Thursday, September 30, 2010

The men

I am currently seeing a lot of couples.  I think it's related to the recession; stress is high, tempers are short, a lot of people are in tougher circumstances.  What's worse is that many of these people thought they were doing things right but working, trying to watch expenses, trying to plan step-by step for a house, a car, a kid, a vacation.  But then someone lost a job, or lost the over-time or the expected bonus, and the stock market went down, or someone got sick, and suddenly, ever expense is a hurdle and life isn't as much fun any more. And that makes them angry.

So, blame your spouse!  That's the easiest solution.

With the couples I see the men are of two very distinct varieties, either too loud, too active, too controlling, too quick tempered, and either border on being abusive or sometimes go over that line.
Or else they are the opposite; too passive.  The can't decide, don't fight, don't respond, freeze-up in a crisis, and would rather watch TV and hope the problem gets solved, usually by the wife.

I guess the men in the middle have figured out how to deal with difficulty either by making a decision and getting things done, or by doing what they are told to do.  I do believe there are some people who actually do both. They can negotiate, collaborate, come to an agreement and then act.  All of that is great if it happens but it isn't always necessary.

In the cases I see the therapeutic interventions are easy, either:  cut the shit, or get off your ass.

Easier said than done, but the direction is clear.

The women are not without their own difficulties, but are much more varied in how they act out their angst.

Tuesday, September 28, 2010

Love, alternative forms

Last night in my office I spent the last hour of my day listening to a couple trade insults, barbs, accusations, blame, resentments and recriminations for 45 minutes.  It was a rollicking emotional time.

For the last seven minutes, after they were emotionally spent, I got them to see what they really wanted from each other, which was basically, that after about 20 years of this kind of a relationship, they each wanted to know that the other one still cared enough to keep it going for another 20 years. 

Once they agreed on that, they left happy. 

I think I'll skip a week of going through that again.  That marriage will last.

Friday, September 24, 2010

The patient stream

People come to me in streaks; that makes me feel good.  I've seen several neighborhoods.  I get a couple, then they refer their neighbor, then the kid across the street, then his uncle.  It's good to know that someone thought I was worth the effort of driving across town, or even from twenty miles away, and much more, even.

What's great for me is to get different perspectives on the same stuff that happens.  I have seen several sets of sisters, or cousins.  A few times I've seen four, five or even six people from the same work place.  I can never mention that I see the other people, even if they are the ones who made the referral.  If someone brings up that they know their friend is coming to me, I just kind of nod.  I really enjoy hearing about my patients from other patients and getting a different view of them then the one they bring in about themselves. I can't say that Suzy, in the next cubicle, thinks you're a slob, but it's helpful to know.

Once I had a woman who was having an affair with a married man.  He was making all kinds of promises to her, and telling her that he was three weeks away from leaving his wife.  About three weeks later a couple came to see me about their marriage.  Sure enough,  from the information that I had already it was clear enough to me that he was the man in question, although what he was telling his wife was quite different than what I had heard from his girlfriend.  But, I really couldn't say anything, I just kind of let things play out.  I did kind of warn the "other woman" that things were not going to break in her favor, but I probably would have done that anyway.

Over just the last month I seem to have tapped into another vein of patients --- other psychologists.  I am not sure if they knew each other or if they came from very different sources, but I am seeing four other Ph.D. psychologists now.

Three of them make great patients.  They come with notes and speculations about all of their thoughts, motivations, unconscious demons, and deeper underlying internal processes.  They send me emails in the middle of the night. They are working at it. 

From my vantage point they are way over-doing it.  I'm not that kind of therapist.  I don't try and uncover every last possible psychological nick and scratch that may have cause a psychic bruise at some time.  I'm more of a kind of a "let's just get on with it and feel better" guy. But the intellectual churning can be fun for a while.  And I am old(er) so they look to me for approval of their self examination.  All I have to say is " Well, what do you think?"

The fourth one is just nuts.  She's angry and screaming, and in a terrible, chaotic relationship, with a guy who has more issues than that pop-up box has tissues.  But she has a full practice and she's probably good at it.  She's right out there and very expressive. She certainly lets you know how she feels, and she reacts quickly and intensely.

I don't think I would want to be her client if I was a man, given what she expects in her own relationship.  But, then again, that could be really good for some guys to hear about it.

This is an interesting profession.  You never really know what's going to happen once the door closes.

Tuesday, September 21, 2010

Inside trashing

My battered profession continues to take it's lumps.  The press, the clients, the insurance companies and now it's an inside job.  The Past President of the American Psychological Association, Alan Kazdin, gave an invited lecture in which he said that psychotherapy, as it is practiced today, is inefficient and elitist.  It is slow and works with people one or few at a time, while the mental health problems that are facing this country are huge.  He said that there is a need for new approaches, and that psychologists/therapists should not sit in their offices and wait for people to come to them, they should devise way to get out and treat the problems where they exist.

He's not wrong. He just twenty-eight years late.  I don't know how old he is but he must be younger than I am.  He was probably not riding on his high horse in the 1970s when the community mental health movement was taking hold.  I was working in another city at the time, another New England Mill city much like the one I am in now.  I was running a small Mental Health Center that was funded by state and federal funds, as well as payments from the people we were treating.

We had programs that went into schools, brought new parents together, worked with kids in housing projects, consulted to policemen, had follow-up care for the seriously mentally ill. We had the early formation of alcohol and drug education programs and outreach. We even were dealing with domestic violence and racism.  We were doing lots of cool stuff.

I remember that I really enjoyed working with about twenty-five kids in a concrete building in a not very good part of town.  I would meet them twice a week after school and help them organize activities, or figure out school, or complain about the way they were being treated.  Once, when were organizing a weekend dance,  I didn't want there to be trouble, as that could give the whole program a bad rap with the community.  I asked some of the bigger kids what we should do if the "bad element" showed up and wanted to be disruptive.  They broke out laughing.  They explained that if I was to ask around town for the four names of who was considered the "bad element" I would find out that they were sitting right next to me.

But all that ended quickly in the 80s, with Reagan.  I am sure that what we did would be very quickly labeled as "Socialism" by many in the media today.  Dr Kazdin is not really searching for new, innovative ideas.  Like many, many visionaries, especially in Psychology, he is just recycling old ones.

Tuesday, September 14, 2010


Jane, who commented on my last post, brings up an interesting and complex point: "Who is responsible for the mess that many people, the economy and our country is in?

Clearly, there is more than enough blame to go around two or three times.  In the early 2000s government lowered interest rates, especially for home mortgages.  That encouraged everyone to refinance and take money out of their homes.  Many people did this and used the money to spend on stuff they wanted but didn't really need.  I had lots and lots of clients who did this. Added to this, many mortgage companies intentionally sold mortgages to people whom they knew could not afford to keep paying them Some of those people were foolish, some were just lied to

But many people knew what they were doing. They wanted to turn the rising value of their home into cash.  They were encouraged to do so by many ads, from mortgage companies, and by other consumable type products, especially bigger homes and SUV, and all the stuff that went into them.   But I didn't do that, and I don't think Jane did either.

Meanwhile the government was waging two wars costing trillions of dollars.  The real goals of those wars are still not very clear. This still continues.

Then, since so many people were buying and selling mortgages, and it was somehow assumed by all of the country's brilliant financial minds that home prices cold only go up, banks invented mortgage default swaps, so they could increase their profits and leverage all of their bets.  The government at the time, led by Alan Greenspan, decided that these kind of business did not need to be regulated. The :free markets" would regulate themselves.

So then, in 2008, housing prices began to drop and the economy feel completely apart.

Should the government have done nothing and let it all go completely to hell?  They decided they needed to help or the world economy would collapse.  So they helped out the banks, who were some of the biggest crooks of all.  They felt they had to, which they probably did. But people got angry at the government, and the banks, for needing and taking tax payer money, while most tax payers who had financial problems were not given too much --- although unemployment benefits were allowed to keep going for a long time.

Then nobody had as much money, and no place to get it, so they stopped buying.  So business stopped selling, so they laid people off.  So things go worse.

 Then the government tried to get things going by pouring money into some places.  But it isn't enough, nothing is happening fast enough, the deficit is growing to frightening level.  Everyone is angry, except for the bankers, and other people who are very rich and are paying for ads and lobbyists to keep them rich.

Again, I think that in order to get things right a lot of people who seem to have major disagreements about what to do will have to decide to work together, make compromises, look at the whole picture, and decide to make the country whole again, and to pull people together.  I think Obama was a bit naive for almost two years, thinking he could do that.  There are some powerful people who just want to see him fail, just for their own benefit.

Now, I would rather put my faith, and I agree I have very little of it, in a government that I elect, than let my economy be run by insurance companies, banks, oil companies, Rupert Murdock and the Koch brothers,  who have already shown how willing they are to screw us out of our last dollar, which they will do if the government steps aside and calls that a "free market."

Unfortunately, I don't see much hope of getting enough people in business, banking and government to work together.  The "freedom" some people are screaming about seems to be mostly about tearing everything and everyone apart.  I hear very little about people offering to sacrifice and to work together to make things better for all.

Yes, I hope everyone out there took care of themselves.  If you didn't it is partly you own fault for getting sucked in, and partly because the rules are stacked against you, and those who are doing the stacking want to run the government too.

I know a lot of my clients are suffering during this time of economic distress.  I do not see many places for long-lasting job growth.  We had one great twenty-year growth spurt due to new technologies.  We followed that with money from a housing bubble and debt spending, from both the government and citizens. Now what?  Green Energy?  America's Got Talent?

Today was primary election day.  I went to vote early.  I voted for some incumbants and some new people.  I tried to vote for people who made sense, and weren't just angry.  I was there for ten minutes.  Two other people came in to vote.

Is this the freedom we are sending people across the globe to protect?

Friday, September 10, 2010

money therapy

It is my belief, as a result of my years of sitting, listening and mumbling, that a great deal of what is called "psychopathology" is really a result of the culture of the times coming down upon a person's life and mind.  The American Psychiatric Association, as evidenced by the forthcoming DSM V, is going in the opposite direction.  They are trying to classify many behaviors, such as being addicted to the internet, or compulsive shopping, (although these changes will only be put in the appendix for now)  as basically "brain disorders."

I don't see it that way.  I also am currently having a very tough time having to treat so many people who are unemployed or underemployed, or who are stuck in jobs they hate because they know they will have a very tough time getting another job.

Yes, I am sure the the stress of not being able to meet your mortgage payment, or struggling to feed you kids, or even losing your vacation home, creates changes in your brain.  But the real causes of these depressions and anxieties are based in the workings of our society. We have a system in which the financial conditions of many families can vary greatly from year to year.  Our culture encourages consumerism; the desire for unnecessary goods. Some segments of our culture purposely and by specific design, allowed many people to accumulate a great deal of debt to buy these things.  This helped some people get very rich, while many others are now getting poor.
. I see many marriages that after many good years, are now under great stress. Many people are not only scared and struggling, their self-image has been shattered.  After months in a downward spiral they are left feeling helpless and powerless in a way that many have never felt in their lives. They are angry because they feel duped.  They feel that they did what they were told and followed the American Dream, and now they are being left out, and even blamed for it.

Treating these individuals and couples is very difficult because what would really be the best thing I could do is find a way for them to make money.  I work on that, to help them brainstorm, or network, or make use of skills that they didn't realize could be put to use. But it's very tough.  Not many places are hiring, and very few new ventures can get capital, and many fewer people will spend money anyway.

What also bothers me is how many of these hurt and angry people have been sucked in to be angry at their own government, which currently is trying anything it can to help.  I don't think they would really prefer to be at the mercy of the oil companies, insurance companies and banks, but they don't seem to see that that will be who benefits from their political stance.

However, I am not surprised.  Fear and anger do not usually help rational, longer-term planning and thinking, but they always have been a major factor in political behavior.

 But whenever I get a new patient now, I find I really, really hope they have a way to support themselves.  I can't do money therapy.

Thursday, September 09, 2010

High Tech, Blown Away

I have seen this guy for a while.  He's a real techie: hides in his basement, does a lot of sophisticated software consulting.  He comes to see me because his wife hopes I can teach him to be verbal, which he can be if you talk about his stuff, but that bores her.

Anyway, that's not the topic.

He is working with his new Apple, and to be good he is trying to do things that relate to the family.  So he puts together pictures of his son and himself.  On the new Apple software there is a dazzling new feature that allows you to highlight a face and click on it.  Then the machine will scan all of the 2100 or so pictures you have in your iPhoto and it will pull up all the pictures with that face in it.  Amazing stuff.

So he does that for him and his son and about fifty pictures of them appear.  Then he sees, among the pictures, that there are two very old photos from when he was a kid, and the focus of the app is on a guy who was a friend of the family.  He enlarges the shot of the guy wearing a dark suit, then he enlarges a shot of himself dressed in a similar fashion.  Then he examines the pictures and he said to himself that the software is pretty good, because he sees how similar they look.  Then he goes back to putting together a family album and the event fades away.

Two weeks alter he is talking to his mother, and he tells her that he will send her the album, and she is all happy and they are joking around.  In that spirit he tells her about the picture of the old family friend, and he says, without thinking really,that from the looks of it, that guy could have been his father.

Suddenly, the phone goes silent.  After a long pause his mother says: "I really don't want to go into that."

The guy is 41 years old.  Even though his life is exactly the same, it has suddenly become totally different.