Sunday, June 24, 2012

Jerry Sandusky and his Adopted Son

Jerry Sandusky is guilty, will likely spend the rest of his life behind bars.

Only a few days ago Sandusky's wife, Dorothy (Dottie) testified that she heard nothing, saw no reason to believe that her mate had been having sex with children in her basement. She apparently knew not to go down to do the laundry.

She's the interesting patient, to me, as an example of dysfunctional loyalty.  Families are so powerful.  It can't be easy being Mrs. Sandusky, never was, that's for sure.  This had to have been her worst nightmare.



It's amazing that some families stick together, though, even as it becomes apparent that a member has done something monstrous, appalling. Regarding Sandusky, even the word evil appliesaccording to Shana Stamm (27), a young woman who remembers hearing his motivational speeches at her elementary school as a child.

He was there to raise money for his charity, The Second Mile. Sandusky set up the children's charity, now we have to assume, to choose from any number of vulnerable, disadvantaged youngsters. A pedophile's dream.  He adopted six of them.

He is guilty of 45 counts of sexual abuse. Eight victims testified against him, none of them his adopted sons.  They told stories like Mr. Weaver's:
Travis Weaver . .(is) suing Jerry Sandusky, (and) told NBC's "Rock Center with Brian Williams" that Sandusky abused him more than 100 times over four years starting in 1992, when he was 10.
Story, after story, after story, after story, after story.  All while one of Sandusky's adopted sons, Matt, looked on at the trial as if he were his father's loyal supporter.

And then:
after a week of tearful, gruesome accounts by eight men that they had been abused as boys by Jerry Sandusky, the former football assistant coach at Penn State, Matt Sandusky . . . offered to testify that he himself had been abused by his father. . .
Matt's biological mother, Debra Long, has come forward to say that she suspected, many years ago, that something was wrong in the Sandusky home, that Matt might be in trouble. Her reports to authorities fell on deaf ears.  She regrets not pushing it, thinks she may have spared her son and subsequent victims so much pain.

Perhaps Jerry Sandusky could have been stopped, even put behind bars, back then.

To bring the story home:

A young woman recently tells me that she is getting a new job.

She has a school teaching transfer from a school in a good neighborhood, with a difficult administration, to a school in a bad neighborhood, with a friendlier administration. She's excited about the change, but worried that she will see many young victims of child abuse.

That goes with the territory, working with kids, but she's afraid to report (teachers are mandated reporters).  She's afraid of the repercussions, revenge at the hands of angry, psychopathic (or almost psychopathic) parents who are likely to get that knock on the door from protective services.

Oh, I remember making those calls, I say, reminiscing, seeing leg bruises the size of baseball bats because they were inflicted by baseball bats.  And that was in a nice, middle-class neighborhood.

I tell her that (a) the statistics on child abuse cross class lines, although there is likely to be more street violence where she's going;

(b) her calls to the Department of Child and Family Services could save lives;

and (c) as we've all come to find in the case of Jerry Sandusky, child sexual abuse and pedophilia are everywhere, neighborhood doesn't matter.  You can take little boys out of their disadvantaged neighborhoods and make them victims of predators who work in America's very best schools.

She'll tell, I'm sure, when she has her suspicions.  She'll make those calls or have her principal make them for her.  And my guess is that the social worker from her state's protective services department will be listening, and wondering: Is the family covering for a terrible perpetrator?  Is there more here than meets the eye?  And maybe, just because of Sandusky, the team will do a very thorough investigation, complete with follow up.

Something positive has to come out of this.

therapydoc

Thursday, June 21, 2012

First Contact/ First Visit

I thought I had already blogged about this but couldn't be sure, so I went to the Blogger search feature and entered first visit to bring up my many posts and drafts. So much popped up I almost packed it in, headed for the kitchen to rummage the fridge. Almost.

So many posts! How did my friends (what's wrong with a liberal definition of that word?) ever get through them? As I once told Jack, author of Random Thoughts: Do They Have Meaning, there are hundreds of drafts hidden in the Blogger dashboard. But I'm given to hyperbole, so he didn't believe me.

Is this a manic symptom? It could be, but it isn't for most of us. How much we write, if not how well, reflects personality, a need to communicate, to socialize, maybe verbal aptitude. Having a lot of words, needing to express them, some of us do it this way. People who don't know that we write might even think we're quiet, because some of us are. If we engage in this consistently enough, it might be fair to say we are writers. For anonymous writers this is a hidden aspect of personality, not one that is necessarily noticed or known in our ecosystem, our world outside the Internet. But it is personality, none the less, an aspect of identity, a way of expression.

Therapists with too many words are likely to be vocationally frustrated. We aren't hired to talk, we're hired to listen. We have to let you talk, even encourage you to talk (Tell me!), make it safe for that to happen. You're paying for this, after all. The wonderful thing is that our restraint factors into a more focused, clearer summary. We say things in fewer words, make an impact with less energy.

I'll often ask, after a short, tentative interpretation of someone's words, "Does what I just said ring true to you?" The patient might ask for more, more words, which is a trap, gives me license to embellish, to talk a lot more than I should.

It isn't always obvious when the patient is checking out, uninterested, even upset that she has lost the floor. So even then, even when asked to explain, the therapist had best reflect the question back to the patient. "No, tell me what you think. It doesn't matter what I think."

See, even when we have the license to talk, we have to control it, perhaps the hardest thing ever, for some of us, not only as mental health professionals, but as people.

A blog is a license to print, and as my rabbi likes to say, we should print wisely, or not at all. This is just like in therapy! The therapist should speak wisely, or not at all. Both venues, therapy, blogging, lend themselves to open spaces, opportunities to fill the silence when perhaps the silence shouldn't be anything but that, silence.

In a couples therapy, when people argue in the name of problem solving, it can get destructive, so we ask people to rethink what they're saying, to edit their words. It isn't exactly like talking to bickering grandsons at the Target prescription counter. "If you have nothing nice to say, don't say anything at all." A white haired customer, overhearing this will smile, and even more remarkably, children quiet down. But we can't do that in therapy. There has to be a covert or an overt rule that nobody gets hurt here. Not in my office, I say.

The trick, of course, is not to shut anyone down. Therapy is about opening people up, getting to core issues. It happens when we resist the temptation to share our opinions, to probe, and certainly, to explain.

Here's an old draft. I'm pretty sure I never posted it, but I'm not sure what's out there anymore.

FIRST CONTACT

Sounds like the title of a Star Trek episode.

We talk here on the blog about couples therapy, family therapy, even healing an ailing institutional setting. But a good individual therapy is golden, with a focus on the patient, the individual alone. Individual therapy is still the a Cadillac, if not the Rolls Royce, of treatment.

Even systems therapies (definitely the Rolls), attract empathetic therapists who sense when someone needs to talk alone, free of interruptions, reactions of other people. We try to oblige, and it isn't always easy extricating the needy individual from a significant other or parent to work alone for awhile, not lose the one left behind in the process.

When it is an individual therapy from the get go, it is because someone determined that therapy is not a luxury but a necessity. That, or a respected someone suggests a professional. Being social animals, socially influenced, feeling awful but open to change, we pop for it, we make that call for help, especially if there's insurance to rely upon, some other way to pay than robbing our ever-diminishing nest eggs.

First contact, the therapist is listening, feeling for what is wrong. Sometimes the quiver of a voice tells us much about the person on the other end of the line. We’re drawn in, want to alleviate the anxiety right away; this is our territory, calm and empathy, and it is natural for us to give it our best to get shy, reluctant patients into our offices. We hope they will make that first appointment, we know that someone has whittled them down, robbed them of that feel good, and we want to help make it right.

Because the prevalence of psychiatric disorders is on the rise, has been for twenty years, more people than ever are calling. Thanks to the Internet, digital marketing, Psychology Today, and a steady stream of variants on Dr. Phil, everyone is therapy-wise, sophisticated. Some still call with trepidation and unconditional respect. But most sound savvy, with expectations, and this isn't good or bad, it just is.

Empowered, help-seekers catch us on the phone and ask if we wouldn’t mind answering a few questions. Or we get email, voice mail asking for a couple of minutes of our time. We are interviewed by prospective patients who sound confident, wise about preferred treatment solutions, needing certainty we will provide.

Everyone wants a good fit, something that systems therapists think is fabulous, of course.

Some busy therapists don't want to be interviewed, don't have as many words to spare, maybe, and aren't actively seeking work. Most of us don’t have a receptionist, either, to field our calls, to go through our email. (The job doesn’t pay that well.) If we answer the phone, sometimes we're caught in an interview against our will, depending how much we enjoy being grilled while people wait for us in the waiting room.

The first visit really begins right there, engaging, reaching someone we may never see, someone who may choose not to use us as their therapist.

Or perhaps we will agree that the time "wasted" is part of a process, what we do in life anyway, have conversations that will go nowhere. And surely, even when it is only a telephone interview, what a therapist tells a prospective patient might be repeated, somewhere, somehow, to someone.

So yes, it goes without question, Rabbi. What we say, no matter where we say it, even at that first, invisible contact, had better be nice.

therapydoc

Friday, June 15, 2012

The Waiting Room

When book publicists (they still print them, you know) notice your blog, they send you an email: "I came across your blog. . .”). They are hoping you will advertise their book, of course. The good thing is you get to read new books for free, don’t even have to worry about late fees, like you do at the library. It is a win-win. The downside is making the time to review them.

I always say, “If I don’t like the book, I won’t review it,” and they are totally cool with that. One publicist actually wrote me back, however, to say, “No. We’re interested in your honest opinion.” In other words, bad publicity is better than no publicity at all.

What is fascinating is that this, a blog, is the equivalent of a waiting room. You, dear friends, represent people waiting to see the doctor.

The room is a little different than your average waiting room, holds many, many, many more people. Everyone is waiting for good content, and most won't wait very long.

I tell a new patient before the first visit, “Wait in the waiting room. You can’t miss it when you walk into the building, and it is huge, you’ll get a seat.” This puts everyone at ease. But this waiting room has even more chairs.

Traditionally, doctors get free magazines, good ones, too. Why? Because hundreds of patients pass through and have to do something to pass the time while waiting. And each and every one of the magazines has a subscription card in the centerfold, even the family fun throw-aways.  The subscription cards are very useful as bookmarks for real books, in any case. (Not to mention the cool things you'll find to do for family fun, I'm serious.)

Thus the waiting room is a marketing tool. Sending a doc a free magazine is advertising on the cheap, and this is the way it will be, should be, and why print journalism will never die. Unless everyone gets a Kindle or a Nook for free, just waiting to see the doctor.

So have a seat.

Two books, one wet and one dry, both excellent.

(1) Dry, but full of good things:
Changing Behavior, by Georgianna Donadio, SoulWork Press (you have to love that, SoulWork).


 
And the pictures are simply fabulous, all Picasso-esque. The book measures large, 11” x 8.5, and that should change. Not a beach book. But it isn't supposed to be. It is a means of promoting the National Institute of Whole Health, and a good one, at that. I like the descriptions of the brain, How It Is wired, Made Easy, if such a thing is possible, and it isn't. But it is much more interesting than the one that high school seniors read in AP psych.

And I love the behavioral engagement, Pure Presence paradigm. We talk about empathy on this blog, how to zero in on the emotions of others, how not to insult, how to engage, to meet, connect to people, really. But here is a set of rules for doing that. Or if you prefer, a list of the elements, variables, that go into establishing a better listening (hence engaging) environment.

The thinking is that if you don’t

(a) Find relationships sacred, worthy of reverence and respect,
(b) Use eye contact properly,
(c) Inquire without probing,
(d) Feel compassion, and least show some,
(e) Focus,
(f) Accept
(g) Let go of control

you can’t connect, not as well as you could otherwise. Pure presence compises more than those seven. I think there are twelve steps. Wouldn’t you know.

(2) Wet:

I’m watching Law and Order with my son, it’s late, and I have warned him to pay attention because I’ll probably fall asleep for the last twenty minutes and will want a recap on what happened, but make it to the end.

There is a spoiler, sorry, no other way to write this one.

The story is about two boys in foster care. Their parents are addicted or in jail or both. One kills the other (the spoiler).

The killer is gorgeous, blond, sweet, barely pubescent face. He doesn’t smile, he shows remorse, and at some point he even tells the truth. Yes, he murdered, and yes, he has done it before and believes he may do it again. He wants to be locked up. Should he be tried as an adult, or given the reprieve of juvie?

The defense takes the position that he has an XYY chromosome. He inherited DNA that is associated with criminals. He’s doomed to be an overly aggressive young man, maybe old man.

Harvard University sent me this little gem of a book, Almost a Psychpath . Maybe they know I’m obsessed with why people hurt other people, and helping them change. It is the harder part of being a systems therapist, complicated, but rewarding. Almost a Psychpath reinforces that notion that differentiating the true psychopath from one who is almost a psychopath is one of degree.

A psychopath, to make it short, is, one who couldn’t care less who he hurts to get what he wants, has no compunction about stealing, lying, maiming, even killing to take care of number one. He hurts without remorse, on instinct behaves in ways that benefit no one but himself.

“She shouldn’t have made me angry,” is the typical excuse for abusing an intimate partner. It is never his fault, always the fault of someone else for crossing him.

The examples in the book send chills. Better than Law and Order. I'll be writing more about it soon.

therapydoc

Sunday, June 10, 2012

Authenticity and Growing Up

David Schnarch, we learn in Psychology Today (June, 2012), is a psychologist who has spent decades going against the grain, debunking even Masters and Johnson. Debunking M & J, he is up against much of what is considered to be mainstream sex therapy.

Less interested in the mechanics of sex and communicating what we like, Schnarch is more interested in passion, passion between spouses, something he believes is only possible when we own our differences, maintain our individuality, and don’t fret every moment about what the other thinks.*

Sexy means different, separate. Opposites attract.

For what it’s worth, I can’t understand how this is a new concept.

Margaret Mahler (1897-1985), in the 1950’s, discussed separation and individuation, a variation of attachment/detachment (John Bowlby) as the psychological developmental process of human infancy. Mahler said that as newborns we start out symbiotic, with a sense of oneness, total attachment to our primary care-giver, usually Mother. As we gradually become aware that we are not the same person, that Mother has a life of her own, that we are really not one person, we begin the process of detaching from her psychologically, which will continue with others throughout our lives. But detachment in infancy is the beginning of the process of individuation, becoming an individual. By the age of two we're saying No! With attitude.

This process of developmental growth, becoming a being unto ourselves, different, unique from any other, varies for each of us. But we all go through it. Surely some of us start out and end up more dependent than others, and a more dependent, less secure partner might merge in many ways, seek to share values and characteristics of a more dominant partner, just as we do with friends in adolescence. Couples therapists see this as typical of one type of dysfunctional relationship (see the third below), and we see it often in the early stages of connecting, when, it is true, both partners may not be terribly grown up, especially if they partner young.

Some of us like to think we're never completely grown up, that we'll need to work on that until we die.

To Dr. Schnarch, the less grown up, less authentic, more dependent, gooey relationship is not sexy. It might be cute in the beginning, but it gets old. And none of us would disagree.

But really, doctor. Are they all like this, the marriages that need work? And those partners who are less mature, who are less well-individuated, should they just buck up? And if they can't or won't, then what?

If we were to quote Forest Gump on this one he might say, Sexy is as sexy does. And that would be your basic Master’s and Johnson/ standard sensate focus pleasure protocol. It is what any trained AASECT sex therapist (American Association of Sexuality Educators, Counselors, and Therapists) would recommend.

Schnarch wants us to grow up already, to be authentic, because this is sexy. We are more authentic when we hold our ground, when we don’t automatically move closer to the center, when we argue for what we believe in. It is independence that is erotic, not attachment, not if attachment implies that we must agree, lose ourselves in the process.

Certainly he's right, we could learn to do that, and therapy is a great place to start. Most relationship therapists have that part down, indeed, we spend much of that 45-minute hour encouraging authenticity. Honesty is sexy. It is the essence of intimacy.

Thankfully attachment theory, when it comes to infancy, is given a nod (he hasn't thrown the baby out with the bath water). Attachment is needed for healthy infant/childhood development. But for adults, attachment implies enmeshment, at least according to authenticity theory. Attachment, for Schnarch, when we're talking about adult to adult relationships, feels horrible, makes us feel guilty and stuck in our relationships because we feel we have to constantly tend to one another’s needs. Empathy, if I am reading him correctly, feeling another’s pain, actually messes us up.

Oy vey. Surely spoken by a male, one who relates to empathy intellectually.

Schnarch is opposed to marital attachment, or perhaps puts it second to authenticity (detachment) because it leaves no room for partners to speak their own mind, think their own thoughts, or attain their ambitions and dreams. (No room!?)
“We’ve eliminated from marriage those things that fuel our essential drives for autonomy and freedom.”
Whose marriage is he talking about? Every couple is so different! No two alike. And there are many different types of dysfunctional relationships, different types of marital pathology.

Consider four of them:

(1) conflictual marriages;
(2) relationships in which partners complain about missing intimacy,
(3) relationships characterized by one having to be sick in some way for the other to be well, and
(4) couples who pretend to agree, to be on the same page, who present to the world that nothing is wrong, when really, nothing is right.

There are unsatisfying, even pathological marriages, and we could say that a marriage that discourages independence would be one of them.

But there’s no question in my mind that Scharch is missing the central thesis to some off our therapies, one that this therapist has imparted to hundreds of couples over the years, driving them to more intimacy, more closeness, and yes, more attachment and surely, better sex. The mini psycho-educational lecture is addressed to those who complain about the second type of dysfunctional marriage above. But really everyone complains about intimacy in therapy. It is the nature of the beast, and it is rarely, too much intimacy.

A different psychoeducation:

One partner complains about not have enough time with the other. But the other partner thinks they already have enough, even too much time together. One feels suffocated (perhaps because the other isn't well-individuated, in the authenticity model). Another alone.

The novice therapist is able to accommodate, adjust that uncomfortable psychological space. Just grow up! Differentiate, add a new hobby, skill, book club to your life! Distance is good. Learn golf. The partner with the need for more intimacy is thought to be too dependent and is guided to fill in time with other things, develop more self. It feels like a win-win, at least to someone in the room.

But when it happens, in that growing up time, the golf instructor finds a passionate new student and attends to her intimacy needs. Do we not see this every day? She can certainly take this as flattery and rebuff him, run home to her partner exhilarated at the prospect. That’s sexy, for sure.

Is this what Schnarch really means? Possibly. Individuated, she has new ideas, new thoughts. She is more attractive. To everyone. Which is more attractive to him. (Switch genders if it makes you feel better.)

No, it doesn't have to go that way, the growth need not be co-opted by the golf instructor, and perhaps it usually does not.

A seasoned therapist, in any case, does not to go the distancing is sexy path, does not suggest golf right away. Surely golf is good, hobbies are great, individuation is for all ages, not only for infants. But the seasoned therapist tells both partners that intimacy is much harder than distance. Anyone can accomplish distance. It is staying close, being together that is hard.

Ask any retired couple. Accommodating to finally being together after years of individuating can feel like horribly suffocating, drives people who managed well throughout their marriages to therapy.

I agree with Dr. Schnarch, of course, that we have to be ourselves, and only ourselves in marriage (unless fantasy works, and guess what, it does), and that loving one another is easier when we are just that, crazy unique, original creatures that we were made to be. If owning who we are is growing up, then he is right on. But again, no chidish (Yiddish for something new, rhymes with hid-dish).

And to say that empathy is passe, over-rated, misses the point. Caring about the other’s feelings has to be a primary objective in an intimate partnership, should take precedence over golf, even politics, even if it doesn’t feel all that sexy in the moment. Empathy is tuning in to the other's mood, joining, attaching, and it doesn’t feel good is the truth, because our moods aren't always pleasant so no, it isn’t sexy. We don’t like to feel one another’s pain. Far better, really to be on the green, or at work, to avoid the other’s negativity until that other gets over it. Far better.

Not really. Not really far better, not at all.

therapydoc

*A good sex therapy program, by the way, is never all about the mechanics, always beam the flashlight on emotional marital dysfunction, especially anger. We could say that Schnarch's emphasis on authenticity is really a variation of that.

Wednesday, June 06, 2012

Snapshots

Just a few more, and we'll get back to something with real therapeutic import.

(1) Me and Time

Sometimes I think about the effects of my childhood on my development, and The 8:30 Bed Time comes to mind. Not sure how old I was, but 8:30 pm is imprinted on my brain as the first forced bedtime, lights out.

When you aren’t tired and you are supposed to go to sleep, and you’re too little to protest, have parents unafraid to parent, or both, you lie around imagining things.

They’re not all good things. This isn't to say that parents shouldn't use their power.

Anyway, some of us grow up and become therapists and everything becomes quite clear to us, much more clear than had we gone to therapy for years, although that would have been nice. Most of us get just enough therapy to empathize with that experience, the experience of being on the other side.

I also remember early elementary school years, watching the clock and learning that you can time how long you can hold your breath by watching the second hand on that big black and white clock above the blackboard-- still never missing a thing. This is good to know, how long you can hold your breath, because it is likely one day you will take swimming lessons and have to dive for things.

Working as a therapist you learn that watching the clock makes time move infinitely more slowly. If you concentrate on the patient and what is going on in the room, only check the clock when you are pretty sure you have hit the thirty minute mark, time flies by. Unless you are very, very sleepy, in which case, God save you.  If you've been in therapy, you know this happens.  I've said before, it is the reason not to call your therapist in the middle of the night.

But everyone has to wait for things, and most of us have figured out by now that when we're busy, waiting is less frustrating.


This obscure photo is me waiting for the service elevator in my building. You would have to imagine me, actually, but here is my bicycle. The handlebars of my bicycle. It is 7:45 pm and the service elevator that leads to the bicycle storage room is still running (that stops at 8:00), and I’m happy about that, but rushing, have to be somewhere in half an hour.

The door opens eventually and inside a man and a little girl welcome me, bike and all. The diode for "4" is lit up on the light panel.

They are going up, apparently. I smile and inform the two. “I’m going down. Have a nice night.”

The elevator isn't going anywhere. He is holding the door. I repeat the circumstances, Going down. Not up. Finally he turns to push a number for his floor, the very highest floor in the building.

“Of course,” I say under my breath. “Of course.”

I take a deep breath, take out my phone, and snap that picture above. By the time I have snapped a few more for good measure, the elevator is here to take me down to the storage room.

That took no time at all.


(2) Do You Hear What I Hear?

The weather in Chicago has been variable, warm and sunny for the most part.

Hottest Sunday ever. Hottest Memorial Day on record. That sort of thing. Then the temps drop into the forties.

We bring out our one warm sweater not packed away for the summer. Mine is wool, zips up to the neck, and I'm indoors, where it is probably a toasty 69 degrees Fahrenheit.

FD reaches over to loosen the zipper and I flinch. "I just thought you would be more comfortable," he protests.

"Isn't it funny how people assume what makes other people more comfortable? Like we don't know, really, that we're too warm or too cold. You're hot, I must be, too!"

He smiles but defends, "But sometimes we're right, are we not? Those of us making assumptions?"

"No," I reply. "How could you know better than me how I feel? And anyway, you could always check it out (an old family therapy technique). You could ask, 'Are you not hot in that sweater?' Or better, 'Want me to hang up your sweater for you?'"

We don't even discuss any subtext here.

(3) Definitive Dog

I'm walking home from someplace and spot four dogs and their three owners at my corner.

The dogs are panting a little, smiling away. These aren't scary-looking dogs with muscles bulging down their backs through short-cropped hair. They aren't the types of dogs that bite the kids I see in therapy, sadly treating their dog phobias. (Those dogs have serious looks on their faces.) These are your basic well-fed neighborhood mutts, living the dream.

"You always know," I greet my neighbors on the approach, "when you see a bunch of people hanging around on a corner with their dogs, that it is a happy corner."

These folks know me, know better than to suspect my reality testing, at least I think. They are all smiles and the dogs want to show me affection. Noses begin to nuzzle too close to my personal comfort boundary.

"You could at least ask," I tell one, gently pushing his snout away.


(4) Ambiance

We've moved a little closer to real city, to a more congested part of town. FD and I are taking a walk, come to a busy street. It's loud, but interesting, considered one of the most diverse streets in the city of Chicago, or it was when I took Community Psychology many years ago.

When I'm on my bike, on my way home from work, I stop and look around, right here at the traffic light. It tends to be about communicating with drivers. Are you really going to turn left and see if you can mow me down? It's a blink game. Who goes first? You can tell which drivers want to mow you down. You let these people go first.

We get to this corner and FD says to me, "It's so noisy here that the birds have trouble communicating, you know. They have to find times of the day when traffic is less congested, just to sing." This is something I've never thought about, birds having to find a good time to sing.

And he's right, of course, noise pollution affects us all, especially him. He has that super-sonic hearing that some males have, a redeeming feature of the sex. Females have the better sense of smell.

The whole thing makes me wonder how anyone out on a date in a crowded bar, or even out with friends at Starbucks, expects to communicate at all. There are quiet bars, I suppose. I see them on television.  And sidewalk cafes.

therapydoc