Facebook Like


Wednesday, April 01, 2015

Co-Pilot's Troubled Past Was Known

We'll get to co-pilot Andreas Lubitz, who crashed Deutsch Lufthansa AG Germanwings Flight 9525 during a depressive episode. But first, when therapists become aware of dangerous situations, our responsibilities right here in the USA.

(1) Firearm Owner's Identification (FOID) and the Mental Health Reporting System

 I'm not sure when it happened, whether it was after a shooting at a school or maybe the Batman massacre in the movie theater in Colorado, but soon after I opened my office slowmail to find a pamphlet from the State of Illinois that disclosed a mandate for mental health professionals. We are to report individuals who have firearms if they have suicidal or homicidal ideation.

The exact statutes vary, but states regulate the sale and possession of firearms to the mentally ill and developmentally disabled, along with federal regulations, too. The Law Center for Prevention of Gun Violence provides us a map of the United States. We can click on a state before deciding if we want to move there.

In Illinois, for example, the state:

  • Requires that any person obtain a ten-year license (a Firearm Owner’s Identification, or FOID, card) to purchase or possess firearms and ammunition. The licensing process requires a detailed background check on the prospective FOID cardholder;
  • Imposes waiting periods between the purchase and actual transfer of a firearm to a purchaser – 24 hours for long guns and 72 hours for handguns;
  • Has implemented some design safety standards for handguns and has equipped the state attorney general with the authority to adopt detailed standards for handguns;
  • Has a Child Access Prevention law, which prohibits leaving a firearm unlocked and accessible to a minor under the age of 14;  and
  • Requires firearms owners to report lost or stolen firearms to law enforcement.
Caveat: The case descriptions in these blog posts are composites of different cases and different individuals and my imagination.

While I read the pamphlet about FOID regulations, I realized that I was to see a gentleman who had suffered from serious depressive bouts in a few hours, and he probably had a gun. He had a military background and worked security.

We had been working together on his depression for about a year, on and off, and he had made significant progress, was back to work, enjoyed his usual activities. But we still got together about once a month, and neither of us trusted that he wouldn't suffer new episodes. If that were to happen, he would be a clear and present danger unto himself. We both knew that. He also had a psychiatrist and a very involved medical team working with him on this and other medical issues.

So about midway through our session I asked if he had ever seen the FOID pamphlet, and showed it to him. He raised his eyebrows, looked at me carefully. "What does this mean?" he asked.

"Do you have a gun?" I asked gently. "Because I think if you get into serious trouble again, I'll have to report you. I could be wrong, have to look into it. Just saying, it's possible I have to do it even now."

He didn't answer, skipped over the subject to something else, and I let him. We finished up and rescheduled. The next day he called to cancel the next appointment, said he'd call me when he needed me. We had been operating like that for a year, a few months weekly, then a few months off. But he never did call, and I didn't follow up.

(2) Aviation as a Mental Health Specialty

It is likely that Andreas Lubitz saw an aviation mental health specialist. This young pilot suffered suicidal ideation and was told not to fly Tuesday. He somehow circumvented the direction and took down an airliner and 149 people with him.

If you have an insurance based practice it is likely that at some point you will work with flight attendants and pilots, even aviation engineers and the blue-shirts behind the counter who help you when your flight is cancelled. And TSA folk.

It is very stressful, flying for a living, or working in an airport. Having treated a few handfuls, at some point, while filling out a profile on the Psychology Today provider site, I checked aviation specialist. Now I'm thinking of editing that.

Not that the stressors are so unusual or different. But many people who work for an airline have commuter marriages and relationships. They sometimes feel homeless, adrift, sleep deprived. There's guilt not being around to go to normal life events, birthday parties. The kids miss you, you miss the kids. Your spouse or partner bears the brunt of the second shifting.

Relationships are intimate among the crew, or certainly there is plenty of opportunity for that, and that can be stressful, too. It is too intimate in those hotel bars, drugging yourself to sleep with alcohol deciding on the cocaine. That movie Flight, highly recommended, is not off base, scarily enough.

Did you know that one of the airlines is known as the love airline? No, not for me to tell, which one.

And naturally, pilots and flight crew don't have it easy. Passengers can be difficult, unpredictable, demanding. On The Moth, a podcast, a flight attendant tells the story of an older gentleman who passed away mid-flight. What do you do? Where do you put him? It is surreal, but real crises happen thousands of miles above us, on those airplanes we take for granted, those dots of white in the sky.

Flight crew persons are not exempt from run of the mill mental health issues and addictions. Depression is the diagnosis of the century, even for them. Those who are impaired, when they come to therapy, beg us not to use that diagnosis: Major Depression.

"Isn't there a V-code you can use?"

A V-code is about life circumstances, marriage problems, social issues. Most people who go to therapy can easily find one that applies, and it is less stigmatizing than an illness that might sneak up, compromise one's ability to do the job.

So often, yes, we do that, because they are true. We use a V-code. But if it is serious, no, you bet, we can't, even if that pilot will be grounded. He might have issues, and may not necessarily a diagnosis other than a V-code. We really have to be careful, though, examine our motives when we ignore a major threat.

The latest on Andreas Lubitz is that he didn't want anyone to know about his depression because he was afraid he would lose his license if the diagnosis became known. He deliberately put himself in a position in which he might kill himself and many others, rather than be tagged as mentally ill, and lose his license.

To him, losing his license was the big thing, totally irrational.

What should have been discussed in his therapy? Surely the potential for harm, should he keep his license, and how that feels, how thousands are affected, when 150 people die. Witness to excessively irrational thinking is one way we know someone is really sick. When thoughts are far removed from reality, we call it psychotic thinking. In a good therapy, the discussion about his thoughts is the discussion to have. The conversation that has to happen really is about keeping the license, losing the license, staying alive, keeping others alive, the risks in all of that and why he can't take them.

Like my discussion with that security guard, somehow it didn't.

therapydoc 



Tuesday, March 24, 2015

But You Never Said: Why Couples Remember Things Differently

We couples therapists, if we want to stay in business, try not to take sides. To be effective (and keep a couple in therapy) we have to be on everybody's team. Some of us will push it. We'll say, with total confidence:
There are three patients in the room, both of you, and your relationship. We have to treat all three or there's a good chance of relapse.
And inevitably, when we get to the gory details, the hurts, the nursed grudges, recollections, both partners, two of the three patients, remember things differently. Only the relationship gets it right.

My approach, when this happens, is to say,

You see? Your relationship suffered way back when! This hadn't been discussed well enough, not to the degree that you would agree, in the future, as to how it would go down in history, when you might tell it over to a grandchild, or to your family, drunk on a holiday, or to a therapist.

We tend to remember things from our own perspectives, forgetting, or never understanding, that of our partners.

This buys me time.

WSJ psychology reporter Elizabeth Bernstein fills in the blanks. Her example, one partner buying two arcade games on Ebay, the other remembers barely conceding to one monstrosity. Substitute your own relationship quagmire if you can, some disagreement or another. (We tend to remember large purchases).

The reason there is so much contention about how things happened, is that from the very beginning couples perceive and record events differently. There are two people receiving information and recording, after all, and they don't have the same video-recorder. These recordings will effect that third patient, the relationship.

That we record memories, by the way, totally off-topic, is why EMDR works. Memory desensitization files disturbing "recordings" so they lose their power to disturb us.  Here, years after the issue transpired, those less than integrated recordings are still readily available, nagging at one of the partners, for sure.

So we begin with two versions of an event existing in the minds of two different people. The event is upsetting to at least one of the two, which is why it comes up in the therapy.  Add to this that negative emotions are likely not to be integrated, are not let go

Then add to this that women are prone to remembering more details about issues having to do with the relationship (that third patient), and reminisce more.

Pile on the research that we all remember our own behavior much better than that of others, the irrefutable egocentric bias. Egocentric bias explains why, when a therapist asks, Who does more of the second shifting, both partners raise their hands.

Finally, there's that negative mood. Anger, sadness, anxiety, all contribute to memory, increase the likelihood that something will be remembered, and how. This is why problem-resolution is so important. Buried problems are likely to resurrect at inopportune moment, come back to haunt. When one partner hasn't let a slight go, it is likely to come out of his or her pocket later, even stickier, messier.

Why should that be? When we hold onto a memory, on each recall something is added or changes. Our memories are fallible, morph incrementally into entirely different recollections. In that process, a partner is devalued, loses his or her glitter.We like glitter, prefer to think of our partners in a positive light.

That the truth lies somewhere in the middle is hard to grasp, a difficult concept to get across in therapy. Couples receive somewhere in the middle as, "You are both wrong." What we should be telling them, in our best psycho-educational tone, is: 
Your recollection is valuable information. We need to accept all of the information, go over it, and discover how the data changed over time, and why. You're both right.
Andrew Christensen, professor of psychology at UCLA, in his book, Reconcilable Differences, agrees with that approach, the politically correct, You're both right. It is the emotions that matter.

Because it is the emotion attached to what happened, way back when, or even now, that will determine how that third patient, the relationship, is going to fare.

therapydoc




Thursday, March 12, 2015

Snapshots: Late for the Plane

(1) Ducks in a Row

Families fall into three camps, usually. We're either: (a) anxious, (b) depressed, or (c) both. Not a scientific fact, just my humble opinion. My fam, depending upon the weather, runs on high anxiety. Discussing it at a recent wedding, obsessed with shooting photos and getting them right before stuffing our mouths, even the younger cousins agreed that yep, most of us run scared.

For those who worry and over-think situations, not dinged with technical OCD (obsessive compulsive disorder) or GAD (generalized anxiety disorder), but symptomatic enough to get sick with worry, the thought of leaving on a jet-plane is exactly as Peter, Paul and Mary sing in that l969 song about leaving on a jet plane; don't know if I'll be back again. Leaving on a jet plane is loaded with meaning.

Rationally you know you have a round trip ticket. But emotionally, you're not sure. It is that return trip in the back of the brain, talking trash. Will you make it home?

So you make sure the flash drive with all your tax information from 2014 is updated and in the clear plastic box clearly marked 2014 Tax Information, and that your sweaters are folded in your drawers, your kitchen counter swept for crumbs, refrigerator clean. It could take days to prepare to leave for a one-day vacay. Because you know, anything can happen.

The wedding is on a Sunday, so Saturday night I'm engaged in all of the above and notice my AmEx card is missing. Not like there's no back-up credit card, but it bothers me. It is a credit card, after all. So while straightening up, watering plants, putting away dishes, etc., even though we leave in the morning, get back in the evening, I am obsessed with finding it. I remember taking it out of a wallet, stuffing it into a drawer, but it isn't there. The online balance checked out so it isn't stolen, has to be here. Somewhere.

The rational brain tells you, don't worry. It will show up. Go to sleep and be fresh for the early morning flight. But it is Daylight Savings Time and sleep will be difficult under any circumstances. Flying, you know, on a jet plane. And FD has gone to the office to tie up his own loose ends, hoping this way nobody will need him while we're gone. He has asked for a 5:00 am wake up call at the office to make sure he gets home for the flight.

Forget that. He wakes me before my alarm. He's ready to go, hyped up, hyper for him. I leisurely dress. We're on time.

But in the car, he's kind of worried we're late. This is odd because usually it is me, not him, worried about missing the plane.

There are some things that really are binomial, and opinions about the right time to get to the airport are like this, one or the other. Some prefer to be at the gate at the very minimum, a half an hour before boarding, preferably an hour. The rest of us love the game, the excitement, the challenge of getting to the gate at boarding, as the groups are called, when everyone is lining up. Many marriages have their best fights about this one. Many times I have threatened divorce.

So he turns to me, even though he is making insanely good time on the road, we have not even had to stop for a Metra passenger train, and asks, "Why are you not nervous? Why am I the one who is anxious here?" (This is a process question, for those of you who look for such things in couple dynamics).

This has to be worked out, why the low anxiety. It is a game changer. We could say, for sure, that I burned it all last night, but that doesn't feel true. The credit card is still missing, that program still running, but I have let it go. I am not anxious. The question is legit.

We answer questions with a questions. "The real question is, what's going on with you?  Because you usually are into this, getting to the gate without wasting any time waiting there for the plane. You never worry about missing planes."

We brainstorm, determine that it is a combination of things, usually the case. (a) He had no sleep the night before, feels out of control. (b) It is Daylight Savings Time, and DST always plays with a doctor's head, patients not showing up, showing up too early or late. And it is likely to mess with flight times. The time zones are all different. Does anybody really know what time it is?

Whereas I always let it go, DST. My patients traditionally do show up on time, and because I'll only see five, maximum, at a shot, they get a call to remind them on Friday.

But here, face it, we can't exactly call and remind the flight crew and the pilot to say, "Stay sober Saturday night! There's this family wedding in New Jersey Sunday and these people start on time, so do me a favor and don't oversleep. Remember, spring forward!"

We park, rush to the gate, our phones buzz. The plane is delayed, naturally.  The flight crew is late.

(2) Straws
Biodegradable straws

I buy a bottle of water at a concessions counter, the adult alternative to Starbucks, but forget to get a straw. Tempted to take one from Starbucks, I hesitate. That's stealing. But I need a straw. Straws make me happy. The woman manning the straws laughs at me, asking her for permission. Of course, take two.

The straw falls into the bottle, irretrievable. FD offers to fish it out and I push his hand away, this is just weird. People stare.

We board uneventfully, and having thought it through, I tell him the real reason I didn't worry about being late this time. CBT works. The drive to the airport, typically high anxiety, didn't faze me because of repeated reminders, little messages to myself, the night before while packing, and then again in the morning, brushing my teeth:

(1) We had Pre-TSA, a perk of  frequent flying, being not-so-young anymore, so the line is short at security.
(2) United is notoriously late flying east, probably would not fly on time. If we were late, they would be later still.
And (3) No luggage, not even carry-ons. Nothing to shlep. We could run to the gate if we had to, and we wouldn't have to, haven't in ages.

So although my bag brimmed with many unnecessary objects, a second pair of shoes, nylons, etc., and now the straw, there really seemed to be every indication that things would work out fine. Just chilling, exhausted from the night before, eye-shades in place, FD to my right, flight magazine in hand, my mind scans the house. Still looking for that AmEx card.

(3) The Return: Uber and airport golf carts

We're in pretty good physical condition, but the days of running through the airport to make a plane, having dawdled too long at a wedding, are over. Never again.

He's lost in the dancing so at 6:10 I leave the party to get our coats, shoot him the following text:
Come on! We gotta go.
In good fashion, he tells me: 
Too early. Flight leaves 8:15, 30 min to airport.
He wants to have dinner, and they are serving.

Rationally, it is true. We have two hours, and we are Pre-TSA again, should buzz through security. The airport is 15 minutes away in decent traffic. So I take a deep breath or three, have dinner, and we say our goodbyes for the last time.

Uber replies right away, at 7:00, but then the driver's pic and plate disappear, so I try again. This time they want more money. Traffic is horrible, you can see it from the hotel and there is a line of limos and cars leaving that can't even get on the service drive to the highway. Uber offers me the chance to double my money and get a car, so sure, what other alternative is there. A driver responds. He calls, we talk. We tell him we'll meet him on the service drive, hoof it past the limos in line. Our driver flashes his lights when he sees two anxious people in black raincoats waving.

Except only one of us is anxious. We will miss the plane, of this I am sure. We will have to pay for another flight in the morning and a hotel, and I will have to call to tell people, "Um, I may not make it in time for our appointment. I'll call you as soon as I know." We have, at this point, 35 minutes to get to the gate. Traffic is crawling.

But he is skilled. We are there in 20 minutes.

At security we are told that the Pre-TSA line is closed. But they hand us a card and we are able to skip over the line. FD gets through, starts to run. It is 8:05.

I am stopped. An officer is checking my bag. Apparently that bottle of water is still in my purse. I bite my lip, wait. He hands the bag back with a smile. It is my turn to sprint, which feels good, but in 200 yards, that's it. Walk, run. Walk, run.

And then. The guy in an airport trolley pulls up next to me from nowhere and says, "Hop in."

"Who, me?"

"Yes, I'll take you to your gate."

There is a god.

He zooms through the terminal. We see FD and I tell the driver, "That old guy in the grey hat! Pick him up!"

FD is stunned. His machismo speaks to us, "No,go without me. I'll make it." I growl/shout. "Get in!!*!"

He obeys.

We make the flight.

When we land, walking through a dark, nearly deserted Ohare, shop-keepers closing up shop, we begin to process the whole thing, how he chatted for 18 minutes about sports with the Uber guy while the man gunned it through traffic, my nails digging into my skin; how we never dreamed of flying through the airport on a golf cart; how the other passengers looked at us when we got there and the woman in front of us in line somberly confides, knowing. "You didn't have to rush, they never fly on time at Newark." We laughed and laughed until it hurt, and he told me that yes, he loves that challenge, the test, eeking out those last moments to the gate, he hadn't worried, not for a single minute. And I told him that I hate it, truly do, and we can't do this again, we just can't, and he will have to get his own ride to the airport the next time.

Just like I have told him, so many, many times before.

therapydoc

Sunday, March 01, 2015

The Duck Song

I used to tell young parents that until their kids learned to read, there was no sedating them.

We've since learned that television does a more than admirable job Not that I'm condoning it. FD and I literally cut the power cord. He transformed the piece still attacked to the TV to a female, and added a male connector to the other (both ends male) and either took it with him to work, or hid it where we thought they would never think to find it. They would, of course, we heard years later, and dangerously fiddled with the double-ended male electrical cord, eventually turning on the tube to watch He-Man and the like.  It is a miracle no one electrocuted themselves.

But anything electronic will lull most of us into a state of uncomfortable consciousness, sleep without the glitter. There seems to be research to the effect that our electronics keep us awake. It isn't that way for everyone, and with very small children the effect might be paradoxical. It probably depends upon what they see and how much sugar they had before bed. There are always variables unaccounted for.
Steven Kellogg and Margaret Mahey treasures

Sometimes I have the privilege of putting my grandson to sleep, apparently a task no other babysitter is equipped to do, and we have a routine and it includes both the hard and the soft drugs, meaning real books hard, and animation or old Beatles songs on my phone, soft. He'd love to ditch the paper in favor of the electronic, but I won't let him. He can read, too, if he tries. He's almost six.

Fact is, when children can't read yet, or are only just beginning to read, someone has to read to them, or should read to them, for reading is a wonderful sedative and we depend upon it to learn, that and other ways. Bedtime is the best time to introduce it. Mother Goose is totally out, by the way, a bad idea, as Into the Woods has made abundantly clear, too violent and libidinous. Aesop's fables, surely had a moral, but at what price, nightmares?

But remember the frog and toad books? They're still around. And if you've never met Robert, not lived through his experiences with hippos following him home from school, you haven't lived. We gorged on anything by Steven Kellogg in my family (Can I Keep Him?), and checking Amazon, there are no less than 641 pages of books by the celebrated author-illustrator. He also wrote the Pinkerton books. Let's not forget The Green Bath by Margaret Mahy, and Much Bigger Than Martin, a story in every younger brother's top five. 





My daughter-in-law surprised me when she said that she sits on the floor with her little guys, just two, and they stare at her phone, watch the animated version of Goodnight Moon by Margaret Wise Brown. It is on YouTube.  Don't judge. Watch it. I dare you to stay awake. 

So that got me started, but when I showed it to their cousin one night, perched on his enormously tall bed in pajamas the very first time, he did not fall asleep and only wanted to see more animation. So we scrolled through the suggested children's books on video, rejecting most of them as too seedy or too boring, and suddenly we found The Duck Song. (The song by Bryant Oden, video, Forrest Whaley). This is not about Donald. It is an upbeat video-joke, obviously a song Bryant made-up while trying to put somebody to sleep, monotonous but cheery, seemingly never-ending, with a punchline at the end. We kind of love it. At almost six, my grandson gets it that the duck's mission is to annoy the guy at the lemonade stand. A duck walks up to a lemonade stand and he says to the man running the stand, "Hey, you got any. . .grapes?" The duck is teasing him, pure and simple.

Last night I have the honors, and as we cuddle up on this enormously high bed looking for something new and fun on YouTube, the closest thing to new and fun is a video of a small group of children between 5 and 13 watching The Duck Song, discussing their reactions. Some are really angry at the duck for being so annoying (they must have younger siblings). Some get it, like my grandson gets it, that it is fun to be the object of a prank, and it is fun to be the perpetrator of the joke, too. Best to be able to take it, even better, to predict it.

Great moral, teaching about being the brunt of a joke, handing over the control, even if it is to a duck. How many kids have avoided depression in just this way, by laughing at themselves?

therapydoc

P.S. I realize it is not that simple, avoiding depression, and the anti-bullying programs are late, but here to stay, for good reason. Bullying and child-adolescence are associated, so if your child is the object, do not tell him, Hey, just laugh along. Get a family therapist and talk to the people at the school. But there is such a thing as benign teasing, meant to be taken well.

And when I need a good laugh, all I have to do is ask a six-year-old, almost any six-year-old,  "Hey, got any grapes?"

P.S.S. For all the years I've been blogging, I still don't know how to create links in a consistent fashion. Just know that any type that isn't black is probably a link to a book, or a movie, or a resource. It could be yellow, ochre, red, scarlet, or if you are color-challenged, another shade, but it will take you somewhere if you click on it. 

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.