President-Elect Trump

I know, I know I said it.
I said that both Mr. Trump and Mrs, Clinton needed therapy (last post). People are taking down their FaceBook accounts because of things they have said publicly, and this should worry me. 

But that was yesterday. And the theme of this blog, remember, is that everyone needs therapy. So it isn't an insult, okay?

President-Elect Donald Trump acceptance speech

Today, the day after the election, I'm thinking more of the President-Elect. No matter the personality we saw during the contest, he knows this country better, more intimately, than any of us. We underestimated him.  

And this intimacy, this knowledge, is the reason he won the election without contest.  It is why he said he would give us hell if Mrs. Clinton had been elected, that he wouldn't accept the election results. He knew. He had his finger on the pulse of America all along, when nobody else did. 

America, to most of us, has been the America that is outspoken, everyone shouting at everyone else on some media or another. Yet in the big bell curve, in reality, not everyone wants to be the center of attention, and Mr. Trump spoke to that majority. President Nixon called his electorate the Silent Majority. The shape has changed, as has the demographic. But people wanted change, and they had no place to channel that desire until Donald Trump walked into their lives.

And that’s a type of social intelligence, is it not? Understanding the people in the country, the forgotten ones, those who have for years felt disenfranchised, unimportant. It could be interpreted, rightly, as intellectual, even emotional empathy. We’ll soon see if such empathy is universal, if it spans across the universe, if it is inclusive. 

People are really worried, or so we hear on the news, the radio interviews. Many woke up this morning, and hearing the outcome of the election suffered features of panic attacks— literal panic attacks-- shortness of breath, heart palpitations, dizziness. 

Jews just make jokes about being sure their passports are current. It is how we think.

The results seemed remarkable, unbelievable. For the polls had us ready to crown Mrs. Clinton, and whether we liked her or not, we had prepared for that, her resumption of Clinton rule. .

It was the surprise, the upset, that set off an arousal response, the panic, as much as the fear of what a Trump presidency might look like. Those who have learned the art of meditation, or emotional management might easily reverse the negative symptoms. A tried and true intervention is to remember not to dwell on the past, and equally as important, let go of the future. Only the present, what we are doing in a given moment, is within our control. Not that we can't work towards the future, put plans into place. But under the influence of anxiety, the here and now serves us better. Stay there. Do what feels good, right. Live one day at a time. Maybe pray. It is hard, but wrangling thoughts is a major component of serenity. 

Or just watch the President-Elect's acceptance speech. His voice, his posture, his very persona are reassuring, convincing, healing. There is none of the narcissism he’s been labeled with, none of that NPD, or Narcissistic Personality Disorder* that scares so many. Our new president looked and spoke Presidential. 

“It is time for us to come together as one people.” 

He doesn't say, "It's time to get to the work of deporting people." He talks of uniting, which is what new presidents all say after an election, but some of us expected another Donald, the one that is unbridled, who can't resist a snarky remark. But no, not a single I told you so, nothing negative about anyone, certainly not Mrs. Clinton. Only magnanimity.

If you read my last post, the one about social justice, you might remember that human rights activists and social workers do what they can to make things happen, to change deplorable conditions. Dr. Luis Zayas told an auditorium full of academics at the Council for Social Work Education annual program meeting that cynics and conservatives believe there will always be injustice, that it is inevitable. Get used to things being hard. But the social work response is just the opposite: Injustice is intolerable. 

So here's the big challenge, and a message to President-Elect Donald Trump. 

We’re all in agreement for the first time ever. Mr. President-Elect. It is time for us to come together as one people, a task that seems impossible. But the divisiveness, the hatred especially, should be intolerable, especially to you.

Accomplish that, make the seemingly impossible, possible.  Because you have the power to do this. Create an inclusive culture, one that bring us all together, and don't dial back the progress of your predecessors. Do it, make this country great again, as only a strong leader can. We are counting on you. Many fear you, disperse the fears. We could use a mentally healthy, loving United States of America.

And we know you hear the country's voices, that plurality, crescendo above us, above you. Make good, Mr. President-Elect Donald Trump. Go for it, the one people idea. Even if it wasn't exactly a campaign promise.

therapydoc

P.S. For those readers who feel this is a totally, ridiculously naive essay, I say. . . maybe.
For a much more rational opinion, one based upon everything we've seen in the past year's campaign, not based upon hope and a belief in the potential of man (when reaching potential, true potential is within his reach) read David Remnick's essay An American Tragedy, in The New Yorker. 

*Narcissistic Personality Disorder

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by (five or more) of the following:

(1) has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

(2) is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

(3) believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)

(4) requires excessive admiration

(5) has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations

(6) is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends

(7) lacks empathy: is unwilling to recognize or identify with the feelings and needs of others

(8) is often envious of others or believes that others are envious of him or her

(9) shows arrogant, haughty behaviors or attitudes

Social Justice: Orphan or Exile

Most of us have voted by now for the next President of the United States. The candidates have been talking for months about many, many issues, but mostly themselves, talking about, and defending themselves.

If this were not an anonymous blog, I'd offer each my card.

Social workers are generally democratic, and highly educated, and when educators get together, some 3,000 educators, as they did last week for the Council for Social Work Education (CSWE) annual program meeting in Atlanta, the synapses in the halls of the hotel burn so bright, the place might just burn down. (Social workers like to speak in hyperbole).

When I told my son, who I consider a balanced man, about the topics presented at CSWE's #APM16, he opined,

"Wow, you guys must be the most pinko-liberal educators in the country!"

Maybe. Yet we are a diverse group, not always predictable, and despite the mostly liberal leanings, nobody has it in for social workers anymore, not like the late Mike Royko did. He loved to poke fun at us for our politics. And our codependent personalities.

There are good reasons for the field's politic. Social work missives begin in the here and now; they're reality-based, not like TV reality shows, which are scripted. Social workers hear heart-breaking stories, are personally invited to visit, to see inhumane, squalid living conditions. Poverty. Powerlessness.

The hearts stir. Dr. Luis Zayas, a keynote speaker from University of Texas, Austin, alludes to hearts and stirring in reference to the difference between conservatives and liberals. Cynics and conservatives believe that social injustice is inevitable. Injustice say conservatives, is inevitable.

We say it is intolerable.

This profession is the one that won't accept the many rational reasons, all those whys, why things cannot be done. 

Once stirred, social workers organize, swing in the direction of protecting human rights, service administration. They invest time and energy, money, to accomplish good things, big things. Maybe even something along the lines of, let's just say it, social justice.

Dr. Zayas is this year's choice for CSWE's Carl A Scott Memorial Lecture.

In recognition of Mr. Scott's ground-breaking contributions  . . . equity and social justice . . . through building knowledge . . .

He's here to teach and to inspire.

So he tells us that social workers, like human rights activists, take on tasks that aren't even immediately tangible. Their work is not all that different from law enforcement professionals, people who run towards trouble, danger, not knowing what they're even looking for.

This teacher is a poet. I'm buying his book.*

He speaks of immigration--without the need to mention Mr. Trump, or his wall. The word bites about the lecture:

The immigration enforcement policy and practices undertaken by the United States in the past two decades has . . .affected the health and mental health of immigrants and their US.-born children and of refugees seeking asylum from the violence and lawlessness of their countries in Central America. . . violating human rights and turning our backs on social justice.

Even more enticing than the hotel pool, which was nice, but not that great.

The veteran social work educator points immediately to President Barack Obama. The President didn't start the deportation mess, but he didn't help it, either. In the past ten years hundreds of thousands, no, an estimated 3 million! families have suffered the consequences of deportation. They had to leave the United States of America. Leave this, their home.

And for every two deportees, one had a child born here, a birthright child. That makes 1.5 million children, at the very least, dispensable.

Liken it, Dr. Zayas humbly suggests, to Sophie's Choice (not the equivalent, but still) or King Solomon's decision, the one about the baby, minus the compassionate ending.** In Sophie's Choice Meryl Streep has to choose which of the two of her children will go to the gas chamber, and which to the work camp. One to an immediate death, the other to slow starvation.

When the unthinkable happens, when a parent is to be deported, citizen children become either orphans, should they choose to stay in this country, or exiles, if they choose to leave with their parents. Orphan?  Exile? Not much of a choice.

Children are the future (someone sings that), but you don't have to be a clinical social worker to know that their past will play a part in that future. Either of the two choices, orphan or exile, will affect their lives immeasurably.

Exiled means not to disappear, but to shrink, to lose the sense of American citizenship. An exile might even associate with another national identity, turn against America. The law, our law, creates the terrorist.

Orphaned implies losing the daily physical presence, love, attention of parents, even if the parents are alive. Who is around for protection?  

Dr. Zayas tells us the history of the deportation process. It doesn't happen overnight. First there is detainment in what are now called "Family Residential Centers." You can find them in the Texas towns of Karnes, or in Dilley. These started as detainment camps, operated by Corrections Corporation of America, cash cows receiving $500.00 a month per deportee from the government.

Our tax dollars at work. Detained there? Over 2500 mothers and children, dispatched to cold, dirty cells, like prisoners of violent crimes. Cold and dirty. Mothers and children. That shouldn't resonate with anyone.

With a bit of research the detainment situation in Texas had come before the courts. Social justice advocates found a precedent, the Flores Settlement Agreement of 1997, which governs the standards for the detention, release, and treatment of minors. 
The court ruled for women and children.

But the centers were merely renamed as group homes, licensed child care centers, Family Residential Centers, and the conditions stayed much the same. When this came to light (via social justice advocacy, again) publicity followed. The head of the Texas Department of Child and Family Services resigned. Things are better, now.

If you're a cynic or a conservative, you think things can't change. If you're a social worker, you think: Sure, they can.

A deportation facility (family residential center) in Karnes or Dilley Texas

Immigrants who come to America illegally say that it is a difficult choice. They know that it is illegal, sneaking past authorities to cross the border. Yet they are leaving a world filled with immorality and violence, so leaving that feels like the moral choice for children, a moral decision. And threaded into that decision, some will tell you, is a vow never to break the law again, not once they make it here, after God has granted them a better life, opportunity for their children.

That's the way it is. That is how people think.

It is next to impossible to seek asylum, impossible to prove to authorities, that lives are at risk in Mexico, or Central America, wherever, if you cannot speak the language, have no money for a lawyer. The thinking is that our immigration laws are the ones violating moral principles. We have a legal system in conflict with itself, immigration law versus family law. Family law has always been predicated by the best interests of the child.

So what's an interested activist, a liberal (pink or not) social worker to do? Not necessarily about this, but about anything like this that feels unjust?

Well. . .

Research, if you're an academic. But don't rely on academic publications, no one reads those. Get into the papers, shoot for The New Yorker.   (Dr. Zayas, heads up! Do that! They would love this story!)

Take the issue to congress, condense immigration to a paragraph, perhaps the idea that we are creating terrorists, not harboring them.

Do what you can to educate the public. Blog, write an op-ed, get on the radio. A podcast. NPR. This American Life.

Testify for clients in court, have hard data with you. Or partner with other advocates, get involved in a class-action lawsuits, amicus briefs, testify to your legislature.

These ideas sound so vague, so inaccessible, so out of reach to the average social worker.

But with a little energy, a little time, anything can happen.

therapydoc

*Luis Zaya's book: Forgotten citizens: deportation, children an the making of American exiles and orphans

**You might remember the story. Two women give birth the same day, but one baby dies in the middle of the night. The woman whose baby died grabs the healthy infant. His mother objects and they come to the king. King Solomon proposes that the women slice the baby in half, it is only fair. One woman, obviously the baby's true mother, objects, tells him to give the baby to the other woman if that is the only option. The king knows, now, that she is the baby's mother.

Cubs Win!

I watched most of the games, I'm embarrassed to say. Therapists should go home after work, tend to the people in their families (second shift), have a quiet, newsworthy, intimate dinner with someone they love. Be an example to the community. Don't shame-faced tell their friends, Yeah, at the end of the day. . . I watch the Cubs.

But who wants to talk to anyone, in the evening? We want to change into sweats, turn on the TV, and maybe, just maybe, if there's one on, watch the game.

There's a knock on the door, it could be a friend who wants to power walk. Would this not be the better thing to do? No, it would not, you gently explain. You see, the Cubs are going to the World Series this year. You'll see. And this game counts.

Then you go back to  it,  and during commercials toss up a huge salad, maybe bake a potato, check your phone, texts, email. You might even return some calls, straighten out drawers, even a closet. You might do an entire aquarium water change, all the while, the game is on, and the volume is up, unless you had to mute it to actually talk.

It was hard for me, when my mother was alive. She wanted to talk every day, but mostly, she wanted to listen to me, telling her about my day. If the game was on, not so much of a problem. That you can do, watch a baseball game, while talking to your mother.

At the end of the game the guy who is calling the game, maybe Pat Hughes, Ron Cooper, Jim Deshaies or Len Kasper, would shout out at the top of his lungs, CUBS WIN!!!!!!

What a summer this has been for Cub fans. You'd see one, a fan wearing a hat, maybe while waiting for a bus. You would nod and say, This year for sure!! And both of you smile.

THE STORY.

I registered for a conference, the Council for Social Work Education's Annual Program Meeting (APM16) in Atlanta, (CSWE16), had scheduled my flight for Wednesday night, last night, months ago. It never occurred to me to check the schedule for the World Series. And wouldn't you know, the last game, the most important game of the year, the deciding game of the World Series, would begin at 7 pm, when FD and I would be in the air.

So I downloaded all kinds of apps to stream it, and told myself the flight would be late and I could see the game in the airport, but nothing, nothing helped change this most powerless, angry, futile feeling, that we would not see that game, and seeing it in the repeat would not be satisfy.

My son-in-law invited us over to watch the game and I had to tell him I'd be in the air, and he texted back and said, "You're daughter just called you a loser. CUBS!!"

It woke me up. Sometimes someone has to speak the truth.

The backstory is that I had been navigating the app for the conference for a few days, and couldn't understand it. Anyone who knew the organization better would understand it, but having been focused on learning about mental disorders and how to help people who suffer because of them, education, the science of educating social workers, went fallow. So I didn't realize that the modules offered for Thursday didn't even apply to me. I didn't have to be there until Thursday night. I could definitely change that Wednesday flight and hotel reservation.

So Wednesday morning, as soon as I could, I checked United to find that there were plenty of flights early Thursday morning, and they were only $99.00. Sure, we might have to pay to change, but so what?  People paid thousands to get a ticket for these World Series games. I could certainly pop for a few hundred.

FD agreed.

And United, as if they understood what this was all about, was totally on board, waived the change fee.

We popped some corn and brought the salad to the family (those without little babies) party, surprised everyone.

When I told the other kids about changing the flight, the ones who could not be with us, one of the boys merely wrote, Respect.

And when we heard that final, CUBS WIN!!!!   well after midnight, I have to tell you, there was nothing in my experience, nothing quite like it, no words to express. The feeling.

We're waiting for the plane now; there are CUB hats all around, very tired CUB fans in the airport, and I've go on my light blue CUB sweatshirt, and that feeeling, it's in my chest, it isn't going away. And I know it isn't the same anxiety that I get when thinking, "We're gonna miss this plane." This is a good one. This is excitement.

It used to be crazy to be a CUB fan, but it's not in the DSM 5, and nobody can doubt this young team of very talented, highly watchable, men are likely to give us a great run for it next year, too.
It has been #GoCubsGo for months now, and I promise I'll stop.

Next year, however, I buy the white and blue flag.

therapydoc

Boy, You've Got to Carry that Weight

It isn’t easy navigating healthcare today, finding the providers you know and love in a new network. You want to continue with your therapist, but when you thumb through the lists of mental health providers, no surprise, she's not there.

It hasn't been easy for those of us on the provider side, either. When the Affordable Care Act passed, we knew that we would be denied claims from these seemingly wonderful, spanking new, mega-cheap health care plans, especially the ones offered by the big companies-- United Health Care, Blue Cross Blue Shield, Aetna, Humana. Some of us didn't want any part them. We told our patients: Before you sign up, do some research . .  if you want to keep this thing we have, going.

We had no idea (still don't) whether or not insurance would pay us for services rendered.

Then it began to happen with regularity, and it continues to this day. An established patient would give us a choice: Do you take this insurance? Or this one? 

Then she would explain: My boss says I have to choose a new one. These are the only plans they've got.

Somewhat shaken, a provider might gently answer:  Likely neither. But call the number on the back of the card and ask for customer service. Mention me by name. See what they say. 

Providers like me felt compelled to add the ugly truth; Oh, and even if they say I'm on that list, the answer might still be, No, they're wrong. They make mistakes, and if that happens, I know it sounds bad, but you have to be prepared to pay out of pocket when my EOB comes up bubkus (Yiddish for Zero paid to provider).

How does it happen, that the customer service rep at the other end of the line deliberately delivers the wrong information? The answer lies in the lists. They are likely using an old provider list. Providers drop out, but companies don't retire our numbers. We're still on the mental health provider panel, although we shouldn't be. Is it intentional? You have to wonder.

The situation puts us in an adversarial position. We're the ones having to explain, post facto: Maybe I'm on the list, but I ended my contract with that company a long, long ago. If they don't pay, or don't pay enough, you'll have to cover the bill. I'm so sorry. It stinks, I know, and but I'm pretty sure that EOB will return with a big fat zero next to Provider Paid.

We sound like the broken records we are.

Suddenly a beloved provider is the enemy, a source of patient stress. We're stressed, too, as providers, because we knows we're stressing the people who count on us, people we would much rather commit to helping through their troubles. But we also know that if we work for less, if we aren't paid what we're worth, we will resent the work and the patient, and likely that will manifest, show itself somehow, in some subtle way. Here come the negative Yelp reviews. Not good.

For those of us who had trimmed third party payers well before the act passed, shaved them down to only "some Blue Cross plans" Obama Care has been less of a challenge. We simply denied new patients with insurance we didn't recognize, might say, I only take a few of the Blue Cross plans, sorry, but there are great people out there. Find one. Because there are.

We could see the writing on the wall years ago, that the only ones making money in this system are the CEO's, executives who are not paying self-employment taxes, as are all of the mental health practitioners in private practice, taxes that slice into our earnings significantly (it is as if we pay social security twice-- once through our wages, like everyone else, but also as our employers, who happen to be ourselves; we pay that other half of the social security net-- we're essentially dinged twice).

So we dropped out of the many provider panels that had never paid us enough, considering our educations and experience. Then we determined a tolerable fee schedule, fees for service that we could live with, not resent, that a middle class client, someone likely to take his family to Disney World for vacation, might be able to afford. We would see patients less often, perhaps, but our time would be be well worth it, quality time. It would be that, or refer those with "bad" insurance" along.

Someone like me, who once would see a couple weekly, would cut that back to every other week, or even monthly when insurance went to the wind. I'd suggest that each partner use the new insurance to see someone in their plan, get individual help for the things we had been working on for some time. Then, when we could, even if it would be once a month, we would catch up. They would pay out of pocket. If you have the volume, you can be creative, do that sort of thing.

But mostly we found a few groups, or a few good insurance plans, and made sure that the patients we would see affiliated with those.

Whatever we put into place, whatever new fee schedule, however we vetted insurance, it can backfire when we're talking about really sick people. Some patients really need that weekly checkup, and they won't be able to make our magic number when the insurance changes, or the job disappears, and it is a matter, truly, of life or death. How do you tell someone who wants to die that he needs to find a new life preserver?

As soon as you get the news from the patient, I've lost my job or I've had to change my insurance and you're not on the plans, it is a very big problem. It shouldn't be, this is hardly a terrorist attack. You might secretly even want the patient to move on, not liking the responsibility of carrying that weight, but it is your weight, and you know how to carry it, and you know, deep inside, that nobody knows it better, or will do it better, than you. Not right away.

So you say, We'll work something out.

And the patient says, I need to know. How much do you charge, anyway?

Because his insurance has covered all of it, until now, except for a co-pay of $10-$50.00.

So you say, My fee is more than you will want to pay, even if you have saved your pennies*, and I still have to see you every week to feel comfortable being your therapist. We have to work something out.
 
And the patient says, What does that mean, we have to work something out? How much is working something out per week?

Then you do some brief calculations in your brain, might offer: What if I see you for a half an hour a week for $60.00?

And the patient says, I can do that every other week. 

And you say, Done. But we talk for a few minutes on your lunch our on your off weeks.

And the patient says, But what if I don't ever get a new job? What if I run out of money?

You smile and you say, I have confidence in you. I'm sure you'll find a new job.** And whatever happens, we'll work it out. There's always a solution. 

The clincher is the confidence, having confidence in the patient's resilience, and it is much easier to do that with young patients, when we're talking about finding another job, even young patients with bad disease, chronic major affective depression, for example. They get hired faster, even with severe symptoms (no, they don't talk about those in interviews) than patients in their fifties and sixties with less oppressive mental illness.

In my practice, just this past year, it has happened four times (really, four times) what I'm calling sudden treatment-coverage interruptus. Each patient had sought me out, initially, with serious suicidal thoughts or plans, and we had worked for months, sometimes for over a year, grappling with recurring symptoms. When the insurance stopped, or the patient was let go from a job, a crisis loomed. But in each case, following that lag, sudden treatment-coverage interruptus, (not service-interruptus), after some months, the patient either found a new job with decent insurance, or transitioned over to another therapist. We held hands along the way. It felt good, not saying, prematurely, goodbye.

The affordable insurance climate is, in a word, formidable. But therapists have established practices, signed up with people well before the President signed the bill, made the changes, and in those very first meetings, we committed to helping people, or to helping them find help. We can't just close our eyes, run from the insurance crisis, when it presents itself, leave them hanging when the going gets tough. And when we don't do that, what we're seeing in the aftermath of it all, having held on tight, is that not only did our patient grow from the ordeal, toughing out the emotional adversity, but we providers do, too.

therapydoc

*We know if they have saved their pennies or have not, generally recommend that they do when they talk about things they think they want to buy, comfort retail. it is a part of the job, talking about one's relationship to money.

**When the patient is in late middle age, the you'll find something is replaced with, something will change for you. Like they may have to move in with someone, be of service, eat a good deal of pride.

Prayer

It was an afterthought. 

I was writing about dysfunctional obsessive behaviors: drinking, drugging, gambling, sex, over-eating, and watching way too many baseball games on television.

Chicago Cubs WIN Flag

The usual coping strategies. And I added, as an afterthought, I considered, just for a moment, prayer. 

But stopped right there. Because, can we really pray too much?

This is the time of year that Jews pray for the welfare of the entire world. Our attention, highly introspective, drilled into us by parents, teachers. God is thought to be closer, He, She's sweating the details, paying attention, trying to see who's been naughty or nice. Santa, sorry, is a total steal.

In the synagogue daily, for the past month, or maybe at home, if you live with a musician, the blow of the ram's horn, the shofar, is a wake up call. Wake up! Think about what you really value, think about the important things. Pray for what matters, strive for better, reach to be a better person, extend yourself. We say that God judges the world, all of it on Rosh HaShana, the Jewish New Year.

It begins tonight, and the Days of Awe last 10 days. Last month, the prequel. This isn’t a party holiday, it is serious. Those of us who observe it don’t drink much in celebration, don’t want to be caught napping. There are loftier things to do, learning in particular, praying, and that's how we want to be seen, as if God, considering us for the coming year, will merely think of us this way.  

There have been extra prayers penitential prayers, beginning before the holiday, continuing until Yom Kippur, the Day of Atonement. People pray early in the morning, late at night, fall into bed exhausted. Why bother with this? Isn't praying three times a day enough?  Either you believe or you don't, is the answer, and if you believe, then you know there is much to pray for, much that neither Donald Trump or Hillary Clinton can or will even try to do a thing about. 

Our lives, the lives of the animals, the fish, the trees, gardens, insects, the atmosphere, the earth's resources, the weather, every income, our stocks, our jobs, you name it, everything is determined, the fates, sealed for a year. It is a one-year contract, designed to keep us on our toes.

Because otherwise, we take everything for granted. This is why therapists try to get you to buy into the idea (with several exceptions) that a little stress is good, a little depression, your problems good too, because these annoyances force our hands, inspire growth, creativity, change. Even learning how to manage emotion, the physiological-psychological baggage that goes with stress, all that painful emotion, is a good thing; managing it, a rite of passage.

When it's not too much.

When it is, when things get really bad, that's when some of us, if we pray at all, start to pray with a vengeance. When things are very bad, people who pray, pray harder. They ask for others to pray with them, for them, for their families. And some of us who never prayed before, begin. Coping in this fashion tends to help us find solace, a little bit of comfort, even if we don't get what we pray for. We will say, You can’t pray too much, you can only pray more. Free will? Sure, but in the end it isn't such a bad idea to ask for help. 

No atheists in the foxholes.

Once I had an acquaintance who, you could tell, prayed daily, maybe three times a day (since she's Jewish), with intention, meaning attention to the words. People in her synagogue thought this because at weekly Saturday services she spent a long time during the silent recitations of prayers, and she cried, sometimes a lot, sometimes just a bit. So most of us assumed that she had problems, and we guessed at what they were, but we all assumed that she truly believed in the whole idea, the idea of prayer.

Just an aside, in Judaism prayer is important, but actions are more important. During these High Holy Days we're judged on tefilah, tzedukah, tshuvah-- prayer, charity, and a return to doing what we’re supposed to do. (We're assumed to have messed up somewhere). Charity and return are behavioral, not contemplative, and an effort at all three at once holds the keys to life in the coming year.

But back to our story. So one day I noticed this friend wasn’t so intent on her prayers, that she seemed much more relaxed, chatting it up with the other women who sat near her. After services, the women were talking, just idle chatter about books and television, and she joined in. She mentioned that she liked some show that actually bothered me, it had so much gratuitous sex and violence, and I teased her, And here I thought you were so religious. 

She laughed and said, Aren’t you?

Sometimes we are, sometimes we're not. It is the way of all people who appear to be religious. 

Chances are, things picked up for her, something lightened her load. Or, she just burnt out, all that devotion, too much to keep up. She would say, my guess, is that as a coping strategy, prayer can be a masterful, powerful form of meditation, focus. Many of us concur. Still others say, It is more than that. It is life or death.

We can't help but hope that when we do pray, when we talk, when we put an invisible concept in the room, as if our words are under consideration, it will make a difference. There's nothing dysfunctional about that, obsessive or not. Perhaps insisting that others do the same, be the same, is.

Have a happy, healthy new year my friends. May God judge us leniently, give us a good one, rich and meaningful, with snapshot memories that move us to good tears, a year that only gently shakes us out of our comfort zones, motivates us to do whatever it is (for I believe it is different for everyone) that our Higher Power wants us to do.

And it wouldn't hurt, honestly, since She is paying attention, if she waved the blue and white WIN flag, and the Cubs win the World Series.

therapydoc

Snapshots

We were joking around, and at the turn of a word FD remarked, "That might have come out of ________'s mouth." And at the same time we sighed and said. "I miss him." 

It's been a rough summer, still it went by too quickly anyway. A child has surgery, a young man's disease wins the fight. Friends, family, the people we see in our offices all have troubles. We're just here, riding the wave.

Disrupted, Mind Over Mood, SweetBitter

The upside is that I read a few books, almost read others; watched a lot of baseball (Go Cubs Go); lots of lighter side TV, nothing dark or deep, no Thrones. We can talk about books and teev later. Because, you know, it's 9-11.

1.   9-11

The day always gives us pause, or should. We should be taking a moment and reflecting, just a little, on the blue sky that day, the loss, the devastation, the heroes.

The stories are told about heroes, sometimes a fire fighter, sometimes an everyday Joe. We read about these people, or knew them, hear about them on talk radio, young men going up and down stairs, shepherding people to safety, carrying others on their backs, starting over. Not making it outside themselves.

It makes me wonder: Would I have done that? If given the choice, either escape or go back into the flames to help people, what would I have done?

It shames me, even though my rational self fights that feeling, And what makes you think you could lift someone, carry anyone to safety? 

Probably couldn't. Yet is shames me to think that panic would make the choice for me. I'd have stopped breathing, or slowed to a dizzying state. Then recovered just enough, hustled, found my way down, followed the heroes to safety, terrified. Then, finally out of harm's way, the decision to leave would have been regrettable. Totally regrettable.

Fifteen years. It has changed our way of life, probably forever. We take airplanes but stand in long lines, our bags are checked by TSA. This isn't the America some of us loved our whole lives.

Texas Eagle

not clouds

But it is America, and there are choices. FD and I make an annual summer pilgrimage to St. Louis, visit his family and take in a Cubs-Cards game at Busche Stadium.

fields of grain or corn

He's from around there, and I'm from Chicago, so we obviously have very different baseball loyalties. Until last year it's been a slam dunk as to which team had the right to call itself the better team. But now the Cubs are Wonder Boys (I think of them as children, boys), and it is a very good bet that they will win Monday night's game against the Cardinals.

We'll be there. Look for us.

And oh, we took Amtrak. A train.

Two and a half feet of legroom, no crowds. We have two seats each, can spread out. This train has no wifi, but my phone seems to be doing the job and there are electric plugs. (Remember those?)  I can get up and stretch, stand on one foot if I want. The scenery, oh, the fields of gold, the burnt orange baby pumpkins, the tall green corn. Much more here than clouds.

But mainly, no lines, no waiting for the vacation to begin.

2.  Summer Vacation

One of the lessons I learned from my brother's death at a young age:

When you see an opportunity to live, take it. 

On the other hand, it hasn't made me less phobic in certain situations. Like mountain climbing, bungee jumping, or jumping out of airplanes.

So the story goes that we raided the cookie jar and flew south to babysit our southern grandchildren. Their parents deserved a break, needed to get out of town, wanted to attend a wedding and a bar mitzvah in New York. We're in a position to do this, leave the weather Chicagoans wait for all winter, mid-70's, low-80's, to bathe in Atlanta's hot-humid atmospheric conditions, lows-in the- 90's.

And don't forget the rain.

And yet: I'll go back again when it cools off in early November, attend a conference, the Council for Social Work Education's annual meeting. I'd have gone to Costa Rica, Jamaica, the South Pole, anywhere for this conference. But we'll have a do-over to ATL.

What I learned, what made this time so memorable, had to do with one of my fears, acrophobia. 
A fear of heights.

Face Your Fear:

Acrophobia: an extreme and irrational fear of heights, not related to vertigo, an inner ear problem that makes you think you're moving when you are not.

Not the same as aviophobia, by the way, the fear of flying. Don't have that.

But as long as we're talking, the odds of crashing on American, United, Delta, Southwest, etc., are pretty slim:

• 4 fatalities in one million flight hours for airliners,
• 10 fatalities in one million flight hours on commuter airlines,
• 22 fatalities per million flight hours for private aviation (see, private planes are bad).
• On the world's major airlines the odds of dying from a plane crash are most remote, 1 in 4.7 million

The phobias tend to generalize, mush together. An elevator takes us to the top of a building and triggers claustrophobia in one person, acrophobia in another, agoraphobia in another, and all three in someone else. We can treat these disorders with medication and CBT, maybe meditation, thought charts, flooding and desensitization.

It stands to reason that if someone is the type to look up the statistics of death-by-airplane, then for sure she would look up the statistics of death-by-ziplining, before agreeing to take a spouse and 3 small grandchildren across the forest in the Southern Appalachian mountains.

Ziplining, not for the feint of heart

On a zipline.

The fellas working at the State Park assured us that the zipline could hold a school bus, and altogether we didn't weigh anywhere near the weight of a school bus, so being rational people, we assumed this to be an excellent way to face the Buddha, conquer my fear of heights. That and be heroes, in this very small way, to our grandchildren. Mainly, by taking them.

It is, in a word, terrifying. They kept saying, Don't look down, but what is the point of this, being up in the treetops, swinging like Tarzan and Jane, if you don't look down and enjoy the view? And so, we engaged in a desensitization therapy, the kind you don't generally read about in the books.

The only problem with this intervention is that there is really no turning back. Once you're strapped to the line, you don't have anyplace else to go. (Or so they said). It is a do or die thing. And honestly, I loved it.

Turns out that it is good not to have Googled the odds of death, or even injury, by zip-lining before saying yes to the kids. A 2015 study found fatalities on the rise. But these are primarily due to backyard kit set-ups  drinking beer, probably, while doing the installation.

Six deaths in 2015.

The annual injury rate for all zip lines climbed from almost 8 per 1 million U.S. residents in 2009 to nearly 12 per 1 million in 2012. Causes included falls, collisions and slamming into objects at the end of the course. Injuries were most common in children and teens.

So I don't know. I guess I wouldn't encourage this as the best way to get over acrophobia, although it certainly works.

But those glass elevators at the nicer hotels do, too.

3.  TV, Books, the Movies 

New to me, Crazy Ex-Girlfriend, and Rachel Bloom had me at West Covina. Crazy Ex is longer than most sitcoms, might even be a full hour, which made it even better, and actors break into song, ala the musicals of old. Does she suffer mental illness, our new favorite lawyer who leaves partnership at a top firm to move across the country (West Covina, California) to stalk her ex-boyfriend?  I don't know, have only watched a few shows so far. But she's very, very funny.

I caught up with old seasons of Mom, am now ready for Allison Janney to hit bottom again this coming season. Right, have to blog about those 12-Step meetings. Will get to it.

Saw only one movie, Finding Dory, which nobody spoiled for me, so I'll not write about it, will return the favor.

Finding Dory--topical

I don't know where to begin with books, considered writing about Mind Over Mood in this post, but it will take too long. It's going to have to be a whole post. The authors have found a way to put all cognitive behavioral therapy tenets into one little feel-better flow chart and shared it in this work book. So wait for me on that. Or just buy the book.

Meanwhile, we have Disrupted, which for the life of me, when I mention it, always comes out Disturbed.

Disrupted, by Dan Lyons.

At the age of fifty, Dan Lyon lost his job writing for Newsweek, a print magazine. Newsweek is in jeopardy, online news has cripple sales, and the magazine wants to replace older, more expensive writers with younger, cheaper staff. Esteemed in the industry, Dan is hired by a funded tech company, HubSpot, perhaps as a PR stunt.

He is a fish out of water, the oldest employee in the shop, and can't relate to the jargon, the values, and the cult atmosphere. Millennials pledge robotic loyalty to the founders and the company which is not turning an actual profit, and never may.

But here at HubSpot, kids are hired right out of college with the lure of stock options. They drink the Kool Aid that they will become rich one day, and that they are amazing, that the company is amazing, that the industry is amazing, a word used as often as a pronoun in a normal conversation. The minions are herded onto the sales floor as telemarketers. Their product is software, quite probably, second-rate software, if that. It is the type of software that businesses buy to spam the rest of us, garbage email. Open it, there will be follow up spam. Click on the company link, be hounded for life to buy amazing products you don't and never will need, products that aren't even very good.

The incentive for this tedious, demanding sales job? The company is flush with perks, those exercise and yoga classes, a plethora of food and candy, not from vending machines, but in dedicated rooms, walls of candy. Parties that begin early on weeknights, last until the next day, the kinds of parties that overflow with alcohol, employees sneaking off with one another to empty rooms. Make work fun so people love to come to work in the morning, gladly working their you-know-whats off, remaining loyal, until they are fired on a whim, lose their coveted stock options. Bye bye.

Millions, billions of dollars are to be made, we learn, but the money goes into the hands of the very, very few.

Do we hear about it in therapy? You bet we do.

Dan, by the way, is now a writer for the television show Silicon Valley. The disruption probably turned out to be a good thing for him.

therapydoc

Expletives, Suicidal Thoughts, and the F-That Video

Note: The following comments have nothing to do with any particular religious code or belief system, are not officially endorsed by a minister, priest, shaman, rabbi, witch, or any other clergy person (so far as the author is aware).

On occasion, a therapist will let an expletive slip, immediately regretting it. After hearing her apology, the patient will say, No problem, don't be silly. The therapist might ask, What would be a better word?

There's always a laugh and a consensus: There is no better word.

We're taught that the emotion should come from the patient, although people like to see signs of life from their therapist. It feels intuitively correct, this protocol, that if anyone should emote strongly, abandon control over words, it should be the patient. The therapist should control it; it is not his therapy.

Therapy is an empathetic process, however, and in that process of validating the patient's right to strong feeling and expressing it, a therapist might fall under the spell, emote too, communicate with too much empathy, use those expletives feeling the pain. Because expletives have the power to convey felt pain. Extreme pain inspires exaggerated language. Ever stub your toe?

We must take a more scientific look at this, and in the scientific process, define terms, clarify:

expletive (def): An additional word in a sentence that lacks intrinsic meaning; a word often interjected into a sentence as an exclamation, implies obscenity.  

Exclamations, we learn in school, deserve exclamation points. The example of the stubbed toe plays out this way:

 "Oh, s___!"

But we don't want our children to use that word, so convention has it to teach them other words, substitutes, like fiddlesticks (!).

And when writing, to use exclamation points.

"Jack returned to find his bicycle gone!"

Jack was really upset.

The exclamation point eliminated the need for expletives.

Otherwise, a declarative sentence, one that simply declares, conveys information, ends with a period.

"Class is dismissed at 3:30."

Now, of course, an emoticon would be expected, a variation of a smiley face, most likely, after Class is dismissed at 3:30. But assuming this a classic grammar class, only the period is necessary, in this way the words, and the period after them, must do the work. Ditto, the question mark.

"Did you ask permission?" 

Question marks, however, oddly, get in the way, sometimes, and are forgettable. And commas become a way of life, one that needs to change, become forgettable. Break up that sentence or use a semi-colon for G-ds sake.

Exclamation points win the prize as most highly valued punctuation marks, taught to be used sparingly in college writing classes; otherwise they lose their effect. The exclamation mark is privy to its own renaissance, however, in the past fifteen years, as THE preferred means of written emotional expression. Second only to CAPS and EMOTICONS.

WE CAN THANK THE MILLENNIALS, whose social networks far exceed those of the average baby boomer's, who felt the need for an effective emotionally loaded repertoire, and disseminated, however that is done, caps and contemporary hieroglyphics, those symbols that say so much more than a few words can express, worth a thousand words.

Emoticons are easy on the eyes, whereas letters are not, useful to convey what we are doing, feeling, (at all times), with symbols of food, drink, recreation, holidays, sadness, disappointment, anger and love, each color heart a different meaning, if only one learns the code.

All good, too, because online communication has had a positive effect on most of us, enables more and better communication. If we do it anonymously we can let down our guards, our defenses, unmask in a chatroom or with a blog, even a comment. Even with friends, in a text, we'll express feelings with emoticons and it feels perfectly safe. Even smart.

Therapy has always been a safe place to express the ugly, share when sharing with others is just too uncomfortable, too embarrassing, or has been unsuccessful in the past, accomplished nothing. And therapists have light-sabers with different settings that zap negative emotions, unexpectedly. They do it with just one look, sometimes, saber set to the look setting. If all anyone has to do, to feel better, is talk to just anybody, or shout out online, or on the phone, there would be no need for therapists.

Therapists would not need training in those Jedi schools. The economy would tank.

But should the expletive be a light-saber?

Four-letter words, the ones we're talking about, by definition imply obscenity, either as an action or a blasphemy. As such, these words successfully express negative feelings by temporarily externalizing them, like pregnancy, the feelings better out than in. Swearing tamps down the affect, displaces it, like slamming the door.

So for the therapist feeling badly for the patient, expletives work, too. But if they are not in the service of the therapy, if the therapist isn't using them intentionally, then it isn't right, might even upset the patient more.

Which is why Yiddish is better. For centuries, the old Jews, sweeping the floor of a hut or tiny apartment that never looked clean enough, rather than beat their wives or smack their husbands, kids, the dog, although they did some of that, too, used words that sounded funny but strong, externalized their pain. We should use them. They upset no one and make everyone laugh. There must be a list online somewhere.

Take the word, drek, rhymes with wreck, evocative of the "s" word. Typically, when one drops a pickle jar in the street or on a hard kitchen floor, what comes out of the mouth is:

"Oh, s___!"

But one could say, "Oh, drek!"

Except that this is not how the expletive is supposed to be used. It is more of an adjective: "The house smells like drek (if  a pet has not been able to wait).  Or better, "I feel like drek."

In fact, most yiddish words don't quite make it as substitutes for the "f" word, or the "d" word, or even the "b" word.  Chaval. So forget that online search.

(Chaval means too bad, or what a shame, rhymes with la-doll. That you can use.0

So we are back to therapists controlling their use of strong language, remaining professional, letting the patient do the swearing.

And yet, (as Jonathan Safran Foer would say in that survivor book Everything is Illuminated):

A Story

I'm with a friend and we're talking about meditation, that tried and true intervention, a distraction from obsessive, recurring thoughts, stinking thinking in Alcoholics Anonymous-speak. Thoughts are self or other-blaming, self or other-punitive, cohabit with hopelessness and self-pity, fear and loathing, and maintain depression and anxiety, tempt substance abuse and suicide to alleviate the pain.

She was really down, rock bottom sad, and I felt powerless, had to ask, "Hey! Have you seen the F-that meditation video?"


No, afraid not.

"Oh, you should. It is really, really funny."

Will do, she says, still very sad.

A laptop in my purse, I pull it out, find the link, hope not to be hacked in a coffee shop. She laughs so hard, tears come to her eyes.

I determine to recommend this paradoxically conceived video to patients, one punctuated with expletives delivered in a soothing, therapeutic, relaxing cadence.

And never again to swear in therapy.

therapydoc

TOTAL NONSEQUITOR-- Best treatment I've ever seen on perfectionism, WHY I QUIT  PERFECT, really good read.