THIS is love?

I had an associate professor who didn't particularly like me. He taught Research 540 (I think that was the number, could be wrong) first semester, first year, first research course on the way to that Ph.D.

Most of the docs-to-be in my cohort bucked to become either full-time academics, grant writers, or social service agency directors. He knew I'd probably shirk all that, continue to do what I do best, maybe charge a few dollars more.

In the end, ironically, I did continue on to teach and do research, if not full time, and had an offer to direct a social service agency.

Anyway, the first day of class we tossed around dissertation ideas. The doc encouraged us to fantasize about things we wanted to study. I naively suggested Internet Addictions, explaining that I had been treating a woman who had an obsession with chat rooms. At that time what she did was called "hot chat." Her spouse didn't approve.

He chuckled at my expense (embarrassment).

"And how would you propose to get your data for that," he laughed. "How would you get a sample?"

Ha, ha, ha.

I crawled back into myself and didn't say much for the rest of the semester.

So imagine my not surprise reading Is This Man Cheating on His Wife? a Friday Weekend Journal feature by Alexandra Alter.

This man is Ric Hoogestraat and he spends 12-18 hours a day on-line in a virtual video world, Second Life. There he has a virtual wife and a virtual job. He goes to virtual parties and has virtual sex. He is strong, handsome, viral. He is Someone.

And his real time marriage is in pieces. His wife attends a support group for women who have lost their spouses to video games.

Some 30 million people are involved in these virtual worlds. Their avatars, computer generated cartoon likenesses of themselves, are living the good life in a "better" world.

Ms. Alter tells us that according to researchers at the University of Washington, the brain doesn't distinguish between virtual reality and reality. Processing stimulation from a computer screen (virtual reality) is the same as processing real sensory data. Byron Reeves, a professor of communication at Stanford University, says that the social dynamics of virtual relationships mirror real life. "People feel bad when something bad happens to their avatar."

Yes. This certainly explains our compulsion to run to the computer or check our Blackberries fifteen times a day. It explains why 30 million people create cartoon alter egos on-line and are willing to live vicariously through them, interacting socially with other cartoons. We feel badly for our on-line friends and creations, we feel good for them. They make us happy, they make us sad.

And the data seems to indicate that we can't tell the difference between our virtual lives (or those of our virtual creations) and our real lives.

Well let's try to think critically for a moment, please. I for one, can tell the difference, and think you can, too.

If I couldn't then I'd have to believe that 30 million people really, really are at risk, marriages are in the toilet, parents, siblings and friends are shut out, virtual relationships are ascendant, more real and important than the flesh and blood creatures who share our bathrooms.

For sure there are such things as Internet addictions. The Chinese take kids from their homes and put them in isolated treatment for this. Kids are skipping school to play on line. I've seen it in my practice.

Games aren't for children. And they're probably dysfunctional in a lot of adult relationships

But let's think. I'm going to object with the U of W findings, provisionally, and hypothesize that most adults who have lives on line do know the difference between virtual reality and reality, and propose alternatively that we choose, believe it or not, reality. We do choose Life.

Still I have to wonder, sometimes, where our loyalties really lie. Our friends wonder, too.

Like I've worried that my real friends are jealous of my Internet relationships. (They're not). Or if FD, perhaps, wonders if I'm carrying on with one of my readers in some gathering place in the sky.

Oh dear.

Were it not for the fact that the better sensory data isn't available on-line, he might have cause to worry. A computer screen is only marginally stimulating compared to other sensory input.

Sex therapists encourage sensate therapy for that reason. We believe that most sexual problems are curable by couple work that re-establishes connections between the body and the brain. It's recommended you enhance ALL of your senses if you're having difficulty with arousal.

As a therapist I recommend enhancing sensual stimulation for all kinds of disorders, not just sexual ones. What is aroma therapy all about, anyway? Or art therapy?

How do you do that? Try playing around with . . .

the sense of smell (rose petals, perfumes, Bvlgari if you're me),

the sense of taste (apples or apricots, chocolate, but it's your call),

the sense of touch (tell him/her for crying out loud, what feels good),

the sense of hearing (music or chirping birds on a window sill)

and the sense of sight (your choice, of course, perhaps take a look at a decent art history book or show someone your In Style, Vogue, or W).

Or dress up and go out and accomplish all five.

I'm sure that what people see on line, including virtual games can be really, really good, unbelievably entertaining, and for sure emotionally satisfying.

I don't play the games, but I'm sure they distract nicely from hum drum every day life. But you can't touch the people behind your screen. You can't smell your avatar's cologne (not yet).

So I don't think they're a threat to most of us sentient types.

I recently went to I-Tunes to download a song for a mix. I couldn't remember the name of the song and had no idea who did it, but it went something like this. . . far away for far too long. Must've been 200 songs with that lyric and I-Tunes gave up on me.

So I Googled the lyric and found a music video on YouTube with avatars, or perhaps they were only cartoons. It was fantastic. I'd never seen anything like it, visually (I live a sheltered life). Mickey Mouse and these romantic/beautiful cartoons all interacted in a virtual StarWars/Gilligans's Island music video and I said to myself, "THIS is what the kids are talking about. THIS is what's so appealing about the new graphics on the Internet. I get it."

Except I can't smell it. I can't taste it. I can't feel it. The music and visuals are nice, though. But like television, all they do is say, Gotcha'. Your computer snags only 2 of the 5 senses.

Another good dissertation for a young therapy-doc-to-be is how imagination IS the 6th sense. That would still net only make 3 out of 6 senses though for on-screen stimulation.

Our brains are SENSORY PROCESSORS. They are capable of processing ALL of the five senses. And it's true that what you don't use, you lose. And I think most of us want to use them. It's why we shop.

As good as you make him, you can't smell an avatar. You can't touch him.

And virtual friends? We can't stand in line with them at the movies, we can't kvetch about our portions at a restaurant, and we can't get an opinion on new shoes. Not really.

I'm loyal to you readers. I seriously get all warm and fuzzy and just love it when you comment, don't care what you say. I love the virtual relationship thing and surely you "read me." The definition of that expression may be grounded in our blogging culture.

But will blogging ever be better than dinner out with the girls? Come on.

I can look at pics on blogs, but the eyes will never look back. We're not sharing real tears (okay, sometimes we do, I take that back). But at the end of the day, how really satisfying is it?

And is there anything on the Internet more interesting, attractive, exciting or seductive than your guy's hands on your trapezius, deltoids, supraspinatus (shoulders), squeezing them just right, and saying, "How about you and me go to bed early and read until we fall asleep?"

That's love, Mr. Hoogestraat. Get out of Second Life. Go back to your wife and get a first.

respectfully,

therapydoc

The 4th Carnival of All Substances-Therefore, Choose. . .

WHAT? You come here for booze, meth and coke and I offer you cheese, figs, spices, grapes, almonds a pomegranate, olive oil (that's an ancient olive press, perhaps used 2008 years ago), carob seeds, baklava and a peach?

Maybe you can make a substance out of something. Frankly, they're better for you, taste better, will get you high if you consume in the right frame of mind (mainly if you're hungry), and have fewer calories, except for maybe the baklava and the cheese.

But when was the last time you had cheese like that, and when has anyone had baklava, seriously?

Those who burtz (yiddish, rhymes with tour, add the "tz", means complain) about sugar addictions haven't submitted anything so I can totally get away with all of this!

You've heard "Therefore choose life?" We say, Therefore, choose . . .

Okay here we go.

Erin, who beat an Oxycontin addiction tells us about differences in motivation (like why be dirty when you can be clean) over at What Winners Do.
Thanks, Erin.

Two Dogs Barking reminds us what a drag co-dependency can be. She tells us how it's pretty hard not to be angry when an S-O who had been using through-out the relationship finally gets sober, except she's already booted him and now he's with someone else. Two wanted to break dishes but got a grip (yay).

Fact is, it's pretty hard to express anger safely. The sixties are over, basically, but I'd like to get my hands on those styro-foam bats, if anyone still has them.

And Jimson Lee, over at Speed and Endurance informs us that real athletes know how alcohol messes with your body. His personal fave drink is Gatorade mixed with H20. I'll have to try that. (Isn't Gatorade loaded with caffeine?)

Another fitness buff, RT, tells us who to call if someone we love is using. Ghostbusters, it's not.

Meanwhile, the Registered Addiction Counselors at Bright Eye-Online Alcoholism and Addiction Counseling give you a nice rational, cognitive therapy approach to coping with cravings for drugs and alcohol (picture your S-O saying Bye, Bye, been nice to know ya'). They also present a cognitive tx spin on relapse prevention. This is EXACTLY the stuff I taught at Univ of Illinois. You'll love it (if you like this sort of thing).

Charles H Green, Trusted Advisor generally writes about business, but is kind enough to lend us a philosophical spin on recovery. Booze, drugs, money, there are parallels to finance, obviously. Charles has a really nice post about apologizing that probably is more connected to us, check that one out, too.

Addiction Recover Blog reminds us of 15 signs of trouble, as if we need to be reminded(we do, we do!).

Tracee Sioux at So Sioux Me, Complaint Free House kvetches about her kid's kvetching and then tells us that she thinks she's also addicted to complaining. She writes, Could complaining be considered a substance if the idea of giving it up as a coping mechanism makes me feel as if I'm in recovery? Sorry dear, you're reaching.

But Scott, equally off the track, presents the characters from Harry Potter as real people you meet on campus, in College and Finance, the first humor blog I've seen about money.

Let's finish up with a couple of late submissions that I haven't read but you probably should (or could, or would, far be it from me to tell you what to do):


You get the professional take on co-dependency, Nancy at Emotional Well-being tells you where that's at. I trust Nancy.

Andy at Money Walks (is this an addiction, spending? I suppose it is, fine). Has something to say about paying off those cards. Just do it, maybe, I had to shop so I didn't have time to read it, but you should.

John, at the Universe of Success is serious when he tells you how to stop drinking.

And finally, Bill, at the Universe of Success (would I lie) asks if we're all nuts.

Very nice. My daughter-in-law's mother once sent me a nut-cracker shaped like a squirrel. Not a small item, takes up a lot of room on the table, and it's grown on me. But I have to tell you, I don't take that kind of talk lightly, don't appreciate words like "nuts" or "crazy" to describe people who have the guts to talk about issues in therapy.

Just an FYO.

THE BAR IS CLOSED. YOU CAN ALL GO HOME NOW. PEACE AND LOVE AND HAVE A SOBER WEEKEND. That goes with slow down when you drive, you'll live longer.

therapydoc

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

Feeding Them

They look like they can take care of themselves.

That's a pic at Newark. We're waiting for a flight to Ben Gurion Airport, Tel Aviv, Israel. We took a little vacation last week.

Number three son Duv, youngest daughter-in-law Cham, FD and I took off for a simcha (happy event). We still think of weddings as happy events.

Although Cham’s been part of the family for a long time, she and Duv are only married a couple of years. She’s slowly, perhaps quickly learning the family culture.

For example, the four of us had to get to the airport by 6:00 a.m.

Although I pride myself in running on time, when we were young FD and I literally ran down the tarmac to catch planes. In the late seventies a flight crew stopped a taxi-ing plane to Eilat (or maybe it was Sha'arm El Sheich) and rolled down the stairs so we could climb aboard.

I have to admit, it was pretty cool. And did I mention? We're nobodies. We're not dignitaries, not Clintons. Life was simpler back then. Oh, you're late? Not to worry, come on in.

The airlines don’t do that anymore and Cham and Duv are nervous types. She's from a family that makes the Girl Scouts look lame. It's the Girl Scouts,with that motto, Be Prepared, right? I think that three hours early for a flight's about average for Cham's fam.

I totally admire this, of course, as one who prefers to be early over late, if it has to be one or the other. Why does it always have to be one or the other?

Then there's FD who wrings every minute of its usefulness. Every second counts and he's in a hands-on profession. So being early can feel like a real waste of time. I've tried the cognitive therapy stuff on him (and me), but at the beginning, middle, or end of the day, someone always has to show him something. Or he has to listen to something, or talk to someone about someone about something.

What DID we do without cell phones?

Anyway, to be fair, FD really does his best to make sure that we aren't chasing down planes on tarmacs anymore.

So we took this vacation a couple of weeks ago and had it set up so that we'd meet the kids at the airport. We were relatively on time, made it by 6:20 a.m. and if it weren't for the budgers (those people who just HAVE to stick their suitcase on the scale ahead of yours, even though your boarding passes are ready and theirs aren't) we'd even have been early for our flight.

We all sighed the collective sigh of relief in our seats at the gate. On time for an international flight means your flight will take off 2 hours after you've checked in, assuming it really is on time.

Cham: Hey, Ma. Did you happen to bring anything to eat?

Me: Uh. . .

Duv: We're starved.

Me: I. . .uh. . .I didn't. . .

Duv: It's okay, don't worry about it.

Me: I'm so . so sorry. . . but. . .

I forgot. A failure as a mother. I forgot food. My mother would never have forgotten food.

Now if you recall, in one of my posts about visiting the kids in L.A. I packed such mouth-watering sandwiches that the lady in security almost confiscated them. She said, "You know, if you had made liver and onions I really would have confiscated them."

Who knew you could joke around with security? Ah, our care-free post 9-11 days, always funny.

For this trip I had it in my head that we'd eat on the plane since EL AL, the Israel trans-Atlantic airline, serves fairly edible kosher meals. They're standard; you don't have to order kosher.

But we were on American connecting to EL AL in Newark and American is American, meaning no meals no how.

I tried the, "Get yourself a latte kids, and a yogurt/apple," but that didn't work. I think they really wanted a sandwich.

No problem, they tell me. Worst case scenario they'll graze at Newark between flights.

So of course it's no big deal, and they really didn't care. They were hungry because they had just moved into their apartment and hadn't stocked the fridge, knowing we were leaving for vacation in a day or two.

They hadn't actually depended upon me bringing breakfast, being supremely independent in so many ways.

And they know they can raid my fridge any time.

But I have to admit. It was nice there for a moment, being back in the mom role, even if so characteristically disappointing for them at "crunch" time.

copyright 2007, therapydoc

More on the field of Infant Mental Health

I got a great comment, one that took issue with the way I took on the issue of infant mental health.

Jaylark has left a new comment on your post "The Field of Infant Mental Health":

I work in the field of infant mental health, and thought that I would provide a little more context about it. Speaking as a therapist, you wrote “Of course, we love infants, so bring them along, if you'd like.” Speaking as an infant mental health therapist, we're generally seeing the children together with their parents in play therapy, not working with the parents alone in talk therapy... although if it will be useful, we can do both, to be sure. For this reason, the level of reflection about the parents' own childhoods and parenting styles varies a lot from therapy to therapy. However, even with a parent present, play therapy is usually either child-centered or “parent-child relationship”-centered: the parent’s own parenting experiences receive attention to the extent that they appear within, help with or disrupt the parent-child relationship in the room.

Classic articles about this include Fraiberg, Adelson & Shapiro’s (1975) Ghosts in the Nursery and Lieberman, Padrón, VanHorn and Harris’ (2005) Angels in the Nursery.

There may also be confusion about he term “infant”, which in this context includes toddlers who can talk. There is now very compelling evidence that infant mental health (often defined as therapy provided to children ages 0-3, or even ages 0-5) is by far one of the most effective forms of therapy when necessary. For each $1 invested in infant mental health, estimates of effectiveness range from $4-$17 of subsequent savings in physical and mental health costs to society in later life. For more information about the value of investing in early intervention with children, the free resources at the following links may be helpful:
http://mi-aimh.msu.edu/Policy/InvestmentintheEarlyYears.pdf
http://www.rand.org/pubs/monographs/2005/RAND_MG341.pdf

I agree that infant mental health would be a lot less useful when, as you imply, the purpose of the therapy is to make money from parents experiencing normal parenting anxieties. All therapy is most effective when it addresses actual problems that cause actual heartache. It seems to me that when the goal is money, the same criticism could be leveled at any professional endeavor, whether psychological or educational or in business. On the other hand, I imagine that helping a parent to alleviate or address parenting-related anxiety could be phenomenally helpful to both parent and child, since children are always well-attuned to their parent’s moods even when they might not know what those moods mean.
Like most therapy, however, I believe that infant mental health is typically sought if a child has left the normal development track and is having problems.

At the hospital where I work, our therapies are all grant-funded, meaning that they are provided to families free of charge for periods ranging from just a few weekly sessions to 50 or 100 free sessions. Rather than seeing our work as a cash cow, we're trying to help address psychopathology when patterns of behavior are still least fixed and most flexible, and often among society's poorest and least-connected children. When they display problematic behaviors, we endeavor to get them back onto healthy developmental tracks before they begin having behavioral, attentional, social or learning problems in school that can contribute to lifelong social or emotional problems, as well as lifelong struggles with feelings of shame, alienation, rejection or failure.

Just another perspective.

Publish this comment.

So I published it and responded to his comment as follows:

Jay, I don't think I've ever intentionally implied that the purpose of therapy is to make money. As a matter of fact, I'm pretty sure that if a doc wants to make money, I've suggested real estate.

Your comment is so important, however, that I'm going to copy it and post the whole thing on a separate post.

Thanks for your valuable input. When I post on something like this I'm really fishing for input like yours.

And Jaylark wrote back the following:

Thanks for your response. I apologize if I misunderstood about the financial end of things. To share some of my own context, I'm an all-but-dissertation predoctoral intern. As such, I work unpaid and full-time with clients who typically cannot afford to pay. I think I pushed my own hot-button there, and I absolutely agree with you that real estate would have made more sense financially! Reading over my post, which is a little dry, if you approve I'd like to include a few more specific examples about infant mental health.

As with all therapy, of course different things are needed for different situations. When you wrote, “But the therapy's about you and the family you came from (or your spouse's), I'm 99% sure” , I have also found this to be mostly true of any therapy, whether infant, child, adult or family. However, when a little child has lost a parent and is talking daily about wanting to die in order to see them again, and maybe is fascinated with window ledges or knives (and maybe their little siblings), I think you’d agree that the therapy is necessarily about the child. Even two year olds grieve when they lose their parents, through their play if not in their words. When their words fail them, they can still fail to understand that the parent did not want to go, did not mean to leave without saying goodbye, still loves them from up in Heaven, and so forth. That’s where infant mental health can come in, hopefully with the input and active involvement of the caregiver.

At our hospital, see many children who have been abused, molested or have witnessed horrendous acts of inhumanity. To name a few examples, many of these children have repeatedly witnessed one parent being battered by the other, suffered physical or emotional abuse themselves, or seen a parent die or murdered in front of them. Many have effectively lost a parent due to custody battles, prison terms or deportation of the parent by INS/CIS, none of which are within the normal range of a child’s ability to understand... but all of which are becoming distressingly common childhood experiences in this 21st century. These are the issues that can drive adults to therapy: children, while arguably more resilient than adults, nevertheless remain much more primitive in their coping skills and defenses. And while I might wish that these were isolated cases, unfortunately there are often many more children on our waiting list than our staff of 15 or so is able to see, and many more whose parents never follow up on referrals to us after incidents of domestic, community or personal violence.

As any parent can attest, parenting is not an easy job for anyone, but it can be much more difficult for parents of children who have suffered traumatic events. Parents can find their children’s trauma symptoms baffling. As you likely know, in traumatized children we sometimes see overwhelming exaggerations of common problem behaviors like tantrums, nightmares, clinginess, being controlling, or attempts to harm self, siblings or other children. These symptoms are pleas for help every bit as much as they are misbehavior. While love and discipline are both important, if trauma symptoms are not understood in the context of the child’s emotional life and experiences, there is a risk that discipline will actually compound the trauma and its symptoms, rather than alleviate them. For examples of this, I would refer you to Bowlby’s On Knowing What You are Not Supposed to Know, and Feeling What You are not Supposed to Feel, and Slade’s Making Meaning and Making Believe: Their Role in the Clinical Process.

Another thought is that, for two year olds as for older children, play is a critical form of communication in which children not only have fun, but also attempt to process the issues that they encounter in real life. Their play is a window into their thoughts and feelings. In play therapy, we see play in session as an opportunity to strengthen experiences of mutual understanding, attunement and relatedness for both parent and child, creating experiences of happiness and relatedness that can sustain the child emotionally and in relationships for the rest of his or her life.

With a little less grandiosity and more pragmatism, infant mental health also includes assessing a child’s sensorimotor, cognitive and emotional development. This can help to identify signs of the disorders you mentioned, but may also alleviate any potentially unnecessary parental concerns, or help parents to shore up any areas of developmental weakness that might potentially be substantiated.

Some kids (and parents) don’t really know how to play, and infant mental health can help to teach this critical relational skill, as well.

I also agree that one of the most important things that infant mental health therapists do is to help parents to reflect upon how the parenting they learned when they were children themselves does or doesn’t respond to their own children's needs. Many parents are, of course, doing a wonderful job and are very responsive already. However, in many instances we provide services to families in which the parents' own parents were either neglectful, abusive, substance addicted or absent. For a parent who never experienced "good enough" parenting themselves, some time to reflect with a professional upon what they'd like to do, or not to do as parents in sessions with their children and the dilemmas of parenting present in the room can already be an invaluable gift for parent and for child, no matter what the therapy is called. Therapists can help parents to understand the meaning inherent in their children’s play, what it might imply about the child’s inner life as they try to make sense of their world... but highlighting, emphasizing and enhancing the relationship between parent and child is paramount.

We believe that this is most easily and most usefully accomplished with the child in the room.

This is all a very long-winded way of saying that what we do depends upon the children and the parents, which, of course, you know already. But I thought a few more concrete (if long-winded!) examples might help.

See why I love this job? Children on window sills. You bet they need therapy. I wrote back:

Sorry, I mistakenly thought that the field of INFANT MENTAL HEALTH was about INFANTS and thought . . .infants, as in. . .babies.

I stand corrected. Who knew? The Wall Street Journal article said nada about children.

Of course CHILDREN need therapy. Everyone needs therapy. Infants, apparently, too.

Thanks again, JayLark. Something tells me you're a super therapy doc, ESPECIALLY if you like to play and have some good toys. My bets are that you won't ever sell out to real estate, even when the market picks up.

We look forward to that book on the dissertation, btw. Good luck.

therapydoc

Diagnosing Cats

I know it sounds weird, but I found all kinds of blogs about pets and they're chock full of stories. Mostly about cats. There are some about fish, surprisingly enough, and a few about dogs, but cats are huge.

The last post I read was about a cat who scratched and ruined whatever was handy to ruin in the house. Is this typical of cats? Why do I think it is?

Is it true that they have no consideration? I know they jump up onto counters and will gladly drink your milk, eat your goldfish, that sort of thing. Maybe dogs do, too, but I've yet to see one on a counter.

On the one hand I want to be charitable and say that cats who do as they please have an atypical psychotic disorder and are incapable of testing reality. They just don't know that their behavior is sociopathic. They feel they're doing the right thing. They behave as if we're a step beneath them on the evolutionary ladder. If we could, we'd jump on counters, too.

On the other I'd like to say they're personality disordered; they know but they don't care, can't help themselves.

I see no Axis I disorder, no eating disorder, no affective disorder, no anxiety disorder, no paraphia. They're not sick, right? They're just doing what cats do. But not ALL cats are destructive, right? Perhaps only cats who have seen some hard knocks, street cats who know from abuse and street crime are destructive.

The real question I have, and maybe one of you out there knows the answer to this one, Do pet psychologists diagnose pets in this way?

I had a great session on the phone with a patient who gave me the opportunity to play pet shrink. She's generally very anxious and when her cat was sick she was sick with anxiety and had to talk to me right away. As we were talking she noticed that the more anxious she felt, the sicker the cat behaved. The cat seemed really, really stressed.

"He's shaking," she told me.

Ah. So we worked on dialing her anxiety down and lo and behold, the cat chilled down, too.

Now I know that pets are very sensitive to our emotions and that dogs in particular will cozy up next to us when we're sad. So what this says to me is that if a cat is chewing up the furniture. . .

Nah, can't be. Makes no sense.

copyright 2007, therapydoc

Intimate Opportunities

No, not what you think.

I'm thinking about opportunities to connect and simply be with people, the ones that will make a difference years from now.

Here's a typical decision.

My d-i-l, an up and coming therapy doc, did something really wonderful. She's young and idealistic and she put herself on a registry that searches for people who agree to willingly go through dialysis to become stem cell donors. Plasma phoresis can be a brutal procedure. They stick a catheter in your vein for hours, perhaps in the neck. But there are types of leukemia that respond to healthy stem cells, and it's a rare opportunity to save a life. Her DNA made a match.

D-i-l went through dialysis for 6 hours, and days of hormonal preparation that made her sick and crazy (she felt a little off, she tells me). My son was with her the whole time.

It wasn't easy and it wasn't risk-free. Without the procedure, the person she matched (and she has no idea who this person is) had little to no chance of survival. We don't know if it worked, either.

So why do I mention this? Not to brag, although I'm incredibly proud of her and fall off my chair at the thought of these generous, wonderful, idealistic kids.

I mention it because healthy people her age (early 20's) are really independent. They'll tell you, I don't need you with me, and maybe they don't, but if you're not there when they need you, any procedure, even a minor procedure, can be a pretty lonely, empty, scary experience.

But the default for young people is often, "I don't need you, I'm cool." And sometimes they are, sometimes they're not.

If you offer therapy to a kid in college, it's likely the kid will say, "I don't need it." By the way, it's a GREAT time to get therapy, college, if you're lucky enough to have the opportunity to go to college.

It can be a real relief to parents when a kid says "I don't need it" when it comes to therapy And parents who are still on the fence about the actual benefits of therapy will say, "Okay, good."

You know what I say, right? Every one needs it, at least for a little while, at some point or perhaps several points in their lives, if only to deal with everyone else. So on that score, push the idea with your kid. Tell the kid to just go, try it.

Kids in their early twenties, even in their teens, maybe at any age, want to be independent and should be encouraged to be independent. But almost all of us have one foot in childhood, even if it's an unconscious foot.

That piece of us that's in childhood wants company. It's a healthy, social piece, assuming it's not a whiny, overly dependent personality disorder (we'll get to those another day).

I remember once telling my mother I'd stay overnight with her when she was in the hospital. She said, "No way, I don't need it," but she thanked me for it. I'm not patting myself on the back. I feel I'd have been a snail not to have stayed. It's not a question of being a good person. It's a question of quality time and being there for someone.

But back to young adults. When your kid is going through a medical procedure and tells you, "I can handle it alone; you don't have to be there with me," don't buy it. Be sure that SOMEONE in the family or perhaps a close friend is there. It doesn't have to be you, but someone.

If it is you, it's an opportunity. It's one of those snapshot memories you two won't ever forget. Remember the time. . .?

Delicious.

(As I was writing this I ditched the computer to get a cup of coffee and caught an NPR story on daughters pulling away from mothers during adolescence, and I thought how that ties into this, how it's not so easy to create these memories when your kid is itching for separation. So for sure, we'll have to talk more on that another time.)

But working people like me feel we've missed too many opportunities for intimacy with our kids. ANY opportunity you have to be alone with your kid that gets you out of the everyday hum drum is something to really consider seriously, if they'll let.

Sometimes you have to construct the opportunities, create them, take a kid on vacation overnight even, alone with you, perhaps. The time together doesn't have to be a medical procedure. Any time will do. Family vacations are fine, but they're also potentially really stressful.

Going fishing works, or to a spa maybe even. It can be hard to find a good hook.

In my family, going out and buying a new marine fish made for intimate snapshot memories. Picking it out, bringing it home. You bring fish home in plastic bags. Plastic bags can break.

These kinds of memories go in the What We Won't Ever Forget Book of Life.

You could be writing it right now maybe, at least working on the intro.

Copyright 2007, therapydoc