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.

therapydoc

Conflict in relationships: Timing is Everything

I'm always talking about time. There's a time and a place for most things (not everything), especially communication about hot button topics, things that get people hot under the collar.

Dinner isn't one of these times or places.

Conflictual couples, actually, shouldn't argue at all. (If you and your partner fight and hurt one another, you're half of a conflictual couple.)

Conflictual couples shouldn't argue at all until they have learned not to be conflictual, because someone is going to get hurt, for sure. There will be blood, internal scars perhaps.

You wouldn't let your kids hurt one another. What's with the masochism?

So you can't argue if it's going to get ugly. But arguing with a professional referee around is okay.

After an initial evaluation, a therapist like me will send a conflictual couple home with instructions NOT to problem solve, which is ironic, since therapy is all about problem solving. I tell them to talk about why they fight.

That's all. If you're one of these conflictual couples, you can talk about anything parve,* like who you've talked to lately, who is sick, who has died, lost a job, whose kid is on drugs, what can be done for world peace.

But you really should work on why it is that you fight, and not fight, if arguing is hurtful. Later you can problem solve in a petri dish, a professional's office. Get that part figured out, why the need to fight, and you can problem solve like everyone else.

First, however, it's all about getting to the bottom of that mystery, or is it misery, the Why.

This is usually a dynamic grounded in psycho-social history, occasionally no more complicated than going at it in the ring of sibling rivalry, having garnered a repertoire of verbal sniping as a child. Sometimes the sniping is a learned whisper, almost inaudible, because Mom and Dad wouldn't let you physically whack one another or tease one another. And other times, there weren't any editors at all, or gloves to soften the wreckage.

Then, history in hand, in therapy we have a go at it, real problem solving. The therapist, a person who specializes in beating on people by gently reminding them to look in the mirror, tries to stay invisible.

And since you'll surely fight, your therapist will have to break form to break up the fight, force you to review your problems and stay objective. You see yourself as we see you and hopefully can laugh at yourself, accept that you have faults. Both of you work to change. This can take a year or two or more, and includes individual therapy, as well. But it's worth it.

The devil you know. . .

This accomplishes so much, this process, as painful as it can be at times, for most us don't laugh at ourselves. But in couples therapy we figure out:

(a) why you're both so sensitive --there are roots to this, as we've indicated, usually seeded in childhood, genetics, and experiences with parents, sibs, teachers, peers

(b) why one or both of you tend to use dysfunctional, combative, inflammatory strategies instead of constructive, empathetic discussion. The reasons, beyond childhood tutelage, include but are not limited to a sense of powerlessness, frustration, alcohol and drugs,** or some combination)

and

(c) how to problem solve constructively.

I couldn't write this if I didn't know that the process works. This week I discharged three couples from therapy. Three! All giggly and silly and happy. All better.

Couples therapy is fun, it really is, can be, I should say, sometimes. Sometimes. That said, I pity Empath I, my poor colleague in the room next door who has to listen to it when the volume goes up in my office. I feel sorry for her, I really do, for the noise, but I tell her, it's GOOD noise. We're figuring junk out. And all of my lamps are nailed down now.

Anyway, one of the good things about postponing your fighting for therapy, aside from the fact that you pay for this and deserve your money's worth, is that you know that you're resolving things constructively. You get the knack of talking nice and bring it on home.

Discussion (a.k.a., arguing) in therapy should be timed, ideally, so that you can kiss and make up when it's over. While I check my email, you argue with one another, then I interrupt you and say, "Are you sure you want to say it that way? Can you say that differently, maybe start the sentence with how you feel?"

The coaching part of this job is awesome. "FOUL!" I cry, jumping to my feet and waving a flag when one or both are out of bounds.

At home a foul might mean someone slams a door or throws a dish or breaks a hand, some plaster. Here the worst that can happen is one of you storms out. Then you come back, feeling a little silly.

Happens all the time. I might send your spouse to retrieve you.***

Problem solving in therapy is all about focusing on one thing, one little piece of a problem or a slice of life, past, present or future. The goal is to understand one another differently and reach consensus about something. The agreement, sometimes is simply a temporary solution, something to try out. If it doesn't work, it's back to the drawing board, but trying something is better than doing nothing new. In time, something will work. And we time solutions.

Lately we're timing solutions for Thanksgiving, always a riot.

Timing is everything. When the system works, it works because you've timed your argument, measured your words. You've learned that rather than argue, it is more important to take care of feelings, negative emotions, physical ailments, if at all possible, at the very least try to be empathetic, sympathetic, and to give more than you take. Especially with time.

Now, I personally have worked on my timing and problem solving and am a big one for waiting until my partner is in a good mood before mentioning new shoes or the importance of a new sofa.

FD has pretty good timing, too. He tries to be sensitive to my particular personality quirks. He knows me and is fond of saying, for example, that I'm a bear when hungry. I'm conscious of it and a little embarrassed about it, but it is what it is. It's important to know yourself.

The story:

It doesn't have much to do with the introduction except that it is about the importance of timing and how to handle it when someone oversteps the rules.

We picked up some fast food from a restaurant a few days ago. Picture it. FD is driving. I'm in the passenger seat, the take-out is in a bag on my lap, and I'm starving, haven't eaten in days, an exaggeration, but okay.

FD, however, is not. He wants me to listen to a song on a tape before we leave the car to go into the house to eat. He's saying that one of our sons should use this song to try out for American Idol. No, he's not serious, but he's really pushing for me to listen to this song.

I'm hungry, okay? But I don't spleen him. I'm keeping my cool. Constructive problem solving here, obviously, is taking the tape into the house to hear it while we eat. But we haven't got a tape player in the house that works. We're working on throwing away things like cassette players that don't work and even, dare I suggest, cassettes.

So here we are in the car and I'm being patient while he's fast forwarding the tape, rewinding the tape, searching for the song. It's really getting hard to be patient. The food smells so good. I'm so grumpy. Finally he finds the song.

I listen to a minute of it and say, "Nice song. Can we go inside now?"

"But you haven't heard the whole song."

"And I don't want to, really. It's raining. I'm tired. I'm hungry. I want to change clothes. Can't I go inside?"

"Okay."

He's okay with it, me listening to only a little of the song, half-heartedly at that, and there's no violence. Falafel could have been de-bagged and utilized here, theoretically, in this situation. But no. No food fight, no battle of words.

We could say I made an effort at managing anger. Or was that hunger. Or fatigue? A long, day. See, there's a lot that goes into putting off conflict. You need anger control, impulse control. Your partner's timing can't always be perfect.

And one thing we know, it's even more of a challenge to problem solve at the end of a long day, when your emotions are virtually indistinguishable from your appetites.

It could have been worse, you know. He could have pushed me to listen to the whole album.

therapydoc

*Parve rhymes with Marv and means something that hasn't got either milk or meat products in it (vegan), so it's basically not going to upset the karma of anyone who keeps kosher. A parve person isn't a very exciting person, necessarily, but you can always tolerate having him around.

**If addiction is another variable in the equation, that has to be addressed as a problem and has to be resolved. This tends to slow down the therapy which angers the patient, another excuse for the patient to drink or use drugs. Don't buy it.

***At the Second Road I wrote a post about a woman who gets high (Dialing Back) and there's a comment by Retriever that's worth a look. Sometimes, honestly, you learn more from people who write in than you do from me.

Dependency and Sabatage

So we talk all about independence, and how behaving independently, making our own decisions, doing things all on our own, all by ourselves, the younger the better, makes us unique, confident, powerful people.

And how parents, when they deny children opportunities, simple decisions, complex peer relationships, and alternative voyages out of the nest, undermine that process, generally in the name of protection.

One thing to talk about that with kids. Quite another to see how it plays out in marriage, years later.

Someone like me will see a patient who had been programed as "overly" dependent by parents transition into someone "overly" dependent upon a spouse. This might feel sexy in the beginning (she/he NEEDS me) but it gets boring in time.

The two will come into couples therapy for any number of reasons, but the dependency tends to manifest itself as angry, childish, jealous, unlikeable behavioral traits, traits you see in people with personality disorders.

And our white knight is generally not a white knight, really, but someone who likes the idea of a romantic, traditional marriage, one that values family relationships and "white knight-ness." If he marries her because she's close to her family, he is often very close to his-- or wishes to be close to a family.

That's not bad. I'm not saying that's bad. But it enters into the conflict as soon as the sparks fly. It falls in the unresolved matter of relationships. His/her family of origin fills the need to be needed, admired.

See, it's more than dependency. This is about applause, too.

So at some point dependency can become terrifically dysfunctional and the couple might even separate, often following a violent interaction. They'll go back to their own families of origin. And I'll be working with both of them, building that sense of self, those unique wonderful individuals who really wants to operate independently, deep down inside.

And wouldn't you know? The seemingly more independent partner will inevitably undermine the process, telling the more dependent partner (not in my presence, usually) that he/she is making poor decisions as an independent soul, shouldn't be spending money this way, shouldn't have said this or that to one of their parents, shouldn't have decided to go, all alone, on a vacation.

And that always happens, by the way, as soon as the "more" independent, functional partner skips out of therapy, misses appointments, supposedly glad that the "less" independent, functional partner is getting better, separating from family, growing.

The two of them were never more or less. They were always on the same level, the same page when it came to at least that one very important dynamic.

That's what we mean by an emotional system.

Things are rarely as they seem. You know?


therapydoc

Mr. Satuday Night

I want to teach you a simple family therapy technique. It is the whole of family therapy, really. Not that you can't learn from it if you're not a therapy doc. Maybe you can.

Deep breath.

We use big words like process, meta-message, homeostasis, triangulation, and the like. But the most complicated lessons are more intelligible without all that jargon. Process is one of them.

Do you remember the movie, Mr. Saturday Night?

I haven't seen it in years and can't remember the entire plot. I keep meaning to take it out and watch it again. But I usually remember the key messages in films, the ones that family therapists take out and mull over to eventually tell over when the time is right.

It's about a comedian, Buddy Young, Jr. (Billy Crystal) and his brother Stan (David Payner). Buddy has all the ego; he's a performer and he's brilliant, but he emotionally and verbally abuses Stan, his accountant for many years. We watch them age, Stan more gracefully than Buddy.

One of the things Buddy does well, for all his faults, is teach Stan process. After he tells a joke, or better yet, enacts the joke, performs a sight gag, Buddy says to his brother, See what I did there?

That's process. What he does, is process, not usually what he says. If you can see what Buddy does to make his audience laugh, you get process. It's much more than telling a joke. Families do this, too. Everyone in a family behaves in ways that make everyone else respond. Except usually, if they're in family therapy, they're not getting laughs.

Forget Mr. Saturday Night for now. Let's use a typical family therapy example that a student presented to me in supervision. He tells it over like this.

It was great. We were sitting in your office and Don (15) completely ignored his mother's request to stop playing with his cell phone. But he put the phone away when his father asked him to. So I asked the father, "Why do you think Don listens to you and not to her?"

"Because she never makes him do anything," Dad replied.

My student was very proud of his question and how the father got involved, how dad thought about it and proffered the interpretation about the content. But it's times like these that I press an imaginary buzzer and say bzzzzzzzzzz to indicate wrong and I say as much. Wrong.

"What's wrong?" asks the student.

Give me your best shot.

"I thought that went well, actually. We were making the point that mom has to get tougher to get respect."

And who made the point?

"Well, Dad did."

So this is a chidish, him beating on her in front of the children? (a chidish is Hebrish, a combination of Yiddish and Hebrew, meaning something new).

"I suppose not."

Well, we really showed her.

"I guess it didn't accomplish anything."

It didn't accomplish anything because the student got sucked right into the family system, played into their family hand, joined the family discussion about "safe" content. The problem isn't really about the kid listening to one parent over the other. That's "safe" content that allows Mom and Dad to disagree, probably to avoid intimacy, which as we've already established, scares almost everybody.

Most functional couples will disagree about parenting but they find ways to do it together without egregiously annoying one another. They talk about differences and find resolutions without putting one another down, especially in public.

This couple had a fight in my office so that someone, theoretically the therapist, would stop them from fighting destructively. What my student witnessed was a family enactment of their biggest problem.

After they hurt one another, couples will retreat to their own respective little corners and won't come out for awhile. Kids are very uncomfortable with this. They want their parents out of the ring altogether. They want their parents to be happy. So a kid will lure his parents to my door by becoming the "identified patient." You have to misbehave to do that.

Kids are very smart, so they do that.

I told my student that one of the things he might consider doing with families is commenting on process. You try to make the family aware of what they're doing. You ask, DID YOU SEE WHAT HE (anyone in the family who does just about anything) JUST DID THERE?

Or

(to the group) DID YOU SEE WHAT JUST HAPPENED HERE?

Someone might say, Well, so and so insulted so and so. Or So and so isn't listening.

Then you can say, Why don't you guys talk about that.

Even if they look clueless and say nothing and act as if they didn't see anything, you don't interpret for them. You don't fall into that same old trap of being the smart, wise old doc with all the answers. You say, Why don't you (anyone) talk to him (anyone else) about either (anything) or (anything else).

You get 'em talking. If they hurt one another you stop them. Wait, I'll cry. You can't do that here. Now talk about . . .And do it nicely.

And as soon as it makes sense, you dismiss the young sacrifice, ask it to wait in your waiting room while you talk awhile to its parents, keeping in mind that the goal is for them to talk to each other, to love each other and express that. Take that risk.

Leave your office happy.

Junior is superfluous, really. Once you have the 'rents alone you can cut right to TherapyDoc's favorite list of questions (Q) and directives (D) that a therapist could care less about but which are far more interesting any day of the week than talking about how to punish Junior.

(Q) So how did you two meet?

(D) Talk to each other about how it feels to be in this predicament at this stage of your relationship

(D) Talk to each other about what you could have, should have done differently over the years. . .

If you feel resistance you can start a little more softly with,

(Q) What was he like as a baby?

(D) Tell her (him) when you first noticed that Junior stopped looking you in the eye?

(D) Tell her (him) how it was for you when Junior left for nursery school.

(Q) Did you two argue when he was a baby?

Then crescendo with a vengeance to

(Q) Did you two argue when you were engaged?

(Q!) Why do you think that was?

(D) Tell him (her) how you felt about (pick content)

(Q) Did you think it wouldn't last, this marriage of yours? DO you think it will last?

(Q) What's it need, really, your marriage?

And that's just the short list. Your objective is to track back to better times. Everyone likes you when you get them to talk about happy times. And the goal, of course, is that they like you so there's a chance of trusting you and coming back to see you so you can help them get out of their corners, get out of the ring, and into the sack.

And you definitely want to do some individual work with ALL of them. Early as possible. Especially with Junior. It hasn't been easy being Junior.

But the family will do best if you teach process. Without process they'll never stop playing Who's the Better Parent? Or Who's the Worst Kid?

And they'll NEVER get under the covers together that way.

Interpreting, chatting with the patients, holding court, this is what therapists who haven't been trained in family therapy do when they think they're doing family therapy. These are psychodynamic, individual therapy techniques. And they're great for individual work.

But you have the family in your office. MAKE 'EM TALK TO EACH OTHER.

This way they don't have to depend upon a professional for the rest of their lives. It's not about learning one lesson. Face it, nobody remembers anything for more than a week. (See The Five Minute University on U-Tube.)

Okay. Back to Mr. Saturday Night. If you haven't seen the video and plan to see it, don't read any farther.

At the end of the movie Buddy, always the star, is seeing pretty hard times and Stan, always in the proverbial shadow, is retired but happy. The men are old, well into their 80's and they're reminiscing.

Stan says something to the effect that he wasted years of his life working with Buddy. Buddy defends himself. I didn't take your life, Stan. I gave you one.

Then Stan tells over the line I've repeated a thousand times in therapy, and now you probably will, too, at least once, to someone.

Yeah, but you could'a been nicer.

I just love that line.

Did you see what I just did there?

Copyright 2007, therapydoc