Wednesday, February 18, 2015

Fifty Shades of Grey and Informed Consent

Fifty Shades of Grey-the ebook
Prior to reading the book, I thought 50 Shades of Grey had to be a middle-aged woman's lament about her hair.

Okay, that's the last joke.
Men Can Stop Rape

I bought the book months ago, needing an ebook to read while the nails dry. It could take me a year to finish just one ebook. But I lost my place, which happens when you use Kindle on multiple devices, and never found it again. Not being patient with such things, I switched to a print book,  Understanding Mass Violence: A Social Work Perspective which is pretty good, actually.

The poster above is from the Men Can Stop Rape organization. I bought a bunch of them. 

Not that Fifty Shades of Grey is about rape, but it is about hurting. And therapists deal with hurting pretty often, tend to wince when people intentionally hurt themselves. Doctors as a rule are down on self-harm, risky behavior. My father-in-law, a family doctor, called people who ride motorcycles organ donors. Knowing it is dangerous isn't a deterrent for everyone. Because you know, it looks like fun, riding that bike. So is it worth the risk? Maybe. But maybe not.

Risky behavior is expected at certain ages. There's a post on the blog about being crazy in college. Point being, we often regret what we have done in the past, might suffer shame then and in the future, even when we know, rationally, that free from the watchful eyes of parents, kids push their own limits. Forgiveness is hard because these types of moments form snapshot memories in the brain, and often, body memories. We don't forget.

That should put informed consent into context. We can consent today, woefully regret it tomorrow.*

Quick recap: The 50 Shades story finds Anastasia Steele, an average young woman interviewing a very handsome, very rich business executive, Christian Grey. She falls in love with him at first sight. He likes her, too, and offers her a contract to begin a sexual relationship. He likes bondage, whipping, and other types of torturous sex, so he wants to be sure she consents to it. Keep things kosher. No consent, let's not even begin.

Five things to consider when we speak of informed consent for sex in real life:

(1) neither party can be impaired by drugs or alcohol in the consent process
(2) both parties must be of legal age
(3) both parties must be competent, understand exactly what is going on and why
(4) neither party fears personal injury or punitive consequences for refusing to have sex (in the sexual harassment literature, this is called fearing retribution)
(5) neither party is in a position of authority over the other, i.e., a supervisory position, a teacher, an older relative, because this could be interpreted as financial, academic, or emotional coercion

If Christian Grey had been her boss he would have been guilty of sexual harassment, even with his signed contract, because that puts him in a coercive position, having the power to fire her or suspend her without pay. So if someone dates an employee or a student, it can come around to haunt. These cases cost companies, and perpetrators, millions of dollars every year.

But that's real life and this is the movies.

MamaMia reveals the ending, so if I got it right, this would be a spoiler alert:

The handsome dom, Christian, changes, probably so that he doesn't lose Anastasia, his subdom, his prized possession. He learns the meaning of true love and the hole in his heart, the one suffered as a child, begins to heal.

Because that's how it always happens in real life, right? Relationships are curative.

Let's just say, not usually. Don't marry (or date) the man to change him. That old expression, spot on.

So Anastasia, without any pressure from her boss, signs a contract and agrees to let him whip her, hurt her, in the name of "great" sex. (You will love this, he assures her). She is sober, of age, of sound mental capacity, and isn't feeling coerced. She becomes his possession, agrees to let him tell her what she will eat, what she will wear, how she should bathe, the amount of sleep she must get, how many hours she works out per day, etc. She is to be there for him, when and where tells her to be there. She must sublimate her will to this perfect stranger.

15.21 The Submissive shall accept whippings, floggings, spankings, caning, paddling or any other discipline the Dominant should decide to administer, without hesitation, enquiry or complaint.


That, if she wants him as boyfriend. There is a time-limit to the relationship and she can complain if he kills her, we suppose. She is crazy for him, so she signs on the dotted line.

So you get it what it means to be a dom, versus a subdom.

Courtesy of Relationship-Wise
Women have endured a cultural battle for equal rights. (This despite our obvious superiority.) We're criticized when we are dominant, forceful, assertive, even when we're respected in the corporate and professional world. Many of us would not want to go back to serving coffee, not when we've seen the other side of the desk. It isn't only our struggle, of course. We celebrate Martin Luther King Day, have seen 12 Years a Slave.

So being a subdom should feel bad, not good. But it does feel good to many, male and female. It is how some brains respond to abuse as children. But I'm saying we should fight it, should turn that around. One in three women, one in ten men, have suffered some type of negative experience with sexual domination. Add all of the other types of abuse (see chart in blue) and the numbers are likely to be one in two for women, one in five for men.Suffering abuse means suffering domination.

Oh, but these are loving relationships.

When I blogged about this many years ago, the dom-subdom community told me that these are loving, consensual relationships, not to worry. It is intimate, they love one another, and bondage, et al helps them work out their family of origin/childhood relationship dysfunction. Totally intimidated, I considered myself informed and dropped the conversation.

What I didn't say, but can say now, is that as a first year graduate student, one of the very first treatment modalities presented to us happened to be Joseph Moreno's psychodrama. In psychodrama, families act out what has happened in the family of origin, or what is still happening in the home today. They do this in the confines of the office. There isn't any real hitting, only shadow-boxing. This is play-acting. It feels good, too, very healing, and I sometimes still use it. So, if the purpose of the dom-subdom relationship is to master what happened in the past, we could say that it is overkill.

Remember styro-foam baseball bats? People whacked our sofas to their hearts content until expressing anger lost status. We also talk about things in therapy. Talking heals.

There are two things that bother me, both related to the act of consensual relationship violence.
(1) We have laws that prevent corporal punishment with children, laws against child abuse. It isn't called child abuse because children are irreparably damaged from a spanking. They aren't. But because we never know when we'll lose control, when we'll hit too hard, send the child reeling, crashing into the wall (we've all heard this story too often), it is against the law. When a kid sees stars, it is too late to say you're sorry. Ditto when the symptoms of a concussion become apparent.

And here, in a dom/subdom relationship, definitive "corporal punishment" there are no boundaries except, perhaps murder. It might feel right to want it to become progressively more punitive, too, to both partners.

(2) We've learned much from treating people who externalize their psychic pain by cutting. It is a relief, a coping strategy, as strange as that might seem. (This may be upsetting to the squeamish, so you might want to skip the next paragraph.)

Some started with picking, or scratching, which feels good. Then they scratch harder, because that feels even better. The nails dig deeper, even more satisfying. Then a knife is introduced. The cutting with the knife starts with light cuts, which get progressively harder, and deeper, then deeper, and pretty soon we see ( therapists see, because few cutters showoff their scars to other people, hide beneath long sleeves and pants), but therapists are privy to seeing deep, red, ugly, keloid scars that run up and down a person's arms or legs. It is the stuff of secondary trauma.

That's what some of us worry that not only will the memories of this type of relationship be snapshots, difficult to erase, and that the shame of what happened will damage self-esteem, but that the need to be hurt will become a deeper need.

And the dom? He isn't getting hurt, and he's likely not a Jeffrey Daumer, a psychopath who murdered children as an adult, drowned cats, the starter drug. 

More likely it just feels good to play the master, empowering. But is that good for his identity? Is this the person he wants to be? A master over another human being?

What I really want to know, is the answer to this: Is sex that important? If it potentially damages identity, dings emotionally (those memories) and literally scars us physically, is it worth it?

In therapy we're all about loving our bodies, loving ourselves, being cautious and kind to others, respectful, independent, and growing into the people we want to be..

So do I hate this stuff? You bet I do.

therapydoc

PS. Two more thoughts and I'll let you go.

(1) This is a system based upon fear. Fear arouses, for better or for worse, and what makes us afraid today, won't make us afraid tomorrow. 

(2) Low-self esteem is often from child abuse, as is the feeling one deserves to be treated badly, wants to be treated badly. Negative self-messages, inhaled with mother's milk, can program a person to want and accept punishment, to seek out partners who, like our parents, will comply. The dom.

Low self-esteem, friends, isn't a life sentence. It doesn't have to be.

* Just a reminder that well over ninety percent of all sexual assault is between acquaintances.



Wednesday, February 11, 2015

Other People's Stuff

It has been some time since we linked over to other people's blogs and websites. We are totally overdue. Here are some goodies.

(1) EMDR  Eye Movement Desensitization Reprocessing.

Still one of my favorite techniques, although it requires a little upper-arm muscle, focus, and yes, intensive training.

That can be tough, that trip to San Diego in the winter. (There's a post on this blog about it somewhere, all about me, naturally.)

For many years we used EMDR primarily to treat PTSD, but now it is popping up in all kinds of other ways. Check out this link to Anastasia Pollak's Not just for trauma: EMDR and Performance Enhancement. She even explains how it works, the theoretical why, that is.

And of course, so does the founder, Francine Shapiro.






(2) TopCounselingSchools infographic is tops in my book. How we love a good visual, check it out. (Blessings, Brietta, thanks for your patience.)

(3) How to Give a Time Out: Give a Time In Instead  We used to use The Green Chair, and the very thought of it kept my kids in line. (Start them young, is the thing. If they need EMDR later for the trauma, by then it should be cheaper and everyone will be doing it).

Jenny Kepler does a lovely treatment on time-outs in this post. It's mostly about you, you know, not the kid. Surprise.

(4) You've heard it here for years, that when the therapist is talking, half the time nobody's listening. Which is why we really do have to listen and cut the blather. Justin Lioi: The Best Advice a Therapist Could Get? Stop Giving Advice.

(5) David D. Burns, MD has a blog, Feeling Good, with wonderful articles, well-written, for therapists and lay people interested in the therapeutic process. You can't go wrong reading anything by this man.

(6) I'm getting to know some people on Facebook's Therapy Blogger page (this is called social networking) Most are in private practice and they are from all over the world.

Laura Hollywood, along with her thoughts on perfectionism, even quotes Brene Brown: 
“Where perfectionism exists, shame is always lurking.”    
 Also love that British spelling, "s's" instead of "z's".  Coming to London soon, Laura. Will call.

(7) Then there's Psyched in San Francisco, an edgy group of young therapydocs writing their brains out. Thanks Traci Ruble for a few sample articles from Psyched.
Brett Penfil's New Year’s Resolutions for Psychologically Savvy Leaders
Brett is one of the "real deal" executive coaches. She is the Director of coaching for UCSF Medical Center so this is a direct piece that combines psychology, executive coaching and pragmaticism.
Marty Cooper's “Greedy Bastards!”: or, Why Paying for Missed Therapy Sessions is Good for You
Outcomes research shows knowing what to expect in therapy improves its effectiveness and Marty deftly describes why setting really tight boundaries helps clients make real change in therapy.
Abby Volk's Why the “Small” Things Matter: Stop Avoiding Yourself and Your Truth
Abby's work always appeals to the young urban professionals. She has a "tell-it-like-it-is" rawness that is provocative and motivating. In this article she beats the drum for authenticity.
Lily Sloane's Sidelining White Shame and Joining the Social Justice Conversation
How and the heck can regular old white people get involved in the social justice conversation after the court rulings in the last year that sparked riots. Lily covers this with smarts and grace.
(8) More writers from San Fran, must be the salt in the air. This time,The Couples Institute. You might start with Painful Interactions Are Defining Moments in Couples Therapy,. Ellyn Bader makes it look easy; but even she admits, this is cringe stuff.

You would have to be a masochist to enjoy it, but couples therapists do sign up for this, war in the office.

(9) And finally, Michael J. Formica  writes prolifically at Psychology Today. Take a peek at any of his many wonderful articles. .Awesome.

That's enough for now. If you have links you would like me to share for the next Other People's Stuff, comment below or shoot me an email.

What to expect anytime soon around here? Maybe an old favorite, the treatment of pervasive OCD, because it is one of those difficult to treat of psychological ills.

Or maybe we can talk about how to pitch the virtual 15-minute family poker game (because who has time for anything else) penny a chip, a pitch to my family, a game that marks the fourth anniversary of my father's death, which happens to have happened on the exact anniversary of my brother's death, 45 years ago next week.

Ante up.

therapydoc

Tuesday, February 03, 2015

13 Things Mentally Strong People Don't Do

I have to admit, lists rankle me, especially when they are lists of shoulds.*

But Amy Morin wrote a list of should nots. The book, 13 Things Mentally Strong People Don't Do, pulled me in, just like Where Have I Been All My Life, life coach Cheryl Rice's biography, last week. Love those book tours.**

The good news is that the list of don't isn't as focused on avoidance as it  leads on. That's good, because avoidance isn't generally therapeutic. In fact, it can be anti-therapeutic. Just don't  ___ (fill in the blank), never works, not for very long. Humans are far too willful, prone to habit and addiction. Therapy is a process, an examination of the whys and the wherefores of pain--the opposite of avoiding problems.

We even suggest that patients lean into problems. Don't avoid. "Bring it up in a safe place" (before leaning in in vivo). Enough focus and we get sick of feeling sick, leave it for awhile.

Remember what the late Morrie Schwartz suggested to his biographer in a different kind of book, Tuesdays With Morrie?  Morrie's path: embrace the pain, feel it, pass through it. This is mindfulness and it works for some, but it isn't a be all, end all. Yet I find myself referring patients to that book lately, especially when therapy is about a materialistic obsession with success.

So you see why  just don't is too simple. In therapy, we do. Or we intentionally postpone tackling a problem, give it a time and date for re-examination. Timing is everything.

This book, these 13 Things, does manage to focus on doing, thankfully. The "tips"embedded in each chapter are rational-cognitive-behavioral strategies, in list form.*** Alternative behaviors (huge on her suggestion list) add to self. Morin's formula: monitor behavior, regulate emotion, and think about thoughts are basic CBT steps, a steal (totally kosher) from the well-known Beck A-B-C's, affect, behavior, and cognition.

A glimpse inside the mentally strong, the first chapter:

They Don't Waste Time Feeling Sorry for Themselves.

If anyone has the right to feel sorry for herself, our author qualifies, having lost her mom, her husband, and her beloved father-in-law in a few short years. Any loss can throw us into another universe, center us on ourselves. And self-pity, if you're a 12-step aficionado, is stinking thinking. Amy uses herself, just once, as proof that we can rise above it, our pain, use our strengths to take the negative and make something good out of it. In her case, a book, and a good one.


We could and maybe should stop here, but the idea for this particular book tour is that the reviewer choose one of the 13 and personalize it. The chapters apply to most of us, so this isn't all that hard. Look at the first eight.

Mentally strong people . . .

Don't Give Away Their Power
Don't Shy Away From Change
Don't Focus on Things They Can't Control
Don't Worry About Pleasing Everyone.
Don't Fear Taking Calculated Risks
Don't Dwell on the Past
Don't Make The Same Mistakes Over and Over
Don't Resent Other People's Successes

I stopped at the last, because I remember telling friends that I never envied what others have, wasn't quite sure of the meaning of the word jealousy, not until my daughter and son-in-law moved to California. He would attend graduate school, ostensibly, but had family, close family, in L.A. The likelihood of their return to the cold Midwest seemed dismal at the time.

The negative feeling, however, whatever one calls it, jealousy or envy, set in after the grandchildren started coming along. His parents had them. FD and I did not.

Me, to the fellow on the left at the zoo: We have to stop meeting like this.

Then in February, when the temps are below zero in Chicago and I'm visiting a little guy at his other grandmother's pool: We have snow in Chicago. Isn't that better?
And to those children scampering ahead on a hike in the mountains: Wait up!

I tried to keep it in, and truly, my son-in-law's parents are wonderful, and if anyone is going to be good for those kids, they are. To manage my negative feelings, all a person like me has to do is share with others (long dinners with friends, my preference), remember that things do change (there are universities in Chicago), find conferences in Los Angeles (and stay a few weeks, why not), and stay creative, be a grandparent that grandchildren want to talk to, want to visit. Be your best possible self.



It isn't easy, as we say, to rise above it.

therapydoc



*I tried to like BuzzFeed, ended up writing that list, Ten Things to Do Other Than Text While Driving. Went nowhere.

** Next post, seriously, we won't review anything and it won't be about me.

***For those who like to write up reminders and tuck them into their wallets, just a mantra is a good idea, something like, Do I really want to stop at the bar on my way home? (Watch another show on Netflix?) Maybe it is time I worked on myself, or helped somebody, somehow.