Pain 4

Well, it's finally breaking up. The pain is abating, some flexibility is returning, my outlook is improving and there is hope on the horizon.

What is disappointing is how difficult it was to get real help, and how, in the end, I had to find it and do it myself.

So many people my age have been through this sciatica thing. Everyone has their own cure. That's mostly because, most of the time, it goes away by itself. So whatever anyone was doing at the time was what they believe in.

Because I always worked so hard to keep in shape, I really set myself up to be locked out of shape once my body shifted. I actually have spent about 20 years setting this up.

But getting help was not helpful. No one really looked at the whole picture of who I was,and what my muscles, ligaments and bones were doing. What I did for work (sit a lot), and how I worked out.

The doctor (MD) used "evidence based medicine" and recommended for me to follow the course of what most people would need. Unfortunately this course would be very slow, very expensive, involve a dozen different people, and then end up right where I am now-- stretching.

The chiropractor said rest, ice heat, which was fine in the beginning. He couldn't move my bones though, because the muscles were too tight.

The message people were great, but I can't get a message every day. They found the problem, but really didn't offer a solution.

I found all the stretches on Rebuild Your Back.com. I am doing 7 stretches 5 or 6 times a day and it works.

So, I am getting my life back. I have cut my schedule of clients 10 to 20%. I am trying not to get back to the 115% level that got me into this in the first place.

But people keep calling.

I guess they think I have something to say. Or else I just listen really good.

pain 3, the doctor

So, after suffering too long and trying alternative solutions I went to the medical doctor today. I haven't been to a regular doctor, except for my eyes, in years, so this was a new guy in a big medical complex.

He was easy to approach, thoughtful, and reasonable. He did a few pokes and squeezes and twists and agreed that yes, I had sciatica. He said it has lasted a bit more than normal so that isn't a good sign. Then he wrote orders for tests.

I left some blood there at the lab, so they can see if I have cancer, and then I'm supposed to get an MRI. I buy my own insurance and have a $2000 deductible, so this will probably eat all of it up, especially if I get the MRI, which they said is about $1200. In Taiwan an MRI costs $125. I will have to pay for his insight, for the lab, for, and later for the guy to read the MRI, then the new people at the back clinic, and then the Physical Tx people. by then it will be over $2K so I will only pay 20% or something, who knows.

But the medical alternatives seem to be drugs and/or surgery, and I'm not keen on either. He offered my a few drugs to control the pain. that was friendly, but they are not the kind that will dampen the inflammation and heal the problem. They are more the kind that many of my clients try to buy on the street.

He also offered me anti-inflammatory meds, but said it would be cheaper to just triple my doses of Advil.

So, I'm taking more Advil, I will give the acupressure guy and the chiropractor another week to work magic or else I get the MRI and enter the medical world, but I am very reluctant to do so. I guess, as a psychotherapist I remain an "alternative" kind of guy.

For now, I am back to my favorite weekend medication, which is Jamison. It doesn't do much for the future, but it makes the present brighter.

Everything in moderation!

pain 2 -- loss of arrogance

I didn't really realize it before, and I'm kind of startled by it, but now that I am going through this pain thing, it's become clear.

Part of what I've learned is how, as a therapist, I've been carrying around an underlying arrogance, and I don't think that's a good thing.

But somehow, even though I have even posted here about how aware I am that one slight random event can completely change your life, I guess I never really thought that would be me. Yes, I was grateful that nothing really terrible had happened to me, but like most people, I attributed it to my own abilities, foresight and planning.

Yes,I am a good, caring and understanding therapist, but I also always somewhat, put on a very subtle display as having a good life. I was in shape, I was financially sound, I have a long-term marriage,and my kids are grown and doing pretty well. I was not yet rich and famous, but perhaps that would come too. I guess, in some ways, I felt I was a good model. But it was also a kind of arrogance. Kind of "see, I can do it, you should do it too -- maybe not just like me, but like you want it.

Now, I've been in pain for six weeks. This is the kind of thing that is common, and happens to everyone, but it still isn't really over, and it has been very limiting and debilitating. Now, I can show that I can stand the pain and the adversity. I have many clients who have much worse and more chronic conditions, but I am still in the midst of mine.

And I don't like it. it sucks, I'm sick of it.I'm getting treatment and improving, but it's slow. I get worried that it won't end, I get tired and irritable.

The severity of what I am going through is also partly my fault because I don't ask for help. That's part of the arrogance. I had always worked these things out myself. A few pills, ice, stretching. So, I just kind of denied, or hid the problem. That was part of the arrogance too. I caoul handle my problems myself.

So, now I'm finished with that. I'm going for help wherever I can find it.

Anyone who can push the magic button will get a big kiss.

They say it will take time. That's what I say to all my clients.

But this is America -- I want to be better now.

pain 1

Wow, it's been a month. That's quite a while, even for a fading blogger like me.

Well, there was a reason, pain. I have this sciatica thing, pain, running right down my leg. It's mostly better, but it's still there. It makes it difficult to sit in a chair and type at a computer unless I sit exactly right.

I have learned a lot during this month, about myself, growing old, living with pain, and how I react.

I don't like it, this pain thing. I don't recommend it as a learning experience. But it seems now that I will survive.

It has given me insight into some of my clients, and into how no one can really tell how much pain you feel. So many people I see in my practice are sent to me because many doctors feel these people are in pain, but not THAT much pain. It's very difficult to tell.

Some people want drugs, some people want attention, some people want excuses. But many are just in pain, and it kind of sucks.

I will have a lot more to say about this. I've got to stand up now.

The way we are going

They are making artificial blood, but it still kills too many people.

There is an artificial heart, that works for a while.

Artificial skin can be used in some circumstances.

There are many examples of artificial limbs that work well.

Lots if artificial hair.

Silicone breasts

redone noses, faces, lips, chins,

artificial hips, knees, shoulders.

Brains?, well not yet,

BUT

in Switzerland there is a company that has linked over 2000 IBM microchips that can handle 22.8 trillion operations per second. Each is supposed to represent a neuron and the hope is that this will mimic brain functioning, and with enough electricity swarming through it they hope it can generate a mind.

I hope it has good parents.

a Really Great (Great) Grandfather

T was talking about his father, which is something we often do in therapy.

His father was was in and out of his life for many years. T was most raised by his grand-parents. His grandfather was caring, but a bit too harsh.

Then T began to give more a a family perspective about what was expected of the men in his family. He said a lot began with his great-grandfather who was rich and owned a lot of land, and people usually did what he asked.

I guess that was true of the women too because, T went on to say, his great-grandfather had 42 children, with at least 17 different women.

That sets quite a standard for the men of the family.

my old brain.

So, it is finally Spring here and everyone seems to be outside doing all kinds of rejuvenating stuff. How can you live in California without Spring?

I'm taking a walk around town, just checking everything out and I pass a window with the shade drawn. Before I realized it I was singing "All the shades were pulled and drawn, way down tight." Those words are from a song called "Silhouettes" which was very popular when I was probably in Jr. High school, and that was a while ago.

The words just flowed out. I must have remembered about 90% of them correctly.

Is this a good thing and I have access to a good memory, or am I getting like my father-in-law and I don't know what decade I'm living in? Hard to tell.

I know that music helps connect everything, so that with the tune, it is easier to remember the song as one until.

It is even more true that when there is emotion connected to something the memory remains stronger ( although not necessarily accurate). There certainly are a lot of emotions connected to Jr High love songs.

Anyway, I also remember that the song was sung by The Rays, and that about month later a group called The Silhouettes came out with a song that also hit #1 on the charts (Do they still have charts?) That was called "Get a Job" a refrain I still sing to several of my clients.

old brains

We often go and visit my wife's father. He's going to be 94 soon. Until last year he was doing pretty well, but last spring he contracted pneumonia and, although he recovered physically from that, it seems the stay in the hospital knocked out his mental equilibrium.

Now he often doesn't know what decade he is in. Often he is 16, back in the town where he was born, looking for his neighbors. Sometimes he is fifty and waiting to be picked up to play golf. There are lots of other disorienting things. It's sad that brains tend to shrink with age and then confusing things happen.

Would it have been better if he stayed more involved with others and had more interactions to keep him alert? He was never that naturally social. His wife did all the arranging. Once she died he slowly withdrew.

But, I don't know. He's 94. What can you expect?

At the doctor's recommendation we gave him Zoloft. We gave him one pill at a sub-therapeutic level to try it out. The next night he was up all night making phone calls, mostly to people who had been dead for twenty years. He called 911 because his wife was missing.

We didn't give him another pill.

Really, he should come and live with us, but we have too many stairs and we are not home enough. (I'm saying this just in case my kids read this.)

At 93 I'm buying a motorcycle. If I remember.

Irrationality

A couple of weeks ago I spent a day down at the Tech School where I got to see some terrific stuff they are trying to put together. They had robots with cool eyebrows, and big 3-D models of ho my opinions differed from everyone else.

The main speaker was Dan Ariel who wrote a new book about how people really don't make rational decisions, even about money.

So, I went up to him and I said "Duh."

And he said that economic theory is based on the belief that people are rational and will act in their best interest.

Like who they allow to beat them up when they're married I said.

He looked at me kind of strange and worried.

So then I said, like trading Credit Default Swaps.

Then he knew what I was talking about.


Dr. Phil tells people, rationally, with common sense, what they should do.

Nobody really listens to him either.

But he made $96,000,000

and he doesn't even have a license.

Here they come again

Here is the real problem. They call themselves "Health Care Companies" or health Management Companies" or some other misleading euphemism. But the truth is they are financial companies. So, when they come after me and tell me to fill out their Patient Outcome Management Forms, of their Patient Wellness Assessment Forms, or TOP Patient survey, I get upset.

They tell me that they are trying to help me make clearer diagnoses. Or they tell me they are trying to help their subscribers find the best clinical matches. It's all a lot of shit.

All they are trying to do is trying to find ways to justify their existence AND to pay us less.

Two of the major conditions necessary for successful psychotherapy are trust and understanding. I don't trust these companies, and I don't think they really have any understanding of what we do. I don't want their "suggestions" of how I should do treatment. If they know hoe to do it they should be out here doing it. Their suggestions don't come from any research that I respect. The symptoms they want me to treat are not symptoms that I really care about -- they are symptoms, not the problem.
They will go away when the issues are addressed.

But now it is fashionable for each company to begin to make their therapists accountable and monitor their effectiveness. Except they really don't know how to do that.

It's all about the money. They've collected it from the subscribers and they don't really want to give it away to us, the care-givers. An adversarial system of health care is never a good one.

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.

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.

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.

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."

gone

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

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.

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.

marathon

Back in the office. Tuesday and Wednesday were full days. In ways the vacation was really good, but in other ways it makes it difficult to miss a step in the process. Therapy is usually done a week at a time, and for me, after things are moving I often shift to two weeks.

But therapy has a rhythm; it is slightly different for each client, but they fall into it. Each person can only tolerate a certain level of working on each obstacle, each person will change only so fast, and unlike the TV show, the change is usually slow.

By Thursday I was feeling roughed-up a bit. I was still a bit jet-lagged. Still waking up too early and fading earlier than usual. I knew going in I had ten appointments and I didn't know how I would hold up. People kind of get offended if you fall asleep in their session. (I've only done that once, and she was really boring and I was taking antihistamines).

But I saw my first appointment and she was struggling with the similarities between her husband and her father, and soon she was crying. My second appointment just came back from his mother's funeral so that was very busy, and then, suddenly it seemed. it was seven o'clock and I had only hour left to go.

It's like basketball, or marathon running; you can get in a zone and things seem more intense, and it's easier to focus, and you feel like you know exactly what you're doing.

When people ask: "How do you stand to listen to every one's problems?" I try to tell them that it's not like that at all. It's like being handed a different puzzle every hour and it's your job to work with someone you like to try and put the pieces together. It's fun and it's fascinating, especially when it works.

But then I came home

The trip was good. It really cleared my mind. I was out of range and out of touch. I don't have a Blackberry and I only checked email once.

Most people go for outer warmth, but we went to the land of drizzle and mist, where the sea crashes against the rocks and cliffs, but once you open the big wooden door all is warm and welcoming. You sit down, have a pint, listen to the fiddle and there is good craic.

During the day we saw the castles and the ruins, and the Tidy Towns with each house painted a different color. At night we ate fish and potatoes or lamb and potatoes, or fish and potatoes or lamb and potatoes. My wife had the chicken. A question is answered with a story.

Then we flew home.

I checked my voicemail and had 99 new messages. There would have been more but the box was full.

Thankfully, 19 were hang-ups, six were from Jake who was telling me how each person in his life had done him wrong, and fifty were from L, who chronicled each time someone broke into her house, stole a carrot or some coffee, removed a stitch from her sweatpants, scratched a bracelet, used her make-up, tampered with her phone, turned down the volume on her DVR,or replaced the left shoe of the pair she just bought with one that was slightly smaller.

I had told her to keep a list while I was gone, so as not to fill my mailbox, but she could not restrain herself. When I called her and complained she said she was sorry.

Half of the remaining two dozen calls were from insurance companies or lawyers seeking information that I won't give them, the other half were from old clients seeking new appointments, and some new people too.

I should be all caught up by April.

It's always good to go away.

lawyers came and went

So the lawyers came. I told them not to, but they did.

Two of them drove three hours to my office to talk about a a client who had been in a car accident that no one saw.

They asked me if I believed her version of what happened. I said I accepted what she said. They asked me if I made any attempt to verify anything she said. I said, why should I?

They said doesn't the truth matter?

I said, she is my client, to me it is her truth that matters. When she came to see me I told her I wasn't about going to court. If she wanted to learn to deal with the pain she said she felt, and the depression, and work on getting back to her job and her life, then fine. I would be her therapist.

I told the lawyer I had been her therapist, and now, two years later,four years after the accident, she is back at work and I had not seen her for six months. I felt I did my job.

They asked me if the accident was more of a factor in her depression than the terrible divorce she went through two years before the accident.

I told them that she felt she got hurt in the accident and the pain kept her from working. She fell into debt and got depressed and overwhelmed. But, if she hadn't been divorced she wouldn't have been driving there to meet her new boyfriend. But if she never married that abusive first husband she wouldn't have gotten divorced. But if her parents had not been fighting so much she may have taken more time to consider whom to marry in the first place.

That's what I think, I said.

The lawyers left. But they paid me first. I don't think they will come back soon.


Anyway, I'm off for a week to find someplace a bit warmer.

"In Treatment"

From what I can tell the HBO show "In Treatment" is pretty cool. The therapist is pretty good, has a cool accent and has problems. His clients are attractive, dramatic, wildly verbal, very smart, challenging and diverse.

Just like my practice.

Except not.

I think it's good that the thing is on TV. Anything that gets folks to think about therapy, instead of just taking some pills, is a good thing.

Maybe my clients will see the show, rush in, spill their guts in half an hour. Then I can say a few pithy things that bring eye-popping insight. Their lives will dramatically change, and we can all break for a commercial.

This weeks I sat through thirty four hours of treatment, most of which were surprisingly like the previous session I had with each of these clients. Yes, things are changing, but the grass is growing and the paint is drying too.

But if I could compress ten to eighteen months of treatment into six weeks, it could look pretty much like the show.

I have to work on the accent. (and my chin).

hints for kids

Last time I wrote a bit about how many people have just missed the boat and are just hanging around, blaming the world.

I read an interesting article by an interesting woman, Dr. Dweck, who happens to be a professor at Stanford. She writes a lot about child raising and success. What she says makes a lot of sense, and she has some research to prove it. It also agrees with something I wrote about a few months ago, so I am even more impressed.

What she says is that if you praise children for being smart, or talented, or in anyway naturally gifted, then you may be doing them some harm.

Americans are much too taken with the idea of I.Q, or some form of innate ability. But, as I said, most people,except for some pretty rare brains, are pretty much the same. The difference comes really in how hard people work at things, and how well they learn to not be frustrated by mistakes.

Dr. Dweck makes a strong case for praising children for their effort, persistence and creativity. It is that skill that will carry them further in the world, and help them through difficult times.

Children, and adults, who are given the impression that they are brilliant or exceptionally talented get to feel that they should not need to work hard; that things should come naturally. Then, if they don't do something well, their bubble pops and they often don't have the skill to keep going.

It is important for kids, and adults, to learn that the process is where the fun is. The challenge of learning, creating, working, problem solving, and over-coming challenges, often after many tries, is where the greatest satisfaction in life lies. Yes, the final achievement is important. But it is always they getting there that makes us feel alive, worthwhile and accomplished.

Don't wanna do it

It's a new month. I have to pay the bills from the practice; the rent, the water, the phone. I have to pay the bills at home. And it's a weekend, I have to clean and fix stuff, and I'm not good at fixing things.

I don't want to do it. I want to just start drinking and watch the Pats in their quest for perfection.

What still amazes me is how many people there are out there that don't do it. It varies from people who don't pay their taxes, to people who don't pay their bills, to people who don't clean up to people who just don't do anything.

It seems that almost every family has one. Someone, in their thirties, forties and up, who just have a room in the attic or the basement, or hang around the house and don't do anything. Sometimes they drink too much, but often they just can't cope, so they don't.

I'm not talking about people with cancer, or brain injury, or developmental disorders, I'm talking about people who are fairly intelligent,may or may not be friendly, but who somehow missed a beat, dropped out, and never got it back. Then they give up trying and expect that it's OK.


It takes so much energy from so many other people to drag these folks along. Usually, there is one parent who enables them, and always has. One parent who worries, and forgives, and gives just one more chance or one last gift of $50 to $50,000.

Bills, food, laundry, cars, hospitals, and on top of that melt-downs.

There are so many of these folks, but you hardly see them, because they don't come out. And no one talks about them because they are such an embarrassment.

I'm not sure of the solution, but they are frustrating to deal with in therapy. I have a few from some of the wealthiest families in this small city. Lonely, entitled, anxious, angry, and somehow missing the drive to fight their way out of it.

Usually, with some kind of excuse.

They wouldn't last long with Belichick.

almost alone

It is my belief that humans are social animals. that is why therapy really works better than medication. Interpersonal relationships, caring, compassion,and understanding, make a huge difference in keeping people healthy and happy.

So when Charlie comes in a tells me how his life is so much better now it is difficult for me to let it go at that. Although I do believe him.

He works from home, leaning over his computer, making sure that the software for some national utility company works and that the seven state region keeps functioning. When he is not on call he goes into his wood shop and carves very beautiful wooden animal replicas. He has showed me pictures.

When he has finished carving, he puts them on the shelves he built, with the two dozen others.

Charlie is married. His wife goes off to work each day. On the weekend she sees her family. He stays home. He cooks. My impression is they say about twenty words a week. If they have sex he's happy.

He has no plans to show anyone his carvings, besides his wife. I get to see the pictures.

The problem for me is that he is such a nice guy. He would hate my saying this, but he is really sweet. People should get to know him. He would like them; they would really like him. He is smart and interesting. At least I think so. I look forward to seeing him.

Yes, his mother left him to run off with the coke dealer,and his father beat him and humiliated him. He was fat and quiet at school and the kids made his life hell. But that was twenty years ago.

He doesn't want to risk it. He is happy where he is.

But he comes to therapy, regularly. He has a real relationship with me. Maybe he will learn from that, or maybe that's enough.

Another Youth

When Paul turned twelve his mother brought him to see me. It took about eleven seconds to see that this kid had problems. He had been an angry kid long before his father left home with another guy. There had always been tension in the home, but Paul's problems were more complex than that. This kid was wired so tight he couldn't express himself. He stared at me and occasionally mutter "no" or "I don't know." After about twenty minutes of our first meeting he just got up and left.

His mother brought him because he had just been thrown out of Jr. High for calling his teacher a fag.

I sought more intensive help for him. The insurance wouldn't pay for a hospital evaluation because he wasn't that much of a threat. A psychiatrist gave him medicine he wouldn't take. I send him to a children's medical team but they found they couldn't work with him because he wasn't cooperative.

That's the problem I said; it's not a reason to discharge him.

A year later he got thrown out of school for telling the principal to fuck off.

DSS got involved. They did a home visit. They got the school to give him special classes. They paid for his therapy; an hour a week with me. He told his mother he liked me. He told me that he hated everyone. They were idiots. He couldn't explain why. Not a great therapy candidate.

Three months later he got arrested. He got a lawyer. I asked the lawyer to get him a full psych eval and a referral for intensive treatment. The case was dismissed.

Two months later he was arrested. He got a probation officer.

He violated probation. He was given more probation. He got arrested he was sent home.

For six months he took and sold drugs. He got caught. He was assigned to DYS. They set a curfew for him. Three days a week they called to see if he was home. When he wasn't they yelled at his mother. She yelled back at them that no one was helping her. They hung up.

Now, four years later, he is sixteen. He got thrown out of his third school. He needs an expensive treatment school, should be a residential. No one will pay for it because they don't like him.

It's true, he doesn't have a lot of charm. But with structure, guidance, clear rules and positive consequences, and some reasonable medication he could do well. I can see that in how he has learned to respond to me. But I can't do enough in an hour or two a week.

But they are waiting for him to be seventeen. Then he will be caught doing something stupid, arrested and tried as an adult. Then he will be put away and never have a chance to be sane, happy or productive.

Incarceration for thirty of his next sixty years will be much more expensive than three years of intensive treatment now. But no one wants to front the money.

Youth of America

First, yes I am very aware of how important confidentiality is to making people feel safe in therapy. I do not think that this blog violates that. One person actually knows about this blog and I have gotten more compliments than complaints. The examples are camouflaged enough that no one could be discovered unless the chose to tell people that they felt something similar; and that wouldn't necessarily be bad.

But what I am worried about today is the number of kids between the ages of 16 and 23, who are clearly going nowhere and doing nothing. These are rich kids and poor kids, there is often a lot of drugs involved, and they seem to feel that they can't keep up with the world, and then they act like they don't care.

About 20% of the kids seem very stressed and pressured to get good grades, get into college and charge to the head of the pack. At least as many seem to sit around, play video games, smoke dope (or worse) and hope that somehow things turn out for them.

Twenty years ago it probably would. But in today's shrinking economy, that has few unskilled or semi-skilled jobs, these kids start out way behind. As they grow older, and amass credit card debt, they become angrier, farther behind, and increasingly screwed.

See I didn't mention any names, but if you know who you are, try and do something to get organized. It's really can be fun to know you can take care of yourself. Don't get sucked in to chasing millions of dollars, just learn how to pay your bills and have a good time.

liability

Something is amiss here. Maybe you can help me sort it out.

Mary's father was a drinker most of his life. During the first six years of Mary's life he would drink, come home, and push her mother around. But then Mary's mother pushed him out of the house, and he left.

He kept drinking and seeing Mary and her brother about once a month, not being much of a father but not totally forgetting either.

Now thirty years later, Mary's mother is off in Florida and Mary's father has been sober for ten years. He is isolated, bitter, and alone, but he calls Mary once a week and has since he's been sober.

Last month he had a heart attack. Mary rushes to the hospital and they can barely keep him alive. They ship him off to one of the Big City hospitals where the doctor tells Mary that they can try this new medicine on him. If it works he could survive, if it doesn't he will die. If they don't try it he will be dead in half an hour.

So, what can she say? Bingo, they pump the stuff right into his heart and equip him with a computerized pump that will keep the medicine flowing into him.

Two weeks later he is ready to leave the hospital. They have taught Mary how to refill the pump, and that needs to be done every day. They taught her how to fix the pump, or install a new one if it breaks. That has to be done in four minutes or her old man drops dead. They also tell her that someone will come out, once or twice to try and train her father, but basically Mary has to do that if she wants to stop being responsible for keeping hims alive.
Her father is too scared to even think about the thing.

Mary asks for a visiting nurse to help, or if he can go to a rehab hospital to get trained on how to use the device.

No. No one will come to help. The device is so new, and the chance for fatal error so great that no one will touch him or the machine. No one wants to be blamed. The liability is too great.

So Mary is stuck taking care of this guy who never really took care of her. She is trying to get her brother to be of some help but he isn't too fond of the old man, and seems to have some of his problems.

So, right now, Mary has the old guy on her couch, bitching about everything, and asking her for food, drink, care and comfort.

He once saw that she was getting exhausted from it all so he tried to change the medicine himself. He forgot to clamp a tube and his blood shot across the living-room. No too comforting.

thanks for the discussion

Hey, that was good!

I am gratified to find so many comments on my client's deteriorating marriage.

They are all pretty accurate and I have confidence that he will, with some painstaking hesitancy, move in some direction. He is really just in the early stages of his treatment. I have been seeing him since September.

And now that it's a new year his ever-caring "health-plan" has automatically authorized another twelve sessions. Of course, as you all seem to appreciate, working though a change in your life is very difficult. You all noticed how many aspects are involved: money, children, friends, houses, extended family, routines, and even just thought patterns need to change. This guy will be with me for another forty to sixty meetings, over the next one to two years. But I am confident he will make some decisions and some changes.

In order to keep seeing him I will have to fill out forms, use key words, check boxes, and fill his medical record with information that may be used against him at some time.

The irony is that I am saving them money. By coming to treatment he will do something about his life, although what it is has not yet evolved, but he will avoid sinking into a deeper depression that would probably create some chronic, expensive medical problem such as alcoholism, obesity, irritable bowel syndrome, TMJ, back pain, headaches, or just non-localized aches and pains.

For this I will have my compensation decreased because of the rising cost of health care.

If the head of the insurance company would take a pay cut I might be willing to consider one. But since I have not heard that he is, I will begin to find ways to work to make his company obsolete.

Late notice

It's tough to admit that your wife is gay. Even after twenty-five years she won't admit it. But now that the kids are gone, and you notice she is never home on the weekends. She is out "shopping" with the same girlfriend that she takes vacations with. She goes away with her for two different weeks each year. She has for as long as you've been married. But she doesn't go away with you. Never did.

If you bring up that you'd like to spend time with her, she gives you a look like she isn't even sure she is coming to your funeral. It's tough to think of leaving when your sixty and you've been together this long. You can see that you were never really close, and the sex, what there was of it, stopped ten years ago. There once was a job that kept you really busy, and the kids were around, and they were fun, but now that the job is ending and the kids are gone, you notice that you're sitting there, alone, with your glass of beer and the football game.

The choices aren't good: Financial hardship in your old age, or beer and football, alone in the dark.

Go Pats?

Another new year

Hey look, it's a new year!

Things are starting off well with riots in Sudan, Kenya and Pakistan, as well as wars in Iraq and Afghanistan, and those are the ones that my country is somewhat involved in. I'm sure there are lots more.

People, running around shooting, screaming, crying, dying all trying their best to get... what?

Love, Power, Money, Sex, I guess.

I've seen many people in my little office last year, about 160 or so different ones. They too are trying their best to make themselves comfortable, have a good life, in whatever way they try to define it. They struggle valiantly, sometimes against long odds.

But, don't dare accuse this here human race of being rational or logical. We can each do that for a brief period of time, but then we lose it out of fear, passion, laziness, sloppy thinking, bad habits or misinformation.

Then, if no one stops us, we rise up and blame, scold, humiliate, hurt, or even kill each other.

Then we settle back and wonder how that happened.

So, in this new year I, your virtual therapist, would recommend that you take just a nanosecond some of the time to consider what you are doing and why. What are the consequences short and long term? Who else will really be affected? Is this really what I want or are you just doing it because it just came rushing out of you?

We have big, complex brains that can do great things, if you give them a chance.

If you do, I will assure you, it will be a better year for all of us.

In the Blink

Things can just change. Blam.

Dad has a heart attack. Now he can't work. Someone needs to take care of him, so mom can't work for a while. Then everyone falls behind on the bills and and bills are worse because of the medical expenses.

It doesn't even have to happen to you directly. Last year Lex saw someone get run-over by a crane at work. Now he has panic attacks and can't make it to work some days. Disability doesn't like to pay for psychiatric stuff. It's very hard to document, and anyway, they had some psychologist come in and set everyone straight.

Even me, I woke up two days ago with my eye all puffed up. At my age everything can be the beginning of the end. What if this was serious?

Doesn't seem to be. It' cleared up. The best I can figure is that I had an allergic reaction to the very expensive Scotch I got to drink at Christmas. I'm not sure. It may be worth testing that theory a few times.

I've posted about so many of these things before: heart attacks, falling off the roof, auto accidents, strokes, houses burning, factories closing, jobs disappearing.

The worse part is when it's unexpected, and then people take it personally, as if they did something to deserve all that. Sometimes, if they were drinking, gambling, drugging or speeding, maybe they did.

Usually, it's the way of the world -- random.

Drive carefully.

Holiday Party

We are back from the holiday rounds, ending at a friend's Xmas party. For various complex reasons we were invited to join in with their family.

It was weird. It was just like my last post. There were wives and husbands and kids. But each wife was with their new boyfriend, and the each husband was an ex, and some where there with their new girlfriends. Everyone was there, being polite, and acting fine for the kids. Some had come from other places where their kids were with their
ex-es, and their new significant others. Two or three generations of parted, re-formed and blending families.

Kind of, at least on Christmas.

I guess it's all very civil. It's the new "Brittany World."

I can see that I am getting old.

Holiday cheer?

It's holiday time again. I am busier than ever. it seems that almost everyone I've ever seen wants to come back this week. They all are seeing their families, and no grudge is ever forgotten.

The people who seem to be the most upset are those whose parents are divorced and remarried, especially if they have been remarried two or three times. Then you can add to this the couples I see, where each member of the couple has parents who are divorced and remarried.

So, who do you visit, and how much time do you spend, and who gets to see the kids and give which gifts, and who gets left out, and what resentments are left over from last year? Does Mom still cry when it's time to go see Dad? Or does Mom have a restraining order on Dad, which makes bringing everyone together for the Family Christmas a little risky. Especially when your brother is a cop and would have to arrest Dad for coming near Ma.

The best one I heard this year was a woman whose mother has a last name that is recognizable in a certain ethnic group. She was born with that last name and then married a man who also had it. She divorced him, and her next two marriages were all to men who had that same name, so now, at seventy, she has never changed her name, has six kids from three different men, now has fifteen grandchildren -- and everyone has the same last name, and no one remembers who is whose, but they all don't get along.

merry holiday!!

stuck

Ronna is quite attractive, with a very winning smile, even though she is about 120 pounds over-weight. Her weight problem has led to other medical problems which has resulted in her losing her job.

Now she is without a job and is poor.

She is attractive, very articulate, and easy to get along with. That gives me the false impression that she should be able to see what has happened to her and make the necessary changes.

But she is stuck. She has been knocked down so often that she doesn't see the point in getting up.

In many ways she has been dealt bad cards and delivered into bad situations that were totally out of her control. But, in other way she has come to accept that as the way life is.

It is my job to show her that the effort to make these difficult changes will be worth it. If I can support her through the first small steps, and prevent her from resenting the effort it takes, she could begin to do very well.

I just wish she would help me a little more.

anecdotal

If a man finally gets to go out with a woman, and it is a woman who he knows has been with many different men, and then that woman shows no interest in him, even if he hardly has gotten to know her, he will he hurt and upset. This usually leads to anger, and he will vilify her.

However, if she does choose to be with him, he will often become very jealous and possessive. Because of that she will leave him and he will be hurt and angry.

This is not a scientific statement, but I have seen it happen several times.

Tuesday, Thursday

I had a great session with Max yesterday. He was telling me about his Thanksgiving. It was the first one is seven years that he wasn't drunk. He cooked, he was sociable. He don't get loud, bossy and obnoxious. He didn't drive everyone out of the house. People even called up and told him what a great time they had and how good it was to see him.

He was very grateful.

But he wasn't. I pushed him on that. He did say he resented his brother who came and brought his own beer and drank it. He didn't like how his brother rambled around the house, being loud, bossy and obnoxious. I could tell that Max was feeling deprived.

We worked on that, I thought.

Today Max's wife called. I called him back. He said they moved him off a project at work and didn't tell him it was coming. He quit his job, went home and got drunk.

Who is in charge here? How much is rational? Not with addictions.

Where did he go?

A large part of therapy is building a relationship with the client. It makes everything work. It is important that people feel I am there when they need me.

Often, when they no longer need me they are gone. That's fine, but it sometimes feels a but strange. I mean... I thought this was a relationship.

But really, it is only a professional relationship. I give out support, guidance, insight, and help you explore new options, and you give me money ( or let your insurance do it).

But I want to know the rest of the story.

Do you like your new job? Did you get the new house re-financed? Is the baby healthy? Is the kid better behaved? Are you coping with your step-father. With your wife? With your memories?

People call back, two years later, when something else is going on.

I should call them, as a follow-up. But there is no time, especially this time of year.

a call

Sitting, schlumped over, mumbling, barely audible one word responses. Not going to school, cutting classes, smoking dope, acting like they don't care, no confidence, ruining any shot at an immediate future.

Now, they bring them to me. Now that they are sixteen or seventeen. Their father's either see them once a month or degrade them constantly. Their mothers work to provide and try to add structure and guidance. In return the mother's get the anger and the passive aggression. The boys are angry because the family is gone, the money is tight, everyone is stressed and little is fun.

So, we start over. First we twist off the head. (Pop) Then we inject a little humor, a little irreverence, just for surprise. Two doses of understanding and sympathy, but make sure it isn't overdone. Then slowly, slowly, poor in some higher expectations, allow a little slippage but keep pushing along.

The process takes about two to four years.

I got a call this week from Florida. He was a kid like this fifteen years ago. Basically a seventeen year-old drunk. He left a message saying he was doing very well. He had been happily married for two years (his second try) but he now understood what it was all about.

That was nice. It's good when that happens.

Bad to Worse

This is one of those posts that is over-condensed, but it would take about 107 pages to say all of it:


As I said in my last post, Carol's boyfriend died in her arms. Before that her life had been terrible. She had a schizophrenic father, one of her brother's lied, which sent her other brother to jail. Her marriage was awful, her kids have terrible problems and she is almost out of money. Now her boyfriend is dead.

Rick has had so many terrible things happen to him, from being raped as a kid, to having his stable wife of 22 years begin to visit her neighbor and end up a coke addict. That led to his daughter being placed in a foster home where she got molested. That is only about 30% of what he has endured.

Jennette's husband stopped working and would't come out of the basement. She tried everything for years, and finally ended up having an affair. She decided to leave for her new boyfriend but he died on his motorcycle. She left anyway and two years later met a nice guy. She came back to see me because he has cancer.

I could list fifty more examples without taking a breath.

What is my point?

When things go badly, they're likely to get worse. It is very difficult to reverse a downward spiral. And when you are sick or tired, or broke and stressed, that makes more bad things happen.

When things get really bad, just go in the house lock the door and stay there for a month. Then start all over.

That's the short version.

But, then bad...

But then bad things happen and there is nothing to do but put them up here on a blog so that the world can see how much it sucks sometimes.

I've been working with this woman, Carol we will call her, for several years, mostly about her kids. I have mentioned her before but I don't remember what I called her then. She had a husband who left her for another man, and that didn't help her while she was trying to raise her sons. One of the boys is now in the army. I mentioned him before too. One is too anxious to attend school regularly.

While struggling with the boys and financial problems she became involved with another man. He liked her a lot but he couldn't stand the boys. Whenever he came over he would scream at them and they would scream back. That would end up with the boys braking things, like doors, walls or the stove. So, that guy finally left.

Then last spring she met another guy. She didn't want to get involved so she pushed him away. But he was persistent and he was good to her, and to the boys. He just kept hanging around. Slowly she began to accept him.

He was kind and supportive. He drank a little too much, and he sometimes didn't make much money, but when he didn't work he cleaned the house and fixed the holes in the walls. He was crazy about her and made her laugh.

Yesterday Carol was getting up to go to work. He saw her come out of the shower and got so thrilled to be with her that he made her late to work by luring her back to bed. While they were in the throws of expressing their affection he suddenly lifted up his head. He said he had a real pain near his temple. Then, she said, his eyes rolled back and he slumped over and died.

He was fifty-four years old.

Now what?

What did I do to deserve this? she asked on the phone.

These are questions I can't answer.

Life just sucks sometimes.

It will take a while to put even a few pieces back together.

diminishd blogging

Yep, It's been a while. For a couple of reasons.

First, I've been off doing other things. I have begun to figure out how, or if, I can slightly change my career and make use of my many years of experience is a slightly different way. To do that I've set out to visit with other therapists. I have had to organize my thought for that, and that has kept me away from organizing my thoughts for this.

The second point is related to that. Blogging requires a certain kind of mindset that I don't always have. this kind of technology produces quick, clever thought bites, or almost free-association, or stream-of-consciousness thoughts. Often, as you may have seen sometimes, that gets me in trouble. I begin to see things in too much detail, or want to explain the seven contributing causes. Then when I begin I find that the seven causes each have five qualifiers. By then the post is too long and nobody wants to read it.

The third thing is that there is too much information. I get magazines, newspapers, journals, emails, books, and I like to go on line and read all of you blogs to see how your lives are going and what you're all thinking. I also want to see my wife and kids and both my friends. Can't do it all, and begin a new project.

So I stopped doing everything and watched the Red Sox and spaced out for a while.

Now I back, maybe. I'll see.
I kind of miss it, but I also feel I want to put more thought and structure into some of the stuff I write and that doesn't always lend itself to a blog.

But I hope you're all well and will take a real interest in finding a way for this country to get really good health care and less in be involved in less destruction of all kinds. Those would both make my job a lo easier.

Sox Win!

As you can see, I took the World Series off from Blogging. The damn games ran so long. The Sox like to run long counts. They also like to score many runs, which brings in many new pitchers and takes a long time. I can't imagine anyone outside of New England or Colorado stuck around too long, and probably not everyone in Colorado.

But in New England everyone was up all night. Everyone was excited and wearing Red Sox stuff. You go to get coffee, or to the airport or to buy a Chevy, and everyone was decked out.

I don't think any other region cares about its pro sports teams as much as up here. The people here are not that superficially friendly or outgoing. We don't make eye contact walking down the street. We are not generally jolly. We expect sleet, ice and driving Northeasters. Our forefathers farmed rocky soil and had a short growing season. We had somber preachers, and the Puritan Ethic.

For years we all were united in misery about the Sox. Five years ago when Grady Little left Pedro in the game, and he went on to lose to the Yankees, everyone was depressed for two weeks. Even my depressed clients got more depressed.

But now we expected the Sox to win, and they did. The Patriots, our local football entry are run by a maniacal genius who will soon get the team to score 100 points a game. This isn't Southern college football, with the good-ol-boys drinking and crashing into each other, this is the best football team ever.

New England comes out of its reserved stupor to watch and nod.

When anyone inquires about whether we take it too seriously or try too hard or cheer too loud, we now have the refrain that I hear more and more from friends and clients.
The basic description of the world that tells all and reveals nothing comes from the lips of Coach Bill Belichick:

"It is what it is."

And that is true. Take it or leave it. Like it or Not. We are who we are. No more and no less. No more explanation is needed or will be forth coming.

what to do?

I've spoke about this woman before. She is a great lady who was dealt a terrible hand.

It is bad enough that her father put her down, demeaned her, cursed her and actually put a gun to her head, but then she had to spend a year taking care of him as he died of cancer.

But physically, for many reasons, many of them unknown,some probably stress related, and for many years, she has been a mess. Her digestive system constantly turns things into liquid, at one end or the other. She has terrible osteo-arthritis; her back, hips and knees are crumbling. She had one knee replaced and the anesthetic didn't hold and she woke up during the operation. Six months later she had a heart-attack. They put stents into her and her arteries tightened and crushed the stents. She can barely walk, hardly breathe, and not eat much.

Then, from all the medicine her kidneys failed. They took her to the hospital and got everything going as well as the could.

They they sent her home and won't give her any pain-killers. They tell her, probably correctly, that her kidney's can't process them any more. So now, she sees me and can hardly move because the pain in so many areas is so great.

She wants me to talk to her doctors and tell them to give her some pain medicine. They won't do it because of the liability (who would hold them responsible?) They tell me to teach her to hypnotize herself.

She thought that was really funny.

partial list

Freudian Psychoanalysis
Jungian Psychoanalysis
Adlerian too
Harry Stack Sulliwan and Karen Horney
plain old psychodynamic psychotherapy
oject relations theory
Orgone therapy
Primal Scream Therapy
Behaviorism (Watson)
Behaviorism (Skinner)
Cognitive Therapy
Cognitive Behavioral Therapy
Dialetical Behavioral Therapy
Rational Emotive Therapy
Family Therapy
Family Systems Therapy
Interpersonal Therapy
Cleint-Centered Therapy
Non-Directive Therapy
Somewhat Directive Therapy
Brief Psychotherapy
Problem Focused Brief Therapy
Eclectro Shock Therapy
Group Therapy
Couple Therapy
Couple Group Therapy
lobotomy
A good kick in the ass
Art Therapy
Music Therapy
Dance Therapy
Aroma Therapy
Hypnotherapy
In vivo phobia therapy
virtual phobia therapy
All You Need is Love
Eclectic Polymorphous Interpsychic Intergalatic Intensive Therapy

I know the list is incomplete so please feel free to add your own, but I'm going to watch some football.

more of same

I have talked about this before, and it still kind of amazes me.

Over the last two days I have spent six hours talking to people who openly admit they are in terrible relationships. Not just bad, but terrible. Relationships full of lies, deception, humiliation, infidelity, stealing, constant degradation, and worse.

None of them have to endure actual physical abuse -- "I wouldn't stand of that!" they all say.

But there is no evidence they wouldn't, because they stand for everything else.

Yet, to actually leave such a relationship is very difficult. Neither party wants to be together, they both at times will say they despise the other, but no one can break it off.

None of these couples come to me together. In all of these six cases I only see one person. If they would come together things would come out in the open and something would be resolved. Both parties know this, so they don't come together.

The reasons they keep this torture going are countless, and different for each person. But they are very powerful. They include an overwhelming fear, of rejection, abandonment, of loss, of failure, of loneliness, and of being a loser.

In most cases, once they leave, they regret that they had not done so sooner. But they don't know that now.

Many insurance companies give us eight sessions to deal with all of this. It's a great system.

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.