Road Rage

 

Evanston bike lane barriers to protect bicyclists

That's a pic of barriers put up by the City of Evanston Illinois to protect bicyclists. It made me so happy that the safety of others is truly a municipal priority. 

What also made me happy, and you're going to laugh, too, is a story. 

I'm driving my big (it is big) white SUV and come to a neighborhood stop sign. I'm not paying the best attention to exactly where I am, this is a wide street. But is it parked up. 

There's a driver to my left, I have the right of way, and he is waving angrily, frantically, to indicate that I should not be in the center of the street. I should be on the right side of the street. 

Now, as a younger person I might have waved my hand (you know that gesture) to tell him to take it where the sun don't shine. Or I might have lowered my window to tell him to get therapy. But at my age what's working better is seeing him as hilarious, laugh out loud hilarious. So upset over having to make his turn and not hit me? Really? He could have just let me go first, I did have the right of way. 

I'm only telling it over to tell you that if you look at people who are angry at you as ridiculous, and overly judgmental, it frees you up. Sure we have to be responsible and considerate, but is it necessary for the other person's blood pressure to go up if we aren't?

Safe driving, friends. 

therapydoc 

Seeing Red

My Anger Jacket

There's a story about the rabbi who controlled his emotions by donning an anger jacket. I heard about it a week after a run-in with a sociopath. I wish I'd known about the anger jacket sooner. 

Rabbi Shalom Rosner tells us about it in a weekly 'parsha' podcast. (The 'parsha' is what Jews read at services on Saturday morning). By the time I heard the story my trauma, a game of chicken on a side-street, had dissipated. The encounter didn't bother me anymore. 

The rabbi tells the story of the prophet Moshe getting angry at the Jewish people. He's able to wait before he speaks, able to calm himself down before criticizing them.* 

Think before you speak. Be grounded. 

The rabbi then gets to our intervention, repeating a yarn about a revered sage who worked hard not to express his rage (not to his children, spouse, students, etc.) without first putting on a special jacket that hung hidden away in his bedroom closet. After taking the trouble to remove himself from the situation to find the jacket, taking off whatever jacket he had on, because he was a jacket-wearing rabbi, and replacing it with the anger jacket, he had cooled down. He never said anything untoward, nothing regrettable, not while under the calming influence of the anger jacket. 

The anger jacket is a behavioral solution to an socio-emotional-behavioral problem.

Many of us tell ourselves we're not angry people, then lo and behold, we find that we are! Truly tested, the best of anger managers lose their Zen, probably several times in a lifetime. They will unleash that adrenaline, sometimes at someone who is at really at fault, sometimes at an innocent. 

It is very much about where we're at: hormones, neurotransmitters, hunger, sleeplessness, stress, situations. We have all of that unconsciously working with and against us. Lacking as much testosterone women, for example, can be less arousable, hence less angry than men, so estrogen can work in their favor. But not always. What goes up, biologically, must come down.  

Driving a crew of seat-belted/car-seated children in a big white SUV affectionately called the airplane, having navigated arguments about who sits where, wondering where I will park when we get to our destination (FD awaits), I see an oncoming automobile. It will be tight. There is no convenient place to pull over. This is a city side street.

I do my best and stop. I have not pulled over enough, however, for this maniac, a driver who determines to teach me a lesson. He speeds straight at me, threatening a head-on collision, then swerves away just in time to avoid it, side-swiping my back fender in the process. He drives off. 

I jump out of the airplane aghast, very angry. It is a new car and I have already initiated it in a parking garage, hit a pole. The man is half-way down the street. When he sees me chase after him o foot he stops and gets out, too. Not to be intimidated by a woman, real man that he is, he approaches and proceeds to blame me for what happened. I am not cool. I express my incredulity at his driving. Insulted, not to be criticized or out-raged (I was loud), he blames my driving (female) and threatens to tell insurance it was my fault. It is my word against his.

I snap a pic of his plate. He snaps a pic of mine.

I yell some more. What was he thinking. There are five children in the car! He asks me what I had been thinking, and did I even have a drivers license? I shouldn't. 

I withdraw to the car, shaken, leaving him standing on the street. The kids are supportive but confused. What happened? Who was that guy? Why were you yelling?

We arrive at the park and review the damage to the car. One of the kids suggests we get some white paint, you know, just paint over the new black scratches on my shiny white car. Kids are the best.

Thinking back on it, a guy speeds at you on a side street threatening to hit you head-on, you do not confront this person, even after the damage is done. Do we have to experience this to know it? No. It is an oft-visited topic in a therapist's world, talking about avoiding altercations with threatening people. Retreat, avoid. Get away.

And yet. 

How is one supposed to remember this under the influence of so much adrenaline? How can we be cognizant of our anger when all we see and feel, all that we are, is anger? The need to discharge the excess, to reduce what we sublimely refer to as a negative emotion is the only thing that seems to matter.  There is no other way to return to who we are, to our natural state of juggling emotional states. We can't even juggle. There is no juggling, no room or time to breathe.

Clearly I won't do this again, I say to myself as I return to the car to face five mind-boggled children (although they were fine, didn't even make much mention of it to their parents). There will be no more confronting potentially violent people, or anyone, really, in a sharp tone. I tell myself.

That man could have pulled out a gun and shot me. 

A religious person would say that if we put the Old Mighty in front of us all of the time, if we recognized that He/She is in charge and has got this, basically, we can accept everything. We can accept that we have been wronged and let it go. We can add that therapeutic pause to our social relationships. We might avoid screaming at a sociopath in front of our grandchildren.

The rabbi, when he searches for his jacket, is adding that therapeutic pause and he knows it. 

I'll take a look around in the closet, see what I've got.

therapydoc

*Matot 31:14,  מטות לא:יד

P.S. We need that thing that clears the brain, the cross-word puzzle, the Paint By Number*, reading, learning, bird or weather-watching. Star-gazing. Not when we're driving, but in general these things help. The idea of art, being an artist, each of us in our own way, but having not even been able to make good stick figures when it counts, I prefer guides, paint by number. Winnie's Picks might be worth checking out if you're looking for something chill. One day we'll talk about photography.

Outsmarting Anger

First a Story

It doesn't help that between patients this morning, my mother tells me that she's still sick.  It started Saturday, a bug, nothing terribly serious. She looked gray yesterday with make-up.

In anticipation that she might be unable to eat today, before pedaling off to the office at 8:00 a.m. I stopped by her apartment to check her pulse and drop off breakfast, lemonade and jello. That's all any of us get in our family when we have symptoms of gastroenteritis, ala FD's expertise.  It's worked for us forever.

Mom is out cold when I get there early in the morning. After all, no place to go, except maybe the ER, and she doesn't appear to need that. Four various combinations of patient family members at the office later, it is time to check on her again.

Chicago Bike Path June 2013 Spring

How do we interpret the events so far?

I'm stressed, although keeping my cool, not hurrying or riding recklessly to get to the patient.  In my town, although it is considered a biker's town (read flat), if you don't ride cautiously you won't ride for long.

And it is a beautiful day, even at noon when it is ordinarily hot and humid in July. Miraculously, yesterday's humidity is gone and there is a lovely breeze coming from the lake.  I feel that superiority only people who ride bikes can feel-- it doesn't get any better. Runners and sailors feel it, too.

Then guilt sets in for enjoying myself, and I wonder whether or not I love my mother enough.  Shouldn't I  be worried about her falling in the bathroom?

How is it that we humans can feel two very different things simultaneously, worry and happy.  Worry, I posit, is the intellectual feeling of that particular moment. Happy is more sentient, the emotional or physical feeling at the time. We don't get that many great-weather-days in Chicago, so happy overrides worried.

Most of my ride is through parkland on paved paths. Mayor Daley, before Rahm Emanuel succeeded him, made sure bike riders, power walkers, buggy pushers, toddlers on Big Wheels, and he himself, a bicycling enthusiast, could traverse several miles without stopping at a traffic light. .

But once out of the park my last city mile is all traffic, and I have to be more careful, the Sunday drivers are out. Not that there aren't bike paths on the city streets, there are, so technically there should be no problem. Blocking a bike path warrants a steep hundred and fifty dollar fine. Even more, $500 and up, $2000, rumor has it, for those who (a) don't look before they open their car doors or (b) engage in the sport of picking off bike-riders this way. We are a sports town.

So imagine my surprise (not really) that the rules are violated. The first car that blocks my way sends me into traffic, but gets a pass. A few blocks later, a Chevy driver, his elbow hanging out of the driver's window, cell phone attached to his ear, hears me assert,

"You might get a big fine parking in the bike lane."

I'm not exactly a citizen-police type, and in more sane, less stressful moment would never have done this. Blogging about it, btw, one way of working it out. Ours is something like my exchange with the dog people in the park, the ones who used to let their dogs run loose. See that ecosystem post).  The Chevy driver, as I peak at him and ride off, isn't an elegant guy. His belly is hanging over his jeans and his tee-shirt is covered in sweat. Blurting to him is a mistake, we'll see.

He sneers at me as I pass,

"Shut up." A nasty guttural tone. 

I ride off, look back as he shouts the "B" word at me.

It's a beautiful day in the neighborhood, a beautiful day in the neighborhood, won't you be mine.

The crazy thing is that I even considered turning around to explain myself, wanted to tell him that this in his best interest, respecting the law.  But now I have to worry that he may vengefully come after me, veer into my space, knock off that little old lady on her way to take care of an even older little old lady.

I worried so much that I found myself looking back to the point of disorientation, danger, and at one point hopped onto the sidewalk, yes, a violation.

What you need to know:

Outsmarting Anger- Joseph Shrand, Leigh Devine

Occasionally we talk self-help here. It can't just all be about me.  Dr. Joseph Shrand and Leigh Devine, MS, authors of the lovely little book, Outsmarting Anger, might use the story as a teaching example. They would tactfully suggest that I sublimate anger, surely a character trait that will sabotage my sanguine nature in the end.  One day I will blow up for nothing, or displace my anger toward the wrong person, someone who did nothing wrong except maybe be in the wrong place at the wrong time.

Oh! That is what happened, although we might not call my suggestion to respect the bike lane a technical blow-up.

The doctors would be right, probably. But I'm too out of touch with my anger to say.

Anger, we learn from Outsmarting Anger, is the emotion that follows a threat. A threat is someone or something that might compromise our resources, residence, or relationships.  For this lesson alone, the book is on a Number One recommendation for anger management connoisseurs, and who isn't one.

The fellow in the dirty tee, by swearing, threatened my sense of safety, and my resources (the road). I feared for my life, too, my relationship with me.  As you know, fear, an arousal emotion, is a close relative of anger. Shrand and Levine explain how the two connect.  Unconsciously or consciously we fear a potential loss based upon our sensory perception. Then we recognize (cognate) the threat in the form of the other's anger. We respond to protect ourselves in the best way we know how, in kind, with anger.

What else do the Harvard researchers tell us about anger?

Those who can't control theirs have a somewhat immature prefrontal cortex. This makes sense to me, for I've always told my addict patients the same thing, those who can't resist the impulse to use substances, eat too much, gamble, or have lots and lots of sex, little else on the brain.  In those moments of caving to the urge we use a primitive part of the brain, the one that isn't thinking, that operates on auto. Like a dog to a piece of meat.

Stop and think, is the intervention. See yourself as a homo sapien before beginning another cocaine binge. It really, really wasn't fun coming off of it the last time.  But memory for addicts is like memory to women who want to get pregnant again. Not bad the last time, was it, that labor and delivery! A walk in the park.

If our problems with anger are all about an immature prefrontal cortex, how can we hasten its maturity? (This interpretation of scientific findings is rudimentary, but who can stop?!)

Think of another mantra around here, that adults who hate themselves but want to change, should take heart. Adults are quite capable of quick change, more capable than children who may not yet have the biological maturity to abstract, save and review. We have the physiology in place, only need to flex our muscles, establish lasting connections between the brain and the extremities.

Not so fast.

The subtitle of Outsmarting Anger, 7 Strategies for Defusing Our Most Dangerous Emotion refers to a deceptively simple but very useful 7-step treatment plan:

recognize rage, envision envy, sense suspicion, project peace, engage in empathy, and communicate clearly (I tried!).

This sounds simple, but if any of this were simple then we wouldn't have to worry, would we, about people shouting expletives from car windows, wouldn't have to feel that anxiety, disruption, that lingering upset that is bundled with anger, and for some of us fear, for the rest of the day.

We don't have bumper stickers on bicycles, but if we did, life would be so much more fun.

therapydoc 

Anger and Abandonment

It has been blustery in Chicago, the reputation as the Windy City well deserved. So blustery that at the end of March, when the weather is supposed to be mild (March comes in like a lion, out like a lamb, every second grader knows this) that we tell frail little people like mother, "Don't go out for lunch. You'll be grabbing onto your walker as the wind carries the both of you away." She goes to lunch anyway.

FD tells the story. He's in a parking lot at Home Depot, returning the cart. A bundled-up middle-aged man with a white beard is holding on tightly to a cart. If we don't hold them tightly, carts will take charge, fly off and hit parked cars. Chicagoans know this.

The man begins to curse as his hat flies off his head and hits the ground. FD, retrieving it, is rightly impressed by the long string of expletives, ef__, es___, d__, ef'in___b, b___, ef___, ef'n___, es-ef___, spewing from the man's mouth. Listening to this, he doesn't say it, but is thinking, Save your expletives for when you break a leg, or lose a house, maybe. Why waste them here?

A few years ago, two men with romantic accents came to see me in one week for anger management. It sometimes happens that two or even three new patients with similar problems come to therapy in the same week. It is as if there is something in the air or the stars are aligned in some special way. This affords the therapist the opportunity to experiment, to do her own little research study, assign homework and see what works and why, and see what doesn't and why not, because there is something of a control, having that second patient with comparable symptoms, comparable objectives.

It gets better. Both tell their narratives fluently, and both are from that continent hailing the new pope, South America. Both are reflecting upon a childhood living with extended family, not their moms or dads. Their parents left southern climes to establish themselves in this country, the United States, a land of opportunity, and called the sons to join them years later.

Years. Later. A long time to miss a parent. Without means, long distance phone service was prohibitive back then, and letter writing, well, there wasn't money for computers and email, and who had time for it anyway?

The child left behind, defenseless, odd-man out among the cousins, abused by drunk uncles and bullied at school, learned to be a very tough human being, so tough that peers eventually realized that to mess with him meant a fist fight that he relished. To beat another human being with his fists felt fantastic. This is where the phrases  sees red, has a hair-pin trigger, and Intermittent Explosive Disorder can meet as one.

Left behind.

Therapists hear about domestic violence, but usually not from the perpetrator, but the victim. The spouse or child tells the story. Here the patient is both victim and perpetrator. As an angry man, however, he doesn't hit his children or his partner, and has learned, as an adult, not to beat other adults, either, unless the circumstances clearly warrant physical violence. To him, they occasionally do, certainly if he hasn't stopped drinking yet.

We don't need advanced degrees to see where it comes from, the anger, and why the expletives become something that will need work, and surely the physical pounding, the rage, the immediate need to redistribute justice and turn things around, has to be channeled productively. One of the interventions I love, one that started with those two-in-a-week, works as follows.

The patient is told that he has to deliberately lose every argument. Every disagreement, every difference of opinion, my bad. He is to tell his partner, dispassionately, "Fine, I'm driving poorly?  I'll work on it." That kind of thing.

"Two weeks, you're an idiot for two weeks. She's the smart one. It's okay. You're really not an idiot. In your heart, in your head, you know that. You do know that, right?!" The therapist asks this in all sincerity. "Keep that in mind at all times. Nobody left because of you. Nothing to prove. Nobody thinks less of you if you are wrong. Your partner will value you more for being human."

It helps to have a partner or spouse in the therapy to reinforce the intervention, someone to look into his eyes, to tell him, "You're the smartest guy I've ever known. I love you. Love me."

And if he can't, there is that possibility, she might leave. Been there, done that.

therapydoc

Your Worst Nightmare

Some of you who have read old posts might remember that I have had recurrent home invader dreams once or twice a year for as far back as I can remember. Always the same thing. Some big, unshaven, muscle-bound criminal-looking type, sometimes more than one, pushing against the front door to my family home. Me alone, pushing to keep it closed from the inside, trying to keep him out.

Poor FD. I always lost the struggle and woke him up.

Then, for no apparent reason, they stopped. The nightmares just stopped.

As much as I like doing anger management with people, there’s anger management and there’s anger management. I generally don't work with people who are court-ordered, very few hardened criminals. An occasional sex offender, is all.

And if a patient has a psychosis that is disinhibiting, or is ruled by voices in his head and doesn't like the medicine they tell him to take, it's likely I'll punt him along to someone who likes this kind of challenge. An ER doc, even. I won't be discussing identity or teaching any muscle tension and breathing.

Most people who have anger problems aren’t in it to hurt anyone. They’re just poor emotional regulators, and tend to have trouble with very strong emotions. We all have them, you know, strong emotions. And they can make some of us feel like hurting ourselves, or hurting someone else.

Even telling someone off reduces tension, sarcasm, too. People who suffer from Borderline Personality Disorder are particularly vulnerable to this solution, hurting themselves, hurting others, in any kind of way, and we see this disorder present quite often in therapy. We’re getting better at helping people with BPD, and in the process, recognize how difficult it can be, emotional regulation.

Therapists have weeks in which this is all we work on, above all else, it seems, emotional regulation, behavioral blunting. Stop signs.

I think it's what makes this a dangerous profession, that which Freud called id, the very human drive for aggression. We’re not an endangered species, but therapists are at risk for harm.

And we take in a lot of verbal abuse. We either don't take it, won't see a verbally violent individual, or learn to address it dialectically.

"You can get away with talking to me that way," I will tell a patient, "but it won't make you popular at parties."

Some of us get good at this kind of challenge, even welcome it, say, bring it on, even, to change the behavior. We won't debate facts, won't get into it like they want us to, just talk about quality of life.

"Is this what you want to do, put other people down, yell and scream and distance people from you? Or would you rather try to get a tennis date?"

That's DBT, Dialectical Behavioral Therapy, changing the meaning of a person's behavior. Some people do it naturally. We call them masters of the paradox. But ultimately what it is, is getting through. If a therapist never learns how to do this, get through, then there will be no therapy, no changing anyone suffering from Borderline Personality Disorder.

Very occasionally, for it has to happen if you work with people, a therapist will encounter someone in the throes of a psychotic episode. That person might be on the brink of hurting himself or others, might be paranoid or psychotically depressed, or flying manically, not in control of thoughts or behaviors. Out of reality times three might be an apt description, unaware of person-place-time. And this can get violent. People do get killed.

I've been lucky. My only encounter with one of these individuals who actually lost it with me was with a psychotic ten-year old. Never saw him before, but you don’t easily forget the brute strength of a psychotic ten-year old throwing table lamps. Not that I was really at risk. Truth be told, I’m pretty strong when my adrenaline's pumping. FD doesn't sneak up on me anymore.

So yesterday, I’m working with a kid on anger problems, no less, and we’re talking about how it's worse when you don't have parents who want to help with this thing we call emotional management. At least her parents are into the process, we agree, want to learn about it themselves. We finish and she goes out to the waiting room. Her mother takes her place. Mom and I are talking about how in her family there were eight kids and her mother, like her, couldn't control the aggression between her many siblings, and how powerless she feels when everyone totally ignores her efforts at Time Out. Can you imagine that? Time Out doesn't always work. When suddenly . . .

We hear banging on the sliding door of my office (the door for my bike, not people). I jump up and open the usual other door, the one with a handle. I see her. She’s my height, my build, in dirty jeans and a man’s shirt, tennis shoes. I don’t know her, but I know psychosis when I see it, glaring at me with fury. She scowls at me as if I'm dirt, snarls loudly,

“You a doctor?”

I’m sure I blanch. But she's not well, I get my cap on (the therapy cap) and respond in the most quiet, gentle, compassionate voice I can muster, a clinical voice.

“What can I do to help you?”

She pulls up her shirt sleeve, rips off a flimsy Bandaid to show me a freshly wounded, bloody forearm. The blood has already dried, doesn't seem to need any stitches. “You can fix this!”

Now I’ll be honest. I don’t want blood on my carpet, so I’m getting nervous. And I don’t want to turn to my desk to call the police, because I’m afraid that if I turn my back on her she’ll attack me from behind. She’s flying. This is anger. That other stuff we talk about is frustration, powerlessness, aggravation, the other words.

“Oh, that needs a doctor’s attention," I suggest, concerned. "I think we have a doctor downstairs.”

She furrows the brow, lowers an eyelid, then backs out of my office slowly, never taking her eyes off of me, like a bank robber in the Wild West holding a gun to the people in the saloon. The crazy part of this is that if I had to pick her out of a line-up, I’m not sure I could. I'm not thinking, look for birthmarks, eye color.

She’s backing out to the waiting room from my suite, past the door that should never have been left unlocked. I follow her. She points down stairs. “Down there?” she asks skeptically. "There's a doctor down there?"

“Uh, huh,” I reply gently. “Down there.”

My patient is in the waiting room now, too, has followed me out and is with her daughter. "It's okay," I tell them. "Please come back into my office. I'm pretty sure nobody's working downstairs today." They join me and I lock the outer door to the suite after them. Inside we process what happened, they hadn't felt threatened, particularly, didn't realize what was going on.

They're my last patients of the day. I lock up after them. Locked doors make me happy, the one time I forget to lock up, this happens.

I realize I hadn't called 911. Should have called the police.

Moments later, calm, I hear a loud bang on the door to the suite. I shiver, ignore it.

Then the phone rings. It’s my patient. “You have to see this,” she insists, breathless. “You have to come outside and see this.”

"Was that you banging?"

"Uh, huh."

Okay, okay.

Out on the street, about a half block away, three big policemen are working to subdue her. They’re having trouble, too. Arms and legs are flailing.

I feel absolutely terrible, as if I could have talked her into waiting for them, convinced her to surrender peacefully. She would have had a free ride to the ER for her wrist. Instead it seems likely that someone hit a panic button. And she’s treated as a savage.

My patients are spellbound. “How did you know?” the mother asks me. “How did you know she was crazy?”

“I never used that word,” I object. “I said she has a mental illness, isn’t a well person.”

“But how did you know,” she insists that I tell her, “that she was dangerous?”

“You just know, is all.”

therapydoc

FYO, all of the details of the story have been changed to make it fiction. But I think you get the gist of it. The truth is, truth is better than fiction, but sometimes you go with fiction.

September (so I'm late) and October back a' cha

I almost forgot. Here it is, Halloween, and I haven't thanked anyone in months for linking to me. I'm going to be in trouble for sure for forgetting or missing some of you, so please forgive me in advance.

It's like making a wedding. You're always afraid you're going to insult someone you forgot or decided to leave off the list.

There's an old therapy intervention for anger, if it applies.

The idea is that you can't just go off on people. It's nobody's right to rant and scream, insult others. This is called verbal violence. It's frowned upon in therapy, even when someone deserves it, as is plotting revenge. Anger gets us into trouble.

People who drink or use drugs to cope tend to drink more when they get angry, which tends to make things worse, jack up anger even more. So the 12-Step program recommends that they keep a lid on it, anger, even in sobriety, which is hard since it can become a defining emotion.

So how do you keep a lid on it?

(a) We first look at our own piece of a problem, however tiny that might be, and work on that, own it and change it.

(b) Then we go ahead and forgive the other person. Right off. No questions. Do not pass go, assume that individual has his or her reasons for upsetting others, isn't being intentionally malicious. And even if the other person is malicious, he or she must be malicious for some reason, maybe a good reason.* Oy vey.

There's much more to anger management, for sure, but this can really work for your every day narcissistic injuries. So if you think you should have been included below. . . (smiley emoticon here)

I personally use cookies as peace offerings.

Okay, in no particular order, let's start with Amanda at This crazy miracle called "life," because face it, she's got the right perspective. Dear, don't change.

The latest mental health professional to read Everyone Needs Therapy is already getting beat up on the job. Welcome to the family X-Addicted.

Check out Raising a Healthy Family. It might come in handy.

The Secret Shadows is promoting awareness about Dissociative Identity Disorder, always a good thing. Very sneaky disorder, DID.

A Barbaric Yawp is seeing things, people in cow suits. You need two people, I'm telling you, for a cow suit.

That's Enough is weighing in on shoulds, as everyone probably should, shouldn't we?

Amy's writing Whatever I Feel Like, which, as you know, is what we get to do before we get married.

Blinds blogs at Keeping the Blinds Open, awesome pic.

A Sideways Look at Social Care: The Social Work Blog is worth at least a sideways look if not a full-size look.

The Amazing Adventure is much better than the not so amazing adventure, and the people in the pic seem to love one another, so check it out, too.

Joylene talks stress therapy over at Therapy. Someone has to do it. And a real therapist, Melissa, is working hard.

Bookwormmom is an amazing blogger, who really reads real books. Thanks for the link, BWM.

WWright is on a campaign to make poverty history. You have your work cut out for you. You rock.

Simple.ology linked here thinking blogging therapeutic. Thanks, Bean.

Evergreen Help Line can tell you a few things about positive thinking and the subconscious.

The Second Road is great for people in recovery or people dealing with people who have addictions.

Heather's become a cat lady and worries it may get out of hand, but managing, it seems, and having an Amazing Adventure. SYD at I'm Just Fine and I go way back in the blogosphere. Thanks for being there, Syd. And MamaMPJ will give you an earful at A Room of Mama's Own

Frumhouse and Mother In Israel , In the Pink, Juggling Frogs, Nad-Nad, New York's Funniest Rabbi, Coffee Yogurt, Cranky Fitness, and Feminist Gal always make me happy, brighten my day, and The Rebbetzin's Husband teaches me a thing or two.

Great comments and links from Leora, Jack, Wendy, Mark, Porcini66 , Anti-Social Social Worker, Barbara K. SeaSpray, White Trash Academic, Not Faint-hearted, All Rileyed-Up, Dr. Deb, Author Mom with Dogs, Shosh, In the Nuthouse, Looking to the Horizon, April, Rambling Woods (such photos), Jendeis, Auntie Om, Pinky RN, The Fringe, IlanaDavita, Dream Lover, Miriam L, LCSW Mom, RZ, barfly, Karen, Greeny, NashBabe, Lin Rob, Rosey Sunset, Margo, and all of you anonymouses out there, you know who you are.

Thanks everyone.

therapydoc


*None of this, by the way, works for me when it comes to victims of violence, especially sexual violence. Things get much more complicated when you get hurt like that.

Golf

We took a drive out to see the family in the 'burbs last Sunday, and had hardly hit the watermelon when my nephew came home very tired and sweaty from his golf game. Kids in their twenties look gorgeous even when they're tired and sweaty.

I'd been having a bad back week, nagging 3 Advil aggravation, so I asked him if he had any spare clubs. Hitting golf balls is a nice way for me to stretch out, work through the muscle strain, an occupational hazard when you sit in an office for hours on end. But I don't have a set of golf clubs.

Which is silly, really, because there's a driving range all of a mile away from my house, and my father and my father-in-law (OBS) each took turns teaching me how to swing a club when I was young and showed some promise. It's one of those things you either take a liking to or you don't, but since it took in my case, this hankering to hit the ball, for their sakes I feel, I should be hitting golf balls every so often.

So I asked my nephew if he had an extra six or a seven iron collecting dust in the garage. I thought I'd give it a try, take a walk over to the driving range later that day, spend five bucks and hit a bucket of balls. Stretch out.

But there are no buckets anymore. Crazy. You buy a card and stick it into a machine and the golf ball rises on cue from the Astro-turf, complete with tee. You lose the stretch you get bending down, putting the ball on the tee. That's 48 bends a bucket, I mean card, lost.

Bored yet?

Do you think it's a boring game?

Honest, I wouldn't know, having never played, never made it past the golfing range, unless you consider Par King (the one with the windmill) golf. But I do see that there can be some real psychological benefits to the sport.

Obviously, to play golf you basically stroll around on parkways, probably whistling. Not all of us, not those who can't whistle, and certainly not people like me, who never made it past the driving range to a genuine golf course, but real golfers.

Wait! Since I don't really play, maybe I can't really write about the benefits of the game! The best I can do is tell you how it feels to hit a golf ball, put that baby up there in flight, watch as it soars 150 feet, or is it yards, except for those times that you don't, when it dribbles three feet onto the Astro-turf in front of you, and you're embarrassed and have to make a decision, one that you make when no one is looking:

Is retrieving a ball you can reach cheating? Stealing?

The therapy:

I used to tell people that anger management is about two things.

(1) muttering, as opposed to yelling, and
(2) breaking stuff at the recycling center.

Muttering is obvious. The energy that would go into swearing or saying something less than kasher,* is still channeled to the lips, but the product is almost inaudible. A person can still use the same facial expressions and words, even, but no one should actually decipher what he's saying. This can still infuriate a partner, however, so it doesn't always work, in which case Think it, don't say it, is the rule, and rethink that, own some of the problem.

Recycling is one of the lesser known interventions in anger management. Ever since the city of Chicago took over the recycling business with blue bags for our cans, bottles and WSJ's (Wall Street Journals) fewer people have had the inclination to smash wine and beer bottles at recycling centers. Recycling centers still reign, however, in the suburbs, featuring imposing iron bins for paper, glass, and aluminum recyclables. There used to be a good one in Evanston.

You can either drop your recyclables into the bins or you can hurl them. No one cares if you hurl an empty bottle of wine or a mayonnaise bottle with all of your might, as long as you hit the inside of the bin safely.

So hey. It's good for the environment. We're into green.

In the sixties we used Styrofoam bats for anger, which by the way, are not recyclable. People with anger issues were assigned sword fights, Styrofoam bats and swords for duels, or they smashed pillows to get their anger out.

As you know, I recommend that people keep their toxic anger to themselves, keep it in, or express it creatively, perhaps nicely, safely or not at all. Bats, even Styrofoam bats, are out. Smash your pillow if you must, but the actual physical enactment of rage probably needs to be toned down, not jacked up.

But recycling! Who can object to recycling?

Still. Maybe learning to think before we talk is a better way to channel anger, listening to words in our heads before saying them aloud. Or better, write them down. Write the letter, don't send it, then write it again. And don't send it.

The expression of anger tends to get people hurt, which is why we've recommended assertiveness all over this blog. You don't need to disrespect people. There's enough bad karma in the world. The family is there to support us, not to bring us down. If you feel like flexing verbal muscle, buy a dictionary. Get better words.

Theoretically, that other way to channel anger isn't so bad. Battling it out in Styrofoam, hurling wine bottles into a recycling bin, even, might I suggest, hitting a few golf balls, can be a fun way to displace, rather, discharge negative emotion. And it's good for the back, hitting golf balls. Or it's bad for the back, depending upon your back. I guess if you're lousy at golf, however, and get frustrated easily, then hitting golf balls defeats the purpose.

We see little children discharge their feelings during play, and what are we, if not big children? Little kids will smash crayons onto their coloring books when they're frustrated, usually for attention. They'll break the whole box. They don't care.

I tell parents that it's good to get kids to talk about their feelings, but it's just as important to teach them to channel arousal, to teach them to run, and skip. Jump. I think it tires them out, too, like hitting a bucket of balls, I mean a card, tires me out.

It's good to mentor kids, to teach them to distract from their negative feelings with gross and fine motor skills, especially if the skills require a little concentration. Bozo's Grand Prize Game is a good one on a rainy day, and it's cheap. The kid tosses ping pong balls into buckets. We used to pitch pennies, try to hit the sidewalk cracks when we were kids. There were fewer shows on television. As soon as kids are engrossed in these types of activities, they forget about smashing crayons.

Their parents can talk to them about their feelings at bedtime. The first order of business for children at any age is to learn to play well, to be a good sport. For most of us it takes practice to get good at anything, and patience.

But if you don't care about winning, really, if all you're after is hitting that sweet spot ten times out of forty-eight (is that so much to ask?) and you like practicing, then you're still in trouble.

You're going to have to drive out to the suburbs to borrow more clubs.

therapydoc

*kosher or kasher can mean clean in certain contexts, or appropriate.

Holding On and Letting Go

You're Wearing That is the title of a new book by Deborah Tannen.

National Public Radio's Susan Stamberg excerpts from the book and interviews the author. I excerpt from her excerpt below, but it's worth reading the whole post, and I'm sure it's worth reading the whole book (sight unseen I say this).

Most of us instinctively identify You're wearing that as a mother's communique to a daughter, and that's what the book is all about, mothers and daughter and how they talk to one another.

Quick and dirty:

You've heard it here before that when you talk to a significant other you should try on the idea that your S-O is important, as important, indeed more important than your boss, and you wouldn't speak to your boss harshly. You wouldn't second guess or psychologically undermine (out loud) your boss's choices. You wouldn't yell at your boss. You wouldn't hang up on your boss.

Parents assume that they have the right to do these things to children. Children, especially when they get older, assume that they've earned the right to do them to their parents.

Earn the right? There's a right to emotionally abuse a family member?

A little harsh, let's dial that down.

Of course if you don't correct your children then they might grow up feeling the world owes them a living and that they're always right, or conversely, that no one cares about them and they're nobodies. But there is a right and a wrong way to advise people, and probably Dr. Tannen discusses all of this in her book.

(Why is it I didn't get an advance copy of THAT one, by the way?)

Recently a patient told me that the state of being angry is now considered emotionally abusive, a real kick to therapies that encourage you to beat your pillows. I still like the beat your pillow concept. Who does it hurt, after all?

But for sure if you're in therapy or have ever been in therapy and the topic of anger has come up then you know that the expression of anger can be extremely abusive, even in low tones. It's exactly what we tell people in anger management.

You have potential to emotionally damage by being angry-- either at your spouse or at a child-- at anyone, if the way you express your anger as volatile and unpredictable, or if it's cruel, biting, mean.

I've told you this on my Because of You post that discusses Kelly Clarkson's song. She bemoans the domestic violence she experienced by watching her parents fight. I tell you that her anxiety, her fear is a response to trauma.

So no, you don't have the right to be angry, rather, you don't have the right to express it without sensitivity.

I titled this post Holding On and Letting Go because so much of what happens between parents and children is about control. We have such a need to hold on, take care of, protect our children, that letting them fly can be supremely difficult.

Sending them to kindergarten can be hard, how can we do weddings? The stress of letting go (and the energy it takes to hold on, double entendre intended) is a variable that surely drives the way moms and daughters talk to one another.

So when it comes to communication, walking on eggshells, even if it is uncomfortable and doesn't feel intimate is a good thing. The intimacy will come if we're careful about how we talk to one another. It's okay to have to watch what we say-- to think and rethink everything, to couch communication in the most sensitive, caring fashion.

When the kid is about to stick a finger into an electric socket or run into the street, THEN you can scream. But most of the time children aren't doing that. They're not sticking fingers into electric sockets. They're not running into the street. They're looking both ways.

I don't mean to minimize this subject in any way, trust me. I understand that if your child's shooting up that you'd better do something and it might be best to be strict, calculatedly rejecting, even mean. We can talk about that another time.

Meanwhile, here's a quick excerpt of the book, excerpted from the NPR website. Congratulations Ms. Stamberg and National Public Radio and thanks Dr. Tannen.

A woman in her sixties expressed this: “I always assumed that once my daughter became an adult, the problems would be over,” she said. “We’d be friends; we’d just enjoy each other. But you find yourself getting older, things start to hurt, and on top of that, there are all these complications with your daughter. It’s a big disappointment.”

Small Spark, Big Flare-up

Especially disappointing—and puzzling—is that hurt feelings and even arguments can be sparked by the smallest, seemingly insignificant remarks. Here’s an example that comes from a student in one of my classes named Kathryn Ann Harrison.

“Are you going to quarter those tomatoes?” Kathryn heard her mother’s voice as she was preparing a salad. Kathryn stiffened, and her pulse quickened. “Well, I was,” she answered. Her mother responded, “Oh, okay,” but the tone of her voice and the look on her face prompted Kathryn to ask, “Is that wrong?”

“No, no,” her mother replied. “It’s just that personally, I would slice them.”

Kathryn’s response was terse: “Fine.” But as she cut the tomatoes—in slices—she thought, Can’t I do anything without my mother letting me know she thinks I should do it some other way?

Gotta' love it.

copyright 2007, therapydoc

Angry, did you say?

Like I've said in other posts,

Just about all of my interventions weave in some form of cognitive behavioral therapy somehow.

I like CBT for anger management especially. And I personally use it all of the time to control my emotions. But people who see red can't slow themselves down long enough to work the therapy. And they make friends and family very uncomfortable.

So something has to be done.

The rule is that if it's hard for a person to control an outburst then a med eval (medication evaluation) is a good idea. Once chilled a bit, Cognitive Behavioral Therapy (CBT) is pretty useful. Plus there's no harm in getting a med eval. Nobody can make a person take drugs.

I'm forever telling people, We have better drugs!

We do have some really good ones now, meds that take the edge off, and they're not all addicting, either. But you can develop quite a tolerance to some of them, so if that's a concern, check it out with your doc.

Anger's a totally different animal you know, than anxiety or depression. It's sometimes hard for a person to tell exactly what it is that's causing the bad feelings in anxiety and depression, but we know very well who or what is making us angry.

Like this morning. I had almost finished this post when FD asked me calmly, “Where are the car keys? They're not on the hook.” His stress was palpable.

Little One is home from yeshiva and he had the keys last night. FD was leaving. It was 6:30 a.m. He was late. “I’ll find them,” I said. "I'll wake him up."

The keys were in Little's pocket. I said thanks, never yelled. FD didn’t yell. We remained polite and calm throughout the whole drama. But it was tense.

Me empathizing with FD's frustration motivated me to jump and hurry up, wake up the kid. The kid jumped to find the keys.

Negative emotion motivates people like nothing else, for better of for worse.

But what if we'd lost it? What if FD had had a tantrum, then it could have become ugly! I would have been angry and defensive with FD for his tantrum and somehow my anger and defensiveness would have trickled down to Little and we'd all have had a nasty morning. And it was a beautiful morning.

So to me anger's the symptom that best exemplifies how emotions affect family systems. Anger isn't at all fuzzy. You know why you’re angry, you know who you're angry at. Or do you?

If we hold that irrational core beliefs about ourselves drive our emotions, and we have to rationally counter them to feel better, then we have to figure out the core belief. There has to be a little psychotherapy going on for CBT to work.

The emphasis in CBT is on rationality, which is not nearly as sexy as emotionality, like I've said before, which is why people resist being rational. Depression and anxiety make us look vulnerable. Angry people don't give off vulnerable vibes. So anger is not sexy.

Nobody wants to take an angry person in their arms and say, There, there, it'll all be fine, don't worry (although that's exactly what we need sometimes). Most of us wish that angry people would just go away.

I for one am allergic to them unless they're paying me to help them.

But even though I’ll deal with angry people all day long, if you're in my family you know that I won’t listen to you if you’re screaming and that I need about twenty degrees of separation. I can handle anger better on the telephone than in person, or in writing. Violent books are sometimes okay for me. But violent movies? Never.

Nobody’s perfect.

Now. Most therapy docs will agree that a rational argument, meaning measured verbal expression without drama and screaming, slammed doors, fists and silverware flying is a good thing. The way to solve problems is to discuss, debate, present feelings, thoughts, new solutions—with relative calm.

Notice I didn't say dump your anger all over the house to get it out of your system. You can get it out of your system in some other way. If you were in the army you’d have to do a hundred push-ups. So you can do that rather than rant and rave. Push-ups. Or clean out the basement.

Or rearrange the furniture. Weed. You'll lose your rage.

But let's take a quick peak at the psychological/social system and CBT before the weekend begins and people start drinking and throwing things.

We'll use a new fake, fictional totally imaginary couple, Reg and Ranata (choose different genders if you like, gay or straight makes no difference).

Ranata is the identified patient, the one who chose to come to therapy for her issues. But I brought in Reg to get his point of view, of course, to rat out Ranata. After a couple of months of depression Ranata is just now getting in touch with some flammable anger that she says she’s always had.

"It's never bothered me," she says. "I don't hit anyone, I just . . . go off. It's Reg who's uncomfortable with it." He hates it.

This going off thing tends not to work in most relationships. In some cultures the exaggerated expression of emotion is totally expected and even encouraged. This is why sometimes it's best to date within your own tribe so your behavioral mores don't clash.

But I think that even within a cultural context that values the free expression of emotion, it's dangerous to express anger violently.

Your partner, even if he or she grew up in an emotionally expressive family still might not have developed a "tough skin." Sometimes having grown up in a very emotionally expressive family can make us even more sensitive.

"I have to stop for Reg,” she says. “I need to stop for him."

Actually, not only does Reg find anger a real drag, but he's very embarrassed and turned off when he sees Ranata behave angrily at people. She doesn’t get angry at him. She gets angry at others in front of him.

But she wants to change. This is true love, friends. If it's a problem for your partner, it's a problem for you. If it's a problem for you, it's a problem for your partner.

Quick history: Ranata's father, a very old fashioned, critical man, criticized the way she dressed, the way she put on make-up, her friends. He did not let her date (she had to lie to go out) and her occasional back talk brought out emotional, verbal, even physical abuse.

Despite this she has a survivor in your face personality and very successful in the business world. Aggressive successful.

But her core belief is that she's not good enough and that she’s powerless when it comes to changing people who are important to her, like her father. And she likes letting off steam, displacing her frustration on her office team, sales clerks, telephone solicitors, credit card company reps, etc.

When faced with a problem Ranata starts out rational, even intellectual. But as soon as she gets to the point of frustration she loses all civility, bangs on counters, says mean things. That's when her guy wants out of the relationship.

(It's supposed to be one big table, not three little ones, so use your imagination a little. Thanks)

Let's look at the A-B-C in the table, AFFECT, BEHAVIOR, COGNITION. Remember that you can intervene ANYWHERE. You can change the affect. You can change the behavior. You can change the cognition.

Ranata would say, “If I could change my anger (the affect), I wouldn’t be seeing you.”

So change the behavior or the cognition. Start by identifying the feeling.

Ranata, like most people, can tell when she’s getting angry. Because she went to therapy she knows that she learned to be angry from her father, as opposed to say, being sad. I mean, why do some people (like me) get sad whereas other people get angry?

One reason is that some families prescribe a preferred emotion. They give the kids permission to feel and act in certain ways. Like in my family there was permission to be sad, whereas in a lot of families crying is considered a weakness. But my mom said, Go ahead, cry. It feels really good to get it all out. (thanks Mom!)

So of course, people like me learned that it's okay to cry and that crying will generally evoke sympathetic loving responses in people.

You know about reinforcement from the other behavioral posts, I think.

Long story long in Ranata’s case we know that her anger is really about being frustrated and shut down, powerless with her father who gave permission to be angry. She’s aware that being frustrated in her relationships is dangerous and tends to culminate in verbal violence.

Since anger's an aversive stimulus, she loses friends. Her anger spells doom. It's like Voldemorth’s strength in the Harry Potter books, gains power with the host, the object.

So her job is to catch it when it's on the rise. The cognitive piece is recognizing the anger rising, sensing it, noticing the feeling as it becomes more and more uncomfortable. Then she has to ask herself:

What is this horrible feeling? Oh, it's anger. I know it well. Anger puts the "A" in AFFECT.

She recognizes the feeling, then THINKS. Thinking is the next step (COGNITION). She has to slow down the action to mentally evaluate what's going on, what is happening.

Then she has to challenge her knee jerk thinking on the subject and her automatic behavior (exploding) and think of an alternative response, a new BEHAVIOR.

Wow. All of this is so much work. So much easier to throw the dishes, no?

Have a nice weekend.

Copyright 2007, therapydoc