See You in My Dreams

Lately I've been dreaming about my patients. I don't even want to tell you how many years I'm in practice. Let's just say a lot. And this has never happened, not ever, not that I remember, anyway.  

Dreaming in Living Color

Most therapists have an occasional dream about a patient, don’t they?  

 

 

It’s happened twice, each time the night after a visit. My subconscious apparently picked out these unsuspecting women to join in on whatever adventure it had scheduled for the night. 

 

My dreams are always adventure dreams, usually about getting lost and driving endlessly on a clover-leaf highway exit in an unfamiliar city. Or I’ll be on vacation with FD and we find ourselves in a house that is smelly and dilapidated with broken windows. It most likely has been hit by a bomb, and yet is huge, a city in itself. There’s no way out, no map, and no one cares about getting out—or so it feels, except for me.  

 

 

Reliably in my dreams I have no idea where I'm supposed to be, which isn't atypical, others tell me they have that, too. Those are bad, but I’ll take that confusion over the terror of those recurring home-invader dreams in my youth. Those are gone. Now I just live with the fear, lock constantly.

 

 

The most recent dream with a patient in a starring role had the feel of a chick flick. There’s no remembering the plot, but one thing for sure: she isn’t a patient but a girlfriend. We are doing friend things, shopping. My mind’s eye tells me however, that although she’s a patient I should carry on, keep dreaming. 

 We do not usually have this choice in that other reality, wakefulness, the choice to turn relationships into whatever we please, alternative genres. 

 

 

The plot of the flick, alas, is forgotten. I wake only with the sense of positive emotional engagement, the feel-good of the friendship bond. But it is laced with guilt about having breached a professional boundary. I attempt to rationalize away the guilt. As the dream fades away my brain says:   

 

 

Hey who cares, woman? This is a good dream. You like this dream. Here you are, the two of you, that person who sits across the invisible divide every week, and you . . . you’re girlfriends. 

 

 

Wait, I say. Isn’t everyone in my dream really me?

 

 

Well, technically, yes. Nobody else is there, after all, just the dreamer, just her, dreaming away.

 

 

Meaning both of us are me.  I’ve created a friend, projected from inside Me Myself, and I. Hal’vai  (Hebrew for “it should be so” rhymes with rah-l’-tie). Hali’vai we should all have friends who are the people we want them to be. Most of them are already, right? That’s why we pick ‘em. But sometimes they pick us, is the truth.

 

 

I’m not Freud, just making sense of dreams.  

 

 

We’re out somewhere, girlfriend and I, at a mall then a pool. Our roles as doctor-patient are no longer relevant, deliberately abandoned. Those roles that determine the dynamics of our usual interaction—gone! There’s no implied hierarchy or expectation of therapeutic appearances, no guise of being therapeutic.

 

 

Well, that could be nice. A wish dream!

 

 

If we look at dreams as emblematic of wishes, fears, or gas, then this dream for sure lands in the wish category. Sweet and happy, it gets 5 claps and 4 stars, maybe even 5! Except that threaded throughout the cognitive/emotional content is that disturbing certainty that this is a patient not a friend, and the dream is a warning: 

Be careful what you wish for, cross that boundary and you will regret it. Oh, and by the way. Haven’t you noticed? You have more friends than you even want.

 

 

The dual relationship is unethical, unbecoming of a professional. It takes advantage of the patient’s trust in us, that trust that we are there to help them  for one thing, not visa- versa, which is why upon waking I feel a bit disturbed, disoriented, and guilty, despite the 5 stars. 

 

 

The next movie is the usual Where am I? How did I get here? And what in the world is she doing in my dream?!  Not a nightmare so much as a bad dream. It is a different patient and we share a difficult circumstance. We are upset, lost, and dependent upon each other in some way that is out of the official context of our relationship. And we both need to find our way out of messy confusion. Messy and confused. A typical dream.

 

 

 

That’s all I remember. 

 

 

The interpretation of this dream could it be me unsure of the quality of my work, needing to tackle it at night to get a good grade. Or maybe my head is remarking on the complexity of the patient, that she isn’t progressing. Her dreamlike confusion is expected, mine is not.  There should be emotional spillover to me if there's a feeling incompetence, even if it is unconscious until now, and consequences for staying in denial 

It makes sense. She is complicated. And yet, we've been living together in all of her chaos for years and she’s doing so well! Still, the dream is talking to me. The other dream, too. 

 

  

What is going on here? Am I working out unresolved patient/therapist dynamics—a wish in the first dream, fear residing in the next? Are they warnings to resolve my feelings during waking hours to avoid doing it at night? 

Or could it be that because we only see one another on screen, that patients are externalized to the extent that they have simply become videos in the library of the therapist's subconscious. Choose one a week. The Blockbusters of therapy.

 

 

Maybe I just miss them. Maybe I simply miss being with people, any people, but these people in particular, having known both for some time. They are a part of my weekly groove. Maybe I miss the sensuousness of being together—the swish of their bodies as they pass me to enter the office; the whiff of cologne or perfume, a new hairstyle. I saw someone in the office this week and felt that. It was wonderful for both of us to be there, in real time, in real space.

We can't even be sure if anyone is grooming on Zoom. It doesn't look that way. It's so black and white, even though it isn’t, not really. Data of the senses, other than visual and hearing, is not communicated on digital media. We could say a dream is making up for that, but rarely does it feel that real.

 

 

Considering that dreams are legitimate ways to blur boundaries, if this is about wish fulfilment, then patients should always be in our dreams. If you eschews hierarchy (like me) there’s nothing keeping them out!  But to its credit, hierarchy is about who knows more about mental health, if not the person in the room doubting his-- and it helps keep emotional distance. Respecting them keeps patients out of our heads on off hours. The boundaries of therapy are wise indeed.   

 

 

PROBABLY. . . the problem is that I miss my friends! The ones who come over and have long Friday night dinners with us. The ones I go out with—remember going out?— to talk about our feelings, our histories, that trip we took together.  This is as close as it gets, hearing about the lives of the patients, about their histories. Because after seeing people on Zoom all day to work, it isn’t something some of us care to do in the evening with friends.  

In a sense therapy is the equivalent of lunch, except that we consume nothing but reality. So maybe I simply miss lunch. 

Oh, but now patients are in my living room. They see me a little too closely, frankly.

 

 

Let’s sum up: 

 

In pre- and post-corona times the relationship boundary is tight— therapists don’t socialize with patients. We refuse gifts (no thanks for the opera tickets); we don’t take a lesson from a tennis pro; and we make self-disclosure rare and relevant. In fact, if I am honest with myself, my self-disclosure with patients the past few months is off the charts. It isn’t me and it has to stop. 

 

 

It can be hard. There’s temptation to talk about ourselves with patients, our past experiences, which is probably why these dreams that blur the boundaries are so compelling. They speak to unconscious wishes of both therapists and also, patients. Keeping it professional is work. If dreams are another way to master our issues, than that’s what is going on here. 

 

 

There is some intimacy, too, in a dream. Therapeutic intimacy, meeting that projected need of the patient for a mother, a friend. When she cries in a digital visit I feel so powerless—not that I would hug anyone in the office. But it used to feel like all I had to do was move my chair closer and this helped.  

 

 

And yet, like I said, that online human, the one on screen—no matter how large or small our home theater—now has carte blanche to come into our homes, something they may have considered or alluded to —because don’t we all, at some point in therapy, want to be a fly on the wall of one another’s homes? We want to see what’s really up with the other. 

 

 

And if we’re using a tablet or a phone with the freedom to get up and walk around, we might even walk together into the kitchen for a cup of coffee, a piece of fruit. Once she has been in your living room and kitchen, what’s to stop the patient from having a visit in your dreams? 

 

 

Nothing apparently. Nothing.  

 

therapydoc

 

 

 

TAGS  #boundariesInTherapy, #telehealththerapy, #therapistPersonalBoundaries, #wishOrfearDreams, #dualRelationships, #Nightmares, #badDreams, #patientFriendRelationship, #consultationWithOtherTherapists, #therapysupervision

 

 

What's Going to Be with Our Kids?

Will the virus affect them emotionally in a bad way? Is this new era scarring a generation?

Why should kids be any different from the rest of us, my take.

Depending upon their age and the relationships they have with their parents, and how their parents are handling this not-so-brave-new-world, the answers will vary.

Some families are so sure of themselves regarding the actions that public decision-makers are making, that it is a challenge having a 2-sided conversation.  It is not even up to discussion, for example, as to whether or not kids should go back to school. Dare we even suggest that the educators, professionals who have been working on this since March, could be correct about opening schools, albeit in a hybrid-fashion? (Lori Lightfoot's idea, Mayor of Chicago).

Who knows? All we know is that those countries that closed down, the ones that demanded masks for everyone, no longer have rises in their rates of virus detection like we do in the USA. So shutting down schools is the seemingly obvious thing to do.

But that's not happening, not necessarily. Parents, despite their reservations, will have to decide for themselves how to educate their children, whether or not to find a private online school or keep the kids home and home school. Those who have no daycare in place, who are needing that time to work, whether at home (in peace, finally) or on site, are likely on board with the mayor's recommendation to open up schools.

Psychologically how is all of this affecting our kids? 
Young children pick up on their parents emotions. If parents are rational and don't panic, they usually don't panic either. But every child is different and what we know to be Health OCD is a real thing, not only for adults, but for children, too.

Children are anger allergic, and will want their parents to be happy. They might miss the joy of being home in the family pod, but despite this well-needed intimacy, this crazy hiatus in life, they are fine with letting the family intimacy go if it means seeing their friends. Emotionally healthy kids over the age of 2 are dying to get out and be with other children. They are quite sick of the isolation, like most of us are.

Being at home with their parents has been sheer heaven for functional families with small children, certainly for the kids, not necessarily their long-suffering parents. Parents, hats off. How you're handling this, I'll never know.

In the future (again my take) all children will be more prepared than ever for a health pandemic, much more so than we ever were. They will take that dictum to wash their hands seriously; they already do. They will be careful, perhaps, about showing affection. That could be a very good thing.

What about the older kids, the normal ones who flaunt rules? I say normal because it is a developmental task for adolescents to separate psychologically from their parents, to flex their autonomous muscles. They will flex and flaunt no matter how well we have trained them, those children, the ones we can't babysit anymore, the ones who scoff masks, who socialize without distance.

Those young people, being adolescent and breaking the rules of social distancing, if they got sick, feel pretty bad. They know they shouldn't have been hanging out so closely with their friends. that they should have kept the masks on and encouraged their friends to do the same. And, perhaps worse, if they got sick they know they gave the virus to older family members. The mistake, the guilt, cut their adolescence short. Kids aren't stupid, and whether or not they admit this, they think it, feel it.

They no longer have yesterday's sense of omnipotence.

But frankly, none of us adults do, either.

therapydoc

Pandemic Shaming-- or do you just call it Corona-shaming

Here I thought I was being original. A man on telehealth worried that if he had  Covid-19 that others would think he deserved it and worse, that he had done something irresponsible, something that put not only himself but others in harms way.

Jason Gay is always funny

Being in harm's way is exactly what those on the frontlines in treatment are rightfully concerned about, or would be if we gave it any serious thought. It is a given that therapists have the right to a healthy social distance from patients who might have Covid. The implication is that if we get the virus it is because we got too close.

Jennifer Weiner writes in the New York Times about . Pandemic shaming.She says, is alive and kicking. Finger pointing is a big deal. Photos on FaceBook, videos. See? No mask. A crowd in the park.

The writer (who doesn't love her) is angry and notes that her anger is aroused when she hears about those who put us all in harms way. These souls have had contact with corona-positive friends or loved ones, yet still wander out into public without a mask.. George Stephanopoulos is the prime example, his wife ill with the virus, front page news, yet spotted without a mask at a pharmacy. The establishment serves older people.
NPR ran a story about Brian Glazer. He's on his yacht, perhaps the size of a city neighborhood, talking about how tough it is being in isolation. I try to empathize with Brian--he probably has a bowling alley on board.

The story worked, properly shamed Mr. Glazer. He apologized for his thoughtlessness, for complaining that he can't fly wherever he wants these days.

Now with the economy opening up and expectations that the numbers of cases will rise, we'll have a new phenomenon: State Shaming.

And I didn't even start with athletes shaming. Or biker shaming. Especially those who sweat.

The finger-pointing, the direct accusations about putting others at risk, this is what upsets  Ms. Weiner, and me, too. She rightly recognizes that her anger is driven by fear; it is a measure of exerting control. She credits therapy for the insight, and nicely de-stigmatizes therapy, thank you dear, in the process.

Damon Young, she writes, the author of What Doesn't Kill You Makes You Blacker, has seen his share of pandemic shaming. But it is mostly aimed at poor people, people of color.

But posting pictures of non-compliers on social media, or calling them out to their faces, is unlikely to help. It might even make things worse. And it comes with risks to groups who are already suffering more than most from the virus and its effects.

“When there’s a mandate to snitch or to shame, that’s going to disproportionately affect black people,” Mr. Young said. “When you call the police on a group of black people, you are threatening their lives.”

If there is an opportunity to point a finger at someone we want to hate, we're going to do it. Human nature, insecurity, the need to displace self-hate and fear, to fop it onto another, schadenfreude, these are the things we contend with on any typical day. Some are vigilant, on the hunt for another good reason to hate (with self-righteousness to go). Party time on social media.

Try being in Germany in the late 30's and early 40's. The Nazi's had a field day.

But back to being a patient who fears getting sick because of the fear of blame, for causing it somehow.  Mind-blowing that this should even be a thing, a fear, but it is. For some people, having the virus triggers shame for having done something wrong, perhaps going to buy groceries-- even with a mask-- and being outed for it. It is a raw feeling irrationally associated with innocent behavior. The patient feels more at risk of social castigation than death from the virus. These types of patients are the first to keep their distance, the first to disinfect.

Many of you remember when the word "cancer" had to be whispered or never mentioned at all.

Shaming is another way of making people feel good by putting someone else down.  It reminds me of an old Bob and Ray joke. One of the two would say in all earnestness,

"I like to bring myself up by putting other people down."

This always makes me laugh because it is so true of so many, many people.

Parents do it, shame their children. The point is that the kids will refrain from whatever it is that they are doing that is bad (hands in the pants, among other serious crimes). It works if the child is young enough, but adds baggage to the rest of their lives. They come to therapy with guilt for wanting to punch someone in the face.

A word about anger

Anger isn't a bad thing.  Anger is normal. It is violence that is bad.  

We might say that shaming out of anger on social media is a type of verbal and emotional violence. 

As I said to the patient, as I have said to dozens over the years:

If anyone ever does that to you, shames you--about anything--which is unlikely because you are the nicest, most empathetic person on the planet-- consider the source. Then feel pity. If you must respond try something along these lines:

I feel sorry for you. I really do. And walk away. Or simply, Must be hard to be you. 

Because most of the time, if you call someone out on something, that person will lash back at you in response, not cower. (Think about your own response to the driver of the car behind you, honking, a reflexive hand gesture). Nothing gained.

 The shame is in the shaming. Just this therapist's humble opinion.

therapydoc

Why We Aren't Sleeping

I apologize. I was obviously tired when I wrote this (so says FD). There's no mention of our limbic systems or reticular formations, or that many people actually sleep better on a full belly. But there's not time to edit it now. He tells me it will sing to some of you.

We're not feeling great in the morning, many of us, not sleeping so well at night. What's going on?

Aside from the obvious. 

The answer is multi-factorial. (There are many reasons). Let's dive right in because the obvious doesn't explain much. We need the commentary.

1. Work
If we're lucky enough to still have a job then working from home is essentially like working on another planet. Another planet that feels very familiar. Yet the shift of venue demands cutting new paths in the brain to adjust to an ever-changing environment. Outside in the workplace, despite perks like a yoga room or snack station, it can be ho-hum in that even the surprises are expected. It is as home used to be. These WFH (work from home) environmental changes are a new  paradigm, and new paradigms, revolutionary, stimulate. 

2. Furloughed/ lost job
On the other hand, if we have lost our job, there's the fear of never finding one. Also stimulating. Terrifying. The only difference there's so much company in this place that humiliation isn't associated with that anymore.

3. Annihilation anxiety
No matter if we have jobs or not, during discretionary hours there's always been the option of staying home or leaving home. No more. Leaving our comfort zone is laced with decisions and fear, or should be, and fear is stimulating. We don't sleep well under fear. It is called annihilation anxiety.

Oh! But you're not afraid. So you think, grasshopper. Enjoy. 

ANALYSIS of ABOVE/ ARMCHAIR PSYCHOLOGY:  That running program, let's call it the Must Protect program (MPP), demands attention, perhaps more than any video game (pick your addiction). The MPP Start button is activated as soon as we prepare to leave our homes. Where's my mask. Do I need a new mask. Can I even touch this mask. I just work it a few hours ago. Do I have my supplies: Purell in the pocket, disinfectant wipes for doors, grocery carts. Must I swipe the doorknob of my car? I must consider these things. 

Once activated, the MPP runs through the body as we move about the cabin, whatever cabin we visit, even the great outdoors. We're suspicious of a passing jogger who has no mask. What's wrong with him? I wish he were dead. 

Now. Do such thoughts and activities affect sleep 8-10 hours later? Maybe yes. No matter how sedating our shows, no matter how funny the memes, it takes energy to attend to them, to consume, and there's even more energy generated by some. Have we put all that to bed? Everything pounding our eyes, ears, even our noses distills to energy. 

And our mouths, dear G-d, our mouths. Let us continue.

4.  The food/exercise equation
Most of us complain that we are not exercising like before, and this is the problem. 

(You're thinking: Why did I never build a swimming pool in the back yard? Now I'll never have the money to do that, not that I ever did). 

Not exercising means changing eating habits-- but that's impossible, or let's say, really hard. If we could do that we'd weigh a zillion pounds less, probably a trillion. We're throwing around numbers differently these days due to the stimulus package. How will that affect our economy? Let's worry about that, too. 

But back to food and exercise. What we need to keep our current weight, calorie-wise, is an equal balance of calories in, calories out. What we take in, what we use. 

Consider: When we take in more than what we use the left-over calories have feelings. They want to be used and they are angry. Fine, that's a stretch. But it is not a stretch to say that they're just hanging around in our bodies. Before we swallow, potential energy. After, there's no limit to that potential  

So these buddies of ours, our calories, are chomping at the bit to be used. Yet we aren't cooperating. We refuse to use them. The exceptions? Worrying, sedentary work (brain), or watching. All imply brain activity. They work anyway. 

Food is digested and energy released, busy finding places to go. If the muscles aren't busy they find a marvelous home in our heads telling us: Stay awake. Pay attention to me

With so much food, so little exercise relative to that, how can a person get any sleep at all? 

5. The new reality
Let's not forget our new reality, the many casualties of war brought to us by whatever news source we prefer. This is a war against disease and deterioration, one that usually is fought in the laboratories of our friends, the scientists. 

The grieving for casualties is exhausting with endless possibilities, ramifications, thoughts about ourselves and those dear to us (scary stuff). Depression, sadness is exhausting. Throw this into the mix. The entire gestalt of 50,000 deaths just in the United States (at this writing) and a feeling person has to feel it. We mourn vicariously. Who hasn't lost someone, or heard of a loss in their community?  

The Zoom funerals, I've been to two, yes this is about me, so intense. A handful of mourners. No one can shovel dirt on the grave. A tractor does all of the work. A tulip in the coffin.

The reality of death is grievous and terrifying and although we defend very nicely on an ordinary day with our humor and our song covers, defending against anxiety--  hey even I wrote one at the very beginning of all of this-- it is still a fact that millions of people are sick and thousands are dying, and as we are reminded by the World Health Organization: It is not over. 

6. Reopening 

People worry, whether they admit it or not, that reopening the economy is going to lead to a corona revival. That is worrisome, too. Our MPP (Must Protect Program, remember?) is activated. Our automatic defenses, the ones that never stop working, even when we think they have, even when we're getting ready to lie down to sleep, operate at full strength. 

Hearing about reopening and resurgence alone-- just hearing about it--  activates the Start button. 

Once again we look our mortality in the face. This is anticipatory anxiety, mother of them all, at its very best. 

7. Body rhythms

There's one more thing, something else that is relevant to the conversation, although we hinted at it earlier when we spoke of working from home, being at home, that ever-changing ecology.  

And that is that for most of us, our lifestyles truly have changed. We aren’t required to clock in at work at a certain time. Our appointments aren't in the flesh. We don't have to wear heels. We don't have a commute. In many ways this is far more healthy and far more normal . Think about it.

In many countries, especially those with intense mid-day sun much of the year, the weather commands a mid-day shut-down. The 2-5 pm siesta is the norm, or it used to be. There's a nap. People take one and don't feel guilty. Linner (lunch-dinner) is before or after.  Then the shops reopen, the malls fill up. Back to work.

Western nations eschew this as unproductive and a waste of time. The go-getter mentality that we associate with America isn’t, or didn't used to be thing in such countries, and it is why, according to the American work-ethos, the American economy thrived, prevailed over all others. 

That may be a be a thing of the past, that siesta,that shut-down, I’m not sure. But even if it is, consider that this is a less stressful lifestyle. The mental set associated with that changes bio-rhythms. People rest. The brain shuts down out of habit. 

PollyAnn-ish, probably, maybe untrue, women surely still second shifted. 

To bring it home, sum it all up, we all have bio-rhythms. 

Those of us who never had sleep problems in the past, who once shut down at around the same time, say 11 PM or even 4 PM for the sundowners are responding to their biorhythms. Our biology lets us sleep a solid 5-7 hours or more. 

Under stress, even before Covid-19 and the uptick in cortisol,  sleep is  interrupted, a problem under stress. We judge it as a problem. We can't function the next day, or so we think. 

In therapy we would discuss it, all of the stress, all of the things that buzz through the brain, and aside from venting, work at relaxation strategies. Breathing is the winner. You still breathe when you lie down to go to sleep. So focusing there is advised (see a recent previous post). It is very hard, but helps. 

Therapy addresses early awakening, too. Up at 3 or 4 AM? The recommendation: Don't give in and get up so fast, give it a half hour and DON'T check the clock. Watch the breath. If this isn't working, don't dwell on thoughts, do something, anything. Get up, drink a beverage without calories or caffeine. Be productive. If jet lag doesn't set in after a few hours begin your day and push through it. Whenever that feeling of inevitable sleep hits, give in. Disappear.

If at all possible. Make excuses. Take an hour and sleep. Set an alarm. 

In the process, especially when sleep is elusive, try not to judge it as a bad thing. Not judging is very Zen and it is crucial now. 

It also means no judging the nap. The nap is the bomb. The nap is life-saving, crazy-smashing. You've heard the expression that quarantine is crazy-making? The nap serves as the opposite when we are sleep-deprived.

And then there's the signature therapydoc recommendation, 
which would be that when you do nap, when you take that nap, if at all possible, do it with someone you love.

therapydoc

The Honeymoon is Over

While the last few weeks have been challenging, the visible among us rise to the challenge of isolation. We're using social media (I restarted my FaceBook account!). We want to check in on friends and family, really want to, as opposed to feeling that we must. Some of us are soothing our lonely souls with stabs at painting, reading, praying, and playing-- either solitaire, video or board games. What puzzle are you doing? Let me show you mine! All done. 

And yet, the honeymoon is definitely over. The most patient among us is feeling either claustrophobic or crowded, out of sorts, at least once or twice a day. even more than we do working outside the home. 

Your therapist will tell you that your mood ebbs and flows as the day wears on without isolation. Nobody isn't cranky sometimes. 

That over-crowded feeling is leading to arguments. I'm hearing about really explosions. The kids are scared. Tensions are boiling over. Consider yourself lucky if your quarantine relationships are in better shape. But people lose it. If they're healthy they apologize, work it out. 

But hey, that's my clinical population. The truly dysfunctional relationships aren't rising to the occasion. And we're hearing that domestic violence is skyrocketing, and marital sexual assaults are on the rise. No place to go to escape.

We'll look at one type of social dysfunction in this post: The Over-adequate Under-adequate Relationship

In this model someone is sick, either has a physical, mental, or behavioral disorder that sucks the air out of the room for the other(s). To be fair, attention is inevitably on a person who is sick-- it has to be. Nobody wants to ignore the needs of a helpless individual. When there's love and understanding, patience, and especially experience in care-giving or health care, the stress is less of a problem.* It is only dysfunctional when there are systemic issues going on. I.e., the one in the sick role

 (1) the 'helpless' partner, is liking it and isn't doing much to be less so.  Or

(2)  the helpers won't let the sick person do more, when he could. That could be for a variety of reasons, such as the fear that the condition will worsen. But also,

(3) it feels good to be a helper. It raises self esteem knowing we're helping someone who needs the help. Yet you can see how that need for an ego boost isn't helpful for a person who wants to flex a few of her under-employed muscles. 

Then there's another creepy reason, which is that

(4) having a sick person stay sick legitimizes avoiding avoidance. We can't . . . you know. 

No, not a thorough discussion but add your own thoughts by all means, in the comments. They are undoubtedly correct. 

And guess what? We're all in the inadequate role now! We're all being told to stay home, get help with the groceries if you can. If at all possible, for crying out loud Stay home! Don't go here, don't go there, don't do this, don't do that. 

Some of us rise can't take it and are going out anyway. Our self, the independent individual that we have become, needs air. And we wonder, how crazy are we, taking the chance of infecting someone else or being infected. Who me? 

Having our arms tied, legs shackled, we're rising to a new level of empathy, the feeling of what it's like to truly be sick, too weak to go out, that feeling we have when we're stuck in a hospital, for whatever reason, for having a baby on a sunny day.  

Back to the OA-UA

In this classic dysfunctional relationship someone is well and someone else is not. The well person can do more and usually does. The sick person does less-- she is under-adequate. Her partner (or child) does more, compensates, relates as over-adequate relationship. 

The therapy is always to get the over-adequate to do less, the under-adequate to do more. It's more complicated, but that helps.

Now we're all theoretically under-adequate, ordering fruits and vegetables to be delivered, doing as little as possible outside our four walls. This upsets the entire homeostasis we've been talking about.

TWO EXAMPLES

(A) Say it is the young adult in the family who always makes the beer run to the fridge for the adult alcoholic. The child is already over-adequate, a parental child we say. But she has enabled since the dawning realization that this behavior, getting daddy a beer from the fridge while he watches TV is rewarding. There's secondary gain, his love and admiration. 

How does that work when she can't get him a beer, when there is no more beer? He may not be as nice. She may be confused and have to re-examine the relationship. That could be good for her, or alternatively, the relationship might become even more dysfunctional. She may spend an inordinate amount of time trying to make her father happy, land in an even more co-dependent role.  

Or 

(B) What happens when the one in the sick role wants to raise the level of corona awareness with the one who is usually healthy, but incurably carefree? The sick partner pounds the healthy partner with instructions on mask-making, how many feet he must stay away from others, and wiping down his shopping cart with alcohol swabs. Will the "healthy" one not lose his cool? Will it become a horrible argument? Of course it will. This won't go over well, the sick telling the healthy what to do. It just feels wrong.

Suffice it to say that in a clinical population upsets like these aren't unusual. Now, more than ever before, they are what no one needs or wants. There is nowhere to go to cool down. Domestic violence is rising in these troubled times, as is marital sexual violence.  

 So much depends upon the relationship, right? In the above dysfunctional OA-UA relationship model  the therapy is about inching toward the center. The OA, the over-adequate partner, gives over some of the work to the UA, the under-adequate partner, who is to do more. They listen to the complaints of one-another and delve into the origins of learned dependency. Support, trust, and validation rule. This is not the time for criticism. 

Success depends upon tone, the process of expressing wants and needs, validation. 

We could say, as we did at the start of this post, that truly dysfunction families will still be dysfunctional in a crisis; the more things change, the more they stay the same. Or we use this as an opportunity to change them.

Yes, let's do that. 

therapydoc

*Watch Zoey's Extraordinary Playlist to see how that's done. You'll need insulin, but it's okay.

Empty Spaces

FD is a doctor and when he tells me, it's okay, we can go out on the trails and ride, I take it as the word of the Old Mighty and fill up my tires.

The New York Times has a recent feature, Empty Places, I think it's called. There's also a place there with only stories, most pre-quarantine, but not pre-diagnosis. 

Here are mine. If you're from Chicago, you'll recognize them. It is truly eery, seeing so many empty places.

Von Steuben High School, empty

The river trail, Chicago

River trail, Chicago

Northeastern University, empty