Friday, September 29, 2006

Getting Out of Abusive Relationships, Teri Hatcher and People Pleasing

This piece is not just about Teri Hatcher, it's about all kinds of controlling, exploiting, difficult relationships that make people want out.

Those of you who read Vanity Fair's spread on the actress having confronted the man who sexually molested her in childhood probably sighed a variant of the Yiddish sigh, chaval.

Chaval means. . . well, it's hard to explain. "What a shame" hardly cuts it, but comes close. "OMG" also comes close. But chaval really has to be said with pathos and a tad of disgust, and that's what's sad about saying it. You almost have to say, "Oy. . .(pause, smirk, sigh). . .chaval."

For those of us, and there are many, who learned about our body from someone who had no permission to touch it, Ms. Hatcher's story packs a punch. She came forward to the police with her story when she heard about another young woman the perpetrator had molested.

That young woman killed herself. He had other "lovers," too, apparently. Teri wanted him put away.

Children who have been sexually abused can be bullied into not saying anything and usually are intimidated in that way. There are tomes on what happens psychologically to them, how their future relationships are doomed or frought with problems, how their sexuality becomes the center of their psychology.

When I went to graduate school, we were taught that if you had a sexual abuse case it was a BIG DEAL. The patient (victim) would be on the couch for years. Now the incidence is so high that the profession's rife with good family therapy interventions, confrontation one of them, but only at the right time.

Incest and sexual abuse are still a big deal. The police and the courts are more savvy now, however. The child only needs to tell the truth and the healing begins. There are advocates and therapists all over the place. Just get the job started.

The question is, What keeps adults who have been abused from doing what Teri did, from speaking up? And why did she wait so long? Why do people who are being exploited in relationships not extricate themselves from the situation immediately? What keeps them from GETTING OUT?

I think the same dynamics, the reasons for not shouting out, operate in all relationships that are characterized by domination, abuse and/or control.

Let's digress from sexual abuse and take a look at less obviously violent relationships, those in which anger is always just below the surface, those in which speaking up or confronting a spouse, perhaps, or a parent, feels like it risks a put down or a sarcastic remark.

Or perhaps emotional neglect, when a person's need for validation and approval isn't met or when that individual is denied the power to make basic decisions.

In the case of sarcasm or verbal sniping, the receiver hears he/she's "responsible" for the anger. In the case of emotional neglect, they're "responsible" for their own lack of power, too incompetent to make decisions.

A person (let's use the female gender) begins to doubt herself and her worthiness over time. She thinks perhaps she doesn't really doesn't need the things she thinks she needs, after all. She only needs what he says she needs. She is under the influence. His influence.

It may translate into that famous of all couple therapy bug-a-boos, control. He has control issues.

Sometimes it gets pretty ugly. He controls the movies they see. He controls their vacations (his family can go with them, perhaps, maybe ALL the time). He controls the money, won't let her spend money she herself has earned. He can do that because he's convinced her that it's a selfish thing to do, they need to save.

Once he's convinced her that she's selfish for having material needs, he controls whether or not they buy a second car. He controls whether or not they go out and have drinks with friends. He controls whether or not they go out at all and with whom.

He controls whether or not they have sex. He controls whether or not they buy TIDE over the store brand. If she argues, he convinces her that she's selfish. He's the one with the common sense in the family. He's the one who can make good decisions.

She loses the part of her that went into the relationship with self-esteem. It gets buried, EVEN IF SHE HAD IT BEFORE THEIR RELATIONSHIP BEGAN.

This becomes another example of what you don't use, you lose in relationships. If you don't use decision making skill, you're not validated for making good decisions, you doubt you know how to make them.

How can you leave a relationship under those circumstances? Do you see where I'm going? It's hypnosis, basically. She's too unsure of herself to make a move.

At home, and on the job, out in the world, to get that part back, to be validated for the person she remembers she is, she works harder than anyone else and does more than anyone else, but she's still insecure.

This can be the essence of people pleasing. Living to please; living for praise from others. Sometimes people like this work so hard that they falls into a very well-defined category of depressed people that I am compelled to advise, Okay I think I want you to take some family leave time off work, people who have crashed and burned from overcompensating on the job.

These people NEVER WANT TO TAKE FAMILY LEAVE! They're my favorite people. You guys are my favorite people and I die for you to get out from under the influence, to break the spell.

Sometimes getting out from under the influence is simply taking back one's life, saying no, doing what you want. Most controllers can't fight it when their passive spouses assert themselves. They're too weak themselves at the end of the day.

IF THEY'RE PHYSICALLY ABUSIVE, however, these men are dangerous and their wives know that they had best not rock the boat.

BUT IF THEY'RE EMOTIONALLY or VERBALLY ABUSIVE then the women who are married to them have already lost the shred of self-esteem that might enable them to bark back.

That barking back won't happen without intense professional coaching and scripting. I've talked to hundreds of women who found it almost impossible to say:

"When you talk to me that way I don't love you. When you talk like this you're unlovable. I want to love you but you're unlovable when you behave this way. I want to love you. Please stop. You know you don't mean it. Inside, you love me."

How HARD, (expletive it) is that? It's pretty darn hard to get words out when you've been convinced that he's going to turn it back on you, no matter what you say, make you feel worse.

To come forward, to assert, to stop the violence is to risk hearing that you're a slut, that you didn't object, that you LIKED it, that you encouraged it.

It draws attention to times that you would like to forget. It makes you feel like damaged goods and worse, THAT OTHERS THINK YOU'RE DAMAGED, SCREWED UP, SOMEHOW NOT WHOLE ANYMORE.

Chaval. It should never happen. No one should have to go through abuse or exploitation. If you recognize it happening YES, YOU NEED THERAPY, YOUR RELATIONSHIP NEEDS THERAPY, HE NEEDS THERAPY (check all three).

And if it's not workable and you know it? Just need to get the blank out. You can pick up the pieces later.

Good job, Teri.

Copyright 2006, Therapy Doc

Tuesday, September 26, 2006

The Comisky Wound

I haven’t been to the South Side to see a Chicago White Sox baseball game in a long time. When I was a kid the White Sox didn’t play at U.S. Cellular. The South Siders play Comisky Field. Same place, different name.

As a North-Sider and a Chicago Cubs fan, the White Sox, didn’t matter to me. Too far away. We just didn’t go down to the South Side to watch the Sox. The South Side was not only out of bounds, too far, but could have been too “dangerous.” After all, white flight flew north, not south in Chicago, to the northern suburbs. I lived in the most Jewish of them all, Skokie.

A little shuttle train to the city enabled my brothers, friends and me to take the Howard Street L, an elevated train, directly to Addison Street, a North Side stop. We got off at Addison and there was Wrigley Field, tall and proud, home of the Chicago Cubs. Five bucks and we’re in the gate.

It was that or stay at home and watch the game in black and white on WGN, Channel 9. I could quote batting averages of greats like Ernie Banks, Billy Williams, and Ron Santo back in the sixties, and sure, collected baseball cards.

Almost twenty years ago, married with children, I determine it’s time to reward Bobby, one of my four boys, for something or another, probably for reaching 20 points on the ever-present behavior modification "point system" on the refrigerator.

So I buy some tickets to the White Sox/Blue Jays game, not so much for the Sox, but for the Jays. I don't know why, but Bobbie loved the Blue Jays, not the Cubs, not the Sox, neither Chicago team. He probably liked the bird.

We leave Bobby's twin brother Ricky to baby sit our youngest, Sammy, who is about 4 at the time. I think my instructions to Ricky went like this:

1) pick up Sammy at camp
2) take him the park to play
3) take him home
4) eat the dinner that I left you
5) don't burn down the house.

These were the usual instructions.

We take off for the game in the car (you can take the train, but it’s a long ride from where we live in the city), but I’m worried. Ricky is only 11 and Sammy is my baby. It wasn't that I didn't trust Ricky to baby sit a four-year old. It was just that as a working woman I'd had a literal army of babysitters. My experience leaving the kids with kids hadn't been the greatest. They tended to leave me with no vodka at all.

And Ricky was still a kid. But I had told myself and my spouse, FD, that this would be okay. I could deal with a baseball game. Bobby deserved it. Ricky could handle Sammy. We'd be home before too long. The neighbors knew to check in, and FD wasn’t in China, he worked only five miles away.

So the two of us are off to Comisky Field and we get there in one piece, park and find our seats. I’m unimpressed and already regret going to the game. The Sox are not my team. I simply don’t care about baseball, not really, not anymore. I have no interest in drinking beer, like most people, to assuage the boredom. There are no big TV screens, no electronic banners, no bells and whistles. And Bobby doesn’t seem so Tom Terrifically interested.

These are not cell phone days, by the way. Nothing to play with. I wait until Ricky and Sammy should have been home from camp and the park, maybe it’s the third inning, and leave Bobby to find a pay phone to call home. The public phone, since we’re so high in the bleachers, is near our seats.

The phone rings, rings, rings.

It rings and rings.. They aren't home.

Or they were home and have been slaughtered by the home invader. (I have a repeating home invader dream about once a year, never know when it’s coming on, am convinced now, that this is why).

Being a rational-cognitive therapist (among my many beings) I know I must counter these thoughts if I am to survive my anxiety. But I can’t convince myself that the possibility of home invasion is remote. Maybe there was a home-invader. Without proof, who knows?

I call a neighbor and she checks the house, returns to the her telephone to say, "They're not answering. It doesn't look like anyone's home."

"Did you see any home invaders perhaps?"

"Uh, no."

I return to my seat and say to Bobby, “They're not home."

"Oh, I'm sure they're probably over at the Levitt's."

The Levitts! They live near the park! I call the Levitts. No, they aren't there.
I call home. No answer. The phone rings and rings and rings.

Forget countering negative thoughts. The boys have been kid-napped, obviously. I have the worst panic attack in years, have forgotten what a panic attack is like it has been so many years, but even now I can feel this one in my chest remembering it.

My thinking on this, just so you should know, is that if you don't have true panic disorder, but you do suffer occasional panic attacks, with a little searching you can remember them all. I remember them all. I ask myself is these are like the snapshot memories that some prostitutes have, the ones I’ve treated who say they remember every trick.

This panic attack is terrible. My heart is pounding, I can’t breathe. I’m weak in the knees and feel like I’ll pass out. I’m was sick with anxiety, and try to protect Bobby from catching it. Knowing that it’s just anxiety doesn’t help, either.

I jockey between the pay phone and reporting back to Bobby, trying desperately not to panic him. He notices that I’m upset and he is upset, which upsets me more. .

At some point I say, "We're going home."

No argument there. But before we go, obsessively I say, “Let's make one last call for the road.”

Ricky picks up the receiver. These are land phones we’re talking about.

"Where in the world have you been? Are you okay? Is Sammy okay?"

"Huh, yeah. We're okay. We're eating."

"Why didn't you answer the phone? How long have you been home? I was sick with worry about you guys! Where were you?!?"

"We were over at Gershon's house, the Russian kid. We were playing video games in his basement. We lost track of the time."

"Oh. You're sure you're okay?"

"We're fine."

"Why didn't you go home?"

"I thought we'd just stay for a couple of minutes, play a few games and go. I lost track of the time. Sorry."

Never mind that he broke the rule on video games. We didn’t do video games, even then, no Nintendo especially. Not in our house, shunned television, even, and our kids admitted, years later as young adults, that their grades were better, probably because of that. Outside the house, we surrendered.

Never mind that Gershon wasn't on the list of things to do.

They were safe.

"We can stay if you want," I tell Bobby. "We can finish out the game."
But the game is ruined; he wants to go home.

All in all? Not a good memory. Not a feel-good night for the fam, and I stayed away from Comiskey Field, now US Cellular, for many, many years, too traumatized to go back. And anyway, if I’m going to watch two teams play baseball. One of them is going to be the Cubs.


Critical events, risk, and the Chicago White Sox

Critical events are happenings that instantaneously wrest our psychological development from the doldrums, jolt us into growth and differentiation, or potentially retard it, slow us down.

When critical things happen we know we have to talk to someone, a mental health professional, or that eventually we’ll have to work it out. Like we flunk out of school. Or we hear someone has died. The sheer jolt is confusing and the brain just can't do it alone. A critical event can be traumatic, the stuff of posttraumatic stress, recurring memories, intrusive thoughts, and nightmares.

But it doesn’t have to be. A critical event can be benign, too.

You might remember the letter that says you got into college, or the one with your ACT or SAT scores, having a baby, getting your first raise. The jolt applies to finding a new best friend, running the 50 yard dash in under 6 seconds, smoking your first joint, drinking your first drink (alcoholics can tell you the date, time and place), getting your first pet.

All the firsts. . .

First funeral, first car wreck, first prom, first day in prison, first apartment, first day away from home, first bunk at summer camp, first boyfriend, girlfriend, first time having sex, first marriage, first guitar, first time on Letterman.

Psychologists call them snapshot memories. I think of an enormous pop of the light bulb those professionals photographers used before digital became so powerful.

Maybe not all firsts are critical events, and certainly most people don't go to therapy for firsts. They do shape us, however, and serve to divide up our memories, block out the timelines of our lives.

I think of my mother blocking out a sweater, deliberately shaping the heavy wool. Not everyone takes things to the dry cleaners. Some people use Woolight and coax a heavy sweater into shape on a thick towel so that the shoulders don't look funny like they would on a hangar. No, there's no real connection, sorry.

So firsts are good, and they're part of the reason therapy docs are always encouraging us to take small risks, to live a little, push ourselves to do things that are probably good for us, even though we’re scared out of our trees.

New experience is expansive. Action builds self and confidence.


I personally can't stand crowds. The thought of going to Comisky Field, (it's hard to remember that now it's U.S. Cellular ) to see the Chicago White Sox terrifies me. And it's easy to avoid. You just don’t go, save a lot of money.

Last summer FD asked me to please come with him to a Sox game. I hadn't been to one in about fifteen years, had a bad experience that time.

But he begged. Please, honey. I have great tickets. It's our anniversary. Barry and Alex are going (his brother and our nephew, St. Louisans, Cardinals fans). When do you even get to see them? What're you going to do, stay home and watch TV? (Well, yeah).

So I caved.

We approached U. S. Cellular and the traffic got congested. We weren't exactly sure where to get off the expressway . Being late, being lost, this particular anxiety doesn't really throw me, I like exploring. Of course the parking lot was full and the officious-looking traffic people pointed us to a line of cars that edged forward six inches every half hour, going nowhere.

FD somehow made the perfect right hand turn to get us back to State Street where there was parking at the Illinois Institute for Technology. I love architecture so I this was a good thing for me, getting a bird's eye view of a new neighborhood, a new college campus. All my life I assiduously avoided the South Side, being a Cubs fan, and all. The Chicago Cubs are a North Side ball club.

Boy, there were a lot of smiley people going to the Sox game, mostly young, confident people familiar with this world. Or so it seemed to me. Only I was out of my element. But okay, I was cool.

We got inside Cellular and because we had these great seats (thanks to a friend with season tickets-- thanks Stewie) we didn't have to push our way through any crowds. Barry and Alex were already there and my son, I was told, had already stopped by. He vends.

This is the real reason I went to the game, is the truth. I wanted to see him in action before he left home for the year in September. Lemon freeze. Get your lemon freeze.
I took a picture of him and put it up in our front hallway. He’s in his vending jersey. It was a real snapshot memory, with a real snapshot.

Being at the game was unbelievable. They pumped me full of beer (one beer is full of beer, okay, it was 16 ounces). The Sox must have scored 14 runs, and each time, a dream come true for a child at heart, they do fireworks at Cellular!

And the visuals! They have these enormous television monitors broadcasting the game, and moving electronic banners that light up the lower and upper decks. The crowd is insane, their exhilaration palpable. Who doesn't love exhilaration?

And the Sox beat the Cardinals! The Cards are mortal enemies of the North Siders, arch enemies. They always cream our Cubs. But FD and Barry, and Alex, all from St. Louis, are routing for the Cards, and although I don’t like the White Sox, particularly, although hold nothing against them, they beat the Cardinals and that’s good enough for me.

I didn't even have to stay for nine innings because my guys couldn't stand watching their team get whooped. They had had quite enough by the 8th inning. Oh, and yes, I was ready to get out of there by then. Quite enough exhilaration for one night.

The next day I could tell everyone who would appreciate it that I'd been to a Sox game! Those who got it nodded appreciatively.

Honestly don't think I'll ever forget it and am a much bigger person now. I have more to talk about, can join into a conversation about baseball, and I can almost relate to the sport enthusiast thing. Well, not really, but almost

The Sunny Side of Therapy :) :) : ) :) Positive Psychology

This is an FYO on a popular news item in today's Wall Street Journal.

There's a feature story called, "The Sunny Side of Therapy." It's about focusing only on the positive, a person's true resources, strengths, etc. I was surprised the article didn't refer to "blessings."

Now you know I'm a pretty positive person, but I just have to tell you.
This is bunk with a capital B.

It's all well and good to try to stay there, to try to stay happy and to think pleasant thoughts. I heartily recommend it and in family therapy whack bubble bursters over the head with a newspaper (WSJ?).

But when a person is suffering from depression or any of the disorders in the DSM-IV, for that matter, it's going to take a lot more than positive psychology to get well.

Positive psychology is nothing new. Therapy docs have been relabeling problems for years, ever since family therapists (plug, here) found that symptoms were functional for people. People like their symptoms. They not only get attention for them, but they communicate with them.

Even support for "everything's relative" has been around for decades. Broke your ankle? At least you didn't break both. (thanks Y.)

It's actually good to pick yourself up, brush yourself off, and start all over again. Once you can.

Real therapy, good therapy gets in there and resets the bones, cleans out the infection. It requires a little more than applying a Band-Aid.

Those snake oil salesmen made it all up to advertise in the Journal.

There. I've said it. Have a happy day!

Copyright 2006, TherapyDoc

Monday, September 25, 2006

First steps to treating rape-and a therapy story

I wrote this one to show you how badly I can blow a case, and to make suggestions to increase the odds it won't happen to you.

You people know me as therapydoc, but I do research and have a faculty appointment, too. One day I took a call, expecting it to be a client, but it was the dean asking me if I would please take on a funded project. There is this small problem, she tells me, of acquaintance rape.

Ultimately a new agency to treat college rape survivors off campus gets off the ground because of the project, and I get a paper out of it, present it to the annual meeting for the Council on Social Work Education.  It's about how social workers should be treating rape.

But the following story happened years before, when all I had to go on was my fairly extensive knowledge of cognitive behavioral and exposure therapies for anxiety and post traumatic stress.  I had used these tools for all kinds of abuse and assault, even for rapes that had happened in the past.

So I'm thinking I'm good talking to a rape victim, someone freshly violated .  Dispassionately, quietly, she tells me, "I was raped over the weekend."
Tell me everything.
"It was right outside your office, across the street at the park on Saturday night. I had parked my car on the street and left a party around mid-night. I saw a man in the car parked behind mine. Before I got into my car and knew what was going on, he grabbed me and pulled me into the park and . . ."

How awful. Did you report it?

"No. I was very embarrassed and I guess, shocked. I was a virgin. I just wanted my mother. I went home. We wanted to keep this private so we came to you for help. The insurance company said you could help me. You know this."

Uh, huh. I know a little. Do you mind telling me the story again? Try to remember everything.

She tells the story again. I am treating this like other trauma or crisis, going over the story, not because I care about the grisly details, but for the healing and warmth, the retelling in a safe place.  I think she'll suffer, this will haunt her, she will have nightmares, and want to warn her of this, begin the exposure therapy immediately, rather than get to know her as a person.  So I objectify her, too, treat her from the book.  I haven't even heard of Rape Trauma Syndrome, something unique, needing something different.  It's not in the DSM.

Assuming that there is meaning in the madness, the mandatory telling and retelling of the narrative, there is theory behind exposure therapy.  Flood the brain with details and it will tire of them.  People who haven't been raped retell silly stories to their friends about things that upset them, then tell them again to others, then retell them to friends-- and the stories are infinitely less traumatic. Somehow there's mastery in the retelling. We feel more control over the situation

I not only tell people to retell stories, but if they are traumatic, we'll do the retelling under very controlled circumstances, bit by bit, over many sessions, for cognitive exposure.  The cognitive in this type of intervention is a way of saying imagined, or visualized, in the brain. That's how therapy is, sometimes, very purposeful, behavioral.  And this helps quite a bit, structured technique.  Add a little EMDR, and you're golden.

Like I said, I'd done all kinds of cognitive behavioral therapy for trauma victims, and there's more than retelling.  We might do a rewrite of a trauma, for example, then repeat the rewrite over and over again in sessions. Sometimes the victim of an assault will bring in a friend or trusted relative and we'll talk about revisiting the scene of the crime, repeatedly, to allow the brain to integrate the idea that in fact, the perpetrator is no longer hanging around.  This type of therapy is useful for any type of assault.  It's useful for kids, too, who have been beat up, bullied.

But rape.  Treating rape.

Wrapping your head around so much stuff, you can't rush it, and sometimes all of that work does nothing to counter the idea that the perpetrator will come around again, eventually.

Rape can be devastating. It can affect a person's emotional and physical health (and will). Reproductive problems or pregnancy, sexually transmitted disease, broken arms, bruises, tears, concussions, even death happen. Emotional symptoms include depression, anxiety, sleeplessness, intense fear, flashbacks, nightmares, suspicion, hyper-vigilance, isolation, irritability, lack of concentration. Socially things can go crazy—victims hide from everyone, stop going to school, lose jobs. 

All of the above and more are consequences of rape.

This is not a short-term therapy.

I have to admit, when this young woman came to see me, I didn't know enough because I knew nothing about Rape Victim Advocacy.

If I had referred this young woman to a victim advocate program or had worked closely with one at the time, she might have continued her treatment, perhaps joined a support group, worked to become a survivor, to help other victims become survivors. 

Who knew?

Rape victim advocate agencies are state funded (in Illinois, relatively well funded at this first writing in 2006) and employ individuals who have often experienced rape themselves, who may have had therapy, surely had support and advocacy, and are now able to work with victims to empower and transform them into survivors.

Advocates call their clients frequently after the first contact, worry about them when they don't show up for appointments, ensure legal advocacy and medical intervention. In other words, they go the extra, extra mile.

Sure rape victims can use therapy and will need to recover from the physical-emotional onslaught they experienced. But I have to say, seriously, based upon my own knowledge and my experience treating that young woman four years ago, that this trauma calls for more than therapy. My client didn't return after the second visit.

Rape victim advocates are the best first step. All kinds of docs need to know this, not only therapists and psychiatrists, but primary care physicians, Ob-gynes, everyone. Get the word out.


Thursday, September 21, 2006

Why I relate to you and Self-disclosure

Sometimes people ask me if I've gone through what they've gone through. "You seem to get it."

I sort of do, usually, but flip it back, of course.

"Uh, my actual experience doesn’t matter much, this is about your life."

Fact is that I can personally relate often enough, having been on the planet quite awhile. I "get" the things that trigger emotions. And I'm more than okay with my own rich, emotional life, my own wide range of emotions.

But therapy's for the patient, so my stuff generally stays with me, except to admit to having that range. Emotion is so real, it let's us know we're alive.

Therapists are trained to self-disclose, however, under rare circumstances, circumstances in which sharing can be considered supremely therapeutic. I’ve got a few stories that I use in those “circumstances” and will pitch some on this blog some day. One in particular's about affection, and how we all loosened up on that one in my family.

Anyway, shrinks hold that patients should see what they want to see in us, which may have nothing to do with reality. That’s called transference, seeing things in people that really coming from inside ourselves. Some therapists spend years with patients sorting that stuff out. Family therapists talk about transference, too, just not so much. Well, I don't.

But I digress.

Even though the therapy’s not about me, really, I can’t help but wonder, when we look each other in the eyes, when we’re together and we’re both tearful (I blink back on command) how much my patients just do seem to know me , better maybe even, then some of my friends and family.

They get that look that says: We know one another, I can so freaking trust you.

Therapy is VERY intimate.

Is that why therapy docs go into it?

Maybe some, not me. In 6th grade the teacher asked the class what we wanted to be when we grew up.

I said a psychiatrist. She raised an eyebrow. Wow. That teacher just looked at me like, IS THAT EVER COOL OR WHAT?

She was probably thinking: This kid has issues.

There’s some research out there that people who go into the mental health professions are either care-takers or they’re looking for the answers without having to admit that they need therapy.

I was in therapy in my late adolescent years (don’t wait that long, peeps) and it was exactly what I needed. And I went again at some psychotic place in my adulthood and have absolutely no idea what that was about. No lie. (I wasn’t really psychotic, okay, you can relax.)

Then in this training that we social workers and PhD’s have to go through to actually be safely entrusted to shoulder your woes, there was still more self-reflection and supervision and talk of:

PERSONAL INTERFACE THAT WILL SCREW UP YOUR PATIENTS. Just writing that makes me anxious. My pulse still goes up. How much interface is too much? What if I had/have a LOT of issues?!?!

It is something a doc really does have to have under control and it really is important. Yeah, mine are, by the way. Un. der. con. trol.

But maybe it’s true that for some of us, having lived life, having suffered through a few traumas, having married, birthed and raised children, having had to become aware of our own personal anxiety, depression, addictions, obsessions and faults, having lived has made us better therapists. Living has toned up our capacity for empathy.

Yet being able to see beyond our lives, looking at yours as distinctly different, special, unique, NOTHING LIKE ours yet somehow still so marvelously human and pure and meaningful, this is what makes us good docs.

We appreciate you for being you and only you. And all we care about, when you're sitting across from us is you.

But you knew that, I think. I sure hope so.

Copyright 2006, TherapyDoc

Wednesday, September 20, 2006

The Jewish New Year- Rosh Ha Shana

I’ve never once on this blog pulled out the religion card or talked about mine or preached it in any way or even alluded, I don’t think, to being observant. But I am, okay, so don’t call me this weekend. (I never picked up on Saturday, anyway, if you hadn’t noticed.)

But what the blank, it’s my blog, and you guys say you want to know where I’m coming from. So just this once I’ll share about the religion. And that’s it. This is it. Probably. Here goes.

Not working on a holiday is a no brainer. So I'm not working this weekend in observance of the Jewish New Year, Rosh HaShana. Someone else is on call for me. But notice that I said in observance, not in celebration of the new year.

It’s a funny thing, being Jewish. Rather than revel in the possibilities of starting over, the Old Lang Sein thing, rather than drinking and partying, we start out terrified, or at least that's how we're supposed to start out. Joyful, but insecure.

(This year, 5767, by the way, starts on Friday evening, Sept 22 and ends Sunday night, Sept 24)

The idea is that on the first two days of the new Jewish calendar year the whole world is in limbo while G-d considers our future. EVERYBODY'S FUTURE THIS COMING YEAR.

I’m not going to go into the whole Master Plan thing because I haven’t a clue what it is.

But we’re taught that the destiny of every human, every animal, every tree, every sprout, everything is determined on these two days coming right up. The Creator will write us into a book of life if we play our cards right. Or not.

The book is sealed on the 10th of the month, on Yom Kippor, at the end of 25 hour fast of Atonement. It's a real fast, no food, no drink. And that’s the happy day, ironically, of the two holidays. The world's fate is sealed, for good we hope because of the fast. The fast isn't the only variable here, however. Prayer, charity and oh yeah, repentence are key.

So Jews get working on looking good in His eyes the month before the beginning of a new year. They look their innards over microscopically, fess up to their faults, make an effort to change or say they will with feeling, give a LOT of charity, apologize to people they’ve hurt, and pray tons.

So today I was on the train downtown, the Brown Line, if you must know, reading through a book of Selichot. The word means, Sorries. Salachti means I’m sorry.

It’s a book of prayers and poetry, in Hebrew with English translation. And as luck would have it, there was commentary in my edition.

I'm sharing, here, okay? If you’ve got the book it’s Selicha 13,but I don’t imagine too many of you have it.

Le’cha ekoneh ateret: The Artscroll edition I had printed the following commentary:

There is an angel . . .named Sandelfon. . ..who stands behind the Divine Chariot . . .weaving crowns for his Creator (Chagigah, 13b). These crowns are woven from the prayers of the righteous (Tosaphos-another source).

Rabbi Chananel said that this is the meaning of the Kiddusha, another prayer recited at another service, the Musaf:

A crown they will give you, oh Hashem, our G-d, the angels of the multitude above together, with Your people Israel, who are assembled below.

That’s what we’re up to when we’re observing this High Holiday, folks. We’re crowning a king. It's pretty cool. That's what this holiday's all about in the end.

Copyright Therapy Doc, 2006

Tuesday, September 19, 2006

Sex therapy, Boston Legal, and Aging

I don't watch a lot of television, but I do watch enough to feel guilty about it. (Ah, guilt).

One of the shows I like is Boston Legal, mainly because the actors are older than me.

I've watched James Spader (Alan Shore), Candice Bergen (Shirley Schmidt) and William Shatner (Denny Crane) perform in different things throughout my formative years, if you call late adolescence and young adulthood formative. I would.

Anyway, both Alan Shore and Denny Crane, successful lawyers, think about sex a lot. Not that there's anything wrong with that.

It drips validation to baby boomers, the aging middle-aged. Ever notice how young people aren't "aging"? What are their cells doing, anyway?

On the television show Alan and Denny are constantly communicating their awareness of the female body. Denny's pretty loose, touches, kisses every woman he sees, clearly maniacally hyper-sexual. (Shatner's marvelous. You almost wonder if he has bi-polar disorder he's so good).

Anyway,imagine our surprise to find that on the season opener Denny admits to having sex with a life-size doll, the likeness of Shirley Schmidt, his law partner. He's always hitting on Shirley, simply adores her. He uses this doll in a closet at work.

Alan also has issues, too, for he apparently has used the services of a sex surrogate, a professional, to get him through some kind of sexual problem, we're not sure what. He admits that his family was light on affection, as in, there wasn't any from Mom.

He makes a good case in court, by the way. Behavior sex therapy is preferable to pharmaceuticals like Viagra, even if the therapist is a surrogate.

So as a self-proclaimed Viagra hater, I was pleased. Read my post in the archives, unless I haven't written it. I know I wrote something about sexual intimacy and relationships in May or June.

At the end of the show the two men are having their a drink (ah, alcohol, America's favorite drug), half glasses of scotch (I guess it's scotch) on Denny's balcony and they're talking. The show always ends this way, the two on the balcony outside, drinking and philosophizing.

Alan has told Denny about his mom. Then he turns to Denny with full sincerity and asks, "Denny, do you ever get lonely?"

Denny thinks about it awhile. "No," he finally answers, and scowls at having had to think about this disturbing question. Then he tosses it back. "Do you?"

Alan, who is so sensitive and squeezable, without skipping a beat, perhaps having read the look on Denny's face says flatly, "No."

Why am I writing about this again?

Loneliness has been the theme of the week and it's only Tuesday night. More on that one soon.

Copyright 2006, TherapyDoc

Therapy Doc Being a Person on the Blog- Or Intimacy, Shmintimacy

So Mimi said:

Cut loose, (translate: get personal), Be yourself, or be someone else, be me. Or be someone else, you're anonymous on the web.

That’s what she thinks. I’ve already identified myself. And I couldn’t be her because she admits to being cranky and feeling like expletive all the time, which is fine, but one crank in the ‘hood is enough, so I’ll be me, relatively sunny. Still friends, right, Mi?

But she continues, Get naked.

Seriously. This isn't how I get. You may as well know.

Cut loose? Impossible. I’ve been a therapist so long that it is a HUGE piece of my personality.

And it can get me into trouble.

Here's what happened when one of my machetainistas first started to get to know me, about 6 months into the relationship. A machetainista is the mother of a son or daughter's spouse. The Yiddish is creeping into my vocabulary slowly, notice friends, as I get more intimate with you.

I had thought we were having this normal back and forth kind of a conversation. She must have complained about something, and maybe I even made a suggestion, broke the cardinal rule, nobody wants any advice unless they're paying for it.

But maybe all I did was comment, not give advice, maybe said, "Hmm."

In return, what do I get?


And I hadn't even begun, barely opened my mouth.

So this is why I don't talk much. Have to shut up both in therapy, where the patient's got the floor, and can't talk OUTSIDE of therapy, either.

(This all feels so narcissistic, seriously, writing like this, but fine a little more being personal.)

Anyway, it is hard for me to look at any subject, great or small, that is emotional, psychological, or social (even physical, if it has to do with emotion) and not see from my particular lens, too. I'm always working on seeing through yours, but I can't hide my education for very long, and not to brag, but there's a lot of education there.

And in a conversation with friends or relatives, even a therapist has to comment eventually, and it might just be a bio-psychological-social kind of comment. Maybe intellectual even. I can't pretend not to see what I see.

But that can be a problem socially. You can take the therapist out of the office but you can't take the office out of the therapist. The therapist is the office.

Picture a doctor in a coat room. The doc sees a guy who's about to pass out. This guy's going pale, breaking into a sweat, and the doc says to him, Hey would you mind passing me that coat on your left?

See, we're always ON, professionals. Your freaking worst nightmare is having me for a friend. I forget the me that isn't the office. It's very hard to share, not having done that for years, now. So I'm so out of practice.

This is complicated by my understanding that being intellectual, i.e., rationalizing, is a psychological defense. It's one of the more highly evolved defenses, but a defense nevertheless. Read into that whatever you want.

I see it like unless I can think of a good joke, I'm screwed. Sarelle supplies me with the best ones, one day she'll grow up and get a blog, and I can link you to them, and my father emails me a bunch of good ones from his friend Sammy, but I can never tell them right, jokes.

So no promises on the intimacy thing. The narcissism's killing me, that this feels incredibly narcissistic, but I'll work on it, Mi, the cutting loose here thing. It's not easy for a writer who's learned to be omniscient everywhere else.

Did you hear the one about the two octogenarians? One had recently married, the other said, How'd it go? The first one said, . . .

Yeah, I forgot the punchline, see?


Monday, September 18, 2006

Getting Personal

Nicest thing happened.

I hadn't pushed this blog on friends and family. Like I didn't tell anybody, You HAVE to read my blog, okay, and while you're at it would you PLEASE, PLEASE, comment?

I had too much dignity and it wasn't for them, anyway, it was for patients, for people who wanted a little psycho-education for their surfing efforts.

The extended family knew it was up there and either

a) had no time to read it
b) couldn't find it
c) had been been kind enough not to say anything (thank you), or
d) were terrified that I'd soon out them somehow. YES!

But for some unconscious (not) reason, Ihadn't pushed it on my friends, either. Not very much, really. My excuse again, this blog is to better explain concepts to patients and lay people, even budding therapy docs who don't know much about therapy, especially family and relationship therapies.

So why get personal, right?

That was what I told myself.

It's true that I also didn't want to hear people tell me they didn't get it, that I wasn't a good writer, didn't exactly teach what I'd wanted to teach. As a person who has had to edit so many drafts of papers written for journals, not to mention a dissertation (those are long, and formatting is exceedingly tedious), I know myself and know that there would be even greater temptation to waste even more time editing and re-editing entries if people actually gave me feedback.

But it's not been a personal blog because. . .well. . .like many people, I fear rejection. Fearing rejection is one of the top five reasons people avoid emotional intimacy. I have yet to post on one of the five reasons people avoid intimacy, but suffice it to say that rejection is at the top of the list. People are social animals.

Anyhow, an acquaintance of mine in the community DID get a look at the blog somehow and emailed me the following:

I like the blog for lay people who need to recognize issues and that treatment is available from a normal, . . person who is funny. But, as a professional person who deals with mental health issues every day of the week, I want to know what does Linda think. . . what is going on inside Linda's head as she hears things. I know what goes on in my head (or mostly I haven't the slightest idea of what is going on until I am driving home and re-thinking the day) and I'm too darn tired/cranky/bitchy to write about it. How does Therapydoc manage the stresses, sad stuff and downright awful things she hears? . . .you're what the reader wants to know about!

CRINGE, seriously, but thanks, Mim. On all levels. Made me think, always dangerous, but worthwhile.

Of course I tried to turn it on her, Mimi, you should start blogging. I'll read it and tell everyone else to read it, and bingo, you're a blogger! but it didn't work. She insisted that a blog needed the blogger.

So I ask readers. IS IT TRUE? Should I be doing this? Outing myself and everyone else in my ecosystem in the process? (Ha)

Okay. I'll think about it.

I have to go find a mask.

Copyright 2006, TherapyDoc

Sunday, September 17, 2006

Heroin and Being a Man

This is a nice story. It's more than nice because it teaches us the flip side of co-dependency.

Usually we think of a co-dependent as a person who is doing WAY too much for a dependent, someone who is clearly reaping the benefits of the relationship.

Hey, kids do that all the time, but we don't mind taking care of our children. Good parents, however, make their children take on more and more responsibilities for themselves, and the sooner the better. So we're not talking about our children here. Take care of your children. That's your job.

This is about adult-adult relationships.

The story goes that for every heroin addict there's a mom who lets him into the house, all strung out, late at night. She provides the shower, the food, the bed.

She's not supposed to.

That mom is supposed to say, No, dear. You can't come in. Go sleep out in the park in the rain. Learn what being addicted really means.

When the addict wakes up with the rain in his face there's at least some chance he might think, "Hmm, time for me to change. Maybe I should stop using heroin."

This story I'm going to tell is different. Instead of the care-taking parent (we call them enablers) booting the child, the child "boots" the parent. It's not what you think. Here's what happened.

I am fictionalizing this account beyond the recognizable truth.

There was this lovely Asian patient, a widow, who nervously step into my office many years ago. Let's call her Myrna. She told me how she hated her job and was completely burnt out, how she had supported her son, his girlfriend (mother of two of his children), and her two sisters. She couldn't think straight, couldn't sleep, had lost weight.

Yet everyone took it for granted that she would always be there to pay the bills. Here she was, suffering emotional and physical exhaustion, (I spared most of the details, but trust me, it was bad).

So for me it didn't take much thinking. I signed the family leave papers. She had to stop working.

But she wouldn't do that. She told me why. Everyone depended upon her and it was hard for her son to get a job because he had been busted for drugs, served time in prison, and no one would hire him. Plus she had to get out of the house because the family fights drove her crazy so working was a good place to go. She cried alone.

Oh and her son's girlfriend had recently broken all of her dishes and glassware, and smashed all of the windows of the car and hammered the body. "How could anyone be so ungrateful?" she asked me. Myrna was paying the girl's bills, along with providing her and her children food and shelter.

I hauled them all into family therapy without Myrna. (Heck, she needed a break). The sister, the son, the son's girlfriend, they all came. They caught on right away that Myrna couldn't handle it anymore but didn't have the heart to set them all loose.

They would have to leave voluntarily, and they did.

Things went swimmingly. Myrna got better. She did take about a month off of work to recover from her very serious depressive episode.

Then one day she came in and told me that her son got in trouble for something and was back to prison. She didn't seem upset, either. It wasn't drugs. He had been working a 12-Step program and was clean. What happened was that he got involved in a job to make money and the shop wasn't on the up and up.

I said, "He's in prison, but you don't seem upset. What's up?"

She said that as he left she had been nagging him about being safe and how he had to take care of himself, and how he had to watch his back, and how he had to stay clean, and he couldn't trust anyone in prison.

He turned to her, hugged her and said, "Momma, you don't have to worry about me. I'm okay."

She told me, "I looked at him like he was crazy and said, 'And how can that be, son? How can you be okay?'"

He said, "Because Momma, I'm a man. I'm grown up. I can do this. I'm a man."

She heard that and she let him go. Like I said, the sooner the better.

Copyright 2006, TherapyDoc

Friday, September 15, 2006

Is Poker a game or a gamble?

You KNOW it's a game and that it can be a gamble, right? So am I going to beat everybody up on the weekend about it? Uh, no.

But I will define gambling addictions for you and am suggesting that if you're thinking that one of your friends is gambling too much and is losing too much and is addicted, perhaps say something.

That's all. Just say something. Or if it's you, keep reading.

The people you know who are already at the stage where they gamble to win back their losses actually think that is the end of their gambling. At first. This is serious denial, of course.

If by some miracle they do gamble and make enough to pay off a mounting debt, there's still that little voice inside that nags and says, Heck! You're pretty darn good at this. You could make some serious money!

Then it's back to the drawing board. Or is it computer. Or boat. Track. What-ev.

Here are the signs of what we in the biz call Pathological Gambling:

Persistent and recurrent maladaptive gambling behavior that disrupts personal, family, or vocational pursuits. (We don't count it if the person is having a manic episode, see my post on bi-polar or uni-polar disorders in the archives).

The following symptoms are taken directly out of the DSM IV, the Statistical Manual of the American Psychiatric Association. I didn't make it up.

Preopccupation with gambling, either reliving past gambling experiences, planning the next gambling venture, or thiking of ways to get money with which to gamble.

Seeking "action", using more money, increasing bets, and taking greater risks to get a euphoric, high feeling.

Despite repeated efforts to control, cut back or stop, continued gambling.

Restlessness or irritability while trying to cut down or stop.

Escaping problems by gambling.

Gambling to get out of a bad mood.

Chasing losses with an urgent need to keep gambling to win back losses.

Lying to family, friends, or professionals about it.

Concealing the extent of the involvement in gambling.

Using forgery or fraud to cover losses.

Losing a job, a significant other, an education or career due to gambling.

Bailing out, turning to family to help when the situation gets desperate.

Sound like anyone you know?

Don't ignore it, confront and go with that person (or take yourself) to Gamblers Anonymous. Go more than once if you really care.

Copyright 2006, Therapy Doc

Thursday, September 14, 2006

The Illusionist, Assertiveness, and Marital Magic

Marital magic is a Big Subject.

Today, however, we're going to talk about taking the magic out of the relationship.

See, people think they can read minds. When they fail and things don't work out as they wished, they are confused (why didn't the system work?)and get angry or sad, or frustrated.

The quick and dirty is Don't Do It. Don't mind read. Check it out. Ask your partner what he/she is thinking, what he/she wants. Assume nothing. There's nothing very romantic at the end of the day about mind-reading.

Hearing your partner talk to you about thoughts and feelings? Now that's romantic.

It's the verbal communication that rocks.

I wrote more on this on When Therapists Blog. There's more to say, still, but this is a start.

Oh, and the Illusionist (the movie) really is magical. Maybe keep the magic where it belongs, as entertainment, not reality.

Copyright 2006, TherapyDoc

Wednesday, September 13, 2006

Strong, Confident, Sexy and Marie Claire

Just a comment on this. Marie Claire is a magazine, in case you didn't know, and the reference is actually to fashion, the way women and men in politics dress for work makes them strong, confident, and sexy.

The pols did look good in the magazine, but I had to check out quickly at the grocery store so I didn't have time to look really carefully.

This brings up the question of dressing for confidence. Honestly, I wish it worked, but am thinking, based upon nothing but a handful of very well-dressed clients who have very poor confidence, that it might not always, in fact, can backfire.

Spending thousands on a wardrobe that one cannot afford, thinking it buys confidence when it doesn't is a set-up for feeling even LESS confident (having thrown out all that green).

The quick and dirty on confidence is that it is something inside, and although you can fool people into thinking you're strong and confident, especially sexy, which is might work in business, it may not work for one personally or even socially.

Not that you should look like a slob or not care about appearance. Feeling you look good does make you feel good. All I'm saying is that there can be a disconnect between what is communicated to others and what we say to ourselves.

I think we listen to the voices in our own heads, predominently. There's more to say about confidence, but that's enough for now. Argue with your head when you feel you're inadequate, rather than your spouse for having spent too much on clothes.

Just a thought.

Copyright 2006, TherapyDoc

Monday, September 11, 2006

Playing hard to get?

I did a post on psychological space and intimacy back in May that basically tells you that some people need more psychological space than others. But if one partner, the one who wants more closeness is unhappy, then the couple needs to close that space, just a little (at first).

The idea is that although there's usually one of the two who will need more space in couple-hood, we value intimacy. This means, ironically, that it is psychologically more healthier to get used to sharing time than to self-actualize sometimes.

Not that one shouldn't always strive to learn new skills, challenge the mind, and become involved in a community. Family therapists believe there is time in the day for both. We can talk about the value of sleep another day.

So what was I talking about when I said that pulling the rubber band, consciously stretching the psychological space between two people is a good thing?

When one of the two feels crowded, suffocated, and unable to concentrate or get things done, the person who is chasing after that person's time has to pull away, make the space even greater.

A very seriously stretched rubber band still will not break. It represents the relationship, here, and the boundaries a a relationship are always in the head. Relationships are not tangible things.

So when you give someone who needs space the space that he or she needs, the person who needs space is exceedingly grateful. Being grateful, that person will naturally initiate intimacy.

That's why the relationship pundits are coaching everyone (women) to play hard to get It's not playing hard to get. It's playing, Appreciate me, blank it.

In marital therapy, however, a couple commits to making their relationship better, more rich, more fulfilling. Sexier in the metaphorical sense of the word. So we push for intimacy whenever we can.

Copyright 2006, Therapy Doc

Thursday, September 07, 2006

Objectification of Women

Could be men, but let's look at women. We're talking about seeing women as sexual creatures, not people.

I just posted more on this on BlogHer in a Comment to How do I keep my kid from objectifying women?

I promised an annecdote. This story happened about ten years ago, but it could happen today.

A couple came for couples therapy, much of it about what she called his blue collar attitudes towards women. She was pregnant and had many issues, one being that he liked to go to a restaurant called Hooters.

At this restaurant the women are practically topless.

He said he likes the food. This happened to be a great guy, by the way. He didn't cheat on his wife and he worked hard, adored his spouse. He gave to charity. I loved this guy.

I said to him, "So you think it'll be a girl?"

He smiled. "Maybe."

"Would that be okay?"

"Sure. I just want a healthy baby. I can teach a girl to throw a baseball, too."

"And what if your little girl grows up and wants to work at Hooters?"

"Over my dead body."


"Come on, you know."

"I do."





He stopped going to Hooters. He got it.

Copyright Therapy Doc, 2006

Wednesday, September 06, 2006

Positive thinking, Little Miss Sunshine, and quicksand

Movie review time. Don't read this if you haven't seen Little Miss Sunshine. Consider yourself warned.

We saw it on a rainy day and like everyone else in the theater fell in love with Olive, a little girl (played by Abigail Breslin, watch out for her!) who makes it into a California beauty pageant.

She's a happy little kid in an unhappy family that has to work at faking being happy--for Olive's sake. They fake it because they love her. That alone is a wonderful thing, right?

Fake happy to be happy is the stuff of behavioral therapists. We really think that you sometimes have to fake it till you make it. In the process of faking it you forget that you're faking it and you simply are that which you fake.

Anyway, I surf the blogs, true confession, to see what the world out there is thinking. The self-esteem bloggers and the life coaches are telling us that true happiness is about loving ourselves, not looking for validation from others.

We have to love ourselves to be happy, they say, and they're right. Plus, at the end of life most people are alone, so this helps, at least at the end, apparently.

The bloggers also talk about the power of positive thinking. This is not the same, believe me, as faking it 'til you make it, but it's not that far off.
See Aurelia Willams' blog for a pep talk on that.

For most of us, however, positive thinking is a sincere challenge. LIFE simply gets in the way.

Negative thinking's more natural, for a lot of reasons, the primary one being that we're human and we get tired. When we get tired we don't feel like doing anything much, even being happy or thinking positively, especially, which is work.

And we get hung up thinking of all the things that we have to do that we're not doing. Some of us end up feeling like losers, even, in the process.

And that might be because of fatigue, or it might be because the brain is depressed when fatigued, or it might be because of depression, often the case.

One of the prima facto symptoms of depression, not surprisingly, is fatigue. And becoming tired, every day, is as inevitable as death. So thinking positive? A challenge.

So what's this got to do with Little Miss Sunshine?

The little girl's father, Richard (played by Greg Kinnear), is a positive thinking confidence seller. That's what he sells for a living. He's selling Nine Steps to Winning, which are basically about thinking positively. And he drives everyone else crazy. Why? They're all depressed, and they CAN'T think positively.

The family is positively stuck in reality, and their reality is kind of dark (no money, etc.). The family is depressed so Richard's positive thinking flies inanely in their face. It's funny. His denial is quite laughable.

Things perk up in the movie, the family gets better, actually, when Richard steps into the family reality. He quits working his agenda and works with his family, not against them.

The moral of the story, and the moral of this post, is that if indeed you face reality and tackle it together with the people who care about you, reality's not as bad. Being together, solving problems together, is functional, no matter how dysfunctional our first degree relations.

Thinking as a group, no matter how bizarre the thinking, feels really good. The thoughts don't all have to be positive.

That's not to say we shouldn't try to be optimistic. Dwelling on the negatives (there are so many) can really feel like quicksand. Whereas, hope (something, something, is it "springs"?) eternal? Well, yeah. It does get the serotinin flowing, I'm sure.

Copyright 2006, Therapy Doc

Why Men Rape

Women and men who have been raped are usually (not always) talking about a male perpetrator. It might help to take a look at some of the reasons men rape. Knowing the "whys" may help victims reduce self blame. It may not, unfortunately.

The following is extracted from a paper I wrote and presented at the Council for Social Work Education in February, 2006. It will be republished in another journal.

But briefly, and I'm sorry, a bit scholarly, here's a summary:

Feminist writers trace the history of perpetrator motivation to a patriarchal society that assigns females a status as property without rights. As property, they had no right to object to their treatment.

Sociologists have discussed women as objects, commodities to be bought or stolen—the pornographication of women, a process by which men relate to women as pornea, a Greek word for whores.
This perception of a woman’s body as property or a commodity is grounded not just historically, but in contemporary metaphors, language, and common slang for sex. Like:

Sex is a hunt, a conquest: I’m going to go out and get a piece of ass.

Sex is instruction: I know how to show a woman a good time.

A review of the literature into the etiology of rape indicates that overall, men who rape have rape supportive attitudes, misinterpret social clues, and blame the victim.

Younger offenders learn from their families, peers, or the media that their role in a relationship is to take the initiative in sexual relationships. This is called the dominance theory.

Studies find significant associations between beliefs in rape myths and acquaintance rape, i.e:

Men think women want sex but are not comfortable asking, which justifies their force

Nice girls don't dress provocatively or use alcohol. Bad girls, girls who want sex, do and deserve to be raped.

Cross-sectional studies of male college students find significant correlations between having committed acquaintance rape and having hostile attitudes towards women.

In one study students who raped acquaintances also reported accepting domestic violence, an attitude uncharacteristic of students who did not rape.

Stranger rapes, conversely, have been found to be characteristic of serious psychopathology—extreme anger, a need for power and control, and sadism.
They have feelings emptiness, worthlessness, insecurity, loneliness, depression, suicidal and homicidal ideation, and desperation.

And no empathy, obviously. They have few friends, and most came from disengaged families.

I'll let you know when the rest is published and where to look.

Copyright 2006, Therapy Doc

Tuesday, September 05, 2006

Being Poor, Self-esteem, and Anxiety

It should be easy to make this connection, the one between being poor and having low self-esteem and anxiety.

You may have heard a story like this one:

Immigrant family moves to this country to make a better life.

It is a better life, but it isn't fabulously better because one of the parents, say the father, succumbs to a debilitating disease like, let's say, multiple sclerosis. This is before HIV research had discovered the better medications that we have now.

Mom goes to work, perhaps at the local factory and fits together widgets of some kind. Carpel tunnel is the least of her problems, the factory also has asbestos. She is the primary wage earner, and at minimum wage, she barely affords basic sustenance for the family.

At some point mom is either laid off or has to have surgery.

Luckily, like many families who come to the United States for a better life, this family has resources: cousins, aunts and uncles who are doing pretty well, so well in fact, that they own an apartment building of their own.

The aunt and uncle of our identified patient (IP), call her Joanne, allow the family to take over one of the flats in their building for a modest rent.

The family moves in and both daughters, Joanne and her sister, work very hard to keep the house clean and stay out of the way. They study very hard. Joanne even goes to college. Yet here's how Joanne describes growing up with her cousins:

"They were mean. If I worked to save money for college, they would say, 'Why do you think you can get a college degree? Shouldn't you give the tuition money to our father? Don't you think you owe him?'

"Or if I took driving lessons: 'Why are you taking driving lessons? You'll never have enough money to buy a car. And if you did, don't you think that would be wrong, considering how much money you owe our father?'

Or if I looked at a bridal magazine, 'Why do you think anyone would marry a poor girl like you? No one will marry a poor girl like you.'"

Reading this you might think that this is really only one particularly pathological, mean family. I think not. I think those messages are everywhere and they are very subtle. The mean cousin (yes, she's mean, no doubt about that) is expressing the messages that others, even the media, send unwittingly to those less privileged.

Any one of us might buy a fashion magazine and point out pictures of expensive clothing to a friend, knowing full well that we can't afford to buy what we're looking at.

'Why am I looking at this? I'll never be able to afford anything in this magazine,' we may say to ourselves.

We put ourselves down by asking why, of course. It is our right to dream, to fantasize, to strategize to have more, and to think of ourselves as upwardly mobile.

I saw a woman of color who told me that she walked into an expensive shop and a sales clerk handed her a few business cards, saying: "These shops might be more in your price range." This patient, ironically, has the resources to shop where ever she wants.

Is it true that people of means actually think less of everyone else? Unlikely. I think that sales clerk had subconsciously identified with the upper class. She thought of herself as "one of them" even though she was a simple clerk. Scary stuff.

But people like Joanne who have absorbed messages that they might not even deserve to even look at nice things, let alone fantasize about them, who feel guilt for having been on the receiving end of charity, really do have low self-esteem.
And it's deep.

Even someone like Joanne, who graduated college, who watched her cousins get addicted to drugs (and then go through dry recoveries), who now earns more than most people in the middle class (but is still hopelessly middle class, as are most of us), still suffers from low-self-esteem and anxiety.

Anxiety? Why anxiety?

Because of her self-doubt, when she has problems in a relationship she assumes that it is her fault. In every relationship she worries that she's not doing enough. After all, she wasn't ever really welcome in her uncle's home, and she did a lot over there.

When she leaves her house, even to go to the grocery store, if every hair isn't in place, she's terrified that others will think she's a slob. Why would anyone want to marry her, right?

And her house? You could eat off her floor, not because she worries about germs, but because she worries others will think less of her for her house-keeping if things are dirty or out of place.

People like Joanne can change their thinking, but takes work. Every time Joanne thinks she's "less-than" she has to remind herself of her accomplishments. Every time she blames herself, she has to remind herself that others contributed to a problem as well. Every time she helps someone, she has to remind herself that it is because she is a kind person, not because she owes the world a living.

Being poor?

It can really do a number on you.

Copyright 2006, TherapyDoc

Positive Communication: The 51% Rule

Back in May I wrote about the five types of intimacies: recreational, problem-solving, work, sexual, and emotional intimacy.

The thinking still is that it helps to have all five of them in good shape to have a well-oiled relationship. Pun intended? Maybe.

People get married, of course, without having all five types of intimacy in wonderful shape. If we looked honestly at our relationships and waited for everything to be perfect, face it, no one would get married.

In fact, one of the cooler things about being in a committed relationship is that you have time to work things out, there's time to tweak the areas of your relationship that need tweaking, including the two people in it.

A marital therapy has three patients: The two partners plus the marriage. All three need to change to make a committed relationship work.

And you all laughed at the title of the blog, as in, yeah, right, everyone needs therapy? So okay, fine. Maybe you don't. But to work a marriage that's not working? You do.

This post is about working the relationship. It'll be helpful, perhaps, even if you're not in a committed relationship, but it's MOST relevant when you're already stuck in one. Bad word, let's say, blessed with one?

It's like this. If 51% of your marital communication is positive, the marriage will survive if you want it to survive. That means you can complain and carp at one another the other 49% of the time, I guess. But you don't have to.

Let's assume that you're not even sure of your percentages. You don't know how your marriage is batting. Here's a little primer on positive versus negative communication.

I'll start with positive communication.

Positive communication is supportive, encouraging, helpful, holds back criticism, lends praise and fosters hope.

Negative communication does just the opposite.

"Good supper, honey" is positive.
"Way too salty on the vegetables," is negative.

Too simple? You'd be surprised. Try these.

"I'd like to see you in the grey trousers," is positive.
"You look fat in those pants," is negative.

"I'll go with you for that mammogram," is positive.
"Damn, that mammogram is expensive," is negative.

"I'll visit your father in the hospital," is positive.
"If your father had admitted he needed a walker in the first place, he wouldn't have fallen," is negative.

"We probably should be working together on the kids' behavior," is positive.
"You let the kids get completely out of control," is negative.

"I'll baby sit so you can go to that meeting," is positive.
"You should never have scheduled a meeting when you don't have a sitter," is negative.

"I'm sure you can make it at that community college; let's take it slow," is positive.
"I don't know, it's so much money, and you flunked out of high school, why would you think you'd do any better now?" is negative.

"Let me pick up the clothes at the cleaners. It's on my way home from work," is positive.
"Why would I pick up the clothes at the cleaners? I'm the one working in this family," is negative.

"I'm sure that no matter what happens, even if you lose your job, we'll make it somehow. We'll be okay as long as we're together," is positive.
"We're dead if you lose that job," is negative.

"We'll find a way to get to that funeral," is positive.
"She's dead anyway, you don't have to go," is negative.

"You're a terrific painter. Keep at it if you like it," is positive.
"I think by now you'd get it; you're not going to make it as an artist, I don't see why you bother," is negative.

"If you don't get into medical school there are a zillion health science professions out there that need a dedicated person like you," is positive.
"You're at the bottom third of your class. I don't know why you'd think you're going to get in," is negative.

"I'll take the kids to baseball tomorrow, so you don't have to leave work early," is positive.
"There's no way I give a blank about baseball; I hate doing that carpool," is negative.

"It's sweet that you want me to golf with you. I really don't like golf, but if it's that important to you, I'll try it again," is positive.
"Why in the world would you ever ask me to do that?! Forget about it, not on your life," is negative.

And on, and on. Could it be true that marriage versus divorce really hinges upon positive versus negative communication?

Yeah, I think so. Probably the five intimacies are all "intimate" precisely because to be intimate requires supportive, encouraging, helpful, hopeful communication.

I tell people who are having trouble being too honest, which makes them too critical, to treat a partner as they would treat a boss, a superior at work. We never disrespect, criticize, swear at or complain to our boss, not unless everyone is joking around and it's somehow okay. Usually, however, we treat the boss like he or she is the boss.

In marriage there are 2 bosses. You guys are the executive committee. You have to build each other up, strengthen the bond, unite. Or else, boy, will having children be a challenge.

At the very least, shoot for the 51% rule.

Copyright 2006, TherapyDoc

Monday, September 04, 2006

Abortion: On the Other Hand

Although I'm not staunchly democratic, as a social worker I generally lean to the left. So don’t think this is a Pro Life post. It’s not. 

This is only about mental health. That's what I write about, mental health and how to keep it, if that's possible. 

On the one hand, pregnancy is a pathological physiological condition, as is giving birth. Being pregnant is a risky condition for a woman, and being inside a pregnant woman for nine months can be risky to the fetus.

And there are financial and psychological burdens to parenthood, once the baby is out. Mothers undoubtedly lose opportunities afforded to childless females in the work force.

And being poor undoubtedly has potential to negatively affect both a woman’s physical and mental health, not to mention the infant's nutrition.

Then there’s the other hand.

On the other hand, let's say a young woman goes to an abortion clinic. She will be subjected to many things that will determine whether or not she has a good or bad experience aborting that baby: family support, financial resources, the way she is treated at the clinic, the pre-abortion counseling, where the father of the fetus is holding, her previous mental health history, how well she does post-op.

These are only a few of the things that can affect her immediate and future adjustment to that key decision. Again, this isn't about the decision.

A woman might be able to load the deck in her favor if she has social support, aftercare, a solid philosophical world view about abortion, as in it is a woman’s right to make decisions about her body, etc.

But her accommodation to her decision in the future is a still a question mark. It is impossible to know, at the time of the decision, how she or the father will feel about their decision years later.

I’m not exaggerating when I say I have seen dozens of women who still regret their abortion(s) many years later, who grieve that it had to happen and that it had to happen to them, in particular. And I’ve seen many men who report the same grief and remorse, tearfully. Men cry, too. This is one of the things that they cry about.

I’m not saying "Don’t do it" or "Do do it." I’m just saying that if you do, be prepared for the possibility, and I have no idea how remote, of backlash.

Depending upon what kind of person you are, grieving the loss may be considerable. It's never too late to work it out in therapy, so I'm pushing that on this post. Get therapy at any time with any professional, and get it early, and maybe often if you need it. Community mental health centers are generally free, still. Thank your sixties parents.

Having held the hands of so many (figuratively speaking, T.D. rarely ever touches her clients in any physical way) I have to wonder: What is it that they do say in the pre-abortion counseling? Will someone tell me, please?

If getting a therapist isn't possible, talk with trusted friends and family. Talk, talk, talk. Try to prepare yourself in case the other shoe drops.

There’s no way of knowing, is there?

A caveat to this piece is:

IF you’re in therapy for some other reason, perhaps years down the line, if you’ve had an abortion, don’t forget to mention it. Mention it somewhere along the line in treatment. Not every therapist will think to ask about it, seriously, although they should.

If you’re a therapist, ‘nuf said.

Is this a hot topic?

It shouldn’t be, but it is. As a source of potential post-traumatic stress, this doc thinks abortions are worth talking about, thinking about, and rethinking and rethinking. That type of cognitive exercise can't hurt.

Again, I'm just unloading about something that's bothered me for years. There's probably no easy way to have an abortion, no matter what they're telling you at the clinic. But talk it over in any case.

There. I've said it.

Copyright 2006, TherapyDoc

Sunday, September 03, 2006

Stress eating and Bree Vandecamp

Stress eating, mmmmm

So I asked my favorite consultant, the one who lives with me, the genius, I asked,

Genius Doc? Why do people stress eat?

Tastes good, he said.

No, seriously, why?

He said that we eat when we're down or when we're anxious because:

The actual physical sensation of eating, the sheer pleasure simply drives us to it. Like a mouse to cocaine. That's my analogy, the mouse to cocaine.

If you haven't seen the psychology videos on mice and cocaine you haven't lived. The mouse chooses the coke over cheese and eats it until he dies.

This is a plausible theory, for sure. Feel bad. Eat. Feel good. Immediate gratification.

The only problem with that is that it puts food into the addictions, the things we do compulsively for immediate gratification.

Sigh. And I thought I could just nibble and it wasn't such a pathological thing.

In Genius Doc's favor, he also laid out a brilliant piece on estrogen and women and how our bodies store rather than metabolize fat because they want to get us ready to feed a fetus if there's a drought.

Makes a lot of sense, too.

I'm going to offer yet another theory and will throw in the intervention for free. The idea is to help a people, gender is immaterial, to stop using the mouth as a way to control stress.

It's a cognitive-behavioral strategy.

Cognitive-behavioral strategies require thinking before doing.

Cognitive therapists (and who isn't one these days) suggest staying in the moment, countering negative thinking, changing one's world right now to defocus from pain and things that trigger negative feelings.

It's not that talking about the past doesn't help, it just may not be as effective, or so says the National Institute of Mental Health.

Ranting, blaming, and obsessing in therapy about our spouses, or how a sibling got more attention, or how other family of origin dynamics contributed to our "issues" and neuroses has a time and a place.

Stress eating probably won't stop, however, unless something gets between memory lane and the refrigerator.

And you know you want the quick fix. You know you do.

It's all about staying in the moment, challenging negative thoughts, assessing how you feel physically, DOING SOMETHING DIFFERENT.

Yes, perhaps I am simplifying too much, but I'm responding to readers who have requested that I dumb this blog a tad, to simplify like I promised to do in my "about."

Fine. Here's the real scoop on stress eating.

It DOES calm anxious people down physiologically for a very simple physiological reason. It takes energy to digest food.

Say Suzie is a real hyper-secreter, meaning her stomach juices get going when her adrenaline gets pumpin. Or, simply put, she knows that she's easily an easily agitated, nervous type of person.

When we're anxious the arousal system in the brain works in sync with the adrenal glands to pump more adrenaline. The process makes us feel zippy, not necessarily comfortable zippy, however. We interpret this nervous system arousal as "anxiety" or "stress," rather than simply, "extra energy," which it is.

If Suzie is a coffee drinker then she's adding even more speed to the mix. Add a real problem, like job loss, marital stress, whatever, to the brew and it IS stress.

But if Susie eats, the food sits in her belly and requires all of her free-floating energy to digest it. She eats, she feels better. Some of her adrenaline is tied up for a long time digesting the Ben and Jerry's.

That's why some moms, not just Jewish mom, will push food on their kids when they sense they're upset. Sit down, have a cookie, we'll talk. We learn to eat when stressed from our parents. Some of us learn to drink. We still choose to make that consumptive decision at the end of the day, whatever it is.

If Suzie has a cognitive therapist she'll be told to be in touch with her anxiety and will be taught a few self-relaxation exercises, particularly muscle contraction (if it were me, no question). Jogging's good too, so are sit-ups or simply holding the body in a push-up position until you have to drop down to rest.

These exercises literally burn off the adrenaline; they use the extra energy productively. I even recommend doing laundry or the types of busy things Bree Vandecamps does on Desperate Housewives to burn off the steam.

You only get to watch TV, btw, if you're exercising, at least stretching. You knew that, right?

But what about depression? People definitely are drawn to the cup board when they're feeling down. Why do people eat when they're depressed? They're not cooling down, they're already down.

In that case, honest, I'm betting on Genius Doc's answer.

Tastes good.

Copyright 2006, TherapyDoc

Saturday, September 02, 2006

Being insane, college, and defining normal

Sometimes I'll be talking to patients and hear about how much shame they have attached to something they did at some insane time of life. They'll look at me with sincere remorse and ask, "Was I insane?"

Yes, you were.

Yes, you were, I want to say.

Yes, you were, I say.

Well, thanks. Thanks for the encouragement.

So insane is a little strong. But there are stages, and you ALL know it's true, when a person is less in control, has less desire to be disciplined, has no incentive for discipline. When a person does things that a person in their right mind would never do.

These behaviors (affairs, drug overdoses) can be triggered by stress and depression. They can happen mid-life, and most notably, during adolescence and young adulthood, which is where we're going on this page.

A wise man once said that Americans prolong adolescence with this business of college. At a time when able-bodied people should be working either to become self-sufficient or to pay back those who have sustained them throughout childhood, we send our children off to college.

Where they party.

Where they learn how to perfect their drinking and drug abuse.

Where they contract sexually transmitted diseases.

Where they get raped or rape.

(As an aside, if a person "consents" to sex while being under the influence it is not legally considered informed consent. Technically it's rape).

Okay, okay, I'll stop. Not everyone does these things.

But these things are brought to my attention in therapy at least once week, episodes folks wish they could forget. Most of us have at least one.

I'm very forgiving of college students partying, frankly. There seems no stopping them. It is the young married couples I see who are having trouble in their relationships due to alcohol consumption, drug use, and or nights "out" that I begin to label alcoholic or addicted.

By the mid-twenties a person should no longer be waking up with a hangover. That's my cut-off. The drinking and drugging has to stop there. Adulthood.

That may sound very liberal and even crazy, coming from a professional. Like I'm giving covert permission to teenagers to use substances. No way.

The professional party line, should the subject arise, is that alcohol IS the enemy, that women get sicker quicker, that it is EXCEEDINGLY RISKY to ever drink to the point where the room is spinning or one can't remember things, blacks out. It is exceedingly risky to smoke pot, use cocaine, enjoy designer drugs. These substances make the brain happy, and when the brain is happy, friends, it never forgets and looks to these sources for more happiness.

I'm not afraid to say that it is EXCEEDINGLY IRRESPONSIBLE (I try not to say stupid) to let oneself get dependent upon alcohol or drugs, especially of there's a family predisposition to addiction.

Enough preaching. You people know all this.

What I'm going to present here is the quick and dirty (YES DIRTY) on normal psychological development, something that unfortunately implies living, doing, and learning, EVEN MAKING MISTAKES.

Let’s look at Abraham Maslow's Hierarchy of Needs.

In my day it was a ladder, now it's a pyramid. Maybe it was always a pyramid. The idea is that we have various needs that change as we grow up and struggle to master the various developmental stages of our lives. Stay with me here.

The Maslovian pyramid looks like this:

1. As infants and toddlers we're all about getting physical survival needs met, as in

2. Then in early childhood we get more into basic safety and security issues:

3. At some point we get more into finding the kids at school interesting. Socializing meets the need for belonging. We get out of our own little autistic world.
Wow, these people are so cool! I want friends! I want to belong! I want to hang out. I’ll die if you don’t let me go on My Space!

4. Then there's a reevaluation of group-think and the shift towards inner focus and a need for self-esteem. We have a need to really like ourselves.
Oh, I don't HAVE to sleep with everyone I think is hot! I have boundaries! I can say, NO, or work on a RELATIONSHIP instead!

Developing boundaries, which requires a little (sometimes a lot) of self-discipline is only one way to raises self-esteem, but it's a good way.

Developing boundaries isn't as complicated as it sounds, and I'll write more about it another time, but the process sometimes starts with saying NO to something, someone or oneself. It starts with looking back at what we've done, taking responsibility and saying OH, (expletive) WHAT WAS I THINKING!

Are we our own worst enemies? Maybe, but I'd rather think that we're educable, we learn, we grow, and with that we develop a little self-respect, self-esteem on Maslow's pyramid. Second to the top tier.

So if after a slip, a set-back, a bad decision, A MOMENT OR SEVERAL MOMENTS OF TEMPORARY INSANITY, say an unexpected or expected sexual encounter, an unwanted pregnancy, maybe an abortion OR THREE, something that brings on shame, regret and remorse, IF THEN A PERSON FINALLY SETTLES DOWN?

I would say that's taking a monumental developmental step on the old pyramid, wouldn't you?

5. And finally, at some point, perhaps not until one is in his or her mid-thirties to forties or fifties there's a theoretical need to self-actualize, to be the best person one can be, to really stretch out and grow, do new things.

I say it's a theoretical need because in our world there's simply so much to do that's done for the sake of fun, because face it we work so hard, and we've already paid for cable and the shows have really improved, haven't they, over the years?

There are so many feel good things to do these days that striving to become a better, bigger person can be a real challenge. Becoming, growing, may be irrelevant.

Jury's out? Yeah, maybe.

Copyright 2006, TherapyDoc

  Bring them home, the Homeland Concert There's not much to say. Wait, I take it back. There's SO much to say it is too much. There ...