Sunday, November 28, 2010

The President and Sportsmanship

"It's unbelievable," FD says, "this guy elbowing the President.  You don't just elbow a guard, especially if the guard is the President of the United States."

"He said he was sorry," I offer.

"I just don't get it."


The President, playing basketball with friends and family, walks away from the fun braced for twelve stitches to the lip. If you have ever had twelve stitches in the lip, and most people cannot say that they have, all I can say is, it hurts.  The stitching, the healing, none of this feels good. You don't want to know what I did to be awarded mine, only that it was not due to the usual suspects, domestic or intimate partner abuse.  That  would leave falling, tripping, or stray rocks.

But this is not about me. Rey Decerega, director of programs for the Congressional Hispanic Caucus Institute, accidentally elbowed President Obama. Decerega tells us the game was all in good fun,
"I learned today the President is both a tough competitor and a good sport. I enjoyed playing basketball with him this morning. I'm sure he'll be back out on the court again soon."
I sure hope not. This is likely a minority opinion, but Michelle might agree, and there have to be others, too, who are upset that of all places, our Commander in Chief has been injured on a basketball court, playing a game of hoops.

A person should be more careful playing basketball.  Whenever FD leaves the house to play alumni basketball for a school that he never attended,  I shout, "Be careful!"  It comes out more like, "You're old. You shouldn't be playing basketball."

He goes anyway, because he loves the game.  And it is a wonderful game, as only those who of us who run back and forth, back and forth, back and forth, or once did, gasping, drenching our shirts, purging the poisons, could possibly know.

I mainly worry about crunched digits.  FD plays the piano.

It is the emotion of the game responsible for our leader's split lip, the drive of adrenaline, not even his adrenaline, is the irony.  It belonged to a director of one of his programs.  The director's competitive spirit is responsible for the trouble the President will have next week talking to diplomats of other nations. 

"I'm good," is probably what the President said, after the injury.  He won't plot revenge or jail the fellow.

Can we do that in this country? Can a President jail someone for a foul? No, of course not. But he might have a long memory.

The ultimate lesson of all this should be directed to the children, and the President should be the messenger, for he really shines when he talks to the kids.  (See his first day of school speech).  He might say something along these lines, but more eloquently,
It's just a game! Save a little of that aggression, that competitive attitude, for your homework.  You're going to need it, too, when you have jobs, when you ultimately move into the workforce.  The point of sports is control, precision, moving the body gracefully to reach a goal.  You shouldn't have to poke, gauge, or gash anyone to be a valuable player. 
Is that so naive, telling them to work at skill and avoid brutality?

While you're talking to them, Mr. President, when you have recovered the gift of painless speech that is, tell them to pass the advice along to their parents.


therapydoc

Wednesday, November 24, 2010

Snapshots: The Day Before Thanksgiving

Usually I take pictures when I do snapshots, and usually it is after a vacation, a rendezvous with my kids, the people that I let go, why, I'm still not sure. Something to do with autonomy, individuation, growth.

And no family business to fall back on.

Today I had absolutely no intention of posting, but when you go through a trauma, hey, you have to tell your friends.

The morning was okay. I started getting ready for an impulsive, fairly ridiculous Black Friday garage sale in my front yard, an event surely to take place in really, really cold, maybe even snowy post-Thanksgiving weather. It's set, the time and date, no turning back, but we're not. This is to divest of the many things my father left behind, New Old Stock from his gift shop, stuff people only use for Xmas, and being Jewish, how in the world can I possibly use any of it? Xmas plates, Xmas bells, Xmas figurines with kids on sleds. Stocking stuffers. By Friday afternoon we should have some remarkable deals, Black Friday virtual give-aways, minus the late night TV advertisement glitter. I have promised not to keep these things. A person has to let go.

Anyway, after sorting and bubble-wrapping, I take mom to the beauty parlor for a touch up, and while they all touch, I shop at Jewel, the Albertson's of Skokie. I buy things I never buy, things she needs, like Witch Hazel, something she never used when I was a kid, and a pencil sharpener, Kleenex, paper towels, bananas. Your usual shop.

Then off to score three dozen bialis and a dozen bagels at Bagel Country (don't ask why so many, not sure, these will go into my freezer, the winter is long). I drop off her slacks and sweater set at the cleaners, and wouldn't you know, she calls; she's ready. And wowzers, she looks great.

Everyone at the beauty parlor is thrilled to see me.

I drop her off at her senior living spa in time for lunch, shlep (you know this one, rhymes with rep) her stuff up to her apartment, unpack it, steal a piece of Fannie May from the freezer, and take off for work.

No surprises here, sad people, ordinary lives, my people.

I had had a little trouble turning off the car, actually, before getting to all of that pre-holiday angst, and this is a really busy street, where I work, the last really busy street with free parking, but it adds to my stress, cars whizzing past at forty miles per hour. Mine is a vehicle with a very cool ignition system. It's called keyless entry, but it seems a little funky, the system, like it's misbehaving. Ordinarily you push a button, the car starts. Push it again, the motor turns off. Leave your key in your purse, always know where it is. Like power windows, you don't look back.

But today, after turning off the car, the dash still seems lit in the mid-day gloom, not a good thing, but hey, you know who is important, not the dash, not the lights, but my 1:30 appointment. People, not dashboards.

There are days, honestly, even cold ones, you wish you rode your bike. Sure, we're taking a detour here, but bear with me. Picture it. The seemingly brainless biker in three layers, although how could you know this, nylons, flannels (could be pajamas, not sure) under rain resistant pants, skirt, a parka, a hat, another hat under a bike helmet. It's not so crazy. People ski and nobody says, "But it's so cold! You're crazy to ski in this weather!"

Today would have been that day.

So I leave the office at 6 pm, cold, because it really is sleet, I think, coming down, although it melts as it hits the street. A really thick, delicious, hearty soup, I'm thinking, nobody needs more than this. If soup is on by 7:00, it will be ready by 9:00, and this therapist will be in dreamland by 11, because it's been a long day.

But of course, the automatic car door does not automatically open, not as the automatic lock on the door of an automatic vehicle is supposed to do, and the cars really are whizzing by now. It is rush hour. I worry immediately, because it is rainy and sleeting and the wind threatens to blow me away, and how will we jump this car in the middle of this very busy street? At some point I reason, Try the old fashioned way, put the key into the lock. Except there is no key, only a button on a very expensive oval transmitter, we call a "key".

G-d is good, somehow the electronic ticket is cashed, somehow I get into the car, which of course, does not start. None of the other doors open, either, and I am afraid to let the driver side, the only door that is open, close. Because what if I get locked in the car? So I wedge a coffee cup between the door and the frame of the car, and it is really, really cold, that air that whistles inside. And the airfares to those people I let go, the ones in warm places, have burst through the atmosphere.

Needless to say, this comedy becomes ridiculous, and you don't need to know but I'll tell you that I lose the key altogether (find it later in a hidden pocket of my parka) and my son rescues me with jumper cables, his. Mine are in my trunk, a place inaccessible when all things electric go funky in a vehicle like this. And the driver of the lone SUV, the one parked in front of me, when I ask him for help, perhaps he could help me jump my car, condescendingly tells me: You just turn it, the key, two times. Turn the key like this (he demonstrates) and then like that. Two times.

Oy vey.

All this crazy car needs, we come to find out, is an electric pulse, a kiss on the cheek, really, not even a jolt. We don't even turn on the ignition on the Rescuemobile and my kid's electrodes send some special message, telepathy, perhaps, but affectionate, that reaches my battery terminals, the positive and negative, and a current, not even a spark, and the dash lights up like Xmas. It never looked so good, my dash, against the night. The door locks work, the car starts with the push of a button, as it should, as other cars, I suddenly begin to feel, never would, never could, not without the sacrificial groan, that ugly rev of the engine, that painful moan of the Rescuemobile. But mine does. What an automobile! What a vehicle! Gotta' love it. Better even, than a bicycle in the rain. Are we ever thankful!

Right?

Happy Thanksgiving, dear friends. Soup's on.

therapydoc

Friday, November 19, 2010

Intimacy Regulation

The last post, Therapy Abuse, was confusing to many of you, and I apologize.  Ironically, I started out writing a sweet piece, Forget the Pickles which morphed into a long, serious piece full of big words about simple concepts, replete with examples of feedback loops and homeostatic processes.

Too much raw material to dump on anyone, not even patient, long-suffering readers, Nancy Grace somehow took over.  It must say something about me, posting on Nancy Grace, maybe that I want an authority figure to yell at me, or maybe I want to have Nancy's chutzpa, maybe secretly want to yell, having repressed all kinds of negative emotion over the years. But none of that makes much sense.

Whatever the reason, Nancy apparated into my post, and I was thinking my literal imitation of of her was fairly hysterical. FD validated me and said it worked for him, I posted and the post fell flat.

Which means either (a) nobody else jumped out of their chair, (b) I've finally lost it and worse, FD is senile, (c) none of you watch Nancy's show. (My editor offers a third option, a sacred rule of writing apparently, which is that if you laugh out loud at your own work you should stop drinking while working. Except I can promise you that I don't drink and write at the same time, which could be why I rarely laugh out loud at my own work.)

For those of you just tuning in, Nancy Grace is a prosecutor turned judge for Swift Justice,  a popular people's court daytime television show.  She verbally bullies and belittles both plaintiffs and defendants to get to the root of the problem, to get to the truth. The post was to spoof that. What Nancy does isn't right, not for therapists, but we all wish we could do that in our professional lives, just once would work, probably, for some of us.

I had hoped, too, that more than one reader might come out and say,   
That's right! I like it when someone calls me out on my stuff!  I won't own it otherwise! 
A lot of people are like this, won't admit their personal guilt or character defects until they're backed into a corner, have hit bottom, lost everything, everyone,  no place to go.*

The post apparently hit a chord because many readers do relate to having difficulty showing affection, not exactly an unusual issue. One thoughtful writer even wrote her own post on the topic to make up for the brush off nature of mine.

So let's give intimacy regulation the attention it deserves this time around, for it is intimacy regulation that is driving behavior that distances people from one another.

Reasons Some People Are Less Affectionate Than Others:  A Short List

(A) No modeling of physical affection as a child.

People say that we don't know miss what we never had, which is partially true.

If you are raised in a disengaged family, that will be the life you know, but you will notice that other families do things differently. Something is missing for you.

The chilly family isn't always chilly, but physical affection is minimal, and really feeling the love, using skin as the operative organ, is important for psychological growth and development.  Have You Hugged Your Kid Today is all about  self-worth, making kids feel they are worth something.  If they are not worth enough to be hugged by their parents, why should they think they are worth anything to anyone else?  And why dare to ask for it?

(B) Family Worldview and Religion

Some families really think that it is wrong to be loving to the child, feel that it spoils a person, too much love, builds too much confidence.  Humility is the world view in such a family, humility keeps us in touch with others and our position in the universe.

Touch is discouraged in other families between opposite-sex relatives and friends, for fear that it will lead to sex, which should be reserved for marriage.

(C) Fear of Rejection and Exposure

With little experience in the actual behavior, touching for the sake of kindness, to express love, a person who hasn't tried it might be afraid of screwing it up, doing it wrong and being rejected, ridiculed, found inadequate.  You don't want to do this wrong, affection, or so goes the thinking.

(D) Incest and Sex Abuse

There really are ways to do it wrong-- touching a child, as incest and sexual assault survivors will attest. Victims of sexual abuse do sometimes push away their intimate partners, not wanting to experience intrusive memories associated with touch.

(E) Anger

The real culprit, however, the one most therapists can assume is floating everywhere when a partner has stopped expressing affection, is anger.  Physical intimacy issues, no surprise here, are associated with someone being really angry with someone else.

All that in mind, have a look at a fairly typical homeostatic feedback loop between a heterosexual couple.

He either does something or fails to do something that she feels is important.  This happens systematically, on a regular basis

She behaves judgmentally, criticizes him harshly, often, for being a slacker.

He feels badly, knows she is right. He owns being a slacker, apologizes, admits that change is hard, but commits to trying.

She wants to believe this and stays positive, lets the subject drop.

He slips back to the old behavior, maybe did try, maybe didn't, but reverts.

She does the slow burn at first, eventually explodes, criticizes him harshly, behaves judgmentally, verbally attacks again.→
They have come full circle.

Eventually partners come to me and one of the first things we do is establish ground rules: no criticism, no judgmentalism. It kills intimacy, kills the marriage.  And the hardest yet, no blame.


But if you can't criticize, if you can't be judgmental, if you can't blame, then how can you make someone change?

The answer lies in the light bulb joke.

How many psychologists does it take to change a lightbulb?  Only one, but it really, really has to want to change.
Does this mean we shouldn't even try to change people, shouldn't even try to change for people?  Not exactly.  In the process of trying on functional behaviors, some of us come to like them.  Give it a try, you might like it, is a great approach.  You notice there are no accusations, no sharp words, in Give it a try.

It helps to stay with the big picture, to go back to the courtship, when we fell in love, why. In therapy this discussion is emotional and rich, full of sensory memories, and as such can be therapeutic, or potentially dangerous. The good old days clearly aren't here anymore. We can't will them back. So it is a sad discussion and has to wait for the right moment. It is the art of therapy, the right moment.  Enough right moments and couples learn to trust there are more to come.

I think that deep inside, most of us want to change when we commit to someone. Most people are thinking it under the magic of the chupah (rhymes with hoo-pah!, hard "ch" like Bach) the wedding canopy, gazing into the eyes of perfect love. We are impressed, very impressed, and with that impressed-ness we want to be new, to be better, be like that idealized partner.

But it is so exhausting, trying to be someone else, to live up to that idealization. So we give up, over time, or immediately, which is fine, and we settle into being who we are, and that's the way it should be. If we partner well, commit to someone wonderful, there is an implicit desire to please and be pleased, to join, to work together, and self-improvement is in there. Somewhere.  In the best of all relationships, each of us sees, within our intimate partner, our best self.

It is anger that we have to watch, really.  A million things, normal things, events that have absolutely nothing to do with our dysfunctional childhoods or our mental illnesses, can and will get in the way of intimacy if we let anger run our emotional template.  Get angry, sure.  Stay angry, then yes, our relationships will suffer.

Considering how emotional we all are, how stressed, how irritated, the real mystery is how anyone can be intimate at all?  How to be nice and still be grumpy at the same time, now that is the question. How is it that some of us do that so gracefully, whereas others never even try?   

A trunk full of groceries, worries about the future, bicycles in the driveway, pets unattended, it is hard not to slam the door after a long day out in the battlefield, hard not to holler.

Affection, sex, going, going, gone.

So a couples therapy addresses all of these things, and we'll go there next time, no promises.

therapydoc


* It works well in 12 Step programs, too, is fundamental here, for in a 12 Step group people talk about character defects and the need to work on them, wanting to work on them, needing others to help them change. The person with an addiction wants to change, really, really does, and the group, or maybe it is the sponsor who does this, reflects back, confronts with a very sharp mirror, but only when asked. Lying in a 12-Step meeting is just lying to yourself, doesn't help you at all.

Sunday, November 14, 2010

Therapy Abuse

In the last couple of years some of the men in my practice have complained that their partners, generally women, but they could be men, aren't as physically demonstrative as they would like them to be.  They tell me they want kisses as much as sex, although sex would be nice, too.  You know the old joke:   
How do you cure a nymphomaniac?  You marry her. 

We could talk about the joke forever, right?  But my editor tells me that I have to focus, so let's do that, focus on this problem, the disappearance of affection.  I'm thinking that if men are complaining, it means that they have finally caught up to women, feel more free to talk about their feelings in the twenty-first century.  And it's a good thing, not a gender issue so much as a windfall from the Women's Movement.

Women can ask for love and sex.  Men can ask for sex and love.  Just say something, please.

When it's brought to my attention in therapy that a partner in a committed relationship has become painfully avoidant, unaffectionate, emotionally distant and cold, I want to shout out, act like Nancy Grace of CNN fame, now the vigilante judge on the new daytime Fox TV show, Swift Justice. I want to verbally beat on the ostensibly withholding partner, glare at the poor, unsuspecting soul, and make harsh, judgmental faces while bellowing:

What were you thinking when you got married?  That you could let it go?  Do you think that just because you have a ring on your finger you don't have to show love anymore?  Do you believe that just because this person (I would point at the beleaguered spouse) signed up for life with you  that you can do your own thing, turn your mate into chopped liver?  What's wrong with you?@!@!?  Do you think people can go through life, day after day, week after week, with no kisses, no hugs?  Don't lie!  Don't lie to Swift Justice!
Men, women, doesn't matter which gender is the stingy party.  When it comes to affection, I (and Judge Nancy, we're thinking) take no prisoners.

But that's so judgmental!  So not therapeutic, ranting in this way.  It is what lawyers do, not therapists.  Most people don't see a therapist to be beaten up verbally and emotionally, what might be considered therapy abuse.  When we go to a mental health professional we're hoping for calm, relaxed, half-asleep doctors who explain the psycho-dynamics to us, the whys and wherefores.  We want to know why a partner is unwilling, unable to show affection, maybe.  Or we want to work on change, changing our partner, sure, but maybe changing ourselves.

Most of the time that's the case, and it is a slow, healing, sensitive process.  But some people are just dying for us to let loose, give them hell.  You can tell when they want someone to sober them up.  And quite honestly, when that happens with my patients, when I launch into a critical and judgmental tongue in cheek rant, for it had better be tongue in cheek, then that person is likely to love it, and will want to come back for more.

You could say, and you would be right, that this is dangerous water in which we tread at this moment.  A therapist on the Internet  probably should not be giving young, impressionable therapists the impression that it is fine to beat on patients.  Suggesting this, even whispering it, begs a lawsuit, screams professional suicide.

So don't do it without an amazing relationship with your patients, okay?  That would be unprofessional. And make sure they know you're kidding, or at least make the case so that they strongly suspect you are kidding.
If you're lecturing a patient, no matter how badly he or she deserves it, make that delivery tongue in cheek,  and act apologetic as the insults roll off your lips.

At this juncture it is best to reinforce what tongue in cheek really means.  Find a mirror, gaze at yourself in this.  Push against your cheek with your tongue.  Push that cheek way out. Go ahead. Do it right now.  We'll wait.

Could anyone possibly take you seriously if you look like this before, during, even after a rant?  Preferably during the whole show? 

Yes, it's possible, you say,? Your rendition of tongue in cheek in the bathroom mirror looks serious? Then that's bad.  Bad because the more concrete, the more literal among us take us at our word.  Best not to do this intervention with terribly concrete, literal patients.  And to be sure you are not misconceived, consider utilizing the other cheek, too, alternating the process:  Tongue in the right cheek, push.  Tongue in the left, push.

Return to the mirror and practice this, and for good measure, try raising your eyebrows up and down a few times.  If you are still worried that someone will feel abused when you rant in this fashion, be sure to tell them that you were being facetious. Confess, 
"I was just kidding.  You have good reason, seriously, to withhold affection.  Let's talk about it." 
Then go into it with the patient, find out what that good reason is. Because how should you know, otherwise?

We would call this giving somebody his day in court, presumably. Or just good therapy.

therapydoc