, dependency and abuse, but You might like to read this.

There's something about tea drinkers, Southern tea drinkers specifically, that makes me just want to brew up a pot and mix it with tons of sugar and sip it through a slice of lemon. Read about that side of the Mason Dixon line in A Public Diet.

Dr. Hal chimes in thinking he can rewire your urges to smoke and drink (everything's got to be rewired, you know, since Tim Allen of Home Improvement got us all started.)

Blue Skelton Productions warns us not to watch the movie Smiley Face about a pothead. She shows the trailer and it really does make pot smoking look very sad, indeed. So maybe that's a good thing. Surely it's cringe, but some people like cringe.

Stop Drinking Advice.Org tells us to meditate AND use CBT (cognitive behavioral therapy) to stop drinking. I'll tell you right now, though. You don't meditate AND do CBT at the same time. That's for sure. They do not mix.

Wellness Junction tells us NOT to go into McDonalds if it's the Big Mac attack that drives your compulsion for Pure Junk. She's got something in the post about an "accountability partner" that sounds interesting.

Karen at the Bilerico Project, an LGBT awareness/rights blog informs us that meth, MSM (men who have sex with men) and HIV all vary together in a study of Californians. That's a scary thought. I'm having my research methods class take a critical look at this.

Carol Bentley who writes copy can't lie about the products she recommends. Well, she can, but it doesn't usually come out authentic. She's serious about a particular chocolate that's supposed to be good for you. I just report the news, folks, I don't do the research, so take it with a grain of salt. Or would you say, a glass of milk.

Rita's path to fitness is exercise. Just move, she says. Like I said earlier, this is not a fitness blog per se, so I shouldn't have considered this post for today's carnival, but exercise does raise endorphin levels, so I gave it a little lee-way.

HOWEVER. This is it. The Carnival of All Substances is hereby on on hiatus. Too many off-topic submissions, too little patience on my part.

*But just out of curiosity, do you think that strawberries really can cure cancer?

therapydoc











Wednesday, January 09, 2008

The Perfect Friend

There are so many deep things we can talk about on this blog.

So did anyone see Desperate Housewives Sunday night?

As far as I know, only Empath Daught and I own up to watching Desperate religiously. We hadn't discussed it at all this season, but a couple of weeks ago, right after the tornado episode (great television) I called Daught traumatized and pleaded with her.

"I know, I know you're busy with the job and the kids, I know. But by any chance, have you watched Desperate lately?"

"OMG yes!" she cried. "Did you believe that tornado?! Isn't the show amazing this season?"

Yes, in a word. But Sunday's show, the one following the storm, had only a few good moments, only a few scenes that really got to me emotionally.

They're usually the ones with Felicity Hoffman. I'll watch the whole show, alternating between treadmill and exercycle, knowing that some of it will surely be boring and annoying. But oh, those moments! When it's good, it's splendid.

Anyway, I'm going to tell over one of the scenes right now to make a couple of points, one about friendship, the other about the need to be perfect. How I'll relate the two is anyone's guess.

So as you may know, one of the housewives, Bree Hodge (Bree Van de Camp before she married Orson Hodge) is a perfectionist. She casts a spell over everything she cooks, everything she bakes. Her house is immaculate. She irons her sheets. She has a spice garden. She's gorgeous, always dressed. Her make-up's perfect. Heck, she's Marcia Cross.

Her house is wrecked from the tornado and her friend Susan (Teri Hatcher), always the people pleaser, offers up her home as Bree's temporary residence. Susan's daughter Julie (Andrea Bowen) is really upset about it and correctly predicts that Bree and Orson (also a perfectionist, played by Kyle MacLachlan, I love him) will be moving furniture within the hour.

But Susan can't say no to Bree. Make yourself at home, that's what friends are for, she says. We help one another. The show thrives on hyperbole, which is why it's cute, of course.

By evening the next day Susan returns from work (I guess she works). The ambiance in the house is sensuous, the room lit by candle light, the table set. Classical music filters through the the house and remarkable smells waft from the kitchen. Julie sweeps down the stairs to greet her mother:
"Welcome to Heaven," she says, obviously thrilled.
And it is heaven. They realize they can get very used to Bree, very used to ironed pillow cases and the smell of lilac.

But of course there's conflict. Bree essentially pimps out her own son to a gay roofer, hoping the roofer will move along the construction. Susan squashes the plan because she doesn't want the roofer to hasten Bree's exodus from her home.

Bree sits Susan down To Talk.

Susan fesses up. She doesn't want Bree to leave so soon because having her there is keeping her sane. The only reason that Susan is functioning at all is that Bree is there, taking care of her. Without Bree, Susan can't make it right now. She has issues. She's pregnant and her husband is in drug rehab.

But basically, Susan is Teri Hatcher. She has to have issues.

It's not codependency, it's friendship. Bree softens up, bakes Susan cookies, brings her a glass of milk. That's what friends are for.

So we need to take a second look at this, my friends. Bree's natural care-taking qualities, the way she takes care of house and home. "Heaven" is holding Susan together. Susan feels nurtured. She's fed, literally.

But as much as Bree is a perfectionist at material things, and gets it that her friend needs her, as a parent she's a disaster. Pimping your son? Is the lesson here that perfection is in the eye of the beholder? Or is it that denial rules. I can make a perfect crème brulée and pimp out my son.

Pick Door Number Two.

Therapists tend to pick at perfectionists as O.C., obsessive-compulsive, but that's really not fair. There are people out there who can do it all, parent well, keep a great house, attend to their parents and spouses, call their aunts and uncles, deacon at the church. And they don't always crack under the pressure, either.

At the risk of simplifying, it depends upon the support system, among other things. Energy out versus energy in. A person needs balance and a vacation now and then to function consistently well. A rewarding job really helps, add exercize, maybe spirituality, too. And eliminate all those other variables like an onset of depression, loss. Resolution of family of origin and marital issues helps. Getting handed divorce papers, on the other hand, can blow your whole day, really put a dent in the vacuuming.

Add it all up, make your subtractions, and trying to to be perfect might just net you headaches, ulcers, sleeplessness, all kinds of stress related physiological feed back.

Sometimes it affects the kids, too, setting that bar too high, either for yourself or for them. Demanding, perfectionistic parents are a challenge. Most kids have difficulty flipping them off, as hard as they'll try to rebel. And if they don't rebel, they're the ones with the headaches. Or they become care-takers, possibly co-dependents. Surely I'm simplifying. There are other outcomes.

Like a child's self-esteem, for example, that can suffer in the process of making mental comparisons with the perfect mom, the perfect dad. To me, the perfect mom lives in the shadows. Maybe not in the shadows, but she tries to stay backstage, be there as the working memory on the family computer that never breaks down. She's not perfect. She makes mistakes and owns them.

I think the saying is To err is human, to forgive, divine. Error makes us palpable, it's what we can relate to, the fallibility in our personalities and in the personalities of others.

Bree manages to make the perfect quiche. Do we really care?

Well. . .

Listen, we LIKE a good quiche. That kind of perfectionism, making the tangible in life excellent, is only dysfunctional when it hurts, when it's achieved at the expense of self (too much energy out) and something more important, like a child or spouse's well-being, or neglecting an elderly relative.

And perfect, it's my job to tell you, is only one level of functioning. It's nice. It's a very nice level. But it all depends upon what you're measuring.

It's nice to make a great dinner and not burn anything :)

It's nice to fold the laundry well, make the beds, sort the mail and pay your taxes on time. But doing it really well when other things (like people) get less out of you might mean that although you're functioning very highly, perhaps you're not really functioning well enough.

So yeah, we therapydocs tell you to drop it. Drop your coat on the floor, leave the dishes on the table for awhile, give the brain a rest and play with your kids.

Although Bree's perfectionist home-making make Susan feel nurtured, it's questionable whether or not her perfectionism really mattered all that much to Susan. I'm guessing that the perfect crème brulée is what we call the spurious variable in therapy. It just so happened.

The variable that matters, surely, is Bree's understanding. Her empathy cements the friendship. And let's not forget. Susan confides in Bree, she trusts her. I'd say pick Doors Number Two and Three, Trust and that corallary, sensing the freedom to speak intimately. A real blessing if you have that. It's not a given in life.

Indeed, the television is probably the best friend for millions of people who live alone.

So if you've got a friend who will make you cookies when you're down, you're incredibly lucky. And if she's understanding, and on top of that, makes really good cookies? Luckier still.

therapydoc

Sunday, January 06, 2008

Acute Stress Disorder

There's nothing cute about it. It's an anxiety disorder, 308.3 in the DSM IV-TR.

But since you suffered through that last post you deserve to know the symptoms of Acute Stress Disorder. You can decide for yourself if this therapist has it. NO, I didn't sleep well last night. But it could have been the chocolate ice cream at 11 pm, don't you think?

A. The person has been exposed to a traumatic event in which both of the following were present:
(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
(2) the person's response involved intense fear, helplessness, or horror
(B) Either while experiencing or after experiencing the distressing event, the individual has three (or more) or the following dissociative symptoms:
(1) a subjective sense of numbing, detachment, or absence of emotional responsiveness,
(2) a reduction in awareness of his or her surroundings (e.g., "being in a daze")
(3) derealization,
(4) depersonalization,
(5) dissociative amnesia (i.e., inability to recall an important aspect of the trauma
C. The traumatic event is persistently reexperienced in at least one of the following ways: recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving the experience; or distress on exposure to reminders of the traumatic event.

D. Marked avoidance of stimuli that arouse recollections of the trauma (e.g., thoughts, feelintgs, conversations, activities, places, people

E. Marked symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor restlessness).

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or impairs the individual's ability to pursue some necessary task, such as obtaining necessary assistance or mobilizing personal resources by telling family members about the traumatic experience.

G. The disturbance lasts for a minimum of 2 days and a maximum of 4 weeks of the traumatic event.

H. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition, is not better accounted for by Brief Psychotic Disorder, and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.

Saturday, January 05, 2008

Working it out

Settle back. We're talking on the order of That Bruise on the Face one of the more intimate posts (January 31, 2007).

Meaning this one's embarrassing.
As in,

Do I write about this? Shouldn't I be embarrassed about this? What will my friends think? Won't my mother worry? Shouldn't I worry? Such a clutz to let this happen.

Aw, here's the story.

On Thursday nights I usually try to let everything else go, concentrate on cooking and baking for Shabas, the Jewish sabbath, which begins on Friday an hour before sundown whether we're ready for it or not. We can't do any cooking, no work once the bell rings, metaphorically speaking, although there is a siren in Jerusalem. In truth, after candle-lighting, all semblance of work stops.

I love it, the Thursday night preparation. I cook, talk on the phone, blast the radio, maybe take a break to watch The Office when there isn't a writer's strike. FD is playing basketball or at shul or both. Friday will be a work day and although leaving work early enables me to get most everything done by sundown, it's soothing to know that the meal's in the bag, the table's set, the chala baked, everything's ready. There's less pressure. It's terrible being so neurotic, but if you live your life on Jewish time, there's no alternative.

Sometimes I have it so in the bag there's time for a manicure on Friday afternoon. Right, and if you believe that. . .

No, really. And in the summer, when sundown is really late, I'll grab FD and we'll take in a movie on a Friday afternoon. Now that's fabulous.

Anyway, back to the story.

We've got a simple 4-burner range, a GE self-cleaning electric double oven, that was popular in the eighties. The smaller of the two ovens hangs about 11 inches above the range that's just above the larger of the two ovens. The thing looks a little like a crane, like it belongs on a construction site.

Sometimes having that smaller oven just above the stove makes cooking a little awkward, too. You can't get to the back burners easily and have to remove a pot from the burner to see what's going on inside. Tasting can be a challenge. You stick that big spoon in there and inevitably spill the soup on the way to your mouth.

So Thursday night I started a lovely vegetable stir fry on the right front burner and was about to make some popcorn. For corn I use the left back burner, the most powerful, reliable, if less accessible burner on the stove. This stove is about 22 years old, so the thermostats require a little mental accommodation. But if I want to cook something fast, I'll use that back burner, the one that always works and burns consistently hot like it should.

I added the oil to a 6 quart pot that I use mainly for popcorn, but didn't add the corn.

Somehow I got it into my head to check comments on the blog.

New metaphor for life and foreshadowing: You don't see electricity unless it's glowing.

So I get that urge to check comments and go upstairs, log on, scan the mail. I don't know about you, but when I post a comment, I might visit the person who commented if she/he has a blog, read a little. I love this stuff, love this community.

Suddenly I hear a crackling sound. That's all I can say. It's literally crackling. Something's crackling. I rush downstairs, worrying about my stir fry even though I'm sure I left it barely simmering. But I'm wondering, "What's That Noise?"

There's a foot of smoke under the ceiling in the living and dining rooms.

That noise is fire. It's always fire. You know it, you really do, before you see the smoke.

I dash into the kitchen, scared but tough, not panicked. It's surreal. There, on the stove, I've got a bonfire going in the popcorn pot. I'd left that burner ON, obviously, and the oil did what oil will do. A bonfire is blazing on the stove, flames licking upwards to the top oven.

You could have roasted marshmallows in that thing. Forget marshmallows. You could have roasted a chicken. It's smoking, flaming eight by 15 inches within and above the pot.

Plus, the top stove caught, the fan's ventilation grate is dripping flames. Apparently I don't clean as well as I think because the oil on that grate caught mightily. The fire glowed right through. That was the Extra Crackle. This is fire.

I grabbed for the salt. My mother taught me long ago to use salt to put out fires, and it works. I've put out lesser fires in the kitchen, the types most of us have if we're not careful when oil splatters. (I use a lot. The kids joke that if I can't stir fry something, then I won't bother eating it, and there is a grain of truth to that, except for a baked potatoes with butter. You know about my sandwiches already).

I completely forgot about the fire extinguisher, but the salt worked.

And I spent the evening washing walls, ceilings, cleaning the stove. It was penance, surely, for my carelessness, and many times I thought to myself, Am I losing it? What's wrong here? Can I even tell anyone about this? I'm so embarrassed.

FD came home and I told him. He said, "Yeah, you have this tendency of cooking and leaving the stove. Maybe it's not a good idea, huh?" Then he raised an eyebrow. "So what distracted you this time?"

I could end this right there, of course. But I won't.

The stir fry, you should know, survived. It was really good, too. I was careful about throwing the salt, didn't want needless clean-up. And food is food. We don't waste it.

We were actually invited out for Friday night dinner. I was bringing over the veges, a sliver of a Friday night Shabas meal that's generally a 12 course spread. There's nothing more wonderful, by the way, than having one of your kids cook for you. Cham did an amazing, amazing job, and it's rumored that Duv helped, too. I saw him cutting the melon.

Anyway, I found myself telling the story about the fire at the Shabas table. This wasn't my intention, you should know. And as I'm telling the story I'm aware that I'm still working it out. I'm doing what we all do in therapy when we tell over something traumatic. We work it out. Get rid of it. Leave it, leave some of it, at least, somewhere else. Even knowing that the story made me look like a scatter-brained, terrifically flawed individual, I HAD to tell it.

Big deal, right? By repeating stories, word for word, sometimes over and over again, we work them out.

Now. That's the psychological piece.

But a religious person has an even greater test, a more important mind-game to wrestle when something bad happens. Just getting rid of traumatic events, purging them from the psyche by telling them over so often that the brain literally gets bored isn't enough. Stories will lose their intensity on the twentieth take, usually, so retelling works for post traumatic or acute trauma disorders. Wonderful. But. . .

It's not rich.

Indeed, it can become a So What if you let it. For some people the There but for the grace of G-d go I thing means Take a deeper look.

A religious person will look at something bad that's happened in two ways. (Wait a minute. Now that I think about it, you don't have to be a religious person at all to think about it in these two ways!)

Okay, so I take that back. Everyone can look at an occasional traumatic event in the following two ways. It's called making cognitive sense out of the trauma. Again, mastery.

(a) What am I supposed to learn from this? (b) What does it mean for all of humanity?

Notice I didn't add, (c) What did I do wrong to bring this on? or Why am I being punished?

It's really not up to me to tell you that the Old Mighty isn't punishing you when things go south. How am I supposed to know? I personally think, however, that it's more functional and accomplishes the same purpose to ask, What am I supposed to learn from this?

I'm not going to tell you the things that went through my head on Thursday night after the fire, but they weren't too far off from Don't Leave the Kitchen When You Have Something on the Stove. I'm not very deep when it comes to self-reflection.

But the bigger question, the one about humanity hit me at the synagogue this morning as that image burned itself deeper into my imagination, that vision of fire on the stove, the distinct crackle of burning metal.

Fire, destructive fire, should make us think. Maybe about ourselves, and how we should be more careful in general, but maybe simply about the BIG FIRES, how people use fire destructively.

I'm thinking about the fires that blazed in Europe during various regimes, over several centuries, burning martyrs a stake and books and scrolls, and even ordinary people, too, culminating with the ovens, the crematoriums of WWII.

Or the fires that blazed across the South when the KKK burned down homes, burned(s) crosses in the name of White Supremacy.

This kind of insanity still reigns. Terrorists make fires. They bomb buses, restaurants, hotels, ships, embassies. Suicide bombers burn people. Is this culture ever going to die down? I'd like to know.

So yeah, sure, it starts with a kitchen fire, and now it's an anti-terrorism rant, ostensibly to educate young children not to blow themselves up in the name of . . .what? There are these anti-terrorism campaigns going on. We should support them. I'm voting for the first candidate who talks about re-educating would-be, wanna-be terrorists (blee neder, no promises on the vote thing).

Catastrophes happen, often intentionally. My little kitchen fire is nothing. It's only something to me because as I wipe the soot off the kitchen ceiling (I'm not finished) and am thinking we'll have to paint again, I have to say to myself, perhaps pray, Lo Aleinu.* No more.

The good news, of course, is that the pot is about as kosher as it's ever going to get.**

copyright 2008, therapydoc

*Lo Aleinu means, It shouldn't happen to us.
**One of the ways of making a cooking utensil kosher is by heating it until it glows. Jews use blow torches for Passover, a closet pyromaniac's favorite holiday.

Thursday, January 03, 2008

December Back'acha'

Back to saying thanks to people who have linked over here over in December. If I forgot you, give me a shout and assuming you're nice and have a relatively clean blog, or a blog about clean relatives, I'll get you next month.

Doing this also allows me to find out if anyone's got a grudge against me (we'll be talking about grudges next post) and I can try to make peace, apologize, rectify the situation. You can't let people hold grudges against you if it's at all possible to make peace, you know. Bad karma.

Off to the posts last month. Between burning the cookies you wrote:

An important post about going off medication abruptly. I told Dr. Deb that doing that can really screw up your "vacation." If you're taking medicine, always work out that vacation with your doctor before deciding it's time to go off of them, or "forgetting" to take the meds for a couple of days.

And just to remind you about why people do this, read Just Me a master of irony, who bemoans (rightly so) the weight that the psychotropics usually puts on.

Dr. Mori has a nice carnival on eating disorders, primarily blaming eating issues on body image issues. She included my nap post. It's probably time for me (or go ahead, someone else) to write the family therapy take on this, right? (Surprise, it has something to do with wanting to (a) please the parents or (b) please the parents).


Joel linked here to our last post about the check out in his Insert a Metaphor carnival. You know how I love metaphors. Look for sex posts on this blog for more on that.


For more on metaphors and a little practical advice, check out Mixed Metaphor.net . MM is hosting a carnival of family life.


Living in Stigma is hosting Mental Illness carnivals (no clowning around here, friends). Bloggers are blogging, and the host lists a bunch of resources.


Family Village hosts the SAHMS, Stay at Home Moms, also seriously resourceful.

And Observations from Missy's Window features movie reviews by other bloggers, always a good idea to check those out before you shell out ten bucks.


Here's one, a psychantenna feed. You know how we like to be fed. And another by a budding play therapist, AnnD. Surely that's got to be one of the better gigs, no?

Mass defective tells me that Post Secret cut off half of the secret on his post card in the posting, which changed the substance of the secret. This is why bloggers should be bound to certain ethics. We need a code for this profession.

A nursing student (you know I love you nurses, always a hats off) presents a list of rounds and kvetches. Check out Brain Scramble.


You can find thoughts about marriage, prison, and Asia at My Faith although he does not exactly equate the three. And Katy Murr is a poet. She'll make you think.

Resonant Enigma says we should talk less, draw more. Can't I just write more? Do I have to draw? Or how about other creative pursuits? Check out A.D.'s sketches.

And there's a focus on patience at, where else, having patience.com.

I don't think I have an art therapy resource on this blog, but we do now. Check out Resting Place for ideas.

MondoReb at 1000 Paper-Cuts is a hero, and he interviewed Dr. Joel Haber who has a new book on bullies. The interview included me, strangely enough, so all kinds of bloggers who cut and paste from it have linked over here at ENT. INCLUDING:

A super-vigilant blog basically about cyberbullies and cyberpaths. It scares me just thinking about it, but take a look and you'll see that indeed, cyberspace is no different than real space, meaning the relationships you have on-line can parallel those off-line. That's my take, at least. I love the banner at the top, btw. Blogger News Network also cut and paste that bullies interview. Now I feel like an expert.

Kevin over at Change Your Family Tree might have something there. What's the point of therapy if not to interrupt some seriously dysfunctional transgenerational relating? Positive and Successful Lifestyle tips might sound like a scam, after all, can you really get anything out of the personal development/coaching bloggers. Oh, my, yes, with very little psychobabble, all common sense, all too uncommon these days.

Kimmee Sook's pretty outrageous, see Me Sook for Dummies. And coffee yogurt is looking for intelligent blogs with frank talk about sex. Hi CY.

If you want the rabbi's spin on things, try Rabbi Without a Cause. James Dean, he's . . .not? He is?

If you're looking for a Kosher cooking carnival, check out Me-Ander. No, you won't find any of mine, sorry.

Blogger Living in Stigma posted a mental health carnival. Seems she's not going to be blogging there much longer, so get it while it's hot. And Mind The Health is mostly about happiness. Who can blame her? E3 Success Systems linked over here to the pornography post, thanks E3.

Therese Borchard at Beyond Blue shot me some interview questions. Therese's blog is always worth a look, even if my answers weren't standard fare for her readers.

Enough, enough. Let's get out there and seize the day, or be seized by the day, whichever it is. We'll handle it.

therapydoc