Wednesday, April 30, 2008

City Cats

This is ridiculous. I live in Chicago. Occasionally, if we're lucky, Chicagoans will see a stray deer in the viscinity of the forest preserves. Indeed I pulled over on my way home from the airport last week to show my grandsons Bambi and a friend of hers, two doe grazing in an empty lot.

Last October, in 2007, as I was on my way to work early on a Sunday morning, a coyote zipped past me on the bike path near the Chicago River. I spotted a few of them trotting down Sacramento Ave just last week. Understand, this is the third largest city in the country. Non-domestic animal sightings are a little weird. We have to drive to Lamb's Farm (a nice non-profit organization in Libertyville that you should check out with the kiddies) to see sheep.

But 2008 is apparently the Year of the Cougar. A few weeks ago police shot a wild cougar (is there such a thing as a domesticated cougar?) in front of Ravenswood Hospital, not that far from my office.

Animal rights activists were up in arms, as cougars are generally after deer and smaller mammals, not people, but this defense has yet to be tested here in town. Cougars can kill people, we think. They're armed. The protesters opine that Chicago's Finest should carry yet another heavy piece of equipment, stun guns with animal tranquilizers, something less lethal than bullets.

The cops I see in my office are overdressed as it is. They sink into my sofa. A bullet-proof vest weighs in at about 22 pounds. And guns aren't light. This is not an easy profession, law enforcement in Chicago.

The cougars follow the Chicago River. Native to the Americas, probably from the Dakotas, they have theoretically been chased from their natural habitats and are hungry. They have found the big city and can't get a seat at McDonalds or won't try.

We thought this one cougar sighting/assassination outside the hospital only a few weeks ago, a fluke. Probably someone's cat got loose. People do this. They buy exotic animals and keep them at home, squirreled away in their family rooms. The psychology behind this is flirtation with danger, a need for excitement, primarily, under the guise of a love of animals.

But then we heard that indeed, this isn't the case! The cougars are not pets. They are following the river, some say from northern climes, the Yukon, some say from the south, perhaps as far as the Andes of South America. A long way away. Not an easy trip.

Cougars, as in, plural. More than a rogue cat.

This morning CBS warned us of yet another cougar sighting at California and Lawrence Avenue, again, same neighborhood.

As a relatively cautious, environmentally green individual, I tell people that when I ride my bike to work I am safer than they are driving around in cars. And I take the river route, too, which is scenic. The only danger is an occasional dog off a leash (a $500 fine) that likes to chase bicycles, and I tend to outride them.

So I need to know, real soon. Someone tell me, please, because the weather's getting good and I'm ready to roll.

How fast is a cougar?



Friday, April 25, 2008

The Law of Attraction

This is not hard science. The post, I mean, it’s not hard science. It’s not even soft science.

You know I took some time off, a wonderful thing to do. The kids were in and they have small children who try to stretch out bedtime. We've found the best strategy is to rent movies, not go looking for them in the theater at night.

Their parents rented three:

one that no one could sit through for more than five minutes, Before the Devil Knows You’re Dead, we’re talking serious violence and very graphic sex here;

one I’d seen, Lars and the Real Girl, which we still have to talk about;

and Enchanted.

Even though Enchanted is a good movie for children, we thought they had seen enough from the glowing orb in the family room. That morning it had been my job to keep them from waking their parents and they insisted on watching just a little. PLEASE, of a DVD. Since they were essentially inoperable, I gave in, wanting their parents to sleep, which they do well in my house, which makes me happy, some kind of very primitive parenting dynamic that needs research, to be sure.

The little ones chose a half hour of Fantastic 4, Rise of the Silver Surfer. It was my job to figure out the DVD player and to master the remote, which exhausted me, but I did it. It would surely have been better to have gone out to find bugs and look at birds and things, but the little guys were too tired. And they're from L.A.

We'll get to that Law of Attraction thing, we really will. But not the law of attraction in that book, The Secret. I haven't read The Secret or even heard much about it, except from patients in therapy. In therapy we end up talking about very different laws of attraction.

A story:

A few weeks ago while talking with a couple of friends, they happened to let it slip that they had seen Freedom Writers.

WHAT? I exclaimed, furiously for me. AND YOU DIDN’T CALL ME?
We saw the previews. The hushed dialog in the theater during the preview for Freedom Writers went something like this:
Oh, we have to see that! For sure we'll see that together!
I glare at my friends. You were out of town, they say, defending themselves in unison.


Apparently not.

They love Patrick Dempsey. They love movies full of hope and sugar, although not as much as me, talk about adding insult to injury. They’ll see all kinds of stuff I can’t stomach, like Gladiators.

Love the one you’re with our motto, my so-called friends saw Freedom Writers without me.

WAS IT GOOD? I ask, trying to be a good sport.


My friend R. loves exactly the same movies I love. Exactly. One night I stayed in her apartment in Jerusalem alone and had a difficult time choosing a DVD. She has so many I like. She had to go away for business in China.

But before she left she pulled out Never Been Kissed and said, This one, dear. Perfect.

The two local friends who saw Freedom Writers without me, just loved Knocked Up, which I thought not something anyone could love, certainly not me. But I suffered through it with them, and the parting shot of Los Angeles from the air made me miss Empath Daught and #2 son and their families. So actually, I hated it.

Anyway, one night I talked FD into watching Freedom Writers with me, and apparently he’s more of a Hillary Swank fan than he thought, because he watched the whole thing, whereas I could go to the kitchen, get some ice cream, wash the floor, polish silver, and still not miss anything. Freedom Writers did go on and on.

In this true story Hillary plays Erin Gruwell, a very idealistic new teacher hired to babysit in a ghetto-fied high school in Long Beach, CA. I have patients who teach in difficult Chicago high schools who do this, babysit, and we mainly talk about how to get out of the job into more gratifying positions.

Ms. Gruwell, however, makes it her business to turn the kids around. These freshmen each have truly heart-wrenching stories, very much the kinds of stories therapists hear. Our patients teach us, you know.

She spends all her money and time doing that, raising their level of scholarship, so to speak, and she is totally amazing. It’s a crazy believable story and it has to be, because it’s true. In the film, Hillary’s new spouse, played by Patrick Dempsey, isn’t on board with her program, unfortunately. She spends all of her energy teaching, relatively little on him. In fact, he’s so not on board that he’s very unattractive. I just hate him. Movies always work on me.
So I’m with my friends and we’re talking about the movie and I happen to mention that I hate the guy who plays Hillary’s husband. AND I think he’s kind of ugly.

They look at each other. I’m obviously insane.


What do I know? I don’t watch Grey’s Anatomy. It’s a medical show and I hate medical shows, although hate is too strong a word, I suppose. Let’s say that there’s enough medicine at home, and has been for over thirty odd years. FD talked medicine with his father (OB”S) for two hours at the first family dinner I ever had at his parents’ house, while I stared blankly at the art on the walls. To his mother’s credit, she tried unsuccessfully to steer my boy out of primary care.

I cry out, WAS THAT WHO THAT WAS? THAT WAS PATICK DEMPSEY? HE IS NOT GOOD LOOKING. And I wouldn’t recognize him on the street.

Clearly insane.

But last night, while FD and my good-looking son-in-law played basketball, my daughter got the kids to bed early so we could watch Enchanted in peace. Patrick Dempsey plays the no-nonsense divorce lawyer that Giselle, the princess of Andalaysia, falls in love with in Manhattan. He clearly begins to fall for her early in the film and a palpable softness takes over his personality.

Everyone falls in love in Manhattan, let’s face it, and from the minute I saw Patrick falling, I liked him. I liked his looks. I actually like him rather early on when he gives his daughter a book about important women for her sixth birthday. Even then, I liked his looks. I thought, What a nice jaw, what nice eyes, what a nice looking man. It never occurred to me he was Patrick Dempsey.

He plays Giselle’s prince, of course.

I’m not going to spoil the movie if you haven’t seen it, but I almost wrote a one sentence post.
So I guess to me, the laws of attraction have everything to do with what’s inside. The jaw, the chin, the nose, the eyes, all take on a little more when there’s that certain something inside.

Who would have thought?


Tuesday, April 22, 2008

The Robin

FD taps me gently and whispers in my ear, "It's 5:30. Better get up."

I had set the alarm for 5:37. Swinging out of bed, I jump into some clothes, wash up a bit. Son #1 has an 8:00 flight out of Midway Airport, which is way away from where we are. If we don't leave early we'll hit morning rush hour.

I quickly grab some coffee, heat him up a bite to eat, wrap it in foil. He'll hit the road packing with food for a few dinners, depending upon his appetite tonight. On the way we talk about his research, my online class, how much we both like the Chicago community, the future of the universe. At some point he asks, "So Mom, where do you see yourself in ten years?"

Pretty sure he's wondering the same thing for himself, I still fall for the trap and talk about me. "I'm hoping I'm alive in ten years. I see people my age with brain tumors and Alzheimers. Just hoping to stay in the game, dear." But we talk about possibilities, fantasies.

In moments he's gone, and alone in the car, I flip on the radio to hear the morning news. You don't really get much when you celebrate Jewish holidays with an attitude. You sort of avoid the outside world and focus on whoever is visiting.

A mistake, the radio. The mother of three missing children found suffocated (bag over her head). Mr. Casanova, the prime suspect drives a Dodge, probably with the three little ones. China is selling the Zimbabwans weapons, but neighboring portal countries refuse to allow ships safe harbor. An NPR reporter interviews a tortured man with broken hands. In African English he tells us about an unrestrained militia butting heads with rifles, whipping civilians with bicycle chains. I begin to feel sick and change the channel.

On a seemingly innocuous rock station, talking heads yuk it up about the Milwaukee Brewers baseball team and their fans who are unwilling to wait the lines to use the facilities and wear diapers to the games. They discuss this, remark that their own bodies wouldn't allow them to do this, meaning to use Depends. I am now wondering, as I always do, where American culture is going, when the male head remarks, They really have NO shame, none. This is the absolute truth. Shame isn't even a consideration.

Well, this says it all, so I flip to the one Chicago classical music station, WFMT, which generally isn't all that great, but recently clipped me of $40.00 anyway, and remember seeing the envelope in the mail on Saturday, thinking, how fast! A
pastoral piece draws me in, calms me down, and I'm sure I don't know what it is, but am thinking, Copeland.

It's so lovely that very soon I'm seeing myself in a movie, ala Albert Brooks in Defending Your Life. He's in a convertible feeling great, top down, singing along with Barbra Streisand when a bus stops short and Albert winds up in Heaven. This is a GREAT movie if you haven't seen it, by the way.

So I drive carefully, like an old lady, which is the best way to drive, no comments about me and being old, if you don't mind.

All of a sudden the traffic slows to a crawl. I'm at Bryn Mawr and consider exiting, but we're approaching the curve to Sheridan Road and Devon and Loyola University. Only a week ago a young woman, perhaps 19 or 20, was hit by an automobile in the rain, crossing to go to school, only about a half mile from where I am sitting in traffic.

I have to go there, I say to myself. I have to see it, this intersection with new construction, this place that is so confusing in the rain. I have to pay my own personal respects to a woman and her family that I don't know, yet know.

The pastoral ends. It is The Promise of Living, the finale of an opera by Aaron Copeland, the Tender Land. Isn't that amazing, I say to myself.

Before I can blink I'm passing Indian Boundary Park and a baby robin is in the road just ahead. I slow down to be sure he knows how to fly, that I don't hit him. And as birds do, he's airborne in less than a second.

It's only 7:30 and I say to myself. Maybe one of my grandchildren is awake. Perhaps someone is ready to play.


Thursday, April 17, 2008

The Family Reunion

Let's talk a bit about dealing with the family reunions and not getting sick. Family can make you sick; we've discussed this.

Someone once asked me how exactly to avoid getting sick when certain subjects are destined to come up that will make you sick, and the answer, of course, is Steer clear. Or as the kids say these days, Don't go there.

Meaning if you know it's toxic, as Boris or Natasha or someone used to say on that cartoon, Spy versus Spy, on the Rocky and Bullwinkle show, Exit; stage right. Or at least have a stage door in mind.

Conflict avoiders among us relate. Fight or Flight? No contest.

A person doesn't always have the option to fly, however, and sometimes assertiveness feels too hard. So there are other alternatives. Like dropping the gefilte fish on the floor, which makes a huge mess, but distracts nicely. Or spilling some sort of liquid,like water or wine. The more creative among us might pull off the tablecloth altogether.

There are family reunions that are just for fun, but sometimes there are reunions that are more purposeful. I know of people who rent cottages in Colorado once a year and everyone gets together just to hang out for a week. They float in and out and don't necessarily talk about their issues with one another.

Therapy tends to be about how to handle it when there are issues that should be ironed out, and who should do/say what. It's very complicated. In therapy we entertain the options, sometimes include the siblings or a sibling, parents or a parent, just to prepare for the extended time together.

Then there are the shorter reunions, the kinds that are played out over a dinner on a holiday or a birthday or anniversary. These tends not to be a good times to work on relationship problems.

But there's often a person at an affair trying to corner another person to do just that, which is why sometimes plates drop and drinks spill.

Pehaps more respectful variants of dropping the fish (respectful to one's host)include noticing what one's nemesis is wearing (people often buy new clothes for parties and holidays) and going crazy over it.
OMG, your tie! It's so beautiful! Italian? Where did you get it? I just love the design, and how the tones bring out your coloring.
Or you can try to change the subject, as in:
How's ____ ?(pick someone) I heard he/she is:
(a) thinking of leaving his job,
(b) expecting),
(c) just came into a ton of money,
(d) is running for village council.

(make something up)
If this doesn't feel right to you and you think this is a good time to resolve differences, think again. You're at dinner. This is not the time for conflict resolution that should take place at lunch with just the two of you and a few well-designed therapeutic interventions in your head.

Instead, say,
Eventually, you know, we're going to have to get together and resolve our differences.
Put this meeting off for as long as you wish, but do your best to get through the party.

Family reunions are supposed to be happy.

Can you tell we're getting to the Passover seder? Well, it is that time of year, and the first of the two sedarim starts on Saturday night. It's a hugely labor intensive holiday for the observant, but even many non-observant Jewish people have a family dinner.

For those of you who aren't familiar with it, the seder is an ordered meal with traditions to remind us that we were slaves in Egypt (1500 B.C.E. about). It can take awhile to get through this dinnertime service, too long for some of us who want to get on with the meal.

Eventually you do get to dinner. So it is to this end that FD and the kids put together a list of things to avoid talking about at the seder, especially at dinner, after the telling of that story starring the late Charlton Heston.

They even started a list of things we should talk about.

I'm going to hand them off to you since there's still time to inform your guests, but surely these are ours, so make up ones of your own that make sense:

We don't talk about:
baseball (there's this Cubs versus Cards problem)

any politics, any politics, even Valley Village politics, we'll try not to, but we will

credit cards, mortgages, or tuitions

We do talk about:
the Masters (golf)
shoe sales
the food
why Saba is throwing toys (frogs, insects, ping pong balls) at the table

Star Wars jokes
past performances of the Four Questions

that story about the grandfathers who were switched at Cedar Sinai hospital in Los Angeles and sent home with the wrong families!
Now, some people like to really get deep and understand the true meaning of everything, why we celebrate Passover, what the symbolic foods mean, etc.

If you're one of those, even if you're not, I'm going to take the liberty of recommending one particular author's lovely and serious piece, but not too serious, if you know what i mean. Stewart Weiss writes, Top 10 Pessah talking points, and for some crazy reason, they're different than the ones my family put on our list!

Friends, I need of a little rest and plan to take a few days off. Not just work, but this, too. Slavery's not for everyone, and we Jewish women strongly feel that way by the time we get to the holiday (the cleaning, the cooking, the shopping, the juggling of menus, guests, the self-correction, another day on that). I'll do my best to post your comments over the holiday, but probably won't have a chance to reply to them until it's over and the last child is on an airplane home, assuming the airlines remain solvent, that is.

Have a great week, and I'll see you next year in Jerusalem. That's what we say when the seder finally ends, the last song is sung, and most of us are already asleep on, or off our feet.


Sunday, April 13, 2008

Spirituality, Mental Health and Desperate Housewives?

I didn't see it coming, honest. All set to write about spirituality and mental health, my show comes back on the air. And it's about spirituality, and maybe mental health.

We really took a hit with that writer's strike. Three months of no Desperate. No Boston Legal. Let's not let this happen again. Please.

Warning: Although I only reveal one subplot, the following post might be a spoiler if you haven't seen the April 13, 2008 episode of Desperate Housewives.

As soon as I saw the listing in TV guide this morning I emailed all my kids between patients to tell them Desperate would be on tonight. I inserted this announcement in a thread FD started about all the topics we can't talk about at the Passover seder. Only Empath Daught cared in the least bit about my show.

"We'll talk tomorrow!" she said.


Did I tell you that I shlepped the exercycle up from the basement so that I could watch cable and fake a little cardiovascular at the same time? It's a compact little thing that my significant other lifted from someone's basement for fifty dollars, but it weighs a ton. He couldn't believe I got it upstairs myself, having sworn off furniture years ago.

This is what happens when that ant gets going at the rubber tree plant.

Anyway, a few years ago I had a patient who experienced an Aha spirituality moment. Spirituality is a big thing in mental health. I think I wrote in a previous post that the HMO's ask therapists to check off ten or so "specialties" for referrals and that spirituality is on a list of about thirty "areas of interest."

At the time I saw way too many patients for my own health and didn't turn down many HMO panels. This is probably the default reason therapists get cranky, too many patients, too much stress. And to merit too many patients and too much stress, one fills out managed care applications and checks off specialties like, spirituality.

Being kind of religious person, I thought maybe I should check that, since I felt that I could empathize with anyone who used the Higher Power coping strategy thing.

Except on occasion I'd get a call like this:
You're a Christian therapist, right?

Uh, no.

Never mind.

This made me feel bad, especially since I really like people no matter their race, color, creed, etc., assuming they're not into terrorism or any kind of violent belief system, and yes, I have reservations about taking patients who believe in incest, statutory rape, bigamy, polygamy, and the like.

What's good about being religious, however, is that when a patient wants to talk about spirituality, or his or her concept of the Old Mighty, I'm not afraid of the discussion. In fact I'm totally open to all of it: atheism, agnosticism, as well as a belief in something out there. I'll even tip my hat to aliens, and have.

How DID we ever get on this subject, anyway?

Oh yes. What I wanted to put out here is an Aha moment, a patient's Aha moment. (all identifying details are changed, of course, as always)

Our unidentified patient obsessed about relationships, not unlike many of us. She obsessed about her boyfriends, she obsessed about her mother. She obsessed about her children and her neighbors, the clerks at Nordstrom, even the people she typed for at the office.

Then one day, in the throes of depression, she sat in a chair totally wrecked with despair. She talked out loud to what she thought of as the Old Mighty (what my grandfather, not terribly familiar with English, called Him or Her). She talked to her Higher Power and she cried. She prayed and talked, discussed and argued with her Maker. Would it be so terrible, she asked, if.. . Would it spoil, some vast eternal plan?

Sure, she was Jewish. We do this, argue, try to reason on occasion.

When all of a sudden she had that Aha moment. As she tells it, "All my life I've been wasting my time obsessing about people, thinking what I want to tell them, worrying about what they'll think of me! I should really be talking to Him! I get nowhere with people, and when I talk to Him, not only do I feel He's listening, but it's possible, certainly, that He'll answer. And no one else does, honestly. There's nothing to lose. It's a win-win!"

Do I plug assertiveness training or social skills at this point? What would you do?

It is a tough call. But of course not. What she's talking about is a major coping strategy, one that millions of people use every day. They are believers. They have, at least in their minds, a relationship with their Big Guy/Gal.

So of course, all I do is raise an eyebrow and smile. Whereas, it could be a You go girl moment for another therapydoc. But I'd never say that. These are moments in therapy where the support is all in the look, the understanding, the empathy, it's all in the eye contact. Words pale.

Oh, you want to know what happened on Desperate Housewives. Well, Lynette has an Aha moment in tonight's show. It's Sunday morning and she's watching as her neighbors pile their families into their automobiles, all dressed up, going to church. She's the staunch non-believer in the community, has never had any formal religious education.

And she's married to a Catholic and has a bunch of children, so she's thinking maybe they should go to church. She watches her friends going off to pray and she makes a decision.

"We're going to church," she tells her husband. He fights it but she wins in the end when her son says, "Sure I know who Jesus is. He helps Santa Claus."

But which church? She relies upon Bree's church initially since Bree is the most religious of her friends. It's obvious that Bree has made it through some serious problems and she credits that resilience to her faith.

At the Presbyterian church, Lynette, unfamiliar with the formal culture, raises her hand and asks a question, something you just don't do in a Presbyterian house of worship, apparently. The minister is truly surprised, but patiently answers Lynette's questions. Bree is mortified. "You don't do that here," she whispers to her friend, desperately trying to get her to stop interrupting the service and asking the minister questions. Everyone just wants to get out of there, apparently.

Lynette continues peppering the minister in front of the congregation and Bree is dying of embarrassment. Later Bree tells Lynette, "We just don't do that in our church, ask questions of the minister."

"Huh?" Lynette asks. "I thought religion was for answering questions."

"Well, yes, but we wait for the minister to answer them in his sermons. We don't ask him anything. We hope that he'll get to answering everything eventually." Then Bree does the unthinkable, she intimates somehow that Lynette embarrassed her. Lynette gets upset and decides her family will go to the Catholic church down the street.

The next week the Presbyterian minister asks Bree, Where is your nice new friend? He's so happy she came to their church. He thanks Bree for introducing the Scavos to him, for bringing them to church.

"But she asked questions!" Bree objects, seeing the error of her ways, regretting sending Lynette away. "I thought the church is about answers, not questions!"

He corrects her, "Of course it's about questions. It's more about the questions than answers. First the questions."

You'd think he's a Jew.

Bree hurries over to the Catholic church. "You must come back, Lynette! I miss you! Please. Please leave this place and come with me to my church." Lynette doesn't fall for it.

Bree persists, "Please, let's talk outside."

They go outside to talk and Lynette tearfully confides to Bree, "I've been through cancer and a tornado and I've survived both of them. I need to know why!"

Bree gets it. Lynette isn't going to church because she feels she has to go, like everyone else. She's going because she wants to go. She's looking for answers. "Why didn't you talk to me? I had no idea. Of course you're right. Faith shouldn't be blind. We should question things. I want you to have faith, and I want you to have faith in our friendship, too."

So they make up, and I'm happy, because I hate to see friends fighting. And Lynette, bottom line, does trust her friend and they talk about the ideas of faith as the camera fades to the next scene about Susan catching her cousin in bed with. . .

Those Aha moments are really fantastic, you know. I'm pretty sure they're all about slowing it down, stepping outside of our lives and reexamining what we're doing, how we're doing it, and thinking, I should change. And the funny thing is, that although those moments surely happen in therapy, and we do speed them along, we really do, there's no reason they can't happen at home.

copyright 2008, therapydoc

Wednesday, April 09, 2008

What's Wrong with Being Angry?

There's another "new" development in therapy. New is in quotation marks because for family therapists, the idea that arguing is healthy isn't at all new.

Owning one's anger, discussing it with passion, not insisting that it be mollified, relishing the conflict as a hallmark of differentiation, a divine right to one's point of view, well, this is nothing new.

I just spent 45 minutes today with a kid and his parents and insisted he spleen them, that he argue his point until he won. He lost, but only because it was about curfew, and face it, I can't tell parents to let their kid break a law, and they sure weren't going to give him permission to stay out past curfew.

It's all about the killing on the streets of Chicago, which does have something to do with anger, I imagine. But that's for another day.

That family argued and screamed. They cried and threw up their hands in disgust, and at the end of the session everyone was hugging and kissing and it was a wonderful thing to behold.

Fine. They didn't hug and kiss. But they did feel pretty darn good and went home for another round about something else.

The process of resolving conflict and hurt feelings is the foundation of intimacy. It has to happen to have healthy family (and marital) relationships.

Anger as adrenaline is really functional, perhaps the driving force in some creative problem solving. Even working to avoid anger as such is good; it channels the arousal. But as a concept, anger has always been just that, an interpretation of bodily arousal, an emotion, something we have to contend with, manage.

It's how we express it that separates the amateurs from the pros. We try not to be too indelicate, but sometimes we are! And when that happens, then damage control is necessary. When anger builds up it can be especially nasty, and all the zen distraction in the world won't stop it. And perhaps sometimes that's for the best. As long as there's resolution.

And no one should go to bed mad.*

Mark Epstein writes a terrific little piece, originally published at The Oprah Magazine, "What's wrong with anger?" now up at Check it out before CNN takes it down.

He seems to think, however, that relationship therapies have failed in the past because they focus too much on empathy and understanding. Too much of this "attunement" denies the need for rupture and tension in relations. Rupture and tension are really happy events. Rupture and tension are normal. Healthy.

The language makes me think of child birth, and what could be better than that?

We family therapists have always said that when couples need space, the quickest way to get it is to have a fight. It works wonders. When we've had enough intimacy we naturally attack one another. Or when we're out of sorts, like wounded animals, sometimes we'll go on the offense.

We can't exactly yell at our bosses. We'll lose our jobs! A good spouse knows this.

As soon as we recognize that what we're doing is having an undesirable effect, meaning we've gone too far, or if the "discussion" or tantrum (sometimes it IS a tantrum) is getting mean, then those of us who have learned to fight well apologize and kiss and make up. We compromise, accommodate, yield points.

That process can take a little time.

Family therapists value intimacy over psychological space so we hope to speed up the process with good communication and empathy, quickly get to the kissing and making-up part. You see, empathy IS good.

But people need space.

Otherwise we might melt, merge, lose our identities. Much better to fight for them.

And we have our narcissistic injuries.

And lest we forget, conflictual couples, couples who are destructive naturally with one another, shouldn't be fighting at all. They don't know how to do it well, and it does take a good year in therapy sometimes to get it right. (See the comments section for elaboration on this).

Some people do seem angrier than others, and in therapy this is not a light matter. Anger is a negative emotion, it creates other negative emotions in other people, people who are afraid of anger. So it's not exactly good.

And to be honest? If you're not a little afraid of anger, you might end up dead one day. Best to be careful around angry people, not to embrace them. Most people aren't violent because they're feeling loving.

So no, this will not be a complete discussion because anger is no simple subject.
But it reminds me that anger that is not intentionally violent inspires memories of childhood conflict, the type of conflict that makes us what we are today.

Dr. Epstein quotes D. W. Winnicott and draws a lovely comparison between our relationships between ourselves and our primary care-takers as children, and how we'll relate to partners in future relationships. He says it so well, I'll let you read it yourself. He says that the "new" thing (there's that word again) in psychology is to be 'a good-enough mother', not better than that. It is no longer necessary to be Super, Allstar, Empathy-maven, All-Attunement Mom.

It's good enough to be good enough.

Some of you peaked too soon, I imagine. Here's what he has to say.

'Good-enough mother'
Psychologists who study the origins of intimacy in mother-infant relations support this shift in emphasis. The template for all intimate relationships is the one between infant and parent. Studies of these relationships have exploded the myth of the 100 percent responsive mother. Research suggests that the best parents are fully attuned to their children only about 30 percent of the time, leaving lots of space for failure.

D.W. Winnicott, a pioneering British child analyst of the last century, laid the foundation for this shift with his concept of the "good-enough mother." Parents cannot possibly be at one with their children all the time, he suggested. Babies are not benign beings emitting only love. They are rapacious creatures who love ruthlessly, and who, as often as not, bite the hand, or breast, that feeds them.

The good-enough mother is one who can tolerate her infant's rage as well as her own temporary hatred of her child; she is one who is not sucked into retaliating or abandoning, and who can put aside her own self-protective responses to devote herself adequately (remember the 30 percent figure) to her child's needs.

This "good enough" response, while not denying her own hatred, teaches the child that anger is something that can be survived. Winnicott wrote about how the child whose mother survives his or her destructive onslaught learns to love her as an "external" person, as an "other," not merely as an extension of themselves.

This child recognizes that the mother has survived the attack and feels something on the order of joy or gratitude or relief, a dawning recognition that mother is outside his or her sphere of omnipotent control. This is the foundation of caring for her as a separate person, what we call consideration or concern or empathy.
Just terrific journalism.

*One last thought. Although obviously I'm advocating healthy conflict, you probably should keep in mind that whatever you say in the heat of an argument can and probably will be remembered.

You can try to take it back. But even when you apologize and take it back, you've still said it.

That's why it's not so simple for me to say, Let it fly. The safer recommendation is to suggest you say nothing when you're angry, that you wait until you cool down, and THEN have the argument.

It's still an argument. Go for the point!

But try to follow a few rules of basic decency. Watch the expletives (meaning keep them to yourself). Let yourself cool off before you go to the mat. Don't say things you'll regret later. And don't even think of letting the volume get so high that you scare the children.


Tuesday, April 08, 2008

The Plastic Surgery of Identity

The original working title:

Rethinking: You can do anything and You go girl.

This is coming up quite a bit in therapy lately. Maybe it's the positive thinking movement in psychology catching on. Or maybe the books that Oprah talks about are having the desired hypnotic effect, books like The Secret and A New Earth: Awakening Your Life's Purpose.

Maybe I don't know what it is that's going on because I haven't read the pop psychology books, the best sellers. So blee neder, (no promises) I'll try.

I watch movies. I'm glued to the TV. I read books. I do it for you.

And then we have ToBeMe quoting Franz Kafka, telling us to write our own story. This is a therapeutic intervention,* no doubt, writing one's future, skeptically assessing one's strengths and weaknesses, challenging perceptions of who we are and what we can become to rewrite our story.

I call it the plastic surgery of identity.

Even Franz says that that the only way to approach some problems is to try going at them by another, perhaps paradoxical path.
"There are some things one can only achieve by a deliberate leap in the opposite direction." Franz Kafka
If you think you can't dance, DANCE, says ToBeMe.

The Rambam, a 12th century commentator on the Talmud (and a doctor) advised that we exaggerate the opposite of the personality trait we don't like in ourselves. If we're shy, rather than try to be assertive, shoot for loud. Exaggerate that which you think impossible.

They're all right, Kafka, Rambam, ToBeMe. But John, one of my supervisors at the Center for Family Studies/Family Institute of Chicago a hundred years ago, says differently. And he's right, too.

John used to supervise students at CFS/FIC, which was and still is a hip place, now a master's degree program at Northwestern University in Evanston. I don't know where he is, but he said a few things to me that still stick.

The first day of class he introduced the concept of a Family World View. He told us that this is integral to how a family sees life and affects our behavior as adults in subtle, unconscious ways. Since it's so embedded in our upbringing, we're barely conscious of it. I don't know if he said it exactly this way, he probably didn't, but it's how I took it home.

We were a small group of trainees, probably five, and we had to tell over our family of origin world views, at least some of what we could remember.

And I said, thinking I was bragging about my old man, "Well, my father used to tell me, 'There's nothing you can't do.' I wasn't allowed to say, I can't. Ever."

This astounded John. "Poor you."

Excuse me?

"Yeah. What a set up."

"I don't understand," I objected. "I think it gave me confidence. I approach most problems with a go-to-it attitude. If I fail I don't care. It's the challenge that matters. I'm a loser at Trivial Pursuits,** but I don't care!"

He told me that this worked, MAYBE, for me, (seeing through my every possible insecurity) because of natural talents and aptitudes and all sorts of strengths, mainly the family on my team, the big net to catch me.

So I was lucky. If I had come from a different family, however, and if I kept failing, and falling, I'd have been criticized and even emotionally, certainly verbally abused. In a different family, this kind of world view is dangerous.

In the wrong kind of family, if I had failed and kept failing, then for sure the flaw wouldn't be in the system. The flaw would be in me.

Low self-esteem. Self-loathing. Sex, drugs, rock and roll.

I guess I'm lucky I survived.

The whole experience really shook me up. Here you think that your parents raised you right, only to find that indeed, you're lucky that you made it past seventeen. Different genetics, different family, same world view, kabang!

Sure, I'm exaggerating. But what DO we do with this positivist, no can lose, be what you wanna' be, you-go-girl movement that's rocking the culture? Are our children going to raise children who are destined for disappointment? Johnny has to take antidepressants because he's too tall to be an astronaut? Becky can't lift five hundred pound weights so she's smoking crack?

I didn't tell John (too afraid to breathe at 27) that the corollary to what my parents told me is, Go ahead, try. And if you fail, if you fall, brush yourself off, pick yourself up, and pick a new major.

Which is why I'm not an artist today.


*A cognitive strategy, revisualizing a traumatic event in a different way can lesson the impact of the trauma, especially with repetition. There are other visualization techniques like this, and literally rewriting one's desired future is one of them, combining the behavior (writing) with the thought/wish.

The therapist is there, of course, to temper rewrites doomed to failure. Everyone needs a good editor.

**Depends upon the edition, sure, but usually I'll lose.

Monday, April 07, 2008

Black Holes

Sometimes I do answer your questions.

A reader tells the story of a relative who had been dumped by her therapist because she had a certain personality disorder. The reader queried her own therapist about this and her therapist is said to have said:
Some (personality disordered) folks can be black sucking holes. That therapy would go on for a lifetime if her therapist let it.
Therapydoc, our reader asks, have you ever had to tell a patient, There's nothing more for me to do. If so, how did that go?

And secondly, when you have a person who is a woe is me victim, can you generally see through that? These are the people for whom trouble follows. They tend to create their own trouble, strange as that may seem. Have you run into one of those and how do you deal with that?

Hey not to tell you how to run your own blog, but that might make an interesting post

I once had a feature like this, answering reader questions, way back in the archives. Like most of my ideas, it lasted a week, for sure.

Have I ever told a patient that I've gone about as far as I can go?

In the State of Illinois, after six months of treatment, if a patient isn't getting better under a social worker's care the social worker is legally mandated to punt to another therapist. I'm not sure how the other mental health professions handle this, but social workers can't let you malinger very long.

Although six months can feel like a long time.

My style is to evaluate how therapy's going relatively often, being of the empirically-validate-your -therapy-or-you're-a-quack generation. If you have no idea what I'm talking about, don't be surprised. Therapy is usually predicated upon what the patient brings to the table, not evaluating progress. Evaluating outcomes for a treatment's intrinsic empirical value is nice in theory, but impractical.

Unless you're a behaviorist :) in which case you do it all the time.
Therapist: How many times did you shower this week?
Patient: Seven times!
Therapist: Feels great, doesn't it? (writes in notes, patient is caring for hygiene, showered 7 times. Looks a whole lot better, too).
But at the six month mark, no matter what kind of therapist you are, you're really supposed to take a good look at what's going on and decide if your patient might benefit from another doc's approach. I'll say,
We have to discuss how we're doing, seriously, in this treatment, because I'm legally mandated to make sure you see someone who will help you more than I can if I'm not doing a very good job.

Incredulity. YOU ARE????

Uh, huh.

Wow. Maybe I SHOULD see someone else!

But usually we talk about it and set a few goals and reevaluate our progress in four weeks time.

As to patients for whom worries follow, who seem to invite trouble and suffer from interminable aggravation. Am I onto them? Do I know their game?

Game? What game? This is surely justification to stay in therapy.

I tell patients who have one problem after another, As long as you need to be sick, you should probably be sick. One day you'll get sick of me, too, and sick of therapy. But if you aren't sick you can still come and see me, you know. As a matter of fact, I'm pretty sure we haven't covered 1979-1985* yet.

And those had to have been hellacious years.


*Fill in the proper years/gap.
The director of a very prestigious managed care group in Chicago now defunct) once told me, Whatever you do, make sure you keep 'em coming back. (tongue in cheek)

Friday, April 04, 2008

Eating Just Enough

They're beautiful, aren't they? Each one $1.25, and I probably paid too much.

I had just about had it with the week last Friday, when FD turned to me in the late afternoon and said,

"You said you wanted to go visit that fish."


The story is that my son found him on Craigslist--a four inch Huma Huma (see video below) to be sold in Wrigleyville on the cheap. Saltwater Guy says on his blog that he and Cham wanted a trigger, because they needed a fish that could handle stress.

He's therapydoc's son, okay?

His tank is about the size of my saltwater tank and I keep one fish, Blue, who is very happy to be alone and not feel he has to compete for food. Blue keeps his tank clean and he assumes that roommates are likely to be slobs, so it's not easy to live with him.

He figures, You never know who raised them or what kind of families they come from, new fish, and you know, it's possible that they went to all the wrong schools.

Blue is for sure something of a snob, but he's beautiful and beyond correction at this point.

Although they assumed that the Huma Huma would be too big for their tank, they had to do it, check him out, because on Craigs List the owner wrote the following strange description:
"Will hand feed, and loves to be pet!!! It's sooo cool!"
The fish likes to be pet. Cham could not resist this. She's always wanted a dog.

I thought it a sadistic Wrigleyville trap. A Huma Huma is really a Picasso trigger. If you know about the saltwater trigger family, triggers have decent sized teeth and are known to take off bits of fingers. People don't really think about petting them for this reason.

So the young marrieds left for Wrigleyville to take a look at the petting Huma Huma while under the influence of dinner at my house: broiled white fish, potatoes, cauliflower saute'ed in tumeric and garlic, and salad.

They bought the huma. He was an amazing deal, too. Only later did it occur to my sensitive son that he ATE fish before he BOUGHT a fish. When I pointed it out it did upset him, but he says he only ate a little bit.

They bought Huma, and FD and I visited our new grandfish that late Friday afternoon. It was definitely the highlight of the week and inspired me to buy a few new freshwater fish. I rarely talk about the freshwater tank because I'm so partial to Blue, who is, well, blue, and a saltwater fish, as one might expect. And he's interesting, too, you know. He moves rocks. One day we'll discuss this at length.

Whereas, the fish in the freshwater tank are rather pedestrian. For about a year, Hi Ho Silver had the not always so fresh freshwater tank to himself. I was too lazy to get him some friends. Indeed I got sick of replacing the mollies who died if I looked at them.

Inspired by Saltwater Guy's purchase of the Huma Huma Picasso trigger, I stopped off at PetSmart (they do seem to keep their tanks tidy) and bought three new orange and black platies for the freshwater tank. And while I was at the fish store, I picked up a bunch of frozen cubes for Blue, too. They freeze food into miniature icecubes for fish these days.

Except that when I got home and examined the package, it read "For Freshwater Fish." Meaning the cubes were not for Blue, a fish who can easily down a whole science diet cube all by himself.

Generally a picky eater myself, I was afraid to plunk a big cube like that into the freshwater tank. Maybe Silver and the new fish would eat too much all at once and die, all of them, right there, that night, in my kitchen. They're delicate, small. They eat flakes.

No guts, no glory. Ker-plunk. I did it.

As they nibbled voraciously I worried and worried. It was terrifying, seriously, the thought that I'd overfed the fish. But suddenly, as if on cue, they stopped eating. An uneaten half of cube hit the stones at the tank floor and remained there, untouched. None of them cared to continue.

It was as if everyone agreed, "Wow, that was great. Let's play cards."

And the next day, when I got home from work, they had cleared off the bottom of the tank, finished off the last bites of cubed veggies and chubs, or whatever it is they put in these scientifically determined frozen fish cubes.

So you see, my friends, the lesson is that we can learn from our fish, ease away from the table when we've had enough. Or get off the floor, or the sofa, or wherever it is that we're feeding these days. And maybe go for a swim.

copyright 2008, therapydoc

Thursday, April 03, 2008

A Year Later

Cham said, Ma, you don't blog so much anymore.

It's not true, but you're right, it's not an everyday thing because (a) you don't need this everyday, and (b) you don't need this everyday.

And you know I have a thousand drafts, so when I'm ready to publish I go over them and push the button, come what may and often, dismay.

But Cardiogirl commented on an old post, and I reread it, and wow, it's been a whole year since then and maybe those of you who are new readers should read this to get a feel for where we're coming from here at ENT.

There are some errors. For example, I say:
Individual therapists have the right to say they treat families and couples, but I'm sorry, they don't KNOW family therapy. In their heads it's still more likely to be about the patient/doctor relationship and how the doctor can get the patient (the most dysfunctional member of the family) to behave differently.
It's not obvious that I mean that the identified patient is usually not the most dysfunctional person in the family. People just assume that they are, and they're often way off base.

The other real problem with the post is that there are too many dashes. Psycho-analysis. Psycho-dynamic. Feed-back. Psycho-education. Polly-ann-ish. G-d.

It's called On Self-disclosure and Family Therapy And it's long. But at least there's no mention of fish, plants (read the post below), skis or religion.

Or even sandwiches. Which is a problem, I feel.


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