Wednesday, June 29, 2011

Therapeutic Snapshots: The Blurt

Quick housekeeping note:  For those of you who email asking for help. . . I can't give Internet advice. I'm sorry.  And I'm afraid to even write back-- too much crazy sociopathic stuff out here-- spam, phishing, people stealing email addresses, etc.  So whatever it is, please don't wait for me to answer.  Find local help by looking for community resources.  These can be terrific.  Look in the phone book or Google Community Mental Health Centers.

Thanks to all of you for the comment love while I was  gone. I'm sorry I didn't respond to most of them.  Maybe some day.

Moving on.

The bus, the 49B, lumbers southbound toward the train, moments ahead of me, which is fine. I can walk the 3/4 of a mile. 

The 49 B
I’ll catch my people on the Brown Line downtown instead.

Something about being on the move-- walking, biking, driving, especially on public transportation-- my brain downloads conversations, entire dialogs, scripts.  I flash on the ways people announce themselves in therapy, how they react to what I say, what they say to one another.  It’s all remembered, like snapshots.  

More like albums.  File this one under:   


You’re a therapist, so you are charming, and people are comfortable talking to you.  The nervous couple on the leather sofa sees you as an authority figure.  Each one worries that you will take the side of the other.  

Or they might not be nervous anymore.  You have disarmed them, this is your specialty.  You sell that snake oil, whatever they think it is, called understanding.  The shoes (this is upsetting) and the gloves (not good either) tend to come off, ironically, at disarmament. 

From the first visit we're getting to know one another and the therapist is diagnosing.  Depending upon her training she might seek out these types of relationships:

(1) conflictual, 
(2) conflict-avoidant
(3) over-adequate/under-adequate, or OA-UA.  

The first two are self-explanatory, but the OA-UA more subtle.  Roles are assigned, sometimes, before commitment.  At that time taking care of somebody might seem like a good idea, an easy sacrifice.  But it gets old, taking care of adults who should be more adult. We're looking for equal partners, most of us.

Many couples fall into combined relationship types, and there are different paradigms.  There's no simplifying the therapy.  Volumes could be written on any one of them. 

There are, however, universal process basics to smooth the process along.  We'll call these change directives.  You can find them in

The Therapy I Ching.*

A couple that fights all of the time, shouldn't fight.

A couple that never fights, should.

Dispassionate problem solving is hard, but rising to this--
quintessentially human.

No one should get hurt while getting better.

The doctor lays down these ideas in the first visit, and reinforces them, but the couple is likely to be too nervous and too entrenched in their patterns to absorb directives and rules.  They have already watched Oprah, read a few books, consulted a spiritual leader, mined the therapy bloggers, and know where they want to be.  The therapeutic objective is architectural--add reasonable structure to the melee.

By the third or fourth meeting, what isn't working in the relationship is played out right there in the office, a marvelous thing to behold.

Marriage in 45 Minutes, you might call it.

One of the more disturbing Marriage in 45 Minutes moments is The Blurt, an embarrassing statement by one partner describing the dysfunctional behavior of another.  A blurt is something the other might have confessed voluntarily, given the chance. 

But the conversation the night before the therapy appointment went something like this:

Partner No. 1: You will tell her about it, right? You'll tell her.
Partner No. 2: If I feel like it.
Partner No. 1: You better tell her.
Partner No. 2: Stop nagging me.  That's the problem.  You don't let up.

The tell will have something to do with:

(a) porn, (b) drugs, (c) stealing, (d) sex, (e) lying, (f) deception, (g) rage, (h) past abortions,(i) cruising,

Fill in the (j)-(z), you know you can.

It is hugely humiliating to be outed like this to the therapy mom or dad.  Typically the one who blurts is really, really worried, and with good cause, that without the blurt, the therapist will have no idea, truly will not understand the enormity of the situation-- how bad things really are.  Rather than waste time, the secret out, we can get to work.

Except that the outed individual's privacy has been invaded, and we treasure our privacy.  The nightmare of couples therapy has begun.

And the therapist watches the victim of this emotional abuse (yes, that's what it is) sink into the sofa, crest-fallen and ashamed.  The words that should be said,

"How could you do this?  How could you embarrass me this way?"

are never said.  That would be an admission of the truth.  Rather, the betrayed captures the doctor's eyes.  Help me.  The therapist has made a mistake, has let this happen. It all happened on her watch.

The blurter, meanwhile, is relieved.

In the remaining minutes of the visit we discuss  more
Therapy I Ching basics, this time with feeling.

One is thrown into a furnace for embarrassing another.

But if you can't embarrass someone, how can you assign blame?  Someone has to be to blame.  But wait. Let's approach that scientically.

Cause and effect, what social scientists refer to as linearity is a Western concept based upon statistical associations.  The whole of behaviorism is about pairing measurable variables (behaviors), fitting those straight lines on a graph.  Cause --> effect.  The very purpose of scientific inquiry is to find causes, and when we find them, we publish! 

It is up to someone else to seek out the cause of the cause, causes of the causes.

For there is a cause for a cause, and a cause for a cause for a cause, etc. The effect is a cause, too, and if we construct our theory wisely, we can test to see if the effect ultimately causes the cause, closing the feedback loop. No beginning, no end, impossible to assign blame.  A chicken/egg thing. This is eastern thinking, by the way.

Take a look at what happened before The Blurt.  Make the symptom gambling.

The couple had a discussion the night before. They have had many discussions about gambling. In one of these, the non-gambler has told the gambler that she will leave him if he doesn't stop.

She has said this before, but threatening him only makes him gamble more.  He doesn't want her to leave him and he thinks that if he wins, she will forgive him, love him, stay.  She has given signals that she likes it when he provides for her and winnings provide.

So he's just gambling to be her hero. He does it for her. Doing so increases the odds that she'll leave, but he's a gambler and denial is the nature of the disease.

She doesn't want to leave is the truth.  And she is worried that we won't get to the real issue, which she thinks is his gambling.  So without the blurt, the therapy won't work.  He won't change, and she really will have to go. So she takes matters into her own hands.  She blurts. 

We could intervene anywhere. No need to blame anyone. It is their love, their desire to survive, that matters.

I think people blurt because the pain is so palpable, so disturbing, that it has to go somewhere.  In individual therapy spilling secrets is safe, alone in a room with a professional sworn to confidentiality. There is well-deserved trust on the operating table.
It has to be earned--(Poster in the Merchandise Mart)

But in couples therapy, talking about a "character deficit" is embarrassing, so the secret is deliberately shielded for awhile. We therapists take it slow.  Most people aren't in 12-Step programs, aren't comfortable discussing personal issues with total strangers.  But the long-suffering partner is sick of the deficit, so she blurts. Can't help it, the girl can't help it.

There are other reasons people blurt. The kid in school who blurts out an answer wants attention, admiration from the teacher. But here, it is about being sure the therapist knows her job, knows what she is supposed to do.   

Fix him (her).  Please!  I have had enough!  At the end of my rope. . . fed up . . .can't stand it anymore. . . I can't do it.

Another quote from The Therapy I Ching:
Therapists don't change anyone.

People change when they see the value of change, when they understand why change is desirable, and have a blueprint, directions as to how to go about it. 

The Brown Line to Downtown
I'm on the train, headset on, waiting for a patient to call me.  A song starts, out of nowhere, usually annoying, but it's  Fix You, by Cold Play.  Always gives me chills, that song.

* The only thing about The Therapy I Ching (copyright therapydoc, obviously, 2011) that is similar to the real I Ching is that both books are books of change.