When it comes to kids, it's the little things that count. Mainly, rides.
Check it out.
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Friday, July 22, 2011
Tuesday, July 19, 2011
Do You Feel Better Now?
FD and I were bantering about them. You know, the bad drivers, the ones who drive poorly, cut you off and then "flip you the bird." It doesn't happen to me very often because I opt out, ride a bike. But it did last week.
"You know what you should do?" FD tells me. "You should get that vanity plate, the one we talked about years ago."
He's talking about the one that says,
"Except that people who rage like that aren't going to connect the dots," I reply.
"Then a bumper sticker," he continues. "It's bigger, more visible." He suggests:
The real issue, I tell him, isn't the occasional road-rager, because he's so obviously out of control and we'll never see him again, and who cares? The real problem lies in everyday communication, where we're struck by insults or barbs, non sequiturs out of the mouths of people we actually know. They are generally just letting off steam, and it's usually displacement. I.e.,
Online today a blogger opines, It is much easier to displace anger online, to cause tremendous psychological pain via viral messages, malicious gossip, or exposure and shame, and the audience can reach thousands. Beats the schoolyard for impact.
In that situation, the violence of bullying isn't coming out of nowhere. It is planned. Most verbal and emotional violence, however, isn't like that. It isn't premeditated, it isn't intentional bullying. Outbursts are the outcome of emotional overflow. Tears are more mature, to be honest. When the flood is anger, not tears, look for displacement.
But it isn't always displacement, of course. Any of us can be triggered, might have a difficult time holding back our words in many different situations. All of us are capable of becoming a little over-reactive, or a lot, especially when a memory or an event lights up those neural pathways. Or when we're just tired. Or drink too much.
In family therapy, when one family member complains about another member's frequent verbal assaults, the recommended response is variable; it depends upon the circumstances. But often we suggest assertiveness-- labeling what's going on without emotion.
Overt and covert permission from our parents to be colorfully expressive, adds to that emotional vortex that rises to overflow. We learn from our parents, and from our teachers, and now from the media (what we see in the movies and on television), that lashing out sometimes feels really good. Raging families unconsciously know this and can be fairly robust, meaning members become immune, in their way, to feeling emotional or verbal abuse. It is the toughening up process of childhood.
That doesn't make it a better way to communicate, of course. At some point, no question, going off will be dysfunctional, somewhere, somehow, and may even cost the rager a job, or a relationship, an account or a recommendation. Loyalty, trust. Bye bye.
Which is why I told FD, "The bumper sticker I'd really like to see would be more to the point, process-wise. How about something like this?"
Big assumption.
Safer, we suggest, to wait it out. The irritability will go away.
Forget the bumper sticker! It's a good idea, but make it an intervention. In situations that seem safe, when we're fairly sure there will be no retaliation, when someone insults us or flings blame, or just lets loose with a couple of well-timed expletives, we should ask . . .
Then overflow-ers, aka ragers, get a pass with people who love them. Sometimes.
But you know, you can take back the words, the memories still stick. People have long memories for this sort of thing.
If I remember correctly, it was a white Honda, maybe an Accord with a beat up bumper, and there was one of those bobbing things in the rear window. No chains dangling from the mirror.
therapydoc
"You know what you should do?" FD tells me. "You should get that vanity plate, the one we talked about years ago."
He's talking about the one that says,
GET THERAPYI had always wanted that one.
"Except that people who rage like that aren't going to connect the dots," I reply.
"Then a bumper sticker," he continues. "It's bigger, more visible." He suggests:
Slow down, you'll live longer.This is also something we have talked about in the past.
The real issue, I tell him, isn't the occasional road-rager, because he's so obviously out of control and we'll never see him again, and who cares? The real problem lies in everyday communication, where we're struck by insults or barbs, non sequiturs out of the mouths of people we actually know. They are generally just letting off steam, and it's usually displacement. I.e.,
The boss makes you work overtime, you come home tired and angry and kick the dog.Kicking the boss will get you fired.
Online today a blogger opines, It is much easier to displace anger online, to cause tremendous psychological pain via viral messages, malicious gossip, or exposure and shame, and the audience can reach thousands. Beats the schoolyard for impact.
In that situation, the violence of bullying isn't coming out of nowhere. It is planned. Most verbal and emotional violence, however, isn't like that. It isn't premeditated, it isn't intentional bullying. Outbursts are the outcome of emotional overflow. Tears are more mature, to be honest. When the flood is anger, not tears, look for displacement.
But it isn't always displacement, of course. Any of us can be triggered, might have a difficult time holding back our words in many different situations. All of us are capable of becoming a little over-reactive, or a lot, especially when a memory or an event lights up those neural pathways. Or when we're just tired. Or drink too much.
In family therapy, when one family member complains about another member's frequent verbal assaults, the recommended response is variable; it depends upon the circumstances. But often we suggest assertiveness-- labeling what's going on without emotion.
Overt and covert permission from our parents to be colorfully expressive, adds to that emotional vortex that rises to overflow. We learn from our parents, and from our teachers, and now from the media (what we see in the movies and on television), that lashing out sometimes feels really good. Raging families unconsciously know this and can be fairly robust, meaning members become immune, in their way, to feeling emotional or verbal abuse. It is the toughening up process of childhood.
That doesn't make it a better way to communicate, of course. At some point, no question, going off will be dysfunctional, somewhere, somehow, and may even cost the rager a job, or a relationship, an account or a recommendation. Loyalty, trust. Bye bye.
Which is why I told FD, "The bumper sticker I'd really like to see would be more to the point, process-wise. How about something like this?"
Do you feel better now?Because that's what it's all about, discharging negative energy. It's hard to contain negative emotion and we feel better when the arousal, the irritability is gone, the baby delivered. And that's okay, letting it go, assuming everyone knows that nothing is really meant by it. Nothing personal.
Big assumption.
Safer, we suggest, to wait it out. The irritability will go away.
Forget the bumper sticker! It's a good idea, but make it an intervention. In situations that seem safe, when we're fairly sure there will be no retaliation, when someone insults us or flings blame, or just lets loose with a couple of well-timed expletives, we should ask . . .
Do you feel better now?With concern. Make it come from the heart.
Then overflow-ers, aka ragers, get a pass with people who love them. Sometimes.
But you know, you can take back the words, the memories still stick. People have long memories for this sort of thing.
If I remember correctly, it was a white Honda, maybe an Accord with a beat up bumper, and there was one of those bobbing things in the rear window. No chains dangling from the mirror.
therapydoc
Sunday, July 10, 2011
What I Did For Love
Wow, it seems my vacay from blogging never was, it's so easy to come back to this. But I needed a break, just some time to attend to things, like shredding twenty-five years of old tax receipts, returns. That was fun, bringing those boxes out of the attic. I approached it like I do everything else, with a broom.
While I was away I did an Anniversary Post. Not a blogging anniversary post, but a Marital Union Anniversary Post. What you will get out of it are prime examples of conflict avoidance. Or do you prefer: Synchrony of Emotion. Empathy. All depends upon what color glasses you're wearing. We prefer something in pastel.
June 22, 2011
FD and I have been married for 36 years.
You should know that the number 36 is considered a lucky number, because it is twice 18, and 18 is a lucky number. If you're Jewish you understand that multiplying things has tremendous psychological power. The number 18 is lucky because it is the numeric equivalent of chai (hard "ch", rhymes with fly), the Hebrew word for life.
How does a word become a number? Each letter of the Hebrew alphabet is associated with a number. Add up the numbers that correspond to the letters of a word, and you get numbers with feeling. You can imagine the speeches at the Bar Mitzvahs.
What we do to celebrate our life together is regress, stick it to the whole idea that we're getting older and crankier. Meaning, we take off and do what we used to do when it wasn't as hard to do it, with less intensity. We cancel our appointments, sign out, give over coverage and run away for a day and a half, never too far away. The Midwest is a lot prettier than people think. We met in the cornfields of Illinois, two and a half hours southwest of the city of Chicago, in school.
FD does most of the work as I put together a cooler of fish salad and fruit. He somehow gets our bicycles to stay on the back of the car using an ancient bike carrier. I make a big deal about making the salad while I talk on the phone. It does take forever, right, to make a decent lunch?
We drive away. This particular anniversary morning follows a night of severe storms all across the western suburbs. We have reserved a bed and breakfast in the western suburbs not far from Fermilabs. FD has discovered that there are extensive bike trails near the nuclear reactor. Finding the trails is easy, choosing the B & B is hard. My job.
Do we go to Marcia's Bed and Breakfast in Ottawa? When I ask Marcia how much, she asks if we're bringing our horses. I like her right away.
If not Marcia's then perhaps Oscar Swan's in Geneva, where the service is said to be iffy, but we might catch a wedding.
To be honest, Marcia's is a little too far away for a day trip, and frankly, I don't travel well anymore. So I tell her another day, and we book at the Oscar Swan. Then FD gets sick, and there is no going anywhere.
But being a doctor, he gets well! How he does this, I'll never know, but he goes from looking like death warmed over to, "HEY! Let's go someplace! I haven't had fever in two hours* and the antibiotics are working, and it's our anniversary!"
I'm saying, "Dude, we should totally stay home, and if we're adventurous, measure the kitchen floor. We take the money we save at Oscar Swan (significant!) and apply it to the new floor."
He goes, "Yeah, but it's our anniversary." He says it with a certain nostalgia. Or is that a whine.
We settle on a show. Yes! Let's go see a show! We live in a big city, Chicago. There are many of these. I suggest Chinglish, a comedy set for Broadway, soon. He's good with this, but we can't get cheap tickets. He finds The Outgoing Tide, a play about Alzheimer's with John Mahoney. John Mahoney is best known as Frazier's father. He's an older television star.
"Fine, dear. We'll see a play about something depressing. That's cool. I'm good. Truly."
I cancel our reservation at the Oscar Swan. I have already discussed our issues with Marcia in Ottawa, the proprietor who asked about our horses. She knows we'll be back one day, probably with grandchildren. We have a relationship. We spend more money than we should at the Northlight Theater, thinking that if the weather is good and he still feels good, we can get out during the day and ride somewhere and still make it back to get dressed up for the show. I love getting dressed up for a show, although this is a passing trend, at least at the Northlight.
The night before, as we've already indicated, the storms are fierce, make religious animals out of Chippy and Dale and everyone else who doesn't live in our attic.** We wake up to find that our neighborhood quite possibly has the best weather within a hundred miles. The sun is shining. The skies are blue, and the weatherman is telling us otherwise for all of Chicagoland.
But we can't stay here. We have to go someplace we haven't been before, somewhere only we know, as the song goes. I watch the Weather Channel with great interest. "If we're going to ride, it seems to me that Antioch might stay clear for awhile."
This is Chain of Lakes in Illinois, where he takes the grandkids fishing sometimes. Before we blink the food is ready to go, and the bikes are hanging low on the Nissan; this is an old drill. "Drive slowly," he warns. "The bikes are hanging low." Noticed that, between us, didn't say a word.
And it is, as it always is, just fantastic. We find the park, get out and air out. There are three hiking/riding trails within seven miles and check them all out via pedals. He complains that I ride too slow. I tell him that I have to stop to take pictures. It's an addiction, remembering. We lose that ability all too soon.
It is lovely, we're having a good time. Neither of us cares much who is trying to reach us when we miss those calls.
It is all good until we hit what feels to me is a highway. At this point FD tells me that we have to ride on the shoulder of this Route, whichever it is. The traffic is whizzing by.
No, dear.
He tells me there is no other way to get to where we want to go, and I still insist, Not Me. Now We.
We look at one another. Stalemate. We both want to go. We want to keep exploring the area. We rarely ride on the busy streets, but occasionally are forced into it and there is this thing they call a shoulder. To turn back is white bread, there is no fiber to this trip yet. We're not white bread people. Our eyes turn, once again, to the highway.
All of a sudden there is NO traffic. Of one mind we hightail it across and in moments are comfortably riding west on the shoulder, not a care in the world. It will be a mile and a half to the next official trail.
The traffic, of course, catches up with us, but we're within three feet of the nearest flying automobile, and we've been here before. We have faith. We'll be fine.
Except for the flash flood. We should have seen it coming. The sky had changed.
We feel the moisture, we can tell that the water on our skin is rain, we just aren't prepared for a flash flood in the middle of nowhere while riding on the shoulder of a highway as trucks kick what have become rivers onto the shoulder.
We get off our bikes, rapidly hunt for our parkas, soon a little more protected. Except that it is pouring and we're in the middle of nowhere and a parka is only good from the waist up.
"What now?" I ask, hoping he knows what he's doing.
"We find a shelter and have a picnic, of course."
Of course.
"We're not riding to this shelter," I inform him.
"No, we can walk there."
And the rain keeps pouring down.
There is no shelter. But by the time we get to the park, five minutes away, really, the rain is quite finished. The sun is out, and we're drying off. It helps to ride standing up, and who can't do that?
I'm wary of another storm, keep my parka on, but FD stops to tell me that this is slowing me down. He hates that I ride so slowly. I give in, take it off, hoping that this really is the end of the bad weather. We have vacationed for thirty-six years in all kinds of weather, weathered all kinds of storms. A little drop of rain can hardly hurt me now.
At some point we're lost. My Iphone has a compass that tells me we're heading south and I know we need to go northeast. FD tells me that my compass is wrong, that we're heading east, which is fine. "How can a compass be wrong," I ask, suspicious.
"I don't know, but it's wrong."
This inspires confidence, obviously. I am tired, and a little hungry, and not totally dry, although the sun is doing what it is supposed to do, and there is a lamb on a farm that is basically saying, Come take my picture. But by the time I get to doing that, he disappears.
Seeing a lamb makes me happy. We reach the car and FD begins the process of loading the bikes on the car carrier. It is beginning to rain. I get in the car, hope he doesn't get too wet, and he doesn't. We pass the home grown fruit stand, stop to buy some berries, and of course, nothing is home grown, but you have to love that, too. Home grown bananas. Right.
therapydoc
*Actually, FD came down with this ridiculous illness the day before and started treating it immediately. Loathe to use unnecessary antibiotics, we know he wasn't faking.
** The Is it a raccoon? Or Is it a squirrel? story is priceless, but not for today.
While I was away I did an Anniversary Post. Not a blogging anniversary post, but a Marital Union Anniversary Post. What you will get out of it are prime examples of conflict avoidance. Or do you prefer: Synchrony of Emotion. Empathy. All depends upon what color glasses you're wearing. We prefer something in pastel.
June 22, 2011
FD and I have been married for 36 years.
You should know that the number 36 is considered a lucky number, because it is twice 18, and 18 is a lucky number. If you're Jewish you understand that multiplying things has tremendous psychological power. The number 18 is lucky because it is the numeric equivalent of chai (hard "ch", rhymes with fly), the Hebrew word for life.
How does a word become a number? Each letter of the Hebrew alphabet is associated with a number. Add up the numbers that correspond to the letters of a word, and you get numbers with feeling. You can imagine the speeches at the Bar Mitzvahs.
What we do to celebrate our life together is regress, stick it to the whole idea that we're getting older and crankier. Meaning, we take off and do what we used to do when it wasn't as hard to do it, with less intensity. We cancel our appointments, sign out, give over coverage and run away for a day and a half, never too far away. The Midwest is a lot prettier than people think. We met in the cornfields of Illinois, two and a half hours southwest of the city of Chicago, in school.
FD does most of the work as I put together a cooler of fish salad and fruit. He somehow gets our bicycles to stay on the back of the car using an ancient bike carrier. I make a big deal about making the salad while I talk on the phone. It does take forever, right, to make a decent lunch?
We drive away. This particular anniversary morning follows a night of severe storms all across the western suburbs. We have reserved a bed and breakfast in the western suburbs not far from Fermilabs. FD has discovered that there are extensive bike trails near the nuclear reactor. Finding the trails is easy, choosing the B & B is hard. My job.
Do we go to Marcia's Bed and Breakfast in Ottawa? When I ask Marcia how much, she asks if we're bringing our horses. I like her right away.
To be honest, Marcia's is a little too far away for a day trip, and frankly, I don't travel well anymore. So I tell her another day, and we book at the Oscar Swan. Then FD gets sick, and there is no going anywhere.
But being a doctor, he gets well! How he does this, I'll never know, but he goes from looking like death warmed over to, "HEY! Let's go someplace! I haven't had fever in two hours* and the antibiotics are working, and it's our anniversary!"
I'm saying, "Dude, we should totally stay home, and if we're adventurous, measure the kitchen floor. We take the money we save at Oscar Swan (significant!) and apply it to the new floor."
He goes, "Yeah, but it's our anniversary." He says it with a certain nostalgia. Or is that a whine.
We settle on a show. Yes! Let's go see a show! We live in a big city, Chicago. There are many of these. I suggest Chinglish, a comedy set for Broadway, soon. He's good with this, but we can't get cheap tickets. He finds The Outgoing Tide, a play about Alzheimer's with John Mahoney. John Mahoney is best known as Frazier's father. He's an older television star.
"Fine, dear. We'll see a play about something depressing. That's cool. I'm good. Truly."
I cancel our reservation at the Oscar Swan. I have already discussed our issues with Marcia in Ottawa, the proprietor who asked about our horses. She knows we'll be back one day, probably with grandchildren. We have a relationship. We spend more money than we should at the Northlight Theater, thinking that if the weather is good and he still feels good, we can get out during the day and ride somewhere and still make it back to get dressed up for the show. I love getting dressed up for a show, although this is a passing trend, at least at the Northlight.
The night before, as we've already indicated, the storms are fierce, make religious animals out of Chippy and Dale and everyone else who doesn't live in our attic.** We wake up to find that our neighborhood quite possibly has the best weather within a hundred miles. The sun is shining. The skies are blue, and the weatherman is telling us otherwise for all of Chicagoland.
But we can't stay here. We have to go someplace we haven't been before, somewhere only we know, as the song goes. I watch the Weather Channel with great interest. "If we're going to ride, it seems to me that Antioch might stay clear for awhile."
This is Chain of Lakes in Illinois, where he takes the grandkids fishing sometimes. Before we blink the food is ready to go, and the bikes are hanging low on the Nissan; this is an old drill. "Drive slowly," he warns. "The bikes are hanging low." Noticed that, between us, didn't say a word.
And it is, as it always is, just fantastic. We find the park, get out and air out. There are three hiking/riding trails within seven miles and check them all out via pedals. He complains that I ride too slow. I tell him that I have to stop to take pictures. It's an addiction, remembering. We lose that ability all too soon.
It is lovely, we're having a good time. Neither of us cares much who is trying to reach us when we miss those calls.
It is all good until we hit what feels to me is a highway. At this point FD tells me that we have to ride on the shoulder of this Route, whichever it is. The traffic is whizzing by.
No, dear.
He tells me there is no other way to get to where we want to go, and I still insist, Not Me. Now We.
We look at one another. Stalemate. We both want to go. We want to keep exploring the area. We rarely ride on the busy streets, but occasionally are forced into it and there is this thing they call a shoulder. To turn back is white bread, there is no fiber to this trip yet. We're not white bread people. Our eyes turn, once again, to the highway.
All of a sudden there is NO traffic. Of one mind we hightail it across and in moments are comfortably riding west on the shoulder, not a care in the world. It will be a mile and a half to the next official trail.
The traffic, of course, catches up with us, but we're within three feet of the nearest flying automobile, and we've been here before. We have faith. We'll be fine.
Except for the flash flood. We should have seen it coming. The sky had changed.
We feel the moisture, we can tell that the water on our skin is rain, we just aren't prepared for a flash flood in the middle of nowhere while riding on the shoulder of a highway as trucks kick what have become rivers onto the shoulder.
We get off our bikes, rapidly hunt for our parkas, soon a little more protected. Except that it is pouring and we're in the middle of nowhere and a parka is only good from the waist up.
"What now?" I ask, hoping he knows what he's doing.
"We find a shelter and have a picnic, of course."
Of course.
"We're not riding to this shelter," I inform him.
"No, we can walk there."
And the rain keeps pouring down.
There is no shelter. But by the time we get to the park, five minutes away, really, the rain is quite finished. The sun is out, and we're drying off. It helps to ride standing up, and who can't do that?
I'm wary of another storm, keep my parka on, but FD stops to tell me that this is slowing me down. He hates that I ride so slowly. I give in, take it off, hoping that this really is the end of the bad weather. We have vacationed for thirty-six years in all kinds of weather, weathered all kinds of storms. A little drop of rain can hardly hurt me now.
At some point we're lost. My Iphone has a compass that tells me we're heading south and I know we need to go northeast. FD tells me that my compass is wrong, that we're heading east, which is fine. "How can a compass be wrong," I ask, suspicious.
"I don't know, but it's wrong."
This inspires confidence, obviously. I am tired, and a little hungry, and not totally dry, although the sun is doing what it is supposed to do, and there is a lamb on a farm that is basically saying, Come take my picture. But by the time I get to doing that, he disappears.
Seeing a lamb makes me happy. We reach the car and FD begins the process of loading the bikes on the car carrier. It is beginning to rain. I get in the car, hope he doesn't get too wet, and he doesn't. We pass the home grown fruit stand, stop to buy some berries, and of course, nothing is home grown, but you have to love that, too. Home grown bananas. Right.
therapydoc
*Actually, FD came down with this ridiculous illness the day before and started treating it immediately. Loathe to use unnecessary antibiotics, we know he wasn't faking.
** The Is it a raccoon? Or Is it a squirrel? story is priceless, but not for today.
Sunday, July 03, 2011
Process Over Content: De-shaming
Let's address those questions from the last post. In my excitement, coming back to blogging after a nice hiatus, apparently I never got to the point. It is why therapists should shut up and listen.
The post is about blurting and embarrassment in couples therapy. There are therapy rules, The Therapy I Ching, that predict the process of positive change.
The therapist is an authority, has proprietary knowledge, which is why she is paid the big bucks (this is surely relative and not always deserved, and sometimes no amount of money is enough, but that's another topic for another day). As the authority, she lays down therapy basics at the beginning of treatment, and reinforces them. One might be:
Extend that obligation, Do No Harm, to everyone in the room, and we have a shot at getting something done. We don't want anyone to become even more hurt, embarrassed, or depressed in the name of healing.
The blurt, the cause of the suffering we're talking about today, is associated with the emotional pain of a long-suffering partner. She (for the sake of simplification, make it a she) is fed up, her angst, palpable. It bubbles over with the blurt. She has to inform the therapist, get to the point, how bad her partner really is. Her partner's privacy is violated in the process.
It happens and it is a recovery moment. To her dismay, we have to divert from content, that embarrassing thing she says he does, and roll to the process, that he has been shamed in front of the therapist. How do you de-shame?
Embarrassment is emotional abuse. But it isn't particularly therapeutic to tell someone, You are emotionally abusive. Some people do come to therapy expecting a beating by the doc. If we know that we'll gladly oblige. For example, many who work 12-Step programs use the language: working on character defects. They see this work as laudable, the goal of all therapy, and it is incredible, great stuff. Much healing comes from fixing ourselves, changing, becoming better people. So people who work a program welcome criticism.
But others don't need it, not consciously, and don't come to therapy for it. Safe to say that most of us don't want criticism and judgement in therapy.
Yet there it is, in your office, a huge traffic accident and you have to clean up the mess.
I start with a process statement. Process is the opposite of content. It is the verb to the noun, the interaction. Content is the detail. He steals! That's content. She just outed him, embarrassed him. That's process. The therapist wants to make the process, which is usually unconscious, conscious. Anyone can deal with content.
As soon as the secret is out, the therapist gets it and directs the process.
As if we didn't even know. But we act as if, truly, we need help here. Help us figure out what just happened.
It is a diagnostic question, What just happened there? We're seeking out how sensitive and how aware the patients are. Most of the time the one who blurted will answer right away, "He's angry because I told you that he _____ (fill in the blank). I told on him."
And the therapist can say, "He's angry? Is it anger? Are you sure he's angry?"
Then we can talk about emotions, which is an awesome thing to talk about in therapy. We let this one go on, and on, and on. When we hit embarrassment, or shame, the mother lode, I say, "Ooh, this is a great place to go, a great thing to discuss! Let's talk about life's embarrassing moments! Who wants to begin?"
Silence. Usually, if you want to think of something embarrassing, it is hard. We repress these events, a gift. The therapist must begin.
Since we're talking about me now, I might start them off with one of my great embarrassing moments: Second grade. Too afraid to ask the teacher for permission to use the bathroom.
The stuff of a reality TV show, no? Everyone wants to join in.
The fun of disclosure, real intimacy between partners, is about to begun.
therapydoc
The post is about blurting and embarrassment in couples therapy. There are therapy rules, The Therapy I Ching, that predict the process of positive change.
The therapist is an authority, has proprietary knowledge, which is why she is paid the big bucks (this is surely relative and not always deserved, and sometimes no amount of money is enough, but that's another topic for another day). As the authority, she lays down therapy basics at the beginning of treatment, and reinforces them. One might be:
Nobody Gets Hurt Here.This is the essence of the therapist/doctor/rabbi's obligation,
Do No Harm.
Extend that obligation, Do No Harm, to everyone in the room, and we have a shot at getting something done. We don't want anyone to become even more hurt, embarrassed, or depressed in the name of healing.
No one should get hurt while getting better.Hurt can be prevented, but it isn't always, and isn't usually cause for calls to the Department of Professional Regulation. But when someone gets hurt in therapy, it has to be discussed.
The blurt, the cause of the suffering we're talking about today, is associated with the emotional pain of a long-suffering partner. She (for the sake of simplification, make it a she) is fed up, her angst, palpable. It bubbles over with the blurt. She has to inform the therapist, get to the point, how bad her partner really is. Her partner's privacy is violated in the process.
It happens and it is a recovery moment. To her dismay, we have to divert from content, that embarrassing thing she says he does, and roll to the process, that he has been shamed in front of the therapist. How do you de-shame?
Embarrassment is emotional abuse. But it isn't particularly therapeutic to tell someone, You are emotionally abusive. Some people do come to therapy expecting a beating by the doc. If we know that we'll gladly oblige. For example, many who work 12-Step programs use the language: working on character defects. They see this work as laudable, the goal of all therapy, and it is incredible, great stuff. Much healing comes from fixing ourselves, changing, becoming better people. So people who work a program welcome criticism.
But others don't need it, not consciously, and don't come to therapy for it. Safe to say that most of us don't want criticism and judgement in therapy.
Yet there it is, in your office, a huge traffic accident and you have to clean up the mess.
I start with a process statement. Process is the opposite of content. It is the verb to the noun, the interaction. Content is the detail. He steals! That's content. She just outed him, embarrassed him. That's process. The therapist wants to make the process, which is usually unconscious, conscious. Anyone can deal with content.
As soon as the secret is out, the therapist gets it and directs the process.
"What just happened there?"
As if we didn't even know. But we act as if, truly, we need help here. Help us figure out what just happened.
It is a diagnostic question, What just happened there? We're seeking out how sensitive and how aware the patients are. Most of the time the one who blurted will answer right away, "He's angry because I told you that he _____ (fill in the blank). I told on him."
And the therapist can say, "He's angry? Is it anger? Are you sure he's angry?"
Then we can talk about emotions, which is an awesome thing to talk about in therapy. We let this one go on, and on, and on. When we hit embarrassment, or shame, the mother lode, I say, "Ooh, this is a great place to go, a great thing to discuss! Let's talk about life's embarrassing moments! Who wants to begin?"
Silence. Usually, if you want to think of something embarrassing, it is hard. We repress these events, a gift. The therapist must begin.
Since we're talking about me now, I might start them off with one of my great embarrassing moments: Second grade. Too afraid to ask the teacher for permission to use the bathroom.
The stuff of a reality TV show, no? Everyone wants to join in.
The fun of disclosure, real intimacy between partners, is about to begun.
therapydoc
Wednesday, June 29, 2011
Therapeutic Snapshots: The Blurt
Quick housekeeping note: For those of you who email asking for help. . . I can't give Internet advice. I'm sorry. And I'm afraid to even write back-- too much crazy sociopathic stuff out here-- spam, phishing, people stealing email addresses, etc. So whatever it is, please don't wait for me to answer. Find local help by looking for community resources. These can be terrific. Look in the phone book or Google Community Mental Health Centers.
Thanks to all of you for the comment love while I was gone. I'm sorry I didn't respond to most of them. Maybe some day.
Moving on.
The bus, the 49B, lumbers southbound toward the train, moments ahead of me, which is fine. I can walk the 3/4 of a mile.
Thanks to all of you for the comment love while I was gone. I'm sorry I didn't respond to most of them. Maybe some day.
Moving on.
The bus, the 49B, lumbers southbound toward the train, moments ahead of me, which is fine. I can walk the 3/4 of a mile.
 |
| The 49 B |
Something about being on the move-- walking, biking, driving, especially on public transportation-- my brain downloads conversations, entire dialogs, scripts. I flash on the ways people announce themselves in therapy, how they react to what I say, what they say to one another. It’s all remembered, like snapshots.
More like albums. File this one under:
More like albums. File this one under:
MISTAKES RELATIONSHIP THERAPISTS ARE LIKELY TO MAKE
You’re a therapist, so you are charming, and people are comfortable talking to you. The nervous couple on the leather sofa sees you as an authority figure. Each one worries that you will take the side of the other.
Or they might not be nervous anymore. You have disarmed them, this is your specialty. You sell that snake oil, whatever they think it is, called understanding. The shoes (this is upsetting) and the gloves (not good either) tend to come off, ironically, at disarmament.
Or they might not be nervous anymore. You have disarmed them, this is your specialty. You sell that snake oil, whatever they think it is, called understanding. The shoes (this is upsetting) and the gloves (not good either) tend to come off, ironically, at disarmament.
From the first visit we're getting to know one another and the therapist is diagnosing. Depending upon her training she might seek out these types of relationships:
(1) conflictual,
(2) conflict-avoidant
(3) over-adequate/under-adequate, or OA-UA.
The first two are self-explanatory, but the OA-UA more subtle. Roles are assigned, sometimes, before commitment. At that time taking care of somebody might seem like a good idea, an easy sacrifice. But it gets old, taking care of adults who should be more adult. We're looking for equal partners, most of us.
Many couples fall into combined relationship types, and there are different paradigms. There's no simplifying the therapy. Volumes could be written on any one of them.
(1) conflictual,
(2) conflict-avoidant
(3) over-adequate/under-adequate, or OA-UA.
The first two are self-explanatory, but the OA-UA more subtle. Roles are assigned, sometimes, before commitment. At that time taking care of somebody might seem like a good idea, an easy sacrifice. But it gets old, taking care of adults who should be more adult. We're looking for equal partners, most of us.
Many couples fall into combined relationship types, and there are different paradigms. There's no simplifying the therapy. Volumes could be written on any one of them.
The Therapy I Ching.*
A couple that fights all of the time, shouldn't fight.
A couple that never fights, should.
Dispassionate problem solving is hard, but rising to this--
quintessentially human.
No one should get hurt while getting better.
The doctor lays down these ideas in the first visit, and reinforces them, but the couple is likely to be too nervous and too entrenched in their patterns to absorb directives and rules. They have already watched Oprah, read a few books, consulted a spiritual leader, mined the therapy bloggers, and know where they want to be. The therapeutic objective is architectural--add reasonable structure to the melee.
By the third or fourth meeting, what isn't working in the relationship is played out right there in the office, a marvelous thing to behold.
Marriage in 45 Minutes, you might call it.
One of the more disturbing Marriage in 45 Minutes moments is The Blurt, an embarrassing statement by one partner describing the dysfunctional behavior of another. A blurt is something the other might have confessed voluntarily, given the chance.
But the conversation the night before the therapy appointment went something like this:
Partner No. 1: You will tell her about it, right? You'll tell her.
Partner No. 2: If I feel like it.
Partner No. 1: You better tell her.
Partner No. 2: Stop nagging me. That's the problem. You don't let up.
The tell will have something to do with:
(a) porn, (b) drugs, (c) stealing, (d) sex, (e) lying, (f) deception, (g) rage, (h) past abortions,(i) cruising,
Fill in the (j)-(z), you know you can.
It is hugely humiliating to be outed like this to the therapy mom or dad. Typically the one who blurts is really, really worried, and with good cause, that without the blurt, the therapist will have no idea, truly will not understand the enormity of the situation-- how bad things really are. Rather than waste time, the secret out, we can get to work.
Except that the outed individual's privacy has been invaded, and we treasure our privacy. The nightmare of couples therapy has begun.
And the therapist watches the victim of this emotional abuse (yes, that's what it is) sink into the sofa, crest-fallen and ashamed. The words that should be said,
"How could you do this? How could you embarrass me this way?"
are never said. That would be an admission of the truth. Rather, the betrayed captures the doctor's eyes. Help me. The therapist has made a mistake, has let this happen. It all happened on her watch.
The blurter, meanwhile, is relieved.
In the remaining minutes of the visit we discuss more
Therapy I Ching basics, this time with feeling.
One is thrown into a furnace for embarrassing another.
But if you can't embarrass someone, how can you assign blame? Someone has to be to blame. But wait. Let's approach that scientically.
Cause and effect, what social scientists refer to as linearity is a Western concept based upon statistical associations. The whole of behaviorism is about pairing measurable variables (behaviors), fitting those straight lines on a graph. Cause --> effect. The very purpose of scientific inquiry is to find causes, and when we find them, we publish!
It is up to someone else to seek out the cause of the cause, causes of the causes.
For there is a cause for a cause, and a cause for a cause for a cause, etc. The effect is a cause, too, and if we construct our theory wisely, we can test to see if the effect ultimately causes the cause, closing the feedback loop. No beginning, no end, impossible to assign blame. A chicken/egg thing. This is eastern thinking, by the way.
Take a look at what happened before The Blurt. Make the symptom gambling.
The couple had a discussion the night before. They have had many discussions about gambling. In one of these, the non-gambler has told the gambler that she will leave him if he doesn't stop.
She has said this before, but threatening him only makes him gamble more. He doesn't want her to leave him and he thinks that if he wins, she will forgive him, love him, stay. She has given signals that she likes it when he provides for her and winnings provide.
So he's just gambling to be her hero. He does it for her. Doing so increases the odds that she'll leave, but he's a gambler and denial is the nature of the disease.
She doesn't want to leave is the truth. And she is worried that we won't get to the real issue, which she thinks is his gambling. So without the blurt, the therapy won't work. He won't change, and she really will have to go. So she takes matters into her own hands. She blurts.
We could intervene anywhere. No need to blame anyone. It is their love, their desire to survive, that matters.
I think people blurt because the pain is so palpable, so disturbing, that it has to go somewhere. In individual therapy spilling secrets is safe, alone in a room with a professional sworn to confidentiality. There is well-deserved trust on the operating table.
 |
| It has to be earned--(Poster in the Merchandise Mart) |
But in couples therapy, talking about a "character deficit" is embarrassing, so the secret is deliberately shielded for awhile. We therapists take it slow. Most people aren't in 12-Step programs, aren't comfortable discussing personal issues with total strangers. But the long-suffering partner is sick of the deficit, so she blurts. Can't help it, the girl can't help it.
There are other reasons people blurt. The kid in school who blurts out an answer wants attention, admiration from the teacher. But here, it is about being sure the therapist knows her job, knows what she is supposed to do.
Fix him (her). Please! I have had enough! At the end of my rope. . . fed up . . .can't stand it anymore. . . I can't do it.
Another quote from The Therapy I Ching:
Therapists don't change anyone.
People change when they see the value of change, when they understand why change is desirable, and have a blueprint, directions as to how to go about it.
 |
| The Brown Line to Downtown |
* The only thing about The Therapy I Ching (copyright therapydoc, obviously, 2011) that is similar to the real I Ching is that both books are books of change.
therapydoc
Monday, May 23, 2011
Last Post
Last post for awhile. I'll try to pick up sometime this summer. Too much to do, and believe it or not, I spend a lot of time, maybe way too much time, online. Shocking, I know.
Meanwhile, you'll have to settle for The Five Ways We Grieve, (below) chew on that a bit and read other bloggers. I'll tweet when I can.
Can't wait to come back. Miss you already,
therapydoc
Meanwhile, you'll have to settle for The Five Ways We Grieve, (below) chew on that a bit and read other bloggers. I'll tweet when I can.
Can't wait to come back. Miss you already,
therapydoc
The Five Ways We Grieve
A friend of mine stopped by late on a Saturday afternoon. We learn together (that's code for learning Jewish stuff). It so happens she's a psychiatrist. The soft tap on the door rouses me from an out-stretched position on the floor.
"Did I wake you?" she asks, concerned. Nobody likes waking anybody.
"No, I was reading."
"I woke you, for sure."
"Seriously. I was reading." She looks at me in disbelief.
"Look. Here's the proof. I'm reading two books at once." I point to the books on the floor.
"How can you read two books at once?" she challenges me.
"I read a half-hour of one, get bored, pick up the other, read awhile, get bored, pick up the other." I thought everyone did this. One book is a novel, the other is The Five Ways We Grieve, by Susan A. Berger. For sure a summary of her Harvard dissertation research.
"I almost didn't even start this one," I tell my friend, pointing to Berger's book. "Because I hate anything that minimizes the topic to numbers like five. But her publicist sent me the book to review, so I felt obligated to at least start it. And the work is solid qualitative work, well done, and she really did find five themes, five ways that people grieve. She summarizes the literature well enough, makes sense, and teaches with examples. Who doesn't like examples?"
She agrees, lets me steer away from the topic. "Tea?" she asks. You have to love psychiatrists.
If she had asked me for more, I would have told her that the way of grieving that we focus upon in therapy, the emotional kind, doesn't even get top billing in the book. Grieving isn't the issue so much as the way a person manages life under the influence.
There's an assumption that there will be sadness, anger, denial, guilt, maybe acceptance at some point. The five ways of grieving are ways of marching through it all.
For example, one way is to Memorialize. When I refused to give my father's things to consignment, chose to inventory it all with Excel, put items up on Ebay, wrap and mail them myself, participate in the neighborhood yard sale ($1600 bucks!) this was a way of Memorializing my father. With every sold chackha (sounds like got'ch'kuh, or Kafka, hard ch) I could say, He invested in this. Now she (mom) gets something out of it.
There are other ways to grieve. FD would probably Normalize, put it all in perspective. The deceased (pick any deceased) was really old and really sick and now he's out of his pain, and he would have liked those eulogies. Or:
Then there are those of us who can't do that, can't Normalize, who think: Death is really not normal, nothing about it is normal except that we all will die.
If anyone in my family had spare cash, or chose to raise huge sums to cure heart disease or arthritis, or any of the other illnesses that afflicted my father in his lifetime, this would be Activism, another way of grieving. Mothers Against Drunk Drivers grieve as Activists. Many moms in this club have lost a child and crusade to protect other mothers from the same affliction-- loss.
People who turn to answering the Big Questions in Life, who find that now they need meaning, understanding, spirituality, perhaps a way to explain a sudden, untimely death, are called Seekers. They turn to the holy books, consult rabbis, even people like me, for an explanation and meaning. Their previous carnations feel transparent.
And finally, when grief isn't resolved, when it shatters the psyche, sets us pathologically adrift, shatters our world view, rips our very selves from our bodies, we become vulnerable to grieving as Nomads. Losing a parent as a young child can do this to us. It's like losing such a huge piece that we can't be in the same room with everyone else because they all have their pieces and we don't. So we literally rove without seeking, rather we coast, float through the years. The ones who turn to alcohol, sex, and drugs after a loss fall into this box, this way of grieving.
Therapists see a lot of Nomads. Some call what we see unresolved grieving, others call it complicated.
Cheryl represents the classic Nomad. She lost her brother Allan in the North Tower 9-11 terrorist attack. Twenty years his senior, having parented him since his birth (I can't recall the details in the book, maybe they were orphans), the news of Allan's death hit her as if she had lost a child.
But because Allan had married Judy just the year before, authorities contacted her, not Cheryl, with tidbits of news. Judy would be the one to hear that a bone matched Cheryl's DNA, for example. As his sister, not his wife, certainly not the mother of Allan's fatherless newborn child, Cheryl fell into the last to know about anything Allan-related category. Similarly, condolences, letters, settlements, media interviews-- all attention escaped her. Disenfranchised, this is called.
Disenfranchisement is quite common according to grief researchers. The disenfranchised are lovers, very close friends, colleagues, nieces and nephews, siblings. They are unacknowledged, sometimes even avoided after the death of a loved one. In Cheryl's case, perceived as independent, not needy, nobody visited her. No one took care of her in her grief.
This used to happen fairly regularly when sexual minority persons lost a partner. The deceased's parents called dibs on grieving and burial rights, relegating a partner to persona non gratis for lack of a marriage license. Perhaps this is changing.
What moves me most about the topic of loss is the idea of attention. A part of grieving is wanting to isolate, to be left alone; and a part finds the loneliness, the isolation, unbearable. And there is a need to be nurtured, cared for, even fed. A need for hands-on attention. The Nomad, Cheryl, needed that,
Another way of grieving, not mentioned specifically in the big five, is ritual. Ritual grieving that lasts longer than a few days, or one week.
A few weeks ago my rabbi lost his mother. The following week, after the shiva,* he delivered a public eulogy, talked about his mother and what it was like for him to be a mourner. He told us that during usually during shiva people visit and some bring food, not just a Jewish thing I understand. Then the official week of sitting shiva passes and you have to follow a litany of rules (certainly a Jewish thing), mainly things you cannot do for a full year, and things you must do for a full year, like praising the One who took your loved one, three times a day. Some of us ask someone else to go to the synagogue, to pray by proxy, to be sure it is done, the Kaddish, the prayer of praise.
And while everyone else is dancing at weddings, buying new clothes, listening to music, living, you stay home and putter around the house. It feels right, separating yourself, but you do feel alone. And that, the Rav says, is the point.
therapydoc
P.S. This post has absolutely nothing to do with my break from blogging! It just occurred to me that some people might think so.
*Shiva marks the seven days following the burial of a Jewish person. During this time the children of the person who has passed away, the siblings and spouse, aren't supposed to go to work, or cook for themselves. Rather they stay home and are comforted by visitors.
"Did I wake you?" she asks, concerned. Nobody likes waking anybody.
"No, I was reading."
"I woke you, for sure."
"Seriously. I was reading." She looks at me in disbelief.
"Look. Here's the proof. I'm reading two books at once." I point to the books on the floor.
"How can you read two books at once?" she challenges me.
"I read a half-hour of one, get bored, pick up the other, read awhile, get bored, pick up the other." I thought everyone did this. One book is a novel, the other is The Five Ways We Grieve, by Susan A. Berger. For sure a summary of her Harvard dissertation research.
"I almost didn't even start this one," I tell my friend, pointing to Berger's book. "Because I hate anything that minimizes the topic to numbers like five. But her publicist sent me the book to review, so I felt obligated to at least start it. And the work is solid qualitative work, well done, and she really did find five themes, five ways that people grieve. She summarizes the literature well enough, makes sense, and teaches with examples. Who doesn't like examples?"
She agrees, lets me steer away from the topic. "Tea?" she asks. You have to love psychiatrists.
If she had asked me for more, I would have told her that the way of grieving that we focus upon in therapy, the emotional kind, doesn't even get top billing in the book. Grieving isn't the issue so much as the way a person manages life under the influence.
There's an assumption that there will be sadness, anger, denial, guilt, maybe acceptance at some point. The five ways of grieving are ways of marching through it all.
For example, one way is to Memorialize. When I refused to give my father's things to consignment, chose to inventory it all with Excel, put items up on Ebay, wrap and mail them myself, participate in the neighborhood yard sale ($1600 bucks!) this was a way of Memorializing my father. With every sold chackha (sounds like got'ch'kuh, or Kafka, hard ch) I could say, He invested in this. Now she (mom) gets something out of it.
There are other ways to grieve. FD would probably Normalize, put it all in perspective. The deceased (pick any deceased) was really old and really sick and now he's out of his pain, and he would have liked those eulogies. Or:
Everyone has to dies sometime, we should really appreciate life.My brother and sister-in-law, who put my father's affairs in order, a monumental, ridiculously complicated task, returned life to normal. Turned chaos into sums.
Then there are those of us who can't do that, can't Normalize, who think: Death is really not normal, nothing about it is normal except that we all will die.
If anyone in my family had spare cash, or chose to raise huge sums to cure heart disease or arthritis, or any of the other illnesses that afflicted my father in his lifetime, this would be Activism, another way of grieving. Mothers Against Drunk Drivers grieve as Activists. Many moms in this club have lost a child and crusade to protect other mothers from the same affliction-- loss.
People who turn to answering the Big Questions in Life, who find that now they need meaning, understanding, spirituality, perhaps a way to explain a sudden, untimely death, are called Seekers. They turn to the holy books, consult rabbis, even people like me, for an explanation and meaning. Their previous carnations feel transparent.
And finally, when grief isn't resolved, when it shatters the psyche, sets us pathologically adrift, shatters our world view, rips our very selves from our bodies, we become vulnerable to grieving as Nomads. Losing a parent as a young child can do this to us. It's like losing such a huge piece that we can't be in the same room with everyone else because they all have their pieces and we don't. So we literally rove without seeking, rather we coast, float through the years. The ones who turn to alcohol, sex, and drugs after a loss fall into this box, this way of grieving.
Therapists see a lot of Nomads. Some call what we see unresolved grieving, others call it complicated.
Cheryl represents the classic Nomad. She lost her brother Allan in the North Tower 9-11 terrorist attack. Twenty years his senior, having parented him since his birth (I can't recall the details in the book, maybe they were orphans), the news of Allan's death hit her as if she had lost a child.
But because Allan had married Judy just the year before, authorities contacted her, not Cheryl, with tidbits of news. Judy would be the one to hear that a bone matched Cheryl's DNA, for example. As his sister, not his wife, certainly not the mother of Allan's fatherless newborn child, Cheryl fell into the last to know about anything Allan-related category. Similarly, condolences, letters, settlements, media interviews-- all attention escaped her. Disenfranchised, this is called.
Disenfranchisement is quite common according to grief researchers. The disenfranchised are lovers, very close friends, colleagues, nieces and nephews, siblings. They are unacknowledged, sometimes even avoided after the death of a loved one. In Cheryl's case, perceived as independent, not needy, nobody visited her. No one took care of her in her grief.
This used to happen fairly regularly when sexual minority persons lost a partner. The deceased's parents called dibs on grieving and burial rights, relegating a partner to persona non gratis for lack of a marriage license. Perhaps this is changing.
What moves me most about the topic of loss is the idea of attention. A part of grieving is wanting to isolate, to be left alone; and a part finds the loneliness, the isolation, unbearable. And there is a need to be nurtured, cared for, even fed. A need for hands-on attention. The Nomad, Cheryl, needed that,
Another way of grieving, not mentioned specifically in the big five, is ritual. Ritual grieving that lasts longer than a few days, or one week.
A few weeks ago my rabbi lost his mother. The following week, after the shiva,* he delivered a public eulogy, talked about his mother and what it was like for him to be a mourner. He told us that during usually during shiva people visit and some bring food, not just a Jewish thing I understand. Then the official week of sitting shiva passes and you have to follow a litany of rules (certainly a Jewish thing), mainly things you cannot do for a full year, and things you must do for a full year, like praising the One who took your loved one, three times a day. Some of us ask someone else to go to the synagogue, to pray by proxy, to be sure it is done, the Kaddish, the prayer of praise.
And while everyone else is dancing at weddings, buying new clothes, listening to music, living, you stay home and putter around the house. It feels right, separating yourself, but you do feel alone. And that, the Rav says, is the point.
therapydoc
P.S. This post has absolutely nothing to do with my break from blogging! It just occurred to me that some people might think so.
*Shiva marks the seven days following the burial of a Jewish person. During this time the children of the person who has passed away, the siblings and spouse, aren't supposed to go to work, or cook for themselves. Rather they stay home and are comforted by visitors.
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Rabbi Zev o nce told us that a rabbi, a Jew, has to be ready to go to a funeral and then a wedding on the same day, maybe within a few ...
