It is my belief that humans are social animals. that is why therapy really works better than medication. Interpersonal relationships, caring, compassion,and understanding, make a huge difference in keeping people healthy and happy.
So when Charlie comes in a tells me how his life is so much better now it is difficult for me to let it go at that. Although I do believe him.
He works from home, leaning over his computer, making sure that the software for some national utility company works and that the seven state region keeps functioning. When he is not on call he goes into his wood shop and carves very beautiful wooden animal replicas. He has showed me pictures.
When he has finished carving, he puts them on the shelves he built, with the two dozen others.
Charlie is married. His wife goes off to work each day. On the weekend she sees her family. He stays home. He cooks. My impression is they say about twenty words a week. If they have sex he's happy.
He has no plans to show anyone his carvings, besides his wife. I get to see the pictures.
The problem for me is that he is such a nice guy. He would hate my saying this, but he is really sweet. People should get to know him. He would like them; they would really like him. He is smart and interesting. At least I think so. I look forward to seeing him.
Yes, his mother left him to run off with the coke dealer,and his father beat him and humiliated him. He was fat and quiet at school and the kids made his life hell. But that was twenty years ago.
He doesn't want to risk it. He is happy where he is.
But he comes to therapy, regularly. He has a real relationship with me. Maybe he will learn from that, or maybe that's enough.
Wednesday, January 30, 2008
Thursday, January 24, 2008
Another Youth
When Paul turned twelve his mother brought him to see me. It took about eleven seconds to see that this kid had problems. He had been an angry kid long before his father left home with another guy. There had always been tension in the home, but Paul's problems were more complex than that. This kid was wired so tight he couldn't express himself. He stared at me and occasionally mutter "no" or "I don't know." After about twenty minutes of our first meeting he just got up and left.
His mother brought him because he had just been thrown out of Jr. High for calling his teacher a fag.
I sought more intensive help for him. The insurance wouldn't pay for a hospital evaluation because he wasn't that much of a threat. A psychiatrist gave him medicine he wouldn't take. I send him to a children's medical team but they found they couldn't work with him because he wasn't cooperative.
That's the problem I said; it's not a reason to discharge him.
A year later he got thrown out of school for telling the principal to fuck off.
DSS got involved. They did a home visit. They got the school to give him special classes. They paid for his therapy; an hour a week with me. He told his mother he liked me. He told me that he hated everyone. They were idiots. He couldn't explain why. Not a great therapy candidate.
Three months later he got arrested. He got a lawyer. I asked the lawyer to get him a full psych eval and a referral for intensive treatment. The case was dismissed.
Two months later he was arrested. He got a probation officer.
He violated probation. He was given more probation. He got arrested he was sent home.
For six months he took and sold drugs. He got caught. He was assigned to DYS. They set a curfew for him. Three days a week they called to see if he was home. When he wasn't they yelled at his mother. She yelled back at them that no one was helping her. They hung up.
Now, four years later, he is sixteen. He got thrown out of his third school. He needs an expensive treatment school, should be a residential. No one will pay for it because they don't like him.
It's true, he doesn't have a lot of charm. But with structure, guidance, clear rules and positive consequences, and some reasonable medication he could do well. I can see that in how he has learned to respond to me. But I can't do enough in an hour or two a week.
But they are waiting for him to be seventeen. Then he will be caught doing something stupid, arrested and tried as an adult. Then he will be put away and never have a chance to be sane, happy or productive.
Incarceration for thirty of his next sixty years will be much more expensive than three years of intensive treatment now. But no one wants to front the money.
His mother brought him because he had just been thrown out of Jr. High for calling his teacher a fag.
I sought more intensive help for him. The insurance wouldn't pay for a hospital evaluation because he wasn't that much of a threat. A psychiatrist gave him medicine he wouldn't take. I send him to a children's medical team but they found they couldn't work with him because he wasn't cooperative.
That's the problem I said; it's not a reason to discharge him.
A year later he got thrown out of school for telling the principal to fuck off.
DSS got involved. They did a home visit. They got the school to give him special classes. They paid for his therapy; an hour a week with me. He told his mother he liked me. He told me that he hated everyone. They were idiots. He couldn't explain why. Not a great therapy candidate.
Three months later he got arrested. He got a lawyer. I asked the lawyer to get him a full psych eval and a referral for intensive treatment. The case was dismissed.
Two months later he was arrested. He got a probation officer.
He violated probation. He was given more probation. He got arrested he was sent home.
For six months he took and sold drugs. He got caught. He was assigned to DYS. They set a curfew for him. Three days a week they called to see if he was home. When he wasn't they yelled at his mother. She yelled back at them that no one was helping her. They hung up.
Now, four years later, he is sixteen. He got thrown out of his third school. He needs an expensive treatment school, should be a residential. No one will pay for it because they don't like him.
It's true, he doesn't have a lot of charm. But with structure, guidance, clear rules and positive consequences, and some reasonable medication he could do well. I can see that in how he has learned to respond to me. But I can't do enough in an hour or two a week.
But they are waiting for him to be seventeen. Then he will be caught doing something stupid, arrested and tried as an adult. Then he will be put away and never have a chance to be sane, happy or productive.
Incarceration for thirty of his next sixty years will be much more expensive than three years of intensive treatment now. But no one wants to front the money.
Wednesday, January 16, 2008
Youth of America
First, yes I am very aware of how important confidentiality is to making people feel safe in therapy. I do not think that this blog violates that. One person actually knows about this blog and I have gotten more compliments than complaints. The examples are camouflaged enough that no one could be discovered unless the chose to tell people that they felt something similar; and that wouldn't necessarily be bad.
But what I am worried about today is the number of kids between the ages of 16 and 23, who are clearly going nowhere and doing nothing. These are rich kids and poor kids, there is often a lot of drugs involved, and they seem to feel that they can't keep up with the world, and then they act like they don't care.
About 20% of the kids seem very stressed and pressured to get good grades, get into college and charge to the head of the pack. At least as many seem to sit around, play video games, smoke dope (or worse) and hope that somehow things turn out for them.
Twenty years ago it probably would. But in today's shrinking economy, that has few unskilled or semi-skilled jobs, these kids start out way behind. As they grow older, and amass credit card debt, they become angrier, farther behind, and increasingly screwed.
See I didn't mention any names, but if you know who you are, try and do something to get organized. It's really can be fun to know you can take care of yourself. Don't get sucked in to chasing millions of dollars, just learn how to pay your bills and have a good time.
But what I am worried about today is the number of kids between the ages of 16 and 23, who are clearly going nowhere and doing nothing. These are rich kids and poor kids, there is often a lot of drugs involved, and they seem to feel that they can't keep up with the world, and then they act like they don't care.
About 20% of the kids seem very stressed and pressured to get good grades, get into college and charge to the head of the pack. At least as many seem to sit around, play video games, smoke dope (or worse) and hope that somehow things turn out for them.
Twenty years ago it probably would. But in today's shrinking economy, that has few unskilled or semi-skilled jobs, these kids start out way behind. As they grow older, and amass credit card debt, they become angrier, farther behind, and increasingly screwed.
See I didn't mention any names, but if you know who you are, try and do something to get organized. It's really can be fun to know you can take care of yourself. Don't get sucked in to chasing millions of dollars, just learn how to pay your bills and have a good time.
Sunday, January 13, 2008
liability
Something is amiss here. Maybe you can help me sort it out.
Mary's father was a drinker most of his life. During the first six years of Mary's life he would drink, come home, and push her mother around. But then Mary's mother pushed him out of the house, and he left.
He kept drinking and seeing Mary and her brother about once a month, not being much of a father but not totally forgetting either.
Now thirty years later, Mary's mother is off in Florida and Mary's father has been sober for ten years. He is isolated, bitter, and alone, but he calls Mary once a week and has since he's been sober.
Last month he had a heart attack. Mary rushes to the hospital and they can barely keep him alive. They ship him off to one of the Big City hospitals where the doctor tells Mary that they can try this new medicine on him. If it works he could survive, if it doesn't he will die. If they don't try it he will be dead in half an hour.
So, what can she say? Bingo, they pump the stuff right into his heart and equip him with a computerized pump that will keep the medicine flowing into him.
Two weeks later he is ready to leave the hospital. They have taught Mary how to refill the pump, and that needs to be done every day. They taught her how to fix the pump, or install a new one if it breaks. That has to be done in four minutes or her old man drops dead. They also tell her that someone will come out, once or twice to try and train her father, but basically Mary has to do that if she wants to stop being responsible for keeping hims alive.
Her father is too scared to even think about the thing.
Mary asks for a visiting nurse to help, or if he can go to a rehab hospital to get trained on how to use the device.
No. No one will come to help. The device is so new, and the chance for fatal error so great that no one will touch him or the machine. No one wants to be blamed. The liability is too great.
So Mary is stuck taking care of this guy who never really took care of her. She is trying to get her brother to be of some help but he isn't too fond of the old man, and seems to have some of his problems.
So, right now, Mary has the old guy on her couch, bitching about everything, and asking her for food, drink, care and comfort.
He once saw that she was getting exhausted from it all so he tried to change the medicine himself. He forgot to clamp a tube and his blood shot across the living-room. No too comforting.
Mary's father was a drinker most of his life. During the first six years of Mary's life he would drink, come home, and push her mother around. But then Mary's mother pushed him out of the house, and he left.
He kept drinking and seeing Mary and her brother about once a month, not being much of a father but not totally forgetting either.
Now thirty years later, Mary's mother is off in Florida and Mary's father has been sober for ten years. He is isolated, bitter, and alone, but he calls Mary once a week and has since he's been sober.
Last month he had a heart attack. Mary rushes to the hospital and they can barely keep him alive. They ship him off to one of the Big City hospitals where the doctor tells Mary that they can try this new medicine on him. If it works he could survive, if it doesn't he will die. If they don't try it he will be dead in half an hour.
So, what can she say? Bingo, they pump the stuff right into his heart and equip him with a computerized pump that will keep the medicine flowing into him.
Two weeks later he is ready to leave the hospital. They have taught Mary how to refill the pump, and that needs to be done every day. They taught her how to fix the pump, or install a new one if it breaks. That has to be done in four minutes or her old man drops dead. They also tell her that someone will come out, once or twice to try and train her father, but basically Mary has to do that if she wants to stop being responsible for keeping hims alive.
Her father is too scared to even think about the thing.
Mary asks for a visiting nurse to help, or if he can go to a rehab hospital to get trained on how to use the device.
No. No one will come to help. The device is so new, and the chance for fatal error so great that no one will touch him or the machine. No one wants to be blamed. The liability is too great.
So Mary is stuck taking care of this guy who never really took care of her. She is trying to get her brother to be of some help but he isn't too fond of the old man, and seems to have some of his problems.
So, right now, Mary has the old guy on her couch, bitching about everything, and asking her for food, drink, care and comfort.
He once saw that she was getting exhausted from it all so he tried to change the medicine himself. He forgot to clamp a tube and his blood shot across the living-room. No too comforting.
Thursday, January 10, 2008
thanks for the discussion
Hey, that was good!
I am gratified to find so many comments on my client's deteriorating marriage.
They are all pretty accurate and I have confidence that he will, with some painstaking hesitancy, move in some direction. He is really just in the early stages of his treatment. I have been seeing him since September.
And now that it's a new year his ever-caring "health-plan" has automatically authorized another twelve sessions. Of course, as you all seem to appreciate, working though a change in your life is very difficult. You all noticed how many aspects are involved: money, children, friends, houses, extended family, routines, and even just thought patterns need to change. This guy will be with me for another forty to sixty meetings, over the next one to two years. But I am confident he will make some decisions and some changes.
In order to keep seeing him I will have to fill out forms, use key words, check boxes, and fill his medical record with information that may be used against him at some time.
The irony is that I am saving them money. By coming to treatment he will do something about his life, although what it is has not yet evolved, but he will avoid sinking into a deeper depression that would probably create some chronic, expensive medical problem such as alcoholism, obesity, irritable bowel syndrome, TMJ, back pain, headaches, or just non-localized aches and pains.
For this I will have my compensation decreased because of the rising cost of health care.
If the head of the insurance company would take a pay cut I might be willing to consider one. But since I have not heard that he is, I will begin to find ways to work to make his company obsolete.
I am gratified to find so many comments on my client's deteriorating marriage.
They are all pretty accurate and I have confidence that he will, with some painstaking hesitancy, move in some direction. He is really just in the early stages of his treatment. I have been seeing him since September.
And now that it's a new year his ever-caring "health-plan" has automatically authorized another twelve sessions. Of course, as you all seem to appreciate, working though a change in your life is very difficult. You all noticed how many aspects are involved: money, children, friends, houses, extended family, routines, and even just thought patterns need to change. This guy will be with me for another forty to sixty meetings, over the next one to two years. But I am confident he will make some decisions and some changes.
In order to keep seeing him I will have to fill out forms, use key words, check boxes, and fill his medical record with information that may be used against him at some time.
The irony is that I am saving them money. By coming to treatment he will do something about his life, although what it is has not yet evolved, but he will avoid sinking into a deeper depression that would probably create some chronic, expensive medical problem such as alcoholism, obesity, irritable bowel syndrome, TMJ, back pain, headaches, or just non-localized aches and pains.
For this I will have my compensation decreased because of the rising cost of health care.
If the head of the insurance company would take a pay cut I might be willing to consider one. But since I have not heard that he is, I will begin to find ways to work to make his company obsolete.
Tuesday, January 08, 2008
Late notice
It's tough to admit that your wife is gay. Even after twenty-five years she won't admit it. But now that the kids are gone, and you notice she is never home on the weekends. She is out "shopping" with the same girlfriend that she takes vacations with. She goes away with her for two different weeks each year. She has for as long as you've been married. But she doesn't go away with you. Never did.
If you bring up that you'd like to spend time with her, she gives you a look like she isn't even sure she is coming to your funeral. It's tough to think of leaving when your sixty and you've been together this long. You can see that you were never really close, and the sex, what there was of it, stopped ten years ago. There once was a job that kept you really busy, and the kids were around, and they were fun, but now that the job is ending and the kids are gone, you notice that you're sitting there, alone, with your glass of beer and the football game.
The choices aren't good: Financial hardship in your old age, or beer and football, alone in the dark.
Go Pats?
If you bring up that you'd like to spend time with her, she gives you a look like she isn't even sure she is coming to your funeral. It's tough to think of leaving when your sixty and you've been together this long. You can see that you were never really close, and the sex, what there was of it, stopped ten years ago. There once was a job that kept you really busy, and the kids were around, and they were fun, but now that the job is ending and the kids are gone, you notice that you're sitting there, alone, with your glass of beer and the football game.
The choices aren't good: Financial hardship in your old age, or beer and football, alone in the dark.
Go Pats?
Tuesday, January 01, 2008
Another new year
Hey look, it's a new year!
Things are starting off well with riots in Sudan, Kenya and Pakistan, as well as wars in Iraq and Afghanistan, and those are the ones that my country is somewhat involved in. I'm sure there are lots more.
People, running around shooting, screaming, crying, dying all trying their best to get... what?
Love, Power, Money, Sex, I guess.
I've seen many people in my little office last year, about 160 or so different ones. They too are trying their best to make themselves comfortable, have a good life, in whatever way they try to define it. They struggle valiantly, sometimes against long odds.
But, don't dare accuse this here human race of being rational or logical. We can each do that for a brief period of time, but then we lose it out of fear, passion, laziness, sloppy thinking, bad habits or misinformation.
Then, if no one stops us, we rise up and blame, scold, humiliate, hurt, or even kill each other.
Then we settle back and wonder how that happened.
So, in this new year I, your virtual therapist, would recommend that you take just a nanosecond some of the time to consider what you are doing and why. What are the consequences short and long term? Who else will really be affected? Is this really what I want or are you just doing it because it just came rushing out of you?
We have big, complex brains that can do great things, if you give them a chance.
If you do, I will assure you, it will be a better year for all of us.
Things are starting off well with riots in Sudan, Kenya and Pakistan, as well as wars in Iraq and Afghanistan, and those are the ones that my country is somewhat involved in. I'm sure there are lots more.
People, running around shooting, screaming, crying, dying all trying their best to get... what?
Love, Power, Money, Sex, I guess.
I've seen many people in my little office last year, about 160 or so different ones. They too are trying their best to make themselves comfortable, have a good life, in whatever way they try to define it. They struggle valiantly, sometimes against long odds.
But, don't dare accuse this here human race of being rational or logical. We can each do that for a brief period of time, but then we lose it out of fear, passion, laziness, sloppy thinking, bad habits or misinformation.
Then, if no one stops us, we rise up and blame, scold, humiliate, hurt, or even kill each other.
Then we settle back and wonder how that happened.
So, in this new year I, your virtual therapist, would recommend that you take just a nanosecond some of the time to consider what you are doing and why. What are the consequences short and long term? Who else will really be affected? Is this really what I want or are you just doing it because it just came rushing out of you?
We have big, complex brains that can do great things, if you give them a chance.
If you do, I will assure you, it will be a better year for all of us.
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