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Friday, August 26, 2011

Snapshots: The bride, the new dress

1.  There's a snapshot, a bride and her cell phone.

The bride-to-be fears her wedding will be an earthquake casualty.  She rushes through a park holding up her white dress with one hand, the phone with the other.

My first thought, "Great dress!"

And a millisecond later, "But she's on the phone!  Really?  In that dress?  It doesn't fit.  She must be a doctor."

But she's not.

Valeriya Shevchenko, 18, evacuated a NY courthouse during the earthquake panic but the eye-catching photo of her wedding-dress dash created complications. The young bride and groom were keeping the nuptials a secret from their disapproving families -- not such an easy feat with the highly circulated image that is now being called the “Earthquake Bride.”

“They’d say we’re too young and not for each other,” Shevchenko told the New York Post.(Photo: TIMOTHY A. CLARY/AFP/Getty Images, cropped to oblivion by therapydoc)

The show did go on, a few hours later.

2. Someone told me a story about a different young woman. When asked what she wanted for a college graduation present, she replied,
"A new dress."
Her parents thought it a little odd.  They had been thinking:
Box as furniture concept
She must want something practical, maybe even the gift that keeps on giving. . .

She's up to her eyeballs in student loans, has an apartment to furnish.  She might want to replace the box as furniture concept.

So a kitchen table.  A lamp.  A painting.

Or something sentimental. A bracelet, a pendant.
But it's not weird at all, a new dress. If you haven't shopped for yourself in years, have had a nose in the books and haven't dropped more than a dollar on rare occasion at a pick-it-up-off-the-floor-and-buy-it department store sale, then the thought of taking a few Franklins and feeling pretty is very, very seductive.

The nouveau-riche get it, those who never had money and suddenly find it. This doesn't happen often any more, finding money, but in the days of prosperity, when it did happen, the newly endowed were known to spend it like crazy, and who can blame a person for that, deprived for so long. 

Not all do, of course, spend it, even after a lifetime of deprivation. Many immigrants and second, even third generations who make it here don't find it so simple. Some never get the hang of it, which is why, in this dreadful economy,  they still have some.

But back to that new dress.

3.  In my tribe we have self-imposed eating, drinking, and shopping deprivation for different reasons.  For a full year, after a parent dies, more observant people who have lost a parent don't listen to music, go to parties, or buy new clothes (not unless work demands it).   Ironically, wine and spirits are still permissible, and there's no mourning on Saturday. It's just the way we do things.

So shopping the year after losing a parent is a No, No.  And if that parent has been ill before the loss, then the nouveau mourner might have spent the year prior to the death trying to work and still juggle a thousand other things, shopping for food for these elderly parents, shlepping to the life support doctor appointments, running to emergency hospitalizations.  So it is likely that this person hasn't shopped for two years by the time she finishes her official year of mourning.

Then, when it is all over, a person doesn't necessarily have the will, or the psychological energy to get out there and look at price tags, deal with the people in the stores. You have to be ready for that sensory light show, the women in the cosmetics aisle offering make-overs and perfume, the wait at the register, and the countless floor people and personal shoppers showing you to the dressing room that you will inevitably never be able to find again.

But when you are ready, when you get it together to shop, there really is nothing quite like the new dress, and nothing better than putting on your contac lenses and a little make-up, showing up in it at a party and hearing people say, 
You look so young! You look wonderful! Where, oh where, did you buy that dress?

And your partner, if you have a partner, is watching you walk, is steering you away from the crowd to a quiet room to talk about his day, your day, and later, that night, after the party, he says to you, 
"The men were watching you all night, you know."
And you say,

"No, dear. I didn't notice."  And you didn't.

He looks confused, so you add, 

"I did it for you, dressed up, you know."

And until that moment you thought it was the women, their opinions on dresses, that counted.

therapydoc


Sunday, August 21, 2011

Set Rape Education Back 20 Years?

I know, not everyone cares. Probably, most people don't care.

And I realize that intellectuals believe in free thought and the right to behave as one believes is within one's rights, and a benevolent government doesn't interfere with personal liberties, rights, rather supports the right to speak whatever is on one's mind (we do that here), no matter how much it hurts another.  Bill of Rights.  Freedom of Speech.

The implication of one writer's rant on rights is that governmental legislation of verbal (maybe physical, too, I don't know), sexual, gender, ethnic, and racial harassment, to name a few types of violence, violates individual rights.

If you haven't had rape education, which is voluntary, unfortunately, you might agree to a degree.

Rape education, or sexual assault awareness, isn't about how to rape.  Rather the purpose is to disseminate information about the health risks, the consequences of rape.  On college campuses it is the school's obligation to sponsor such awareness if that school receives federal funds (think the federal student loan program).

But some people think the schools should stay out.

Perhaps they think that parents will pass it along, this type of proprietary knowledge, with the ketchup at dinner.  Read the story here: College Accusations and the Presumption of Male Guilt.

You can let me know what you think over there if you're interested.

therapydoc

Wednesday, August 17, 2011

Ghosting

You have been rejected, dumped. Your ex hasn't been very nice about it, either. You feel used, used up, hurt beyond words. And because you have cried so much, you are beginning to feel angry. It won't take much provocation to do something rash, to exact vengeance. You are not in a charitable place.

And deep inside, you think this won't ever get better, that it can't, because there are too many memories, too many triggers. You live in the same neighborhood, frequent the same bars. You share friends, go to the same weddings. And every time you see him, or each time you run into her, you break down, have to start healing all over again.

Your therapist tells you,
"Well, that's what happens when you light up those old neural pathways. Stay the ___ away! No Facebook stalking. No mining friends for information. Avoid your ex whenever possible. The longer you stay away from the source (of neural activation), the better your chance to heal."
To heal in this case means detach. The advice is sound because forgetting is impossible when your physiology, your body, is busy remembering.

But there's something else at work, psychologically.  Relationships add to our identity. Our very self is inclusive, adds those we love. We depend upon these slices of our ego to be there for us in various venues, at predictable times, and that reliability adds to our sense of wholeness. Maybe we shouldn't, but we can't help but expect things to be predictable in close relationships. This is what it means to feel attached, security in numbers. Attachment and dependency are associated.

Not that love is dependency. But we get so used to our partners, that breaking up, establishing a permanent separation, is tantamount to feeling a part of us has died. We're accustomed to too many things. Even Henry Higgins* grew accustomed to her face.
She almost makes the day begin.
I've grown accustomed to the tune that
She whistles night and noon.
Her smiles, her frowns,
Her ups, her downs
Are second nature to me now;
Like breathing out and breathing in.
I was serenely independent and content before we met;
Surely I could always be that way again-
And yet
I've grown accustomed to her look;
Accustomed to her voice;
Accustomed to her face.
A huge piece of reality, of ourselves, is ripped away at the death of a relationship, whether we're waiting for it to die or not.

We see a lost lover everywhere, not literally, but everyone looks like her, like him, what I call phantom sighting. We crave the sensory stimulation that defined our relationship-- eating together, playing together, listening to the same songs, the physical and emotional intimacy, the sharing. Apart, we can't just change our habits, we still want to do many of the things we used to do as a couple. 

Thus it feels impossible not to grieve, not to feel angry, even when one can say, Good riddance! Even when the other has flaws as numerous as the ice cream flavors at the shop we must now avoid.

And as good as your therapist's intentions are, this theory of avoidance is as good as the carpet in her office. One can't just move to Hawaii. There's the lease, the mortgage, perhaps children to think about, parents. Walking away to avoid triggers isn't happening. Hiding, crying, avoidance feel like the only alternatives.

To complicate the grieving might be the knowledge that the other has moved on, is even happy, perish the thought.

____ ____ ____ (these are expletives) as Henry Higgins would say.  One might run into them in the usual places, the ex and your replacement. They now haunt your places. The thought of seeing him, the thought of facing her, is a tremendous source of anxiety. And it could happen.  The patient asks:
What do I do if I bump into either of them in the produce aisle?
The therapist:
What do you want to do?
Most common answer:
Run!
Running is a respectable solution, but as you were told as a child, one can't run away from problems. This will fail. Better to think, I have a right to be here, wherever I amI have shopping to do.

And if it happens, if you run into your ex or your ex with a new partner, and you feel the uncontrollable need to cry, which is your catastrophic expectation, Well, good. Let him see you cry.

But don't engage.

Unfortunately, this is an incomplete answer, guilting with tears. We don't feel the power crying, not unless we have a histrionic personality disorder. No one wants to be seen at Whole Foods with mascara dripping down a cheek. Far better to manage these negative feelings, or yes, leave the store, shop later. Your therapist has a small arsenal of emotional management techniques that might stave off the tears. Grab a few good ones. I personally like breathing. Slowly, deeply. And squeezing a pen.

If you think, perhaps, that the answer to What Do I Do When I Run Into Him/Her might be
Tell her off! 
or Punch him! 
even, Glare
then those of us of the cloth might suggest not. Signs of aggression only validates an ex's decision to break up. You want to look good, not crazy, you want to seem rational, to exude strength and independence. Verbal violence, throwing a tomato, undermines this.

That Hold your head up song by Argent feels good about now.
And if it's bad
Don't let it get you down, you can take it
And if it hurts
Don't let them see you cry, you can take it

Hold your head up, hold your head up
Hold your head up, hold your head high

And if they stare
Just let them burn their eyes on you moving
And if they shout
Don't let them change a thing what you're doing

Hold your head up, hold your head up
Hold your head up, hold your head high
So contrary to cookie cutter psychobabble -- that you must grieve, or just avoid-- we're saying these are mutually exclusive processes. Grieve away, of course, and avoid if you must, but not at Dominick's, Jewell, Albertson's, the hardware store, or anywhere in public. Wear sunglasses perhaps, but don't run.

You don't have to talk. Ridiculous!  Why would you? You're picking lettuce, he's at zucchini. No need to talk. He sees you, you see him. Does everyone deserve a greeting? Do we really have to converse with people just because we know where they have their birthmarks?

I put it like this to the patient:

Imaging the Queen of England. She recognizes, perhaps even chats at home with the man who polishes her silver. But in public she is standing tall, nodding at people who adore her. Does the person who polishes her silver run up to her and say,
"Queen Elizabeth! So wonderful to see you!" 
Does Liz cry out,
"Joel!  You're here! We must talk polish when you have a moment." 
No, they mutually ghost one another. He's invisible to her.  And he wants to be invisible.

The person who has dumped you no longer has conversation privileges. Your working agreement is null and void. No need for acknowledgement, validation.** Or as I like to remind patients, If you couldn't work out your differences together, do you really think you can do it apart without years of therapy, mediation, etc?

There's a blockbuster hit, a book that sold millions its first week out, Go the "F" to Sleep. I'm not recommending it, haven't read it or listened to it on YouTube, not beyond the first expletive. But I happened to catch the author, Samuel L. Jackson, on National Public Radio. Mr. Jackson said that one night his daughter kept popping out of bed and when he sent her back for the twelfth time, finally alone, he put his thoughts down in literary form. The rest is history.

He apparently didn't know the "ghost" bedtime technique. Before there was Ferber, there was ghosting.

The child, too big to confine to a crib, is cognizant of ghosts, but isn't afraid, has been taught there is no such thing as ghosts.  He knows the mantra, There's no such thing as ghosts, there's no such thing as ghosts, there's no such. . .

There may be, wink, wink, a tooth fairy, ironically, and a Santa Claus. Children should believe that the forces of the night are good.

The child has been fed and watered, but can't sleep and keeps popping up. You, the parent, need sleep. You need the child to respect your need to veg, to see an end to the day. The child, being a child, isn't terribly concerned with your needs, and wanders into the TV room.
I need something to eat.
You say to your partner, "I believe there's a ghost in the room asking for something to eat. I say we ignore it."

"Right-o," says partner. "I pay no attention to ghosts. If that ghost breaks anything for attention, there will definitely not be doughnuts for breakfast, nor snacks at lunch tomorrow. Could you change the channel, dear? I want to see Antique Roadshow."

The child continues to whine fruitlessly, or scream, but at some point realizes there will be no attention, none, to be gained from wakefulness. Bed will feel better than this, being treated as an unwelcome intruder, a ghost. Off to sleep we go.

So at the bar, in the store, on the street, in the subway, an ex, one who lights up those neural pathways, doesn't exist, merits no attention. You look past him, past her.

A ghosts of relationships past, let's just say.

therapydoc

*Henry Higgins tutors Eliza Doolittle, makes a poor flower girl a princess in My Fair Lady, a musical adaptation of Pygmalion.

**If you parted as friends, none of this applies. And surely, when there are children to parent, there will be some conversation necessary, a good deal, perhaps, to co-parent.  This dialogue is necessarily dispassionate, rational conversation. And not in public.

Tuesday, August 09, 2011

My 100 Children

Sometimes I feel that I have at least 100 children, maybe more. But that's ridiculous.

http://www.jewishfilm.org/Catalogue/films/my100children.htm.
We find our inspiration wherever we can.  Some of us have to slow down, get in touch with the old time religion, whichever one that might be.

As a Jew, I'm lucky, because my religion is really, really old. And when a religion is old and historically rich, there are many, many stories. There are so many they become one long story if you're Jewish. They are sad sometimes, but often, inspirational.

Today was Tisha B'Av (the ninth of Av, rhymes with wish-above).  Av is a Hebrew month. Most people haven't a clue what this means, Tisha B'Av, and that's okay, it won't be on the test.  Suffice it to say that it is a fast day commemorating several historical Jewish tragedies.

To name a few:
the destruction of both holy Jewish temples (where the Moslem Dome of the Rock now rests),

the papal decree to start the Crusades (otherwise known as: Let's get this murderous party going!),

the expulsion from Spain

and the start of World War I, a war that many feel set the stage for the Holocaust.
Twenty-five hours with no food, no water, it's not an easy fast.  We begin an hour before sunset, end the fast a few minutes after sundown the following day with food and drink that never tasted as good.  We sit on the floor in the synagogue, or on low stools, and as mourners chant poems, lamentations, the sadness of our people.  The Holocaust is still fresh for our parents, for survivors everywhere, and there are many stories to tell and we're telling them. 

http://www.aish.com/j/jt/Jtube_Schindlers_List.html#.TkFQ1rg5Tto.facebook
The best part is watching sad movies as a community, and everyone likes a sad movie.  The day seems to drag on forever, otherwise.

One of the funniest guys I know, serious on Tisha B'Av, linked on Facebook to

Why saving one's life like saving the entire world, a clip from the Spielberg movie.

 Worth the minute or two, for sure.
 
My friend thinks it's the best movie scenes ever, maybe because a man breaks into tears, I'm not sure, maybe because the message is so sublime.  I looked for more Schindler, only found the trailer.

Many of us blow off work to see Holocaust movies on this backwards holiday.  But this is not the only advantage to calling in sick (which is no lie, you feel pretty sick).  Going to work would be bad because no one can work without (a) caffeine, (b) snacks!

So far, nothing inspiring, right?  So try this:

A woman has lost her family in the Holocaust. Parentless, but an adult, she decides that she will parent 100 lost, parentless Jewish children who survive the war, too. She discovers dozens of orphaned Jewish children holed up the Jewish Committee Center in Krakow.  They have found their way to this place and she has found her way to this place, and her vision is about to come true.

Years later, Lena Kuchlar Silberman's biological daughter makes sure that this important story be told. The documentary, My 100 Children, patches together saved lives. We hear tapes of Kuchlar Silberman interviewing her "children", now adults. They are asked what they remember of those days, the days before finding a safe home with Lena in Zakopane, Poland, after the war. They say things like,
"I was so alone."

"I had no one."

"I knew no one."

"I had not a friend, not a relative.  No one."

"I had no one for as long as I could remember."
Being a child, every day with no guidance, is forever.

Being a holocaust survivor is not entirely like being tossed into a forest to fend for yourself, like a feral Child, born to be raised by dogs or wolves. But in many situations, indeed, these children hid in forests, in basements, in closets, cellars, in sewers. And they had witnessed more killing, more violence than they might have, had they been born in the woods.

Lena Kuchlar Silberman, became their mother. She "brought them back to life" in a Polish orphanage.  Growing antisemitism and violence in those post-war years forced her to smuggle the children out of Poland, first to France then Israel.

We hear the stories.  One little girl makes her way from the camps to take the train to Krakow.  She is crowded into a station with hundreds of people. She is weak, starving, febrile, unable to move another muscle.  She collapses in a corner of the station.  A priest sees her and asks her why she is sitting like this in the corner. She must go.

She tells him, I can't move. 

He says, You must get up.  The train is coming.  You must get on the train! 

She whispers, I can't get up

He begs, Try!  Please try! 

She tries to get up and she falls.  Her legs are swollen, she is very ill.  He picks her up, throws her over his back, carries her to the train. 

The identity of the mysterious priest is revealed at the end of the film.

Many stories. One about emotional blackmail. When it becomes too dangerous for the children to stay in Poland (antisemitism rabid), one of them refuses to leave without his sister.  She is living with a Christian family as a Christian and has no interest in leaving.  Her brother tells her that he will not leave without her, that he, as a Jew, will be killed if he stays.  She leaves with him. Emotional blackmail works.

Three of the meanest, most hard-core bullies, Lena's most difficult children, are judges in the orphanage.  The children run the disciplinary system, they try one another for misbehaving.  Either Lena thought they would learn to become humane with responsibility, or they chose the method themselves, I can't remember.  But they mete out justice, lots of it, justice their mother wouldn't approve.  But in the end, she changes them.  They change because she won't leave them, not even after emigrating to Israel, not until she is sure that each and every one of them is emotionally stable, can tolerate the separation.

And the worst day of their lives is the day of her death. 

Years later, interviewed in this documentary, the three judges are asked about their angry, vengeful childhood personalities. What made them this way, so mean, so cocky, so cold, so seemingly incorrigible?

The now adult children reply (and I'm paraphrasing if not rewriting the script),
all that loss,
all that loneliness,
the fear of death,
the running,
the hiding,
the violence everywhere,
no one caring.
This is the baggage they carried with them to Lena Kuchlar's orphanage. So much rage. It had to go somewhere. We would be angry, too.

An argument for benevolent, kind parenting, living, and an example of courage we just don't hear about anymore.

I don't know about you.  But I was inspired. 

therapydoc

Wednesday, August 03, 2011

The Therapist and Confidentiality


This will be a maximalist post.

1. Confidentiality/other professionals:

Some of us like to consult with other doctors. To do this we must first ask the patient to sign
The Release of Information
which consists of pages of legalese and finally, the
Date: _____________________________
Printed Name:______________________

Signature __________________________
You can tell how professional the professional by the uniformity of the lines.  This is harder than it looks, uniformity in lines.

I always assumed that the form protects the patient from a breach of privacy. If someone other than the doctor handles a faxed evaluation,  
             Release of Information
-- PERSONAL AND CONFIDENTIAL-- 
attached, surely that individual wouldn't think of reading the evaluation.

For sure not.

When Blue Cross/Blue Shield of Illinois audited my charts last summer (they said I did high volume so of course they had to audit my charts) I was told that my default releases of information, sometimes an abbreviated form, sometimes handwritten scribble scrabble, didn't cut it. I learned this before the audit, thankfully, so that when BCBSIL really did have a look, my forms were HIPPA compliant.  No chance of breach of privacy there, an audit of mental health records.

And twenty-plus Office Maxed copies of:
I hearby give Dr. ______ permission to speak with _____________ about anything she wants to talk about regarding me, with the exclusion of _____________________, which she should totally not talk about. This release is good for exactly thirty days, starting

Date: _____________________________
Printed Name:______________________

Signature __________________________
went to recycling.

But in the past, within those thirty days I would track down that primary care doctor or psychiatrist and we would pick one another's brains and come up with a logical assessment and a treatment plan. All assuming the patient concurred that such a discussion might be a good idea.

Then the fun would begin.

If you're a family therapist and you work with family physicians or family psychiatrists, the beauty of consultation is that both of you probably know other people in the identified patient's family system. You both have priceless data to share. What’s wrong with the patient isn’t based solely upon the patient's perspective anymore, but that of generations of souls.

At some point as a professional, you gather a small army of professionals who think like you, work well with you.  And if you’re me, you want to know them better. It's not enough just to talk shop.  But this isn't efficient in professional life, yapping about your own health or family matters, even if the interest is there. There's no time, not even for professional geography, a Who Knows Who.  So we rarely finesse professional intimacy, is the truth.

There are pluses and minuses to privileged consultation, besides all the shared data about the patient, which is surely a plus. And each has something remotely related to intimacy in relationships. Relationship therapists see all relationships through the intimacy lens.  It is an occupational blessing and a hazard, too.  

On the plus side, consultation is essentially chatting, which is always fun.  And it's about a mutual patient. This makes it feel like the two of you are just a couple of friends, chatting it up about someone you both know, relieving tension, because your patients are sometimes a danger to themselves or others, and you want to be sure everybody's safe. That is your job. That's what you're paid to do.

But you hardly ever do this with friends, just chat it up about someone else, certainly not someone who isn't a first degree, because you're a professional and you almost feel like you need a release of information to talk about other friends to your friends, unless there really is a danger and you think maybe that your psycho-education might help.  We're not good gossips. 

So this feels good, talking with other professionals about other people.  We finish talking about the patient, then maybe sneak in a few words about our money stress and how we're going to stop taking credit cards.  Some of us find this intimacy (work intimacy) lacking, a little shallow, but it's better than nothing.

On the minus side, it's not like we speak with our consultants every day, probably not even every week.  If we catch up once a month, even every two months, we are doing extremely well.  So if a physician dies or gets sick (and this happens), crazy as that sounds, we might not hear about it until a mutual patient tells us about it in therapy!

When that happens, I can tell you, we're totally taken back, stunned, and the poor patient's visit becomes a discussion of our mutual loss. And then it turns into an exercise in self-restraint for the therapist, keeping it about the patient.

(One day we'll have to talk about that self-restraint, how we do that, keep it all about you, even after hearing that one of the neighborhood kids has died in a tragic accident or our own kid didn't make it home from school that day. It really is an art.)

Another minus is that if you do finesse the intimacy, you end up making people wait because people are always waiting.  Between two professionals, at least one is going to have somebody in the waiting room, perhaps even on an exam table! So you make your call brief and you feel badly, because despite what people think, everyone wants to run on time.  So as soon as it's getting good, one of us has to go.  You could say we're avoiding intimacy, but we're not.  This is being professional, running on time.

The best thing about consultation, the biggest plus, I think, is that when it's good, it is mutually validating (which all relationships should be, of course). Good consultants don't just want to tell over what they know about the patient. They want to learn something new.  So we listen with respect and we validate the other's thoughts and opinions. We do it for one another.  It's a love fest.

2.  Confidentiality/our families:

When your sister-in-law tells you something about someone, she has no Release of Information, and you don't either.  It's implied that neither of you will tell anyone, and you probably won't.  But sometimes you slip, you have held secrets all day long, and have left your professional hat at the door.  Even therapists, who should know better, can be weak at the end of a long day, when it comes to family secrets.

I know, I know, you're going to say, I am a therapist and I can keep a secret!   I'm the best secret keeper in the universe.  And that may be true.  But not everyone can do it, and kol haKavod to those who can. (Hebrew, rhymes with dole-pa-la-toad, means you're awesome, deserve respect, more power to ya').

My in-town kids and I tried to keep a surprise visit from FD. One of our out-of-town kids was coming in for a wedding, unexpected. Even the bride and groom were sworn to secrecy. She wasn't coming in for three weeks. 

Three weeks of secret-keeping.  This proved to be impossible. We blew it four times, which averages to over once a week, and everyone took turns blowing it.  FD is so clueless, he didn't even notice until the fourth blurt, and maybe he wouldn't have noticed then, maybe we could have mystified him about the blurt, but one of us, ahem, simply couldn't handle it anymore. And she gave it all away.

It could be that the whole gestalt, keeping the lives of everyone else so hush, hush, makes some of us a little loose with our own families. Or our boundaries are bad.  I'll try harder, is all I can say. I really will. People change.

As long as we're talking, please don't take that story as permission to blow family secrets, good or bad, it's really not permission, not at all. The best line ever about this came from the mouth of one of my first degrees. When I asked if I could tell someone else in the family a secret she had just told me, she said:
It's my secret to tell!
Good or bad, secrets are proprietary, and there's joy, and pain, in the telling. It is the owner's right to both.

3.  Confidentiality and friends:

Therapist are used to being tailors.  People take off their clothes, we rip them apart, put them back together again, seamlessly, to the consumer's measurements. We like being tailors, like getting to know what people are made of, and in the end, despite the cutting and sewing, everyone feels better.

Most of the time.

And our friends, depending upon our friends, try to do the same thing with us. To us. Because who doesn't want to rip into a therapist?  It's so much fun, and we're such good sports, and we tell you when you're right, and correct you when you have no idea what you're talking about, with a Nice try! But think about it this way.  And we pontificate psycho-babble until everyone is bored out of their tree.

Sometimes friends want us to help them, too, and we gladly oblige.  Friendship is a two-way street, after all.  It's complicated because of the attachment-detachment conundrum. We're used to detaching with patients, while at the same time being empathetic. The empathy chip is working all the time, in all of our relationships, as a default, sometimes better than others. No matter, an empathetic therapist gets better at detaching from patients over time.

But the empathy chip, let's just digress to that for a sec, is always whirring. Empathy, by definition, implies a sense of caring and genuine concern, which is why you see so many therapists nodding until you want to strangle them. It is the active ingredient in therapy and in friendship, as it turns out, tuning in, sensing, sharing the emotional life of another, feeling the pain.  And the joy.

But as professionals, we really don't want calls after hours from patients, so we gracefully detach, keep it all very professional.  And I think we automatically try to do the same with most of our friends, too.  And they do the same with us, maybe because we all have other things going on, or maybe because too much intimacy smothers some of us.  And like attracts like. 

So it's interesting.  Both professionally and in friendship, empathetic humans get their hands dirty.  As professionals we wash every 45 minutes, but with friends we're not so quick to wash it off, or forget.  We'll text a friend quicker than we will a patient, shoot over an email-- You okay?  (I'm pretty sure HIPPA has no room in the rules for texting or email).

People complain about surgeons, say that they are cold. But really, it’s because their engagement and detachment are so brief, so clean, so surgical that there is no time for more. At least that’s the excuse I’m giving them.

Back to friendship. If I am having a long talk with a friend, at the end of 45 minutes I get a little antsy.  Still, after all these years. When I realized that my friendships were lacking because of this, that it really is a problem for me socially, I suggested we take off for parts unknown (at least a half hour from home, Chicago's a big town) and that we stay overnight. I don't know how we ever pulled that off, seriously, looking back, but it was great and we did it for a couple of years in a row.  Now I understand that bridal parties are doing this, getting out of town for weekends, even weeks, with fairly drunken outcomes.

My guess is that the intimacy is just too much, so people get bombed.  And with that?  Everyone's confidentiality, certainly, goes out the window.


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