Tuesday, July 31, 2007

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.

Saturday, July 28, 2007

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.

Wednesday, July 25, 2007

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...

Sunday, July 22, 2007


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.

Friday, July 20, 2007

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, July 15, 2007

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.

Tuesday, July 10, 2007

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.

Sunday, July 08, 2007


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.

Thursday, July 05, 2007

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.

Monday, July 02, 2007

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.


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.

Sunday, July 01, 2007

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.