Love and Power

I shlepped the February issue of Psychology Today to Miami in January (we can discuss that trip another time), which is why the pics here are so crumpled.

The Love and Power article will get you CEU's, that's how relevant it is.

There's always something interesting inside, a summation of research, and this time it is about power. Feminists have known all along that having too much can dilute intimacy. Shared power is the ticket to happy and satisfying intimate relationships, and heterosexual couples tend to err on the side of poor distribution.

Control, not power, has been the focus in the archives on intimacy, but power is really a better word. Control implies that the power distribution is intentionally lop-sided. When it comes to power, the latest studies confirm, women yield control far too easily and their partners don't even want them to, necessarily. Then, powerless, no surprise, not having it makes us feel badly, affects the intimacy of our relationship,and not in a good way. Not to blame women, notice. This is a psychological system.

Caveat: this is not the case when a relationship is consciously, mutually, sado-masochistic,and one of the two consistently, voluntarily assumes a subdom role, although it might be in certain contexts. Let's just say that if a partner accommodates and doesn't feel good about it, this is a barrier to intimacy. It is why we say that when you win, you lose. So nice to be validated by the research.

photo by Yasu+Junko

photo by Yasu+Junko

Hara Estroff Marano summarizes the research nicely and interviews the relationship experts while taking us back to the historical roots of intimacy, if not so far back. But we get it that intimacy between marrieds in the past didn't have to surpass the intimacy of other relationships, closeness between girlfriends, cousins, mothers and daughters, fathers and sons, the proverbial bf best friend forever. What we have now is the ascent of couple intimacy to the detriment of other relationships,which isn't necessarily a good thing, not if the power in the relationship is what matters, not the sharing.

To ground us here, family therapists have always considered intimacy between partners to be primary, one objective of a couple's therapy. The couple is even labeled the primary dyad. If one partner is more intimate with her mother, or with an office colleague, the other is likely to feel left out. We call it triangled out. Thus we might take issue, those of us trained in this way, even say that good couples have both: primacy and emotionally intimate relationships outside their commitment to one another.

Marano wisely cites social historian Stephanie Coontz that having upped our expectations for the couple in the twentieth century, all of the feelings and expectations of other relationships become piled on top of that dyad, a poor distribution of feelings and expectations. Yes, absolutely, and a shame, explains the popularity of television shows about with girlfriends talking We instantly clamor for more of these, miss it. Let's not do that, a therapist would say, make our partners solely responsible for our intimacy needs.

The real gripe about power is that values and priorities are compromised when one partner gives in too often under relationship pressures. A person loses self, and at some point it feels like there's nothing left, as if identity has merged, someone has lost one. It isn't a good feeling. Thus shared power has to be the new paradigm. It isn't that power is lop-sided, necessarily through manipulation and coercion, but for many there is an unconscious agreement that one has more influence than the other. That agreement has to change; the two need to influence one another. Each must assert, hear and respond, not take automatically take the advantage, not automatically capitulate.

I take away from this that if a couple is codependent, and one of the two usually makes the decisions, then the one who ruled heretofore has to wake up and give it over. Therapists find it isn't all that hard, giving up control, and it feels good for everyone. The group hug.

Lucky for us, the full article, the definitive study about power is online, see Family Process, (Vol 52, Issue 1: Why Power Matters: Creating a Foundation of Mutual Support in Couple Relationships, by Carmen Knudsen-Martin. The author provides examples, too, which is why we don't need them here. Her research group at Loma Linda University is on fire.

We learn that power differentials are maintained because:

(1) once people can get their own way, they don't consciously want to relinquish control,
(2) many of us are attracted to confident people and let them lead, latching onto their confidence. We seek someone to make decisions, gladly accommodate, go with the ideas and proposals of the other, at least initially. The one with the power may not even know this is even happening;
(3) gender-assumed power is unconscious,and even those of us who disagree with that paradigm still fall into interactions that maintain it.

. . . women and men say that they do not use gender to determine roles and responsibilities, but women end up listening to and accommodating their partners much more than the men. A smaller number of couples, which we labeled “postgender,” made conscious efforts to resist stereotypic gender patterns and demonstrated relatively equal accommodation, attending, and status in their relationships.

How to change things?

Direct communication, asking for what we want, the first step (assertiveness). Forget the hints. They don't work.

Validate one another as valuable, this confirms a separate identity, puts the less powerful partner on the map, a beginning). In couple work (see John Gottman, Seven Principles for Making Marriage Work), that simple, seemingly obvious step,can be a month's worth of homework.

Influence, influence, influence, it has to be shared. The ability to influence a partner to respond to our needs is what builds trust and relationship resilience. Interestingly, Gottman found that when women expressed anger they could influence their partners, and this predicted happiness in the future. Perhaps it is the only way they are heard in these cases.

Mutual attunement, a word we've not all heard before, but will be hearing again. Consistently working toward an emotional connection, feeling understood, valuable, respected, and heard. When we have that, there is shared responsibility for a balanced, equal relationship. Equality, really is the new paradigm.

In more technical terms, the ideal relational model looks like this:

(1) shared relational responsibility, being accountable to the effects of our actions on our partners (getting out of denial).
(2) mutual vulnerability (sharing emotions is not just for women any more)
(3) mutual attunement: responding, communicating, understanding the other
(4) mutual influence: letting the other influence us, not always easy, but can feel very, very good, especially if it is new.

It's going up on my white board today.

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Practice Snaps

Oh, I will ramble a bit. Take it in pieces or go get a sandwich.

DBT Made Simple Worksheet

(1) The Perfect Patient Mix

Everyone knows who the worst patients are. But one man’s silver is another man’s gold. Meaning my  nemesis isn't yours, my ideal patient, not your ideal patient.

By best and worst we mean type of personality, type of disorder, type of patient who jolts us out of our hum drum, our oh bla di, those who grab our attention whether we like it or not.

What makes for the best or the worst? Too many things. But if my father had borderline personality disorder, then it might mean that I’m pretty comfortable with people who have it. Or, it might mean that someone with that disorder makes me extremely uncomfortable. Therapists all have interface of some sort or another. We have our triggers.

Before we're let loose on the therapy-seeking public (a clinical population, as opposed to our friends and fellow students, unless they, too, are in therapy), those of us trained to be therapists usually have identified our comfort and discomfort zones. But these zones are squirrely, they can change, especially as we absorb new knowledge and want to try out new skills.Meaning, the zones change.

At a great continuing education workshop, for example, we might have learned volumes about dom-subdom relationships. We might want to work with this population, understanding that their issues are varied like all of ours. Feeling confident, we advertise as an expert and begin to get referrals. Things are going well.

Then one day a dom tells a what happened to me on the way to therapy story that changes things. Perhaps he stopped for gas. While waiting for a teenager to finish at the pump, he fantasized about taking out a tire iron and killing the teen for being so slow. The patient is a Vet, has killed before.

"Would you really do that? Beat a kid with a tire iron?"  We have to ask.
"Yes, if the moon is high."

Still comfortable with the dom-subdom patient mix? Nothing to do with interface, either, or an average dom. This one probably came for his four-year old's toilet training issues. It happens all the time that things aren't the way they seem. A presenting problem may not be the problem. One homicidal patient and you question what you're doing, are much less comfortable around people who are comfortable delivering pain.

You might be wondering, how to respond to Yes, if the moon is high.
Best to keep the conversation going, not judge, follow through. Ask: "How do you feel about being a man who would do that, beat someone up because he's making someone wait?"

(2) Absorption

Some therapists watch their patient mix, so as not to absorb too much emotion.  Emotion gets all over us.

A mentor of mine told me that if I found myself getting too depressed because my patient mix tipped toward depression, then I had to put a limit on how many depressed people I treated.

That makes sense. But if 90% of the human race suffers a major depression at some point in a lifetime, then it is likely that a good chunk of new referrals are in the throes, first call. And let's not forget that angry people are usually frustrated, but sad is the true emotion deep down. And our anxiety sufferers cry, the anxiety can be so debilitating. It is exhausting, so much sadness, so many tears. We may as well stop working if we're going to limit depression.

On the other hand, there's depression, and there's depression. Not everyone rates an Axis I.

(3) Punting

No matter what we might hope for, no matter how we try to watch our personal discomfort barometer, we can’t merely reject someone who comes for help, not in good conscience, once he is there in the room. We might say, as the patient tells his story, that we have a colleague who would be a better fit. If we have that colleague.

Using our best self-relaxation, anxiety reduction skills, listening for the patient's real needs, we find that we can handle it, whatever it is, all of the time. It is true, what they tell you when you graduate, that having a master's makes you a thousand times more capable at this job than the average ear. The trick is to sit tight and trust yourself.

We dig in and treat, do the job. But it ain't easy.

Perspective: A consultant, a psychiatrist and I work as a team. We have a running gag. We’re not supposed to send one another sick patients. What we mean is no really sick people. We joke that we’re too old for it, too burnt out to treat those with demands that run too high. Or so we say.  Of course this is a joke. The only reason it is funny is that grain of truth we both know is there.

Finding the network isn't easy, but there are new docs graduating every day, ready and willing to take on what could be our worst when we aren't up to taking it on. Maybe we can even find an entire team of  DBT specialists. 

(4) DBT

Oh, but what is DBT?  It is not the pesticide that the Americans used in Viet Nam in the sixties and seventies.

Sheri Van Dijk's DBT Made Simple

Dialectical Behavioral Therapy is a therapeutic model for the self-injurious population, the brain child of prodigious research psychologist, Marsha Linehan. Dr. Linehan has authored seminal books and manuals and has thousands of protegees, therapists who follow her religiously. She understood, well before anyone else could put it into words, why the cognitive behavioral strategies that work with most everyone else, don’t always work with those who have the most severe pathology-- the suicidal, borderline population.

Cognitive Behavioral Therapy (CBT), an older school, is about behavioral change, first and foremost, whereas Dialectical Behavioral Therapy (DBT) is about accepting reality first. Yet another acceptance therapy, Acceptance Commitment Therapy (ACT) is close to both ideologically. The therapist works with the patient to develop a new narrative, very much in sync with the patient's world view. DBT might incorporate the narrative, but offers much more than a better story.

The basics include a range of emotional management/distress tolerance skills and group therapy. Individual therapists have support or they would go sleepless otherwise, and oh, a 24-hour hotline.

The founder, Dr. Linehan recognized that the very sick are often an abused and neglected population. They experienced life at its worst. For them, countering negative thoughts can be waste of time. Life's evidence is to the contrary, damning. They have witnessed trauma to the degree that they believe themselves culpable, deserving. As you sow, so shall you reap. The sentence is issued, judgment must be served. The abused adult bought into her guilt years ago, like the foster child in  The Language of Flowers, a novel, about a child punted from one group home to another. (That one should be required reading for graduate students. A nurse recommended it to me.) They are full of anger and confusion.

The behavioral therapeutic schools have shifted the blame away from parents in the past forty years, but when we talk about causality, the environmental approach to mental illness wasn't so far off the mark. Parents have the power to construct realities, to make the world heavy or light. Some literally choose to make it heavy, don't know any other way. So while blaming, judging isn't fair,  saying they had no hand in the outcome isn't true, either. We can make the connection without judging.

Remember that Holocaust movie, Life is Beautiful? There, in the horror of a concentration camp, a father, by force of his positive personality, makes avoiding Nazi barbarism a game with his young son. The game is to spare the boy's optimism, to hide the truth of his experience. The two laugh throughout the movie. Most abusive contexts aren't this way, aren't fun or funny, and parents don't have this parenting skill, the skill of finding humor, creativity and laughter. Their children can't merely wish away negative thoughts, not even with the best rationalizations to counter them, not with our best hypnotic suggestions.

Therapists, then, need to accept the patient where she is, not a terribly novel idea, and introduce the irreverence, the humor in what is real, only possible if we stop fighting it, accept that some lives are more difficult than others. We old Jews, when we speak of some things that are anything but clean, we refer to them as holy, rather than profane, switch up the words. In this way, I refer to the difficult life as a beautiful life. Abused people get it right away.

(5) Beyond Acceptance

Linehan knew what she was talking about. She experienced the worst of depression, made serious suicide attempts. I read somewhere that she had an epiphany moment, one in which she decided that it was okay that she wanted to die, but she had to love herself, it was her job. No one else had that obligation in reality. If she loved herself then she wouldn't kill herself, killing isn't loving. She had to move on and teach others how to do it, too. Accept the raunchy feelings, then have a good life. Why the hell not.

So how do we do that, exactly, accept the raunchy feelings, then have a good life?

Lucky for us, Sheri Van Dijk simplified Marsha Linehan’s work, cleared the smoke of Dialectical Behavioral Therapy with DBT Made Simple.

This manual is fresh, refreshes, and if you buy it (not cheap at $27.96 on Amazon) the patient handouts between the covers are free to use. No more dividing your college rule paper into columns and scribbling homework assignments. They are all here. And the good doctor, Ms. Van Dijk, gives us permission to copy and use them at will. Who does that? Sheri, I love you.

Among the pages of patient information are ways to act differently, and pages of columns with dozens of words to describe every emotion. Who doesn't need more words?  It feels so good to describe our angst, our happiness. So yes, it is recommended reading. Required.

The Language of Flowers, a novel

To be fair, I don't like that shade of green on the DBT book cover (above). Compare it to the cover to the right for The Language of Flowers.

There, the review is balanced.

Ms. Van Dijk reinforces acceptance and teaches self-validation to reverse the self-castigation game. She teaches emotional reactivity reduction and distress tolerance skills, even mindfulness. Support for the therapists is a part of the plan. Therapy for therapists. Like having a suite mate who reads it in your eyes and takes five minutes to let you debrief.

Yes, that is why some of you wait a bit in the waiting room. Not complaining, just saying.

(6) What if there isn't a DBT therapist anywhere to be found?

My suggestion, assuming there is no DBT therapist at a local mental health center near you, is to take the time to learn the skills we've been talking about, reducing painful emotion, increasing the positive. (These are cognitive behavioral therapies, by the way.) Watch the basics of mindfulness (see video links below). Work with a psychiatrist, a therapist, and a primary care physician. Have a suicide contract in place, and the option of insisting upon a hospitalization. If the patient is in an Outpatient Day Program, stay in touch with staff. They need your input.

One on one, no team around, the job is to help people accept and love themselves. You’re fine exactly as you are, not that we all couldn't be better people. You are entitled to your anger. You are entitled to your sadness. Why wouldn’t you be angry? Why wouldn’t you be sad? Why wouldn’t you want me to feel your pain, manipulate your therapy so that I do, so that I know what it's like?

You see, misery loves company. If you don't want the  patient to turn on you, because some do, increase her demands, to try to make you miserable, then the heart of your work must be to join her, make that joining obvious, discuss the ugliest of her truths. Much more powerful than—Let’s try this!

(7) And If You are the Patient? How Do You Help Yourself?

You help yourself by being honest in therapy, for sure, and by having compassion, patience with a sometimes deficient therapeutic system, patience with loved ones, patience with yourself, if you are your only loved one. Then add patience to that patience, compassion on top of compassion. (I'll review Jonah the Woodcutter one day. In that book by Joshua Rubin, Jonah tells the shoemaker that if we have compassion, we don't need patience.)

Read the Ten Reasons Not to Kill Yourself, while you're at it, and buy Sheri Van Dijk's book, or Marsha Linehan's about how you really have a wise self. Begin to use it, that wise self. Start working your own program.

They say Linehan suffered schizophrenia, BPD, and depression. She has at least five videos on Youtube. Watch her teach.  Try her  breathing techniques, watching the breath as opposed to controlling it. Many of us teach diaphramatic breathing  for stress management, much harder, no need. Click on the mindfulness videos at  DBTselfhelp.com fall asleep to them.

Don't do anything to harm yourself. You only have one ultimate mother, one father, and that mother, father, is you.

(8) Politics

We can only hope that with changes in health care, money will be earmarked for the vulnerable, will move Marsha Linehan's epiphanies right along, train more teams of DBT therapists for the trenches, make mental health something we can buy at the local intermediate care center. It is a war, I tell you, that war against self-hate.

Next time I post, it will be on something light, maybe the Dove Real Beauty videos, or maybe whether or not having a mother who shoplifts expensive dresses from Lord and Taylor is likely to have a terrorist for a son.

Maybe why I just want to shake Don Draper and say, "Don, you are like your father, a terrible father, because, like him, you are an alcoholic. Kids are a real inconvenience to you."

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The Bridal Shower Or . . .

It's not as if I want to talk about sexual assault or sex all the time, or exploitation, or homophobia. The big joke in my family is that we couldn't have a meal, we couldn't sit down together, even if there was company, without something embarrassing coming up. From me. Somehow I brought it up.

This gets huge laughs now, now that the kids are adults, at my expense. It mortified them then, of course, and I couldn't promise, in all seriously, never to do it again. 

And it's taken years to stop altogether, to avoid initiating discussions like these.  Writing has helped, teaching, too, talking to people who are looking for practice wisdom or the fruits of higher education.  People who feel like they're having dinner at my table. 

The irony is that I'll want to write about something completely different, maybe even personal, like what it's like making a bridal shower with my mother as a co-hostess, only to get distracted with a Yahoo story about the arrest of a guy like John Hopkins.  And there goes the bridal shower.

If you've never heard of John Hopkins, more power to you, because the story is a confusing soup of cross accusations about sexual slavery and Craig's list solicitations. A veritable He said.  She said.

Quickly:

Mr. Hopkins, arrested last week for allegedly tying a woman to a radiator, supposedly raped her for a week, made her call him Master.  The unidentified victim claims she answered his ad offering free rent in exchange for housekeeping and cooking.   But he bought her a ticket, picked her up at the airport, and then supposedly tortured her in his home, told her she was now his sexual slave.

He tells us, however, his rebuttal is that theirs was a consensual dom/subdom relationship. She wanted to be tied up, handcuffed, beat-up, and raped. It was a part of their deal. She all but signed a consent form.  My spin accepts that that could very well be true, maybe not.  We don't know.

So the story on Mom and the shower, all the things leading up to it, what we talked about in the car, will have to wait.  I'm sorry, you have no idea.

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