Thursday, August 30, 2007


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.

Tuesday, August 28, 2007

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.

Friday, August 24, 2007

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.

Wednesday, August 22, 2007

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?

Monday, August 20, 2007


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.

Wednesday, August 15, 2007

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.

Tuesday, August 14, 2007


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.

Wednesday, August 08, 2007

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.

Monday, August 06, 2007


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)

Thursday, August 02, 2007

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.