Thursday, June 25, 2009

Top Ten Excuses: Governor Sanford

No, I'm not finished with it.

Last night I had the house to myself (the remote) so I settled down to a warm teev to see what the world has to say about Governor Sanford.

What a nice looking guy, seriously. You can see why we're all so upset. He seems so presidential, has a little of the Lincoln jaw.

Anyway, the media is brutal and I'm pretty worried about the Gov's mental health. A sensitive man like him could get suicidal listening to what I heard last night, pundits and comics blasting him to smithereens. So we won't blast here, not much.

On the other hand, there's so much to blast.

You play you pay, Governor. And we learn all kinds of things, do we not, from our elected officials.

David Letterman feels sorry for not only the first family, but also the good people of South Carolina who have to endure this embarrassment. The governor, facing television cameras tells us:

(a) he went hiking
(b) he was exhausted
(c) he needed to get away
(d) he's really, really sorry--the list went on like the thank you speeches at the Academy Awards, and
(e) oh yeah, he had an affair.

He should have come clean, continues Letterman, should have told us straight up: I was taking care of business. You don't say, I was hiking on the Appalachian Trail. Say, I had s a board of trade meeting in South America. I'm looking at silos.

Letterman's top ten excuses. We'll add our own in a second.

10. Did I say hiking? I meant, cheating!
9. I had to do something after the devastating news about Jon and Kate!
8. I learned everything I know from Governor Spitzer.
7. Let's talk about more important things, like the Nestle Tollhouse cookie recall.
6. I learned everything I know from Governor McGreevey (apparently McG had an affair with his limo driver)
5. It's Ahminadajab's fault.
4. If you met my wife, you'd leave the country, too.
3. I'm auditioning for the Amazing Race (whatever that is)
2. If you run the state and have to leave the country for a week, since when do you need to tell someone?
1. It wasn't me, it was my alter ego, Bruno.

So let's add a few!

10. I can't communicate well with my wife, can't tell or show her what I need or want, it's too embarrassing to talk that way.

9. After all, she's really scary. Have you met her?

(She looks like the nicest person you'll ever want to meet, and she doesn't need him, by the way, her family owns the Skill tool company and has an MBA).

8. I have no imagination, zero.

7. I believe that it is women who are responsible for keeping their men interested, and that means they should be tan, preferably show tan lines.

6. If you have a close friend then how are you supposed to be able to stop that friendship from becoming sexual? Especially if you share so many of the same things, like you both have children? And why wouldn't you ask her for her email address?

5. I have an honest face, the people love me, I can get away with this. I think I can, I think I can, I think I can.

4. Denial is just a river in Egypt. Maybe I'll go there, too, check out some silos.

3. I'm in politics. What do you want?

2. I have a spiritual adviser so I'm working on it. Love the sinner, hate the sin.

1. And as Bob and Ray, that famous radio comedy team used to say, paraphrasing Nixon

NUTS! I'll never run again!


Wednesday, June 24, 2009

Take me away: Gov. Sanford

So I feel pretty silly, not knowing or even suggesting to anyone that Governor Sanford was having an affair, wasn't hiking in the Appalachians as he led us to believe.

The transcript of his confession indicates that he's getting some religious coaching, attends a bible study, and is trying to work this through whatever this is. No matter, he says, his heart is in the right place. We're not judging.

Five months later, still attending to his studies, still consulting with his spiritual advisers, still
no change. Just blather about a walk in the woods, more lies, and another disappearing act or three. More misbehavin'.

Are we out of line to suggest the obvious? Like, Get therapy, Governor Sanford.

Mary Ann Chastain at The Fix-Chris Cillizza's politics blog at the Washington Post for that photograph that what will be, one day, famous, maybe already is.

Man cries. Feels the angst.

During the day the news just got juicier-- while my sympathetic post from this morning, alas, all about getting away, finding a happy medium between tuning out and neglecting one's relationships, did not.

That said, here you go. At least you find out what I did yesterday, knocking off work. And you'll see, apparently, I wasn't the only one duped.

There are ways of getting away, you know, and there are ways of getting away.

You can do what Governor Sanford did, hop into your SUV with your hiking boots to commune with nature; or you can say to your best friend, your main squeeze, that significant other, not just anyone,
Take me away.
Which is what we did, me and FD, took off a weekday to celebrate our 34th anniversary, 35th year of our relationship.

We pretended we were going on our first date and bopped around downtown. The idea was to enjoy the day together, see the people, feel the pulse, but focus on each other. If only for a day. Our phones would still ring and we would take calls, as always. But we could do it, get away, the easy way.

Before getting out of the house, however, FD handed me the Wall Street Journal and said, "Can you kindly make sense of this story for me? As a mental health professional, can you please tell me:

What is going on with this guy!!??"

In case you're unfamiliar with the story, South Carolina Gov. Mark Sanford took off last Thursday night in a sports utility vehicle, unattended by his bodyguard, for five days. Alex Roth and Valerie Bauerlein at WSJ tell us,
Mr. Sanford has regularly ditched his bodyguards when taking a run or dashing out to Taco Bell or other favorite spots in the past.
He didn't tell anyone where he was going, apparently felt like hiking the Appalachian Trail. The word is that the Governor does this now and again, turns off his phone and doesn't tell anyone where he is going, usually after a legislative session. He needs to unwind.

He has a lot on his mind, and one way to clear it is to take off.

Except that he's the Governor. That's Governor with a capital g, a man many hope to be a US Presidential contender in 2012.**

That's basically the whole story. Man gets tired of it all. Man goes off into the woods, does whatever it is guys do when they need to get away.

Everyone copes differently. And it's likely that the good people of South Carolina could care less. They elected him, and they know the score. The state is a mess and Sanford doesn't want to accept the Federal stimulus package, the President's bail out, doesn't believe in it.

This might be a difficult thing for an elected official to pull off, turning down $700 million dollars.

That's a lot of stress.

First Lady Jenny Sanford of Winnetka, Illinois, by the way, a long way from home, told the Associated Press on Monday that she hadn't heard from him, but that he
"was writing something and wanted some space to get away from the kids."
And FD wants to know what I think.

I'd say, quick and dirty, that the Sanford marriage is a good example of how far a guy can stretch that rubber band and still not break it. We're not hearing Mrs. Sanford complaining to reporters. In fact, she's avoiding them. A little space can be good for a relationship.

We also hit a wedding last night and balancing hors d'euvres and drinks with two other women, both of them started to tell me this story at the exact same moment. It was hysterical because neither stopped, so it was hard to hear what either of them said, but one surely thought it outrageous that Governor Sanford does this, goes unaccountable for four days running, and the other thought it phenomenal.

His fan, the one who thought it phenomenal, screamed, "Poor guy decides to turn off his phone for a couple of days and everyone acts as if he's committed a federal offense."

Well, leaving the state unattended may not be a federal offense, but it's not exactly model citizenship.

The women are talking at me, and the crowd starts to fill in, everyone's all dressed in their best, one guest more beautiful than the next, and all of a sudden I've got that song in my head, the Natasha Bedingfield song*, the one that goes,
I got a pocket, got a pocketful of sunshine.
I got a love, and I know that it's all mine.

Do what you want, but you're never gonna break me.
Sticks and stones are never gonna shake me.

Take me away: A secret place.
A sweet escape: Take me away.

Take me away to better days.
Take me away: A higher place.

I got a pocket, got a pocketful of sunshine.
I got a love, and I know that it's all mine.

Wish that you could, but you ain't gonna own me.
Do anything you can to control me.
Oh, no.

Take me away: A secret place.
A sweet escape: Take me away.

There's a place that I go,
But nobody knows.
Where the rivers flow,
And I call it home.

And there's no more lies.
In the darkness, there's light.
And nobody cries.
There's only butterflies.

Take me away: A secret place.
A sweet escape: Take me away.

Take me away to better days.
Take me away: A higher place.

The sun is on my side.
Take me for a ride.
I smile up to the sky.
I know I'll be all right.

The sun is on my side.
Take me for a ride.
I smile up to the sky.
I know I'll be all right.
It's not all that hard to do this, you know, get away. It's a psychological thing, or it can be. Sometimes being with a lot of people, being anonymous (or not) in a huge crowd, in the big city, is as good as it gets.

We really did pretend it was our first date, a blind date. I'm by myself at the fountain (in reality he's dropped me off to park the car).

I get a call.

It's him.

"I'm nearing the park," he says. "How will I recognize you?"

"I'm in a black dress, standing by the red sculpture, overlooking the fountain, talking on the phone."

"Okay. I'm wearing a dark straw hat."

"A straw hat?"

"Uh, huh."

I see him approaching and I walk towards him. "Excuse me, are you looking for me?"

"Are you ____?"

"Yes. Did you bring food?"

That's kind of how our dates go.

Anyway, it was fun, people-watching and reminding ourselves what it was like to be young, or merely to be on vacation. For who has time, anyway, even if you're not a governor, in the middle of the day, in the middle of the week, to go downtown and look at the skyline?

We were too late to get into the Art Institute, but the gardens were open and some high school aged kids were romping around, taking each others' pictures.

And we made it to the that wedding, too, which was wonderful.

So no, we didn't turn off our phones, and miraculously, neither of us had many calls. It was like they knew, not that we told anyone. And he looked great, and he said I did, too. It's nice to dress up and just go.

Millenium Park teemed with people, for it always does, and everyone it seemed was in a good mood.

It's been a long winter and summer's finally here.

Here are a couple of pictures, in case you've never been to Chicago's downtown playground. The monolith with the reddish portrait is a moving picture, the camera is on her, I think, and she's in the park somewhere, for all we know. It's really quite remarkable. You can't tell, maybe, but the monolith is a fountain.

And these kids are just goofing around by the Chinese sculpture exhibit. They're not the art students mentioned above, but they're quite adorable.

So I'm thinking, Governor Sanford, maybe you could do this, too. Grab the missus and take her with you, wherever it is you go, or perhaps compromise, go someplace she wants to go that works for you, too. Get a sitter if you have to, tell someone how to reach you, and go. Start working on a smaller rubber band.

For the sake of the nation, the Republicans would say.

And maybe take in a wedding, while you're at it.

Although something tells me you won't see weddings like this one in South Carolina. But I could be wrong. They're feel-good events, in any case. Most of the time.


*If you're religious and blush easily and don't like seeing alluring women singing in YouTube videos, don't watch this one with Natasha Bedingfield singing Pocket Full of Sunshine.

**This is NOT a political blog, not an endorsement of Gov Sanford for president in 2012. It's just a story and he happens to add the brushstrokes. Thanks, Gov, and I hope someone checked you out for lime disease.

Thursday, June 11, 2009

Friendship and Professional Boundaries

In the last post Porcini asked me a question in the comments section. You can go back to that to see how I answered her there.

She wants to know how I handle it when I really like a patient. Don't I want to be friends, seriously, with delightful people? Technically, she reminds me, after a two-year break in the therapy, I'm allowed this legally, can have this
friendship with a client.
Or I can use an "ex" patient as a plumber; I can commission an artist to paint me a picture.

The problem is that I don't ever really, hardly ever, terminate the therapy.

With people I see professionally, there's no terminating, not really, although I'll go to weddings if I can. That's part of a therapy, going to a wedding. But basically, when all's going splendidly in life, and there's no need for my services, it becomes:
See you next crisis. Call me if you need me.
Life is all about the next developmental crisis waiting to happen.

And I feel it's a disservice, a dilution of the relationship, almost a perversion to take it out of the office. It's not possible to give a relationship, always the third person in the room, its due any other way.

All that said, I'll help friends as a professional, do the therapy, literally, or provide referrals. But I'll offer them advice. I couldn't have done that as a younger doc, but now keep my legal pad ready for them, a 5 X 8 in my bag. Or sometimes will doodle on a napkin. I'm nothing if I can't write or diagram.

Not that we won't do this over dinner, but there's little time for dinner, so it's really better if a friend comes to the office.

I know other docs who do it, too, help out friends. Some even do it at home. I know a psychiatrist, who treats his entire community, . He treats people that his wife invites over for lunch or dinner, people he goes to basketball games or movies with on a Saturday night. But he does the therapy in his home office. You sometimes see people leaving with paper bags of samples.

It's all about how well a therapist can detach emotionally from people, and some of us are amazingly good at detachment. Therapy is really an intellectual exercise, you know. Although it helps to have heart.

So boundaries are a personal choice. A person has to be comfortable with the perforations, and by default, therapists are taught to keep a nice solid line to protect the patient. But nothing is written in stone, and I personally have learned, by watching people's lives in my community go to ____ without intervention, that if I don't step in when I can, I'm going to feel guilty.

With friends, crazy though it might seem, I expect a certain amount of therapy back. At least I should be able to talk to my friends like I'd talk to a therapist, spleen about my life when it's not damaging to someone else, report a decent nightmare. I tell my friends,
You're not to try to fix anything here, just shut up and listen.

And they do, and I feel better. They feel worse, but I feel better.

Just kidding, just kidding.

More on termination when I have a minute. The truth is, there are times when it really has to be a termination, and we should talk about that a little.



Wednesday, June 10, 2009

Chicago Gay Men's Chorus

Rushing to the office after spending too much time writing that last post, I caught NPR's special on this chorus.

I checked 'em out right away, rushing so fast I go to work early.

No matter your feelings on homosexuality, I'll bet you'll love these performances. The second is almost barbershop, and the first totally goes on the sidebar under Things That Make You Feel Good.

I'll get to that one day.

Jimmy, Jimmy

Vive L'amour


Panic, Family Systems, and Psychoeducation

Sometimes it's easier not to blog at all than to try to explain systems in plain talk. But let's try anyway.

I'll just go stream of consciousness, if you don't mind, and you guys put it together, because there's so much work to do (other than this) and time is always nagging at me. I just grocery shopped, for example, something normal people just do, worry-free(not thinking about time) and did the self check-out. It all went fairly well, but as I left, it was clear-- a waste of time, self check-out, if you have a big order, if you're me.

And those beeps are louder when you're the one making them.


Last night I got a call from a patient, one of the handfuls of patients I encourage to call me when they're under the influence of panic. The job, of course, is to teach the family to do this, to address the panic, to get myself out of the system. But often it is the family that is stirring the panic.

So the therapist has to treat the family members, too, for they have to know how they're doing it, stirring the panic, and they have to want not do it. Getting all of the above to happen requires time.

So we're not there yet, not last night, the family is just beginning to get the big picture, and the patient calls me, and it's good timing, actually, so I start a game of Spider and take the call, because for some crazy reason, I can play Spider Solitaire and concentrate on words at the same time. I'm no longer addicted to this game is the truth, rarely even play it, but FD started to play it, and as a result, I'm playing it again when I need something to do and have to concentrate at the same time, hear what someone's saying.

Or can't sleep and it's too late to learn anything and have canceled all the fashion mag scripts and am tired of reading and writing blogs.

Anyway, I talk her down via psychoeducation. The beauty and the beast of psychoeducation is that people want to know why things are happening to them, that's the beauty. But we can't explain it all on one foot, is the beast. And the irony is that although we know about the triggers, can recognize things that aggravate arousal, we can't explain everything, not that it isn’t a worthy endeavor to try. The investigative process, however, should be something you do in the office. But sometimes things need to be reinforced, and sometimes, in pre-panic mode, you get new insight, new information, never been told before, not yet processed.


So I like to get that information, as long as it's before 9 o'clock.

I need it pre-panic because people can’t process rationally while under panic. Panic turns the brain to junk, basically. Which is why I say, Catch it pre-panic. If you’re going to call, call me pre-panic. We can head it off.

So we take a quick look at the thought, air it out and examine it, and we find, lo and behold, that someone else in the family has expressed the same thing in the past, the same negative thought.

And since personal boundaries just stink at some stages of life, certainly young adulthood, when the thought pops into our minds we don't know why it's there. It can happen that someone else’s thought becomes our thought. And this is really scary. The thought itself is scary, and not knowing where the hell it came from is scary, or why we have it. You can see how people think they're possessed.

But they're not. They just have poor boundaries.

Sometimes the person who has expressed the negative thought originally in the past is doing it now, in the here and now, stressing the patient unknowingly. Or maybe knowingly.

(As an aside, panic isn't always triggered by negative thoughts, and it’s not always about boundaries, it’s never always about anything. We're just looking at this slice of psychology right now).

So a family therapist will yank the original thought-keeper into the therapy, the one who also has this thought (usually a parent, but not always), or something similar, and will work on a multi-system level, will address this person's thoughts and how negative thoughts originated, how they still disturb, and how they are affecting others, meaning the identified patient, my patient.

And we can help this person cope without dragging vulnerable others into the coping process, polluting the identified patient's thoughts. We set all kinds of boundaries in therapy. Someone asked me to post on boundaries, and you see I can't, post on them in any generic way. There are simply too many.

Hopefully, depending upon how deeply the original thought-keeper suffers from features of personality disorders (how oppositional, usually, or narcissistic) we'll get a good result. Voila. Magic. Everybody begins to heal.

What if, however, you can't do that, can't get that other person in the family into therapy, can't engage the one still triggering emotional distress?

It's harder, but we help the identified patient with insight, understanding, and work towards behavioral change. We look at the negative thoughts and tag them as old stuff as unresolved childhood junk, and counter them. Ultimately it is about shoring up the boundaries of self, differentiating, becoming one's own person, impervious, if not insensitive, to the noise and distressing energy in the family. There can be so much of that.

Family therapists find at least one significant other, a sibling perhaps, or all of them if possible, and their spouses, educate everyone about the situation, the patient’s needs. We’ll have the patient do it as much as possible, tell over the psychoeducation that has been learned in therapy. This reinforces the learning. This is extremely intimate, you know, telling someone you have a problem and need that person to help you on occasion.

With time a person doesn't need anyone to reinforce rational thought. The brain will go there naturally, and you'll be okay.

And I'll miss that solitaire game, you know. But I lost it anyway.


Wednesday, June 03, 2009

The D Word


I’ve been avoiding this post, primarily because I just know that if certain patients run across it on the web, they’re going to say, THAT’S ME! OMG! SHE WROTE ABOUT ME AND PUBLISHED IT ON THE WEB!

But you have to understand, this is not about you, unless, perhaps it fits and it is. This is a very common interactional sequence, and if you fit into it and you're pretty sure I'm your doc, well, that can’t be helped. As I’ve told you before, you’re not that special. We're all unique, but our emotional lives are not.

The Post:

A patient will come into therapy fed up with a partner, sincerely ready, wanting, willing, to leave. The partner has a thousand deficits, some of them truly tragic flaws. (If you think you don’t have flaws, character deficits, think again).

We all have these, tragic flaws, features of character disorders. There isn’t a soul who is free of shtick, and we therapists say, Long live the shtick, for it is our specialty, you see, working it through, turning it around. We have you rethink it, and if we have enough time and you have enough money, the shtick melts away and is no longer tragic, and the relationship improves, and no one has to go anywhere.

But yes, it can take a long time, and a lot of money. I’m always saying that the lawyers are making so much more, however, invest it in good therapy. You look at a lawyer and you’re broke. That’s why I sent my son to college to become a lawyer. At this writing, as a lawyer, he is making less per hour than the piano teacher across the street. But okay.

Back to you, this is not to say that every character deficit can be fixed or will be fixed, or that we should intuitively understand the other's deficits and accept this person as he or she is. We don't get things like this intuitively just because we walk on two legs and have a rational, thinking chip in our heads. How to live with and adapt to personality is surely an art and a skill, and it helps if our partner is willing to change those maladaptive slivers of self.

Why be dysfunctional when you can be functional? Why be a part of the problem when you can be a part of the solution?

But it's never that simple, is hardly intuitive, and is the reason you pay for help, is the truth.

And when therapy begins to drag on, when things aren’t getting better, many choose to call it quits, and that’s okay. If it makes you happy, I am prone to say, or actually sing. And sometimes it does, or it will.

Yet we are destined to bring into the next relationship that which we brought into the last relationship, thus the next relationship is likely to be unsuccessful, as well. We bring ourselves.

I serve on a committee that reviews proposals for research for ethical violations. It is called the Institutional Review Board, or IRB, the Office of Protection of Research Subjects. Each member of the committee reviews the research proposal and together, in a small room, we hold up, block the student’s journey to a PhD, block the proposal for as long as it takes to get things right. There’s metaphor in this, holding things up, working on things until they’re right, and in this process the student learns a great deal. It is the humbling hurdle, getting through IRB, but you have to do it or you can’t proceed with the adventure.

But the metaphor isn't why I bring up IRB here. Last week I read through one of these research protocols and learned that 62% of second marriages fail. That’s much higher than the rate of divorce for first marriages, 50%, and although you can do the Freakonomics, you can find alternative reasons, surely, my guess is that remarried partners are bringing themselves into that second marriage. And haven't changed.

Let's assume, however, that no one's been divorced yet, and everyone is still chipping away at the relationship and themselves, peddling as fast as possible in marital therapy. At some point in the middle phase of therapy, in the thick of the marriage, deep into conflict and avoidance, it is likely that one or both will not see any light at the end of the tunnel, despite the therapist's well intentions.

One of the partners is confident, actually, that this marriage is unbearable, unfixable, and might say:

You have to change or I want a divorce. Something's gotta' give, and it's you.

And the recipient of that good news will say: YOU have to change.

And partner #1 shoots back: I’m this way because of you.

And the wheels go round and round.

And the therapist enlightens the couple with circles and squares and arrows, interactional sequences and patterns, the dance you can read about in books (and should), yet the two magoos just can’t break out of their old behaviors.

And one says, often, unfortunately, "I want a divorce," but may do absolutely nothing about it, because inside it isn’t what is truly desired.

You want successful relationships, and if you've been married many years and have children, really want things to work.

You want things to work so even though you're complaining, you never get that lawyer, or if you do it is to spend your hard-earned money just to tell him,

"I’ll think about it."

But the damage is done. As soon as you threaten with the D word, certainly if you do it over and over again, a partner’s abandonment issues are lit. That part of the brain that says, FAILURE! LOSER! lights up.

In this situation we see ourselves embarrassed, alone, powerless in the face of our children who will act out all over the place because they know that they can. We are alone and the kids are acting out and we'll be damned if we’re going to call our ex to help us out because we're still furious about the emotional abandonment, one that began well before the divorce.

Calling the ex when the kids are acting up, of course, is what you have to do, because without that executive committee (read about it somewhere on the side bar), the kids have executive power and do whatever they want, and you’ll never know the half of it,either. Obviously this is not always the case, many children are sensitive and caring and do not want to make our lives miserable to accomplish their selfish task of individuation, but many are not. And they will have issues regardless of how they behave.

Thus once the abandonment nerve is triggered with the D word, our most primitive defenses kick in. No longer will we risk intimacy. No longer will we come closer, tell a wounded partner, “I’m sorry. I know you’re miserable. I shouldn’t have said that. Let’s talk. Let’s work it out. I love you.”

How can you say that when you might get kicked in the head? You might hear, “Well, I HATE you and I wish I had never married you!”


Once the D-word is out, there’s no taking it back. It’s out. And it comes out again, and again, and again, because without that bravado that comes with commitment, the other will not say, , “I’m sorry. I know you’re miserable. I shouldn’t have said that. Let’s talk. Let’s work it out. I love you.”

But that has to be said. I’m sorry. Just say that. Get over it, that fear of getting kicked in the head. Move in, not away, and assert, assert, assert. Pronounce the confidence you have in your problem-solving matter, the confidence you don’t have, but should have, and melt that miserable partner of yours with kindness. Keep any criticism out of your tone (you really can do this, you know, edit not only your words, but your tone), and kill with kindness.

No, it won’t always work. The partner who is already involved with someone else may not want you. It’s true. Once you taste other fruit, eating cantaloupe every day is not the same. On the other hand, if you only had cantaloupe, you really would be fine, you know.

Okay, hit me with your best shot. I kept it as short as I could.