Friday, August 31, 2007

The Shofar

Maybe you know it as The Ram's Horn.

In the bible it's all about big announcements, calls for war, and calls for repentance. Little stuff.

Jews designate an entire month to repentance, and I suppose it's something along the lines of Lent. All I can say on that is that no matter what the similarities, when it comes to most traditions, for better or worse, we've usually started them.

The month of Elul (we're already in it a couple of weeks) is the Jewish month of consideration.
It is said that one of our holier rabbis would think about what he had done wrong the night before, before he ate breakfast.

Then before lunch, he considered what he'd done wrong between breakfast and lunch.

Then before he ate dinner, he went over what he had done between lunch and dinner. He didn't eat a morsel of food until he looked himself directly in the mirror and fixed his make-up.

He did it every day. (And they wonder why we're the most neurotic of nations, or wait, maybe that's just how we're portrayed in film. I'll have to have a chat with Woody Allen about this.)

Anyway, if you do this every day, seriously review everything you've done between meals, then you can fix things, like you can apologize to people you might have slighted. Then by the time you get to the holiest day of the year and have to really stand before the Old Mighty and beg for another year of life. . .

Oh, and by the way, don't think you're off the hook if you're not Jewish, the whole world is judged, down to the very last leaf on a tree. . .

If you really do that, think about your bloopers every day, three times a day, then by the time you get to Yom Kippur, the Day of Judgment,

which is ten days after Rosh HaShana, by the way, the Jewish New Year, coming right up the night of Sept 12, it's a Wednesday night and lasts until Friday night, Don't Call Me with Your Problems, go to your Nearest Emergency Room and try to make it to shul if you're Jewish, everyone and his brother will be there, even Barbara Streisand. . .

If you do that, examine your deeds, your thoughts, your desires then by the time you get to Yom Kippur, you can probably proverbially look the Old Mighty in the eye and say, We're good.

Of course none of us are and we're virtually in tears, begging forgiveness, humbly asking Him/Her for another year because NOBODY does this, even in the month of Elul, nobody repents properly, and NOBODY looks the Old Mighty in the eye.

Some Jewish bloggers write phenomenally descriptive posts about this month of repentance because it makes for incredible blog fodder. We have this concept that in Elul, this month only, during the entire month, not just for one week like He does during a holiday (Succos is like that), the Old Mighty comes out from where-ever it is He/She lives to give us face time.

Some link it to a king who leaves his castle or a gentleman farmer who leaves the ranch, or a president leaving Camp David (that would be me who made that association) to visit people in the villages, fields, and Starbucks.

Remember that song? What if G-d Was One of Us? He is. But he's not a slob. I hate even saying that, repeating that lyric, the whole idea. A king wears a white shirt and a black tie, like my zaideh (grandfather) EVERY DAY. Or do I have the words to the song wrong?

Anyway, FD asked me today if our youngest took his shofar with him to Israel. He just left last week for another year of learning.

No idea. Call him.

So indeed the shofar's gone! Little One took it with him. And the only shofar left is on its way to California with it's rightful owner, #1 son who visited this week and wanted it back.

You have to understand. It's not easy blowing these things. They're like trumpets. If you're good at trumpet you surely can blow shofar. Most of us are bad at trumpet and can't get a single note out of a shofar.

But FD is an all around musician and in Elul he comes home in the morning from MPWTG, (Morning Prayers with the Guys) and blows the shofar to "wake us up," us being me, to examine all the lousy things we've done over the year, that being me, and tell the Old Mighty that we'll try hard to change.

I really will, I'll do both, I'll tell Him whatever I can remember I did wrong (this is really hard if you skip meals) and then I'll try to change, like every Jew does this time of year.

FYO, my mother-in-law says that if people would just watch their basic manners, we'd all be okay going into this holiday season.

It's going around, interestingly, that the month Elul is now called, Derech Eretz Month. "Derech Eretz" is Hebrew for many things, including good manners or basic human decency.

So I guess we could start there.

Tekiah. . .

Today is the 17th day of Elul.


Wednesday, August 29, 2007

Tough Neighborhood- Fear of . . .

Once I read a book about about the fear of success. I read it and still didn't get it. I mean, how could people not want to succeed, not want to meet potential, not want to use talent? Talent isn't an everyday thing, you know?

It's special. Yet most of us have a talent for something. Latent sometimes.

The book* said that if your parents put you down, then you don't think you've got what it takes to be someone. Having a gift at something doesn't change your mind. Knowing you have certain strengths means nothing. You develop this irrational fear of exposure from the constant put downs. We've talked about the fear of exposure in relationships. Abuse is one of the germs.

If you've been abused then you might develop the fear that if you try to do something fabulous you'll be PROVEN the idiot you think you are. You're sure you'll fail and everyone will KNOW you're a loser as opposed to just guessing.

So you don't try to succeed because you think that if you do, for sure you'll fail. And that's too embarrassing for words.

Makes sense, and this dynamic makes sense, too, although it's a little different. Title the essay,
Kids Who Live in Tough Neighborhoods
(I know, I know, some of you are going to say that this can happen anywhere, that the socioeconomic bias infuriates you, and it's not necessary, and you're right. But be patient, okay? Don't spleen me I'm just trying to illustrate a point.)

Maybe you were the kid who grew up in the tough neighborhood. The windows in your home were always open and people, your parents, could be heard screaming from your house all the way down the block. Screaming about what? Anything.

Others in this neighborhood didn't care much because they had their own problems, mainly poverty or another sociological ill. Or they did care, but boy, they didn't say anything to anyone, didn't call the police, afflicted or not.

The kids in the schools in neighborhoods like these tend to be tougher and angrier than most. (See posts on angry kids, The Columbine Kid in particular). When kids are tough and angry they look for another kid to pick on. This feels good, displacing anger, giving someone else your aggravation. Misery loves company. The grown up version is dad Kicking the Dog after work or mom or anyone screaming in general.

So angry kids (and there are many and they tend to be suckers for group think) are prone to bullying other kids, usually the vulnerable kids. Why pick on a kid who will beat you up? The angry ones look for the vulnerable ones, children who may have already been beaten up at home, in one way or another, or who have other problems.

A vulnerable kid will nervously make an appearance that first day of school. He's a little overweight, a little too smart for his own good. He starts out innocently enough making good grades. The teacher shows his paper to the rest of the class, the one with the big 100% or Smiley Face in marker.

Time for recess.

Whack! Crunch go the glasses. It sounds so cliche but it's true!

You know victim profiles, right? The fat kid, the shy kid, the tall kid, the short kid. The dark kid, the light kid. The black kid the white kid.

Boy, I'm a regular Dr. Seuss.

So the LAST thing a vulnerable kid wants to do is to draw attention to himself. Attention is bad, blending in is good. Be like everyone else. Be normal. Not special. If you stick out, it'll hurt.

And the kid is fabulous, sensitive, a very normal kid at that. And he or she comes to me as an adult and I see the fabulousness but he asks, Why do I fear success? Why do I worry so much that people WON'T like me if I'm a success, if I succeed where others, basically, fail? I don't want to be the one who succeeds where others fail.

Always threw the game, lost the homework, dressed badly even when he could have looked so good.

Blend in. Someone else with less to lose will take your place, someone with more drive, more confidence.

It's not so hard to understand, really, when you think of it that way.

*It's true, I didn't read any book. But if I had, that's what it would have said. If I wrote that book, I suppose, that's what I would have said.

copyright 2007, therapydoc

Tuesday, August 28, 2007

Spot not Pot

I don't like to assign intentional malevolence to other bloggers, but listen to this one.

I was reading other blogs, throwing my 2 cents in here and there in Comments. When you identify yourself in Comments you can also type in your domain name to tell other people about your blog (i.e.,

So the other day I mistakenly wrote: http://everyoneneedstherapy.blogpot. com on someone else's blog.

I forgot the "s" in blogSpot leading people who thought they were clicking on my domain name to the wrong blog, not to mine at all, to a religious site, but not one I'd ever visit or recommend.

And I have this one question, of course. If the blogPot writer is so religious, who-ever you are, what's with the stealing names and misrepresentation?

The blogPot domain has NOTHING to do with therapy, by the way. Mother in Israel found the sabatage. Thanks, M-i-I.

Now I happen to like religious blogs. I was just reading, in fact, about a fellow named José Luis de Jesús Miranda, a former heroin addict with a ministry in Miami. His followers believe he's the reincarnation of all sorts of people including the Old Mighty, probably. Miranda wears a 666 tattoo on his forearm. Bloggers are getting a lot of mileage writing about this fellow. He's very in.

I assume he's doing good in this world, or hope so. But maybe he's just making money.

But back to the problem of identity theft. It made me very angry, the idea that someone took almost all of the ENT trademark domain name, all but the lowly letter "s", and rerouted unsuspecting bloggers to the wrong house. It's a form of identity theft, seriously.

Not very many things really make me angry, so I feel there has to be a reason this happened. I'm thinking the reason is so that I'm supposed to warn other blogSPOT bloggers to be careful when they type in their domain names while commenting on other people's blogs. I'm hearing, sensing, feeling this vibe.

And we should write to Google and kvetch.

I imagine that blogPOT has stolen thousands and thousands of domain names. It's legitimately hosted, believe it or not, by WORDPRESS. The good people at Wordpress probably know about it and can't do a thing. Free trade, says Mother in Israel who wasn't bothered in the least.

GOOGLE and WORDPRESS probably need to communicate.

But 'nuf said.

have a blessed day, ;-)


Saturday, August 25, 2007

Parties I've Missed

There have been lots of them. Parties I've missed.

So yesterday I was working, doing a little over-kill so that I could have 2 full WEEK-DAYS free to hang around with my grandsons and look at bugs and things. It's not everyday that I get important company.

Between patients I nervously took a peek at my new phone. I say nervously because it's a little intimidating having a phone that has a higher IQ than you. And the manual is 300 pages long and you have to read it on a file on your computer and who the h. . . has the time.

Yet we're up for the challenge, right? There was a phone number on caller ID (that I get) and it looked so familiar, but I couldn't place it. No voice mail.

I hit Call. A kid answered the phone, "K. residence."

Can you imagine? At my house they answer like this, "What? Huh?"

The clue, "K residence," helped the search function. At least I knew who it was who had called and I asked to speak my old friend N., a woman who did play group with me about 14. years ago (that's a long time). "She's not home. Would you like to speak to my father?"

Your father?


M. got the phone and explained that he'd called but it wasn't an emergency. On my cell you get this horrible message:
If this is an emergency. . .call. . .or. . .Just please, please, please, don't kill yourself, not on my watch, OKAY?!?#@
So M. felt funny leaving a message and it was all too complicated, anyway. He tells me that he's throwing his spouse, my old friend, a 50th b-day party and could we (me and FD) please come?

Wow. I'm flattered. I really would have liked to have made it, too, which is a little unusual. And I missed their son's wedding only a few weeks before (it was overseas, as in Australia overseas, and you just can't make all of the out of town weddings, you know?). But I had this IMPORTANT COMPANY and once again, couldn't make the party.

And it made me think of so many other parties that I've missed over the years for so many reasons, usually work related. I work on Sundays, and most wedding showers are on Sundays. I've also missed parties because I skip town to visit my kids whenever I can, whenever airfares aren't over the top.

FD is much more the party animal. But I've convinced him that the party is not about us, and that nobody really minds spending a hundred dollars less if we don't make it to their daughter-in-law's shower, kid's bar mitzvah or wedding.

And that's true to a degree, but there are a lot of people who really do want us there to dance with them, and we probably should do our best to trip over our toes to join friends in their happiness. Happiness isn't an every day thing, as you know, and it has nothing to do with knowing how to dance. We should grab the gusto. We really, really should.

Once my own kids planned a party for us, for me and FD, a surprise party. They had invited 20 plus couples before we found out and put the kabosh on the whole thing. We were going through something or another, some huge crisis, and both of us were on empty emotionally. We couldn't handle the mental work it would take to smile that whole evening. We made them cancel the party and they were devastated.

They argued, too. Probably our worst control issue with adult children, and of course, we won. (Structural family therapy axiom #1: Parents Rule). The party was canceled and #2 son (the second of the twins to be yanked out of this ol' bod') said to me, Never again. You don't get another. No more parties for you. He really was hurt, so much wanted to give us a party, and I'm sure it was full of wonderful thoughts, ideas.

So I regret life's emotionality, regret canceling that party. And kids, I apologize.

But sometimes you just can't make it to the party, even if it's your own. (It gives you something to talk about, right? The whole surprise idea. Is it like tickling? Some like it, some don't? Is there research on tickling?)

Anyway, dear friend who is going to be (finally) Over Fifty: HAPPY BIRTHDAY, MANY MORE, and let's party together another time, for sure. It is an amazing thing, looking back and remembering, which is what you'll be doing, looking back and remembering, looking forward and wondering.

Wish we could be there. But you know how it goes. As it is I'll miss most of a Bar Mitzvah tomorrow.

What can you do?


Thursday, August 23, 2007

No Reservations: How NOT to talk to your kid

Don't read on if you think it might spoil the movie for you. I'll spoil it from the top, but no more than any advertisement or other review you've seen. Maybe.

No Reservations

Catherine Zeta-Jones is the perfect Kate, an egotistical chef in a psychotherapy that her boss (Patricia Clarkson, wonderful) has insisted on. This happens more often than you'd think in real life, usually for anger management.

Aaron Eckhart is Nick, the perfect guy, you can look at him all day and you do. He has perfect timing, is believable through and through, loves opera, food, and is slow to go in relationships. Abigail Breslin, Zoe, is Kate's niece, the very same child star you saw in Little Miss Sunshine. She doesn't disappoint here, either.

Such a feel good/feel bad/feel good movie, what a surprise. Add an extra feel bad if you're me and just HATE matricide or reminders that mothers die and leave small children. I can deal with it any day of the week in the office and do, but when I'm off, would rather not. Not at the movies. (But CZJ, food, no contest)

It's one of those films that didn't know where to end, so we get a third act (thanks #1 son for pointing that out to me) to make it even longer. It's like a good read. We like 'em long, more pages, please. With lower back issues you're fine without Act Three, but like many second endings, the real second end is better, so you might as well sit back and enjoy it. Oh, and finally, finally, finally, a little conflict.

There are all kinds of ways to do reviews, and my way is to take a look at the scenes that make me want to stand up and scream, "NO, NO, NO! It's just WRONG to say that! Or, WHY OH WHY would you say that in THAT WAY!" Either the content or the process is lame and I'm always wanting to correct errors in either/or.

For your edification.

The script is just fine. The cringe is that dysfunction is bound to happen, something WILL go wrong when people deliver bad news badly. In this case because Kate's character is vulnerable yet altogether tactless, when she delivers poorly, it's unintentional, but painful to watch. She has this, I-really-don't-get-it-ness, a pathetic lack of social sensitivity.

Examples, just two.

Kate's at work and gets a phone call in the kitchen. Her face drops and she dashes off to the hospital to see her niece Zoe, who is still alive, but all bandaged up, attached to machines with tubes. The doctor tells Kate that her sister, Zoe's mom, didn't make it in the car accident. It's going to be Kate who has to tell Zoe.

Kate is in a chair by the hospital bed. The kid wakes up. Her eyes well up with tears. Kate looks at her. Hi Zoe.

I want my mom. I want my mom. Where is my mom???@@!!! (tears stream)

Kate's silent.


From the chair: Yes. She's dead.

She doesn't move in close, doesn't take Zoe's hand, doesn't soften the impact (as if you really can but you have to try).

She's dead from three feet away.

Wooden human wake up call here. I know, I know, how hard it can be to make that moving in close move, but there are so many times, so many times you have to move in, maybe touch someone.

I tell students: There are times to move in. There are times I move my chair closer. I don't take anyone's hand, but I move in.

Okay, the next scene I hated, and I'll stop. Seriously, I loved the movie and would totally rent it with the girls.

Kate drops Zoe off at school but the school principal (Stephanie Berry, great) calls her over to talk. Zoe's been nodding off in class, according to her teacher, and when asked, has mentioned working at the restaurant and going to bed really late.

There are laws against that sort of thing. We'll have custody revoked if it continues. Great.

So how does Kate tell Zoe? Does she say, Honey, let's talk about working at the restaurant, I know you love it, but you're falling asleep at school, and that's not good, and I have this fantastic babysitter who will watch movies with you, or maybe even cook with you, tell you a bedtime story. . .

No. She says, Zoe, you can't work at the restaurant or they'll take you away. I don't want them to take you away. Now Zoe's most catastrophic fears are realized, You don't want me. I want my MOMMY@!@!

Enough said. A therapist that only sees individuals is going to look at Kate's personality and think. . .borderline. . .narcissism. . .A family therapist looks at it and says, tweak here, tweak there. She can do it.

Best parts of the movie are the therapy scenes, not too many, just enough. All I can tell you is that it's not good form to eat food that your patient has prepared for you, not usually, not really. Unless, of course. . .

Copyright 2007, therapydoc

Sunday, August 19, 2007

The Rabbi and the Second Shift

As long as we're grousing about the past and talking about parenting . . .

When I talk to people of my generation, doesn't matter if they're Irish, Jewish, Italian, Polish, German, or Japanese (I could go on with that but I think you get the idea), they talk about their parents and their traditional roles.

Sure, they complain about old school parenting, whipping out the belt for effect, silent but deadly looks. But at least the food was on the table, the laundry clean, and the kids got to bed by 10:00. (Yes, I'm way over-generalizing, I know, I know).

But when I talk to people a generation or two younger, they talk about their role confusion, and how between the two of them working, nothing gets done since nobody particularly wants to claim this job, or that job. Sometimes one of the two will try ALL the second shift jobs, burn out, and need me to fill out forms for family leave. So burnt out.

The kids are on the Internet until the next morning, don't understand about alarm clocks, think that gang-banging could be a concept (so bored).

What to do, what to do.

Don't ask me, I just thought I'd rant a little.

I'll pass this one along, a story I've repeated about 2 zillion times, maybe even on this blog.
The story goes about a young man who sat in Kollel and learned Torah (the Holy Books) for a living. Orthodox Jews respect Torah learning so much, that they set up groups of men to learn professionally just to make sure the world continues to spin properly. The ones who are paid to do this are married, and it's generally expected that wives will earn a living somehow, too, as well as bear children and see to it that they're well-groomed.

So this young fellow, Yankel, was expected to be on time for morning prayers at the synagogue; that's one of the expectations if you take a place in the Kollel, you make it to the meetings for prayer 3 times a day on time. And he was forever late for the morning prayers, in fact he often didn't make it to them at all.

One day the head of the Kollel took him aside and said to him, "Yankel, what's going on? You never make it to shacharit (morning prayers). What is your excuse, anyway? It's not right, you know."

Yankel looked embarrassed, but he answered the rabbi.

"Rebbe," he said, "I have this problem. I want to go, I really do. But there's this woman, and she has many children, and the mornings are impossible for her. She has to feed them all and get them dressed and off to school, and they go to different schools. It's very hard. So I feel it's important that I help her."

The rabbi, incredulous, raised his hands to Heaven and shouted, "Yankel! Who is this woman? We can help her! I can find someone who will come to her house in the morning to help her!"

Yankel shrugged his shoulders. "That woman, Rebbe, is my wife."
So you see, friends, at some point you just have to figure it out.

thoughtfully yours,


Thursday, August 16, 2007

You're not the boss of me: Playing defense

Not the Boss of Me
is the theme song of a television show, Malcomb in the Middle. The show is about kids and the song is performed by They Might Be Giants. Here are some lyrics:
Yes, no, maybe
I don't know
Can you repeat the question?

You're not the boss of me now
You're not the boss of me now
You're not the boss of me now, and you're not so big.
I was riding my bike to work when another biker cut me off on the street and said, "When you turn the corner you should really be sure to look to see that nobody's coming. Just be careful, okay?"

Excuse me?

It was the When you . . . something. . . you should . . . something. . . that got me. It wouldn't get to everyone, but it got to me.

What, like I didn't look? Here's some 20-something kid telling me to look. HE was going too fast on his bike, obviously. Like I need his advice on how to ride a bike?

I'm not going to bore you with the details. It turns out that although I had looked for cars I hadn't looked for bicycles. He came up on me fast, but he had the right of way.

And all he said was, Just be careful, okay?

Outside of my blog I don't tell patients much about me. I don't even tell new patients about the blog any more to tell you the truth (the anonymity feels so good). But there are times when a therapist has a personal life example that packs that perfect punch.

So here's a story I've told over in therapy a hundred times. More or less.

My father is a wonderful guy and he did a great job as a parent and we did what he said we had to do. He said, Shovel snow? We shoveled snow. He said Weed the garden? We weeded the garden until there wasn't a weed in the yard. That sort of thing. In my house you didn't say, When this t.v. show is over I'll get to it. You did it immediately.

Encouraging assertiveness wasn't exactly his bag. He was old school, as many of the people who are still vertical in his age group tend to be. He and my mom have a traditional marriage to this day, except my father does a lot more cooking and quite a bit of work around the house.

When I think back on it I'm sure he really did leave room for us to ask questions about why we had to do certain things his way when he wanted, but we didn't feel comfortable doing that. And to his credit, at every age we were given plenty of room to explore our world, to become independent, confident people.

Anyway, like I said, what he said ruled. My mother didn't usually contradict, although she softened things up. If you've read my posts on structural family therapy then you know that parents should rule. And yet there are different kingdoms, different countries.

Being the boss of your kids can have interesting consequences. We think it better to encourage the kind of dialog that encourages a kid to do the right thing for himself, not for his parents. A kid who isn't bossed tends to be less sensitive to criticism.

It works like this. If you take orders you feel small. If you feel small you feel powerless. If you feel powerless you feel vulnerable. If you feel vulnerable you feel defensive. If you feel defensive you reflexively assert your boundaries at some point, set your limits. You're less open to even innocuous suggestions

as in When you. . .something. . .you should. . .something.

So the story goes that when FD and I had been married about a week the telephone rang. He said, "Get the phone."

Not Would you get the phone, please? Or even, Can you get the phone?

Get the phone.

I think I said the following, loudly. I remember it word for word.


And I probably said a few more things, but I can't remember them.

Well okay then, he probably replied.

I'm not a yeller, either, but I felt like I'd been hit from behind, attacked. And all he said was, Get the phone.

And I got all defensive. And I knew why. Then today, this kid cuts me off, and in a very sweet, concerned way tells me, Be more careful, and I get all weird like that again.

But I didn't go off on him. I followed him to the light and I asked him to explain to me what happened, and he did and I apologized.

Scary, isn't it? That more than thirty years later, a simple suggestion can still trigger a person like that?

Off the defense,


Wednesday, August 15, 2007

An Assortment of Links That Have Nothing to Do With One Another

In keeping with the promise to link to people who link my way, take a look at Saints & Spinners, who writes about books and song and what could be bad. I'm taking the liberty of handing you a ticket to her site.

Then there are people who recommend books, crazy I know, check out Reading is My SuperPower

And as long as we're talking about music, there's the Soul of Rock. Who knew so many types of rock could co-exist? I just didn't know.

Leah in Chicago/Accidentally Jewish will fill you in on some of the features of another cool Jewish custom (honestly, it was never my intention, when I started this blog to have so many Jewish spins on things, but you can take the Yid out of the shtetle (suburb, not), yet you can't take the shtetle out of the Yid.

For movies, you have to see Nehring's blog--it looks great, but looks aren't everything as you well know. Check him out.

And for those of you interested in nursing, check out Change of Shift.

Or of course, there's

Change has been kind enough to link over here, when really, the rule is nurses are a club and try to keep on topic. You know that for me, that's impossible. But what a blog that is.

Musings of a Highly Trained Monkey

Dr. Sanity is another academic who has fun on the net. Always a good read.

And anything about child abuse you can find a Wired for Noise (it's still happening, I don't understand it, oh, actually I do)

And Yehuda at Haveil Havalim does a great round up of J-blogs and includes my Intimate Opportunities post. He read way too much into it, as men tend to do.

The mommy blog of the week is Mommy Babble, what else would one expect, really. Can't blame the cell phones for this one.

Find Religion is a nice place if you're thinking out-there thoughts. We won't judge you, honest.

Then there's the Centre for Emotional Well-being, which is nice because it gives us that British spelling thing that makes us all feel very cosmopolitan, and all (plus Talia's very smart).

Then there are all the cat people. Check out Life From a Cat's Perspective for good cat pics. Then there's The Modulator, a virtual Friday's Ark on pets, cats included, of course. And CatSynth--about music and cats, what else. I can't wait to move on to fish.

On the Coach Team, there's Think Happy Thoughts. THT tells us to assume people are stupid, not mean. Gotta' love it. Even though "stupid" is a little harsh and surely isn't "happy", I like it better than Think Happy Thoughts. Rock on, Miguel.

There are also MONEY BLOGS on the net, and MsMoneyGirl linked over here. One thing you won't get here, I'm sorry to say, is money. I do avoid talking about it, let's say have for over a year now. But okay.

Whereas, FOOD I can always relate to and ATeam has recipes, so why not try something new?

And as long as we're talking about food, Cindy is a holistic wellness person and has recipes for stuff that HAS to be good for you. Although you're not getting an endorsement, frankly, from me if you think I'll prescribe herbs over what your doctor recommends. I've heard horror stories about St. John's Wort, for example. But Cindy's blog is cool.

She SAYS she's an oddball, but Pollywog's Pond isn't nearly as odd as she thinks.

The SKWIB is as odd as he thinks, and we do love him. He's Canadian, which might explain it. I have Canadian relatives and tho we hate to generalize, there's something about it. . .like being American is a trait, too, right?
Wired for Noise gives us a Carnival Against Child Abuse, good idea to be down on that and I like the blog.

Homespun Honolulu
takes us to various cities, and face it, if you stay home too long you'll get grumpy so you may as well get out of your rut.

If you're into art, try Arts and Stuff. It takes me away.

And Travel Minx collects travel articles and some of the pictures her bloggers post are just great.

Tracee, at Blog Fabulous mentions an association between anger and backpain and links to my Angry, did you say, post. Gives new meaning to what my mother would call a pain in the neck.

UrbanWanderLust is the kind of blogger who really does the diary of wandering, which is probably healing.

And if you like a feminist point of view (like me) check out Femtique.

That's enough for now.

Thanks to all of you for linking over here,


Monday, August 13, 2007

Yad Vashem

were sent to slave labor.

Our tour guide told us that those who were sent to slave labor were allowed 200 calories a day.

The photograph above is in the Yad Vashem Holocaust Memorial in Jerusalem. I took it off their website. The album is the only surviving visual evidence of the process of mass murder at Auschwitz-Birkenau. It is a unique document and was donated to Yad Vashem by Lilly Jacob-Zelmanovic Meier.

When I was a teenager one of my cousins (a South Sider) came to stay with us for what was supposed to be a couple of months. It turned out to be over a year and great for me, because as you know I was the only girl in my family and had my own room and it got a little lonely. So she and I talked into the night that year and it was very nice on all kinds of levels.

My cousin suffered from migraines and when she did, she mostly slept. One day I asked her what she thought caused them and she said she didn't know, but they started the day she heard about the Holocaust. I was fourteen and I hadn't even read Night by Elie Wiesel, or heard any first hand Holocaust stories, which was ironic since my parents had at least a handful of survivor friends.

All four of my grandparents had come to America in the early thirties, escaping Hitler's reign of terror.

Or I wouldn't be here.

I always felt a little guilty for not pouring over the books about the Holocaust. I read NOTHING about it in my social studies primers in grade school the fifties and early sixties. And I'm still a little light in this department. But I go to the museums if I'm in a city with a memorial museum and suck up as much as I can.

L.A. is good, Washington's better. The one in Jerusalem is the best.

So I was in Israel a couple of weeks ago, and since Yad Vashem is considered the world’s largest repository of information on the Holocaust, of course I had to go. I had been there ten years ago, but new founders have reinvented it, turned into performance art, a collection of photos in motion, sculpture, visuals and sounds, a sophisticated vehicle that breathes life into the victims, the perpetrators, and the bystanders of that awful period in time.

I've had it in mind to go to there since my youngest son, a particularly sensitive young fellow said to me after I booked the flight to Israel, "You should definitely go to Yad Vashem, Mom. It's very cool."

I rely on my kids to direct me in life, especially to things that are cool. For example, Empath Daught tells me what to wear (sends me home with sweaters), the Stooge tells me what movies I'll be able to stomach.

If you haven't been to any of the Holocaust museums then you're missing out. These memorials are much more than store houses of historical facts, artifacts, newsreels, etc. Their entire raison d'etre is to put you face to face with so much truth that you have to be emotional.

If you suffer from depression and know you can't handle too much reality then forget about this particular reality field trip. I tell MANY of my patients not to read or watch the news. Stay in LaLaLand and don't go to the Holocaust museums. But you HAVE to tell others to go in your stead. It's your responsibility.

I went with FD, his mom, sister, and brother-in-law, a few days after my niece's wedding. You last met them in a post I wrote about how saying incantations can help you find lost objects (I AM a social scientist, I REALLY am). We sang show tunes at Borders that Saturday night. It was unforgetable.

Anyway, bro-in-law Michael immediately sized up that we needed a guide for this exhibition. We were lucky to get Devorah Gold, perfect. Her grandfather made sure that her father escaped the Nazi's. He sent him away. I think she said that her father met her mother and married her in a DP (displaced persons) camp.

Devorah delivered every powerful line of her script with careful precision. It was like psycho-surgery. Hypnosis. I felt right at home.

FD was upset by the way the museum worked emotions. The museum is set up to make you feel the experiences of those who perished, and those of the few who survived. My guy found it all too emotionally manipulative. After the tour he wandered off for about an hour to see the art and other exhibits. He totally tranced out, didn't even answer his phone. I was a little worried about him.

But I feel that this type of emotional upset is good for people. It connects us with reality and we have to know this reality. It's good to go through this. It's nothing, frankly, compared to the horror that that generation suffered.

It's a fact of life that the world is replete with horrific acts of mankind. Rape, torture, and murder are universal. Violence sells newspapers; it is the stuff of NPR. I have to wonder if there's something wrong with a society that is so captivated by horror. We're literally entertained by horror films and desensitized to violence.

Some of us even LIKE the Holocaust museums. Even though 6-10 million people died in that genocidal world war they remember.

And to this day there are people who deny that it ever happened. Not the war, the death.

We listen to fireworks on the 4th of July, barely connecting them to the rockets red blare, but at least it's an effort to connect to death and destruction. Annual memory pitches that honor Good Wars include Memorial Day and Veterans Day. We LIKE seeing photographs in newspapers and magazines of men (mostly men) in uniforms wearing medals; men who fought for freedom.

Yet, most of us manage to avoid the pictorial side of the Holocaust. The emaciated bodies of starved concentration camp survivors, the piles of dead in mass graves, the death marches to gas chambers, the empty eyes of children. .. just not attractive. A downer.

I have a well-heeled, wonderful friend who set up a social service agency for rape victims. She had problems getting funding. "I could get the money to stage a week's worth of performances of Madame (pronounced Ma-da-meh) Butterfly, but get funding for rape victims? Ha!"

So most folks don't volunteer to see photos of emaciated, dying people, or medical experiments that turn the stomach either.

But it is VERY cool going to museums in Israel these days, technologically speaking, seriously. Yad Vashem is virtually new, and at Masada, too, there's a new museum, complete with a "smart" audio tour. No longer do you have to hit a button on the remote control to hear narrative . The remote control knows where you are in the museum. You go into a room and you hear about what it is you're supposed to hear about what you're looking at, perhaps ancient coins or pottery inside the display case. It is very cool.

And at Yad VaShem, if you use a guide like Devorah Gold, you get a head set and hear her speaking loud and clear, explaining what it is that you're seeing, assuming you haven't drifted too far away from your group. The head-set audio tour is great for the predominantly aging populace that visits the museum.

Ten years ago, before the remodeling of Yad Vashem, I saw hundreds of pairs of shoes behind a vertical glass display case, the shoes of the victims of the Holocaust. Now the shoes are in a display under a floor covering of thick glass. We're encouraged to walk on the display, to walk on the shoes.

Go ahead, walk on it, walk on those shoes, says our guide. No one does.

I do. She's really saying,Walk in those shoes.

The museum is like that, very experiential. Do you want to know what the German soldiers were thinking? How could they kill every Jewish child under the age of 10, for example (a 1942 proclamation, Every Jewish Child Under the Age of Ten Must Die) .

Open the door to a wooden box on a wall and read a soldier's explanation to his family.

One officer, Karl Kretshmer says (I'm paraphrasing): It is a weakness not to be able to stand the sight of dead people. The way to overcome this weakness is to kill more often. You get used to it.

I'm told there's a movie we should see, The Wave, about a brilliant teacher who teaches children how to be murderers, willing executioners.

When the Germans invaded the Soviet Union, soldiers were ordered to shoot victims in the head at close range. To do this they were ordered to first drink 1.5 liters of vodka.

14,000 people were murdered at Babi Yar in two days.

It is a weakness. . .

The Pope didn't leave his palace. . .

Martin Niemoller, a German pastor wrote these famous lines:
They came for the Socialists, and I did not object because I was not a Socialist.

They came for the Trade Unionists, and I did not object because I wasn’t a Trade Unionist.

Then they came for the Jews, and I did not object because I was not a Jew.

Then they came for me, and there was no one left to object.
The only children who survived the Holocaust were those sent away by their parents. Some left on the KinderTrain (Google the Kindertransport Association). They left Poland, Austria, and Czechoslovakia on a train to Great Britain. Alone.

The "Righteous Among the Nations," risked immediate death if discovered harboring a Jewish person. But the Righteous (euphemism for Gentile) hid Jewish children in attics and closets. After liberation, some "lucky" children were reconnected with war-traumatized parents who came for them, whisked them away from their adoptive parents, the people who had loved and cared for them.

The enormity of such separation, so many separations, is inconceivable, even to those of us who think we understand separation.

Devorah Gold asked her father why he married her mother, how he chose her. He said, straight faced, "She was rich."

"Rich!" shouted Ms. Gold. "How could she have been rich? She was a survivor!"

"She had two sisters," he replied.

She had relatives. Anyone who survived the Holocaust with relatives was rich.

It gives us a little perspective, I think, when we begin to feel sorry for ourselves.

Lest we forget.


Saturday, August 11, 2007

THIS is love?

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

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

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

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

He chuckled at my expense (embarrassment).
"And how would you propose to get your data for that," he laughed. "How would you get a sample?"
Ha, ha, ha.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Oh dear.

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

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

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

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

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

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

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

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

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

Or dress up and go out and accomplish all five.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



Friday, August 10, 2007

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

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

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

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

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

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

Okay here we go.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Just an FYO.

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


Thursday, August 09, 2007

Holding On and Letting Go

You're Wearing That is the title of a new book by Deborah Tannen.

National Public Radio's Susan Stamberg excerpts from the book and interviews the author. I excerpt from her excerpt below, but it's worth reading the whole post, and I'm sure it's worth reading the whole book (sight unseen I say this).

Most of us instinctively identify You're wearing that as a mother's communique to a daughter, and that's what the book is all about, mothers and daughter and how they talk to one another.

Quick and dirty:

You've heard it here before that when you talk to a significant other you should try on the idea that your S-O is important, as important, indeed more important than your boss, and you wouldn't speak to your boss harshly. You wouldn't second guess or psychologically undermine (out loud) your boss's choices. You wouldn't yell at your boss. You wouldn't hang up on your boss.

Parents assume that they have the right to do these things to children. Children, especially when they get older, assume that they've earned the right to do them to their parents.

Earn the right? There's a right to emotionally abuse a family member?

A little harsh, let's dial that down.

Of course if you don't correct your children then they might grow up feeling the world owes them a living and that they're always right, or conversely, that no one cares about them and they're nobodies. But there is a right and a wrong way to advise people, and probably Dr. Tannen discusses all of this in her book.

(Why is it I didn't get an advance copy of THAT one, by the way?)

Recently a patient told me that the state of being angry is now considered emotionally abusive, a real kick to therapies that encourage you to beat your pillows. I still like the beat your pillow concept. Who does it hurt, after all?

But for sure if you're in therapy or have ever been in therapy and the topic of anger has come up then you know that the expression of anger can be extremely abusive, even in low tones. It's exactly what we tell people in anger management.

You have potential to emotionally damage by being angry-- either at your spouse or at a child-- at anyone, if the way you express your anger as volatile and unpredictable, or if it's cruel, biting, mean.

I've told you this on my Because of You post that discusses Kelly Clarkson's song. She bemoans the domestic violence she experienced by watching her parents fight. I tell you that her anxiety, her fear is a response to trauma.

So no, you don't have the right to be angry, rather, you don't have the right to express it without sensitivity.

I titled this post Holding On and Letting Go because so much of what happens between parents and children is about control. We have such a need to hold on, take care of, protect our children, that letting them fly can be supremely difficult.

Sending them to kindergarten can be hard, how can we do weddings? The stress of letting go (and the energy it takes to hold on, double entendre intended) is a variable that surely drives the way moms and daughters talk to one another.

So when it comes to communication, walking on eggshells, even if it is uncomfortable and doesn't feel intimate is a good thing. The intimacy will come if we're careful about how we talk to one another. It's okay to have to watch what we say-- to think and rethink everything, to couch communication in the most sensitive, caring fashion.

When the kid is about to stick a finger into an electric socket or run into the street, THEN you can scream. But most of the time children aren't doing that. They're not sticking fingers into electric sockets. They're not running into the street. They're looking both ways.

I don't mean to minimize this subject in any way, trust me. I understand that if your child's shooting up that you'd better do something and it might be best to be strict, calculatedly rejecting, even mean. We can talk about that another time.

Meanwhile, here's a quick excerpt of the book, excerpted from the NPR website. Congratulations Ms. Stamberg and National Public Radio and thanks Dr. Tannen.
A woman in her sixties expressed this: “I always assumed that once my daughter became an adult, the problems would be over,” she said. “We’d be friends; we’d just enjoy each other. But you find yourself getting older, things start to hurt, and on top of that, there are all these complications with your daughter. It’s a big disappointment.”

Small Spark, Big Flare-up

Especially disappointing—and puzzling—is that hurt feelings and even arguments can be sparked by the smallest, seemingly insignificant remarks. Here’s an example that comes from a student in one of my classes named Kathryn Ann Harrison.

“Are you going to quarter those tomatoes?” Kathryn heard her mother’s voice as she was preparing a salad. Kathryn stiffened, and her pulse quickened. “Well, I was,” she answered. Her mother responded, “Oh, okay,” but the tone of her voice and the look on her face prompted Kathryn to ask, “Is that wrong?”

“No, no,” her mother replied. “It’s just that personally, I would slice them.”

Kathryn’s response was terse: “Fine.” But as she cut the tomatoes—in slices—she thought, Can’t I do anything without my mother letting me know she thinks I should do it some other way?
Gotta' love it.

copyright 2007, therapydoc

Tuesday, August 07, 2007

Feeding Them

They look like they can take care of themselves.

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

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

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

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

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

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

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

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

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

What DID we do without cell phones?

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

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

We all sighed the collective sigh of relief in our seats at the gate. On time for an international flight means your flight will take off 2 hours after you've checked in, assuming it really is on time.
Cham: Hey, Ma. Did you happen to bring anything to eat?

Me: Uh. . .

Duv: We're starved.

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

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

Me: I'm so . so sorry. . . but. . .
I forgot. A failure as a mother. I forgot food. My mother would never have forgotten food.

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

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

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

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

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

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

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

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

And they know they can raid my fridge any time.

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

copyright 2007, therapydoc

Monday, August 06, 2007

More on the field of Infant Mental Health

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

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

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

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

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

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

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

Just another perspective.

Publish this comment.

So I published it and responded to his comment as follows:
Jay, I don't think I've ever intentionally implied that the purpose of therapy is to make money. As a matter of fact, I'm pretty sure that if a doc wants to make money, I've suggested real estate.

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

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

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

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

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

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

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

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

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

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

This is all a very long-winded way of saying that what we do depends upon the children and the parents, which, of course, you know already. But I thought a few more concrete (if long-winded!) examples might help.
See why I love this job? Children on window sills. You bet they need therapy. I wrote back:
Sorry, I mistakenly thought that the field of INFANT MENTAL HEALTH was about INFANTS and thought . . .infants, as in. . .babies.

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

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

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


Friday, August 03, 2007

Diagnosing Cats

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

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

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

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

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

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

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

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

"He's shaking," she told me.

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

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

Nah, can't be. Makes no sense.

copyright 2007, therapydoc

Thursday, August 02, 2007

Intimate Opportunities

No, not what you think.

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

Here's a typical decision.

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

Copyright 2007, therapydoc