Thursday, November 24, 2016

One Snapshot, then other Bloggers

Here's the snap:

Impatient with Patients: The What Else Is New

It often happens that someone (in therapy) will say, "I’m doing great! So much better!"

And in the very next breath it is: "Actually, then (this happened), and (that happened). But still. . . I handled it so well. . ." 

And you are waiting. 

There is a pause. Maybe even a short one, the response could even be sans pause and pow! 

The patient looks right at you, the mood has changed, the patient narrows his eyes, might even scowl, becomes a different person, his old self, for he remembers. 

"I’m just really, really angry at . . ."

and another story tumbles out, same story, same offender, or some other offender, on a good day there may be multiple offenders, persons who share the responsibility, the blame for the change in mood. Even if the patient attributes a good reason, an empathetic reason for offender behavior, the narcissistic injury stings.  

A narcissistic injury, just to digress, can motivate people to positive action, or negative, depending upon one's point of view. There is a legend about a man, Donald Trump, roasted at the annual National Press Club dinner. This is traditionally a roast, a night of humor, sarcasm, good cheer. But apparently President Barack Obama roasted Mr. Trump, not yet a candidate, and kept it up, went on and on with jokes, all at Mr. Trump's expense, they kept coming, and coming. And at first he tried to take them, pursed his lips in a smile. Then the smile went away, and his face hardened, turned blank, emotionless, flat. Then the brow furrowed, an empty stare, the one we associate with dissociating. And at some moment, it might have been that moment, now President Trump elect consciously made a decision, determined to show President Obama, to show them all, to show everyone sitting at that dinner, all those people from the press cub laughing it up. He would show them exactly who they were messing with, embarrassing. Embarrassing someone is, in some circles, a very dangerous, negative, bad thing, even a huge sin. 

That said, my mother loved it when we made fun of her, thrived on it, embarrassed or not. To her, the most humble person on the planet, the family laughing, uproariously, even at her, especially at her, was a good thing, good fun.  

But back to our story, the What Else is New, story, about the pattern, when people start positive then get off track, have no staying power with a good emotion, also known as the
I can't be happy with just that, just having had a good week, it's not enough
patternJust doing great is not enough. Therapists wonder, will there ever be enough therapy to help this patient? Defining success is the answer, certainly. Will he ever get better? Again, define better. He will, if we are patient, don't impose our values or needs upon our client. All of us resist change, get married to our emotions, and usually lean towards a favorite emotion, the one that suits us best.

This is part of the job, working with difficult marriages, especially marriages to negative emotions. And we all have our pet peeves, our interface. We dislike particular character traits, certain responses in particular. So as a therapist who happens to be a person, too, one grateful for everything good in her life, for every good day, even the bad days, grateful for the people she knows and mostly loves, even her patients, as a person who is grateful when the elevator isn't slow, or when someone opens a door for her, who is happy when the phone call on voicemail isn't spam, or a relative from far away sends an email, one who feels blessed with the opportunity to have one more free day, who is not wrongly imprisoned, immobile from an accident, or dreading the next bout with her health, not that aging is a picnic, such a therapist's feeling, when that patient shoe finally drops, when that man's good day takes a turn to an angry day, evokes, for lack of a better word, impatience.

When the zinger comes, the story about whoever or whatever it was that burst the bubble, the sense of goodness, a therapist is likely to envision the silent cartoon bubble over her head, the one that says "And what else is new?"

The good therapist rarely says that, though, not aloud, and wouldn't repeat it, is embarrassed for thinking it. Because the "what else is new?" is not empathetic, and empathy is what is called for in therapy. Patience, not sarcasm. The job is to let the patient spleen (rant on angrily) until there are no more words, because THAT is what is therapeutic about therapy, 99% of the time. Then the processing, maybe, if the patient allows, if time allows. Otherwise, we're merely to let the patient spleen.

That, so they come back. Once when I was consulting with a very high end group, an academic medical group, the director told me, "Whatever you do, just keep them coming back," and I never forgot it. "Are you serious," I asked. And he said, "Yes." This is a people pleasing job.

The odds are therapists will be empathetic, not mean. We're not going to say, What else is new? The drop of the other shoe is predictable, the same things still bother the same people, which is why the go-to response will be:
"Wow, so inappropriate!"  when it is about what the other person did or didn't say, did or didn't do. Whatever it was that made the patient, who had been doing so well, so angry, cannot be minimized, not ever.  Empathy, not sarcasm, not even a joke.  

That would be enough, that snapshot.  But it is a holiday, and folks do sit around, hunt for things to read, and it seems to me, before life got in the way, that I used to post a blog every so often and link to or recommend other blogs. That was when there was time to read other bloggers, but there's something else. Bloggers, back in the day, were not in it to find business, or maybe they were and I just didn't notice. But there was an innocence, a real creative thing going on. 

And you know, things change. Yet, there's still good reading out there, and it is formatted so well. It wasn't hard to find good blogs. So without endorsing, or even agreeing with the following therapist-writers, for your entertainment and erudition, here you go. 

Being partial to AA and AA bloggers, we have to begin with Drinking Diaries, especially this time of year, when the booze and drugging opportunities play.

And Syd, I'm Just F.I.N.E (hi Syd!)

Anita Sanz, in I've Got Your Back, on boundaries. You could say, life is like a bowl of Halloween candy, without any boundaries. You go girl.

Therese Borchard, an old blogger buddy, writes on the New Science of Exercise (and depression), because who are we kidding? Unless you move around, physically shake the lead out, the symptoms of depression, i.e., vegetating, hyper-hypo eating, lethargy, anomie, thoughts of worthlessness, hopelessness, etc., move in. Friday, do more than shop. Take a real power walk.

And Lindsay Holmes, of the Huffington Post, brilliant. Watch where you seat people at the table this Thanksgiving. But you already knew that. .

A Handy Self-Care Guide For When Politics Come Up At Thanksgiving

Kim Bowen, at The Marriage Place has some thoughts on verbal abuse. My own can't be verbalized (it brings out the warrior female, just saying). MEN WHO RAGE AND THE WOMEN WHO LOVE THEM  Also, just an fyi, all due respect, women who rage aren't exactly rare. But you knew that.

Karen Franklin, a forensic psychologist presents the another side to the crimes that make us cringe, abductions, physical-sexual assault, and a review of the numbing podcasts that chew them up. For those who don't mind taking a walk on the dark side, she's prolific.  

If you're into transitional objects, and object to the latest hysteria about how to properly put your baby to sleep, Claudia Gold, an MD has a terrific post, one that debunks the myths. Old fashioned pediatrics in the New AAP Sleep Guidelines, the Baby Box. . .Child In Mind is her blog. Thanks Doc!

And of course, if you're in the mood for a little education, you should check out SocialWorkSpeaks, where you'll find research snaps and news about mental health professions who get out of the office and do, what I call, real social work.

There are more, for sure, but you have cooking to do, or moping, and you have to love yourself either way. Happy Thanksgiving, and Go Cubs! (smiley face there)


Anarchist Soccer Mom: A modest proposal to VP-elect Mike Pence. (on abortion)


Mound Builder said...

Though it wasn't the main point of your post, or not the only one anyway, I hardly know how to wrap my mind around the thought that narcissistic injury might prompt a person to run for president. And considering how much the possibly narcissistically injured person harassed Obama about his birth certificate, about his citizenship, seems like the president elect could have been able to take a little at that roast of what he dished out for years. I believe I saw that National Press Club roast and saw what Obama said. I don't recall it going on for more than 4 or 5 minutes, at most, possibly less. That seems slight compared to the years of harassment, the energy that got taken up needing to address the matter of Obama's birth.

Anonymous said...

I am not a psychiatrist, psychologist, counselor, social worker, just a person who loves your blog! You are kind, smart and funny, and whenever I read your current post I always enjoy it, no matter the subject.

therapydoc said...

Thank you Anon!
MB, also thanks. I don't doubt that it took only 5 minutes to insult Mr Trump. The point is, that it need not even be 5 minutes worth of insults. One insult is all it takes to trigger obsessive thoughts of revenge. Embarrassing someone is dangerous stuff. I'll add a quote from page 59, Baba M'tziyah, when I get the chance. And by the way, it is not a minor lesson in the post.

Mound Builder said...

Therapydoc, That's depressing, sad, and terrifying, to think that someone could want to get revenge over that. I decided to look that segment up again, as I do remember watching it. And I timed the part of the 5 minutes of video that were devoted to roasting Trump: it amounted to approximately one and a half minutes. Much of the rest of the video was, in fact, Obama making fun of himself, beginning by saying that he was going to share his birth video with the audience and then playing the introduction to The Lion King. I'm not disagreeing with you, just saying, wow, a minute and a half could motivate a narcissist to exact revenge on an entire country?! And that's really frightening, given that even a wildly popular president could expect to receive some insults. And Trump has already seen that a lot of people are quite unhappy with him.

I've been watching a documentary from 2011 called You've Been Trumped, about what Trump did when building his golf course in Scotland in an area that had been a nature preserve, a pristine ecosystem of dunes. The kind of behavior documented in that film in 2011 was exactly like what we've been seeing over the last year plus of campaigning. And Trump resorted to some really awful tactics, enlisting someone locally to turn off the water to several residents who did not want to sell their land to him, no matter what the price. He turned off water to human beings!!! Because they opposed him in what he wanted to do! So what will he do to us when he inevitably feels opposed, feels narcissistically injured? It's very disturbing to contemplate.

therapydoc said...

But sometimes, when a person has what he wants, a sense of invincibility washes over him, security, and that person changes. Old behaviors, reprehensible, are beneath him, and growth, benevolence, takes the place of, for lack of a better word, politics, and the rawly competitive tactics, once employed as if survival itself depended upon them.

I pray, every day, for this evolution of the personality of our President-elect, and actually expect to see some great things in the next four years. You could say I'm a dreamer, but I am not . . . the only one, and no, didn't vote with any of the above in mind. Not a gambler.