Sunday, November 14, 2010

Therapy Abuse

In the last couple of years some of the men in my practice have complained that their partners, generally women, but they could be men, aren't as physically demonstrative as they would like them to be.  They tell me they want kisses as much as sex, although sex would be nice, too.  You know the old joke:   
How do you cure a nymphomaniac?  You marry her. 

We could talk about the joke forever, right?  But my editor tells me that I have to focus, so let's do that, focus on this problem, the disappearance of affection.  I'm thinking that if men are complaining, it means that they have finally caught up to women, feel more free to talk about their feelings in the twenty-first century.  And it's a good thing, not a gender issue so much as a windfall from the Women's Movement.

Women can ask for love and sex.  Men can ask for sex and love.  Just say something, please.

When it's brought to my attention in therapy that a partner in a committed relationship has become painfully avoidant, unaffectionate, emotionally distant and cold, I want to shout out, act like Nancy Grace of CNN fame, now the vigilante judge on the new daytime Fox TV show, Swift Justice. I want to verbally beat on the ostensibly withholding partner, glare at the poor, unsuspecting soul, and make harsh, judgmental faces while bellowing:

What were you thinking when you got married?  That you could let it go?  Do you think that just because you have a ring on your finger you don't have to show love anymore?  Do you believe that just because this person (I would point at the beleaguered spouse) signed up for life with you  that you can do your own thing, turn your mate into chopped liver?  What's wrong with you?@!@!?  Do you think people can go through life, day after day, week after week, with no kisses, no hugs?  Don't lie!  Don't lie to Swift Justice!
Men, women, doesn't matter which gender is the stingy party.  When it comes to affection, I (and Judge Nancy, we're thinking) take no prisoners.

But that's so judgmental!  So not therapeutic, ranting in this way.  It is what lawyers do, not therapists.  Most people don't see a therapist to be beaten up verbally and emotionally, what might be considered therapy abuse.  When we go to a mental health professional we're hoping for calm, relaxed, half-asleep doctors who explain the psycho-dynamics to us, the whys and wherefores.  We want to know why a partner is unwilling, unable to show affection, maybe.  Or we want to work on change, changing our partner, sure, but maybe changing ourselves.

Most of the time that's the case, and it is a slow, healing, sensitive process.  But some people are just dying for us to let loose, give them hell.  You can tell when they want someone to sober them up.  And quite honestly, when that happens with my patients, when I launch into a critical and judgmental tongue in cheek rant, for it had better be tongue in cheek, then that person is likely to love it, and will want to come back for more.

You could say, and you would be right, that this is dangerous water in which we tread at this moment.  A therapist on the Internet  probably should not be giving young, impressionable therapists the impression that it is fine to beat on patients.  Suggesting this, even whispering it, begs a lawsuit, screams professional suicide.

So don't do it without an amazing relationship with your patients, okay?  That would be unprofessional. And make sure they know you're kidding, or at least make the case so that they strongly suspect you are kidding.
If you're lecturing a patient, no matter how badly he or she deserves it, make that delivery tongue in cheek,  and act apologetic as the insults roll off your lips.

At this juncture it is best to reinforce what tongue in cheek really means.  Find a mirror, gaze at yourself in this.  Push against your cheek with your tongue.  Push that cheek way out. Go ahead. Do it right now.  We'll wait.

Could anyone possibly take you seriously if you look like this before, during, even after a rant?  Preferably during the whole show? 

Yes, it's possible, you say,? Your rendition of tongue in cheek in the bathroom mirror looks serious? Then that's bad.  Bad because the more concrete, the more literal among us take us at our word.  Best not to do this intervention with terribly concrete, literal patients.  And to be sure you are not misconceived, consider utilizing the other cheek, too, alternating the process:  Tongue in the right cheek, push.  Tongue in the left, push.

Return to the mirror and practice this, and for good measure, try raising your eyebrows up and down a few times.  If you are still worried that someone will feel abused when you rant in this fashion, be sure to tell them that you were being facetious. Confess, 
"I was just kidding.  You have good reason, seriously, to withhold affection.  Let's talk about it." 
Then go into it with the patient, find out what that good reason is. Because how should you know, otherwise?

We would call this giving somebody his day in court, presumably. Or just good therapy.



Jack Steiner said...

One of the many reasons why I don't think that therapy is my calling is that I can't imagine not being to yell a bit.

While I am perfectly capable of maintaining a poker face I simply can't imagine not rolling my eyes from time to time.

Ms. Adventuress said...

I, too, cannot imagine witholding affection. After all, why else be in a relationship...

Leigh said...

What if you're not witholding - it's just the way you are?

I grew up in a family that never touched, never hugged, never kissed. It's hard to remember to do these things because I never practiced and it never became a part of my manner of being.

Strangely, I married a man who can't have enough physical affection and attention -- it's quite overwhelming sometimes.

(That may be why I became a massage therapist - so I could touch in a controlled and empirically helpful way.)

Anyway, thanks for your passionate view on affection - but if I was on the business end of that speech (albeit tongue in cheek) I'd feel inadequate. Even "cold" people have feelings.

therapydoc said...

I better clarify right now, I woudn't ever say those things, even tongue in cheek. The post is a total jest. You can never risk hurting someone's feeings in therapy, not even tongue in cheek. And I mean never. I just wanted to hear from people like you, and everyone else with thoughts on the subject.

Leigh said...

Oh I know you wouldn't -- no cause for alarm. :)

I just get a bit touchy because I know the way you think about is how many people feel about affection. I'm just sad that I can't live up to the acceptable standard.

More thoughts on the subject:
My need to be recognized as a sentient being is greater than my need for physical affection. I will talk about anything, read anything, speculate about any subject under the sun with another person -- I'll even hold your hand while we talk -- just don't ask me to cuddle.

Cuddling makes me feel like an object, like I'm not there. I want to scream "I am not your security blanket -- I'm a person!!!"

When I was a kid I would end up sleeping on the floor when I slept over at my friends house because I just couldn't bear the hugging/cuddling.

So there it is -- add in a handful of traumas and you get a not so physically affectionate person.

However, being a massage therapist I do know caring human touch is absolutely vital to health and growth -- you will always find me championing the value of compassionate touch.

I substitute massage for hugs/cuddling in my family close friend relationships -- it's a great coping mechanism -- everybody gets what they want :)

One last thought, -- I've had a family therapist verbally persuade/force me to "hug" a family member with whom I was very angry during a session. Why!!? I hated that!!! Why do that? It feels abusive and wrong.

EG said...

You are so busy judging that you seem oblivious to the fact that something has caused the "cold fish" to withdraw. Something has happened to break the intimacy. It's your job as a therapist to dig deeper and help them speak about the unspeakable. The one who has withdrawn affection is in pain too.

porcini66 said...

I think that I get it, TD. Sure, some therapists might *want* to say those things. Many more might THINK those things. Most therapists WON'T say those things out loud, of course they won't! It's up to the person seeking therapy to come to those conclusions on their own, right?

On the other hand, I appreciated the hard, cold honesty that my T gave me after a time. I had been practicing my denial to the point he was calling me (in his head of course) the artful dodger. I didn't really even realize it! But without his facing me head on with absolute honesty, I could have played the game forever. It was so reassuring, after all.

This was a huge step in my growth actually - his going all Nancy Grace on my butt. Not recommending it, but the politically correct, always positive, always giving people their space "stuff" didn't work for me. After a time, I was just feeding on it. It was brave of him to call me on it, and I needed that to get to this.

Thanks for sharing.

Oh, and PS - LOVE the new copyright piece! Gotta love the FB beating the blog thief got! :)

porcini66 said...

Oh, and Leigh?

I would take massage over cuddling ANYTIME! I feel smothered and confined with cuddling - like a stuffed rabbit being dragged by its ear...quit TOUCHIN' me! For what it's worth, you would do just fine according to my standards.

AT said...

I'm the touchy-feely person in my relationship. Always was, always will be. For the first many years it didn't bother me, but then I got tired of always being the one initiating contact (except for sex). So, I decided not to for a whole week. Throughout that week, I watched my SO become more and more miserable, but not once did he come over for a hug, or try to take my hand. After the week was over, I went back to normal, and some time later had a talk with him about it.
Typically, he had no explanation for why he'd not initiate contact, but something got through and now I get the occasional unasked for hug, and hand-holding. Hurray for progress :D
I guess what I'm trying to say is that physical contact for me is a two way street, and I'll confess that I did the experiment partially to see if I was crowding his space. My guess is that if I hadn't done it so abruptly, it would have happened gradually with time, and neither of us would have known why.

Nainja said...

I would not be happy if my therapist half sleeps during the session. But as it took me about half a year to believe, that she was actually taking me serious and not making fun of me, her being cheeky would probably be even worse.

Ella said...

I'm another one who is not withholding affection. I'm actually showing affection by caring for the kids, and handling all the details of our vacation to your parents, and serving as case manager for our son's ADHD. And I have a job and earn 60% of our family income. I'm really tired by 9 PM! This is not the "women's movement", this is reality of 2010, two working parents.
So, if sex is your only measure, then you will not be happy in a relationship with me - I can go weeks or months without it. You've got to appeal to my brain, show lots of love to our kids and ask "how can I help? make dinner?" - all those things fill me with affection for you.
Hugging and kissing are always a prelude to sex? why is that?

So, the problem is me, I have to fix me because I am broken because I don't want sex as much as him.

therapydoc said...

Jack, rolling eyes will never do.

Ms Adventuress, affection takes some getting used to for many of us, but that’s the point, really, that it is worth working through the many issues and not so intimate interactional sequences to get there (see next post on intimate interactional sequences).

Leigh, you have to read my post on my family and affection. About Affection Part III Behavioral Therapy
I love that you’re a massage therapist! The standard has to be relative, and for your family, you’re way above the standard, I’m sure, having married a very physically affectionate man. Oh, and hugging someone you’re angry at is just plain nuts.

Porcini, my guess is that the therapist who gave it to you also knew you had enough of a relationship to sustain that.

AT, expecting him to get it tends not to work. From what you’re saying, he sounds like he just got used to the behavioral sequence of you initiating affection. But he could change that (have him read the post I recommended to Leigh.

Nainja, a therapydoc that doesn’t take the patient seriously? Oy vey.

Ella, thanks. That’s the reason I actually started writing this post, then somehow the bit about Nancy Grace distracted me and I got caught in that. So I’m going to write the original post right now. It’s this fear of disappointing my editor that has me in a strait jacket. I’ll be okay. 

Ella said...

Looking forward to it TD!
I mean, the guy is trying to woo me with a bunch of flowers on Friday. But I think I'd be more woo-ed by a family size chicken pot pie, a gallon of apple cider and a box of cupcakes for the kids. The language of love has changed!

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AT said...

Therapydoc, I don't know what I was expecting. I guess I was hoping that if I didn't initiate all the time, then he would start coming to me. In reality I think I suspected he'd be unaffected. That he got so miserable, and still didn't come over for hugs and kisses, or even ask if something was wrong, surprized me.It told me a lot about him, not in the least that my affection was valuable, which was good - otherwise I might have thought that I was just crowding his space, and we'd be unlikely to be together today.

But I will read your post :)

Syd said...

Affection and the haves and have nots is a fascinating subject. I think that most of us either learn from or shun what we saw in our family of origin. I don't recall seeing my parents kiss...ever. Yet, I know that they loved each other. I enjoy kissing--the antithesis of what I saw in my family.

Anonymous said...

"Most people don't see a therapist to be beaten up verbally and emotionally"

Maybe not, but some of us appreciate a therapist who will do it when the situation warrants. Mine usually has no problem with telling me when he thinks I'm being an idiot; I want him to do so and he knows it. Do I feel like he's somehow abusing me up when he's painfully blunt? Oh, hell no! I'm not paying him to mollycoddle me and wouldn't respect him if he did.

Jewelly said...

It's absolutely true that it's hard to appreciate what you own because the grass is always greener on the other side, but if we can be in the moment and appreciate being alive then our whole lives become interesting to us, including the coatstand, and we might consider cuddling it. But do we want to depend on meditation bringing us into the present moment in order to find some excitement at being with our partner or do we want to be swept away at all times? It's incredible how we can feel so differently about the same person. We can go from awe to disdain in a short space of time over very little, in a romantic relationship and I guess this is a reflection of our psychic reality in which there's a constant battle between winner and loser and a constant question about ourselves and our status. We can't help being SO rude and at other times we've got the patience of a saint, depending on how we judge a new customer to be - what social status etc.