Independent to a Fault

I wrote this on Sunday, July 2, 2006. But I don't think I ever posted it, and on the reread think that it is probably a good pre-Mother's Day post. None of the concepts are new, old time readers have heard them all before. But maybe not the therapeutic suggestion at the end. I'm pretty sure that's new.

A person grows up in a home with sick parents, people who couldn’t attend to his emotional or physical needs. Or a family in which a sibling is sick and needs constant attention. The “healthy” child takes care of himself, makes his own lunch, does laundry—helps out his family the best he knows how. It can go the other way, of course, he might act out to get attention, cut school to go out for donuts.

But if he doesn’t, if he merely tries to make do, keeps hope alive, he might find that he tends not to ask for help. He is used to taking care of himself. Asking for help feels presumptuous, an imposition. He is capable, others are not. Asking for help has been beaten out of him. The answer, clearly, is no. And even if it were yes, it feels selfish to ask.

An independent-to-a-fault child might have watched as one of his two parents nurtured that less-than-healthy child or spouse. Someone else is nurtured, not him. Nurturing is modeled, so reluctance to nurture feels wrong. This wonderful person feels guilty saying to anyone, “No, I don’t really have time to . . . “ Some would surely label him co-dependent, an interesting label for someone who has worked to be independent all his life.

In other families, children are free of responsibility, their parents tend to their needs, quiz them on spelling tests. Children ask parents for help and hear, “Be right there!” and the parent materializes. A certain envy ensues, but acceptance, too. This will never be my life.

For our hero, asking for help is adding to the burden of an already over-taxed family system. He learns the opposite lesson, Take care of yourself; don’t ask for help; you can do this. A cognitive-behavioral therapist, seeking a core belief, might find that deep down this now adult child feels unlovable, believes the only reason people love him is that he is useful, a big help to have around.

His world view, a family world view, is that it is best to be a helper in life. Everyone likes someone who helps out, who seeks nothing in return. The cooperative, socially functional world view, a social contract that implies trust, I’ll scratch your back, you scratch mine, is anathema. He doesn’t really feel worth it, asking for a back scratch, stealing another person’s time. There are others more worthy, needier than he.

Independent to a fault, someone will love him, who wouldn't? But he will be difficult to love. He doesn’t understand that the gift is in the giving, and others need to give just as much as he. He won’t accept help, isn’t fond of gifts. Partners, children, find this annoying in a spouse, a parent. They want to give, too, and he denies them the pleasure. It feels good, making other people happy.

Treatment is behavioral, naturally. We suggest tennis*.

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*If you don't play tennis, here's how the game goes. Usually, if you play on public tennis courts, there are several courts side by side. If you aren't the best tennis player, or even if you are, you will naturally hit the ball in a such a way that it lands on another court. You have to wait until the players on that court err in play and stop play for a moment. Then you ask, "A little help please?" This is universal tennis language and people who play tennis don't resent chasing down your ball and throwing it back to you. Or they shouldn't.

Snapshots: Moving

If you look closely, you can see where the headboard came apart. And you can see the box.  This is why hoarders hoard.  You never know when you're going to need a perfectly good box.

I haven’t moved in 32 years.
I moved.
I’m glad I work out.

Oh, we've taken a year Sabbatical to a foreign country. But that isn't moving. That's not downsizing. Downsizing, divesting of your belongings to get out of your house, is mental and physical torture. And I'm a sixties kid.

It's the work, the constant rearranging, reorganizing, revising, rethinking, more than anything, that kills you, and the thought of the shlepping.

Not that we didn’t hire movers; a wonder, these professionals. You sign on the dotted line, agree to pay for their time and effort, and for the bubble wrap, the wardrobes, boxes and tape, if you're not careful. Then you watch, spellbound, as they pack your cherished possessions at lightening speed. You feel you’re on a reality TV show, keep looking at your watch.

People tell you to make three piles, but you knew that, learned that lesson moving your mother to her retirement home: one to donate, one to pitch, another to sell. Your piles seem very high, your trash overflowing. You can’t believe that you can really live with a third, perhaps a quarter of the things you thought you needed to live a quality life.

You forget things like extension cords, your jacket, coffee filters, the 1/8 measuring cup for the beans, travel mugs. Your partner keeps asking you where questions, and you shrug, have no idea. The loss of control is fun. Your attitude about these things is positive. In other circumstances, having no idea where your travel mug might be would unravel you, send you into a finding frenzy.

When the van gets to your new destination, and the men begin to haul things inside, you have to make the big decisions-- what goes where. You change your mind a few too many times, in your empathetic opinion. At some point feel sorry for the guys, stop asking them if they wouldn’t mind, just one more time, moving the bedroom dresser, the armoire, even the dining room table to yet another spot then back to the original.

You remember measuring several times to be sure everything fit. When it does, you feel brilliant. But your calculations aren't 100%, and when you can't cram a nightstand into the corner you are up late at night with your partner, working a new solution.

It is something you didn’t think you really needed, but then you decided you did need. He disassembled then reassembled it hours after the movers have come and gone. Together you attempt to move the bed so the piece will fit, but you are moving it on thick carpet, not the wood floors you had at home. The screws holding the headboard together (a three piece monstrosity) disengage. Things get crazy. The headboard is too heavy, reattaching what has now perhaps permanently detached is going to be impossible tonight, if ever.

No marital conflict here. You look at one another, the panic in all four of your collective eyes. You are both very tired. You do your best, use the box from the new microwave with the annoying flashing clock to support the part of the unit that might otherwise crash, wake the entire building in the middle of the night, perhaps kill you. Tomorrow you will get a better box.

The apartment lets in more sun than your old house ever did, and for this you are grateful. Because the heat is paid for in the assessment, it pours into the bedroom and you can sleep with the window open, even though it is in the forties outside, so you sleep like a rock.


You would anyway, of course.

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Yoda and Columbo

Therapy is whatever people want it to be, and the therapist is, too. Some are looking for a spiritual/behavioral guide, others a detective. Some want a therapist to dress up and play the consummate professional; others are more comfortable with the cargo pant look. It is the difference between Detective Joe Fontana of Law and Order, who wore expensive shirts and asked pointed questions, and Columbo, an average guy in a crumpled hat and raincoat, who asked unassuming questions to solve the crime. Columbo even seemed a little slow. Therapists act like this, too, a little slow, like we’re just not catching on. We want the patient to tell us more, is all. The patient knows the answers, so we put a lid on our own thoughts and poke around in his.

Whichever methodology, no matter our school of thought, we are out to detect sources of pain and anxiety (diagnosis) and relieve it (treatment). It’s not all about the money (a little professional humor, here, a disarming tool, meant to relax the patient).

As are many detectives, we’re married—to some theory or another, perhaps several. There are many such theories; some even explain why therapy works. One builds upon the genre of relationship therapy, only that it is the relationship with the therapist that matters, or the therapeutic relationship. A weekly or bi-weekly schmooze with a nonjudgmental, wizened, objective, empathetic guru never hurt anyone. We all need a Yoda in our lives.

Not that the guru has to be your therapist, of course, but if you can kill two birds with one stone, why not? The force, any self-respecting guru will tell you, is within you. Therapists are only one cloth available to help you not only find it, but use it.

Whether the patient needs guidance for the present, or a fresh eye to the past, therapists who have had any professional training within the past twenty years see everything psychological as biological, too. That means our experience is in the here and now, which is why a visit back to the past to solve the mystery isn’t quite enough, even when the past is clearly riddled with trauma. A trigger may have originated in childhood, but the patient is suicidal today, and the family will certainly look at us as accountable if we don’t prevent it.

Whether it is the past raising its ugly head, perhaps the anniversary of the death of a child, or the memory of a sexual assault, or the thought of father pounding mother, or a nasty confrontation with a pit bull last week, therapists are quite worried about the state of the patient’s brain in the moment, the organic variable, or organicity—no matter our theoretical preference. Or we should be. The crime may be old or new, but the imprint is relevant today.

Thus the patient walks into therapy, for the first time maybe, or for the first time with a new therapist, and he is aware that he has issues, perhaps really old ones, or maybe new ones, or some relatively new, hoping to find experience and wisdom, at least one of the two, preferably both. It would be unnatural not to be skeptical under the circumstances, at least a little, and reticent, reluctant to spill the most intimate details of life, past and present, to a perfect stranger.

That perfect stranger’s ability to dispel anxiety quickly will influence the entire process, even if his skills are otherwise lacking. This explains so many bad therapeutic experiences: a prospect of great therapy, come to find, the therapist doesn't quite cut it.

And yet, to put a new patient at ease from the very start takes skill. Personality does matter. The relationship with the therapist matters, but training matters as much, perhaps more, in the end. Which is why we have consultants.

The goal remains, no matter the style, whether ala Columbo, unassuming, open, clueless at first, eventually annoying (like most good parents), or like Yoda, wizened over the years, to establish a safe, drama-free setting. And we want you to want to come back, naturally. Nobody likes to stop in the middle of a good story.

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Family Reunions

I'm always a little reluctant to post about myself, but when there's a teaching moment, I can't exactly resist.

We've talked plenty about holidays and how horrible they are for so many, many people. And because we do this, the emphasis on the good takes a second seat, no seat at all, probably.

But when you reach an age that your children (most) are married (some still do this) and have children of their own, your focus is upon that new generation of young people, the grandchildren. You so want them to be healthy, in every single way, and to follow your traditions, if at all possible, and be the best people they can be.

When they are all together, under your roof, and the noise decibels compete with a good residence hall party, perhaps run away with the prize, there is nothing better. It is an ultimate high, and this is why holidays, for some, have the potential to be truly wonderful.

And in the middle of all of that, feeling quite good, the brain spinning with things to do and, let's not not say it, is filled with joy, you know that this is rare, that many people don't ever have that, can't ever, and it absolutely grieves me.

It is an experience my rabbi would say is perfectly normal, this switching from happiness (he refers to weddings), to sadness (a funeral) all in the same day.

Somehow we have to be able to switch it on and off, all in a moment, to be real people, not animals. When we're happy, we have to temper it, remember that so many are not.

So happy, and sad, holidays to all.

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Mad Men: A Little Kiss

On NPR yesterday, Matthew Weiner discussed past episodes of Mad Men and his protagonist's descent to alcoholism (Jon Hamm, brilliantly plays Donald Draper).  It didn't sound like something I really wanted to watch. As a therapist, alcoholism tends to lose its glitter, even on TV.

My daughter told me to watch the show when it first caught on, but not wanting yet another must-see, I declined.  Then AMC started reruns to promote the fifth season, so I taped them and sure enough, caught the jones.  There was no catching up before Sunday's fifth season premiere, but Don doesn't appear to be an alcoholic anymore.

So here we are, two women, me and my grown daught, watching the season opener. Our spouses are both  working, although it is late evening, perfect for the Mad Men 1950's theme.  I'm absolutely mesmerized, because there's nothing more interesting than watching the ways that two people who supposedly love one another fight, and what they fight about.  Some of us find this fascinating.  (This from someone who will never see The Hunger Games, nor finish the book.)

Spoilers to follow.

So Don has remarried, and he seems very happy, and his new wife, Megan, who works for his advertising firm, is very sexy, and very sweet, and she wants to throw him a surprise 40th birthday party. The surprise is blown as he is about to walk in the door, and it is clear, Don isn't happy.  He doesn't like surprise parties, doesn't like to be the center of attention, and all he wants to do is go home and spend a quiet evening with Megan.

He puts up with it, plays the good sport, because he is a gentleman, or can be.  But at the end of the evening, when Megan joins him in the bedroom and throws herself at him, he makes it very clear there will be no sex.  He is exhausted, and he tells her as much in a very irritable way, as if she is the cause, but he's not discussing it, he's too tired. We're left to think that she should have asked him first.  She should have asked him if she could throw him a surprise party.

She is very hurt by this lambasting  Throwing this party wasn't easy. She invited his friends earlier in the week, late, but still, most were honored to be on the list.  And she promised at least one of them that her guests would go home and make love. Everyone should enjoy life, should be as happy as she is, married to Donald Draper.  Life is beautiful.  Enjoy it.  Some have this world view, and it can be refreshing, if French.

We learn that something else is bothering Don.  At the party Megan gives him a very public gift.  She (Jessica Pare) is the entertainment. She is his gift. She surprises everyone with burlesque, dances to a lovely French song in the original French, Zou Bisou Bisou. 

Sophia Loren recorded it originally in English.  Here are a few of the lyrics, translated by Slate.

Everywhere you hear:
Kiss kiss kiss etc.
My God, how soft they are!
But tell me, do you know
What that means, between us,
What does “zou bisou” mean?
It means, I confess to you,
But yes, I love only you!

Sweet, no?  It's more lovely in French.  Her performance embarrasses her new husband, and his anger is controlled, but he punishes her in the way that a woman tends to feel it the most, by withdrawing his affection, his love, and not wasting words to discuss it.

There may have been romance for the guests that night, but none for Megan.  Her gift is unappreciated, she is rejected.  It is her culture he is rejecting.  Don, now a big advertising executive, is still a product of Puritan farmers.  But he has married a woman who has Latin blood, who doesn't see anything wrong with this, zou bisou bisou.

The journalists are saying it is about liberation, that Megan is a liberated woman, and Don isn't quite there yet.  He can philander, he can have sex, and everyone knows it.  But she?

Perhaps they are right.  I didn't see the episodes leading up to this.  But based upon her pronunciation, her lovely rendition of a French song, Megan is French!  How could it be otherwise?  Megan is French and she has married an old fashioned American man.  She should have known better.

I turn to my daughter after the show, following the resolution of their problems, better communication.  "Marriage is wonderful, no?"  Meaning, It isn't always easy.  Nobody said it would be.

Married eleven years, she smiles that tight-lipped smile that tells me-- she totally understands.

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Post script:  This is not a commentary, not a negative one, on Puritanical values.  Nor is it a vote for the French.   It's really about a relationship, and how important it is to communicate values, especially, well, so as not to embarrass a partner.

Process Versus Content

It's a very simple concept, really.  But I remember first hearing about it many years ago in graduate school and getting it, but not getting it, and what made it worse was that the instructor, Joy Johnson (where are you, Joy?) made a serious pitch, told us that if we didn't get it, basically, we would be only be so-so at this job.  Whereas if we did get it, we had half a chance.

A patient ended up clarifying it for me, unintentionally, of course.  Joy taught us that process is what's happening, the action, and that content is the story.  There's a difference between seeing something, and hearing about it.  The guy selling you a car is going to be friendly, and he'll tell you all about the features and wonders of the vehicle, but if he sells it to you, it is likely because of the way he worked you, not because it's such an awesome car.

But you want to know what the patient said, so many years ago.

Her boyfriend would shut down when she asked him things, asked for any kind of explanation for his behavior.  He behaved like he didn't understand, but she insisted that he did, that he just didn't want to answer, a passive aggressive defense.  She thought him mean, stingy with words.

She didn't realize that he felt cornered, on the defensive, which made him anxious, and his anxiety got to the point where he really didn't know what to say, indeed, he forgot what she had even asked.

They broke up, but she wanted him back, and he wanted her back, so they started it up again after a few months apart.  But she kept coming back to one particular incident in which he avoided her question.  She said: (a) It troubles me that he won't answer the question. (That would be process.) and (b) I really want the answer to the question.  (That would be content.)

Which bothers you more, I ask: that he won't answer, or that you don't know the answer. The former, of course.  The process.

That's what Joy means when she says that process is more important than content.  So we focus on that, because when we resolve the mystery of process, the content barely matters.

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How I Stopped Drowning in Drink

Not me, of course. Paul Carr. I know I promised to write about marriage counseling, when enough is enough, but then this came along and I'm such a sucker for variations on the 12 Steps.

Paul Carr stopped drinking, on his own. No 12-Step program, no mindfulness, no CBT.

Wait a minute, actually his program has elements of all three: (1) the addict (Mr. Carr) is working 12 steps;  (2) he's mindful of his experience, his past, reasons he drinks, and how being in the moment affects his decisions; (3) he is working to change his behavior by being cognizant of its effects. A writer, not a psychologist, he's either brilliant, or bumbling around drunk for so long, has finally stumbled upon a few of the very ingredients that make any good sobriety program work.

Carr, a comedian, has a website that boasts about his book, Sober is My New Drunk (costs only $1.99,  less than a drink in most clubs):

The bestselling humor writer and notorious tech blogger describes how social media helped solve his drinking problem—and explains how Twitter, Facebook, and the Internet can be more useful than AA when it comes to remaining clean and sober.

Let's take a peak, a critical look, because even though it is in jest, many a truth, you know, is said in jest. Remember, he's not going to meetings, and that his program runs contrary to what addiction therapists generally recommend.  (We tend to suggest hobnobbing with fellow addicts, all of whom have been driven to ruin and despair, then recovery, the tried and true kind, tantamount to surrender to God, peer counseling, and a mishmash of cognitive behavioral therapy or meditation.)

The steps below are excerpted from How I Stopped Drowning in Drink.  (WSJ) The commentary is mine.

Step One: Ask Yourself, "Do I Really Have a Problem?" 

Mr. Carr believes that if none of your friends have taken you aside to say that you seem to have a problem, you probably don't,  unless your friends are all alcoholics, in which case they won't.

He's right to qualify because alcoholics are like birds, they flock together.

But millions more are dependent in secret, drink alone, and have no friends, no people to gently remind them of their illness.

Mr. Carr is suggesting that everyone who drinks to excess should simply chip away at their denial, take a closer look.

But seriously, who does that?  Those who abuse and depend upon substances wrap cars around trees, wake up with strangers, lose their jobs and live to drink again.  No problem.

Step Two: Quit Publicly

This, of course, I love. If you tell everyone that matters to you that you have a problem with booze, because they care, they will work your program for you, praise your integrity, your mission to take back your life, and encourage you to rock on-- without the ale. Mr. Carr suggests posts on Facebook and Twitter, and personal emails to those who will lend support, not undermine sobriety.

But what about those who wouldn't tweet to save their lives, who eschew social networking altogether, yet pound back the drinks with the best of them? And seriously, is the type of support and caring Mr. Carr seems to have at his fingertips, something the average Joe can rally?  A good alcoholic encourages another to make a le'chaim, not to abstain.  Am I missing something? Cheers.

Step Three: Don't Fear Failure

Of course you'll slip, it is inevitable for most, and Mr. Carr acknowledges this, says don't sweat the failure.  Expect it and allow yourself one foolish fling with booze in the process of getting better.  Then get back on the wagon.

One?  Recidivism with alcohol is the rule, not the exception. Every slip is cause to restart the program, no matter which program.

 Give yourself as many slips as you need. They might become annoying after awhile.  Then you'll join a program that works.

Step Four: Pull Yourself Together

Meaning, as long as you're not drinking, get a little exercise and lose some weight. Although being British, Mr. Carr didn't seem to go for the former. What he discovered, however, is that alcohol is loaded with calories, so he lost a lot of weight getting sober and there's nothing more awesome than that.

Step Five: Stop Lying

Mr. Carr's love affair with the truth started with his public confession, telling the world that he had a serious problem with alcohol. Sober, he's finding that people really enjoy a straight man, an honest, reliable person.  It's an ah, ha moment for most alcoholics in recovery, finding they don't have to lie anymore.

Those who don't drink, who never did, find liars emotionally draining, wish they didn't have to associate with them.  They confuse us so. Wouldn't it be great if those noses really could grew when they tell a whopper?

Honesty is a huge piece of the 12-Step program.  Nice that it's making a come back in the general public, that place people pay attention, the entertainment industry.

Step Six: Stop Apologizing

Mr. Carr suggests that in the original 12 Step Program, AA, that as soon as people get sober, they run up to everyone they have hurt or disappointed and begin to apologize for the times their past behavior, forgetting responsibilities, arguing, lying, making a public nuisance of themselves. It is ridiculous to apologize because people assume the alcoholic will do it all again, that sobriety won't take. So what if today you're sorry. Tomorrow you'll be drunk.

The apology step of AA is not a first, second or third step.  It's somewhere in the middle, well into the program.  Nobody does it without thinking, and it's never easy doing it right.

Make no mistake about it.  Alcoholics do need to apologize.  Ask their partners, their parents, ask their kids for confirmation of that.  Sobriety might suffice for some, but for others, nothing is more convincing than real remorse.  Show me the tears.

Step Seven: Rediscover Dating

Alcoholics tend to have trouble dating without liquid courage. So Mr. Carr suggests, Do it anyway.  Be honest about your sobriety because people find it sexy..

Because sex and drink run together, some professionals advise the newly sober to wait a year to date. Dating is likely to trigger drinking, the two used to go hand in hand.  Who needs the trigger?

The take on this blog is that the reason dating is so hard, can be so emotional, is that it is so likely to conclude in rejection.  Most of us never get used to that.  The attachment part is tricky, too.  Sex messes with us because it has to be perfect, and it is so mandatory in our day and age.

Does it really have to be one without the other?  Is abstinence such a crazy idea in the first year of sobriety? Apparently.

Step Eight: Replace our Ridiculous Drunken Stories With Ridiculous Sober Ones

Mr. Carr suggests that the sober wannabe take some time to plan a sober adventure.  This way he'll have what to talk about (a Yiddishism).  Friends want to hear about his past craziness.

Actually, they don't.  Those who don't have a problem with alcohol have been doing this their whole lives, living without the drama, planning fairly sober adventures. And they aren't bragging about their drama free adventures.  They will, however, show you the slides, email you videos upon request.

Change this step to: Shut Up ad Listen to Other People's Stories.

Step Nine: Spend Money On Stuff You Won't Lose

Carr is referring to buying something to remind you that you're sober, like an expensive pen, in his case. It is good, being sober, better and cheaper than being a drunk, but nice to be reminded by something concrete.

AA hands out actual tokens, rewards, coins, positive reinforcement for staying sober for long stretches at a time. I love the idea that someone gives it to you and others clap and congratulate. That intimacy thing.

Step Ten: Take a Difficult Test

An HIV test, one that many are terribly afraid they'll fail.
That sex-booze association is difficult, almost impossible for an addict to get around, can't escape it.  Date? sure.  It can't possibly hurt to get back in the saddle.

Step Eleven: Work Nicer, Not Just Harder and Smarter

Whatever that means. Guess you have to read the book.

Step Twelve: Forget Everything You Just Read

Because it works for him, but likely won't work for you.

It's funny, and honestly, the real active ingredient in Mr. Carr's twelve steps is that he uses his people, his community to keep him on track. Once everyone expects us to be straight, how can we disappoint?  How do we face others drunk at a wedding, having made such a big stink on Facebook and Twitter about our sobriety?  And what about that mass email to the entire spam folder?

Living in a glass house, nothing to hide. We're in awe of you, Mr. Carr.

A pity you don't go to meetings.  They would love you.  And you, them.  Should you slip once more, think of  AA or therapy, or both, as an adventure.

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