Tuesday, June 30, 2015

The Supreme Court, the Opposition, and the Gay Marriage Law

We have to talk about the Supreme Court decision making it a Constitutional right for gays and lesbians to marry in the United States of America. Less than 50 years ago the psychiatric community pathologized same-sex attraction, deemed it a disorder with a real DSM II code. That didn't last long.

Reporting the news, in the same breath, journalists quoted various self-identified groups of conservatives opposed to the decision. Googling "opposition to gay marriage," I found page after page after page of groups and individuals dead set against the right of same-sexed couples to marry. Many, if not most, because of a Bible prohibition.

Being one of a bible thumping tribe, the bible being the Torah, thank you, Orthodox the persuasion,
this booming opposition is a concern. There are so many commandments, and it is ridiculously difficult to keep the entire Torah, although that is the goal. (No idea what it means, by the way, to be Ultra-orthodox. Orthodox implies strict observance of Jewish law, or halach. All stripes of orthodox believe that Moses, a servant of the Old Mighty, passed the law along to the Jewish people. They were the only people who would take it, and they had to because God held a mountain over their heads, made them an offer they could not refuse.)

We could talk about all that for hours, but since it was 3500 years ago, and Moses isn't around to verify, we can only assume that he wouldn't lie to that crowd of three million who heard the Ten Commandments, ala Cecil B DeMille, as hail, fire, thunder, and lightning pounded them senseless, along with trumpet blasts, let's not forget, until they cried, "Stop! Tell it all to Moshe (Moses). We trust him. This fireworks display is too much!"

So God did just that, told it all to Moshe, and Moshe told it to those three million, who told it over to their children, who told it over to their children, who told their children, ad sterpes, until this very day.

And yes, we are still telling our children. And it is easy, because it is all written down, and sure enough, in one of the chapters there is a passage forbidding men from lying with other men. And that is why so many Judeo-Christian folks are still confused and intolerant of homosexuality. That is why there are so many opposition groups.

So, the strangest thing happened on my way to getting a PhD. I had asked for and been granted a year's leave of absence following the dreaded first-year comps. My family had a five-year plan to live and study holy things in Israel well before my decision to go back to school. Permission granted, the dean reneged about it being a year off. He wanted me to hook up with a social science professor as a research associate. That wasn't easy, but it happened, and I studied with one of the very best in Israel.

At the end of the year, packing to return home, stacks of academic articles about homosexuality made their way into my suitcases. All that literature, no matter what else might have been in the cards for me, determined my dissertation topic.  I just had to figure out how to make it something that would keep my interest in the coming years.

Being a family therapist, exploring variables in the parental acceptance of gays and lesbians did the trick. Now all I had to do was round up about 60 parents, interview and test them, and I'd be on my way to a PhD.

In 1998 most universities had not made the leap to allow researchers to look to the Internet to find subjects for study. It took some explaining at the time. At the end of the red tape (at a major mid-west state university), the Internet sample of parents most desirous to participate happened to be religious. Christians, many of them, had joined a movement called PFOX, Parents and Friends of Ex-gays, an arm of Project Exodus. Meeting together and talking about their issues, they came to the realization that hitting their kids over the head with theology wasn't working. Better to quit fighting, love them as is, and maybe someday they would give up on the lifestyle. Return to God.

PFOX is no longer around, except perhaps as a fringe group, but the entire Exodus movement, leave the lifestyle, come back to God, petered out, probably because the therapists who supported them had promised parents they could convert their children to heterosexuals (when they were ready) and couldn't. The practice of conversion therapies is and was at the time, unethical. Indeed, the major mental health organizations have all issued statements to that effect. Subjects endured shaming and humiliation from such therapies, treatments that undermined self-esteem and mental health in too many ways to count.

Meanwhile, before that hit the fan, I had managed to interview thirty-five parents who had participated in Exodus support groups. They described their own personal horrific emotional travels beginning when their child came out, or with the realization that their son or daughter would not be bringing home an opposite sex partner, this a traumatic experience for most. All dreams of grandchildren (this was fifteen years ago) dashed. Parents talked about their grief process and how they ultimately came around to accepting partners and friends, having barbeques and picnics in the kill them with love, or hate the sin, love the sinner world view. They stopped fighting, started loving, all the while hoping that their acceptance and love might change their child's predilection.

God can do anything. Let go, let God. So many of us believe this. They defaulted to love is the answer.

But nobody talked about marriage.

I heard their stories, fascinated. The rest of my sample came from the other camp, PFLAG, Parents and Friends of Gays and Lesbians, and random people who saw fliers or had heard about the study. They, too, had difficulty initially, but never thought things would change with a loving, accepting relationship. They accepted with more of a grin and bear it, This is my kid, I love my kid. Often one parent accepted. Another did not.

And now? Now that it is a right to marry? Which parents will be going to the weddings? My guess is that most parents will go, but it will depend upon so many variables, like social support and willingness to differentiate as a marital team. One parent might go, the other stay home. People will do whatever works.

And those who object, but don't want to lose their child, might be telling like-minded friends that it takes a lot to make a marriage work. The divorce rate is above fifty percent. The odds are against them. Getting married and staying married are entirely different matters.

Maybe some will even add, "But if these kids can make it work, more power to them."


therapydoc

Monday, June 08, 2015

The Therapist Takes a Vacation and Blurting: Six ways therapists can recover from mistakes

We all do it once in awhile, say something we wish we could take back.
You may not even notice when your therapist does it, might not even get it, but she does.
Mount Kilimanjaro

You likely will notice! And when you do, might be tempted to confront, and you might just do that. But this is a hierarchical relationship, despite all our talk about Empowerment Therapy and Call me by my first name. We come to rely upon our therapists, don't get excited at the notion of arguing or challenging them. Well, some do.

Which is fine!

But we therapists know when it's a blurt, a wish I could'a taken that one back moment, either by the look on your face, or through the words that play later on in our heads. (Many of us do this, think about you when you're gone, try to capture answers by reviewing what happened in the room.)

If we think we've erred, and shouldn't have said what we've said, we have options, some more mature than others, some more therapeutic than others. Let's start with five of them.

(1) We can wait to see what happens. If the patient hasn't questioned us and didn't look confused or upset, we might totally get let it die.

(2) Alternatively, we might call the patient a few days after, ask if she's okay, suggest that some of what was discussed last visit might have been disturbing. If we're confronted here, we have the option of explaining ourselves. Best to have the explanation ready.

(3) We might do an honest assessment to determine what possessed us to say whatever it is we said. This might take a few days, but the explanation will likely be better, and more true, with a few days hindsight. At some point the data will come in handy.

(4) We can call a consultant and discuss what happened to get another spin on it, get it off our chests.

Whether we think it through ourselves or with a colleague, it is safe to say that we don't just blurt things. There are reasons for what comes out of our mouths, and these are systemic, not all about us. The patient is driving what happens, the therapist is the passenger, occasionally sharing directions.

(5) We can decide not to decide, to wait and see where the patient is next visit. We might bring it up then, at the right moment, explanation in hand.

Let's take a quick example.

A patient of means travels often, talks about his vacations as they affect his family dynamics, mostly. But there is always a reference to the beach, and to the food. The therapist is not of means and does not travel much, but one day has an opportunity to do so, go someplace exotic.

When she cancels for the week she'll be gone, the patient gingerly asks, "So where are you going?"

The therapist tells him, straight out. The patient seems uncomfortable.

This is not a good sign. It means that the tell is a blurt, a blooper; the discussion of the therapist's vacation not the best move.

Why? He could have grimaced because he realized he had to drive car pool the next day, or something else. We can't assume, that, however because of these four unspoken laws.

(a) There is an unspoken (covert) rule that it is okay for the patient to leave the therapist, naturally, whenever he wants. But it is not okay for us to leave them. This feels like abandonment, especially if the therapist is going far away. (When I took two weeks to go to Israel a few years ago, a patient did land in a hospital. Nothing to do with me being gone, she said. Of course.)

(b) Does anyone really need to be thinking of their therapist in any other context other than in that chair, facing someone else's chair, listening intently with concern? Probably not.

(c) The less we talk about ourselves, the more the person who is paying for the visit talks about themselves, which is how it should be. Yes, even as they are walking out the door, it is about them.

(d) If an absence must be discussed, and sometimes it should be, then it is the patient's feelings that matter, not the details of the therapist's time off. When the patient asks, "So, where are you going?" the more relevant response is, "What kind of stuff do you think is going to be coming up for you while I'm gone?" Then, "And how will you be coping with that."

So a blurt, any error in judgement, probably shouldn't be ignored. The patient will be talking about it with everyone else anyway, so direct communication is more than called for. But did the patient contribute to the blurt? Only in having presented a certain amount of information that triggered something, some off observation or comment, and that needs to be discussed, too, the patient's input.

Which brings us to number (6), if we're counting Six ways therapists can recover from mistakes .

A little speech can go a long way toward rekindling the therapeutic alliance. Make it relevant to what was said, and be sure to assess what it is about the patient that contributed to your impulse to share:

(6) Last week, after you left, I thought I detected a little discomfort on your end.

I thought about what I said, that I'm going to climb Mount Kilimanjaro, thought about it a good deal. I tried to figure out why the impulsive share. So much information about my travel!. You might think it natural, after all, you travel a lot, and surely that contributed. But it didn't feel right to me, and I'm sorry. We should have just talked about how you'll be handling things while I'm gone.

Fact is, I hardly tell anyone about trips, certainly not patients. You share quite a bit about your travels, so maybe that had something to do with it, but I think there's more.

It is this wonderful quality you have that makes people want to share with you. It's true, you know, that a lot of people probably want to talk to you about all kinds of things.* So don't change.

But from here on in, I probably will.

therapydoc

Only say this if it is probably true. It does happen to be true about many, many people, and most of them don't even know it.