Carl Rogers

50 years ago Carl Rogers published an article in a psychology journal about how he does psychotherapy. It was a revolutionary article for its time as it broke away from the model of the "analyst" who knew more about the patient than the patient did about himself.

The article has been re-published in a journal this month. Reading it over I can see how much his thinking, and the thinking of the "Humanist School" as it was called at that time, has had an influence on my work, and on my standing as a person among people.

Roger's position is that the basics of therapy is that the therapist needs to be caring, that is giving unconditional positive regard; and understanding, the therapist needs to be able to be accurately empathetic about what the client is experiencing, and to know how this is affecting the client.

Underlying this is the belief that the client is a whole, valuable person, who has the capacity to determine what is best for him or herself. They have the best chance of figuring this out if they are given a safe and non-judgmental place to do so.

I have learned, through reading, practice, colleagues, work experience and life that these conditions are helpful to everyone, everywhere. If you don't challenge, bully, boss, or criticize someone, they have a much better chance of finding their own solution to whatever the problem is.

If you immediately come off as the expert you run a much greater risk of people telling you to go fuck yourself.


I have learned, through reading, practice, colleagues, work experience and life that successful psychotherapy involves much more than the conditions Rogers offers, but it can't really work without them.

not the first choice

His mother brought him down to my office. She filled out the paperwork, yelled at him and left him in the waiting room.

I came out to meet him as she was leaving. He was twice her size. He said nothing.

Zack has not been going to school and that is why she is making him come and see me. She told me so on the phone.

Zack is seventeen, about 6' 1," 200 lbs. He is an African American boy who embraces the role. He had the black sweatshirt, the baggy jeans, the bandanna. He rolled into my office slowly, sat down and stared at me.

"Do you want to be here, or does she want you here?" I asked.

"Her" he answered.

During the next 45 minutes we had a conversation. He was polite and answered my questions. Some of his answers were real, some were just what he thought I wanted to hear.

If I were him I wouldn't open up to me, some middle-aged white guy. How can he possibly trust me?

Perhaps if he comes six more times he will realize that I mean him no harm. I could be of some use to him if he really wanted to discuss things with me, like about how to handle the world, and what his options are. But he doesn't know that; how could he?

All I am to him is the guy who can keep him from getting a probation officer.

I wish there was an alternative, but there isn't much to choose from around here.

priorities

Yes it gets kind of absurd sometimes.

I spend a day in which I see a person whose husband just died of ALS. The next hour I see a kid whose father died of cancer AND his mother was murdered. I saw a kid who got thrown out of school because the Spanish kids were fighting with the white kids. The next guy is having his house foreclosed.

There are worse. It would take hours to write it all in a way that would make sense. People's lives get so complex and some are so sad, and this isn't even Baghdad.

But I leave the office whistling and all I really want to know is if the Sox are going to win. It's the playoffs. That's something to care about.

a disturbing trend

I know you have noticed, but our new technologies have moved more and more communications from written word to pictures and videos. On most news-type websites if you click on a headline you will more often get a video as you will a text article.

Many more people watch movies or buy (or download for free) music than read books or magazines. Reading is slipping away; writing is worse, my mother would be appalled.

Does it really matter? For a while, I didn't think so. New technologies make the brain work differently, and people adapt to the way the world is. Using a computer has certainly enriched our lives. Without it I couldn't read all of your blogs and get to know what goes on in your heads.

I remember when cell-phone technology first allowed people to take pictures. I thought -- who would ever want to take pictures all the time. But now people do, all the time. Why they do it still baffles me, but they certainly do. I went to a Red Sox game and the people in front of me must have taken ninety pictures. Pictures of them at the game, of the players, of the hot dog guy, of them eating hot dogs, buying popcorn, the popcorn guy. I don't know if they will ever look at them. They never looked at the game.

But, who cares. They had a good time.

But, now studies are coming out that show that if you don't read and write, and instead let your brain get information by watching videos, your use of language diminishes. Your brain gets sloppy. You don't have as many complex ways to express yourself, and hence you don't rely on as many complex ways to think.

The world is complicated. If we think about it only in simple terms, then we get simple solutions.

That is how we got our current President. He counted on people to be like him and think in simple terms about complex problems.

Now, our country is the butt of the world and a lot of people are dead and dying, have bad health care, bad mortgages, high credit card debt, bad science, polluted air, dependence on fossil fuels, and fear of foreigners. Not good.

See, it makes a difference. (to put it simply)

Go on -- read,think,type, read.

Progress?

P is now 47. When she was young her mother would hit her with an extension-chord, especially when P would ask her why "that man" was in the house again. The beatings ended when P broke her mother's ribs.

That start led P into a rough life of drinking, fighting and bad relationships. She is understandably quick to anger and can have volatile mood swings. If you piss her off, you know it.

But it's been years since she has hit anyone.

Her drinking is down to two or three times a month.

She has gotten rid of the men who abuse her.

She stays away from her sister, who still drinks heavily, and her brother who is back in jail.

But all this progress has left her alone, with no idea what to do. She doesn't like anyone, and no one likes her. She feels she doesn't fit it, except at the bars, but she knows that going there only leads to trouble.

So she stays at home and listens to right-wing radio and gets angry at the "liberals" who run big-government. She has some insight into the fact that they pay for her disability income and her medical care, but that only interferes with her anger.

I am looking for a spot in the world for her. It hasn't appeared yet, but we will keep looking.

Repeat: Be honest

I have probably said this before, but it is really important.

Be honest with your therapist!

We are not going to reject you if you screw-up, even if you have screwed-up before.

Yes, we are happy when you make progress, and it makes us feel that we are all doing our part.

But, when I've been reassuring your probation office that you've been straight, clean and sober, and you end up passed out in the park, with a blood-alcohol of 3.4, don't come in and tell me that it was a medication reaction.

You see, I really think it is my job to find a way for you to learn new skills, like staying sober and being honest, but I need to know what is really going on.

I'm going home now,
maybe I'll have a drink, but at least I'll be honest about it.

Not a good sign

I went away for the end of August. I left everyone and went out in my kayak among the reeds and rushes.

When I came back I was relieved to find that no one had decompensated to the point of needing to go into the hospital. No one got arrested or had any major tragedy. That was good.

In fact it seemed like good things had happened while I was gone. R left me a message saying she would have to change her appointment because she had gotten engaged while I was away and that she was getting married on the Friday following my return.

This seemed a bit hasty because before I left she was telling me that after going out with this guy for six months she had several doubts about how loyal and committed he could be. I guess she felt he could demonstrate his commitment by marrying her.

In these matters I may say that I think this action is a bit rash, but I don't feel that it is my place to be against it. No one would listen anyway.

"Think about what you're doing." That's all I say.

Yesterday R left a message, she and he had just left the court house. They signed the papers ending the marriage. Not quite two weeks.

BUT, then he says to her. Now that we have finished with that disaster I think we can start totally fresh and this time we will get it right.

This time when I saw her I was more definitive. At least take a break, I said. Don't see him for a month. If you still want to talk to him after that, and if he is still there (which he won't be) then you can consider talking to him. Although I would think that enough is enough.

As far as relationships go, a two week marriage is not a good sign.

too harsh

Last spring I saw a twenty-five year-old young man. He had been in and out of several colleges and was living at home. He was obviously bright, and articulate, but he was struggling to get his life started.

He came to see me four times. He explained his family situation and how his parents were constantly engaged in a not too civil war. He was the go-between. He felt that he was the one who kept the family together. When he had gone away to school his parents had separated. When he returned they came back together.

He has two younger siblings. One had gone off to school far away. She called once a month. The younger one was a senior in high school. Once he got his driver's license he was hardly ever home.

My client explained how his mother would come into his room many evenings and cry. His father would corner him the next morning to find out what she said. This, he could see, was causing him a great deal of stress and confusion. He was worried all the time. He spoke of the times he had gone away to school, or even for the weekend and how good and free he felt.

He also told me that whenever he tried to pull away his mother would tell him about all the psychiatric problems he had. She would give him different diagnoses she read about. She would call his MD to get him on medication for depression, ADD or bipolar. He didn't want to take them.

I worked with him to show him that he had options. That at 25 he didn't need to take care of his parents. They had to make their own life decisions. Their marriage would have to survive or not without him. He had his own career plans that were different from what his parents wanted him to do. He also wanted to spend time with people other than his family.

The last time I saw him he was in my waiting room. As he came into my office he got a call from his mother. She seemed upset that he was still seeing me, and she was having some crisis at home. He left and never came back.

I saw him downtown over the weekend. He was walking with him mother. He had gained about twenty-five pounds. It looked like the puffy kind of weight gain you get from taking some psychiatric medications.

I thought the things I was saying were obvious, but as a form of therapy, they were too harsh. He wasn't strong enough to take her on.

What would you call it

I have been seeing this guy. He and his wife are seeing someone else for couples therapy. They are going there because he had an affair.

The affair is the typical thing. I hate to be so blase about these things, but they make up a good percentage of my business, and I certainly know these things happen. You know, you work with someone, you spend hours on a project. It goes late some nights. There is the excitement about getting something accomplished and working together.

In the meantime you wife of fifteen years is home with the kids. She fine. There's nothing really wrong, but things get a bit stale. She's put on a few pounds, the kids drive her crazy, she complains about the bills. Her mother is sick, her back hurts. All the stuff of life.

He crosses the line with this other woman. He gets dazzled by how much they have in common, by how flat her stomach is, but the way a different woman feels, smells and bounces around.

Then it blows up. Some little clue and the wife finds out.

Then the rying, yelling, remorse, contrition. The wife, the kids, the family, the shame.

Couples therapy, anger, hurt, blame, tears, more contrition. Finally, there is some rejuvenation, forgiveness, reconnection.

Then the guy comes to see me to work out his own issues, supposedly left over from childhood, and all he wants to tell he is that he is still seeing the other woman.

He knows it's wrong but he can't stay away. He doesn't want to leave his wife; she's been a great woman. But the pull, the chemistry, the fascination is still there and it is soooo powerful.

So, what's the diagnosis? Is he weak? crazy? selfish? self-destructive? danger-seeking? Does he hate women or love them too much? Is he going through a mid-life crisis or just reliving his father's sins.

or is lust just too powerful?

Probably all of the above.

join the army

Here's something I learned today.

A couple of years ago I saw an angry kid who was about seventeen. He had a lot of reasons to be angry, including an abusive father who then vanished from his life. There were other problems. The young man was bright but very provocative and got himself thrown out of high school.

He tried to join the Marines but they wouldn't have him. That was in 2004. He spent the next three years getting fired from jobs, drinking, taking drugs and getting in fights.

Last week he went to the army recruiter. They not only signed him right up, they gave him some substance to drink before he went to take the army's drug test. They told him that when he was in the army he could drink all he wanted on his time off, but no drugs.

They told him that there was a chance he would end up in Iraq, but that by the time he was out of boot camp the war could be over. I'm not sure he knows where Iraq is.

They don't seem to care who drives those humvees any more.


(for those of you who continue to wonder -- don't worry -- this young man, and other people I mention here, probably won't read this blog, wouldn't be able to recognize themselves, due to altered details, and most wouldn't care anyway)

Love,
T

dangerous date?

Something happened to me this week that has happened twice before, but always feels a bit strange.

A mother was describing what happened this summer to her fifteen year-old, somewhat boy-crazy daughter. He daughter came home from a party that she had gone to up at the beach. The party was at someones house and this kid knew that kid, who knew kids from another town, who brought other kids, who knew other kids, so there were kids there from all over.

The girl spent the evening and into the night flirting, and maybe a little more, with a real cute boy she met. He was cute, he had the same sense of humor she did, and she was hoping to see him again.

Two days later the boy called and the daughter talked to him on the phone for over an hour. A few things that were mentioned caught the mother's attention. When the girl got off the phone the mother asked a few more questions. Then the mother got upset.

Later that night the mother made a few phone calls. The next day she told her daughter that she was not allowed to go out with that boy.

The daughter was upset and demanded an explanation. The mother cried, but avoided the question. After an hour or two of evasive answers the daughter was not accepting the decision. The mother told the girl to call her father -- the parents had been divorced for about five years, the daughter saw her father regularly.

The daughter got right on the phone and called her father. After fifteen minutes of a private discussion she hung-up the phone and ran to her room crying.

The father had told her that she couldn't see that boy because he was her brother, well, her half-brother technically.

Keeping secrets is always risky.

old guys

I've see some older guys in therapy, by older I mean over fifty. They come for as many reasons as everyone else, but there is a trend I see that is upsetting.

They tend to be more worried about their jobs than they were a decade ago, and it seems that they should be. The ones who have jobs are either doing very well in the company, and are in positions of leadership, or they are on the fringes, and they know it. Several of them are out of the companies they had been in for two or three decades, and are now hanging around as consultants.

If they are in leadership positions they know that there are people on their ass all the time and any major fuck-up and they are history. The other ones feel like so much of the work is based on using technology that they are not totally comfortable with. People who are twenty years younger grew up pushing buttons and clicking mouses, and skipping from screen to screen. Most of my guys can work with the machines but if anything happens to the technology they are screwed. The consultants especially are out there on their own and if the scanner doesn't scan everything in right then they can lose a few thousand dollars in an afternoon. It can take hours to get the systems connected.

They feel that at this age they should have respect and wisdom, but they are scared and feel that they are falling behind. They also feel that they can't learn as quickly, stay up as late or concentrate as long. Many of these beliefs are not true, but the anxiety about them make them so.

These problems are as much cultural as they are psychological. This is America '07. You are free to make a lot of money. If you don't, then nobody really cares. I see plenty of houses up for sale as I drive to work.

I am older than most of the guys I see. I am lucky because my job requires thinking and talking. I can still manage (I think).

Also, I use an Apple.

ducks

Dick Cheney and I went out in our kayaks this morning. We were both looking for ducks. I like it when i see the ducks take off out of the marsh, sqawking and honking, with their wings flapping, as they take off into the early morning sky.

Dick likes to kill them.

I guess we have different approaches to life.

I didn't say anything about that to him this morning. Not while he still had a gun in his hand.

predictive of

A's mother died of cancer when he was fifteen. He was close to her and missed her. He got angry at the world, got in fights, got suspended from school. He bounced from one bad idea to another for ten years before being sent to therapy, where he has done well.

B's mother died of cancer when he was fourteen. He got depressed and didn't function very well. His grades dropped and he barely graduated. Then he stayed in his room playing video games until he was nineteen when he came to see me. He is now at least working part-time.

C's mother died of a brain tumor when he was fourteen. He turned to study and thought. Now he is a priest and consoles people who are dying.

D's mother died when she was fifteen. She took over the household chores and took care of everything for her father. Her father married another woman seven years later. That woman threw D out of the house.

E's mother died of a drug overdose when he was eleven. He is now thirty-one and just out of rehab for the third time.

F's mother died of a drug overdose when he was twelve. He is being raised by his grandmother. He is second in his high school class.

Having your mother die in early adolescence always has a profound effect, but what that effect is going to be clearly depends on many other factors. the most important of which is who else is around.

Out of Body

Saw in the paper today how researchers at two leading universities were able to find ways to make people feels as if they were having an "out of body experience." They used virtual-reality goggles that were slightly off, as well as other ways to produce visual sensations, and/or tactile sensations, that don't quite agree with the rest of the persons sense of what is going on.

It does begin to take all the fun away. Next they are going to explain away ESP, or the fun of being abducted by aliens for sexual experimentation. By aliens, I mean the old-fashioned kind, the ones from outer space, not those green people who sneak across the US borders and kill and eat all the children in the over-crowded emergency rooms.

I did have a client once who was the head of the HR department at a very large and successful company. She said she set-up all of her most important working groups by putting people together who have compatible astrological signs.

Everything works if you believe it does. That's why, in my therapy, I use a lot of fairy dust.

mental illnes

I received a mailing about a program that would train me to be a nurse practitioner, as well as a Ph.D. That would allow me to prescribe the medications that my clients may need without having to refer them to a psychiatrist.

I feel very mixed about that idea.

What is mental illness?

Still as a therapist, I cannot clearly define it. Sure, there's psychosis; when someone is hearing voices, thinking they are Napoleon, or, like L, thinking that everyone is watching them and talking about them, then, I would say that when people get like that, they have "mental illness,"

But who gets that? and why?

Things have changed. There aren't as many schizophrenics any more. And the ones there are don't fit the old categories that I was taught way back when. No catatonics, a few paranoids, and hebephrenic? That's a word I haven't heard for years.

There are trends, there are fads in psychology and psychiatry, like everything else. It's like physics -- will string theory last? But with psychology, clinical psychology, we have to apply it to people. I have to determine why I think someone' is thinking, feeling, behaving, living, the way they are.

As a therapist, who is not an M.D. I tend to believe that the major causes are in the interaction between the person --the total mind and body -- with the environment, especially the significant people. I tend to focus on these factors much more than brain physiology or genetics.

That's my bias because that's what I can work with. I don't tend to see people as malformed, imbalanced, even sick, as much as I feel they have learned the wrong approach, have been mistreated, or stuck with bad habits. These things I think my clients and I can change together.

I don't have a lot of faith in medicine, either in how they define the problem, or how they treat it. But maybe that would change if I were the one in control of the medicine.


If I could prescribe, how different would I be as a therapist?
And what does that say about the things I believe?

effective?

A while ago, in an entry call "Less Money" I wrote that some insurance companies were attempting to find a way to evaluate how effective our psychotherapy is. If course, I wan not thrilled with that, mostly because I don't believe that they really want to evaluate how well we help people improve their lives, but they want to find ways to reward those therapists who are "cost efficient"

But, I do think that we should be held accountable for the work we do. My wife always bitches that my billing rate is only slightly more than she pays the Toyota place. But, I always answer, when you take you car to the Toyota place, when you take it back it runs smoothly. That cannot always be said for those who bring their mind into my office.

So lets look back a year and see the first three people I saw a year ago today and see how well they are doing now.

The first one I saw was a fifteen year-old young woman, who was strikingly attractive and flirtatious, who came and whined about things that were clearly not that important. At the second session she told her mother that there was a man who was now working for her father who had sexually molested her for a year when she was eight. She had never told anyone before.

I only saw her once after that. They went to the police. I think she is doing much better.

The second person I saw last year was a sixty year old woman who has been living alone for ten years. She has been alone since her husband, now her ex-husband, was taken off to jail for selling meth out of their basement. She was afraid of getting sick and having no one to care for her. She had fainted at work and was scared she had a brain tumor was about do die.

It wasn't true. But she was frightened of entering a new relationship with the man at work who was pursuing her. We dealt with her fears until last November. She left happy.

The third hour was spent with a couple who were fighting about money. Her brother and cousin had died within the past two years and she had been spending a lot of money, convinced she would be the next to go. Her husband was upset because he didn't think she was about to die but was afraid they would soon lose their house.

There turned out to be many issues with them, relating to their parents, betrayal, abandonment and money. I still see them once a month. They are financially solvent and getting along.

I guess I am three for three. I will stop there for today.
`

Can I get a Witness

Alice, has such bad knees that it is painful to watch her hobble into my office. Today she told me that within the next two weeks she will get her knee replaced, and that is a good thing.

However, that means her sister will have to be round to drive her back from the hospital when she is ready to come home.

That means she can't tell her sister that, despite all of her sister's efforts to bring her to God and to show her the path to eternal salvation, she is not going to join in and become a Jehovah's Witness.

Alice knows that when she tells her sister this, her sister will beat her up.

In the name of God.

Nike

I tend to like most of my clients. That helps a lot because I think they pick-up on the feeling that I believe they can do better than they are, and that I expect good things from them. We work together to try and promote positive changes, to get through the anxiety or other obstacles, and make things happen.

Sometime, nothing happens.

We talk about the issues, we talk about the bad habits, we talk about the things that keep them locked up, we delve into the deep reasons to explain how they got themselves to be where they are, and we design strategies to make changes.

Sometimes, still, nothing happens.

I was wandering around with my wife the other weekend and we ended up at one of those endless discount malls. I went into the Nike store to see if they had anything besides orange running shoes. I saw a pile of old Nike Tee-shirts, the ones that say "Just Do It." for $10 a piece.

Two days later I am sitting in my office talking to one of these people and I suddenly regretted that I didn't buy a dozen of those shirts. At critical times I need to just give them out.

There comes a time at which I feel I have talked about it, whatever "it" is, enough, and some action is required. Perhaps a bright orange Tee-shirt would get the message across.

Filling Time

Life takes a long time; which is good. I like that. If people die young it's tragic, especially if that was me.

In two weeks it will be my 39th anniversary. 33 good years! That's not a bad ratio.

I have clients who have been married three or four times in a shorter span of time. They have been divorced, widowed, left and been left. All the while I've been sitting here.

I have clients who were in the Peace Corps, went to China, biked across the USA, were in jail in Morocco, fought for, or was it against, the Sandinistas, went bankrupt three times, made and lost three fortunes, or else are still living in their mother's basement at fifty-three.

I see a woman who has had sex with at least twenty different men during the two years I've known her, and I see three fifty year-olds who who have never had the experience.

I see one guy who has six kids with five different women and gives them each $50 a week. He tells me he is a good father. He doesn't know I saw his daughter for a while. She told me he wasn't.

There are a lot of different ways to fill up your time here on earth.

Thanks

Very Good.

I am very pleased with all of you. I only wish you were all on Dr. Phil and we could just tell Sandy what to do AND then she would do it.

The best suggestion is to help Sam find a group home with supervision. That would be good except these things hardly exist any more, even in our relatively caring Commonwealth. I had put her in touch with the State Services for Brain Injured. After three months of phone calls a guy drove out to Sandy's house and evaluated the situation. He said, essentially, that Sam qualifies for services, but they don't have any. He said that Sam was lucky to have Sandy, and if she didn't want to take care of him, no one could blame her. Then he left.

As I mentioned, Sandy called Sam's brothers. They did not sound like a caring family. Nothing doing.

The current plan is for Sandy to save first, last and security for Sam, and find him a place where he can walk to his drug treatment program.

When he doesn't go, and calls her angry and crying, and then goes back on drugs, I will try to reassure her that she did the right thing.

Eventually, she will get over it.

We all do. (unless it is your own actual kid)

Sandy and Sam

Ten years ago, while she was going through a difficult divorce from her abusive husband, Sandra become friends with Sam who was also going through hard time. He was working on kicking his drug problem. His recovery had become more complex because while he was high he crashed his car into a pole and sustained some brain damage. They moved in together.

Now, some things have changed and some haven't Sandra is over the trauma of her bad marriage. She has lost the weight, and also shed the depression. She wants to get out and have a life. She has new job and a new outlook.

Same, for the most part is drug-free, but he still has slips once in while, especially if he gets angry at Sandra. Sandra also realized that the extent of his brain injury is worse than she thought. He is a rigid thinker, who gets angry and frustrated easily. He is also usually in a foul mood and complains that she never does anything for him. He is on several medications that keep him calm but make him impotent.

Sandra is ready to move on. She even has someone lined up. The only problem is that if she moves Sam out she is pretty sure he will be in jail, a mental hospital, or dead within six months. She is attached to him and it makes her feel as if she would be abandoning her child on a highway.

She called his family. They told her they were surprised is was still alive, and that was more than he deserves.

What is a woman to do?

Suggestions are welcome.

less money

So, one insurance company announced that they are cutting what they will pay us but about 4%. BUT if we agree to fill out forms with our clients that track how well they are doing, they will give us an Increase of 3%. That turns out to be a 7% bribe to get out clients to reveal information that they may not wish to reveal. The questions are about their job functioning, sleep habits, sex lives and social relationships.

Then the insurance company can rank us as to how effective we are as therapists so that people can make an "informed choice" based upon unreliable, and possibly irrelevant data..

So, it is bit of an ethical dilemma: We should disclose our financial incentive to our clients before they take the survey. But that will put pressure on them to help out their therapist, even if they don't want to give up the information.

Of course, I don't think that doing psychotherapy is comparable to doing heart surgery. Really finding a way to measure success is complex. Also, it is clear that some people do better with certain kinds of therapists. It certainly isn't "one size fits all."

But the insurance companies need ways to act like they are doing something, especially now that "managed care" didn't even manage money that well.

Of course we will really be rated on how few sessions we use to drive clients away from therapy.

It's the same logic that expects an occupying army to help a country lean how to be "free."

The CEO of the insurance company must have thought his idea to cut our compensation was really creative; he took a raise of almost $1,000,000.

Raise you hand if you're surprised.

I don't see many hands.

Therapeutic Intervention

I was working with Phil yesterday. Phil is in his mid-forties. He lost his job a year ago because of some unfair things they did to him. He is living off some money his mother gave him when his unemployment ran out. His brother is upset that he is taking money from his mother. Phil is angry at his brother. His brother has a good job, so what does he know.

Phil was about to look for work but then his girlfriend got angry at him because his apartment was a mess. She didn't realize how much he is suffering without a job. He can't clean his place because he is depressed. She isn't depressed, so she doesn't know. Now he is upset with her so he can't look for work.

Phil was going to sue the place that fired him, but he went to a lawyer and the lawyer wanted more details about what happened. Talking about what happened gets Phil upset. The lawyer should realize this and make it easier for Phil.


Phil comes to therapy and tells me to tell that everything he feels is normal. He is fine, but other people have been mean to him. As soon as they are good to him he will get a job.

I hit him in the face. It was very therapeutic.

drip, drip, drip

Some people don't put up with anything. The slightest thing goes wrong and they flip out. They cause a fuss, make trouble, and whine about how life is so tough on them.

Other people just "go along to get along," which means that they would rather absorb a little aggravation instead of causing a fuss, getting everyone upset, and then having to wait for everyone to calm down. So their lives just drip away, a day at a time, wishing and hoping.

I've run into one of these strings of people who adjust to almost anything, and thus allow it to continue. I've been seeing a guy who broke up with his girlfriend, but a month later she came back and she told him she was pregnant. So they got back together. She wasn't too nice to him, he wasn't that great to her, but they wanted to try for the kid, which I think is a worthy idea. They never got married, but they stuck together.

That was seventeen years ago. Now, they are all still together. They only talk about the kid. She sleeps on the couch. She works and spends her money on herself. She drinks a little too much, eats a little too much. He makes sarcastic remarks and thinks she will get the message.

Last year he came to see me. We went over all kinds of stuff in his life to make sense of why he tolerates all this. He decided that he will make some big changes. He told her things were going to either get better or end.

She said "Yeah, right," walked away and turned the TV back on.

drip, drip, drip

A couple of months later, as nothing has changed, he is on the Internet chatting with a few women. Eventually he meets one and they start to get together for dinner, or whatever, once a week. The woman at home asks no questions, the client says nothing specific.

drip, drip, drip

This has gone on for a few months now. He is planning to tell her to leave, but she has nowhere to go, and he is afraid of what might happen to her, even though e finds it unpleasant to be around her. Once he a while she asks him where he's been, and he tells her he goes "down the block." She smiles and nods.

drip, drip, drip

I kind of suggested that this guy at least be honest to the woman he is seeing and explain his situation to her. I don't want him to set her up or mislead her. He responded by telling me that he has been very clear with her. She knows why he has not invited her to his place, and she is very understanding. In fact, she seems very OK with the way things are. She probably would like things to change, but...

drip, drip, drip.

life goes on...

Clarity

Today was a splendid warm, clear summer day. The sun beamed down strongly through a few puffy white clouds. The warm summer light highlighted the many colorful flowers and the deep green of the leaves. I sat on the deck and felt fortunate to have time on such a day.

My mind was struck with the vividness and clarity of the world around me, yet I questioned, where and when had I experienced this intensity before?

Then I realized: today things were almost as clear as they are on HDTV. Maybe the 3-D effects were a little better, but the general color and contrast were not quite as sharp. The shadows that were cast by the trees were slightly confusing, and the close-ups were unremarkable.

The other thing I realized was that the plot wasn't nearly as good, just a couple of cars going by. And most of the people weren't as good looking.

No commercials; well, that isn't really true either.

More on that

To answer your question -- Some small part of this thinking, problem solving ability, that we psychologists call "intelligence" is inherited. That comes with temperament, emotional sensitivity and visual acuity. But, as I have been saying, brains are very plastic, especially early on. When used properly they can do amazing things. When misused you can end up broke, broken-hearted, alone, miserable or even dead.

Or, you can invent people to come into your house and put tiny blue dots on your new green shorts.

Right now I have three clients who are great problem solvers. Why? Because their parents, both parents, were really rotten at it. By the time these people were six years-old they were running the house. Their parents were either not home, useless or strung-out. These clients cooked, watched over their younger brothers, got grandma to take her medication, got their fathers up in the morning to go out to work, lied to the Department of Social Services, and hid money when the parents were thinking of buying coke -- all sorts of problem solving skills.

The reason they come to see me is that they each have never gotten a break. All three are forty years old +/-. They still get calls from their brothers, sisters, parents, and now their own husbands, ex-husbands, aunts, neighbors, and friends to come and help solve problems.

They have trouble saying no and setting limits. They feel that if they do someone will get sick, get hurt or even die. They are probably right. It's even happened to one of them. She hung up on her drunken mother, saying she couldn't come rescue her and leave her two children home alone. The mother fell out of her third story window.

Something like that leaves a funny taste in your brain.

Sunday Times -- Use Your Brain 7

Amanda is right, it really helps to have someone, a teacher, a signficant other, but hopefully a parent who can teach you to use your mind. Many parents teach kids to be prejudiced, or throw temper tantrums, or just to shut up and feel stupid. It's all good for my business.

Here are some examples from the news of people who did not have such good teachers:


Judging from yesterday's NY Times "Week in Review" section, it seems like they are trying to compete with "The Daily Show."

On the top of the second page, where they run "The High Ground." They first show Senator David Vitter of Louisiana, admitting that he committed a very serious sin. Then, since they are so nuanced, two pictures away is the picture of the man from the Iranian government confirming that they just executed a man for adultery by stoning him to death.

See, it isn't just here in the U.S. that fo;ks guilty of sloppy and hypocritical thinking.

Then they have the picture of the Pope, who decided on his own, that his church is the best. Good thinking there. Based on....?

No picture of Michael Chertoff, our Homeland Security guy, who "had a feeling" that we may be in for some kind of trouble. I had that same feeling when we invaded Iraq, except mine was based on a slightly more than minimal knowledge of history, and what has always happens when a very distant power invades a weaker country with a different culture. His feeling was based on ....?

I agree with William James, that experience is really the only way to begin to amass knowledge. But you can refine that kind of knowledge by thinking about what you have experienced, and then you can create new experiences to test what you think, and learn from that. But it really does take a lot of work.

Except that after a while, it really gets to be fun, and even HELPFUL.

Still, it is so much easier to believe than to think.

And it is VERY difficult to allow ourself to reject what you once beleived, even when the evidence is very obvious. (ask George; ask anyone really).

Use Your Brain, Part 6

One of the points I seem to be stressing ( and stressing about) on this blog is to find a way to help people take advantage of that marvelous and complex mass of protoplasm that they have inside their skulls. For all we know it may be the most unique such structure in all of the universe.

When used correctly it can solve all kind of problems and make the world a better place for everyone. But, sadly, most people are lazy and don't push it hard to make it perform.

I had two marked experiences this weekend. We were in a not so far away city, a big city, full of people, traffic and cheap restaurants. We had ordered a few sandwiches and when we went to get them there was a mix-up: one was missing, one was wrong, stuff like that. We pointed it out to the person at the counter. She stared back at us. Slowly, we instructed her about how to make the necessary changes. You would have thought we were teaching her how to tie her shoes. She didn't care. She wasn't too interested, and she did what we wanted just to get rid of us. Clearly, she didn't feel the problems were related to her.

Two days later I'm back in my home city, an overly intellectual haven with a good educational system and aspiring, up-beat kids. One was working at the pizza place when I walked in to pick up my order. No order was there for me. But this kid quickly and in a friendly encouraging tone began to trouble-shoot the problem and offer solutions. Within ninety seconds the confusion was resolved and I left with a very good pizza.

Again, I maintain that the difference is not "natural intelligence." It has much more to do with expectations, encouragement, good feed back, good teachers and and an atmosphere that expects and rewards competence.

Problems, even complex ones, even those in your life, can be solved. Think about them, then a few steps a head. Try a new approach. Don't be afraid to be wrong. Enjoy the process of fitting the pieces together.

Remember what H.L. Mencken said: "For every complex problem there is a simple solution, that is always wrong."

Apply that to our current administration, and then the Middle East.

Technologically Primitive

I feel so out-dated and primitive.

I mean this blog is all in words. How dumb is that?

I should at least have a picture of me throwing all my records into the river so that the lawyers and the Paparazzi can't dig into them.

I could show slides of the spots on L's clothes that "They" put there when they broke into her house.

I could show me punching Ed in the face because he is still whining that his father died twenty years ago and he had to take loans to go to college. But HIPPA wouldn't like that.

I should have a sound track that has Dick and Mimi singing "Pack Up Your Sorrows" from 1967. (I really should do that)

I should have the time to learn how to do those things.

But I'm not in college, and I have to go to bed.

Weddings

I love weddings.

I love weddings for several reasons: they are such a great gathering of all kinds of weird, often intoxicated relatives, half of whom you really don't know because they are someone else's relatives. And they are there for a happy occasion. They are kissing and dancing and eating and drinking, and full of hope.

The wedding itself is a primitive leap of faith. It underscores how people are still willing to face challenges, and over-come the odds and be in love and want, for the most part, to have children.

Today we left our week away early to take my father-in-law, who will be 94 soon, to the wedding of one of his younger nephews, who is 45. It was a great wedding of Jewish and Italian families. They had both a priest and a rabbi, who were certainly both gay. They were also exuberant and effusive. They belted out their prayers and songs and blessings. They served wine and waved incense, broke bread and broke glasses. They had fat bellies and beached blond hair and were probably secretly married to each other.

Since the bride and groom were in their forties, the crowd was pretty senior, so the bodies that were clutching, swaying and gyrating to the music were a bit more gray, wrinkled and gnarled than most, but that made it all the more meaningful as they ignored the effects of osteo-arthritis and got out on the floor to shimmy in celebration that the world will continue with some sort of attempt at civilization even after they are gone.

The better irony is that fifty miles away in a different part of the state one of my long-term, more anxious clients was also getting married. This was a great kid who first came to me because he was having panic attacks working at the drive-though window of Berger King. Now, eight years later, with a Master's Degree, a good job and what seems like a caring, stable relationship, he too is doing whatever ethnic dances his tradition offers, basking the the glow of his banker father and schizophrenic mother, and eagerly joining the ranks of the happy and hopeful who believe that life is worth living and creating. He, who for years was so worried that no one could love him, and that he could never speak above a whisper, and that he would never, ever get laid, is full of life and hope.

One can only admire the foolishness, join in, be joyful and dance.

John and me

"Life is what happens to you while you're busy making other plans."

Our old 60s guru John Lennon said that. It's certainly true when yuu're trying to go on vacation, especially if you have a small house near the beach that everyone can get to easily.

I'm here. I want to sit in the sun, watch the waves and mumble incoherently -- no wait, that's what I do for work. But anyway, I don't want to think about anyone, or what they are doing or why.

But our good friend is here, and she is divorced and planning her kids wedding and has to deal wit her ex and his new woman, and all his cries of poor-me and poverty.


Then my niece comes, she is in the middle of her divorce. She comes with her kid, who is sixteen months. And that's great because he can relate to me on my level and we can throw sand at the waves together and think that is really cool.

And my wife's cousin is getting married, at forty-five and we have to bring her father who is 94 and is trying to remember how he knows these people. And my wife's sister is angry at us again, for reasons that don't make any sense but have been repeated for thirty years.

My sister just got out of the hospital. My brother-in-law still can hardly move his arm.

My kids want to get us out of the house so they can come to the beach without us bothering them.

AND, my team lost the other day because I was down here and didn't get to pitch.

Things just continue. whether you want them, expect them, design them or just stand there.

Life happens. Pay attention or you'll miss it.

My job

I know. I just told you about how Lisa drank and screwed up her life and set herself back two to ten years or forever.

But I don't want you to think that this is just a thankless job, like the Myth of Sisyphus, where I'm always pushing rocks uphill just to watch them roll down again.

No, it's a great job.

All I have to do is sit here and people come in and tell me all kinds of shit that they have never told another living soul. They tell me they have cheated, lied, stole money, been raped, molested, beaten with brooms, brushes or wires. They tell me that their wives believe they are married to Satan or Jesus or both, and they know that these proclamations are all just to avoid engaging in sexual activity, or an excuse to having had sex with the wrong person.

It's my job to accept it. To reassure everyone that they are all human and that this is what happens to humans.

And this is helpful. I am not a priest or a shaman, but people like to know that their sins are forgiven.

And they are.

For all of you, whatever you did. I know you meant well. Sometimes we just misread, or misjudge, or we fuck up a little.

That's part of being human.

We will do better next time.

Unless we are Dick Cheney, and how many Dick Cheney's do we need.

None.

Otherwise, do the best you can. That's all we can expect. O tpp wil struggle along, hoping that the few words I have to offer will make enough difference so that someone's life will pull back from the precipice and be able to go on it's merry way.

That's the best we can ask, but when it happens, which is does, it is very gratifying.

Shoot and Ladders

It's the week of the 4th of July. Summer is here . Off we go to the beach. Sit with a few friends, watch the waves roll in, the sun smiling up in the clear blue summer sky, little children frolic in the waves. What could be more idyllic?

I had left the message on my voicemail that I was away but I didn't tell the service because I would take emergencies. I had told L that I was gone and she could leave as many voicemails as she wished (someone moved her cheese -- she actually said that).

The cell-phone goes off. It's my answering service who tells me that Janice from DSS called. She had been called in to check on a woman I have been seeing for three years. The woman, Lisa, began working with me to regain custody of her son from her mother. In order to do that she had to prove to DSS that she had stopped drinking and had remained sober . We went through all kinds of contortions to get her sober, then keep her sober and to impress the child welfare people that she was sober and now attentive and competent.

It had been good to work with Lisa, I have mentioned her here before (on March 14). She had not only dealt with alcohol, but depression, anxiety, OCD and major, major self-deprecation. But we had been doing well.

About a month ago she passed out and was brought to the hospital for a night. She said she had been suffering with a stomach flu, hadn't eaten for two days and took all her medication at once. I believed that.

A week ago Lisa had been doing so well that she told me that she was preparing to break-up with her long time ( seven-year ) boyfriend. He was just about the only person, other than her ten year-old son, whom she spoke with. He was very supportive to her, even financially. The problem was that he was married and she was now convinced that he would never leave his wife. She told me she was feeling strong enough to to want a man of her own, and probably another child. That seemed like progress to me.

But the call from Janice at DSS told me something else. Janice, who had also worked with Lisa, liked her and believed in her, told me that Lisa had been picked up by an ambulance and brought to the hospital again. She had passed on it a park. Her blood-alcohol was .4. That's almost fatal.

I don't know if Lisa drank because she broke-up with her boyfriend, or she broke-up because she wanted to drink. But now, when I get back from a week at the beach, we will have to begin all over. Three years of work, good work, pretty much wiped out.

Two the the three years were pretty good years for her. That counts for something, but for many people life is a game of shoots and ladders. Lise just landed on that long slide to the bottom.

My next book

If I had a bit more talent and discipline, and I took a year off and worked hard, I could write the stories of how two of my client families intertwine. It would be a good story, and no one would believe it of course.

On family is rich, one is poor, and they live on opposite ends of the same street. One in a big house with lots of land that their family has owned for three generations. They ride their horses on the trails in the back. The other lives on less than a half an acre in a ranch house with crumbling steps, holes punched in the walls and a shaggy lawn.

I have been seeing the poorer family for years, as they have always been struggling with mental, financial, educational and legal troubles.

The more prosperous family came to be recently because they have passed the point of exploding. They could no longer keep matters internal to the tight-lipped inner circle.

Each family has three children of roughly the same ages. One has two boys and a girl, the other two girls and a boy. The oldest son on the poorer family drank too much, but managed to get away. He joined the army and is in Iraq. Now his mother sits outside and drinks.

The middle children of each family are sixteen, and they are having sex with each other.

Both fathers have been gone for eight years. The poorer father ran off with a man. The richer father ran off after his daughter accused him of coming into her bed at night. Two years later he "drowned" while fishing in Florida.

Alcoholism, sex, violence, incest, shoplifting, robbery, embezzlement, lies, deceit, betrayal; along with love, devotion, parental advocacy, determination and guile.

Put it all together and write your own story. It's all there.

Sure beats staying home and watching Dr. Phil.

Sometimes I think all this psychotherapy mumbo-jumbo is damn useless and sometimes it seems like the only way to change the world.

What's become increasingly clear and frustrating to this aging Sixties idealist is that despite superficial changes, the human population of this plant is going to continue to roll along, with it's own ebbs and flows of violence and exploitation, mixed with some personal acts of grace and kindness, until, at some unknown point, in some totally unexpected way, and completely by accident, it destroys much of itself.

That may happen in six months, or in 4000 years.

Until then, the only way to have some positive impact is one relationship at a time. Even that is pretty chancy business.

That's what I get from taking the weekend off and reading the newspaper.

I's not that I'm turning into a bitter old man. Really, I love to watch the parade as it passes. I have a ringside seat for the jugglers and the clowns and the constant drama. It's great stuff. And now, more than ever, everyone wants to be a star.

So, until tomorrow, be nice to the person sitting next to you, and enjoy the show.

Yes and Maybe

Some things sometimes go better than I expect, and that can be very encouraging.

Chrissy, who I wrote about last time, called in response to my call. She said she was at work on Tuesday and that she felt hung-over and terrible, but she really pushed herself to pull it together and not let her life tumble completely our of control.

Today she left a message that things were still OK. She felt anxious but could handle it. She would not drink, and wanted to stay away from alcohol.

She also was much more committed to recognizing the triggers and learning how to keep herself under control.

This was very gratifying.

Also, yesterday I had what was really a very good discussion with L. She was able to see, but not admit, that her ideas are crazy. She tried to grasp and hold on to how she would never believe that there is conspiracy of four hundred people involved in damaging her sneakers. She even laughed at it.

Today, as usual, she called about five times with more proof that someone is breaking into her house and damaging her stuff. When I went over everything we discussed yesterday she screamed and cried.

"Don't tell me that's not real. Don't take that away."

Unfortunately, that's progress.

PTSD anyone?

AHhhgggg!!!

It these PTSD people! They are so good and they try so hard and then ping, not even BAM, just ping, they hit a bump and all the wheels come off.

Chrissy, after the divorce, slowly came together, then she saw her Mom and fell apart. Two months of drinking and self-destruction, ended up in the hospital.

Got out, started over. Piece by piece, brick by brick, put her back together again. She got a job. She worried about the job. It was a good, hard job. Could she do it? (Of course she could, but when did she ever feel really capable.) So she had to pass a test. She got nervous and wobbled. She had a bad weekend, but she called. She talked, we held her together and she went on.

But Friday, three things, aspects of life that happen to everyone. The good boyfriend had problems of his own, people at work were yelling - not even at her-- a phone call from her mother and a letter from her biological mother.

Too much to handle.

Drunk again. Self-destructive, crazy talk.

Will probably lose the job.

Start over.

She knows what she has to do. There is certainly hope. Good things will happen sooner or later. But, it's already getting to be later.

Here, I said, just sit in the waiting room for the next three months and don't do anything. Tell me when you run out of magazines.

L, again

It's been a while since I've written about L. She has not gotten better. The kind of thoughts that rush through her head have only revved themselves up and increased, one on top of the other. She went from people noticing her, to people talking about her, to people following her, to people coming into her house. Then she thought people were tampering with her clothes, with her food or her jewelery.

Then she got into this shoe thing where no shoes fit right. She thought that after she bought shoes, people came into her house and switched them with shoes of the same size and style, but just slightly larger or smaller on one foot. She began ordering from various shoe factories, but she thought they were all involved in screwing up her feet. She called the police. She began calling several times a day. She does this now several times a day. They tell her to call her psychologist.

Then she began talking about the cameras in her house and the microphones. They didn't bother her. She thought that all her movements are being put on YouTube and that she is a star.

But now she is crying that she is never left alone. She is threatening her neighbors because they won't tell her who is coming into her house. She tells me that she can't take it and she is thinking of suicide.

It is finally enough to get her into a hospital, fill her full of Zyprexa and take all of her star power away.

Where is the line between being an eccentric pest and being a danger?

more examples

It must be a brain thing. I have said it before: brains almost always choose short-term pleasure, or lack of pain and anxiety, over benefits that will only be evident over the long-term. To make a huge and unsupported pseudo-scientific jump, I think there must be something in our evolutionary make-up that leads to these decisions. I think that the primitive parts of our brain figure that we may not be around in six months or longer so a bird, or a bottle in the hand, is better than two in the bank later.

#1
Joe sat before me today, covered with tattoos, and looking green. His liver isn't working too well after thirty years of drinking. Now, because he is in pain and convinced that another drink could kill him, he has stopped.

The real shame is that he can explain his decisions so clearly and articulately, from how he began to drink at 13, because his parents really weren't around and he thought no one cared. How it lead to all kinds trouble he got into, the drugs he also used, the fights, the divorces, the debt, and now the illnesses.

But, he said he always felt he was making the choice to drink because he hated how he felt sober. When sober he was anxious, guilty and unsure of himself. When he drank he felt calm, relaxed, clever and happy, even if was just for two hours. Now, it really hurts when he drinks, so he stopped. If he is lucky, he will be pain free by December.

#2
Joel has been married for seventeen years. Ten years ago his wife started taking money from their account without telling him. Then she took the tax returns. Then she stopped sleeping with him. Then she began telling their son that he, Joel was stupid and the son shouldn't listen to him. Then she refused to go anywhere with him, and now she won't cook for him. She walks around the house muttering that he's an asshole.

Joel is beginning to believe that the marriage is over. But getting divorced scares him. He is convinced that the process with be difficult, torturous, deceitful and expensive -- and he's right. So he has avoided making things worse.

Now he is aware that she may go to a lawyer first and accuse him of things that are not true and take all the money. So now, that scares him more and he thinks he will get to a lawyer first.

We shall see.

came back with a vengeance

A little over a week ago I wrote about two people who didn't show up. Usually, when people don't show up they disappear for a while. Both of these people came back.

One of them, the man whose wife had left him had worked hard that day, fell asleep and missed the appointment. Today he came back. Surprisingly, he had a lot to say.

I say I was surprised because few people with his background come to therapy, and much fewer still, talk about some of the things that happened to them. He is Cambodian.

He was born in a refugee camp. He has a younger sister. Once he had two older brothers and one older sister, but they were killed as they ran across a field trying to escape the government soldiers. Both of his parents survived, kind of.

His parents made it to this country to be re-settled. But unfortunately his father brought his mind and his memories with him. That meant he had violent flash-backs that led to heavy drinking and then more flashbacks. Eventually, he couldn't hold it together at all and he wandered out into the streets to get away from everyone. No one knows where he is.

That meant that my client, his mother and sister spent time in several shelters before coming up here and finding a way to establish a home.

All of these things haunt my client, as they do many of his relatives. It takes generations to begin to heal from such wounds.

Now, of course, we are part of the process of destroying another country, creating refugees and traumatized children.

But hey, this is not new. It's been like that at least since men gathered together in groups, and probably before. The skulls of decapitated villagers piled ten feet high in the center of town, just to show who is in charge. Would this be Spartans and Persians in 470 BC? the Mongols as they invaded Georgia in 1223? the European settlers slaughtering tribes of Native Americans in 1750? the Serbs in Bosnia in 1993? Hutus killing Tutsi in 1994?

Turks and Armenians? Japanese and Chinese? Jews and Palestinians? India and Pakistan? Irish and English? French and Germans? Germans and French? Vikings and Celtics? Spurs and Cavaliers?

All, of course, and many, many more.

Almost all of them glorified by major motion pictures.

Finding a Therapist

Yes, finding a therapist can be very gratifying or very frustrating. Psychotherapy, despite all of the attempts at standardization and all the claims that it is a science, remains a craft that is practiced differently by everyone who attempts to do it.

One of the goals of psychotherapy is to help whoever submits themselves to the process to live a better, happier, more productive life. Now, what that means exactly, is up for grabs. That's why the profession attracts to many kooks, gurus, shamans, and yes, weirdos.

Everyone is seeking a better life. Some people are sure they have found it. When they feel that way they want to light the path for others, for both fun and profit.

Unfortunately, one person's path to self-actualizatin may be another person's mine shaft.

That's why training, contact with colleagues, and professionalism is important. No one, besides the therapist and his client, really knows what goes on inside that meeting room. Sometimes I tape sessions, and in the past I have been watched by other's, but 98% of the time I sit and talk to someone, the words, the gestures, the sighs, the raised eyebrow, the unfinsihed sentence, and the long silence, all vanish quickly into the past.

If you are looking for a therapist, make sure you feel comfortable, so that you will be able to say anything and everything that is really happening. In my sessions I appreciate complete honesty more than anything. If you drank again, tell me. We have to work on that. If you seduced your brother-in-law, let me know. It probably affects how you feel.

Make sure you feel understood. There were reasons you seduced your brother-in-law. It didn't just happen. It doesn't make you a bad person (don't ask your sister). We have to be able to talk about it.

Also, try to find out how much your therapist thinks about what he or she is doing and why. They shouldn't be just be winging the hour, or leaving the entire direction up to you. They should have a good idea of what they are trying to accomplish, and how they hope to get it done.

If they don't meet the criteria, you can find someone new, or tell them to contact me through this site. I charge for supervision, but it is well worth it.

intelligence?

A while ago, March 5 to be exact, I talked about I.Q. This question came up again with my last posting. Some people are smarter than others. The people I talked about last time were on the low end.

I am a psychologist but I am not a fan of I.Q. tests. Part of me strongly believes that a large part of what I.Q. measures is how much someone has learned how to "get with the program." by that I mean how much have they learned to know and say what is expected of them by the powers than run our society -- our government, school, churches, courts. If you are smart you learn to follow the rules.

But, we know, often the rules suck. The rules are there to help those with power to keep it. If you follow the rules there is a better chance that you will get to join them. Not a really good chance, if you are an outsider, but a better chance.

If you oppose the rules you will not get a good job, get thrown in jail, have your hands cut off, or be labeled as nuts. This is not new to our society, societies have always run this way.

If you are really, really good at opposing the rules, and you are charismatic and good at marketing yourself, and if you focus on a widely agreed upon injustice, you can really change the world and be an historic figure: Ghandi,Jesus, Martin Luther, Martin Luther King, Nelson Mandela, the Franklin, Washington Jefferson group,and Curt Flood are all good examples.

I don't believe in the bell-curve of intelligence. I believe in a flat line with a tiny blip down and a tiny blip up. One percent of the population may have a remarkable talent in something. One percent are congenitally mentally handicapped. (These are not exact). But most people have plastic brains that can be shaped at an early ago to relax, solve problems and have fun; or to be tense, full of doubt and feel miserable.

I would rather work with someone who over-intellectualizes and needs to be taught how to feel than someone who stares at me and answers with one syllable and expects me to tell them how to run their lives. I know therapists who are great at that. I'm not.

off kilter

Feeling strangely out of sorts. Trouble focusing. Trouble sitting still. A haze seemed to settle over my brain, then it settled into my stomach.

Why/ Too much weekend?

No, I am ashamed to say. I had eight clients today but two were of the kind who, although they have depression or anxiety, also are struggling intellectually, and always have.

It's sad, but it's boring.

Everyone deserves a chance. Every human is just as human as another. But it helps to be able to carry on a conversation if you want to be in therapy.

He has panic attacks. He really does. He gets nervous because he is afraid of failure. He should be; he fails often.

He also smells.

It was difficult to keep my eyes open. When he left I staggered down the hall and stuck my head into the sink.

I feel the state got their money's worth when they paid for that hour.

No Shows

Two people didn't show up today. No call, no word, just didn't come.

One really bothered me; the other, I'm not so surprised.

The one that bothered me I had only seen once. He was a young man who wasn't born in this country. Very few people of his ethnic background come to therapy, but he was pretty desperate. He had come to this country when he was very young. He got lost in the shuffle, joined a gang, did a few rough things and his life wasn't going anywhere.

Then he met a woman, actually his cousin's wife, and they fell in love. He changed his life for her. Eventually they got married and had a kid. He got a job, worked hard, got promoted, loved being a father.

But, she left him and he was devastated. He drank himself stupid for a few months and almost lost his job. They encouraged him to see me.

He came in and was very articulate, and very aware of his feelings and how he has been lost, hurt and confused. He seemed to be a good candidate to work through that loss, plus a lot of the other stuff he had reacted to -- but then he didn't come back.

There could be a reason. I will try to find out tomorrow. It is very frustrating. Those things bother me. I take it personally.


The other guy who didn't come had come four times before. He was having panic attacks and I helped him get some benzos to calm himself down. By the fourth visit the doctor felt he should begin to cut them down and depend more on the SSRIs. This time agreed with the doctor.

I am not that surprised he didn't come. I am disappointed because he was really beginning to learn how therapy could help him. I think he was looking for those pills because his wife wanted them. The doctor had alerted me that she was known for her drug-seeking behavior. She may be dragging him to another doctor. Maybe I will find out about that too. Maybe not.

That doesn't bother me as much.

mixed about children

I've been seeing and hearing about all the new children being born through IVF. I have known some great examples of families who couldn't have children who have found a way, with a boost from science, to be able to achieve the world's most gratifying experience of having a needy, time-consuming, resource draining, emotion sucking creature wander your home for twenty years. Few people who ever had one would actually trade them in, despite frequent threats.

But I am also disturbed by what I have read and what I have seen first hand. That is that couples in their late thirties or forties, who have struggled for year to have a child, who then take all kind of drugs, and sometimes purchase eggs. This process often leads to multiple births. Multiple birth children are usually underweight and often premature. This makes them very high risk for all kinds complications.

Families now come to me and my colleagues with twins or triplets, one or two of whom have special needs ranging from learning disabilities to large developmental disorders. All of these kids need and deserve love and delicate handling. The truth is that this kind of attention is very expensive for towns and schools. It is also very draining on the parents and the extended family. It often totally rules the life of the family and community for many years.

It is a very complex situation, and I don't want to seem mean or an ogre for implying that some people shouldn't have children, but it also seems very selfish to go to these extreme measures to satisfy a need when there can be so many severe consequences that are ignored. Any couple who has two, three or four successfully implanted embryos should really think about what they are really getting themselves and their communities into, and not just he miracle of life. Medicine now has ways to keep children alive, even when their lives are very limited and their future holds no prospect of improvement, and without extraordinary measures they would not survive the first two months. This takes millions of dollars and thousands of hours.

Any doctor or clinic that only talks about how successful their birth-rate is, while not clearly delineating the dangers and realistic expectations should be taken out of business.

As time goes by

I don't really care about the newest direction my profession is taking. Yes, everything is chemical and biological and if we regulated our chemicals our lives would be pleasant and smooth. But what is it that puts all of our brains and body chemicals our of whack?

80% of all difficulties begin with our intimate relationships. We struggle with the ones we love: our partners, our children, our parents. We want them to love us, we want them to do for us, and they should behave as we want, as well as respect and appreciate us.

Of course, they want that from us. And so the struggle begins.

These examples are just from today:

Jack, 75, came to see me last year. he and the woman he had lived with for six years had split up because her 45 year old son caused too many problems. He realized she wasn't going to take him back. That took two session. On Tuesday he came in telling me that he was having difficulty trusting his new girlfriend, who is only 60. But he was falling for her. Today he called in a panic. I think the feelings are not as mutual as he had hoped.

Ed, who has panic attacks, came in today with his wife Judy. They are in their late 50s. They have been together since they were teenagers. That is except for the few years that she was married to someone else. The truth is, they were together then also. They screamed at each other lovingly for the whole hour.

A new couple, Mike and Rose came in. They have been together 12 years. Mike is very successful. He runs a very profitable business. Rose is really movie-star gorgeous. But, they have had sex eight times over the last nine years. She says she can understand why he is upset, (yes, I could understand why he is upset, especially sleeping next to her). But, she told him, he shouldn't take it personally. Sex just isn't her thing. Then she really tore him to shreds for being so angry at her. She told him that his anger is certainly not going to solve the problem -- which is true.
But, when pushed, they both said they wanted the marriage and they still cared about each other. This will get complicated; that's all I can say at this point.

Paul and Nancy are in their mid-thirties and have been married for two years. a first marriage for each. It's time to have a baby. But, are we ready? Do we really love each other enough? What about all our arguments, and the fact that her father abandoned the family and his mother went nuts? How do we know for sure?

So, I head off to the long weekend dazzled by these thoughts of love and romance. May we all live happily ever after.

Signs of Spring

May is the cruelest month, and even though that was probably written about other circumstances, it has often been true in my world. I have not checked recent statistics but May is often the most dangerous month for suicides. I guess the winter is depressing, and everyone understands that, but come spring, if things don't get better, then they get dangerous.

Spring is the time when the sap begins to run through the trees and through the veins of people with difficulties. Everything escalates, everything becomes more intense. Last week I received many more calls for new appointments, and most of them were from people I had not seen for a year or more, but who felt the need to get stabilized before things fall apart.

Another sign of spring is that I get at least one thin, sensitive, artistic, contemplative, gay adolescent. They usually come in, as this one did yesterday,upset by the state of the world and man's inhumanity to man. He was well read in philosophy. He was vegetarian. He had a boyfriend and tons of girlfriends.

Like most of them he thought all of his difficulties were due to the weight of the world. The fact that he was gay, that his father was a drunk and disappeared, that his mother was depressed, that his stepfather was clearly very uncomfortable around him and that his brother's friends beat him up, were all denied as part of the reason that he was upset.

Some of then young men are more fragile than others. Sometimes they just need to learn how to leave their families and all of their family's difficulties and go out on their own. Sometimes they are using this as a way to bring attention to all the problems, and sometimes, as may be the case this time, they are really overwhelmed with all of their emotions and in danger of falling apart.

It is difficult to know if a sixteen year-old kid is really gay, in rebellion, or just confused. But these days there is so much sexuality beginning in Jr. High that everything can get intense and confused pretty early.

Take the time to smell the flowers. That's the good part of spring. That and the Sox beating the Yankees.

Summer of Love

I see from the NY Times Arts section that this summer is the 40th anniversary of the year the hippies went public. The human-be-in and all the concerts. The drugs, the very shorts skirts and the anti-war movement. They are all being brought back by festivals and museums. Now, it has become a branding experience.


I don't remember it that way. I remember those summers very clearly. 1966, 67 and 68, were very intense times and very formative for me. I was finishing college and beginning graduate school. I was beginning the relationship that continues to this day. Myself and most of my friends were very concerned about the future of the world.

We were really, really concerned about what kind of world we wanted to live in and how we could build it. We didn't trust the politicians, and they were all exposed as liars. We wanted things to be different. We wanted things to be more honest, more equal and more just. That was much more important than caring about our own wealth or creature comfort. We expected that we would be comfortable, but not much beyond that. None of my friends even wondered about how to get rich.

For about twelve years, from about 1966 through 1978, things seemed to be going in that direction. We ended the war. We got rid of Nixon and Ford. The civil rights movement really made a difference, as did the women's rights, and eventually gay rights. Homosexuality stopped being classified as a disease in the early '70s. From 1960 though 1980, the gap between the rich and and poor was narrowed significantly. America was finally doing some good things.

During those years I worked as a psychologist in a community mental health center. We did a lot of preventive work that no one today has even heard of. We went into schools, housing projects and police departments. We were the first to alert people about child abuse and addictions. We were beginning to learn how to prevent them, or to catch these problems at a very early stage.

But then Carter proved to be an inept leader and Reagan took over. He is the one who changed the tax codes and economy (which really wasn't doing that well) so that the rich could stay rich and get richer, and the poor got stuck with the bill. He also said that all of these preventative programs were a form of socialism, and we can't have that. Why should a government care about it's people? That's BIG government. A government should just watch out for money.

It was his supporters who revised the history of the 60s to look like all the hippies wer a bunch of drug-crazed narcissists.

I don't remember my friends like that at all. We were idealistic, and a bit naive, but many of them did, and continue to do a lot of good work.

nine years

She was not happy today. Really, she hasn't been happy for a long time, which is why she is in therapy. She has been in therapy for nine years; the last two with me.

She is great to have as a patient. She is expressive, articulate, insightful and understanding. She makes connections and comes up with causal connections. But she really hasn't changed much, and today she was upset about it.

She had struggled for years before she first sought therapy. She had always been independent, obstinate really. She had been defiant as a child and didn't want anyone telling her what to as an adult. But when she ended up in the ER having her stomach pumped she realized she had better get some help.

Now, five psychiatrists, four therapists, two hospitalizations and a day program later, how is her life going? Not that well.

She is out of work and on SSDI. She wants to work but she doesn't feel at all ready to meet the demands. She has stopped drinking fairly recently. Drinking had been her first attempt to deal with all the terrible feelings. In a way it had been successful. It helped her through the day. But before she stopped drinking she was having alcoholic rages and black-outs.

She has tried at least a dozen different medications. Of the three she takes now she feels that two are really helping to stabilize her moods. She hopes that their effects will last for a while.

She isn't suicidal anymore. Her self-destructive behaviors and thoughts have greatly diminished. But she still is anxious most of the time. She often feels overwhelmed, and is plagued with self-doubt. She cries most evenings. She has a great deal of trouble sleeping, and the knot in her chest never goes away.

At times like these I feel almost powerless. She is a really fine, caring, intelligent person whose while life is a struggle. Her difficulties are a clear interaction between the highly reactive temperament she was born with, and never having anyone who could comfort her and help her modulate her own moods. Instead, from an early age, she was screamed at, bullied and demeaned.

Working with her now, at forty-five, we can only undo and redo things inch by painful inch. I would love to get into the mechanism and reset the dials and give the works a good tune-up. But all I can do is talk to her.

repeats

That last post. I'm pretty sure I wrote about that situation before. I can't even find it myself, but I know I wrote about it when my client was able to assert herself and get the harassment to stop.

But, like so many things that go on in my profession, and in life, change comes with great difficulty. Problems that are solved can come back. Sometimes they take a different form, sometimes they come right back at you.

Part of what we are supposed to believe is that if something is difficult to do, especially something social, such as speaking in front of groups, making cold calls, asserting yourself, meeting new people, confronting someone's anger, or seducing women, that doing it, and then doing it again, will make it easier.

It turns out that such is not always true. You make that big presentation, you do a decent job, but still, you never want to do it again. You stand up to that bully, and you get your head beaten in.

Problems can be solved; it is much more difficult to really reach in there and change people.

apartment dwellers

I guess it isn't easy living in an apartment. I actually live in a box, but more about that later.

The woman who lives above my client came here as an Internet bride from Eastern Europe. She knew that America was the land of opportunity and she was eager to find her way here. She wooed a man electronically, and who knows what she promised him. He is nineteen years older than she is, and a drunk, but he was the key that opened the gate to riches.

The woman came here found a job, performed her sexual duties for about a year and then found a second job. She has now been here about six years. Each year she takes a large chunk of her hard-earned American money and goes home to the ancient hills for the summer.

My client had been her friend for more than the first two years. My client had listened to stories of the old country and endless complaints about the man who has outlived his usefulness. After a while, my client, who has several issues of her own, politely told this woman that the time she could spend with her was limited. She was tired and tense and all of this negativity made her nervous. (Don't take it personally, but I don't like you).

Anyway, she did take it personally. She went upstairs, rolled up the rugs, and since then has been moving furniture, dropping books, banging pots, flushing the toilet six or seven times in a row, and tap dancing in her ten pound boots.

My client has be defending herself by running the cold water at just the right volume so that the pipes vibrate. She also puts on her old disco CDs very loudly.

Tomorrow the woman will leave for her trip back home. There will be peace in the apartment.

It's not just my clients who have difficulties. The ones who need the help the most are the ones who have no idea that they do.

Right George?

Mother's Day 2

It's about twenty minutes until Mother's Day. The countdown has begun. Our children are far away and their mother is fast asleep. Tomorrow she will get phone calls. Mother's Day once was the busiest day for the telephone company. Now, everyone is on the phone all the time so it's probably impossible to tell. When all this cell-phone stuff started I wondered what everyone had to say that was so important. But just yesterday I got a picture of a drawbridge sent from my son's cell phone, and the day before that I got a message from my daughter's Blackberry that she was meeting an old friend of mine. Then I got a message from his Blackberry that he had met her.

What could be cooler than that?

I was talking to a client of mine who works in software, and he is worried that his job is about to go to India. I figured that my job is one of the few that can't be sent overseas. Sure, people try to do therapy over the phone, or by webcam, or even telepathically, but don't be fooled. Insist on the real thing. Despite all the technology there will never be anything as beneficial as real, person-to-person contact. As any modern materialist, reductionist will tell you, it stirs up all the right chemicals in the brain.

I know that my job often gives a distorted picture of how the world actually works. I know that there really are a whole lot of great mother's out there. Most mothers have nurtured their children, protected them, encouraged them and loved them, as well as they possibly could. I hope yours did. It makes life easier.

So, if you can, pay Mom a real live visit. Take her bowling, steam-up a pot of spinach, buy her a new kite, play a game of jacks, let her win at poker, gather the family around and watch "Gremlins" once more time. There's nothing like real, human contact.

Happy Mother's Day! If you don't have a mother, or you can't be with yours, or you chose not to because it really isn't worth the aggravation, then you don't have to feel guilty about watching the Sox.

Mother's Day

It's the run-up to Mother's Day. I hear about mothers a lot, and it certainly isn't all positive. I wrote about it before, back on March 3. But now, with Mother's Day approaching I am hearing about it again.

For most of my clients Mother's Day brings up a lot of ambivalence. Many of the people I see have come to terms with the realization that their mothers were limited, but most did the best they could. Still, to make a call to Mom and have to spend an hour hearing about your failings does not make that warm, fuzzy connection. Or to hear that Mom is sick and aches, and hurts worse than anyone and always did. Or to hear that, at seventy, Mom is making breakfast for her third boyfriend of the year and her twenty-third of the decade.

Most of the women I see, who are also mothers, feel they need to make the call, to put forth the effort, even if it is just a gesture. The men I see, if their mothers fall into that kind of category, won't bother.


I hope that you all have fonder memories, and that your visits and calls on Mother's Day bring a smile, and even a tasty treat. Most mothers are really some of the best people we will even know, and one of, if not the biggest influence in our lives.

Me, I remember Mom. She tried hard as a mother. If she erred, it was in over-praising her skinny little prince instead of being too critical. She gone now, I miss her opinions. She never would have survived Bush. She died nine years ago, on Mother's Day.

clever comback?

So we were sitting there, the three of us, in the middle of the session. It was a second marriage for each of them. The marriage was in its third year. They both wanted to avoid the mistakes of the last time.

She had been pushed around a bit by her first husband so she was making sure that it wouldn't happen again. He said something kind of negative about her daughter, she quickly shot back a remark to let him know he was out of place.

He looked a bit hurt, and confused that she would come at him with such force. He stammered, and gave a whiny reply.

She looked at me and said: "You'd think he had a vagina between his legs, wouldn't you?"

An interesting comeback, especially from a woman who has been abused.

movie review "Crazy Love"

I saw a movie today that I would recommend to those of you who enjoy seeing up close the extent to which love and lust makes people do wildly irrational things. The good thing about this movie was that it was a documentary, so it wasn't a romantic fantasy. The bad thing was that it is one of those "independent" films, so most of you probably won't find it screened anywhere near you.

The film is called "Crazy Love" and it follows the course of the relationship between Bert Pugach and Linda Riss. This couple were often on the front page of NY tabloids in the late 1950s, and again in the early 70s. He was totally obsessed with her but his wife wouldn't give him a divorce, so she broke it off with him. When she became engaged to another man, Burt hired someone to throw lye into her eyes so that no one else would be with her. Bert eventually got arrested and went to jail for fourteen years for that.

By the time he got out of jail his wife had divorced him. He continued to pursue Linda, who was now almost totally blind. At the time the movie was made, which was last year, Burt was 79 and Linda was 68, and they had been married for 33 years.

It was interesting because he, obviously, is a crazy obsessive narcissist, who cares not what he does to people, while she really seemed to want to get rid of him. But after she was disfigured and blind she made the best deal she could, which was to live off of him and have him take care of her for the rest of her life.

The last fifteen minutes of the film show her nagging the hell out of him, and he seeming to still love just being with her ( even though he did cheat on her too).

I have seen many couples in therapy in which the man is crazy-possessive and jealous, but the women seems to take it as an indication that he really cares. In general, we in the therapy field don't seem to deem this kind of relationship very "healthy." But, sometimes, what the hell do we know.

suicide

During my over thirty years as a therapist I have had six people who have died while they were seeing me, only two of them can be questioned as deaths that were somewhat related to psychological reasons. Both were alcohol related and more accidental then intentional, but I don't think that either of the men who died would stay the were regretful.

I have seen many people about whom I wonder what it is that keeps them alive. But it apparent that life is precious and I believe, really does have a force of it's own. There is a drive to survive, and very few people will give up without a fight.

That is very different from having suicidal thoughts. These thoughts are common, but still very scary. They come from frustration, loss, loneliness and humiliation. They also come from chemical shifts in the brain.

I have seen a woman on and off for years who once realized, while she was standing in her kitchen, cooking for her unappreciative family, that she could just pick up one of those big knives and plunge it into her heart. This thought has plagued her for years. She gets anxious when she enters the kitchen, and sometimes when she is driving her car.

Each times she comes we talk about the pressures she feels, and how she can never please people, and them we spend half the time discussing the difference between thoughts and actions. She is really in very good control of her actions, but no one is really in good control of their thoughts. Thoughts come from everywhere and go everywhere. We have a process that lets us pay attention to some thoughts and not to others. No one seems quite sure what that process is, but it generally works.

But once you have thought about suicide, and the thought has sacred you, it becomes difficult to not think that you have had that thought. And if you don't think it, then you can't really pay attention to the fact that you are not thinking it, or else, of course, you will be thinking about it.

But don't worry, if the thought worries you it's an indication that you don't have anything to worry about.

SSRI warnings

Yes I'm back, thanks. Italy was wonderful. it is all it is cracked up to be. I really felt away. Didn't really worry too much about anyone until the last couple of days when some of the people walking by began to remind me of my clients. It is surprising how the gene pool seems to have lingering effects. The clients I was reminded of all have last names that end in vowels.

Back to work, and it was difficult to walk into the building and see that it was all the same. By the second hour I could remember how the process is supposed to work, and I was cruising along. I notice how before a vacation I can make myself know that I am so exhausted, and now that I'm back it seems so easy, even after a day of traveling for twenty hours. I was eager to see everyone again.


Opened up the paper this morning to see that they are putting a black-box warning on SSRIs. They warn that people up to the ago of 26 are at risk of impulsive suicidal actions when they are on these drugs. They state that the incidence is low and that the beneficial effects of the drugs should be considered when deciding whether to prescribe or not.

I don't want to get into another discussion about how useful medication is. What interests me here is to wonder about what process must be at work in the brain. You give someone a drug that allows the chemicals that make someone feel more stable and content to remain in their brains, and sometimes it makes them want to kill themselves. Why is that?

Does it allow then to lose the inhibitions that were keeping these actions in check, or does it just radically alter their emotional state?

In older people, especially those over 65, SSRI seems to decrease suicidal thoughts. Is this because older people are more prone to hopelessness and this allows them not to care so much, while in younger people it allows them to care too much?

All of this speculation is probably way off the mark. The brain is very complicated, and it is attached to the rest of the body. The body does strange things, and it often does them with other people. Now, we know that other people are certainly strange, so anything can happen in these interactions.

Just today a woman was telling me that she gets very jealous when she feels that her boyfriend is cheating on her. She says she can tell he is because he lies to her in the same manner that she lies to him. "He's just like me in that way. That's why I love him." But it drives me crazy that he lies to me."

"But you lie to him?" says I, knowing that means nothing.

"Yes" she says, "but that doesn't bother me. I know what I'm doing, and I know that I can keep it under control."

Now, if we put her on medication, would she do more of it or less of it?

I happen to know that it wouldn't make any difference because she does the same things when she is on medication as when she isn't.

But still, what makes young people react to the drug that way? And more to my point, is that a question that we can expect to answer or are we in a new world that is only brains and chemicals and physical processes, where such things as motivations, intentions, and personal decisions are antiquated concepts?

Or maybe I've been walking around too many walled cities who fought each other over pasta and olive oil.