Monday, March 31, 2008

worse than it is

Today is Monday, and somehow on Monday I see some of the most difficult, most chronic people that I have to deal with.

I have been practicing in this city for twenty-seven years. I began here the month after John Lennon was killed, so it's easy to remember.

In a practice like this each year I see between 150 or 175 different clients. Usually, about 50 to 60 get carried over to the next year. After 27 years I have learned that the average length of time that anyone spends in treatment with me is bi-modal. It is either six months or eighteen months.

But every year I get one or two people whose lives, or whose minds, are a mess. They stick around for a while. After a while they begin to accumulate.

Today it seemed like everyone I saw was someone I had seen forever, and that I would see until the day I died. But that isn't true.

I checked my records and found that of the 66 people I have seen this year 17 of them I have seen for five years or longer. That is 1/4 of all the folks I see. By the end of the year I will have about 100 people will have finished therapy. But not these folks.

I checked further and noticed that five of those 17 people account for 58% of the phone calls I get.

They are troubled, in constant crisis, some are more than a bit narcissistic, need guidance, reassurance, attention, and seem to have some sense that having a therapist means having a super-mother with a huge breast.

It is these people that have driven some of my colleagues out of business.

I try to set limits. They now know that just because the leave four messages doesn't mean they will get a return call. Life goes on.

Saturday, March 29, 2008

another angry client

I have been seeing Mary for a long time. She doesn't drink much anymore and she hasn't been in a fight for a long time, but she is still an angry woman.

Almost two years ago I began to see another woman, Kate. Kate had led an interesting but pretty difficult life: Her mother was a drunk and her father walked out on the mother and three young children. But Kate had survived this, and several other terrible times, with humor, persistence and the hope of a decent life.

About a month ago Kate left the man she had been living with for the past fifteen years. She realized that she had spent all that time waiting on him, spending money on him, listening to his complaints about the world, and protecting him from the consequences of his own actions.

Two weeks ago Mary came in to her session roaring at me. How could I do this? Do I ruin every one's life? Who can believe that therapy does any good anyway?

It turns out that the man Kate left is Mary's brother. Mary took that as an affront to her whole family -- although she had always said that the members of her family where selfish, useless, and dishonest.

What Mary is really angry at is that she knows that Kate will have a better life. Things will still be tough for Mary, and now her brother will be looking to her to help do all those things that Kate has always done for him.

Some guys are like that.

Friday, March 21, 2008

The Beatles were right

I have been seeing Jake for almost a year. He really struggles with anxiety attacks, especially in social situations, and with bouts of depression. Sometimes it got so bad he would be crying and hitting his head as he drove home from work.

He is about 26, and has been suffering since high school. He has friends, he has a pretty good job, and he functions, but he was not happy. He was often miserable. He has tried several medications and some of them would help for a while, but he couldn't stand the side effects. He settled on a mild anti-depressant, that maybe helped a little.

Because of his anxiety Jake has felt most anxious around women. He had hardly dated, and that made him feel more like a loser. He had a brief relationship with a girl when he was in high school, but that ended in disaster. There was this one other woman whom he liked, but he was never sure if she like him so he was afraid to pursue her.

For weeks that was part of what we discussed in our session. Finally, he understood that maybe she was waiting for him to show he was interested before she would show him that she was.

Well, that turned out to be the case. This woman, who does seem to have her own issues, has been keeping her eye on him for two years, hoping he would approach her.

Now, two months later, they are seeing a lot of each other, and they have some kind of understanding that they are a couple.

Jake is happy, and happy in a way that he has never been. He feels like he a a part of the world. He is hardly anxioius and not depressed. He gets out of bed, goes to work and smiles.

I don't know what would happen if she changes her mind, but that doesn't seem imminent.

Love is the answer: the healer of all wounds, the source of all hope, the force that parts the clouds and brings out the sun. The Beatles were right.

Tuesday, March 18, 2008

they had sex with other people

After poor governor Spitzer went down in flames it seems that it has suddenly become very trendy for people of note to go public with the fact that they have had sex with people other than the ones to whom they are married.

This comes as quite a surprise -- but only to people in this country.

America, born from the Puritan Ethic still can't seem to admit, openly, that most people really like to have sex.

Sex is programed into our genes so that we can keep the species going. Over millions of years we have evolved to really like something that is really necessary. If sex was like taking out the garbage we wouldn't have 6.4 billion people in the world.

Sex strengthens the bonds between people, it enhances self-esteem, it is a great tension release, it promotes harmony and it feels really good.

Most people, but especially men will not turn down an opportunity to have sex, unless the fallout is really negative.

The fallout is often negative, which is very good for my business.

I can't remember the source, but someone read a quote to me recently:

"The most powerful people in the world are rich while men and beautiful women."

Monday, March 17, 2008


Rarely, but sometimes, things get a bit scary.

I am working with a woman who I have seen for a long time and she is doing very well/ But still, at the slightest mention of the wrong thing, she will dissociate. She really, really goes away and isn't there.

It can happen in an instant. Her lip curls, her brow knits and her eyes glaze over and she doesn't hear or respond for anywhere from thirty seconds to two minutes. She says that if it happens at home and no one knows what to do she will be "away" for much longer. She really can't tell how long.

She says it feels like she is floating out there. She can't feel her body and she really can't control her mind, or tell me where she goes or what she is thinking. She just goes away.

I can bring her back slowly, but she is exhausted. She says her body stays numb for a while, she cries, and then she get very angry.

She knows what it relates to, and we can see what triggered it afterward, but the trigger can seem very remote until we look at it.

Such a strong reaction makes it difficult to work on the underlying trauma because the mere mention of thinking about working on it can be the trigger.

Thankfully, otherwise, she has worked very hard to put together and maintain a successful life.

I have a great deal of admiration for her

Sunday, March 16, 2008

away and back

I was up in the mountains for a couple of days, hidden from the world surrounded by family. I was without the computer and even out of cell-phone range, being on the wrong side of the mountain.

It's tough to read the paper after that. I see that people are still very involved in blowing each other up.

I spend hour after hour trying to move people, one at a time, slowly in a direction that will improve their lives. But the tide is always running against them. And then we have a leader who makes jokes about how the economy is going through kind of a rough patch, and the future of the war is kind of hazy, and he giggles and dances as if he has done nothing that could upset anyone.

We have the reformist governor who spends $4200 for some kind of sex. Led slightly astray by a bit of lust. What kind of people are running the show here?

But at least we don't have suicide bombers. I'm sure we do suicide missions, and assassinations, and torture.

I have a client who whines because everything has been done to him, which may be true, but that's no excuse. Everything is being done to all of us. We live in the best time there every has been to be alive. You just have to ignore that 40% of the world lives in extreme poverty and several groups are still intent on slaughtering several others.

That's just the way it is.

Monday, March 03, 2008

Then he said

Harry came back to see me. I saw him for a few months last year, and about three years ago I saw him for a year.

Harry is a major vice-president at a company you would recognize. He comes to me because he gets stressed out, and we have to keep on eye on his drinking. He also worries about having another marriage fail.

But Harry is obviously smart, alert, and does well with people. He didn't get where he is because his father owned the business. He knows how to deal with the world.

As the session wound down Harry began to tell me about things he's been reading and thinking about. He talked about new DNA technology, which is something I follow pretty closely. But slowly the thread of his conversation drifted and soon he was then telling me that he is convinced that part of our DNA has been improved by mixing with space invaders. He went on to say that he thinks he has met some "helpers" who have come from other galaxies, and that they are really all around us, just waiting for us to ask for their help and guidance. Earth is really just a big laboratory to them.

"That's not how I interpreted the data," I replied.