Depressed--a different take on depression, a Jewish point of view

Depressed-by Yoni Palmer, Mosaic Press

 Depressed--a different take on depression, a Jewish point of view.

Well, it isn't so different, not if you are a Jewish, observant psychotherapist, but it is a lovely little book, even wonderful, emphasizing among other things the need (for some of us) to procreate and how devastating it can be when we fail.

If you're a little bit knowledgable of Tanach, those books that follow the Five Books of Moses, you will recognize some of Yoni Palmer's references, especially the story of King Saul in the Book of Samuel (Samuel I). You'll remember noticing, even in that very first reading years ago, that Israel's first king suffered an Axis I disorder--bad. Saul's courtiers did what they could to cheer him up, even brought in a local musician, David. Later the king would chase after David in a paranoid effort to kill him, ultimately killing himself. So out of sorts puts it mildly when we speak of King Shaul.

Anyway.

More of the back story than anyone needs to read. We went to Israel a few weeks ago, had tried to get in much earlier during the pandemic but the country shut its borders to us, fearing contagion would have none of our bringing the disease to Israel. But now that everyone in this tiny country has had covid or been exposed, and many are vaccinated times four, they opened up. And when they did I jumped on a direct flight, ticketed immediately. This before Omicron inserted its viral head into the Israeli calculus. Once the variant took hold the Ministry of Health made people wish they hadn't wanted to return to the homeland--so many hoops to jump through to fly. Then that return flight to the US and a stop in Newark to deplane, retrieve bags, go throught passport control and customs, recheck bags, security again. Why they had to cancel that direct flight no one knows. (Hey, a blog is for venting, am I right?)

It just so happened that our trip coincided with a dedication of stained glass windows in a synagogue. The windows, each depicting a female Jewish heroine, are dedicated to my dear sister-in-law, her memory should be a blessing. She passed away a year ago after a valiant struggle with 4 or 5 different types of cancers. Damn that disease. There, I said it.

At the dedication a favorite cousin of ours handed me a book. Depressed. That's the title. I automatically recoiled. I tend to read either fluffy, funny things, non-fiction (am deep into the Vietnam War right now), or well-written novels. (Sure, sure, I read about neopronouns, too). If a story is about a culture I'm not familiar with, like Native Americans, or people from Asia or Africa, I'll read it cover to cover. These are inevitably sad, but worth the trip.

So when Yoni Palmer hands me a very slim paperback about depression published by Mosaic Press, inside I groan. I feel bad for groaning and hope I am not showing the groan, but in my home there are two full shelves of books on depression, bipolar disorder, and suicide prevention. At least this treatment is light, only 95 pages and will fit right in. 

I read Depressed in one sitting, most pleasantly surprised. It is raw, personal, and insightful. When I ask Yoni what he is doing these days he unapologetically tells me, 'I'm a writer.' How many of us have the guts to say that? I think he also has a day job. 

What I like about his story is not so much his struggle with depression--I've heard twenty thousand of these first hand, I wish this were an exaggeration but people do seek help and they do get better, thank GD. It is Yoni's research into the Talmudic treatment of depression that keeps me in the game. He searches for the 'Jewish take' on the disorder and he finds it. 

I'll sum up that Jewish take with two words: Depression is.

Rather than ignore it or consider depression a weakness or character failure, even some sign of lack of faith, Judaism accepts it--always has. Many say that when we accept what we're feeling, the weight, the burden lightens just a little bit, a sliver. But a sliver, perhaps a shot of serotonin, is good! If we don't accept something we are likely judging it negatively and judging one's self negatively hurts, and it takes a lot of psychic energy--way too much time and energy. This could be one of the reasons depression is so exhausting. Coping with how others judge us, too, takes valuable emotional resources, too much ram. Better to float, sleep, rest, not think. Medicate for awhile. Go to therapy.

You can find Yoni's book here. 

Winter's almost over friends. Not that we're judging winter, we couldn't possibly diss all that white, black and gray that we see if we look out the window. No, we're good. Right?

P.S. My daughter just sent me this wonderful opinion piece in the Jerusalem Post by Harold Goldmeier, another take on not judging: Jews and suicide

therapydoc

Seeing Red

My Anger Jacket

There's a story about the rabbi who controlled his emotions by donning an anger jacket. I heard about it a week after a run-in with a sociopath. I wish I'd known about the anger jacket sooner. 

Rabbi Shalom Rosner tells us about it in a weekly 'parsha' podcast. (The 'parsha' is what Jews read at services on Saturday morning). By the time I heard the story my trauma, a game of chicken on a side-street, had dissipated. The encounter didn't bother me anymore. 

The rabbi tells the story of the prophet Moshe getting angry at the Jewish people. He's able to wait before he speaks, able to calm himself down before criticizing them.* 

Think before you speak. Be grounded. 

The rabbi then gets to our intervention, repeating a yarn about a revered sage who worked hard not to express his rage (not to his children, spouse, students, etc.) without first putting on a special jacket that hung hidden away in his bedroom closet. After taking the trouble to remove himself from the situation to find the jacket, taking off whatever jacket he had on, because he was a jacket-wearing rabbi, and replacing it with the anger jacket, he had cooled down. He never said anything untoward, nothing regrettable, not while under the calming influence of the anger jacket. 

The anger jacket is a behavioral solution to an socio-emotional-behavioral problem.

Many of us tell ourselves we're not angry people, then lo and behold, we find that we are! Truly tested, the best of anger managers lose their Zen, probably several times in a lifetime. They will unleash that adrenaline, sometimes at someone who is at really at fault, sometimes at an innocent. 

It is very much about where we're at: hormones, neurotransmitters, hunger, sleeplessness, stress, situations. We have all of that unconsciously working with and against us. Lacking as much testosterone women, for example, can be less arousable, hence less angry than men, so estrogen can work in their favor. But not always. What goes up, biologically, must come down.  

Driving a crew of seat-belted/car-seated children in a big white SUV affectionately called the airplane, having navigated arguments about who sits where, wondering where I will park when we get to our destination (FD awaits), I see an oncoming automobile. It will be tight. There is no convenient place to pull over. This is a city side street.

I do my best and stop. I have not pulled over enough, however, for this maniac, a driver who determines to teach me a lesson. He speeds straight at me, threatening a head-on collision, then swerves away just in time to avoid it, side-swiping my back fender in the process. He drives off. 

I jump out of the airplane aghast, very angry. It is a new car and I have already initiated it in a parking garage, hit a pole. The man is half-way down the street. When he sees me chase after him o foot he stops and gets out, too. Not to be intimidated by a woman, real man that he is, he approaches and proceeds to blame me for what happened. I am not cool. I express my incredulity at his driving. Insulted, not to be criticized or out-raged (I was loud), he blames my driving (female) and threatens to tell insurance it was my fault. It is my word against his.

I snap a pic of his plate. He snaps a pic of mine.

I yell some more. What was he thinking. There are five children in the car! He asks me what I had been thinking, and did I even have a drivers license? I shouldn't. 

I withdraw to the car, shaken, leaving him standing on the street. The kids are supportive but confused. What happened? Who was that guy? Why were you yelling?

We arrive at the park and review the damage to the car. One of the kids suggests we get some white paint, you know, just paint over the new black scratches on my shiny white car. Kids are the best.

Thinking back on it, a guy speeds at you on a side street threatening to hit you head-on, you do not confront this person, even after the damage is done. Do we have to experience this to know it? No. It is an oft-visited topic in a therapist's world, talking about avoiding altercations with threatening people. Retreat, avoid. Get away.

And yet. 

How is one supposed to remember this under the influence of so much adrenaline? How can we be cognizant of our anger when all we see and feel, all that we are, is anger? The need to discharge the excess, to reduce what we sublimely refer to as a negative emotion is the only thing that seems to matter.  There is no other way to return to who we are, to our natural state of juggling emotional states. We can't even juggle. There is no juggling, no room or time to breathe.

Clearly I won't do this again, I say to myself as I return to the car to face five mind-boggled children (although they were fine, didn't even make much mention of it to their parents). There will be no more confronting potentially violent people, or anyone, really, in a sharp tone. I tell myself.

That man could have pulled out a gun and shot me. 

A religious person would say that if we put the Old Mighty in front of us all of the time, if we recognized that He/She is in charge and has got this, basically, we can accept everything. We can accept that we have been wronged and let it go. We can add that therapeutic pause to our social relationships. We might avoid screaming at a sociopath in front of our grandchildren.

The rabbi, when he searches for his jacket, is adding that therapeutic pause and he knows it. 

I'll take a look around in the closet, see what I've got.

therapydoc

*Matot 31:14,  מטות לא:יד

P.S. We need that thing that clears the brain, the cross-word puzzle, the Paint By Number*, reading, learning, bird or weather-watching. Star-gazing. Not when we're driving, but in general these things help. The idea of art, being an artist, each of us in our own way, but having not even been able to make good stick figures when it counts, I prefer guides, paint by number. Winnie's Picks might be worth checking out if you're looking for something chill. One day we'll talk about photography.

Apologizing

 It seems so easy to me, apologizing, or taking something back that I shouldn't have said. That sense of my bad is so jarring, so upsetting. There's baggage to it, triggers (if something feels bad it is because something else is at work). Someone is mad at me, someone doesn't like me. So to get rid of the baggage someone like me will be quick to own responsibility for messing up. It feels easy, like removing a finger from a hot burner on the stove. 

That's when we're aware. We're all like this to some degree. When we know, when we're aware of the feelings of others and that they will ricochet back to hurt us, we're motivated to reverse the damage. We'll say, I'm sorry.

But as the good doctor/rabbi Peter Rosenzweig likes to say, about 99% of what is happening around us isn't available to us, it's unconscious. 

Or maybe it was 95%.  You get the idea. 

The interesting thing about the subject of apologies is that we know there are people who cannot do it, cannot bring themselves to apologize, which makes doing couple therapy a bit of a challenge. Why? For some it feels like others should be apologizing to them, should be working harder to understand them, to feel their pain. Owning responsibility is exactly what some of us want others to do for us-- feel our pain. If only you would only empathize with me, you'd get it! You first. 

When I notice that going on (and it is sometimes even spoken) in therapy I might say:

(Name of pt). You have lived without that understanding this long, live without it a little longer just for today's visit. Let's get you into the position of modeling the behavior for your partner. One way to do that is to apologize first, say you are aware that you might have hurt her (him) and that you are sorry. See if it doesn't come back to you in a good way. 

We would call that secondary gain, There's just something about saying, I did that. It ends up feeling okay-- you aren't punished-- crazy, I know. You feel like there will be some kind of punishment, but there is not. 

This process is psycho-educational, and for some, it works. If therapists can help partners feel the pain of one another they are half-way there. 

We could call that an intervention, labeling the pain of the one who can't apologize. But it will not always work. There are other interventions, and we'll get to them in a second, but I'm wondering about the corollary of my first paragraph. Does what I wrote mean that people who don't take responsibility and/or don't apologize are not worried about social rejection? Does it mean that pride, a type of blinder, shields all of us from social rejection? As if  I'm right, so you must be wrong, nothing in-between. No need to apologize.

What's a therapist to do? Here are a few more thoughts, interventions:

(1) Chip away at the pride, or insecure narcissism-- that might be one option--The therapist says: Well what if you aren't correct? I think it would be helpful here, in the interest of empathizing and improving your relationship, for you to try on the idea of What if I'm not right? What happens then? 

This isa favorite intervention, although they're all good, because it forces people to face that catastrophic expectation, the consequences of being wrong, which in most situations are anything but catastrophic, and in fact, are benign.

(2) The therapist asks the partner to ask the other partner to do that-- that's good except that he or she has probably done it before without success, and that's the response I tend to get back

(3) The therapist explores the idea that they are both right and it is their challenge to find out how that could be true

(4) The therapist switches from content to feelings, simply do an emotional check-up-- how upset are you, and how upset are you, and what's weighing in on those feelings

(5) The therapist asks them who else they know who agrees with them and have they been talking about this topic with other people, and could that be affecting how strongly they are attached to being right or wrong

(6) The therapist asks, "In the past, how important was it for a parent or sibling to be right?"

(7) The therapist asks, "Has substance abuse made you feel either (a) always wrong, or (b) always right-- because according to the program. . . the program teaches. . . "

Not a complete list, for sure. But it's a start. 

Maybe I'm wrong about the whole thing. 

therapydoc

Measuring the Effects of Racism

 Everyone likes history these days, and January 6, 2021 was historic. Some say it will go down in infamy, a humiliation. Foreign leaders are saying that this is not America, meaning this is not democracy. But it is America. 

There have been marches on Washington before, the most effective perhaps in 1963, predating the Civil Rights Act of 1964. Look at these photographs for a second. Over 200,000 people attended the March on Washington for Jobs and Freedom to send a message: workplace inequality is unAmerican. 

March on Washington, 1963

Same march

Martin Luther King-- it's his birthday  pretty soon, know why the kids are off of school

Then, of course, we have pictures from Wednesday, Trump supporters barging the Capitol to take it back. This is ours, I heard one say. Another: This is a peaceful protest. 

Yet we see them breaking windows and bullying the Black guard at the door, terrorizing him as he backs off, farther and farther, up, up, up those wide stairs. There are hundreds of them, we're told by the newspapers, perhaps minimizing the count. Maybe not. It is their right to support the president. 

I want to give the benefit of the doubt, as always, to understand. They did not have any classes on narcissism or anger and follow him as a messiah. He is the only one, it seems, who has listened to the needs of this demographic and validated each of them, they feel, individually. They are not happy that he is no longer the president. They only see their pain and a country divided, us against them, and the impossibility of loss. The election had to have been stolen. How could Donald Trump have lost when he said he won? A dream, even if it is a confidence game, is very hard to lose.

Proud Boys apparently came in droves, proclaiming this the new 1776, the new revolution. We're all aware of armed militias in the back hills of America. It is a scary moment. We can put our heads in the sand or give them better paying jobs, a better education (for free). Isn't this the source of their malcontent? Having less than those who make a lovely passive income on Wall Street? It would be generous to say this, rather than to think that this is about racism and ethnocentrism, bringing one's self up by putting other people down.

I don't have any answers, am hoping that the younger generation, the new members of Congress will give it some thought.

Lets look at a few pictures. 

Destroying cameras and equipment 

The videos show protesters throwing camera equipment to the ground. 

Looking up at what I'm watching on television, FD says to me: Journalists love this stuff. 

WE love this stuff and we hate it. But some of us love it as a strange, surreal distraction. Anything not to have to think about Covid 19. 

FD is treating this stinking virus, you know, treating the community. I am beside myself and not vaccinated, yet I want to do Kincare- watch a new grandchild for a couple of days a week after my daughter goes back to work. She took off to have the baby, a good time to get out of healthcare, but worked the frontlines for six months last year. Oh this past year! That 350,000 Americans have died from Covid is devastating, and the numbers keep rising. The protesters call it a hoax. How death can be a hoax is confusing to me, and I wonder, which story will go away faster, the one about people dying from that hoax or the new revolution, the new 1776.

What drives people to break cameras? 

Many of us have had more time to read lately, and there are books strewn all over my living room about racism. The better ones are novels I get from the library, like Homegoing by Yaa Gyasi, and Americanah, the 2013 novel by the Nigerian author  Chimamanda Ngozi Adichie. Aaron Bady, a book blogger has a few other recommendations.

Scholars say the same thing, that race is a non-word. There are not separate races. We're all of the same race, the human race.  We have different skin-tone. That's pretty much it. 

Isabel Wilkerson, in CASTE: The Origins of Our Discontents (so good) speaks of a pecking order established before there even was a United States of America. In August 1629, a letter from early settler John Rolfe describes Africans sold to English colonists, people who looked different, who would be assigned by law to the bottom of an emerging caste system. Rolfe describes them as merchandise. 

In the decades to follow, writes Wilkerson, colonial laws herded European workers and African workers into separate and unequal queues and set in motion the caste system that would become the cornerstone of the social, political, and economic system in America. 

There's an obvious parallel to the caste system in India. 

An entire chapter of the book illustrates how Adolf Hitler learned how to institutionalize racism from the good old USA. He praised the near genocide of Native Americans and their exile to reservations, and found the American custom of lynching African-Americans and ritual torture/mutilation, impressive. Seeking alternative models in other white-dominated countries Hitler could find no other that punished interracial relationships, miscegenation. The best example of caste is the United States of America. 

Oh yes, he learned from the best. 

Let us look at Measuring the Effects of Racism: Guidelines for the Assessment and Treatment of Race-based Traumatic Stress Injury, just one more book, and a few take-aways. Unlike most social scientists, Robert T. Carter and Alex L. Pieterse immersed themselves in racial-cultural studies to present themselves as experts in biracial custody cases, equity issues in schools, racial discrimination and harassment, and consumer racial profiling. 

To impute the negative psychological consequences of trauma, experts in mental health are armed with the Diagnostic Statistical Manual, the DSM, the definitive judge of mental disorders. Features of the syndrome PTSD, or Post Traumatic Stress Disorder, identify the specific effects of  external events, some as intentional acts (beating a child), some not (hurricanes).  

Carter and Pieterse recognized racial trauma as different and constructed the Race-Based Traumatic Symptom Scale. 

This should be of interest to therapists, right? No matter our color, we work with people who have been excluded or bullied for no other reason than their skin color, and we feel the pain but are one-degree (at least) of separation to it-- unless we are also persons of that color. We know it is different from anything that we will ever experience, even if our parents did, perhaps, as concentration camp survivors. 

No matter how we are treated, white privilege is exactly this, the absence of race-based trauma. If someone slurs us racially, calls us a honky, gin jockey, gubba, pig or whatever the epithet, it is an unusual random event. It is not what people of color experience, always events. An example I like goes like this: 

An Black American tells her White American spouse that they will have to explain to their little girl that if she needs help on the street that she shouldn't go to the police. White skin-colored people don't think twice.  

We therapists have no idea how deeply our clients have been affected. Do we simply ask? How? Do we pull out the Race-Based Traumatic Stress Scale? There is much to be learned about treating racial trauma. I'll write more about it in another post.

Now what about the actions of the mob in Washington, the peaceful demonstrators who occupied a building in our capital, much like tree-lovers occupied the red-woods in the other Washington, and those who occupied Wall Street. Isn't possession nine-tenths of the law? Isn't that all they're saying? We are here, look at us. See us. We live here, too.

Sure, sure. We see you. Now you. Do the same. See everyone else, too. 

therapydoc 

What I Did on My Covid Vacation

This post is only tangentially about what I did during the Covid quarantine. We'll all be digging out of this in the next six months, processing the effects upon our children, parents, ourselves. But we're supposed to reflect this time of year, and we should reflect on the year gone by, or share our dreams for the future. An alternative post would be called, What I'd Like to Do When I'm Free to Move About the Cabin (when Covid is no longer a threat).

BALANCE BOARD, a metaphor? Nah

Hi FBI! 

Friends, I know that this is going to sound like I had a brief psychotic episode or symptoms of schizophrenia, you decide. It started about five years ago. 

Following someone's incarceration for a federal crime, a parent of this person, still positive that her kid would be freed one day, called me to chat. Not unusual, but as we're getting into it she says, "Oh, by the.way, the FBI is listening, just thought you should know. They tap all of our phones and because we're friends, they're tapping yours now, too!" 

We call that a snowball sample in research.

What do you say to that kind of news, that your conversations are now an open book? 

"Oh, good, no problem, no breach of HIPAA in that, me talking to patients fairly often. LOL." 

So every once in awhile we would pause and one of us would say, "Hi FBI! What's up?!! Everything good?  Great, now run along." 

Now. We've all watched enough television to know what that is like, how it works when the FBI is listening in. We're not talking some guy in a van and a bug planted in a telephone while you're out running an errand. We're talking two guys with headsets in a large room full of similar young men (never women) listening in on the conversations of every day Americans who might be planning a revolution to overthrow the government. Or they might be discussing the merits of buying the bedspread with the blue print over the one in white. 

I think the first time I saw the FBI listening in was on The Good Fight starring Christine Baranski, the sequel to The Good Wife, but it might have been The West Wing. The plot in The Good Fight took a dark turn and scared me, which isn't my thing, so I stopped watching and have no idea if they threw Christine into jail or what happened to the plot. Upset me, fine, like in Valley of Tears. But don't scare me.

Fast forward, we've learned quite recently, although the story has been scuttled to a large degree, that Russian intelligence has indeed hacked into all vital US governmental networks. I hope this isn't news to anyone reading. The upshot is that our identities are gone, our financial information is bare, and we should probably be learning Russian in our spare time. 

Why bring this up now? Because last night, reviewing all of the projects that I had time to work on these past ten months (not having to commute to work frees up a lot of time), I realized that although I had time to throw out old clothes, rearrange furniture, and indulge my hobbies, like buying a new aquarium and selling the old, I didn't do much writing. Except for scholarly stuff which is really difficult to finish because you're always sweating each sentence for a source. And then, in the process of looking things up, you find new things to learn and read about. So you could say that during the past ten months I learned, and learned, and learned, which is an accomplishment, but actually finishing anything to publish in an academic journal hasn't happened. Not that it won't, we're getting there; it just takes time. This is the reason so many begin their dissertations and never finish. 

But more than that, I wasn't in the mood to write for fun. Seven years ago when my mother passed away this blog took a downturn in content. I stopped writing, and now I get why. You need a certain flow in the serotonin to blog well. 

Meanwhile, and here's the exciting subplot, in 2017 it became clear that much traffic generated to this blog came here from Russia. That scared me out of blogging. Once you think somebody is reading your email, you get a little reluctant to use that account. There had always been a great deal of comfort in being an anonymous blogger, occasionally changing my so-called real name. Once the email address and feed were compromised, it simply felt dangerous to write and disseminate posts to those of you who subscribed.

Rationally, that's ridiculous. What in this blog is political? Nothing, nothing political, really, nothing subversive or anti-government. And believe me, the diagnosis of the 45th president of the United States did not escape this therapydoc from the get go. The Russians are not listening to us, we're not that important, or reading this blog. But in case they are, we can only hope they like whatever content is coming up this year. Because this year will be different from all others. The blog, and I say this in good faith, shall go on.

It could be about things that have happened, like two recent suicides in my community, or it could be about current events. But more likely I'll write about getting older, pretty sure, not that a lot of people will care. But getting older is shocking. You think back on the milestone birthdays like 16 (half of 32, a friend's mother told me way back when-- trying to get a reaction out of me at 16, which it did, turns out it's a snapshot memory). Forty and fifty are milestones, wrinkles, menopause, divorce, weddings, launching the kids. 

But you think to yourself, why did you stress about any of that, fifty being the new forty, blah, blah, blah. Then you round sixty and your senses change and the stress quadruples. You can't hear. You have to get hearing aids. You can't see, need cataract surgery. Your hair goes gray, seemingly over night. But you hate the smell of hair color, have distinct memories from your mother dyeing her hair and closing the bathroom door.

You become invisible except to others who are going through similar metamorphoses. You're strolling (with a mask, naturally) and you pass another silver-haired woman who is working on her lawn, raking, also wearing a mask. She's seemingly robust, and you silently nod to one another, acknowledging that the two of you could have been in high school together suggesting to the teacher that you would rather read anything by Jack Kerouac and Samuel Beckett than Silas Marner,* and now you're both thinking that the vision of getting the stinking virus is like looking death in the eye. You want to talk to her about that and ask, So how's it working for you, worrying about an early demise. But you nod and stroll on.

So yes, there's a lot to talk about. I feel like I could be back. I'm in a good mood, hoping for a vaccination, hoping to see people in real time, real space in a couple of months, maybe get on a plane. But even working on Zoom, there's much to talk about-- like how great it is to stand up while I'm working, stretch, balance on a balance board. You can't do that when you work in an office and a patient is sitting on the sofa across from you.

The Zoom blogging material is here. Like the patient who never stops telling me how she likes a blouse from decades ago, or how I look today or my haircut (naturally, my hair). The patient is a heterosexual female, not objectifying me in that way, but it bothers me. I've mentioned it to her but she can't help it. It's like people who always say that they are sorry when there's nothing to be sorry about, a hard habit to break. We could talk about that, that even the nicest people in the world can upset a therapist who gets impatient and has to call another therapist and vent. What the heck? But the patient has no idea that my sideline is sexual harassment prevention and objectification is a trigger.

Hey, FBI, we good?

therapydoc

*I'm ordering a copy from the library right now.

See You in My Dreams

Lately I've been dreaming about my patients. I don't even want to tell you how many years I'm in practice. Let's just say a lot. And this has never happened, not ever, not that I remember, anyway.  

Dreaming in Living Color

Most therapists have an occasional dream about a patient, don’t they?  

 

 

It’s happened twice, each time the night after a visit. My subconscious apparently picked out these unsuspecting women to join in on whatever adventure it had scheduled for the night. 

 

My dreams are always adventure dreams, usually about getting lost and driving endlessly on a clover-leaf highway exit in an unfamiliar city. Or I’ll be on vacation with FD and we find ourselves in a house that is smelly and dilapidated with broken windows. It most likely has been hit by a bomb, and yet is huge, a city in itself. There’s no way out, no map, and no one cares about getting out—or so it feels, except for me.  

 

 

Reliably in my dreams I have no idea where I'm supposed to be, which isn't atypical, others tell me they have that, too. Those are bad, but I’ll take that confusion over the terror of those recurring home-invader dreams in my youth. Those are gone. Now I just live with the fear, lock constantly.

 

 

The most recent dream with a patient in a starring role had the feel of a chick flick. There’s no remembering the plot, but one thing for sure: she isn’t a patient but a girlfriend. We are doing friend things, shopping. My mind’s eye tells me however, that although she’s a patient I should carry on, keep dreaming. 

 We do not usually have this choice in that other reality, wakefulness, the choice to turn relationships into whatever we please, alternative genres. 

 

 

The plot of the flick, alas, is forgotten. I wake only with the sense of positive emotional engagement, the feel-good of the friendship bond. But it is laced with guilt about having breached a professional boundary. I attempt to rationalize away the guilt. As the dream fades away my brain says:   

 

 

Hey who cares, woman? This is a good dream. You like this dream. Here you are, the two of you, that person who sits across the invisible divide every week, and you . . . you’re girlfriends. 

 

 

Wait, I say. Isn’t everyone in my dream really me?

 

 

Well, technically, yes. Nobody else is there, after all, just the dreamer, just her, dreaming away.

 

 

Meaning both of us are me.  I’ve created a friend, projected from inside Me Myself, and I. Hal’vai  (Hebrew for “it should be so” rhymes with rah-l’-tie). Hali’vai we should all have friends who are the people we want them to be. Most of them are already, right? That’s why we pick ‘em. But sometimes they pick us, is the truth.

 

 

I’m not Freud, just making sense of dreams.  

 

 

We’re out somewhere, girlfriend and I, at a mall then a pool. Our roles as doctor-patient are no longer relevant, deliberately abandoned. Those roles that determine the dynamics of our usual interaction—gone! There’s no implied hierarchy or expectation of therapeutic appearances, no guise of being therapeutic.

 

 

Well, that could be nice. A wish dream!

 

 

If we look at dreams as emblematic of wishes, fears, or gas, then this dream for sure lands in the wish category. Sweet and happy, it gets 5 claps and 4 stars, maybe even 5! Except that threaded throughout the cognitive/emotional content is that disturbing certainty that this is a patient not a friend, and the dream is a warning: 

Be careful what you wish for, cross that boundary and you will regret it. Oh, and by the way. Haven’t you noticed? You have more friends than you even want.

 

 

The dual relationship is unethical, unbecoming of a professional. It takes advantage of the patient’s trust in us, that trust that we are there to help them  for one thing, not visa- versa, which is why upon waking I feel a bit disturbed, disoriented, and guilty, despite the 5 stars. 

 

 

The next movie is the usual Where am I? How did I get here? And what in the world is she doing in my dream?!  Not a nightmare so much as a bad dream. It is a different patient and we share a difficult circumstance. We are upset, lost, and dependent upon each other in some way that is out of the official context of our relationship. And we both need to find our way out of messy confusion. Messy and confused. A typical dream.

 

 

 

That’s all I remember. 

 

 

The interpretation of this dream could it be me unsure of the quality of my work, needing to tackle it at night to get a good grade. Or maybe my head is remarking on the complexity of the patient, that she isn’t progressing. Her dreamlike confusion is expected, mine is not.  There should be emotional spillover to me if there's a feeling incompetence, even if it is unconscious until now, and consequences for staying in denial 

It makes sense. She is complicated. And yet, we've been living together in all of her chaos for years and she’s doing so well! Still, the dream is talking to me. The other dream, too. 

 

  

What is going on here? Am I working out unresolved patient/therapist dynamics—a wish in the first dream, fear residing in the next? Are they warnings to resolve my feelings during waking hours to avoid doing it at night? 

Or could it be that because we only see one another on screen, that patients are externalized to the extent that they have simply become videos in the library of the therapist's subconscious. Choose one a week. The Blockbusters of therapy.

 

 

Maybe I just miss them. Maybe I simply miss being with people, any people, but these people in particular, having known both for some time. They are a part of my weekly groove. Maybe I miss the sensuousness of being together—the swish of their bodies as they pass me to enter the office; the whiff of cologne or perfume, a new hairstyle. I saw someone in the office this week and felt that. It was wonderful for both of us to be there, in real time, in real space.

We can't even be sure if anyone is grooming on Zoom. It doesn't look that way. It's so black and white, even though it isn’t, not really. Data of the senses, other than visual and hearing, is not communicated on digital media. We could say a dream is making up for that, but rarely does it feel that real.

 

 

Considering that dreams are legitimate ways to blur boundaries, if this is about wish fulfilment, then patients should always be in our dreams. If you eschews hierarchy (like me) there’s nothing keeping them out!  But to its credit, hierarchy is about who knows more about mental health, if not the person in the room doubting his-- and it helps keep emotional distance. Respecting them keeps patients out of our heads on off hours. The boundaries of therapy are wise indeed.   

 

 

PROBABLY. . . the problem is that I miss my friends! The ones who come over and have long Friday night dinners with us. The ones I go out with—remember going out?— to talk about our feelings, our histories, that trip we took together.  This is as close as it gets, hearing about the lives of the patients, about their histories. Because after seeing people on Zoom all day to work, it isn’t something some of us care to do in the evening with friends.  

In a sense therapy is the equivalent of lunch, except that we consume nothing but reality. So maybe I simply miss lunch. 

Oh, but now patients are in my living room. They see me a little too closely, frankly.

 

 

Let’s sum up: 

 

In pre- and post-corona times the relationship boundary is tight— therapists don’t socialize with patients. We refuse gifts (no thanks for the opera tickets); we don’t take a lesson from a tennis pro; and we make self-disclosure rare and relevant. In fact, if I am honest with myself, my self-disclosure with patients the past few months is off the charts. It isn’t me and it has to stop. 

 

 

It can be hard. There’s temptation to talk about ourselves with patients, our past experiences, which is probably why these dreams that blur the boundaries are so compelling. They speak to unconscious wishes of both therapists and also, patients. Keeping it professional is work. If dreams are another way to master our issues, than that’s what is going on here. 

 

 

There is some intimacy, too, in a dream. Therapeutic intimacy, meeting that projected need of the patient for a mother, a friend. When she cries in a digital visit I feel so powerless—not that I would hug anyone in the office. But it used to feel like all I had to do was move my chair closer and this helped.  

 

 

And yet, like I said, that online human, the one on screen—no matter how large or small our home theater—now has carte blanche to come into our homes, something they may have considered or alluded to —because don’t we all, at some point in therapy, want to be a fly on the wall of one another’s homes? We want to see what’s really up with the other. 

 

 

And if we’re using a tablet or a phone with the freedom to get up and walk around, we might even walk together into the kitchen for a cup of coffee, a piece of fruit. Once she has been in your living room and kitchen, what’s to stop the patient from having a visit in your dreams? 

 

 

Nothing apparently. Nothing.  

 

therapydoc

 

 

 

TAGS  #boundariesInTherapy, #telehealththerapy, #therapistPersonalBoundaries, #wishOrfearDreams, #dualRelationships, #Nightmares, #badDreams, #patientFriendRelationship, #consultationWithOtherTherapists, #therapysupervision

 

 

What's Going to Be with Our Kids?

Will the virus affect them emotionally in a bad way? Is this new era scarring a generation?

Why should kids be any different from the rest of us, my take.

Depending upon their age and the relationships they have with their parents, and how their parents are handling this not-so-brave-new-world, the answers will vary.

Some families are so sure of themselves regarding the actions that public decision-makers are making, that it is a challenge having a 2-sided conversation.  It is not even up to discussion, for example, as to whether or not kids should go back to school. Dare we even suggest that the educators, professionals who have been working on this since March, could be correct about opening schools, albeit in a hybrid-fashion? (Lori Lightfoot's idea, Mayor of Chicago).

Who knows? All we know is that those countries that closed down, the ones that demanded masks for everyone, no longer have rises in their rates of virus detection like we do in the USA. So shutting down schools is the seemingly obvious thing to do.

But that's not happening, not necessarily. Parents, despite their reservations, will have to decide for themselves how to educate their children, whether or not to find a private online school or keep the kids home and home school. Those who have no daycare in place, who are needing that time to work, whether at home (in peace, finally) or on site, are likely on board with the mayor's recommendation to open up schools.

Psychologically how is all of this affecting our kids? 
Young children pick up on their parents emotions. If parents are rational and don't panic, they usually don't panic either. But every child is different and what we know to be Health OCD is a real thing, not only for adults, but for children, too.

Children are anger allergic, and will want their parents to be happy. They might miss the joy of being home in the family pod, but despite this well-needed intimacy, this crazy hiatus in life, they are fine with letting the family intimacy go if it means seeing their friends. Emotionally healthy kids over the age of 2 are dying to get out and be with other children. They are quite sick of the isolation, like most of us are.

Being at home with their parents has been sheer heaven for functional families with small children, certainly for the kids, not necessarily their long-suffering parents. Parents, hats off. How you're handling this, I'll never know.

In the future (again my take) all children will be more prepared than ever for a health pandemic, much more so than we ever were. They will take that dictum to wash their hands seriously; they already do. They will be careful, perhaps, about showing affection. That could be a very good thing.

What about the older kids, the normal ones who flaunt rules? I say normal because it is a developmental task for adolescents to separate psychologically from their parents, to flex their autonomous muscles. They will flex and flaunt no matter how well we have trained them, those children, the ones we can't babysit anymore, the ones who scoff masks, who socialize without distance.

Those young people, being adolescent and breaking the rules of social distancing, if they got sick, feel pretty bad. They know they shouldn't have been hanging out so closely with their friends. that they should have kept the masks on and encouraged their friends to do the same. And, perhaps worse, if they got sick they know they gave the virus to older family members. The mistake, the guilt, cut their adolescence short. Kids aren't stupid, and whether or not they admit this, they think it, feel it.

They no longer have yesterday's sense of omnipotence.

But frankly, none of us adults do, either.

therapydoc