Other Side of the Couch

Aloha

2010-01-06T21:19:00.000-08:00

For those of you who have written asking me why I'm not writing on my blog anymore, I have good news and bad news.

First the bad news. I'm not going to be writing in this blog any longer. I felt that I had exhausted what I really wanted to say here.

The good news? I've got a new blog, "Speaking of Sex With Jassy," and you are very welcome to hop on over and see what I'm writing about there.

I look forward to your questions, comments and emails!

Leave John and Elizabeth Edwards Alone Already

2008-08-12T16:00:00.000-07:00

George Bush has decimated the country, dumped our economy into the toilet, started an illegal war based on duplicitous, purposefully trumped up allegations of WMD's, ordered American troops to bomb, shoot and blow up innocent citizens in Afghanistan and Iraq and we have done nothing. He has eroded our civil rights and trampled on much of what Americans have always held dear and yet still we do little. No impeachment. No taking to the streets in massive numbers. Few demonstrations of outraged indignation, least ways few that have been televised or reported on in the press.

But John Edwards does what countless other husbands have done before him (a conservative estimate by Shirley Glass, Ph.D., has extra-marital affairs running at 25% of wives and 44% of husbands) and the pundits on TV are salivating and creaming in their pants over the salaciousness of the situation. Upstanding, loving, good-hearted and otherwise honest and trustworthy people have affairs. Try as the press might to demonize the likes of Bill Clinton and men like John Edwards, an affair is not evidence of a lack of character. It's just evidence of boundaries that peeled away, leaving the person in a committed relationship open to the lure of an affair.

Focusing on John Edwards is a huge red herring for the American populace, as our cost of living sky rockets, our climate continues its wobbly descent into global warming via serious drought, melting icebergs, wildly fluctuating temperatures and general planetary instability. Our outrage over John Edwards cheating on his plump and dying wife, with a slim blond co-worker, Rielle Hunter, takes our attention off the crap that the neo-cons are pulling as they lurch into the dying months of their last few months in office. Meanwhile, John Edwards and his wife, Elizabeth have a lot of work to do in a short time as they have Elizabeth's incurable cancer to contend with. The task of rebuilding a marriage after an affair is an onerous one. I'm sure that task is not helped by the orgiastic delight with which news shows go over and over the details of the affair, pontificating for hours on end about whether Ms. Hunter's child is Edwards' "love child" and whether he should be allowed to stay in office due to this "serious error in judgment."

Our outrage also distracts us from what we should be doing to protect our own relationships, to have the kinds of discussions in our relationships that draw lines in the sand and define what fidelity means to us, whether we are in a monogamous or non-monogamous relationship. In my experience with couples who are dealing with the aftermath of an affair it feels to both partners like the world has tumbled off its axis. Partners need time, understanding, non-judgmentalism and compassion to heal from the impact an affair has on a relationship.

I hope the Edwards family has thrown out their television sets.

Inspiration For Being A Therapist

2008-05-26T07:46:00.000-07:00

I grew up in the United Kingdom. Although I was born in Swansea, South Wales, my family moved into England when I was still of elementary school age. One of my most vivid school memories was of a particularly loved teacher at Elmbridge Road Junior School in Elmbridge, Gloucester, UK. Mr. Rapson was my home room teacher when I was 10 or 11 years old. He was a very short, rotund gentleman with a short-back-and-sides hairdo, extremely baggy brown pinstripe suits, and a habit of twitching and blinking. In retrospect, I think he had Tourettes Syndrome, but back then it was just intriguing to watch him twitch and blink his way through our classes. English, and in particular story writing, was my favorite lesson time. Back then, we used ink pens that you had to continually dip into ink pots which teetered precariously in their roughly carved out holes in the rickety, creaky, wooden school desks - pens that left you with ink stained fingers and spots of Indigo Blue on your school uniform.

On one particular occasion, I had lovingly written, in ink and “joined up” writing, a vivid story, complete with my usual huge cast of characters, all busy relating, chatting and talking to and about themselves. Mr. Rapson bent over my desk and said to me, “All they do is sit and talk to each other, dear girl. Can’t you make them do something more interesting?” Shocked, I sat and pondered his question seriously. What, I thought, could be more exciting than sitting and listening to other people’s stories?

When my paternal grandparents died my father inherited all their books, which came housed in a huge, mahogany bookcase, with sliding glass doors. I believe it was my grandfather, Stanley, who was the avid reader and one of the book collections he had assembled over the years was a complete set of detective fiction by Erle Stanley Gardner, creator of the Perry Mason stories. I must have been about 9 or 10 years old when I picked up the first one and I was hooked. I slowly read my way through the entire collection, falling in love with the characters, fascinated by the complexity of the plots, and the development of the relationships between people. What 10 year old would not have been fascinated by books with titles like, “The Case of the Vagabond Virgin,” “The Case of the Cautious Coquette” and other fascinating and attention-getting headings? Thus began my love-affair with Mystery/Detective fiction. As I grew up, I moved onto Agatha Christie and Arthur Conan Doyle and later I read my way through the mysteries of Patricia Cornwall, Sue Grafton, John Grisham, The Kellermans, P.D.James, Martha Grimes, etc.

Can you see where this is going?

Being a therapist is a great deal like being a detective. Day after day, people come in and sit on the bright red psychotherapy couch in my office. Their job is to tell me stories about their lives and my job is to listen carefully. I hear about their parents, their siblings, their lost loves, their current loves, their fears and confusions. I hear about times in their lives when they have triumphed. I hear about times when they feel disappointed in themselves and feel that they have sadly failed. I hear about places where they feel strong and confident and places where they feel vulnerable and scared. They come in individually, looking for a place to make sense of the pieces they present to me over the weeks and months. They come in with partners, with friends and family members, each person with their unique spin on the same situation, with their own narrative to explain how their lives intersect. My job is to listen respectfully, and be able to pull all the seemingly disparate pieces together. (I have to confess that in this endeavor, I find it much more useful to think of myself as “channeling” Erle Stanley Gardner than Winnicott or Minuchin!)

So, if you’re good at Math in school, you’re told that you would make a great mathematician. If you’re a great athlete, you may be encouraged to think of yourself as an Olympic hopeful. But hardly anbody has words of encouragement or direction for small children who are just plain entranced by what human beings feel, experience, want and need to talk about.

So, yes, I was influenced to become a psychotherapist not just by my own crazy, wacky, dysfunctional family, but also by Mr. Rapson, Erle Stanley Gardner and the legions of mystery writers who came after him. (And there are those who say I look more like Miss Marples as each day passes!)

Health At Any Size

2008-03-27T14:26:00.000-07:00

I come from a long line of short, strong women ranging in size from voluptuous, to chubby-to-fat in girth, without exception sporting large breasts and wide hips. The women in my family live well into their late 80's and early 90's, with few health problems other than sore joints and seasonal colds. We have always eaten well and heartily. My own mother, nearly 79, still works out at the gym a few times a week, does numerous laps in the Olympic size pool there, still does her own home repairs, and likes to regularly go belly-dancing with my sister. For her 77th birthday, she went rappelling down the side of a 200 foot building and sent me the photos framed as a birthday present. She says she'd like to go hang gliding sometime in the next year or so. She shows no signs of slowing down yet. And she's for sure no light-weight.

If you've seen my photo, you'll know that I have not let the maternal side down. I'm most definitely fat. I tried not to be for years, but I am. That's just me. "Porky of bod," to quote an old friend (and I've come to love that expression) and it doesn't seem to change, no matter what I've managed to do to artificially shape-shift through dieting and (many, many years ago) a not-so-charming eating disorder. It never lasts and I'm miserable while I'm trying, so I've stopped. But I eat healthily and well for the most part, although I am planning to exercise more than I do. I'm in a sedentary occupation, with broken knees (a double knee replacement is in my future) and despite my occasional earlier incarnations as a gym-and-beach-bunny, in my nearly mid 50's I'm beginning to come to terms with the fact that this is just me - who I am - a fat (yes folks, it's just an adjective) therapist with above average intelligence, a big heart and a fairly healthy constitution.

I believe in "health at any size." I don't consider that being fat condemns people to a lifetime of diabetes and heart-disease, and I think that making healthy food choices is important because we only get one body and it's good to honor the one we get. Exercise is important for the same reason. (I'm not going to fight with folks about this - go look at Kate Harding's blog - she's written about this far better than I ever could.) I know that my perspective is an unpopular one, but I also think that time and adequate research will prove what most size-acceptance activists already know - it ain't that bad to be fat, if you are eating well and moving your bones regularly!

My granddaughter is 9 years old. A huge fan of Beyonce, Hilary Duff, Miley Cyrus and Fergie she sings along with her mother in the car, as the radio blares. Most of the words are beyond her understanding, but she's beginning to comprehend the idea that it's important to be "sexy" and that for some reason having the right kind of body is important. She's heard that being bootylicious is good, but fat is bad, although with a size-acceptance grandmother, she understands that laughing at fat people is not kosher and despite this, sadly, I have overheard her occasionally as she succumbs to the use of mockery, the chosen tool of most oppressors, when she sees fat people, young or old, on TV. For right now, she's a gymnast, muscular, slender, strong and lithe. And like many women who walk through my office door each day, she's confused. If bootylicious is good and "shaking your jelly" a la Beyonce is fine, where is the line between that and being overweight or fat?

"Are you bootylicious?" she asks my daughter the other day.
"Why yes, I suppose I am!" says my daughter, herself curvy with ample "toppage."
"Will I be bootylicious?" asks granddaughter, a furrow forming between her eyebrows.
My daughter, contemplating her own heritage, replies "Yes, sweetie, you will be bootylicious sometime in the near future."

Granddaughter is relieved, but I believe she's still confused. I think she's wondering how on earth you maintain bootyliciousness without sliding into fatness?

I can't think of one single female client I've had who hasn't, at some point, talked about the same confusion, and complained about the body they're in. Occasionally a man will talk half-heartedly about "getting in shape" but it's rare that they exhibit the same self-hatred as the women. Some women won't have sex for fear of their partner seeing their bodies. Some won't allow their photograph to be taken because they can't stand to see themselves. Some give up on big damn lives because of the body they have, the self-hatred they have and the flesh on their bones. Some won't go for walks, won't go swimming, don't go dancing even though they really want to, don't pursue relationship because they don't consider themselves desirable, lovable, sexy and attractive. Some of them count each calorie,and live lives of numeric and caloric turmoil as a result. Some of them have had weight-loss surgery, despite the health and morbidity risks attached. Few of them will make eye-contact with me as they talk about their hatred of their bodies. I try to reassure them that it's fine to talk about with me. However, if you're looking for diet support, I'm not a good person to come to. I encourage my clients to do what I try to do as best I can. Live as big a life as you can without being so concerned with the shell you're living it in. Eat healthily and heartily and stop when you've had enough and are full. Have sex. Get wet in a swim pool. Get mad when somebody tells you that you don't have a right to a life of joy, excitement, companionship, sexy times until you've changed your body size. This is your one shot at life in the body you have.

Settling In To Life As A Northampton Therapist

2008-03-20T15:05:00.000-07:00

Moving to Western Massachusetts has been a culture shock in many ways. There are sights, sounds, smells and personalities to familiarize myself with, and as somebody who lived most of my life in an urban setting, the learning curve is enjoyable, but steep.

The small town I live in is very rural, and other than a small log cabin near our home, there are no houses for half a mile and then another 2 miles before you come to the next building - the local (and only) grocery store. Despite the fact that our land is on a fairly major (for Western Mass) route, sometimes more than 15 minutes goes by without a car, truck or tractor driving past. During an ice-storm, few cars can get make it up the steep hill just past our house and when the ice and snow have carpeted the road surface with such a thick slick of slippery white, and we leave the lights on around our driveway to let people know that if they are stuck, they can call friends to be towed, and have a cup of tea while they thaw out and wait to be rescued. In between frequent snow and ice storms the road surfaces are visible and what was once a smooth road surface now ripples with frost heaves; parts of the road are almost split in half where the town didn't get around to crack sealing in time for the winter freeze.

One of the local farmers owns the corn field across from our driveway, and as spring approaches he tows cart-loads of manure and dumps it in the field, ready to spread it over the cornfield, readying it for the summer crop. Right now, the manure is frozen in dark clumps, forming piles which stand out starkly against the snowscape in the field. But as soon as the thaw comes, the manure will warm up and the smell will be unbearable to us city-slickers for a couple of days. I'm sure that we'll get used to it after a few years, but for the moment the smell is strong and unpleasant, as much as we appreciate the benefit it brings to the soil.

People are friendly and welcoming, but cautious and understandably so. I've been told by new friends that local people are wary of growing too close to those "flatlanders" who have newly arrived in the hill towns region of Western Mass. Apparently, as life can be harsh and hard here, sometimes people give up and return to their urban ways, leaving their rural friends behind. So there's a cautious "wait and see" approach to newbies in town. Your impact on a small town is much, much larger than the one you'd have in an urban town setting, and it's wise to be careful and even more respectful towards neighbors than you would normally. We clearly need each other more out here. Alienating neighbors is not a good idea.

I have always enjoyed spending time alone, and can wile away hour upon hour with books, writing letters, journaling and reading professional journals and magazines. Now a lot of my time seems to be taken in driving. Sometimes it takes me as much as three hours to get into Watertown where I spend two days a week seeing clients at my Watertown office. When I'm back at home, I have a 40 minute (19 mile) drive into Northampton to see clients one to two days a week. I plug in my Blue Tooth headset, and talk on my phone to friends and family on the long drives backwards and forwards down the Massachusetts Turnpike, and my CD box is overflowing with music that I listen to in between phone calls. I would still rather be sitting with my legs up on our over-stuffed leather couch, reading a book, but music and phone calls make the trips bearable.

My practice is still building in Northampton, but meanwhile my online therapy practice more than keeps me busy. I have developed a sub-specialty in working with transgender active duty military personnel (and sometimes their family members), and as my name gets passed around transgender chat rooms and transgender support sites online, this practice continues to build. (There is much to say about this, and my intent is to write a series of blogs on the issues facing people who are transgender and serving in the armed forces.) Meanwhile, sitting at my computer upstairs in my study wearing fluffy flannel pajamas, warm slippers and my favorite Pashmina around my shoulders (purchased by my mother as a present for me at a store in Heathrow Airport) conducting therapy online with a soldier stationed in Iraq is another wonderful way to pursue a life as a therapist, and adds greatly to the quality of my professional life that I can conduct some part of it in my PJ's!

Northampton is delightful. The town is fully of bijou restaurants, music venues and clothing stores, one-of-a-kind art stores, and so many bookstores that I feel as if I've died and gone to heaven. They don't call this area "Happy Valley" for nothing! Suffice to say that this is not a welcoming place to live for republicans. The town is very gay and lesbian friendly and while it's not as ethnically diverse as I would like, there's plenty of room for all sorts of people. People watching here is a delight. I described it to a friend as being "Harvard Square on steroids." I don't think I've ever seen as many white people with dreadlocks in my life!

Being one of only three sex therapists in the immediate area of Northampton and Amherst has also meant that I've been met with a very big and friendly welcome by local psychotherapists, eager for places to make referrals for clients struggling with sexual disorders. So, I've been invited to join online lists of local psychotherapists in private practice; I've received invitations to meet and socialize in local restaurants with like-minded clinicians; people have freely shared their resources whether it be suggestions for where to find office space, or how to locate a good billing person. I've been stunned at how fast I've made friends - what took years to accomplish in Boston, has happened in a matter of months in Northampton. So, my practice here has been growing nicely, and I love my new office space on King Street. In addition to being just a brisk walk into the hustle and bustle of the downtown area, there's also the benefit of being set back from the street, so my office is quiet and peaceful no matter what the time of day.

I feel quite blessed these days.

Are "Gay Divorcees" really feeling gay?

2008-01-23T13:55:00.000-08:00

Same-sex couples have been dealing with relationship break-ups in therapy for many years. A new wrinkle for some of these break-ups is the inclusion of legal marriage and legal divorce. While 50% of heterosexual marriages end in divorce, there are particular issues to same-sex divorce that psychotherapists and other divorce professionals must understand. These differences include same-sex couples’ lack of familiarity with the legalities of divorce, the homophobic culture that provides varying degrees of support for the marriage or understanding of the factors existing in same-sex divorce, along with added pressure from both outside and inside the LGBT community.

The Massachusetts high court ruling in November 2003, which allowed same-sex couples to marry beginning in May of 2004, was a landmark decision that took the GLBT community by surprise. Despite all their work fighting for civil rights, few GLBT activists expected the expansion of our civil rights to include legal marriage. The passage of the Defense of Marriage Act (DOMA) in 1996 had explicitly defined marriage as a union of one man and one woman for the purposes of federal law. At the time, the passage of that act felt for many in our community like large, rusty nails in the collective GLBT civil rights coffin.

The idea of having our relationships sanctioned by law was so unexpected, such a never-in-our-lifetime-feeling, that many people leapt to make their relationships legal, in order to take advantage of what they feared would be their only chance to protect their families. Some couples have reported feeling that, thrust into getting married to protect what limited benefits they were being offered, they didn’t really understand the long-term ramifications of being legally married. Some have even told of being audited because their taxes were not understood by the IRS. Other couples faced loss of their health benefits after passage of the bill, and felt they had no choice but to marry.

Same-sex couples aren’t the only ones unfamiliar with their new status. Many lawyers in Boston are refusing to take on same-sex divorce cases because the law is so untested and is even more problematic because same-sex marriages are not federally recognized. From a legal standpoint, this makes our divorces even messier than those of heterosexual couples. As Joyce Kaufmann, a Boston-area lawyer, has pointed out, divorce is one of the benefits of marriage. On top of the complex legalities of same-sex divorce, few of us have had time to catch up with the steep and complex emotional learning curve of such a benefit.

Divorcing same-sex clients often feel like they are walking on the crunching egg-shells of a legal system unprepared for same-sex marriage, let alone same-sex divorce. Kali Munro, an online therapist living in Canada says, “I find that heterosexual couples are more likely to have known other people who have divorced, what their rights were, how finances were handled, what to do, etc., whereas lesbian and gay couples are new to the legal and financial implications of marriage and don't always know their options. I've heard some lesbian couples say that they can't divorce, despite their great unhappiness, because their finances are shared and they don't see a way out of it. This adds even more strain to an already strained relationship.”

Making the decision to end a relationship is a difficult and painful one, a decision that few couples make lightly regardless of sexual orientation. Research has shown that most divorcing couples face a complex emotional salad of confusion, shame, embarrassment, uncertainty, sadness and a profound feeling of personal failure. Bear in mind that this research was carried out using divorcing heterosexual couples as the basis for the research, against the backdrop of a culture and society that promotes, supports and protects their marriages. The same situation does not pertain for same-sex couples whose relationships may have been vilified and discounted by homophobic opposition. Same-sex clients contemplating divorce, in turning to their therapists for emotional support and guidance, may find clinicians who are unaware of the particular complexities of same-sex divorce, including issues that may be concealed beneath layers of shame, humiliation, and internalized homophobia.

Same-sex relationships suffer from bad press and a host of inaccurate, homophobic myths. We have been told that our relationships aren’t “real”, that they don’t last, and have even been equated with bestiality (Thank you, Huckabee!) Joe Kort, psychotherapist and author, says that in his clinical practice he has found that same-sex clients who are in the process of divorcing “are afraid to tell family and friends for similar reasons that heterosexual couples have but, in addition, their divorce is like confirmation that heterosexism is correct and that gay relationships are doomed to fail.” None of us wants to provide fodder to anti-same-sex marriage individuals and right-wing organizations who will point to divorcing same-sex couples as evidence that we aren’t “real” couples. But, as Kali Munro points out, “How odd that anyone would even try to point to divorce in the lesbian and gay community as proof that those marriages were never 'real' when we all know about the divorce statistics in the heterosexual community!”

Same-sex couples with children choose to marry for some of the same reasons as heterosexual couples. Additionally, they want to give as much protection to their children and their own vulnerable relationship as possible by taking advantage of their ability to legally marry in Massachusetts. I spoke recently with a lesbian mother who is going through a divorce and agreed to talk with me on condition that she remains anonymous. She said that she and her partner had been together for many years before they married and her experience in her family of origin was, “You feel like an outsider when you're not married.” For this lesbian mother, having children legitimized her marriage, because her parents saw themselves as having a formal role, that of grandparents.

Regrettably, not all same-sex couples are so lucky. For some couples, some of the emotional issues that arise from dealing with a homophobic culture are further amplified by marriage and then heightened further by a subsequent divorce. A couple who saw me for therapy told me that both their families had consistently treated their fifteen-year relationship as completely unimportant and invalid, even after their legal marriage, and, now, with their impending divorce, as if that too was “invisible.” One of the partners commented that it was clear to her that her parents hadn’t recognized either her marriage or her divorce as important as they did that of one of her siblings, despite the fact that my client’s grief at the ending of her relationship was as profound as anyone experiencing the end of a marriage. While her sibling had been showered with financial and emotional support, she said her parents refused to bring up the subject of their divorce and had even changed the topic of conversation on several occasions. Some of the work we did in therapy involved validating for this couple that their deeply-felt feelings of sadness, loss, fear and humiliation were real, and nothing to gloss over, despite their families’ insistence on treating them disrespectfully and not hiding their disapproval and judgment of them and their relationship. It’s not easy work.

Many divorcing same-sex couples also report feeling pressure from within the GLBT community. The additional burden of feeling like a poster child for same-sex marriage creates an added and sometimes overwhelming feeling of pressure. These couples are struggling with feeling as if they let down their community. Joe Winn, LICSW, a psychotherapist in private practice in Arlington, Massachusetts, reports that among clients going through same-sex divorce he has noticed clients “who refuse to address the intensity of their divorce - minimizing their feelings, minimizing their loss and mourning - which I have been attributing to trying to avoid the shame and sense of failure that comes with loss.” Winn reports that he has seen in some of his clients a re-emergence of internalized homophobia and a developmental regression of their lesbian or gay identity. Other therapists report clients talking about their deep feelings of embarrassment and humiliation and, in some cases, confessing that they dread telling their heterosexual friends and relatives even more than same-sex friends. It’s not only the homophobic response from families of origin and society that same-sex couples fear. As Joe Kort remarks, “Others have been judged negatively by their friends who tell them they should not have gotten tangled up with a legal system to begin with, something that straight couples would not necessarily say to one another about marriage.”

Elizabeth Zelvin, psychotherapist and mystery author, points out that therapists need to be mindful not only of the ways in which same-sex couples are the same or different, but the fact that some same-sex clients may be less willing to reveal relationship issues in therapy. The same issues that are at play in larger society for divorcing same-sex couples may also play out in their relationship with their therapist. For example, if the therapist is heterosexual, the client may be concerned about misunderstanding or homophobia from the therapist. If the therapist is lesbian or gay, the same issue of “letting down our team” may surface for the client. Feelings of shame about divorce may make them less likely to talk about their relationship issues.

Therapists have been dealing with relationship break-ups forever. Now, they must deal with the ramifications of same-sex legal marriage and legal divorce. In order to provide useful support to their clients, psychotherapists and other divorce professionals must recognize the particular issues inherent in same-sex divorce, including lack of familiarity with the legalities of divorce, the homophobic culture that provides varying degrees of support for the marriage or support, and pressure from inside and outside the LGBT community. By being mindful of and addressing the complex interplay of these legal, emotional and social issues, psychotherapists and other divorce professionals will be able to assist same-sex couples who find themselves in this previously uncharted territory.

(With thanks to Joe Kort, Kali Munro, Elizabeth Zelvin and Joe Winn for their clinical input and ideas.)

Learning about Peak Oil and Your Emotional Response

2007-11-19T08:12:00.000-08:00

Readers:

This article appeared in the Washington Post today, November 19th, 2007. It contains some of the arguments, theories and controversies surrounding Peak Oil. You might ask what this has to do with you and your emotional life. Let's go one step further. "What does this have to do with therapy or psychotherapy?" you might ask. My answer is "a great deal." Our lives do not exist in a vacuum - they are dramatically affected by the world we live in and very definitely affected by economic and environmental forces. Your world and mine will be increasingly effected by declining fossil fuel production. One example? How much less money do you have in your bank account as a result of the recent hike in gasoline prices at your local gas station? This increase in oil prices will begin shortly to affect everything - the price of food in the supermarket, the cost of home goods and supplies, the cost of clothing....all these require transportation to ship them to stores, and transportation costs will be affected by increased oil prices. These are all passed along to consumers in the form of increased pricing in stores.

Along with this financial impact comes a corresponding emotional response. If you read it, how did you feel as you took in the information in the article? Does the information feel like it's nothing to do with you? Does it feel like somebody else's problem? Does the topic feel too overwhelming to think about? Do you find yourself reluctant to read it? Feel that you can't take the information in? Distracted? Bored? Upset? If you are able to think about the issues, how does thinking about Peak Oil change any of the future and possible life plans you had?

This is the best site for good descriptions of the emotional responses that are possible when starting to think about Peak Oil. I'll be interested to hear what YOUR responses are, and I will be shortly posting a blog on the challenges facing Peak Oil aware psychotherapists when working with clients who have not yet considered the impact that declining fossil fuel production will have on their lives.

(With thanks to my friend, Mary McClintock, for sending me this article)

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Oil Officials See Limit Looming On Production

By RUSSELL GOLD and ANN DAVIS
November 19, 2007; Page A1

A growing number of oil-industry chieftains are endorsing an idea long deemed fringe: The world is approaching a practical limit to the number of barrels of crude oil that can be pumped every day.

Some predict that, despite the world's fast-growing thirst for oil, producers could hit that ceiling as soon as 2012. This rough limit -- which two senior industry officials recently pegged at about 100 million barrels a day -- is well short of global demand projections over the next few decades. Current production is about 85 million barrels a day.

The world certainly won't run out of oil any time soon. And plenty of energy experts expect sky-high prices to hasten the development of alternative fuels and improve energy efficiency. But evidence is mounting that crude-oil production may plateau before those innovations arrive on a large scale. That could set the stage for a period marked by energy shortages, high prices and bare-knuckled competition for fuel.

The current debate represents a significant twist on an older, often-derided notion known as the peak-oil theory. Traditional peak-oil theorists, many of whom are industry outsiders or retired geologists, have argued that global oil production will soon peak and enter an irreversible decline because nearly half the available oil in the world has been pumped. They've been proved wrong so often that their theory has become debased.

The new adherents -- who range from senior Western oil-company executives to current and former officials of the major world exporting countries -- don't believe the global oil tank is at the half-empty point. But they share the belief that a global production ceiling is coming for other reasons: restricted access to oil fields, spiraling costs and increasingly complex oil-field geology. This will create a global production plateau, not a peak, they contend, with oil output remaining relatively constant rather than rising or falling.

The emergence of a production ceiling would mark a monumental shift in the energy world. Oil production has averaged a 2.3% annual growth rate since 1965, according to statistics compiled by British oil giant BP PLC. This expanding pool of oil, most of it priced cheaply by today's standards, fueled the post-World War II global economic expansion.

On Oct. 31, Christophe de Margerie, the chief executive of French oil company Total SA, jolted attendees at a London conference by openly labeling production forecasts of the International Energy Agency, the sober-minded energy watchdog for industrialized nations, as unrealistic. The IEA projects production will grow to between 102.3 million and 120 million barrels a day by 2030. Mr. de Margerie said production by 2030 of even 100 million barrels a day will be "difficult."

Speaking Clearly

This is "the view of those who like to speak clearly, honestly, and [are] not just trying to please people," he bluntly declared. The French executive said many existing oil fields are being depleted at rates that will damage their geologic structures, which will limit future output more than most people allow. What's more, some nations endowed with large untapped pools of oil are generating so much revenue from their current production that they feel they don't need to further develop their fields, thus putting another cap on output.

Earlier this month, James Mulva, the chief executive of ConocoPhillips, echoed those conclusions in a speech at a Wall Street conference: "I don't think we are going to see the supply going over 100 million barrels a day.... Where is all that going to come from?" He questioned whether the industry has enough support services and people to execute projects to add that much oil production.

Even some officials from member states of the Organization of Petroleum Exporting Countries, which has long insisted on its ability to supply the world with fuel for decades hence, are breaking ranks and forecasting limits. The chairman of Libya National Oil Corp. said at the same London conference the world will have difficulty producing more than 100 million barrels a day.

A former head of exploration and production at Saudi Arabia's national oil company, Sadad Ibrahim Al Husseini, has also gone public with doubts. He said in London last month that he didn't believe there were enough engineers or equipment to ramp up production fast enough to keep up with the thirsty global economy. What's more, he said, new discoveries are tending to be smaller and more complex to develop.

Many leaders of the industry still dismiss the idea that there is reason to worry. "I am no subscriber to the theory that oil supplies have already peaked," said BP's chief executive, Tony Hayward, earlier this month in a speech in Houston.

Exxon Mobil Corp. Chief Executive Rex Tillerson has said that if companies had better access to the world's oil reserves, production would increase and prices would go down. "Sufficient hydrocarbon resources exist to play their role in meeting this growing global demand, if industry is allowed to access them," he said in a speech this month. If access were granted, Exxon Mobil believes the industry would be able to raise fuel production to meet demand in 2030 of 116 million barrels a day.

The oil industry has long been beset by doom-and-gloom scenarios, which so far haven't panned out. "The entire oil industry in the late 1970s was convinced the price [of oil] would be $100 by 1990 and we would need huge oil shale mines" to exploit oil locked away tightly in rock, says Michael C. Lynch, president of Strategic Energy & Economic Research Inc. Of course, that didn't happen, as discoveries ushered in new eras of low-priced oil in the mid-1980s through the late 1990s.

U.S. government experts are optimistic -- to a point. The Energy Information Administration, the data arm of the Energy Department, forecasts world oil production will hit 118 million barrels a day by 2030. But the agency warns that its prediction might not pan out if resource-rich nations such as Venezuela and Iraq don't invest enough in their operations.

"We know that the world is not running out of energy resources, but nonetheless, above-ground risks like resource nationalism, limited access and infrastructure constraints may make it feel like peak oil just the same, by limiting production to something far less than what is required," said Clay Sell, deputy secretary of energy, in a speech in October. Resource nationalism refers to tightening state control of oil fields to achieve political aims, often by restricting outsiders' ability to develop the oil for world markets.

'Undulating Plateau'

Two or three years ago, it was far more common for oil analysts and officials to trumpet the potential of new technology to harvest more oil. In a report last year, Cambridge Energy Research Associates, a prominent adviser to energy companies, made the comforting prediction that oil production could reach 110 million barrels a day by 2015, and "more than meet any reasonable high growth rate demand scenario we can envisage" up to that date. Because of progress being made in extracting oil through new methods, CERA said it found "no evidence" there would be a peak in oil flows "any time soon." In a later report, CERA said world oil production won't peak before 2030 and that even when it does, production will resemble an "undulating plateau" for one or more decades before declining gradually.

Oil companies have seen several years of bull-market prices, and thus of trying to produce more. This has given their executives a better sense of what is and isn't possible.

One limit: Many people think most of the world's giant fields already have been discovered. By 1970, oil-industry explorers had discovered 10 giants that could each produce more than 600,000 barrels a day, according to Matt Simmons, chairman of energy investment banking firm Simmons & Co. International. Exploration in the next 20 years, to 1990, yielded only two. Since 1990, despite billions in new spending, the industry has found only one field with the potential to top 500,000 barrels a day, Kazakhstan's Kashagan field in the Caspian Sea. And Mr. Simmons notes it is proving expensive and difficult to extract.

Big strikes are still possible. This month, Petróleo Brasileiro SA announced a deep-water find off Brazil's Atlantic coast that appears to be the largest discovery since Kashagan.

But some of the most promising geological formations are in locations that are inhospitable, for reasons of geography or, especially, politics and strife. Output from Iraq's rich fields is unlikely to grow much until security improves and outside investment returns. The future of Iranian and Nigerian production is likewise clouded by geopolitical and local instability.

Labor and construction bottlenecks also are making it difficult to develop proven fields. One of the largest obstacles is the booming commodity markets themselves: The prices of raw materials used in oil-field platforms and equipment has escalated. And during the years of low or moderate oil prices in the 1980s and 1990s, companies didn't develop enough geologists and other skilled workers to supply today's needs. "Years of underinvestment in new talent have led to a limited and aging pool of skilled workers," noted Andrew Gould, the CEO of oil-service giant Schlumberger Ltd., last month.

High oil prices have also led to steep cost inflation for drilling rigs and other equipment. Costs have soared so much that the industry is falling behind in the investment needed to sate expected future demand. To meet demand forecasts of 90 million barrels of oil a day in 2010, the industry needed to have spent $350 billion on drilling and producing in 2005, argues Larry G. Chorn, chief economist of Platts, the energy and commodities-information division of McGraw-Hill Cos. But the International Energy Agency estimates that spending on oil-field production in 2005 came to only about $225 billion, he says.

A failure to spend enough in the past few years "may have already put the industry behind the spending curve," Mr. Chorn says. As a result, he predicts "temporary shortages over several years, causing debilitating price spikes."

Compounding the problem: Most of the world's biggest fields are aging, and production at them is declining rapidly. So, just to keep global production at current levels, the industry needs to add new production of at least four million daily barrels, every year. That need is roughly five times the daily production of Alaska, with its big Prudhoe Bay field -- and it doesn't assume any demand growth at all.

Rate of Decline

Mr. Simmons scoffs at estimates that production from proven fields will decline only 4.5% a year. He thinks a more realistic rate of decline is 8% to 10% a year, especially because modern technology actually succeeds in depleting fields faster.

If he's right, the industry needs to add new daily production of at least eight million barrels -- 10 times current Alaskan production -- just to stay even.

Mr. Simmons thinks the world needs to shift its energy focus from climate change to more immediate concerns. "Peak oil is likely already a crisis that we don't know about. At the furthest out, it will be a crisis in 2008 to 2012. Global warming, if real, will not be a problem for 50 to 100 years," he says.

Oil executives who believe a production ceiling is coming are making plans to stay relevant in a world where oil production is constrained.

Mr. de Margerie said at Total's annual meeting this spring that the company was "looking into" nuclear-industry investments and had hired nuclear experts to help make strategic decisions. ConocoPhillips recently said it was considering building a commercial-scale plant to turn plentiful U.S. coal into natural gas.

Soaring energy prices have breathed new life into projects targeting "nonconventional" oil, such as that trapped in sand or shale. But these sources can't be tapped nearly as quickly or inexpensively as the big oil finds of the past.

Vivid Example

Canada's massive oil-sands deposits, which hold the largest oil reserves after Saudi Arabia's, offer a vivid example. They contain an estimated 180 billion barrels of oil. But after years of intensive development and tens of billions of dollars of investments, the sands are producing only a little more than 1.1 million barrels of crude a day. That's projected to reach three million a day by 2015. The oil deposits are so heavy that companies must either mine them or slowly steam them underground to get the oil to flow out of the sand.

Randy Udall, co-founder of the U.S. chapter of the Association for the Study of Peak Oil and Gas, has written that these unconventional oil supplies are like having $100 million in the bank, but "being forbidden to withdraw more than $100,000 per year. You are rich, sort of."

As these uncertainties mount, there is growing hope that Saudi Arabia, which has about 20% of the world's oil reserves, would ride to the rescue if needed. Saudi Aramco, the national oil company, has embarked on an ambitious plan to increase its daily production by 30%, or three million barrels, early next decade, and thus reclaim the title of top producer from Russia. But Mr. Al Husseini, the former Saudi oil executive, now an independent consultant, said others aren't doing as much, leaving the world entirely dependent on Saudi Arabia to provide extra capacity.

"Everyone thinks that Saudi Arabia will pull us out of this mess. Saudi Arabia is doing all it can," he says in an interview. "But what it is doing, in the long run, won't be enough."

Write to Russell Gold at russell.gold@wsj.com and Ann Davis at ann.davis@wsj.com

How to Figure Out When Therapy Is Over

2007-11-02T11:28:00.000-07:00

This article was published in the New York Times this week. I'm posting it here because I found it funny, insightful and interesting and hope you do too.

How to figure out when Therapy is Over
By RICHARD A. FRIEDMAN, M.D.

Published: October 30, 2007

If you think it’s hard to end a relationship with a lover or spouse, try breaking up with your psychotherapist.

A writer friend of mine recently tried and found it surprisingly difficult. Several months after landing a book contract, she realized she was in trouble.

“I was completely paralyzed and couldn’t write,” she said, as I recall. “I had to do something right away, so I decided to get myself into psychotherapy.”

What began with a simple case of writer’s block turned into seven years of intensive therapy.

Over all, she found the therapy very helpful. She finished a second novel and felt that her relationship with her husband was stronger. When she broached the topic of ending treatment, her therapist strongly resisted, which upset the patient. “Why do I need therapy,” she wanted to know, “if I’m feeling good?”

Millions of Americans are in psychotherapy, and my friend’s experience brings up two related, perplexing questions. How do you know when you are healthy enough to say goodbye to your therapist? And how should a therapist handle it?

With rare exceptions, the ultimate aim of all good psychotherapists is, well, to make themselves obsolete. After all, whatever drove you to therapy in the first place — depression, anxiety, relationship problems, you name it — the common goal of treatment is to feel and function better independent of your therapist.

To put it bluntly, good therapy is supposed to come to an end.

But when? And how is the patient to know? Is the criterion for termination “cure” or is it just feeling well enough to be able to call it a day and live with the inevitable limitations and problems we all have?

The term “cure,” I think, is illusory — even undesirable — because there will always be problems to repair. Having no problems is an unrealistic goal. It’s more important for patients to be able to deal with their problems and to handle adversity when it inevitably arises.

Still, even when patients feel that they have accomplished something important in therapy and feel “good enough,” it is not always easy to say goodbye to a therapist.

Not long ago, I evaluated a successful lawyer who had been in psychotherapy for nine years. He had entered therapy, he told me, because he lacked a sense of direction and had no intimate relationships. But for six or seven years, he had felt that he and his therapist were just wasting their time. Therapy had become a routine, like going to the gym.

“It’s not that anything bad has happened,” he said. “It’s that nothing is happening.”

This was no longer psychotherapy, but an expensive form of chatting. So why did he stay with it? In part, I think, because therapy is essentially an unequal relationship. Patients tend to be dependent on their therapists. Even if the therapy is problematic or unsatisfying, that might be preferable to giving it up altogether or starting all over again with an unknown therapist.

Beyond that, patients often become stuck in therapy for the very reason that they started it. For example, a dependent patient cannot leave his therapist; a masochistic patient suffers silently in treatment with a withholding therapist; a narcissistic patient eager to be liked fears challenging his therapist, and so on.

Of course, you may ask why therapists in such cases do not call a timeout and question whether the treatment is stalled or isn’t working. I can think of several reasons.

To start with, therapists are generally an enthusiastic bunch who can always identify new issues for you to work on. Then, of course, there is an unspoken motive: therapists have an inherent financial interest in keeping their patients in treatment.

And therapists have unmet emotional needs just like everyone else, which certain patients satisfy. Therapists may find some patients so interesting, exciting or fun that they have a hard time letting go of them.

So the best way to answer the question, “Am I done with therapy?” is to confront it head on. Periodically take stock of your progress and ask your therapist for direct feedback.

How close are you to reaching your goals? How much better do you feel? Are your relationships and work more satisfying? You can even ask close friends or your partner whether they see any change.

If you think you are better and are contemplating ending treatment but the therapist disagrees, it is time for an independent consultation. Indeed, after a consultation, my writer friend terminated her therapy and has no regrets about it.

The lawyer finally mustered the courage to tell his therapist that although he enjoyed talking with her, he really felt that the time had come to stop. To his surprise, she agreed.

If, unlike those two, you still cannot decide to stay or leave, consider an experiment. Take a break from therapy for a few months and see what life is like without it.

That way, you’ll have a chance to gauge the effects of therapy without actually being in it (and paying for it). Remember, you can always go back.

Richard A. Friedman is a professor of psychiatry at Weill Cornell Medical College

The Last Twelve Months

2007-10-16T13:34:00.000-07:00

I have wanted to post here on many occasions over the last year, but life has come between me and my writing. I apologize. You have all been so patient. A lot has happened and I hardly know where to start.

My online therapy practice launched, and I now have a second clinical practice in Northampton, Massachusetts in addition to my Watertown office. Life is busy and rewarding. The website is still being fine tuned, with encrypted email coming soon. I would also like to add streaming video at some point. The photograph there was a "placeholder" until my web designer could post a new one. That still hasn't happened, hence posting my photo here as I'm a firm believer in truth in advertising.

My father died in June, after a long slow hospitalization in a hospital in Gloucester, England. I'm not going to go into details about that in this post, but I have had many insights into grief and loss since his death. My life has changed and the impact on my family has been monumental. To say that he was not a kind man would be a serious understatement. On the contrary, he was a cruel, mean-spirited, narcissistic tyrant who terrorized his wife and children. But to watch a person slowly disintegrate before your eyes, lose life force and die is a life-changing event. I will write more on this in the months ahead.

Probably the most profound event of the last twelve months was relocating my home. Seeking a lifestyle more in keeping with my politics, and philosophy of life, I moved to the countryside. Having spent my life living in claustrophobic urban environments, where my house was separated from the next door neighbor by a car's width, I'm now living on nearly 20 acres of beautiful farmland in an 18th century house with my spouse and our dog, Ziggy. With two and a half miles to the only general store in town, I pass 2 houses on my way to it and other than that, it's us and the sheep, and the Llamas used by local farmers to guard their herds from murderous coyotes.

I believe that our access to fossil fuels is about to take a dive and when that happens life as we have known it will change irrevocably, making access to food and all other life-sustaining needs, difficult if not in some circumstances impossible. I wanted my family to be in a position to live a simple and sustainable lifestyle. I carefully picked the area I moved to based on input from, and conversations with, a dear friend who was already living in the town. Check out her blog at Peak Oil Blues. The Peak Shrink has written about the impact of diminishing oil reserves on our physical and psychological lives far more eloquently than I ever could - why reinvent the wheel?

The town I moved to is small, friendly and supportive. And, most importantly, they are already working on ways to simplify life, including exploring renewable energy and a commitment to eating locally grown foods. In the last few months, we have been planting tree crops and vegetables, making our house as weather-tight as possible, looking into raising chickens and goats (coming next Spring) and tripling the size of the existing vegetable garden. This stuff does not come easily to me and neither do I enjoy it much. I'm great with houseplants, but mulch, manure and garden gloves are alien to me. I am somebody who likes my eggs to come pre-washed and neatly arranged in a rectangular cardboard carton. The idea of fishing around in hay for my breakfast egg was initially less than appealing. But I notice myself changing. Slowly and surely, I'm increasingly relishing the prospect of carrying eggs in from the chicken coop every morning.

As you can imagine, acclimatizing to a very rural life has not been without its challenges. For instance, we have to drive for 30 minutes before we reach a gas station, so our cars have to be gassed up at all times. The same is true of food and other supplies. No quick trips into town for us. Everything has to be carefully planned and shopped for ahead of time. Like every small town, gossip travels fast. One example of this is that my car was thumped by a pick-up truck in the gas station. As soon as I had finished exchanging information with the other driver, I called my mechanic a mile or so away. "Oh, I know why you're calling," he said before I had even begun to explain my predicament, "and I know that you're going to need an auto body shop!" It turns out that a customer of his on the way to the garage had seen the accident. I'm the only very old, red Saab convertible in town so the mechanic had put two and two together.

Then there's the wildlife. And the bugs. Bears steal the bird feeders off the windows, rummage through compost and have been known to help themselves to the content of the refrigerator. (A neighbor's, not ours, thankfully.) This year, we have had a literal plague of ladybugs. Not just 50 or 60 of them, but thousands of them - they throw themselves against the windows and doors, desperate to get in before the cold weather comes. We vacuumed solidly for two hours the other day to get rid of the ones that had actually made it into the house. Yes, I know it sounds harsh. But one or two lady bugs are sweet and pretty. Hundreds of them dive-bombing the table, crawling into your bed, landing on the coats hanging by the door so thickly you can barely tell what color the fabric is? That's definitely a plague.

On the other hand, when catastrophe strikes, the town hears of it quickly and people are quick to offer help, support and sympathy. There are no street lights and there's almost no cell phone coverage here. But at night, with almost no light pollution from towns and cities, the stars are brilliant and clear, appearing to hang low enough to touch. While there are few stores, there have been garden delights that more than make up for this. I've made apple sauce from our own apples, Portuguese Kale soup with vegetables from our garden and we ate blueberries, raspberries and blackberries daily until the season finally ended. The crime rate is almost non-existent and when you are sitting on your front step staring out at the fields, everybody who drives by waves hello.

There is so much to say about this change in lifestyle. It has affected everything about my life, which includes a change in the way I think about my role as a therapist. I'll be writing more on this in the coming months.

Online Therapy Site Goes Live!

2007-01-12T16:56:00.000-08:00

To all those loyal readers who have emailed me to ask why the long absence, I'd like to thank you for your patience. Buying a house, packing up boxes, moving and unpacking, maintaining a busy clinical practice of face-to-face clients, along with the usual craziness of the holidays, my sister visiting me from England and working hard to get my new online venture up and "live" .....all these things and more have consumed my attention in the last few months. To those stalwart folks who are still awaiting a response to their email, my apologies. I will be in touch with you all shortly.

Meanwhile, I'm very proud of the Jassy Timberlake Online Therapy website and I look forward to expanding my clinical practice into cyberspace. Plus, I'll be back to writing in my blog more regularly in the coming days. Stick around!

Bored in Bed in Baltimore

2006-10-24T15:50:00.000-07:00

Dear Jassy:

My husband and I have been married for 5 years. In the beginning, our sexual relationship was fine. We were very attracted to each other, and we had great sex together - leastways, it was okay sex. I enjoy sex a great deal and consider myself a very sexual person. I've had several sexual partners prior to my husband, and some of those relationships were very sexually inventive and hot, hot, hot!

My husband was hot-to-trot in the early months of our relationship, so for the first two years (we married a year after we met) we had sex 4-5 times a week. Sometimes he would initiate and more often I would. We have an active social life, inidividually and together, and decided early on that neither of us wanted to be parents, so we have a great deal of freedom to come and go, have weekends away frequently and take vacations together whenever we can.

In the last few years, I've grown really bored of our sexual relationship. I have tried hinting to him that I would like to try something different, but he just won't budge. He becomes very defensive, and irritable and says that he's still enjoying it and he can't understand what's the matter with me that I'm not enjoying it too. Our initiation schedule has changed around drastically - I never initiate sex now, and am really only having sex with him so as not to hurt his feelings. I've avoided having weekends away together in the last year or so, because he always expects to have sex and I'm just not interested. The problem is not that I'm not interested in having sex, but that I'm not interested in having sex with him. I'm in my early 30's and think I'm fairly attractive - I get hit on quite frequently when I'm out with friends, and I have to confess that sometimes I've been tempted to take up some of the men on their offers. I am not the cheating type, and I do love my husband very much. I just don't feel much sexual desire for him these days and don't know what to do about it.

I have enjoyed the common sense approach you have towards people and their problems, and would appreciate any insight you may have into my situation. Before you say anything, yes, I do understand that my husband and I would benefit from couples counseling. (Do you know any sex therapists in the Baltimore area?)

Thank you for any light you can shine on the problem my husband and I are having.

Signed: Ms. Bored in Bed in Baltimore

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Dear Ms. BBB:

Oh boy. Where do I start?

It's hard to be one half of a couple for all kinds of reasons. But interestingly, the first six months don't tend to be that challenging, right? The making out and the sex can be fabulous and, even if it isn't, it's so exciting being around that new person that the constant state of arousal you're in seems to make up for their lack of technique, their inability to talk about sex, possible shyness and reluctance, or numerous other ways in which your new person isn't perfect. But once the rot sets in, it seems to really set.

I can't tell you the number of folks who walk through my office door and confide in me that they don't enjoy having sex with their partners, and that they are only "going through the motions." When push comes to shove, they can come up with all kinds of reasons why they don't want to have sex - but the truth is that most of us want to have sex if it's the kind of sex we want to have. You are clear that you want to have sex, just not with your husband. Your problem is that if you don't start getting clearer with him about just how disgruntled you are feeling about your sexual life together, you are going to end up talking to lawyers. In the long run despite the discomfort you may feel, it's infinitely preferable to have honest conversations with our partners about our sexual lives than it is to dig deep into our savings accounts and credit cards to pay lawyers for costly divorce processes.

You don't go into the kinds of sex you do enjoy having, but I'm going to guess that you and your husband have different sexual styles. I'm also guessing that to some other woman, your husband's sexual style would be their idea of heaven on earth. It's just not rocking your world, right? So, it's worth figuring out what you do want (and it's surprising how many folks haven't given this much thought!). The idea of sexual styles was developed by a brilliant man called Charles Mosher. There are three main styles, and usually folks can see themselves either clearly in one style or else a combination of two. There's no "right" or "wrong" style - they are all just different and all valuable. The trick is finding a way to work with the style that you have if your partner's sexual style differs greatly from yours. Trancers tend to be easily distracted when having sex. They tend to like diffuse or no light, are easily put off by sounds outside the room and within, and aren't the greatest "talkers" in the boudoir. They are into the visceral experience of being sexual - body contact, the dreamy quality arousal gives them. On the whole, their sexual fantasies appear somewhat esoteric. "Well..when the sunlight hit that woman's hair...the way her hair gleamed ...I felt warmth in my body..."etc. Partner Engagers are the big time romancers in the crowd. They are the rose-petals-on-the-bed-folks; they will look into your eyes, murmur sweet (and not so sweet!) nothings in your ear; they are all about the relationship between themself and their partner; their sexual fantasies have themes of partnering, emotional intimacy and connection. They like candle-light, want to see and be seen. Role Enactors are what I like to call the "Mile High Folks." They are creative sexually, have numerous ideas of things they want to try, are sexually adventurous and will try anything once. They are the folks having sex in the elevator, in a crowded train, in the bathroom 1 mile up in the airplane! Their sexual fantasies are wild, creative and varied.

My suggestion is that you go back to your husband, armed with the information about sexual styles, and be willing to have the conversation about what really (and I mean REALLY) turns you on. What was the best sexual experience you ever had with your husband? What made it good? What do you not like about what he does? What do you particularly like? How do you like to be approached? Is there any way that the two of you can overlap styles so that it's more satisfying for both of you?

If you get stuck and need help with the conversation, look on the American Association for Sex Educators, Counselors and Therapists website and look for a sex therapist in your area.

One final word - I'm glad that you've resisted the urge to cheat on your husband. This would just make a complicated situation even harder. Talk with him now, before it gets any worse. You deserve to have the kind of sexual relationship that you both find satisfying.

Good luck!

Jassy

Gay (but not telling!)

2006-10-06T10:35:00.000-07:00

Dear Jassy:

I gather that, judging from all the various gay and lesbian sites your name and professional contact information turns up on, you are gay and lesbian friendly. So, I'm taking the risk of sending you an email about a problem that I have. I ask only that you not publish my name and/or email address.

I'm 29 years old, and good looking in a wholesome, preppy way, athletic and toned. I went to an Ivy League school, have an MBA and recently got engaged to a really nice girl. So far, so good, right? The problem is that I'm pretty sure that I'm gay. I've had what you could call "illict" (sic) affairs since I was an early teen - things that went beyond the usual "circle jerk" at summer camp. I've dated women alongside my activities with guys, mostly for a front. The main reasons for this is that my family is very homophobic. I am making a very good living, but also have a trust fund which provides me with an excellent cushion. I live in Manhattan, and own my very small condo outright. If my parents knew that I was gay I'm pretty sure that they would cut off my trust fund, so I don't intend to tell them. I don't tend to "date" men, preferring just to pick up guys at bars after-hours. I would never take them back to my place, because I wouldn't want to run the risk of bumping into my fiancee. I'm not seeing this as a major problem, because I'm not interested in settling down with another guy - it's out of the question. My fiancee is a good person. We have a so-so sex life (I don't think she's that into sex, actually) that seems to keep her happy, so I'm guessing that I'm not doing anything wrong by having guys on the side. (I always practice safe-sex). What do you think?

"Gay On The Side"

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Dear Mr. Gay on the Side:

Yes, I am most definitely gay, lesbian, bisexual, transgender and intersex (GLBTI) friendly. I also consider myself to be a "sex positive" psychotherapist, not judgmental or critical about sexual practice that doesn't harm, hurt or otherwise screw with people's emotional and/or physical well-being. So I have to admit that part of me thinks that this email has to be some sort of prank, because I can't really believe that you're serious. I've been sitting staring at the computer screen just dumbfounded, not knowing how to respond. How on earth to respond? I've started replying to your email on several occasions, but have been unsure how to approach your question. Do I present as non-judgmental, which is my normal way of being and feeling in the world ? Do I keep my opinions to myself and be empathic with your situation? So, my response to you is being written as a human being who happens to be a psychotherapist. This is my opinion based only on what you've told me, and it is most definitely not therapy.

What you describe is wrong on so many levels, I barely know where to start. So while I am GLBTI friendly and affirming, I don't find myself feeling very friendly towards you and here's why.

You are telling me that you are a closeted gay man, who likes his affluent lifestyle. As a way of maintaining this lifestyle, you have become engaged to an unfortunate young woman, against whom you commit numerous infidelities, in order to maintain a veneer of heterosexual respectability so that your parents don't financially disinherit you. You have sex with her periodically but obviously not very good sex given that she "isn't that into sex actually" (and people usually want to have sex if it's the kind of sex they want to have, buddy!) and it is your intent to continue with this lifestyle?

It seems to me that you are not the one with the problem.

Your fiancee is the one who has the problem. And that problem is you!

I implore you to consider breaking this relationship off now before you cause any great emotional damage to the young woman to whom you are engaged. She deserves better. If you are under any illusion as to the moral and ethical wrongness of what you describe, take your email (and my reply) to any other psychotherapist and see what they tell you. I also suggest that you look under the word "Sociopathy" in the dictionary and see what you come up with. Your complete lack of empathy or self-awareness would indicate you might have a problem.

Jassy

Note to readers of this blog: For any homophobes reading this, sociopathy is NOT any more prevalent in the GLBT population than in the heterosexual population. This man's behavior is not because he's gay. He appears to have a limited capacity for empathy and caring, that is nothing to do with his sexual orientation and smacks of a personality disorder.

Running Into My Old Therapist

2006-10-04T22:57:00.000-07:00

Hi there, Jassy:

I'm a big fan. I think I've read just about every post and have found it helpful to read about your life as a shrink, so thanks and keep writing. I like the new format where you answer people's emails, and thought you could maybe help me with a small dilemma.

My question is actually about ex therapists, not current ones.

I live in a small town in Northern California. I saw a therapist here for about a year. She was good and helped me sort out some problems I was having. I came to the end of the piece of work I was doing and the shrink and I agreed that the treatment was over. I was a bit embarrassed about being in therapy, mostly because I was having erectile problems - I didn't really tell anybody I was doing it, because I didn't want people to think I was a head case or nut job.

Since then, I've bumped into her in a couple of places. Once was in a social situation at a party and another time I was out for dinner (actually on a blind date!) and my old shrink was sitting at the next table. It felt a little awkward, and kinda cramped my style with this new date I was on. I didn't quite know how to address running into each other on either occasion. At the party somebody introduced us, and we just said hello and smiled. She looked nearly as embarrassed as I felt. At dinner, I just ignored her sitting at the next table. Is there a protocol for this kind of thing and if so, what is it?

Ex Therapy Client in NoCal

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Dear Ex Therapy Client:

This is a good question and one that often comes up for folks in therapy. My answer is largely dictated by you saying that you had kept your therapy private and had not shared your experience with people you know.

If I think that my path and that of my clients are likely to cross, I often have a conversation with them and ask them how they would like me to respond if we run into each other outside of the office. Some people say that they don't know how they would want me to respond, but if they say "Hi" to me, it's okay for me to respond. Some people tell me that they would like me to smile and say hello if they're alone, but ignore them if they are out with people. Some folks say, "Hell, I don't care - come on over and say hi!" and other people would just prefer that we not acknowledge each other. I guess my suggestion for you is to figure out what your preferences would be and then call your former therapist and explain the situation to her. You can tell her how you felt on the occasions when you ran into each other, and let her know if you have a preferred way of handling this. Therapists understand that this can be difficult to navigate, and I'm sure your former therapist will agree to anything that makes life more comfortable for you.

An important thing to remember is that your therapist is ethically bound to maintain your confidentiality no matter whether she or he is inside their office or outside of it. While it is a shock to run into our therapists when we are least expecting it, our expectation should always be that they would never "blow our cover. " When introduced by an unsuspecting guest at a party, therapists are NOT allowed to say, "Oh yes, I know Mr. Incognito! We see each other every Monday morning at 9am and talk about his erectile problems!" or anything that indicates they know you in the context of a therapeutic relationship.

On a couple of occasions, I have run into clients in place where I least expected to see anybody I knew and I think we probably have both looked at each other like deer caught in the headlights. But the next time we saw each other in session, we talked about the chance meeting and how my clients would prefer to handle such a situation in future. For any therapist, regardless of the feelings they themselves might have at accidentally running into a client, their priority is ensuring that the client (or former client) can rely on their confidentiality being protected.

I hope this was helpful and good luck talking to your therapist!

Jassy

Confused and Loving Dad

2006-10-02T10:29:00.000-07:00

Jassy:

I've been divorced from my ex for a little while now, and separated for even longer (3+ years). We have a 4.5 year old daughter together, and from the beginning of the separation, my ex has been dead set on having full physical custody of our daughter. I spent about a year fighting it, but after getting the same story of failure by a father to get custody in this state over and over again, I relented and agreed to a visitation schedule.

At first I felt like I needed to spend every opportunity that I could with my daughter, but as time has passed, I've remarried, and we're expecting a baby very soon. I love the time spent with my daughter, but that time is few and far between, and when she's at the house, all activities seem to focus on her. I feel guilty if I'm not paying 100% of my attention to her, but at the same time, I feel guilty that everything else in my life that needs to get done is not getting done. Now my ex has moved and she and my daughter live far away. Before, it was a 10 minute ride between houses (we moved specifically to be closer to my daughter), and now it's over an hour. My ex and I have been attempting to negotiate a new schedule, but she wants a schedule that has my daughter with me for most of the weekend. I have suggested that I have her every other weekend, and an overnight during the week. My ex is exasperated that I wouldn't want to spend the whole weekend with my daughter, but I have a life, that 6 days out of the week doesn't include my daughter, and I need to maintain that life. However, I'm made to feel guilty for not wanting to spend every free moment with my daughter. Also, my ex has moved in with her in-laws and lives about 3 miles away from her parents and brother. My wife and I have NOBODY who lives nearby and have a virtually non-existent support system, so when my daughter is with us...it's only us who can take care of her. We know for a fact that my ex's in-laws and parents do a lot of babysitting for my ex. I don't think it's unreasonable to suggest that my daughter spend one night a week overnight during the week and every other weekend, but there's a part of me that feels like I'm being a horrible father. My ex fought and fought to be sole custodian, and now it feels as if she might have regretted that, as she seems to want to spend weekends without her daughter. How do I stop feeling guilty and get my life back? This can't continue, especially after my new baby is born.I love my daughter very dearly and treasure every moment I spend with her, but I don't think my new family should suffer as a result. It doesn't make anyone happy.

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Dear Confused and Loving Dad:

You are on a serious treadmill here, dear man. “How do I stop feeling guilty and get my life back?” This is the question that at some point or other most parents ask themselves and almost nothing brings that question up faster than a divorce. Ideally, your daughter would never have had to go through a divorce along with her parents. But this is not an ideal world. The reality is that there has been a divorce and you’ve done the best you can to be available to her, even down to moving to be closer to her. And it is also clear to me that you love her down to the bone. Soon she will have a sibling who will love and idolize her too, along with her father and new wife. In addition, your ex-wife has done a wonderful job of surrounding your daughter with family who will love her, spend time with her and care deeply for her. She has no shortage of loving care-givers.

The treadmill that you are on is a non-stop road to self-recrimination. If you stay on it, you will never ever come to a place of serenity in which you make peace with the fact that you are less than perfect. The idealized/perfect parent has no needs of their own, no faults, no problems and no imperfections. We all hoped for this from our own parents and were, of course, seriously disappointed. Part of growing up (and how we manage this task has a lot to do with how our parents handled their own feelings of inadequacy) is to realize that our parents had shortcomings, and that we still somehow survived magnificently at best, and intact at worst. Work on forgiving yourself, Confused Dad. Just that, forgive yourself. Then it won't be okay or acceptable in any way if your daughter and your ex-wife are angry with you or disappointed in you. Continue always to express your honest love and affection for your daughter. Make the moments that you do have with her count, whether it’s every other weekend and one night or one weekend in three. Be always respectful towards your ex-wife, no matter what gets thrown your way. Don’t get tied into trying to make people change the story they have in their head about you, regardless of whether it’s your ex-wife or your dear daughter. Their stories do not have to be your stories.

When it’s appropriate, you will have the opportunity to freely admit to all the ways you failed your daughter and apologize. For her part, as she gets older she will need to forgive you for not being perfect, both then and now. All parents go through this (and in my mind’s eye, I imagine my own daughter reading this and thinking, “Oh boy, ain’t that the truth!”) and learning to forgive yourself will enable you to step off that treadmill.

I have one big suggestion for you and your new wife. You need to find yourself a support system of other parents or caring friends. Ask one of your friends to set up 3 weeks of potluck dinners for you and your wife when the baby arrives. Hire a cleaner for the first few months if finances permit. Advertise on Craigslist for a new parent’s support group or put a sign in your local library. Put some thought into how you will make connections with other people. Form a babysitting coop for a few months down the line. Take these things seriously. Couple burnout is high when a new baby arrives as you will probably remember from your daughter’s birth.

Remember. Forgive yourself. Nobody else can do that for you.

Warmly,
Jassy

Hard Hats and Lingerie in Chicago

2006-09-30T00:27:00.000-07:00

Dear Jassy:

Okay, so this is embarrassing and humiliating. But I don't know who else to write to or talk about this with.

I work on a big construction site in Chicago. With the exception of a few girls who got hired on, it's me and a few hundred guys all putting this huge thing up, girder by girder. It's tough work, and sometimes it's dangerous. We all, girls included, wear hard hats, jeans and T shirts in the summer, and then switch out and add in flannel shirts and thick vests in the winter. Unlike all the other guys, I am not wearing boxers or Y fronts under my jeans, but women's lingerie.

I live in fear that I will have an accident and have to be rushed to hospital in an ambulance as they cut off my jeans and find my thong underwear. I sometimes have premonitions as I'm crossing over the construction site that something's going to happen, and find myself flinching. But I can't stop dressing up for work. I'm sure nobody would ever guess, as I'm Mr. Super Macho Man, swaggering around belching and farting like all the rest of the guys. It's not really me.

I'm not gay, I'm really not. I went through a phase where I was scared that I was and looked at some gay male porno just to see. It just looked painful and funny to me. Don't get me wrong - I don't have anything against homosexual men (or women either). I like women, and get turned on by women. But I don't tend to stick in relationships for long, because it's hard to hide the fact that I "dress." I've done this since I was a kid - used to wait until my mother would leave the house and then go look through her cupboards and drawers. It's kind of like I feel all the pieces of the jigsaw fit together right when I'm dressed in women's clothes.

I guess I don't exactly know what my question is. I feel like a screw-up. I'm tired of living with this constant fear of being found out. Got any suggestions?

Signed: Hard hat and a thong in Chicago

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Dear Mr. Hard Hat:

First off, I have heard stories similar to yours from men working on construction sites, so it is not as unusual as you might think. Like many crossdressers, you have picked an extremely manly profession - one in which nobody would ever suspect you of being anything less than completely manly, a "man's man," a masculine man! Interestingly, researchers estimate that approximately 1% of men in the USA crossdress, so you're in very good company. Like you, they just don't talk about it. And therein lies part of your problem - you are very isolated and isolation can easily breed self-hatred and destructively avoidant behaviors.

So, Mr. Hard Hat, you need to educate yourself.

You're clearly comfortable online, so I suggest you get hold of a basket of books - you can order through Amazon if you don't want to walk into a bookstore or library . Peggy J. Rudd's book, "Crossdressing With Dignity: The Case for Transcending Gender Lines" might be a good place to start. You can also check out some of the online information and support sites for crossdressers. For example, take a look at the website of the Chicago Chapter of Tri-Ess which is a support group for cross-dressing men (and their girlfriends and wives if they have them.) In order to feel better about yourself you need to learn more about cross-dressing. You need to understand the myths about crossdressing and the realities.

In fact, let's start with some of those myths, shall we? First off, most crossdressers are not gay. The majority are red-blooded, heterosexual men who just happen to like wearing women's clothes from time to time. Crossdressing and gay drag queens are not synonymous.

Crossdressing frequently starts very young and it's extremely rare for men to begin dressing in their adult years, so you're like most other crossdressers in that you got interested in your mother's clothes when you were young.

The American Psychological Association does not believe crossdressing to be pathological behavior and current theory has it that crossdressing can't be cured. In fact, the failure rate for therapists trying to "cure" crossdressers is apparently abysmal so, to my mind, the primary goal of therapy is to help the client begin to come to terms with their crossdressing and make peace with themselves and their identity. Whether you find yourself less interested in crossdressing as a result, or clearer on the part you wish "dressing" to play in your life, my suggestion for you, Mr. Hard Hat, would be to do the same. Most crossdressers who come into therapy come because they are weary of hiding themselves, tired of feeling so at odds with the world and their identity. So therapy will not change your desire to crossdress, but if you find a good therapist it will help you to understand your desires more completely.

As for finding a girlfriend who will understand? Well, I suggest starting with understanding yourself first. There are plenty of women who will accept and love men who crossdress if you can be honest and upfront about who you are. But it starts there, Mr. Hard Hat. Like many crossdressers, threads of shame, humiliation, fear of discovery and compulsivity appear in your email. Life will be a lot more manageable if you aren't struggling with those heavy hitters! Plus, how can you expect somebody else to love and accept you if you are struggling with those very same issues yourself? Start there, Mr. Hard Hat. Like the L'Oreal commercials say, "You're worth it."

Best wishes,
Jassy

Lacking Confidence in Florida

2006-09-29T15:06:00.000-07:00

Dear Jassy:

I've been reading your blog for a while now, and have wanted to post but feel like my concerns are probably peanuts compared with the problems that some of your readers and patients are probably experiencing. What prompted me was the example you gave in your blog yesterday about the treatment plan for the person who couldn't stand up to their dad. That leapt right out of the page at me and I wanted to know if you had any suggestions for my situation.

I don't know what the clinical terminology is for what I have, but I guess you could say that I'm very shy and lack confidence. I'm 30 years old and I grew up in a small town in Florida with a family that isn't good at handling feelings. My dad is definitely the man of the house, and my mom is almost a stereotypical housewife - she works part-time, and has raised us kids (I'm the oldest of three, but the only girl). My dad's word is law and always has been and even when mom doesn't agree with him she'll stick up for him. She's always making excuses for the things he does and says. If my family were a schoolyard, he'd be the schoolyard bully, always puffing himself up and singling out the weakest one. I feel like I've spent my life avoiding him, trying to make myself small enough so that he won't pick on me. Don't get me wrong - he doesn't hit us, never has. But he doesn't need to. He has this way of looking at you that makes you shrivel and he is constantly angry, although it leaks out sideways and you never know when it will come in your direction.

I'm shy in groups, and am allow myself to be controlled by what I think people will think of me. I always assume the worst, and second-guess myself all the time. It stops me doing anything, because I'm convinced I'm going to fail, so what's the point. This would be easier to come to terms with if he had been outright mean, but it was more that he put us down, particularly me as the only girl (although he didn't always treat my Mom that well either.) I easily feel diminished and put down by people I hang out with - it makes having a boyfriend almost impossible. I'm just too scared I'd pick somebody just like my dad, so it's easier to stay single.

I've ended up in a job I don't really want to do, because I worry that my father will disapprove if I change career paths. I don't have friends, because I find it hard to trust people (and even harder to like them.) I bought a house I didn't really want to buy, but because it was close to my parents and my father said it was a "good deal." I live in a neighborhood I really don't like for the same reason. He's just too much of a bully to stand up to, so it's easier to adopt his dreams for me than to fight back against him and have my own. I just shut down around him as a way to deal with his non-stop telling me what I want to do, what I want to eat, where I want to live and how I should dress. He controls my mother this way too.

When I read back over this, I sound awful - like some kind of freak. On my good days, I can tell that I'm a good person. I'm very kind, thoughtful and caring. It's just that I can't always get in touch with remembering these things about myself.

I want to have a bigger life. A better life. One that I can feel happy in. Do you have any thoughts about my situation and how to change it?

Signed: Lacking Confidence in Florida

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Dear Ms. Confidence:

Your email requires a lot of detailed response, and if I were your therapist I would definitely want to explore all the ways in which being raised by your parents had impacted your ability to make decisions and feel good about yourself. However, for the purposes of this one email response, I don't want to jump in and give you advice or tell you what you should do, because I'm guessing you've been told what to think, what to feel, what to say and how to act most of your life and I suspect any attempt to do that would go over like a lead weight (and I was going to say "like a fart in church" but didn't want to offend any delicate sensibilities amongst my readers!).

If you are 30 years old then your father is probably somewhere between 48 and 60 years of age. He's lived more than half his life already, and hopefully at least some part of it has been the life he wanted. You, on the other hand, are living the life your father wanted for you, and it does not sound to me as if you are enjoying it very much at all. You have two choices. You can continue to live the life your father has chosen for you, and be unhappy. Or, you can start to make your own choices, deal with the fall-out from your father, but have a life that is more in line with your own values, wishes and desires. It really is up to you. If you pick option one, you pretty much know what to expect. However, option two will need some careful planning.

What I am going to suggest is that you carefully and slowly, taking your own sweet time, find a way to envision the kind of life that you would want to live - not the one that your father wants you to have, but the one that would make you truly content and happy. Remember - take this slowly, Ms. Confidence. It's going to take you quite a while, as you will need to get very particular in the details of your vision. To start with, close your eyes. Imagine you are sitting on a chair in the middle of a room. This room is in the house you live in, but not your current home. It's the home you don't yet live in, but will want to ultimately. As you slowly begin to see yourself sitting on the chair, start by describing the chair you are sitting on. Is it a hard wooden seat with a straightback? Is it a soft cushy armchair, with squishy cushions and pillowed armrests? Is it a Papasan chair, made from willow? Once you have the picture of the chair, go on to imagine the room you are sitting in. Which room is it? Kitchen, living room, bedroom or maybe you're sitting in a hallway? Imagine that you have opened your eyes and are looking around the room. Would it be small and cave like? Open and light? Just one large room with all your furniture and belongings around you? Do you imagine stairs leading to the second floor, or are you all on one level?

As you try to day-dream about this, you may find yourself resisting it and you may experience feelings of frustration. That is natural. You have not had free rein over your imagination for quite some time, so it will take a little while for you to feel comfortable and confident back in the driver's seat. Just keep breathing, and keep thinking about the feeling and ambience of the room you're in. Now imagine that you're standing up and walking around your house. Keep noticing the kind of house you're in and remember that you can create it to be exactly what you want it to be.

When you feel that you have a sense of the house, go to the front door and walk out. Take a deep breath, and with your eyes still closed, imagine what you see when you open your front door. Are you surrounded by trees, fields and countryside? Are you on a busy urban street? Are there people waving hello to you as you open your door or are they busy with their own lives not paying attention to you? Drink this in. Notice what feels happiest to you. Start to do this visioning with every part of your life - after all, how on earth can you change your life unless you know what you want it to look like? Think about how you would like to spend your evenings: do you want to go camping and hiking? Maybe dancing? Learn a new dance step? Or maybe a new language? Just keep writing down all the things that you'd like to try to learn, or have fun doing. Nobody is going to commit you to anything. You're just experiencing possibilities at the moment, mulling over potential interests, not committing yourself to a course of action.

If you are comfortable with writing make sure to write down all the things you figure out about the place you want to live, the people you want to live with or near, the kind of environment you want to live in and the kind of community you seek for yourself. Keep adding to it until you can practically taste it, until you can truly see it. Look for photographs in magazines that look like the kind of place you want to live, articles about things that matter to you, values you hold and keep them all in the same place with either your hand-written journal, or print outs from your computer the life you want and where you want to live it. Nobody, but nobody else will be able to do this for you.

Neither your father, nor I, nor your best and closest friends know what is best for you, or what kind of life you should have. You have the right to self-determination. You are entitled to make decisions that may not be the ones that I or your father, your mother, your friends etc., would choose. But you have the right to make them anyway. You even have the right to make no changes at all and to leave your life exactly the way it is. Just remember that it will be hard at first to come up with your own plan for your life - you are going to be stretching muscles that you haven't had to use in a while.

So, am I going to suggest that you cut the cord with your father? No. It would be pointless of me to advocate for that. Only you can know what's in your best interests. But I am going to encourage you to create a vision of the life you would really love so completely that you cannot bear not to be living it.

The next thing you could do, if you felt like it, is get hold of a copy of Brad Blanton's book, "Practicing Radical Honesty." There is a chapter in there on figuring out your "life purpose." It is one of the most useful exercises I've ever done. (If you don't have money for the book, email me your address and I'll photocopy the pages for you - Brad won't object, I'm sure.) Do that exercise as many times as you have to until you can really picture what your purpose is in the world.

At the point when you can see, taste and feel the kind of life you want for yourself, go see a therapist. When you start to put your life plan into action some pretty heavy duty feelings are going to come up, and you will need supports in place to help you deal with them.

First things first. You need to know your purpose AND the kind of life you want. When you've figured that out, you're onto the next place. So, Ms. Confidence, what do YOU want to do?

Best wishes to you,

Jassy

Frightened of Failing Therapy

2006-09-26T06:00:00.000-07:00

Jassy:

I value your opinion as someone who has journeyed through counseling & someone who has "studied" counseling. I need your advice & wisdom. Today in therapy, my therapist said that we need to "re-look at the treatment plan and re-evaluate: see which goals have been met and what new ones can be created". (I THINK she mentioned new ones.) We completed the original treatment plan in 7/04. It has really not been mentioned much. This freaks me out. Am I failing therapy? Am I not working hard enough? (Please don't say, "why don't you ask your therapist?"-that will piss me off.) I think i MIGHT bring it up, but that is 11 days away, but besides that, what do you think? Is she going to kick me out? Am I too dependent on her? Am I not needy enough? Why did she decide on this particular day to say we needed to re-evaluate? She told me I should journal about "why I am choosing to stay stuck; safe vs. unsafe." This was after I shared for the second time this entry I wrote around 8/15ish "Now if I don't want my life to continue as it has been, then obviously I need to make some changes..." and I listed 7 things. We briefly talked about the need to do something different, and about the quote "Mental Insanity equals doing the same thing over and over again, expecting the same results."

Spill it and preach it.

Frightened of Failing Therapy

PS: I am going to sleep on it tonight whether I should ask her for a copy of my original goals (I know I should have it but....), and whether I can see her earlier instead of waiting 2 weeks, because I am really freaking out. I know I need to create attainable goals. But I don't know...in therapy do you do SMART goals like in the business arena???? I am going to go through my therapy journals from the last 2 years. I am going to talk about what positive steps I have taken as a result of therapy, and what negative steps I have taken because of/maybe not because of therapy; and think about new goals I can work on.

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Dear Frightened:

Wow, you really do have yourself in a tizzy here, don't you? I apologize for taking time to respond to your email and yes, of course I am going to suggest that you show the email you wrote me to your therapist. I don't know you inside out like she does, and therefore can't possibly respond with as much insight about you as she would be able to. Go on! Take the bull by the horns and risk it.

However, for what it's worth I will respond to your "spill it and preach it" invitation.

First of all, you can never fail therapy. Your therapist can fail you, but you can never fail. Just by showing up week after week, you show your willingness to make changes.

Let's start by addressing the purpose of treatment plans in therapy. Some therapists, as part of the early work in your therapy, formulate a treatment plan with input and guidance from the client. When used correctly, a treatment plan is a kind of road map for the work that you will do with your therapist during your course of treatment. The therapist, and the client, will use it as the beacon that lights the way for it contains the goals, aims, objectives and ways in which you are planning for your recovery. The treatment plan will often inform all the work that you do with your therapist and is YOUR definition of the ways in which you want your life to change. This plan will include what you are choosing to work on ("I don't know how to stand up to my father. I want to learn how to do this"), what you will do to work on it ("I will identify in therapy the specific things that scare me about standing up to my father. I will identify various ways to practice standing up to my father and work on the feelings that come up as a result, using role play, talking to my therapist about my fears and reading books suggested by my therapist "), and how long you think it will take to do this ("I will use these techniques over the next 3 months and re-evaluate the changes in my relationship with him at the end of that time"). Sometimes they address specific tasks such as consulting with a psychopharmacologist about medication, sometimes they make suggestions about groups to join or meetings to attend. Treatment plans seem very hard and fast, but actually they most often are used flexibly as things get worked on and problems figured out, and also as new issues emerge. Some of the goals may be long-term and some short-term. But the point of the plan is to concretize the direction of the therapy and to make clear what you, the client, hope to get from all your hard work.

Okay, so onto your fears. If you are clear that you and your therapist worked on the original treatment plan together and as you say it has not been mentioned since, my guess is that you met all your goals. This is a good thing, not a bad thing. Give yourself a pat on the back for all your hard work, Ms. Frightened! As goals are identified, worked on and successfully treated, you will move onto the next goal. I suspect this is what your therapist is referring to when she talks about identifying which goals have been met. More than a performance review for you, it's more like a strategic planning session for you and your therapist. Actually, it sounds like you already have plans to do that for yourself, based on your statement that you are going to "go through my therapy journals from the last 2 years. I am going to talk about what positive steps I have taken as a result of therapy, and what negative steps I have taken because of/maybe not because of therapy; and think about new goals I can work on." You are clearly a pro-active kind of client , and this is wonderful - we therapists LOVE working with folks like you!

The insecurity that you display about your relationship with your therapist could probably benefit from attention. For example, unless you are (1) threatening your therapist with physical violence (2) not paying him/her or (3) repeatedly cancelling without notifying her, then it is highly unlikely that you are going to be "kicked out" of therapy. Tell your therapist about your fears. No doubt this isn't the only place in your life that you fear rejection, but it does give you a safe place to work on these feelings so that they have less power over you in your life.

I'll be rooting for you, Frightened!

Jassy

Girlfriend with Jealous Lover

2006-09-24T22:10:00.000-07:00

Dear Jassy:

I am a graduate student and, while doing an internet search, turned up your blog site. I know that you don't provide therapy in your blog, but you did say that you answer people's email questions and so I have a question for you. I'm a lesbian and have been involved with the same woman for the last 5 years. I'm 27 years old and she's 28 years old. We are very committed to each other and would like to spend the rest of our lives together. (Unfortunately, unlike Massachusetts, our state does not allow same-sex couples to get married.) My girlfriend is a wonderful partner. She's very loyal, devoted and we get along really well, despite having different interests. Where we are similar is that we want the same things out of life. Most of the time I'm really, really happy with her. We live together, with our dogs, contribute fairly equally to the household budget and see the same things as important in life - paying bills on time, having good food in the house, and spending time with our dogs and our human friends. From the outside, everything looks wonderful and we are, most of the time very happy together. The first year that we were together was just great. She said that it was the first time in her life that she had ever felt safe, and that she felt drawn to me because of this.

The problem is that after the first year, my girlfriend became more and more jealous. From having talked with friends, I think it goes beyond normal jealousy. Despite the fact that I have done nothing that deserves her jealous actions, she doesn't believe that I'm not going to cheat on her. She has a hard time with my close friendships. She has sneaked into my study and read my journal. She gives me a really hard time if I'm late home, and sometimes has shown up places when I tell her I have appointments. She frequently moves her schedule around so that she can be there when I come out of school in the evening, and is always showing up unannounced at the restaurant where I'm waitressing my way through graduate school. Sometimes she's opened my personal mail, and says that she was in a hurry and didn't pay attention. If I spend any time online, she's convinced that I have an internet romance and is constantly complaining about the time I spend doing internet research for school, or replying to my emails. I'm sure this jealousy has something to do with her own history. Her dad cheated on her mother and left them when she was quite young, and she's had other girlfriends cheat on her quite a few times before.

I would feel differently if I had something to hide. But I don't. I've never cheated on anybody. However, this behavior is crazy making. I'm beginning to feel crazy and dishonest even thought I haven't done anything to feel guilty about! I've noticed myself feeling more protective of my privacy, feeling resentful at her blaming me for things I haven't done and feeling like I don't want to share things with her because she doesn't trust me anyway!

I know that you're going to say I should speak to a shrink, but I don't have health insurance at the moment, and I can't afford to see a therapist until I finish school and have a job. In the meantime, have you got any suggestions for how to handle the situation with my girlfriend? I really love her and don't want this to come between us. I've tried talking to her until I'm blue in the face, and nothing seems to work. Every time I talk about it with her, she just says she loves me so much and she thinks I'm going to leave her for somebody else. Please, help!

Desperate Girlfriend of Jealous Lover

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Dear Desperate Girlfriend:

The first thing to be aware of is that love and jealousy are not synonymous. Your girlfriend is mistaken when she equates the two as equal. This is not to say that she doesn't love you - based on your descriptions, the connection that the two of you share and the life you have created together is clearly real for both of you. However, her attempts to desperately clutch at you have their origins in something other than the experience of love. Based on what you say, they are more based on her experience of loss of love. Unfortunately, if she keeps this up, her behavior may, eventually, have the effect of driving you away, and create exactly the thing that she may most fear. (Please note: You haven't mentioned domestic violence, so I'm hoping that her jealous behavior is not accompanied by violence or physical aggression. If domestic violence is present in your relationship, I recommend that you immediately contact your nearest domestic violence hotline and ask for a list of resources in your area. They usually offer free counseling which I would recommend you take advantage of. They will also help you make a safety plan. Everything else I'm about to write is based on there being NO physical violence in your relationship!)

Many people in committed relationships report the occasional feeling of jealousy, and some jealousy is normal and understandable in any relationship. Usually, these jealous feelings have their origins in our insecurities, after all very few of us feel 100% confident about our appearance, our intelligence, our sexiness, our loveability or our value. Most people can tell that their experience of mistrust is not rooted in anything rational, and are able to figure out ways to soothe themselves, and calm these feelings down. The difference between most people and your girlfriend, however, is that she is unable to tell that her behavior is irrational. For people this jealous, they truly believe that there is something to distrust and I'm guessing that no matter what you say you cannot convince her otherwise. This kind of jealousy borders on obsessional and normal ways of coping do not generally apply.

Locked inside the jealous lover's jealous feelings and behavior is the source of the jealousy and distrust. You wrote, "She said that it was the first time in her life that she had ever felt safe, and that she felt drawn to me because of this" and you also told me that her father had left her and her mother when she was a child You also wrote that she had experienced several infidelities in her lifetime. Now here you are. Finally, somebody she can trust! Unfortunately, the specters of the past come back to haunt us. The very thing she craves, the stability of constant, responsive and reliable love and companionship, is the very thing she is unable to trust. This kind of obsessional jealousy is destructive, for it does not respond to reason or reassurance. Added to this, it's hard to remain long-term in a relationship with somebody who is very jealous - people frequently describe it feeling as if they live with a third person in the relationship, and that third person is a tyrant.

First of all, there are several excellent books you can read on the topic. Although they describe a complex human topic, they are easy to read. The first is "Overcoming Jealousy and Possessiveness" by Paul A. Hauck. The second one is "Overcoming Jealousy" by Dr. Windy Dryden. If money is tight, ask your local library to order them for you. I strongly recommend that you do this, particularly as you don't have access to health insurance or a shrink at present. (If you email me with your location, I can see if I can drum up some resources for you in your town or city.)

Secondly, you say talking to your girlfriend hasn't worked. If you think talking to her won't work, consider writing her a letter. You can hand this to her and ask her to read aloud to you. Some people who won't respond to talking, will respond to visual information. Either write or tell her that you are very upset about the way she treats you as a result of the jealousy and possessiveness that she feels. Explain carefully, using "I" statements, what you feel when she accuses you of being untrustworthy, including that you love her and feel scared by her behavior. Tell her that you are educating yourself about jealousy, what it is, why people feel it and how to respond and that you are going to change how you respond to her in future. Your girlfriend clearly needs a great deal of reassurance, so please - tell her often throughout this conversation that you love her very much and you are not leaving. You need her to understand that you cannot continue like this and that this dynamic in your relationship needs to change. Explain that you are going to start taking responsibility for how you feel about her accusations and you hope that she does the same in order to create more stability, happiness and calm in your relationship.

Thirdly, ask your girlfriend for a short list of things that help her feel calmer. Does it calm her down if you call when you're going to be late? How about having an idea of your schedule so that she can feel more confident about your whereabouts? Are there things that she would like to hear from you that would reassure her? Once you have the list be honest with her about the things that you can and can't do. For example, if she says, "I want you to call me every half hour to tell me where you are, and who you are with" you have to decide whether that feels reasonable to you. (Hint: It's not.) If it's not reasonable, decide what IS. Be clear with her. "I won't do that, however I will call you in the morning and afternoon to check in with you and tell you about my day and see how you are doing." Be clear about what you are capable of. If you are going to promise to do something, you have to be absolutely certain of your ability to follow through.

Fourthly, tell her that from now on you are no longer going to respond to her accusations of infidelity and dishonesty. Tell her that despite what jealousy may whisper in her ear, you are a faithful, trustworthy and loving partner. Say, "Because I know that I am not the person you accuse me of being, if you accuse me of cheating or lying in the future, I'm going to either hang up or leave the room because I love you and myself too much to respond." Dr. Paul Hauck says that another way of explaining this is to say, "I love you enough to want to stop you from becoming the sort of person I can't tolerate." Then do it. If she starts to whine because you didn't answer your cell phone when she called you 10 times, smile and tell her you love her, and leave the room. If she clamors at you for "proof" of where you were today, smile and tell her that you love her, and leave the room. You are going to have to start "taking your sails out of her wind." Just because she's blowing, doesn't mean you have to go sailing! You mention that you have talked to friends about this. Tell them about your strategy, and ask them if you can call them if the going gets tough. It's stressful living with a jealous partner, so figure out ways to de-stress, whether this is spending time with friends, taking the dogs for a long walk, cleaning the bathroom or taking a bath. Find ways to de-stress and calm yourself down.

And yes, you're right...I am going to suggest that you try to figure out a way to meet with a therapist. Many towns and cities have free or low-price (but not low quality) mental health clinics. So, please be aware that this response to you is no substitute for a few sessions with a good psychotherapist. The suggestions I have made, along with the books, are not going to solve the whole problem. Your girlfriend has to buy into the idea that her behavior is a problem in the relationship in order for her to begin the process of changing it.

Good luck and keep me posted on your progress.

Jassy

Therapy Dog (in the fur!)

2006-09-10T00:20:00.000-07:00

It appears that "Therapy Dog" has a small fan club, or so it would seem judging by the number of emails I've received asking for a photograph. So I here present, for your viewing pleasure, a photograph of Ziggy Stardust Timberlake, aka "Therapy Dog."

Who could resist that underbite?

I'm ba-a-ack!

2006-08-22T12:41:00.000-07:00

I've returned from vacation, and will be in my office tomorrow. It's always hard to end a vacation, but it definitely helps if you enjoy the job you are returning to. This particular vacation was helpful in that I realized I don't take enough vacation, and that I need to set aside more healing time for myself in order to have more to give in return to clients.

Meanwhile, having checked my phone messages upon my return, I discover that the telephone voicemail is full. Among the calls I received were:

* Several phone calls from clients checking in on me and asking for call-backs when I get back to town

* Beth from Computer Geeks (again) telling me about their fabulous service based here in Watertown (I haven't yet called her, given that I have "Computer Rick" and don't need Beth, with or without her "geeks!" )

* Verizon Wireless DSL trying to persuade me to sign up for service. I had DSL before and it didn't feel that much faster than dial-up...leastways not enough to make up for the fee differential.

* A couple of clients who decided that they were ready to return to therapy and when could I fit them in?

* 6 calls from prospective clients who would like to come in for couples therapy. One person asked if I worked on Saturday. That stopped me in my tracks. I don't think I know of a single therapist who works on Saturdays. Then I remembered that I used to work on Saturdays many years ago - but there wasn't much call for it, so I stopped.

* Several phone calls from clients who wanted to change their appointment time.

* Sundry calls from other therapists and psychiatrists checking in on mutual clients.

Today was my first day back in town. Despite the fact that I wasn't officially working, I did return calls (in the order in which they were received).

I also spent 3 hours at the dentist's surgery while my granddaughter got veneers put on her two front teeth which had snapped in half during a bicycle accident while I was on vacation. Her teeth have now gone from large, buck toothed and crooked to perfectly straight and average sized. Ah, the wonders of modern dentistry! What was not pleasant was listening to her screaming from the other side of the building...apparently, she spotted "The Needle" despite having been told to keep her eyes closed. These loud and terrified screams came despite the fact that she had previously been giggling up a storm on laughing gas...I dread to think what would have happened if she hadn't been sniffing the gas.

Anyway, it's good to be back.

Time Passing Incrementally

2006-08-15T20:46:00.000-07:00

For people who are finding this blog for the first time, I normally spend a fair amount of my time writing blogs about being a psychotherapist and my ideas about psychotherapy. For now, I'm on vacation, so the blogs have a strong non-psycotherapy tinge to them!

In the meantime, Dori got tagged by a friend, and I liked the "tag" a lot so I thought I'd copy the questions and answer them. I really love questionnaires, probably because asking questions is my stock in trade. It's fun to have the tables turned on me and be the person who gets to answer the questions for a change! The other thing that is fascinating about this list of questions is that, as a psychotherapist, I'm used to my days being parcelled out in 50 minute session chunks. To think in smaller and larger units of time is interesting, and makes me realize how compartmentalized my life is by these 50 minute units!

1. What were you doing one second ago?
My car broke down when Kathy and I were going to take it on a tour around the Berkshires the other day. Today, having called AAA to come and jump-start it, I drove the car to a Saab dealer in Pittsfield. This is a way of introducing the fact that one second ago I was talking to my "spousal unit" on the phone, who was inquiring how long it would take for Performance Automotive in Pittsfield, MA to repair my car. (My car won't be back until Thursday or Friday so no leisurely touring through the Berkshires with the convertible top down, singing loudly as we like to do!

2. What were you doing an hour ago?
One hour ago, I was sitting outside in Kathy's yard, with Ziggy and Jack playing chase in the long grass, watching Kathy's chickens peck at fruit and vegetable peelings in their covered pen. They are so fun to watch. She has several different kinds. Gigantic Delaware roosters, with white feathers on their body, black speckling on their heads, huge red coombs and wattles and a very proud bearing. She also has Bantams, little white darting things with feather trims on their legs and claws. There are also Red Sussex, a British chicken, with mottled feathers and glossy tail feathers.

3. What were you doing yesterday?
Yesterday, I was writing letters, and reading a book on Growing Local Communities. In the afternoon, I drove into Northampton, while Kathy took a nap and Dan, her husband worked in his home office. I had an amazing massage with a wonderful massage therapist, Valdene Etter. (Today I'm sore. My neck muscles were tight and knotted and she worked them into a pulp!)

4. What were you doing a month ago?
Okay, this is getting harder. How to answer this question? A month ago on this date? That would have been July 15th. This means that I was seeing clients in my office in the morning and early afternoon and evening until 8pm. In between seeing clients, I was probably having lunch at home and playing with Ziggy.

5. What were you doing 1 year ago?
One year ago on July 15th, I was probably doing the same thing as above!

6. What were you doing 5 years ago?
I was working at The Family Center, Inc. in Somerville, MA. Tuesdays were nearly always Parenting Journey days, so I would have been getting ready for an evening group, setting up the room and having a planning session with one of the other co-therapists.

7. What were you doing 10 years ago?
In 1996, I was running a lot of therapy groups, including body image groups for women. My daughter would have been 19 years old and my granddaughter was not even a twinkle in her eye. How strange to think of a time without my beloved granddaughter!

Online Therapy Developments

2006-08-14T22:14:00.000-07:00

One of the things that I'm working on while I'm on vacation is the development of my online therapy site. I now have a super-duper web designer, Sheryl Heiser , who has been doing fabulous things with my website design. Most of the text for the pages has been written although, as you might imagine, a website is always a work in progress. I'm not usually a procrastinating prevaricator, but putting this website online has taken a phenomenal amount of time. This is in part because I want to make sure that I'm totally prepared to provide therapy online that is as professional as possible, and creates as comfortable an ambience (within the limits of any online experience that is) as I provide in my face-to-face office environment.

As I begin the task of working with my web designer, I find it fascinating to think about how I'm going to provide the kind of welcoming and safe space that I strive to achieve offline. In my office in Watertown, MA, I can achieve that with plants and soft cushions, with muted color schemes and a comfortable couch. Creating a website that evokes a similar feeling is difficult. Here's an example of the obstacle I'm facing. Sheryl sent me a couple of mock-ups of possibilities for the site design and although both were beautiful, only one of them came close to achieving the feeling of serenity and peace that I was looking for (no spoilers here, folks!). The one that I turned down, while beautiful in its own way, did not create a feeling of safety and stability. The photograph on the home page was a woman floating in the ocean with her back to the camera and in clear focus. The water is a beautiful, mediterranean blue and on first viewing, it looks almost like an advertisement for a Paradise vacation spot. However, looking over her shoulder, you can see the awe-inspiring sight she is staring at. In front of her is a huge wave, crashing first on the rocks, and then exploding in white foam.. The wave is in soft focus, but it's in direct contrast to the calm waters in which the woman is floating. The foaming water looks ominously like an approaching Tsunami, not exactly a reassuring image to somebody seeking therapy online, who may already feel like they are facing an emotional metaphoric Tsunami of their own in real life.

It's a tough challenge to create a website that evokes all the things that therapy online aims to provide. A safe place to talk to an experienced mental health professional, at a time that is convenient for you, in the comfort of your own home, trailer, airplane seat, back yard, sail boat or wherever you may wish to conduct therapy online. Once the site goes up, I will be excited to hear feedback from folks letting me know if my objective, under Sheryl's excellent and inspired design implementation, has been achieved.

Psychotherapy Questionnaire

2006-08-09T16:32:00.000-07:00

I got tagged via email from a fellow psychotherapist. I'm supposed to answer these questions from the perspective of being a shrink. (I'll do this as well as I can, given that I only have 3 days to go before I'm on vacation for 8 days!)

1. I've never: given up on a client, unless I'm clear that I lack the skills and/or experience to truly help them.

2. If only: there were more hours in the day and I didn't need to sleep. I really and truly love being a therapist and wish it wasn't so darned exhausting. Sometimes I have to stop because I've run out of hours, but I haven't yet run out of a desire to listen. Oh, and another "if only" is "If only it were okay to call a former client up after a couple of years and say - So, how's life going? Are you okay?" Sometimes it's hard to have people leave and never know what happened to them.

3. Once, somebody told me that: the most important thing about being a therapist is to bring your authentic self to each session. Clients can see right through artificiality and NO good therapy will happen as a result.

4. It would suck if: I hurt a client as a result of bad therapy. I don't think it's happened yet that something I did caused actual, long-term emotional harm. I don't think I could sleep at night until I had made attempts to rectify that.

5. My feelings would get hurt if: I had a less cast-iron ego.

6. I kinda wish that: I had a magic wand. In therapy, I will often ask clients, "If you had a magic wand and could magically change this situation (substitute "this relationship, this child, this husband/wife") how would it look?" While it's a reach for some people to access magical thinking, most of us can imagine and feel the sense of relief that comes with the powerful sense of having a "super hero" tool, such as a wand.

7. The best thing that happened in a session: would be hard to pin down. There are so many times when I can see that a client's life has moved forward with a big leap or even a small stumble and all of these times need to be celebrated. Overall, I think the best thing that ever happens in a session is that a client has the guts and the bravery to show up. It's really tough work and kudos for anybody brave enough to turn up week after week to tear the scab off emotional wounds.

8. The best thing that could happen in session: is a realization on the part of the client that it was worth it to show up that day.

9. The Psychotherapy profession needs: more and longer clinical training, more clinical supervision, and a greater focus on therapists healing their own family of origin hurts.

10. The Psychotherapy profession could do without: inept therapists, untrained, and using hokey, unscientific, untested and invalid clinical/therapeutic concepts which waste a client's time and money.

Blogging About Books

2006-08-07T00:09:00.000-07:00

I just got "tagged" by a sister blogger so, in answer to her tag, here goes:

One book that changed your life:
I can't think of one single book that has changed my life, but many books have affected me. Charlie Deutsch's book, "Broken Bottles, Broken Dreams" which is about how alcoholism affects families, particularly adult children with respect to birth order, made me see my life and my childhood in a different way and was responsible for changing the way I conducted my relationships with my siblings and my parents. Marge Piercy and Mary Oliver's poems have been transformative for me. But I think "Practicing Radical Honesty" by Dr. Brad Blanton has been one of the books that has most profoundly affected the way I relate to other people and the personal standards I set in my life around truth-telling and honesty.

One book you have read more than once:
I have read many, many books more than once. Yalom's book on Group Psychotherapy is a book I refer to constantly. Millon's book, "Disorders of Personality: DSMIV and Beyond" is one of the best psych books I've ever read and I find his classification of personality disorders more useful than any other book on the topic. I also love "Jane Eyre" by Charlotte Bronte and cry every time I read it. I've read Louisa May Alcott's "Little Women" and the subsequent books more times than I can remember. But J.M.Barrie's "Peter Pan" must top the list. I read this almost daily as a child and longed to be magically transported, via the magic of fairy dust, to Neverland.

One book you would want on a desert island:
I can hardly bear to imagine what life would be like without a neverending supply of books. The idea of being relegated to one solitary book is painful and almost makes me gasp to think about. I guess it would have to be Marge Piercy's book, "The Moon is Always Female." The poetry is uplifting, spiritual and she speaks with such a clear and powerful voice.

One book that made you laugh:
"Good In Bed," by Jennifer Weiner.

One book you wish had been written:
The #1 New York Times bestseller, "The Jassy Timberlake 100% Fool-Proof Way to Find True Love and Happiness and Create Intimate Lasting Relationships" available wherever great books are found!

One book you wish had never been written:
I can't think of one. I think that all books, even supposedly hate-mongering ones, serve a purpose. I'm anti-censorship and believe that people have the right to make their own minds up about their values and beliefs.

One book you are currently reading:
Wow, where do I start. I'm always reading more than one book at once. Here's the list, and it depends on the time of day and whether I'm tired or not....

1. "Sinners Welcome," by Mary Karr
2. "Children of the Self-Absorbed: A Grownup's Guide to Getting Over Narcissistic Parents" by Nina W. Brown, Ed.D.
3. "Dress Codes: Of Three Girlhoods - My Mother's, My Father's and Mine" by Noelle Howey
4. "Bastard Out Of Carolina," by Dorothy Allison
5. "One Nation Under Therapy: How the Helping Culture is Eroding Self-Reliance: by Christina Hoff Sommers and Sally Satel, M.D.
6. "Broken for You," by Stephanie Kallos
7. "Stumbling on Happiness" by Daniel Gilbert.

One book you have been meaning to read:
"Authentic Happiness: Using the New Positive Psychology to Realize Your Potential For Lasting Fulfillment" by Martin E.P. Seligman, Ph.D.

10 Questions

2006-08-03T23:15:00.000-07:00

Here are ten questions I got sent via email. I LOVE getting questions in the mail, or on the comments section so keep 'em coming!

1. So, as a newbie psychotherapist early in your career, what did you do immediately after seeing your first ever client?
I sat at my desk and cried for half an hour. I was help? I talked about this with my supervisor who told me that nearly all therapists feel like this early in their careers. When you start to see people's lives shift and change and see them getting mastery over their circumstances, you feel better about messing around in their lives.

2. What do psychotherapists not like to admit to?
We don't like to admit that we spent a whole session with a client and had no idea what was going on. It doesn't happen often, but it does happen. We also don't like to admit that we make mistakes, screw up or otherwise create messes for our clients. We do it. We just don't like to admit to it. I try to be as honest as possible in sessions, even going so far as to say, "I'm really, really confused right now. Help me out and repeat everything you just said, would you?" Unfortunately, sometimes even the repeat doesn't help.

3. What is the most challenging aspect of working as a psychotherapist?
The amount of background work you could do thinking about a client is endless. I frequently read information on their religion, the part of the world they come from, (even if it's "just" the US), their social class background, etc. I find myself thinking about my clients frequently, and if I'm worried about them for some reason, I've had dreams about them too. I get concerned that I won't be able to get creative enough, fast enough, to help them through a really tough patch in their life. ("Lighten up, Jassy!")

4. Do you ever dread going into your office in the morning and have you ever cancelled an appointment because you were dreading going into work?
I've had days when getting up and going into work has been hard. This is usually more to do with what's been going on in my own life, and rarely to do with my clients. On the whole I don't tend to cancel appointments, and on the rare occasions when I've been forced to cancel sessions, it has been something really unavoidable that precipitated the closure, i.e. my car broke down, our basement flooded or I had something disgusting and gastrointestinal. I figure if I can't stand the thought of going into the office, I should not be working with a particular client.

5. Is there one especially unique challenge with just about any client?
I would have to say that the hardest thing to communicate to just about any client is the concept of differentiation. I could write a whole blogsite which just focused on issues of differentiation, so it's going to be hard to address briefly here. But, as simply as I can put it, differentiation is about the ability of an individual to tolerate feelings of stress, tension and anxiety in a relationship with another, without losing sight of one's core self, without blaming the other person for your feelings: to learn how to self-soothe strong feelings that arise in the relationship; to learn how to hang onto a sense of autonomy in relationships without feeling flooded with feelings or getting overwhelmed by the other person's needs, wants and desires. The ability to differentiate in a relationship has to do with an individual's ability to manage the complicated dance between closeness and intimacy on the one hand, and separateness and autonomy on the other. Few of us learn how to do this as children, and most of us will spend our lives trying to figure out how to do this passably well. More in a future blog!

6. What do you think is one of the biggest misunderstandings about therapy?
I think that people misconstrue the idea of therapy as advice-giving and are surprised when their therapist holds back from doing that. And leading on from this, I think that a "comorbid" misunderstanding is the idea that the therapist is able to fix or cure their clients, rather than the therapist acting as a mirror in which the client begins to be able to truly see themselves, understand themselves and select their future path.

7. Is it important that the therapist be perfect?
No, not at all. How awful would that be to try and struggle with one's personal challenges in the face of an all-perfect, all-knowing, super-persona who can do no wrong? Yucky. What is important is that the therapist be honest, be real, be truthful and be willing to take responsibility for places where they aren't perfect.

8. Do some clients become jealous of your other clients?
I think the fact that the relationship between client and therapist is more or less doomed to end at some point is a really difficult and painful idea for people to think about as they become more invested in their therapy. After all.....doesn't everybody want to feel special? One thing that I have noticed is that when people have a regular appointment, they frequently become inquisitive about the people who come in before and after their particular appointment. Some folks want to ask lots of questions, or create stories about the other clients. I'm quite sure that it's frustrating to be told, "I'm afraid I can't answer that question." But also reassuring. If I won't give out any information about somebody else, then it's likely that I won't pass on confidential information about them either.

9. Have you ever been scared of a client?
I conduct an intake over the telephone, during which time I ask a fair number of questions about the client and their presenting problem, so I have a pretty good sense of who a person is. It's not impossible to fake being a psycho, but I trust the ripple of hairs on the back of my neck as a predictor of craziness. I must admit that I'm more likely to be anxious about men coming for their first appointment (they don't call it "The Dangerous Profession" for nothing) so I tend to sandwich new male clients in between other clients, and schedule the appointments for the earlier part of the day when there are more people in my building and also when the folks next door at Watertown Community Housing are still in their office space. The only time I was really scared before a visit was when an angry ex-husband of a client insisted on meeting with me. It turned out fine and I think the visit really helped stabilize things in the family, but it was scary contemplating his arrival, given that he was an unknown quantity.

10. Do you feel relaxed when you're with a client?
Most of the time, I'm just grooving on hanging out with my "peeps." I want passionately for my clients to have the lives, loves and relationships that they truly want and I get a kick out of watching them work their way towards that. Even when a couple is having a really tough time in a session, I nearly always can reach for a place of relaxed bonhomie. I try to maintain my sense of humor, which helps when couples are trapped in difficult and painful places with each other. As I have been known to point out, I don't have to live with them and so can afford to be relaxed! As I've written elsewhere on this blog, self-care is very important for therapists. Everybody has stress in their life and therapists particularly carry a full load, mostly other people's, but it's still considerable. A therapist who lacks the ability to set down that load regularly isn't going to be a great deal of help to their clients in the long-term.

Thinking About Your Therapist

2006-07-31T12:35:00.000-07:00

I received this email today, and asked permission to post it with my response. I agreed to leave the email address off to protect the blog reader's identity.

The Question:

"I've been in therapy for 2 years, so it's kind of interesting to hear from "the other side of the couch!" I have a question. If it is inappropriate or illegal to answer it, that's okay. I don't want anyone to get into trouble. I think about my therapist a lot. (at least 2x an hour) Not in a sexual way, meaning in a friendship way, wishing she was more a part of my regular life. I think this is because I have so much trust in her. I am always thinking, "What would G say in this situation?". What if G was watching me?" Is this normal? If not, what should I do so that I don't ruminate as much."

My Response:

The feelings you are describing are very normal and are experienced by many people who embark on therapy. However, explaining the therapy relationship is a difficult task. How do you explain a relationship in which one person gets to know your innermost thoughts and feelings more so than nearly anybody else in your life, and yet you know little or nothing about them? How do you explain the process of walking in through the door, and sitting down for an hour and talking with somebody about whom you know nothing, and yet feeling as if you could trust them with nearly anything? There are very few places in our life where the times we spend with a person are totally and completely focused on what is happening in our individual lives, with the express purpose of helping us to solve our problems and make our lives go smoother. Therapy is one of them. For those people who had less than stellar parental relationships, the relationship that grows with a therapist can also be seen as an opportunity to “re-do” that original nurturing relationship over again, to master what was out of our control back then.

In order for your therapist to be able to help you, sometimes you have to feel complex and often uncomfortable feelings. Withholding information from your therapist is not going to help you deal with this discomfort – sometimes the only way out is through. In other words, be willing to tell your therapist things that you would not ordinarily tell another person. In this particular case, I would suggest taking the bull by the horns and sharing either your email, or telling your therapist what you are feeling. I understand any possible reluctance about doing so. There are many reasons to avoid experiencing uncomfortable feelings like embarrassment, fear of rejection, fear of feeling humiliated, exposed, vulnerable and even possibly hurt. Any therapist worth their salt will recognize the value in talking over your feelings with you, and using the avenue of your feelings towards them as a way of exploring your hopes and fears about intimacy in relationships, past, present and future. One point of building a strong, working alliance with a therapist is to have the opportunity for what are known as “corrective experiences.” Talking about this with your therapist should enable you to feel un-judged, accepted, respected and cared for. There’s even a name for what you are experiencing. It’s called “transference” and it’s arguably one of the most important parts of therapy. Transference is a little like entering a time machine. Feelings from the past, along with hopes and fears from the past are magically transported into the present day and attach themselves with longing to the therapist. I suggest taking the risk of telling her what’s really going on with you, and be willing to examine, with your therapist, the feelings that come up.

I’m a good believer in “talking about talking.” In other words, maybe the first conversation you have with your therapist about your feelings starts like this:

“There’s something I want to tell you, but I’m scared of the
feelings that I might have when I explain what I’ve been
feeling. I’m scared that you might laugh at me, or get
embarrassed and that will make it harder for me to talk. So
can we talk about those feelings first before I tell you what
I’ve been thinking about?”

I think you'll find that talking about your "ruminating" with your therapist will help the feelings to find their rightful place in your life.

Many thanks and good luck to the person who emailed me this question,
and I hope that this post helps.

How Are Therapists Seen By Their Clients?

2006-07-25T19:52:00.000-07:00

What Does a Client See When They Look At Their Therapist?

My friend, Kathy, is a great believer in people "living their life out loud." By this she means being as fully and truly yourself at any given moment as you can possibly be, neither trying to live up to somebody else's expectations of who or what you should do or be, nor dumbing down your own expectations of what is possible for you to achieve. Kathy is very good at living out loud, and I pride myself on doing a passable job most days. However, like most people, I have days when it's just hard to be a human being, unaffected by the opinions of others. But living out loud and being a therapist sometimes means that there's a conflict. One of the struggles, and paradoxes, I have is that since being a therapist in private practice I have lived less time in my life out loud than ever before, while I spend more time exhorting my clients to do just that - i.e. live in a way that is authentic and present, in a way that is true to themselves, and as honest as they can possibly be. I’m mindful that if too much of me, the therapist, and my life and history is in the room, there's no room for therapy to take place. It's a balancing act, as I've talked about elsewhere on this blog.

I guess the challenge for me in being a therapist lies partly in the ability to be myself, without being fully myself. This, believe me, is a kicker. It's not that my personality changes, it doesn't. That's a constant. But some of the things that I feel partially define me stay hidden. I'm aware that there are qualities that other folks (maybe even clients?) think I am defined by, and they don't define me at all. To start with I'm a zaftig, full-figured woman. I've ricocheted up and down the scales in my lifetime, trying to deny the biology of my hearty, Welsh peasant roots, but I'm 5'3" tall and have been told that I'm a dead ringer for a meatier Kathy Bates (although I've been known to quip that my driver's license photograph looks like an undercover Linda Tripp). I’m aware of the bias against large size folks in this culture, and the prejudices and stereotypes that are heaped on our heads and I’m conscious that this probably affects how some of my clients view me. I often recognize that people don’t talk about their own struggles with food and body image, probably because they fear offending me. I frequently have to reassure clients that it’s fine to talk about concerns about their own bodies and their eating habits – that I won’t snap and break if they do.

So what exactly does a client see when they look at their therapist? What markers are they looking for? Having spent time on either side of the therapy couch, I know that I want my therapist to be trustworthy, dependable, honest, respectful and respectable. It’s preferable if he or she isn’t driven to flighty impulses that might provoke unsettling changes in my therapy relationship with them, so it’s helpful if they are stable and reliable. I assume that these qualities are important for my clients too. But how can we tell? What criteria do we use to make our judgments?

For most clients, contact with their therapist is limited to 1 hour a week. During this time a therapist can present an image of calm, unflustered competence – an image, by the way, that their immediate family and close friends would frequently find at odds with the non-therapist personality that they live with or are friends with. However, therapists are only required to be able to pull this off in fifty minute chunks. It would be easy for a client to look at this magic trick and find themselves lacking, given that their “job” is to find a way to fall apart in extremely un-calm, flustering ways. A client may feel depressed and have not bothered to iron their clothes that week, while you sit there in neat, professional attire. Little do they know that the ironing basket is full to overflowing, you wore this outfit three days in a row because nothing else was ironed or picked up from the dry-cleaners – evidence of how overwhelming tasks of life can be, even for therapists. Our offices are vacuumed, dusted, our papers (probably) neatly piled up on our desks, filing cabinets with file drawers neatly labeled, the trappings of organization and functionality. When our clients look at these trappings, what are they deducing about us, about me, as a person and what is important for them about this deduction? Would it make a difference to them to know that I hadn’t vacuumed my house in two weeks, and that cat hair flies around like tumbleweed when the fans are on? And what would they do with that information? Would it be helpful, or harmful to their therapy? As a therapist, it’s helpful to know how our clients see us because sometimes it’s the unspoken assumptions that build invisible barriers between therapist and client. In normal daily life, we don’t necessarily take the risk of saying to our friend, “Your desk is so clean, I feel intimidated by it, and assume that all your life is so organized. I see you as impossibly competent, and fear that you won’t care about me, or want to be friends with me, because I’m so much less than what you are.” But this is exactly what you need to hear as a therapist. We need to know places where who we appear to be gets in the way of a client’s clinical process

Most of my clients have only the bare bones information about my life, and little beyond what feels therapeutically useful to share in their sessions and what they read here, on my blog. Clients are often left to guess a great deal at what my life looks like, based on how I look, my very limited office environment and what is expedient for me to share with them. Sometimes they have been known to talk about what they imagine about my life, how they think my home looks and how they think I spend my time. The life that they construct for me has a lot to say about them and their specific hopes and dreams, and often doesn't bear much resemblance to my real life. But it is a very useful jumping off point for a conversation about their thoughts and feelings about their relationship with me.

Everything's Coming Up.....

2006-07-21T15:02:00.000-07:00

.....well, not roses...but flowers that look similar to Sweet Williams, in fuschia, pink, lavender and white. There was a very wonderful man at the plant stand where I bought them in Cambridge and he did tell me what the plants are called, but I have forgotten. Maybe somebody will recognize them and post a comment? I chose something simple (and, yes I admit it, cheap) to test out my window boxes again. If this fails and they are untimely ripped from their window beds, I will give up and take the window boxes down. But in the meantime, I can look out my window and see something other than my red convertible and oceans of concrete. What more can a gal ask for? I'll drive over with my camera at the weekend and take a photograph.

While planting the flowers (which I've previously relied on the spousal unit to do for me) I've had confirmed what I had often suspected which is that I am much less scared of spiders if I have gloves on my hands, particularly thick rubber gloves. I think I'm going to use this as a strategy for removing spiders outside of gardening situations. In any case, I found myself dunking my hands into the dried out soil already in the boxes to pull out old roots and knew even as I was doing this that there was a possibility of eight legged things, but continued regardless.

As I tell my clients, taking action is often better than taking no action at all, and I always feel better when I achieve something, no matter how small, to make my life feel happier. If there's a small, incremental step you can action to take back control of your life, it's the first step on the road to success. The flowerboxes give me happiness, but if vandals decide that the flowers are too offensive to remain, I will fill the inside of the office with flowers instead. As my father used to say, "Don't let the bah-stards get you down, dear!"

YOU AND I

2006-07-21T06:52:00.000-07:00

We all know how powerful and influential our life settings can be. These settings influence both ourselves and the people perceiving us. For people who are receiving inpatient mental health services, what follows highlights dramatically how language makes things appear different than they actually are. I've been thinking recently about the differences between patients and therapists, and how these differences are understood by each party. A blog on this topic will be forthcoming soon. In the meantime, I wanted to post this. I find it highly thought-provoking.

YOU AND I by Elaine Popovich

I am a resident. You reside.

I am admitted. You move in.

I am aggressive. You are assertive.

I have behavior problems. You are rude.

I am noncompliant. You don't like being told what to do.

When I ask you out for dinner, it is an outing. When you ask someone out, it is a date.

I made mistakes during my check-writing program. Some day I might get a bank account. You forgot to record some withdrawals from your account. The bank called to remind you.

I wanted to talk with the nice-looking person behind us at the grocery store. I was told that it is inappropriate to talk to strangers. You met your spouse in the produce department. Neither of you could find the bean sprouts.

I celebrated my birthday yesterday with five other residents and two staff members. I hope my family sends a card. Your family threw you a surprise party. Your brother couldn't make it from out of state. It sounded wonderful!

My case manager sends a report every month to my guardian. It says everything I did wrong and some things I did right. You are still mad at your sister for calling your Mom after you got that speeding ticket.

I am learning household skills. You hate housework.

I am learning leisure skills. Your shirt says you are a "Couch Potato."

After I do my budget program tonight, I might get to go to McDonald's if I have enough money. You were glad that the new French restaurant took your charge card.

My case manager, psychologist, R. N., occupational and physical therapist, nutritionist and house staff set goals for me for the next year. You haven't decided what you want out of life.

Someday I will be discharged . . . maybe. You will move onward and upward.

Big Penis Guy

2006-07-19T12:19:00.000-07:00

Okay, now that I've grabbed your attention....

I got an email this morning asking me if I ever get prank calls from people about being a sex therapist, so I thought I'd post an (almost) verbatim reconstruction of a phone call I had with a man a few months ago. I'm going to call him "Big Penis Guy." Here's how the call went down:

Telephone: :::: brrring:::::brrring:::

Jassy: Good Morning, this is Jassy Timberlake.

BPG: Oh, good morning, Dr. Timberlake (Editor's note: I am not a doctor.)

Jassy: Actually, although I am a licensed psychotherapist, I'm not credentialed as a doctor. But I understand the confusion. How may I help you?

BPG: Um... yes, I hope so. You are a sex therapist, right?

Jassy: Yes, I am. Would you like to tell me what brings you to contact a psychotherapist at this time?

BPG: Well, if you have time...My fiancee and I are having some problems. We've been together for 5 years, and would like to get married, but our sexual life has been problematic. It's kinda embarrassing to talk about.

Jassy: I understand that. I don't know how comfortable I would be talking about my sex life to a complete stranger either. Would you like to give me an idea as to what appears to be the problem between you and your fiancee? Nine times out of ten I can be helpful to couples who are having sexual problems, but occasionally there are other professionals who can be more helpful.

BPG: Well, my fiancee is a very petite woman, and she really enjoys having sex with me, but says that my penis hurts her and is too big. I'm scared of injuring her.

Jassy: Hmm...do you feel that you and your fiancee are able to talk about this issue or are you having problems communicating your thoughts and feelings?

BPG: It seems to be that my penis is too big, and she just can't handle it.

Jassy: I understand that. Do you think she would be willing to come into therapy with you to talk about this issue? I frequently do an informational session with couples to see if I can be of help. There is no charge to you and spending time talking to both of you will help me to ascertain the best treatment plan and future course of action.

BPG: Do you hear of other couples where the man has an enormous penis that hurts his girlfriend?

Jassy: Well, it's not a frequent problem, but from time to time the issue arises and there are usually strategies that a couple can use to help. May I ask what strategies you have used so far?

BPG: It's kind of embarrassing to talk about having a gigantic penis, and I'm reluctant to talk about it with her.

Jassy: It's not uncommon for people to find it hard to talk about sex. Sometimes talking about it with a therapist can help in terms of facilitating the conversation.

BPG: Yes, but it's really huge and I don't know if there's a solution. It's probably one of the biggest penises on record.

Jassy: Hmm. You know what. I think you're probably right. I also think that your penis is probably too big for me too. I recommend that you call this number and see if they can help. Meanwhile, thanks for calling me.

(I gave him the Watertown Police Station Business Number.)

Watertown Window Boxes

2006-07-19T06:54:00.000-07:00

For those of you not living and/or working in Watertown, Massachusetts, USA, my office is situated on Mount Auburn Street, a major thoroughfare for Watertown, running from Cambridge's famous Harvard Square all the way into the heart of Watertown Square. It's a quintessential American boulevard, meandering through wealthy Cambridge streets lined with mansions and fabulous, manicured gardens, past commercial zones littered with gas stations, supermarkets and local bars and VFW's, on into Watertown. Mount Auburn Street's Watertown beginnings are flavored with fabulous local grocery stores such as Kay's, friendly non-corporate coffee shops like Uncommon Grounds, wonderful local markets filled with fascinating foodstuffs and produce from all over the Mediterranean and beyond. Where else can you buy a set of tiny black and white polka dotted espresso cups hanging on their own delightful cast iron stand for under ten bucks!

Sometimes, when I am in between patients, I open the curtains and sit and watch the world walk by my window: Mothers with strollers and children chattering nineteen to the dozen; shambling men and women, talking to themselves and anybody who will listen to them, on day release from what I assume to be local assisted living facilities; groups of handsome, olive-skinned men talking animatedly in languages that I don't speak (I have rusty French and German, which have had years of dis-use) heading over to Starbucks for their morning/afternoon or evening coffee klatsches; gaggles of giggling schoolgirls, with low-slung jeans and high-strung belly shirts, proudly strutting their stuff; the whoosh of skateboards passing the window in a blur and Watertown seniors who appear to be in slow-motion alongside the hustle and bustle of the rest of the good citizens.

In the first year or so that I had this office, I proudly tended my window boxes. Beginning in early spring, I would plant them carefully. My name, phone number and credentials are on the window in Periwinkle Blue, so I chose flowers to complement the lettering: bright blue, lavender, fuschia and purple. Even with the curtains closed, I could see silhouettes of the dainty flowers waving in the breeze, splattering their fronds and shadows across the curtains. The flowers provoked constant comment from the other side of the window. Enthusiastic toddlers frequently tried to pick a flower, while their mothers, bracing for a tantrum, would try to entice them away from the window boxes: senior citizens on their slow stroll past my office, would often comment on the beautiful flowers; others, noticing the flowers, would then pass comment on the fact that there was a therapy office there that they'd never seen before and adolescent girls and boys alike would talk about my name ("Oooooooh! Do you think she's any relation to Justin?"). I could hear all this from the other side of the window.

Then the vandals struck.

I turned up at my office late last summer and somebody had ripped out all the flowers and left them, roots floundering, baking in the hot sun. Heart-sick, I tried to save some of them, but they could not be revived. I couldn't decide what to do. Plant more and risk them being vandalized also? Wait a while and then re-plant? I chose the latter. When October came, I planted Icicle Pansies, hoping that they would last through the early part of winter.

Vandals struck again, this time removing only half of the pansies from each window box.

So, this summer the window boxes are empty, just dried stalks of the Icicle Pansies remain and I haven't had the heart to put flowers in. I miss the attention and joy they attracted, and the color and beauty they provided for myself and others walking by my office. It's nearly the end of July, and I'm still trying to decide whether to risk planting flowers there. With my office situated in a commercially dense part of Mount Auburn Street, and therefore little landscaping, it was sweetly delightful to approach my office building in the morning, with the well-tended window boxes. The gay blossoms provided a colorful, optimistic counterpoint to the tarmac roads and concrete sidewalks. I may have to succumb and plant more.

Good Things Come From Writing a Blog!

2006-07-17T21:03:00.000-07:00

Lots of cool things happen when you have a blog.

Here are just a couple of the things that happened this week.

1. Out of the blue, I got an email from a guy called Jorge who works for a company called M80IM. (You can check them out at www.M80IM.com. I'm sorry but I haven't' yet figured out how to make these links disappear - Dori, could you give me a lesson next time I'm in my office?) He said that he had found my blog on Transamerica and he wondered if I would be interested in writing a review of his company's DVD called "Create Your Own Adventure: The Abominable Snowman." It's an interactive children's animated cartoon adventure , so children can create a unique adventure as the story unfolds by selecting different options and plot twists. I wrote back and said as flattered as I was to be selected for a free DVD and the opportunity to write a review for them, that it didn't seem that relevant to psychotherapy and the practice thereof. However, if he wanted to send me a DVD I would happily show it to my granddaughter. I was telling my friend Kathy about Jorge's email and the DVD this weekend, and we realized that, in retrospect the concept of this DVD is VERY relevant to the practice of psychotherapy. So, while I don't think I will be writing a straight review of the DVD, the concept of "creating your own adventure" is quintessentially what therapy is all about.

2. Interesting, cool people read the stuff I write and send me emails telling me fascinating things about their lives. For example, Ben over at 3mote.com emailed me and shared something of his life. As I have now become a regular reader over at 3mote.com, I'm very honored to have heard from him, plus he's a Watertown resident.

3. I received another email from a therapist I've never met before, who works as a home-based clinician and is interested in starting a small private practice. She wrote to me asking if I would be willing to either email, talk on the phone or meet in the person so that I could share some of my ideas about how to go about starting up a private clinical practice. We have an appointment to meet for coffee next week so that I can share some of my ideas with her.

4. My blog about Starbucks got picked up by a Watertown "town" site, so I feel like a Watertown celebrity!

5. Interesting people, themselves bloggers, post comments and so I get to be introduced to other people and their lives via their blogs.

6. My friends read my blogs periodically, particularly if we haven't seen each other in a while, and can keep up with parts of my life that way.

7. Some of my clients read my blog and make comments when I see them during the week. I like that it gives people a place to go to feel connected to their experience of therapy, even when they don't see me more than once a week.

Humility

2006-07-13T19:20:00.000-07:00

Cleaning my own office, waiting room and rest room keeps me humble. Dori in the office "suite" next door tells me that she hired a fabulous cleaning service and says she can pass their number on to me. Trust me. I'm tempted - I've toyed with the idea of hiring a cleaner from time to time since being in private practice. But, readers, you couldn't swing a cat in my office space (where on earth did that expression come from?) and despite being irritated by the fact that I not only have to clean my house, I also now have to clean my little office unit, I still can't bring myself to hire a cleaner. How lazy would a person have to be?

For a start, the actual therapy office is small - maybe 12' square - and the waiting room and restroom are almost one and the same, amounting to probably no more than 10 square feet . When there are patients waiting in the wait room and another patient wants to use the bathroom, they practically have to sit on each other's laps to get past each other. It's very, well, intimate to say the least. I have a sound machine in the waiting room which is turned up as high as possible, but keeping the space private is challenging at times, and having a cleaner here, despite the fact that my files are under lock and key, would exacerbate that challenge. For example, my phone has caller ID, so if the cleaner was in there alone, he/she would be able to see who was calling in. There's nothing that identifies client's names and addresses on my desk at night, but I imagine scenarios whereby the cleaner might forget to lock the door on their way out, leaving my files vulnerable to break-ins. So, thus far, no cleaner.

I am, however, no stranger to house and office cleaning. When I lived in London I put myself through business school (long story for another time) by working for a cleaning company. In fact, a little known fact is that I used to clean Elton John's press flat in Central London. (It was on North Audley Street, not far from my college which was on South Molton Street at the time - but has since closed down.) And yes, he was there once or twice, in bed. But we never formally met. (The "help" was kept away from the celebrity clients!)

When my daughter was first born, I was young and newly married and didn't want to put her in childcare, so took her with me to several cleaning jobs that I had. One was for a loud, raucous Italian family called the Manzi family, whose patriarch was a successful "punk rocker" and was one of the movers and shakers behind the record label, Stiff Little Fingers. The family was turbulent, tormented and miserable and I befriended their 14 year old daughter, Silvana, who would spend hours at our flat, playing with the baby, and complaining about how her parents didn't understand her! I often wonder what happened to Silvana.

The other cleaning job was for a woman in her late 40's (which seemed incredibly old to me at the time) who, along with her husband, performed cabaret acts at local nightclubs. She had white shag rugs throughout the whole house and my then 5 month old daughter would lie on a blanket in the middle of the floor while I literally raked patterns in the rug, according to specified designs by the cabaret singer. When she was particularly pleased with my "work" she would tip me in pot roast. Yep, you can't make this stuff up. Oh, and I was a vegan at the time, so you can imagine that this went down well! Not one to look a gift horse in the mouth, I would pass the pot roast onto my grateful friend, Dina, also a young newly married mother whose son, Christo, was born at the same time as my daughter and in the same hospital ward at the Whittington Hospital (named after Dick Whittington, Lord Mayor of London, immortalized by the nursery song of the same name) in Islington, London.

Since then, I have cleaned many apartments, many offices and swore that I would never hire a cleaner. "If you can't clean your own house," I was known to pontificate, "then your house is too big!" I've softened a little in my old age and often suggest hiring cleaners to over-worked, stressed-out parents who can afford it. And, when my daughter was trying to find a way to supplement her meager salary as a Preschool Teacher, we hired her to clean our house twice a month for twice the going rate.

So, back to the issue of my office. I guess I'll continue to clean it myself. There's something about being responsible for vacuuming, dusting and cleaning the restroom that is soothing. Besides which, for reasons that I cannot figure out, it really does keep me humble. And that's not such bad thing.

Starbucks Addict

2006-07-06T15:15:00.000-07:00

My office is in a brick-fronted professional building perched in between two small parking lots. On one side is Starbucks, and on the other is Dunkin' Donuts. It's a veritable Java stand-off. I believe I've mentioned before that I'm a hard-core Starbucks frequenter, so much so that when I walk through the door, the manager calls out my coffee drink ("Double tall, non-fat, extra-hot latte for Jassy!") to the "Barista" working the espresso machines. There is a delightful young woman called Jessie who works at the Starbucks next to my office. She has sandy-red hair, and a very vampish, punky pair of red-rimmed spectacles. I don't know much about her other than the fact that she is very close to her mum and that both she and her mother see each other as often as they can given their geographical challenges (I believe Jessie's mother lives down south.) Jessie is sunny, welcoming and friendly and I always get a kick out of seeing her. On the days when Jessie isn't working, my latte doesn't taste quite as good, and the experience of visiting Starbucks isn't quite as satisfying. Sadly, I don’t think she has any idea what a difference her sunny personality, friendly demeanor and upbeat character make to each 60 second transaction that is made across the Starbucks counter.

By the end of each day, the waste paper basket in my office is full of used Kleenex and Starbucks and Dunkin' Donuts paper coffee cups, and ditto clear plastic cups with straws poked through the lids. I hasten to say that only one of those Starbucks cups is mine - I'm strictly a one-cup-a-day gal. Each day I buy my latte, and drink it at around 11am (what we call "Elevenses" in the UK ) accompanied by a teeny, tiny sliver of cheese cake which I bring from home. As much as I detest the corporate conglomerates, I am absolutely hooked on my daily java fix, and Starbucks is infinitely preferable to me than the water-bewitched-and-coffee-begrudged liquid served up by Dunkin Donuts.

As much as I dislike intensely lining Starbucks' coffers, I equally intensely like my ritual of walking into the Starbucks before heading into my office, and I like to feel part of the "community" in and around my office, and see Jessie's cheerful self along with her other friendly associates. It can get a little isolating sitting day after day in my office, drapes closed to shield clients from inquisitive eyes, working intently with clients, so those visits to Starbucks play a part in my experience of working in Watertown.

Recently it hit me with a jolt (and this was without much caffeine in my system) that if I added up all those $3.36 lattes I imbibe throughout the year, I spend a whopping $1,226.40. I had been prepared to suck that up and just accept it as a fact of life. But I'm trying to think outside the box more in my life and it seems to me that my coffee purchases are a good place to start. So, I'm going to invest in an espresso machine. I think they cost about $200. This means that within one year, I will have an extra $1,000 in my savings account, which is nothing to be sniffed at. I'm always encouraging my clients to think in different ways about their lives, so the idea of saving money seems like a good one. But there are some things that not spending money on will not take care of. I would very much miss the regular contact I have with people like Jessie, as small as it is. I'm just another one in a long line of customers to Jessie and the other hard-working Starbucks folks, but I try to make a difference in every situation I'm in, whether it's an extra-friendly hello, or remembering their pet's name, the fact that somebody just came back from a vacation, or asking what else they do with their life when they're not working at Starbucks. Big changes often start with small gestures. For example, if you can stand up to the office bully in one small way, you can maybe start the process of standing up to a bossy, opinionated, bullying parent. If you can show interest in one person in a small way, maybe they feel more a part of the community around them. It’s a start. And yes, I know it’s not much but it is a very simple way of me maintaining a connection to the people in my small "community."

Therapy Dog

2006-06-28T18:23:00.000-07:00

For many, many years I had a beloved therapist, Linda, (now retired) who saw me through some of the most challenging times of my life. She was accompanied daily by her Welsh sheep dog and being Welsh myself, despite not particularly being an animal lover, I approved of her choice of canine. My mother loves dogs, and growing up she would regale us with stories of her favorite dog of all time, also a Welsh sheep dog, Akeila. For this and other more patriotic reasons I hold the breed in high esteem.

Linda's office was on the second floor of the building she shared with three other therapists, and she would always come down to the waiting room to welcome me, with her dog (whose name unfortunately escapes me) at heel next to her. Linda would lead the way up the stairs, followed closely by me. Her faithful companion would herd us both up the stairs and into our respective chairs. His work done, he would quietly lie on his bed next to Linda's desk for the remainder of the session, getting up only when I arose in order to herd me to the door. He didn't take part in the sessions; he didn't attempt to comfort me when I cried, he didn't respond when I or Linda laughed. His job was clear cut...protect his mistress and herd the clients. He did his job well. Other than the occasional head pat, the dog and I did not interact. We were mutually disinterested in each other beyond our assigned roles as herder and client.

My own dog is a designer mutt, half Maltese and half Shi Tzu. He has hair, not fur, and is therefore not likely to cause allergic reactions in folks. He doesn’t shed, which is a huge relief to me – self-confessed neatnik that I am. Standing approximately 14 inches tall and weighing 12.8 pounds, he is a crotch-sniffing, human toe-slurping, tail-wagging bundle of white and beige fluff. He is no Welsh sheep dog. To put it mildly, he is not a working dog. Rather than herd folks to the couch, he invariably jumps on them, prancing around on his back legs like a circus poodle, impeding their route to the couch by employing various disgusting antics, such as the aforementioned crotch sniffing, along with butt snuffling, heel tweaking and occasional, but annoyingly insistent, pawing. He has bad manners to say the least. But he does eventually calm down and will sit on the couch or lie on the floor in his bed.

I am not a dog-lover. I am, however, a lover of Ziggy and therefore I put up with these disgusting annoyances. I am also careful which of my clients I inflict Ziggy on, and carefully select the days on which he accompanies me to my office.

I have clients who are cat lovers and find Ziggy’s canine mannerisms annoying. I have clients who find his presence distracting, and don’t like it when he is there. I have clients who don’t mind him being there, and after the initial “Ziggy welcome” just ignore him and he settles down. Sparring couples upset Ziggy, and he has been known to stand in front of the couch, howling sadly as they shout at each other. This is not clinically helpful to them, and it's distracting for me, so I usually leave him home on days when I have these couples attending sessions.

But there are people for whom Ziggy’s presence is a therapeutic plus. I have a young boy who comes to therapy with his mother, and won’t talk unless Ziggy is in the room. Without Ziggy in the room, he is morose and quiet. With Ziggy there, he will talk haltingly about the things he feels and fears, in between his romps with Ziggy. Ziggy revels in the young boy’s presence, plays with him as if he was another puppy and licks and slurps the boy’s face with gay abandon. The little boy shrieks and squeals happily, reveling in Ziggy’s puppy play.

I meet with a lonely young woman who can barely keep her hands off Ziggy when he is there, who snuggles him lovingly, and who giggles happily when he is present. She currently has few places to feel loved and welcomed and Ziggy’s enthusiastic antics are delightful to her. He reminds her of her lovability and she relaxes in session as he lies on the couch next to her. Another client who is single after the break-up of a long term relationship and very much misses her partner strokes Ziggy’s soft hair as she talks about her longing for intimate connection with the person she lost. Another client who finds it hard to trust anybody and whose memories of her abusive childhood are hazy and scary, is reminded of her love of her childhood puppy by Ziggy’s happy company. Depressed clients often become more responsive and less withdrawn when Ziggy is there. Clients with high blood pressure report feeling calmer when they get to play with and stroke him.

Everybody needs something to hold and to love, and sometimes just for an hour a week, my rambunctious little dog helps some people reconnect with the loving optimistic place inside themselves.

Being Scared Of Spiders Sucks

2006-06-27T21:11:00.000-07:00

I've been scared of them since I was about 8 years old, and I've tried every therapy known to humans in an attempt to overcome my phobia. My parents became creative at thinking up reasons for the sudden appearance of a never-before-seen phobia, but none of their reasons ever fit, and I haven't ever come up with a good enough reason of my own. Be that as it may, I went from an active tomboy who lived her life outside in the fields, to a child who wouldn't sit under a tree, on the grass or walk through fields in case spiders were to (a) drop on me (b) walk across me or (c) attach to me. Beginning at the age of 14 through to the present, I have endured (a) hypnosis (b) Cognitive Behavioral therapy (c) EMDR (d) Exposure therapy (e)myriad versions of "talk" therapy and (f) endless hours researching spiders, learning about spiders and trying to figure out why oh why I'm so darn scared of them. I am sad to report that I have no great insights. I have heard that the Anxiety Disorders Clinic at Boston University has some success with phobias, but it involves allowing them to set spiders free in your immediate vicinity and I'm not in any great hurry to agree to that torment, and pay for the privilege to boot!

However, over the years I'm a little less petrified than I was - there was a time when I would gag and/or faint if a spider came near me. I can now, on occasion, (and I'm not proud of this as I hate to harm any living thing, no matter how lowly) squish them if the clump of papertowels is big enough to "protect" me from the possibility of the spider escaping using its super-arachnid strength and leaping on me with its fangs out. (I didn't say this was a rational phobia, did I?) I can perform this cruel feat as long as the spider is not above me on the ceiling, or at least overhead in some fashion, and as long as it's not too furry and not too big. (Too big would be over half an inch across including legs, and dear readers even typing the word "legs" makes me feel like gagging.)

The reason I feel compelled to share about my spider phobia is that instead of getting an early night as I had intended, I was driven from the bedroom because a large spider crawled up the back of the bed and neither my spouse nor I were able to catch the wretched thing. One abortive attempt to catch the nimble critter ended up with the eight-legged horror dropping kamikaze-like from the ceiling onto my bedside table, from whence it disappeared into the night. We spent about half an hour looking for it to no avail. So, here I sit, trying to calm my nerves by writing about my phobia.

"How come you're a therapist and scared of spiders?" I hear you say. Good question. I've no idea. I'm pretty savvy about some things and a complete idiot about others. If you are having sexual problems, parenting problems, coming out issues, (and indeed just about anything related to sexual orientation) anxiety, depression and just plain feeling crummy, I can probably help.

If you're scared of spiders, forget it. But if you hear of a good therapist, be sure to let me know, okay?

2006-06-27T12:42:00.000-07:00

I thought I would, from time to time, post items of interest with a “Sexuality In The News” focus.

The first news item concerns two sex offenders in Maine who were murdered on Easter Sunday by 20 year old Stephen Marshall of Nova Scotia, Canada. Marshall allegedly got the two men’s names (Robert Gray – 57 years old – and William Elliott – 24 years old) from the Maine Sex Offenders Registry (http://sor.informe.org/sor), drove to the men’s homes in his father’s pick-up truck and shot the men dead. When found and cornered by police on a Boston bus, Marshall turned the gun on himself.

Understandably, this event has created quite a ripple of fear amongst registered sex offenders, whose names, photos and addresses are increasingly posted on the internet by states as a matter of public record. The Maine legislature has promised to reconsider the way in which this information is posted online, but other elected officials are disinclined to change the current system. One Democratic state representative, Patricia Blanchette, said “Nobody want to see anybody cut any slack for pedophiles. Other people such as Tim App, a Northeastern University criminal justice professor, thinks that sex offender registries should not be available to the public, but be information privy to the police only. Mr. App thinks that there should be “intense counseling and supervision backed up with lie detector testing” in order to reintroduce pedophiles back into the mainstream.

While I am against the death penalty, and do not wish to see anybody punished for their crimes by loss of life, even at the hands of a civilian, I also do not believe that communities should be left uninformed about the presence of pedophiles living in their midst.

I am unaware of the numbers of pedophiles who are murdered by concerned citizens who take matters into their own hands. However, I have to believe that it is relatively small in relation to the numbers of child victims persecuted by pedophiles. On balance, I believe that sex offender registries should be available online, complete with names, photos and addresses. Adults have at least a chance at protecting themselves. Children have little or no chance to of defending themselves against sexual predators. Any information that we can employ to keep children safe surely has to be worth the loss of a sexual predator’s privacy.

Besotted with "Six Feet Under"

2006-06-24T07:55:00.000-07:00

I've been turned on to the quirky, fabulousness of the HBO series (now defunct) "Six Feet Under," henceforth referred to as SFU. Thanks to the magic of Netflix, my current Big Love, I have been watching the series from the very beginning. While I didn't see it the first time around, I'm now onto Disc 2 of the Second Season (of which there are a total of 5 discs). With 4 seasons worth of discs to go (so, an estimated 20 DVD's still to plop through our mail slot) I'm in funereal heaven. As hokey as this sounds, I feel like I learn something important, either about the world or myself, with each episode that I watch. Some of the things that I've learned, feel like gems to slide into my back pocket which I will be able to produce when needed.

Watching the season also makes me realize how little thought I've given to the subject of death and dying. While I had rudimentary clinical training in grieving and loss, and have done a little reading of my own, I've lost very few people and I've never seen death, dying or a dead person up close. I've heard others accounts of seeing their dead relatives and loved ones, and these really stick with me. My oldest school friend lost her father when we were still in high school. I remember her describing how she leaned over him to look at him, and realized that his body was cold and like there was nobody in there. She said, "It's not like sleeping. He just was gone." This has obviously made an impact on me, because I remember it to this day. How on earth can somebody you love just be gone? It boggled my mind.

While I don't have anything deep and profound to say right now, particularly as it's Saturday morning and I'm at my desk, while my darling granddaughter bounces up and down on the daybed in my study with her new doll (a so-called "Groovy Doll" with pink streaks in her hair and matching sleeping bag!) one episode in particular stands out in my mind so far.

For those of you who have never seen SFU, it follows the relationships between members of a family whose patriarch has just died, and who are getting on with the business of trying not to screw up their lives while running a funeral parlor. Each episode begins with the death of an anonymous person, whose loved ones end up at the funeral parlor. One particular episode begins with the death of a baby. The normally un-flusterable embalmer at the funeral parlor, a handsome young man called Frederico, finds himself frozen and unable to embalm the baby (his own wife is pregnant with their second child). As the plot unravels, one of the protagonists makes the point that we have words to describe a woman who has lost her husband (widow), a word to describe a husband who has lost his wife (widower) and a word to describe a child whose parents have died (orphan) but there is no word to describe a parent who has lost a child. This event is quite literally unspeakable, with no words to describe the trauma of the loss of a child's life. As somebody who loves to read, who relishes words and how they roll off your tongue, the idea that a human event, a human experience, cannot even be described froze me. But it also helps me to understand why people grieving the loss of children have such a difficult time finding places to grieve thoroughly. As a culture, we cannot even come up with words for them to use as descriptors. Even listening to people's grief is unspeakable to us in Western cultures. I wonder if other cultures have words to describe the state of having lost a child. Anbody know?

Computer Rick

2006-06-22T14:47:00.000-07:00

Yep, you're right. This happened at the same time last year, with a different computer.

I have a virus on my Laptop at the office. It jumbles up all my files. It types in capitals when "Caps Lock" is not activated. It won’t allow me to punctuate, and keeps freezing blocks of text so that I accidentally delete them while doing something as simple as hitting the space bar. It tries to mail merge Excel documents every time I boot up. Even more annoying is the fact that Mr Virus has decided that rapidly scrolling down through hundreds and thousands of blank pages is the most fun, refusing to allow me to halt his frenzied journey. Somehow it mixes up client names on my address list, has moved addresses and phone numbers into baffling combinations, and sends me error messages that my internet connection is not viable, even as I sit listening to that annoying dial-tone and cacophony of squeaks so familiar to dial-up users. (I have cable at home, and dial-up at work where I spend little or no time on the internet.) It's impossible to type up my clinical notes at the end of the day so I have spent the last week hand writing these (my writing is indecipherable, and I'm not sure I will be able to read them again!).

Enough already.

In desperation, I called my computer guy (known as “Computer Rick” on his business cards) to ask him if he could rescue me from compu-hell. But he is taking his family and going to El Salvador for 3 months, so I’m out of luck. Yes, I know. It’s easy enough to update my virus software, but I like it when Rick comes and fixes my computers. He worked wonders on the computers at my home. It’s not rocket science to download new virus definitions, but Computer Rick installed SpyDoctor and BitDefender on my home computer and also cleaned up the computers so they run like clockwork.

Not only does he provide a much-needed service for my business, I also really like him as a person. Rick is in his late 30’s/early 40’s. He has sandy hair, fair skin and is shy and awkward in the way that computer techie types often are. He has two daughters who are young teens and a wife he’s devoted to. He is happy in his life, enjoys his work, loves his family and has lived an interesting and varied life.

The first time Rick and I met, we were discussing housing and I happened to mention how much I love American Log Cabins. On my first ever trip to the USA in 1982, I was here on vacation and stayed with a friend who lived in a log cabin in northern Duluth, MI. Despite the fact that she was without running water and electricity and lived 50 miles from the nearest store, I loved staying there and relished waking up every morning to the wooden "walls" and rustic charm of her lovely cabin. To my surprise, Rick said that he had built several of them in his life time; in fact he still owns two of them on land in upstate New York. Listening to him as he waxed rhapsodic about how to build log cabins was a thing of beauty!

The second thing I admired and enjoyed hearing about was the way he and his wife (who is a pre-school teacher) have gone about raising their daughters. For example, several years ago, they decided that they wanted their daughters to have the experience of living in a different culture. They sold everything they owned (which wasn’t much) and moved to El Salvador. Rick said, “You know, people say that El Salvadoreans are poor and yes, they don’t have any money. But they have closeness and connection to their friends, family and the land they live on and farm and this makes them rich, much richer than urban Americans ever can be.” He went on to talk about how his values and those of his whole family shifted after living there for several years, and how differently he views his life in the US as a result. The relationships he formed with people have endured and they regularly go back to spend time with their friends there.

When Rick asked me what I did for a living and I told him I was a sex therapist, he blushed a deep vermilion red. His only comment was, "Oh boy, that must be an interesting job." And then he buried his head in my computer's innards. Despite his shyness, he is easy to talk to and I relish these opportunities throughout my working days to connect with other folks.

Call me crazy, but I can’t bring myself to call “Computer Geeks” when I have a loyalty to, and connection with, Rick, a real person who shows up at my home and in my office, bringing the world with him.

(PS If you live in the Boston area and would like Computer Rick's phone number, let me know!)

Transamerica

2006-06-06T22:20:00.000-07:00

This weekend my friend, D, came to have dinner with us and to watch a movie. We had rented "Transamerica" from Netflix. I had heard that Felicity Huffman did an amazing acting job playing a Transexual woman. She did. I think this part has done for Felicity Huffman what "Monster" did for Charlize Theron. The acting was nuanced, brave and totally believable. What was also incredible was that a movie with the title “Transamerica,” with the main protagonist being a transsexual woman and her search for serenity and integrity of Self, should end up being a uniquely human movie about the power of love, the challenge of being oneself in the context of family, how we grow into being parents and what it means to live an authentic life. In fact, quite early on in the film, it becomes irrelevant whether Bree is transgendered or not. Her most important evolution in the film is not to do with her gender identity, but her ability to grow into authenticity in her relationship to herself and her son.

Okay, having said all that, what is one of my biggest beefs with some movies?

Stupid therapists. Here was another one. Margaret, Bree’s therapist, breaks most boundaries known to psychotherapists and their clients.

The treatment plan between therapist and client exists as an agreement about how therapy will proceed. The therapist and Bree clearly have an agreement about the therapist signing off on Bree’s gender reassignment surgery (GRS). Without any discussion, Margaret rescinds this agreement because she disapproves of Bree’s decisions concerning her newly discovered son. This decision should have been part of a longer conversation between therapist and client, particularly as Bree’s surgery is already scheduled. While it is a wonderful idea to encourage clients to work through old and life-restricting feelings originating from their families of origin, I have yet to hear of any reassignment surgery (and it’s certainly NOT in the Harry Benjamin Standards of Care!) that has a requirement of this work being undertaken prior to surgery. In fact, if this requirement were on the books, absolutely nobody would qualify for surgery!

It is unconscionable for a therapist to force their agenda onto their client, which is precisely what Margaret does when insisting that Bree tackle the relationship with her son, as a prerequisite for her signature. In addition, Bree’s statement that Margaret is her “only friend” is revealing. Indeed, it quickly becomes clear that Bree is almost completely without friends and family, living a solitary life in her small apartment, and therefore her relationship with her therapist unquestionably takes center stage in her life as her important relationship. While it might arguably be appropriate for a friend to change their minds about an agreement without discussion, it is never okay for a therapist to do so. Margaret appears to have lost sight of clinical process that she feels able to do this. It is an example of what can happen to the relationship between therapist and client when the therapist “forgets” the nature of the relationship. Friends can afford to change their minds. Therapists cannot.

While hugging a client occasionally is not a bad thing, sitting next to them on the couch, holding their hands, and stroking their face while calling them “sweetie” is definitely crossing a therapeutic line in the sand. Need I say more? Movies are very influential in how people view other groups. There is enough confusion already about the nature of the therapeutic relationship, and to my mind this film could add to that bewilderment. The obvious caring and compassion that her therapist displays towards her client, Bree, is heart-warming and not to be dismissed as an important prerequisite for the work that any therapist undertakes with a client. What is more, suggesting that her client undertake the difficult work of reconciling with her identity as a parent and offering to illuminate the path so that this work happens is a sound clinical recommendation.

Requiring it is not.

Single Therapist

2006-06-01T23:16:00.000-07:00

I have a truly wonderful friend, who is a licensed psychologist and a neuropsychologist and who has several professional specialties, one of which is interviewing inmates and then writing forensic reports for these incarcerated felons. She spends more time visiting high security prisons than anybody I know, but truly enjoys the work and has fascinating stories to tell of what it's like in prison. My friend is beautiful, intellligent, funny, generous, fascinating and sexy. She's also a buddhist, Italian born ("Roma!")....and she's single and has been for a long time. I look at her and think that it's nothing short of a crime that she's SO single. My spouse and I are currently having work done on our home, and have a fabulous woman carpenter doing the work for us. While I was busy in my study, the carpenter was in and out, painting closets, caulking holes, plastering, painting and generally beautifying our house. I told her about my friend, and asked if she had any ideas for a blind date for my friend? After chatting for a few minutes, the carpenter asked what my friend did for a living. "She's a psychologist," I replied. "Ah, well," said the carpenter, "that's your problem right there! People shy away from being involved with them! Intrigued, I asked her why. "Everybody thinks they're crazy!" said the carpenter with great conviction. No further information was forthcoming from the carpenter. But her reply has intrigued me. I can see why it would be challenging to be romantically partnered with a therapist. If the rest of them are anything like me, I just can't seem to shut off my brain. Even if I'm not saying therapist kinds of things, I'm definitely thinking them. I can't be the only therapist who has to constantly stop him or herself from jumping in with an annoyingly empathic or supposedly insightful comment. I do censor myself, I promise. But it's a hard habit to break.

I have several friends (and clients) who are single and they tell horror stories of what they go through in their search for their mates. Of course, to off-set that, I have countless friends (and clients) who are in relationships that give them grief and misery and who question their participation in coupledom almost daily.

But back to why it's scary to be in a relationship with a therapist.

I think this deserves a Top Ten List. Anybody care to help me compile one? I’ll get things started.

10. We over-analyze everything.

Any takers for #9?

By Order of...

2006-05-30T14:49:00.000-07:00

So, I have this fabulous client who shall remain nameless, with whom I have sat for many hours,, learning more and more about her life struggles and her joys, and whose many wonderful successes I share in happily. She had to (unusually) cancel her regular appointment this week, and left a message on my voicemail informing me of this. She also added that when she had told her sister that she wasn't able to go to therapy this week, her sibling had informed her that my client should tell me to use the time that I wouldn't be seeing her writing a blog, as they check daily and that nothing new has been posted recently.

So, even though I don't have much time to write (despite the extra hour off today) I did at least want to post that this little event has made me smile happily all day long.

And to those dedicated blog readers, siblings of clients, I dedicate this blog. Thank you for your patronage (and yes, I will be back soon!)

Prime

2006-04-22T21:20:00.000-07:00

I have just finished watching the movie "Prime," starring Merryl Street and Uma Thurman. In case you haven't seen it the premise is that a 37 year old, recently divorced woman (Uma Thurman) falls in love with the 23 year old son of her long-time therapist, played by Meryl Street. The therapist realizes fairly early on that Uma's paramour is her very own son, and makes the decision not to tell her client that she has realized this.

Did anybody else feel entirely too discomfited by the dishonest way in which the therapist handled her ethical responsibilities towards her client? I felt as if I was crawling out of my skin sitting on the couch watching her. I guess this is one more awful representation of therapy professionals to add to my ever-growing list. I asked family members watching the movie with me what they thought of Meryl Streep's portrayal of a therapist, and whether they would have felt safe and comfortable with her as their therapist. Comments were that she was (a) giving too much advice and not giving the client any room to breathe (b) putting her own interests ahead of those of her client (c) confusing her own issues with those of the client (d) making her client uncertain, confused and bewildered by her antics, while denying that she was acting any different or feeling anything unusual and (e) being affected and annoying!

Once the therapist realizes that Uma Thurman is dating Meryl Streep’s son, it becomes increasingly apparent that the therapist is using the client’s sessions to find out information about her son.

Contrary to Streep’s representation of how therapy is conducted, therapy is NOT about a clucking maternal figure, “chatting” with a client and hand-holding their way through a session, while commiserating, in clichés, about how hard life is! A therapist should be able to challenge their clients to see their lives in new and different ways, not alternately soothe them into oblivion with well-placed platitudes about love, romance and religion and the occasional affectionate patting of cheeks.

I’m still shuddering.

Dual Relationships

2006-04-21T21:59:00.000-07:00

I decided to write this blog after receiving a comment recently by somebody who became romantically involved with their therapist and was seeking advice for how to handle the outcome.

In my own experience as a client, it’s definitely a huge bonus if the therapist is friendly, warm and caring. But the ethical guidelines that govern therapeutic relationships, no matter what type of therapist you are, always maintain strict rules around what are known as dual relationships. Therapy relationships are one-sided for very good reason. As much as your therapist loves you and/or you come to love your therapist, they will never and, in my opinion, should never be your friend or romantic partner.

Clients take a huge risk in opening up to a therapist. Most people coming to therapy usually start from a place of extreme vulnerability and unease in their lives. Maybe they are in a shaky marriage. Perhaps they are beginning to look at their sexual orientation. They may recently have begun to work on their sexual abuse history. They may have just lost a significant relationship in their life. Or perhaps they have had a miscarriage or a child has just died. Whatever the presenting issue, people rarely come to therapy because they are so gosh-darned happy, that they need to sit down with a complete stranger and talk about it. The nature of this relationship automatically creates an imbalance of power and it is the therapist’s job and professional duty to uphold the boundaries between him/herself and the client. Any time your relationship with a therapist is anything but a therapist and a client, that is considered a dual relationships.

One important perspective that all therapists need to maintain is the ability to put their clients needs above their own. If I have a clear and vested interest in having some of my important emotional, physical and psychological needs met from my client in the context of a friendship and/or sexual relationship, how can I remain committed to putting them first? Any time a therapist is in a position where they cannot put their client’s needs above their own, they are on shaky ethical ground and it is their responsibility to make the decision about whether the therapeutic relationship is moving (or has moved) into dual relationship territory. Many dual relationships have innocent beginnings, (for example, you find yourself in the same book club as your therapist, or he/she is on the PTA, or n your local community watch group, etc.) but can quickly become exploitative and harmful to the client.

When data from national studies were measured, it was shown that 4.4% of therapists (7% of male therapists; 1.5% of female therapists) have had sexual relationships with their clients. The ethics codes of ALL mental health professions prohibits sexual relationships between clients and therapists, precisely because there is a recognition of the potential for psychological damage from these relationships developing. The most common emotional outcomes for clients who have become involved in a sexual relationship with their therapist are feelings of emptiness and loneliness, difficulty trusting in relationships, confusion over boundaries and the nature of helping relationships, an increased risk of suicidality, anger, feelings of guilt, hesitance and indecision in making life choices. On top of this people often find that their feelings fluctuate wildly, and report feeling out of control and an increased feeling of unpredictability in their lives. When research has been carried out on the outcomes for therapeutic relationships that became sexual in nature, in almost all cases the experience of the former client is predominantly negative. In addition, therapists who engage in sexual relationships with their clients rarely stop at just one client – they have often had multiple other sexual relationships and often choose the most vulnerable clients to initiate sexual contact with.

If your therapist has initiated sexual contact with you, or has offered to terminate therapy so that you can become involved in a relationship outside of the therapeutic context, I suggest that you seriously consider contacting another therapist. If the therapist is licensed or affiliated with a nationally recognized mental health association, consider contacting the association to ask them what action they suggest you taking. Clients frequently get “crushes” and/or fall in love with their therapists. These are complicated feelings to navigate and it is imperative that the therapist remain professional, impartial and maintain strict physical boundaries in order for clients to safely explore these feelings. The power imbalance in a therapy relationship rarely goes away, after either friendship or a sexual relationship has been established, and the power is nearly always in the therapist’s favor.

Taking Care of Business

2006-04-10T17:06:00.000-07:00

It’s Monday. I rarely see clients on Mondays. It’s a day for catching up with my reading,(professional journals and books and the new waiting room “Oprah” magazine, before it goes out to the waiting room!) returning calls to prospective clients, paying bills and doing paperwork. Every other Monday I have lunch with my friend Doriana, a Neuropsychologist and Italian born. But not today.

While I talk about Mondays as “my day off,” I’m still hard at work taking care of some of the important aspects of being a psychotherapist –the minutiae of running a business. For example, in my office sits a bright red suede loveseat. I fell in love with it two years ago, and since then its cheerful red has become somewhat soiled and dirtied by the fingers of anxious clients. While waiting for Carpet Busters to arrive and perform miracles on the couch, I return a call to a guy called Steve, from a health club in Watertown. He wants to know if I’d like to be the exclusive therapeutic referral source for clients from their fitness club membership. This “referral source” honor will cost me $800 per year, and for this I get to be the only psychotherapist who advertises in the foyer of the health club. I tell him that I’ll get back to him. My practice is already full, and don’t know if I can handle any more referrals. I call a colleague, Bettina Dee, a wonderful EMDR therapist in Watertown Square, and ask her if she’s interested in using the advertising slot. She is and says that she’s very appreciative of the opportunity. Bettina moved to the Boston area from California, where she had a thriving clinical practice. She’s just launching her practice here, where her clinical specialty is working with women who have had traumatic birth experiences.

As I type, I have a very friendly young man here from Carpet Busters in Waltham, MA, cleaning both the couch and my carpeting. When I pointed out the love seat and the specific areas I wanted him to concentrate on, he said, “I bet that’s tear-stained.” Good observation. And coffee-stained, pen-blotched and greasy where anxious people have grasped the arms of the couch and clung on for dear life. If only a fresh couch could be a fresh start for all the couples who sit on this couch, working so hard to make their relationships work.

As Guy, the carpet man, works on cleaning my rugs and couch, we chat backwards and forwards about what I do and about where I’m from, and about his business. It turns out that he’s been to Portsmouth in the south of England. Like 250 million other people I’ve met in the last 20 years while living in the US, he comments that he “loves” my accent. By the end of the visit, bringing cleanliness and order to my cozy little office, he’s pronouncing the word “dirty” with a delightful British accent as “dirty” with a “t” instead of a “d” – as in “dur-dee.” I point it out to him and he looks embarrassed, but seems pleased. When people tell me they love my accent, I frequently tell them that I like theirs. Most Americans are stunned. “I have an accent?” is a frequent response. I have one adolescent client who loves country and western music. On one occasion, she was playing me her favorite C&W song, I put on a southern accent and sang along with her. She shrieked and told me to stop. "It freaks me out that you sound like that!" she said. I've never done that again. Accents are very powerful things, don't you know.

After Guy leaves, I sit and admire my slightly damp, but nonetheless clean couch and the rug whose colors are now more apparent than before, smothered as they were previously beneath the salt staining and trampled in mud from the after-effects of a New England winter. I return a couple of new client calls and emails. The first appointment for a new client or clients is nearly always the hardest one to make. Other people’s busy lives and a busy clinical practice make for scheduling challenges, and it’s interesting how different people handle the challenge. Sometimes prospective clients become frustrated and angry at playing phone tag as we try to find a mutually convenient time for the initial session. Sometimes they act apologetically and guilty for being so “difficult” to meet with, as if they are doing it on purpose. Yes, folks…even the first few telephone calls are therapeutically valid as far as I’m concerned!

Dori, the Executive Director of the non-profit agency next door, is in today. I give her Guy’s number in case she should need her office carpets cleaned, and she comes into my office to look at his handiwork. Dori is a great writer, and I ask her if she would be willing to edit my web pages text for grammatical errors and run-on sentences. Affirmative. I’ve been working on the text for so long that I’m making things over-complicated in my attempts to be succinct. The web designer is all set to launch the site as soon as he has the text and I need to also get a photograph taken. Photographs. Always a challenge. I’ve lost some weight recently and seem to be continuing to lose. Do I post a photograph at my current weight, or post a photo that’s a few years older figuring that I’ll look like that before too long anyway? I’ll mull this one over. Meanwhile, I’ll let you know as soon as the site is launched.

Why Sex Therapy?

2006-04-09T00:15:00.000-07:00

When I tell folks that I'm a sex therapist, there are four questions that I'm usually asked almost immediately. (1) Why do people seek sex therapy? (2) Who goes to sex therapy? (3) What kinds of problems do people want help with? (4) What exactly is sex therapy?

Why do people seek sex therapy?
Over the course of a person's lifetime stress, trauma, illness, the side effects of medications, depression and lack of self-esteem can often negatively impact a person’s sexual functioning and desire. It is not uncommon for couples and individuals to experience sex-related challenges at some point in their lives. Everybody deserves to experience satisfying, exciting, loving and fulfilling sexual relationships and sexual contact and sex therapy can often help.

Who goes to sex therapy?

This list is not exhaustive, but some of the people who attend sex therapy are:

* Heterosexual men and women, singles or couples
* Gay, lesbian bisexual, transgendered and intersex individuals and couples
* Busy and exhausted parents who can't seem to find time for intimacy
* People in their 50's, 60's, 70's, 80's and beyond who have questions about their sexual functioning
* Sexual abuse survivors who want to have fulfilling sexual lives, but feel haunted by their past
* People re-entering the dating world after divorce or death of a long-time partner
* People in their early twenties who are embarking on their first serious sexual relationship
* Married men who cross-dress and whose wives either (a) don't know that they are married to cross-dressers or (b) have found out that their partners are cross-dressers and are scared, and/or confused and/or angry and/or upset.
* People who are sexually compulsive and feel that their compulsions are out of control.
* Individuals in a heterosexual relationship or marriage who are beginning to question their sexual orientation.

What kinds of problems do people want help with?

Some of the issues that sex therapy can help with are as follows:
* Difficulties either getting and/or keeping an erection
* Difficulties maintaining control of ejaculation or trouble with “timing”
* Inability to orgasm either alone or with a partner
* Finding the ability to relax and enjoy sexual activity a challenge
* Lack or loss of sexual desire
* Feelings of embarrassment or shame about your body and sexual functioning
* Painful intercourse (known as Dyspareunia)
* Involuntary spasming of the vagina (known as Vaginismus)
* History of sexual abuse, rape or threatened sexual trauma
* Intimacy and relationship problems that are affecting your sexual relationship
* When feeling bad about your body is negatively affecting your sexual life
* When you've been faking orgasms because you're too embarrassed or ashamed to talk about your difficulty climaxing
* When you find yourself passing on having sex with your partner because it's difficult to get and/or maintain erections
* You're so worried about "performing" that you avoid sexual intimacy
* Since having a baby, you're less interested in sex
* You want sex frequently and your partner isn't interested
* You don't want to have sex and you feel like your partner is constantly bugging you about it
* You feel like you spend too much time thinking or fantasizing about sex
* Having sex is painful and you feel hopeless about ever freely enjoying it
* You have questions about your sexuality and don't know who to ask
* Your partner wants an "open" relationship and you're unsure if you can handle it or even want to try

What exactly is sex therapy?
List most other forms of psychotherapy, sex therapy is exclusively talk therapy, which involves meeting with a therapist on a regular basis to talk about how to overcome whatever problem a person has identified. In exchange, the sex therapist shares his or her knowledge of human sexuality and expertise in working with sexual functioning and relationship challenges. Sex therapists are trained to diagnose the psychological origins of sexual issues and work to find solutions. This will often mean collaborative relationships with physicians whose specialty is sexual medicine.

Once the ice is broken and people feel more comfortable asking me about the work I do, they frequently ask if sex therapy involves me touching my clients in some way. The answer is a resounding NO! Despite common misconceptions, sex therapy does NOT involve sexual or physical contact between therapist and client. (Masters and Johnson used sex surrogates in their pioneering work in the 50's but this practice has long since been discontinued.) Sex therapy NEVER involves nudity, sexual contact or sexual touch between the client(s) and the sex therapist.

As with any form of therapeutic relationship, an ability to feel comfortable with a therapist is half the battle. Most sex therapists, including myself, take an extensive sexual history about you and your life. They ask questions that you may not be used to answering. Given that most folks find it embarrassing to talk about sex, it's even more important that you find a therapist who puts you at ease and with whom you can begin to talk freely.

Nearly back...honest!

2005-11-24T00:27:00.000-08:00

My daughter has returned home, and is back to work full time, albeit on "light duty." She is finally pain free after many weeks, and completely free of pain killers and anti-biotics.

I feel as if I can breathe again.

I didn't realize how run down I had become by the stress of her hospitalization and recuperation. I am taking this as my wake up call to prioritize self-care after working so hard to nurse my daughter and take care of our granddaughter. I believe that therapists have a responsibility to model good self-care - and we all define that in different ways, I'm sure. At the barest minimum, mine is adequate sleep, healthy eating, as much exercise as I am able to do given health challenges, plenty of joy and laughter and time spent with people who love me.

The pull to write has been strong, but with both my daughter and granddaughter camped out in my study at home until recently, I have been without my writing haven. Typically this means being ensconced in my study, late at night, when the house is still and quiet. I sit happily at the computer, mint tea steaming in my favorite mug (white snowflakes on a winter-blue, porcelain background), the dishwasher quietly humming in the kitchen, puppies and humans curled up in blankets, perusing my half-finished blog titles.

Deprived of my ability to write, I have defaulted to my other love which is reading. Here's a partial list of books I've read in the last few weeks, in between nurse-maiding and grandparenting duties:

"Tales from a Traveling Couch: A psychotherapist revists his most memorable patients" by Robert Akeret
Robert Akeret, on the verge of retiring after many years in practice as a psychotherapist, decides to visit some of his patients to see whether the work they did together as therapist and patient actually worked. This is intriguing reading whether you are a therapist or not. Amongst the clients he visits are a man who worked at the circus and was in love with a Polar Bear and constantly showed up to his appointments covered in gouges after unsuccessful attempts to show the object of his affections the true depth of his affections.

"Fat?So!" by Marilyn Wann
Marilyn Wann is a truly amazing woman. She started a Zine called Fat?So! several years ago, which then moved online. The book is a compilation of her writings and thoughts, interspersed with the musings of others on what it means to live in a fat body. Funny at times, thought-provoking at others, never boring. Highly recommended to anybody who would like to begin to free themselves from the tyranny of hating their large-sized body.

"Revolting Bodies: The Struggle to Redefine Fat Identity" by Kathleen LeBesco
How anybody could take such a fascinating title and proceed to write one of the most turgid books in the history of the written word is beyond my comprehension. Her body politics are stellar, her ideas are interesting. However, reading her book is like wading through molasses carrying your bedroom furniture on your back - slow going. I finished it because I thought I should, not because I wanted to.

"The Strange History of Suzanna LaFleshe (and other stories of women and fatness)" edited by Susan Koppelman
This is a wonderful anthology of women's writings, exploring fat women's relationships with their bodies and identities. Happily, any shred of body hatred , misery about personal amplitude or self-disgust is missing from these pages. Instead, the pages are alive with fabulous stories of celebration of the body, stories of bodies that "refuse to be contained." Highly recommended no matter what size body you inhabit!

"The Tipping Point: How Little things can make a big difference" by Malcolm Gladwell
Written by the author of "Blink" this is a fascinating account of the moment when a wonderful "idea, trend, or social behavior crosses a threshold, tips, and spreads like wildfire." Very interesting reading.

"The Burn Journals" by Brent Runyon
Brent Runyon was only 14 years old when, depressed and hopeless, he poured gasoline onto his bathrobe, and set it on fire. He suffered 3rd degree burns over 85% of his body. After spending one year in intensive care, burn rehab units and having suffered excrutiating pain, he comes to understand the source of his despair and why wanting to die seemed like the only way out at the time. (The book is also a "How Not to Work with Adolescents" primer for any therapist who reads the book!) I winced my way through each page, but felt that I had been privvy to the intimate workings of the mind of a teenage boy for the first time in my life.

"Sissies and Tomboys: Gender nonconformity and homosexual childhood" edited by Matthew Rottnek
The book is an exploration of gender and child development, looking at what it means to be gender deviant as a child, and how our idea of "normal" stigmatizes and pathologizes children who exhibit cross-gendered behaviors.

Blogging Takes A Back Seat

2005-09-27T21:31:00.000-07:00

I apologize for the gap in my blogs. We've been thrust into full time grand-parenting of our six year old granddaughter, Arya, after my daughter was admitted into hospital last week. She had been having a long-lasting, gastro-intestinal flue for a couple of weeks, and after a brief respite, some of the symptoms appeared to come back, only stronger. Finally, by Thursday of last week, her pains were so bad we took her into the Emergency Room. She had extremely low blood pressure, could barely stand up, high white blood cell count, and a high fever, along with pains that bent her double. After six hours in the ER, they rushed her into surgery for an appendectomy. Turns out that some stool had found their way into her appendix, which then further perforated and finally ruptured. The doctors then discovered a blockage in her gut, which they subsequently managed to unblock after suctioning out half a gallon (no, really!) of gastric juices, mucus and other sundry bodily fluids through her nose. She was very uncomfortable for a day or so with the tubes going down into her stomach, but after 18 hours of this, the tubes had done their job and they were removed during one of my recent visits.

Sunni is currently on three different kinds of IV antibiotics as they attempt to bring the infection under control, and she is additionally receiving IV pain killers. However, there is still widespread bacterial infection in her body so they won't release her until she's fever-free, able to get up by herself, and is without pain. She's likely to be in another 2-3 days at the current rate of progress.

Anyway, I'm relieved that after a very rough week in hospital, Sunni appears to have turned a corner. Walking is still difficult for her but she takes a few more steps each time. Her great excitement this morning was that she gets to have dry crackers!

Meanwhile, back at our house...we have been trading off dropping off and picking up Arya from school and after-school, chasing an active 6 year old around the house, fighting the fights that all parents have ("Yes, you do have to clean your teeth. No, you can't run your egg-covered fingers along Nana's painting. No, it's not possible that the cat let your hamster, Twinkle, out of the cage.") and falling into bed exhausted at the end of the day. In addition to working full time, I have been spending a lot of time at the hospital, and for the last two nights, we have had another puppy in the house, Ziggy's friend, Jack.

Once Sunni has been discharged from the hospital, she will stay with us until she's well enough to return home. I'll be on nursing duty for a while, but hope to be back to blogging soon.

The War In Iraq

2005-09-21T19:33:00.000-07:00

Today I read a blog written by a woman who was, until recently, a nurse in Baghdad. I'm going to remember her vivid description of life as a war nurse each and every time I have a tough day as a therapist because very little can compare with what this woman endured in Iraq. No mortars explode 3 yards from my comfortable, leather office chair; nobody shows up minus their arms and legs; nobody spits at me, rapes me or tries to kill me; there are no enemies staring at me with hatred while I try to do my job; the smell of charred flesh does not linger in my nostrils and no babies die while I look on helplessly. No matter how challenging my day is, I leave my office with my body parts and senses intact.

Today was challenging, but it wasn't Baghdad.

I came face to face with a situation confronting a client that I've never had to think about before, and listened carefully to the client's confusion and upset as they struggled to make sense of the place they have come to in their life. I made a list of people to contact who might be willing to provide consultation, put the word out that I'm looking for a friendly Endocrynologist to talk to and have placed a call to a supervisor asking for help on how to create a meaningful intervention with my client.

I spent a lot of time reading books, articles and websites on Fibromyalgia and Chronic Myofascial Pain in order to better support and work with a client with invisible disabilities, and found my heart constricting with empathy, sadness and compassion as I read the descriptions of how people survive a life of pain, marginalized by the very community (medics) that should be supporting and working with them to improve their quality of life. (Read anything by Devin Starlanyl you can find if you want to know more.)

Today I've watched couples in pain fight with words and silence.

I've watched a brave woman take quantum leaps towards being the person she knows she can truly be, no matter what she risks feeling.

On a non therapeutic level, I ate bad Chinese food at lunchtime and took my puppy Ziggy to the vet (ear infections). He has allergies and is taking Benadryl. I'm definitely on a learning curve in the puppy department.

And now it's after 10 pm at night, and I'm trying to wind down by writing. Speaking of writing, next week I have my first meeting with a new writing group, and I'm excited to be tackling something that I've always wanted to do with a group of like-minded folks. Not only will I now (hopefully) belong to a community of writers, but I've already made a really wonderful new friend as a result of being turned down from another writing group. Will this be an end to the "run on" sentences in my blogs? You be the judge!

My puppy has stopped sniffling and scratching his ears for the time being. My spouse, S., is lying on the couch watching a new TV drama and I'm about to read a chapter on the Lymph System and the Immune Connection for the second time (I have a terrible time absorbing scientific information - I'm an experiential learner and find it hard to take in dry scientific "facts.")

(Just for the record, I am against the War in Iraq and comfortably to the left of democrat. )

Hollywood Therapists

2005-09-16T02:44:00.000-07:00

Therapists have a lot of cultural stereotypes to live down. Most of us are not dazzling or even gallant as some Hollywood movies would have you believe (witness "Awakenings") and while some of us are quite possibly bullies like Dr. Phil, it's rare, or so I believe. (Please, don't even get me started on the horrors of Dr. Phil, peddling cheap shots at people in extreme pain for monetary gain and spectacle - NOT that I have strong feelings about him dragging down my profession by the weight of his coin purses, his heavy absence of true compassion, blindingly huge ego and unethical boundary violations, oh-dear-me-no!) In short, I believe that most of us therapists try hard to be, and are, decent human beings.

Let's take a look at what psychotherapists are up against.

First off, there's the image of the therapist as "Dr. Loony Toons" like Dr. Crane on TV's "Frasier" and Mel Brooks' tour de force in "High Anxiety." All neuroses, crazier-than-their-patients zany and over-the-top wacky. No help there, folks! They really put the word "psycho" in psychotherapist.

Or how about "Dr. Homicidal Maniac" a la Hannibal Lechter, evil to say the least, shady at best and mind-boggling in his ability to inspire fear (and putting a whole new spin on the idea of "having lunch together.")

Then we have the image of the therapist as "Dr. Fantastic" - brilliant in his or her deductive reasoning, able to pinpoint the ONE event in a patient's life that has stymied them throughout life, and to magically remove its power merely by naming it - oh, that I could have that power! (oh that this was clinically valid - and for those of you who doubt it, it's not!!)

And then there's "Dr. Stick Up Butt" as in the old meanie who tries to ruin a child's Christmas on "Miracle on 34th Street." Those therapists! Always getting in the way of folks trying to have a good time!

Barbra Streisand's portrayal of an unethical boundary-busting sexual libertine on "Prince of Tides" was not a great professional moment for us. I don't want to give the impression that I have my head in the sand about therapists violating boundaries, even sexual ones, with clients. Therapists do it more than we realize. It's just hard to have out there as an iconic representation of one's professional field.

To my mind, one of the most scary and stand-out portrayals of therapist as "Dr. Crazy" goes to Richard Dreyfus' portrait of a therapist driven even crazier than his initial presentation as an uptight, OCD, money-grubbing and self-serving Narcissist by the demands of a needy and relentless patient, played by Bill Murray. This therapist is unable to hang on to his own sanity in the face of his client's desperation and becomes unhinged, thus joining the ever-growing list of Hollywood's celluloid images of us therapists as even sicker than our clients. What hope is there for any of us with therapists like that out there?

I can't think of one single image in Hollywood that shows a therapist in anything other than a flawed manner. We're either morbidly curious, sexually predatory, unhinged sociopaths, moody and voyeuristic, power hungry and money-grubbing, or hapless and stupid. Yeah, yeah. I know that we're all flawed. But come on! Hannibal Lechter flawed??

Falling In Love

2005-09-08T14:33:00.000-07:00

This blog was unwittingly inspired by an innocent comment made by a client last week. When talking about an interaction with a fellow bodywork professional, my client referred to their mutual understanding of what it feels like to “fall in love” with clients. I understood immediately that this was not meant in a sexual way, but referred to a clinician’s ability to fall in love with people’s vulnerable humanity. But it got me thinking, because I fall in love with nearly all my clients.

Many years ago I read that the need to love is as important for human beings as the need to be loved. I remember crying when I read those words, because it explained something important about the way in which I contribute to the world that was heretofore unexplained. I am a love machine – not in the way that the Motown group The Miracles meant it, but in a human miracle way. I get a kick out of liking and loving people and I’ve always been good at it. And while I’m definitely a caring person, I’m not exactly a caretaker. I don’t have too much difficulty with giving folks some straight talk if that’s what I think is required, even if it means they experience discomfort as a result. I don’t shy away from people’s feelings. I like people to feel good, but I’m not invested in that outcome if feeling bad for a while will get them to a more whole place in their lives. My friends tell me that I’m very loving, thoughtful and caring, good at expressing my affection and nurturing feelings towards them. My partner thinks that I’m the bees knees in the loving-and-caring department. In fact, I’m so programmed to like folks that I think of myself as somebody who can like and see good in just about anybody. As I have been known to point out to disbelievers, “Even Hitler loved his dogs.” In other words, even delusional crazy folks have at least one good quality, and I have rarely, if ever, failed in finding one.

I like thinking about liking people and interestingly, I’ve come to realize that it’s a lot harder to consistently and freely like and love partners, friends and family than it is to for me to like and love my clients? Why? Because relationships between lovers and family members are complicated. Even people who love you reciprocally will get tired of you complaining about the same old thing and tell you so. They won’t always be sweetness and light first thing in the morning or last thing at night. You have fights and struggles over the top left off the toothpaste and have to find ways to deal with the complicated minutiae of life, like who walks the dog most, and who forgot to pay the car insurance. And we take these fights very personally and they can get extremely messy.

Therapeutic relationships, like all relationships, have rules attached and the rules around caring and love are pretty clear. In therapy, the relationship exists to promote and benefit the client’s life, not that of the therapist. While the eroticisation of the therapeutic relationship is necessarily prohibited and contraindicated, verbal expressions of caring and liking are not. Just about everybody understands that seeing yourself reflected positively through a therapist’s eyes has a beneficial therapeutic impact. And, while there is a fragility inherent in most relationships, if you play your cards right you can return again and again to the relationship you forge with a therapist whose job is to see through your imperfections and personal challenges and reach for the true person inside.

There have been times when clients have made comments about the fact that I “have” to like them because they pay me and there are times when the issue of therapy fees can complicate therapeutic relationships between therapist and client unless you are completely willing to talk about the issue of money. However, while it’s true that therapy ceases for the most part when the fee is consistently not paid, it’s also true that the therapist remains willing to resume that relationship if and when the client returns. (I’m fascinated by the exchange of money in therapy and am working on a blog about this which I hope to post in the next few weeks.) This is not much different from other caring relationships where money exchanges hands. For example early childhood workers and teachers are paid to teach and encourage young children, and they invariably love and care for the children in their care, which is not a condition of their salaried position; the same goes for nurses and their long-term patients, and school teachers and their students.

Most clients are surprised by my willingness to talk of my affection and caring of them. They are surprised that I think of them outside of their sessions and frequently are moved to tears by observations and thoughts I have about them that surface in between our appointments. But as a client in my own therapy, I have had the experience of finding faith in my ability to tackle frightening challenges, buoyed only by my therapist’s caring and love for me. They don’t have to use the “L” word for me to know that I am loved – but sometimes the therapist’s empathy and nurturing have been the only things I have been able to rely on to propel me towards bravery. I use this personal experience of therapy in my own work as a therapist.

So, I see part of my job being to show love towards my clients and to encourage them to use this experience of my caring for them as a tool in other parts of their lives. Many people haven’t had the best experience of being loved in their early lives and without this experience it becomes difficult to love and treat oneself well. Therapy, with its one-way focus on a client is an opportunity to feel that acceptance and affection, the one-way focus on an individual’s life that many of us did not get to have as children. Therapists are, or should be, unfailingly polite and respectful, attentive and caring, concerned and thoughtful about their clients. It’s a gift to have this non-stop outpouring of thoughtful attention lavished on you for one hour a week with somebody who remembers the most seemingly inconsequential details about your life and can pull them together and tie up loose ends. And while being loved and cared for by your therapist isn’t THE whole story in psychotherapy, it sometimes forms the solid ground under the client’s feet that makes change possible.

Continuing Education For Therapists

2005-09-07T13:25:00.000-07:00

I set great store in reading, researching and generally educating myself about all things psychotherapeutic. However, Continuing Education units (known as CE's) are one of the banes of my existence. CE's are a requirement for those therapists who hold licenses. Those of us who are licensed have to produce a certain number in a given period in order to renew our licenses with the state. Professional/clinical workshops and seminars that therapists attend generally lure you in with the promise of CE's in exchange for large sums of money and your attendance. Generally, shopping around for interesting workshops is challenging, despite the overwhelming number of workshops that are offered. Seminar titles may sound interesting, but presenters are frequently dull, turgid and uninspired in their delivery. On rare occasions, I have attended workshops whose titles sounded dreary and hum-drum, only to find that the presenter made the material come alive and I came away learning more than I had expected. It's a crap shoot. (I must remember to blog about the overwhelming number of gaming and sporting references that litter the American vernacular!)

Over the weekend I took the "4MAT Learning Type" inventory and discovered that my style is known as a "Diverger." As a result, I now understand why I get so bored in workshops in which there is so little experiential content (and this tends to be the case with most of the workshops I have attended) . My style is to "learn by listening and sharing ideas and to integrate experience with the Self." I need to be personally involved in the process of learning, not passively absorbing information.

Anyway, brochures advertising these CE seminars drop through my letter box daily. Most of them go straight into the waste basket, coming under the category of "I'd rather read the book." Let me give you some idea of the kinds of seminars that are offered:

* Assessing and Treating Reactive Attachment Disorder: Beyond Oppositional Defiant Disorder

* Is this abuse?: A conference on the intersections between abuser education and therapy.

* Forgiveness: How can I forgive you? A radical approach to healing intimate wounds

* Treating Couples: Clinical Perspectives on Men, Women and Couples Therapy

* Teaching Sexually Explicit, Comprehensive Courses: Reducing the Risk of Professional Liability

* The Perils of Trauma/The Diversity in Healing

* Child Sexual Abuse

Not only are these seminars a crap shoot in terms of interesting material, they are frequently expensive. For example, the Couples Therapy seminar is $260 (possibly because it's offered by Harvard Medical School.) The more credentials you have, the more complicated it becomes in terms of fulfilling CE requirements for that credential. The American Association of Sex Educators, Counselors and Therapists (AASECT) whose CE's I can apply towards my sex therapist credential with that organization, offer seminars infrequently on the Eastern seaboard of the United States, despite the fact that they are really the only show in town when it comes to credentialing as a sex therapist. On top of workshop fees, you then have to factor in travel/flight/hotel costs.

Forgive me, readers, if I take this opportunity to vent and whine about the overall quality of training for therapists. It's abysmal. When all is said and done, (and with few exceptions) the most useful clinical information I have received has come through one of three channels: talking with my clinical psychologist friend, Kathy, (see her blogs at www.humansexualitysextherapy.blogspot.com and also at www.kathymcmahon.blogspot.com ) my own research and reading or clinical supervision.

How to decide which seminars to attend
There are a few seminar presenters whose presentation style is stellar, and if I see their names on a workshop listing I will invariably attend. Failing that, selecting CE seminars/workshops usually involves deciding where the glitches in my knowledge base lie, and seeking out those seminars that appear to supply that training and information. For example, a workshop was offered through the Massachusetts School for Professional Psychology purporting to be a structured guide for therapists working with single clients who were seeking partners. The information focused on how to motivate clients and offer them resources. I believe the cost of that seminar was $95.00. I learned little that was new to me and I won't be attending any more of that presenter's seminars.

At the same location, I took a seminar on Sexuality and Aging. The presenter's style was dry and flat, but the bibliography was very helpful. Probably not $90.00 worth of helpful, particularly as I'm a great "googler" and book researcher, but it got me started in the right direction. And, of course, I came away with 3 CE's.

I typically will sign up for anything new and interesting in the Human Sexuality field that is available, including new theories about working with couples, anything that addresses working with same sex couples or folks who are transgendered, and seminars that address HIV/AIDS and sexual "dysfunction." This has frequently meant traveling to New Hampshire, Maine and Vermont for some of my day-time trainings. (For international readers, I must explain that this means I am often driving more than 300-400 miles in a day to attend a 6 hour training.) Some of the best of these trainings are offered by unlikely sources. For example, I have found that the Northern New England Planned Parenthood organization offers a variety of interesting seminars on many subjects to do with Adolescent sexuality and I have attended several of these, despite the long drive there and back. (Their workshops also tend to be more experiential which also would fit in with my learning style.)

Interestingly, the Boston Area Planned Parenthood organization does not offer as varied a listing of seminars as their out-of-state partners. (It would be much easier to drive 25 minutes into down-town Boston than to make the 6 hour pilgrimage to Northern Vermont and back!)

My profession has generally been slow to use the internet, but I've noticed that gradually there are more and more online CE's being offered and this feels much more do-able in terms of time, resources and the dispelling of tedium. These CE's have the added benefit of learning at your own pace, being able to take frequent breaks and not having to listen to an uninspired presenter. Oftentimes, I will attempt to drag Kathy along to a workshop with me, reasoning that we both need CE's and if the event ends up being a drag, we can at least have fun perusing the book displays and hanging out together!

Top Ten Reasons For Starting Therapy

2005-08-17T18:52:00.000-07:00

10. Your friends and family have tried their best, but they can't seem to help you with your problems.

9. Buying self-help books is growing tiresome and is only slightly helpful (another book on saving your marriage by somebody on their third one?).

8. You don’t trust anybody else to know your innermost secrets and private struggles and have heard that psychotherapists are confidential and private.

7. You and your partner/friend/family member/spouse keep having the same old fight, yet more of the same and LOUDER doesn’t appear to be helping.

6. You can’t stop crying, are either sleeping too much or too little and have either no appetite or can’t stop eating.

5. You’re having trouble making friends and reaching out to people and think therapy might help.

4. You feel lonely, scared and isolated and can’t bear feeling this way any longer.

3. It helped somebody you know, so maybe it will work for you.

2. Getting drunk (or having sex, going shopping, gambling etc) to deal with life’s challenges is playing havoc on your professional and personal life and you don’t know where else to turn for help.

1. You’ve tried absolutely everything else – 12 step groups, support groups, friends, family, books – therapy is your last resort.

Top 10 Reasons For NOT Being In Therapy

2005-08-17T16:18:00.000-07:00

10. If you self-pay, it’s expensive – (a potential IRA.......whoosh........out the window!)

9. If you use your insurance, it’s on record that you have a diagnostic mental health issue (and then BANG goes your life insurance!)

8. It may not help

7. It may help and your life may change – yuck!

6. When you make changes in your life, your family gets mad and family get-togethers are even more awful than before.

5. You may feel uncomfortable

4. You may feel angry

3. You may cry

2. It’s the other person that needs therapy, not you – and they won’t go!

1. You don’t even go see your mother every week – why go tell a
total stranger your business?

Online Therapy

2005-08-15T06:00:00.000-07:00

It's the third day of my vacation and I'm starting to think about the various plans I've lined up for while I'm here. For the last year I've been in the process of doing the background work that goes into setting up an online therapy website, and one of the steps I've taken was to attend an online training with Elizabeth Zelvin, a therapist whose clinical practice is exclusively online. I've been procrastinating, primarily around the building of the website. Believe me, I have no excuse. I have a wonderful web designer, Nick Wigzell, who is going to build the architecture and design the site, and I have a spouse who is designing the back end practicalities of an online business. The place where I'm mainly stuck is in writing the website itself, the front end description of what online therapy actually is. I thought it would help if I wrote a blog about what I understand and believe about online therapy. Talking to therapy folks who are not online therapy savvy is typically frustrating - it scares most therapists to think about doing therapy online, and many of them don't believe that it can possibly be effective. The research belies this.

Meanwhile, what is online therapy? Are there any benefits to online therapy versus face-to-face therapy? What are the pitfalls of online therapy? Are there folks who seem to benefit more from online therapy versus face-to-face (f2f)? What kind of people should avoid online therapy and why?

Now, despite the fact that I haven't yet conducted an online therapy practice, I have a fair amount of experience conducting online chat rooms, as I worked for AOL many years ago as a chat room facilitator. I understand the dynamics of how relationships develop online, I understand the power of lines of text between people and how easily, unless you are careful and attentive to what you are saying and how you are saying it, your words and the words of others can be misinterpreted and misunderstood. I understand the need for clarity, and also for protocols to define online relationships. What follows comes from picking the brains of those who have gone before, along with my own research.

Types of online therapy
There are two main types of online therapy: synchronous and asynchronous. Synchronous therapy sessions happen in real time which means that they are immediate and in the moment. For example, chatting via instant messaging or in a chat room would be examples of synchronous therapy sessions.

What are the benefits of chat room therapy?
As anybody who has ever talked in a chat room knows, things happen fast. Chat room therapy is no different apparently. It's extremely fast-moving and it behooves the online client to either have or develop the ability to multi-task and follow fast-scrolling text. Just like any chat room, it's possible for the online-savvy therapy client to benefit from a lot of the same qualities that accompany f2f therapy, such as expressive communications, and on-the-spot interactions with the therapist, who is able to respond immediately to what the client is saying. Chat room therapy also provides structure to clients, somewhat replicating the idea of standard, scheduled appointments that happen in f2f therapy. Chat room therapy provides some consistency and a sense of ongoing relationship between therapist and client, and allows for the growth of a therapeutic relationship between participants.

What are the benefits of email therapy?
Email therapy is of great benefit to clients whose typing skills are slow. Chat therapy is speedy, but email therapy allows clients to go at their own pace. Without the discipline of a typical 50 minute therapy hour, which is standard for both online synchronous therapy and face-to-face therapy, people have plenty of time to write their therapy email in a reflective and thoughtful way. There's less of an on the spot feel than in face-to-face therapy, and for some folks removing this pressure is an added advantage. For clients who enjoy writing and expressing themselves in the written form, there's an extra familiarity that comes from writing. Conversely, for some clients the emails provide the distance that they need to feel comfortable and safe. They have control over how much or how little intimacy is fashioned and feel that they have more control over the session via email. In a typical f2f therapy session, the therapist answers a client's question or responds to a concern and then the words effectively vanish. In contrast to this, clients are able to retain their connection to the therapist via the written word in email therapy. Communications via email can be read again and again, allowing the online client time to absorb what the therapist has to say in their own time. The speed of therapy via email is a slower. Another benefit is the absence of structure. There is no need to schedule sessions and client and therapists can write and respond at their own pace. Email therapy is typically cheaper than synchronous therapy, and this often guides an online client's choice of the type of therapy they will select.

What kind of people seek out online therapy?
All kinds of people can benefit from online therapy. For example, busy parents who can't find babysitters or have very little time in which to leave their homes for therapy. People with disabilities who can't easily access transportation or accessible therapy offices. There are people with facial/bodily disfigurements who do not feel able to leave their homes or feel reluctant to be seen in public due to the social stigmas attached to physical differences. There are people with stutters who do not feel encumbered by their stutter online. Not everybody lives near places providing mental health services, and the online therapist is their only possible resource. Some sexual abuse survivors, both male and female, have significant anxiety about seeking face-to-face services with a therapist. These and other folks wary of face-to-face contact have the option to pursue online therapy.

Who is best suited for online therapy?
As I've already written. people who do well communicating via the written word are good candidates for online therapy. Plus it helps if you are able to maintain online relationships. It also aids in rapid communication if you have nimble fingers and are fairly internet savvy.

Who is ill-suited for online therapy?
Online therapy is not a good option for people who are very depressed and suicidal, or those who refuse medication or face-to-face therapy. It isn't usually possible using online therapy to create and sustain adequate therapeutic supports for them. Having said that, Azy Barak has an online practice specializing in services for suicidal clients, but he is a rarity. If you have big trust or safety issues, it's harder to develop a trusting therapeutic relationship with a therapist online, which means that it's also more challenging to be effective as a therapist. Not impossible, just more challenging. Some of the challenges that surface in any online relationship, will surface too in online therapy, but the ante is upped. For example, if you are dependent on the internet for contact with the outside world, this means that losing your modem, a dial tone, or the server going down creates hardship for a while. But this becomes an even larger challenge in therapy, where it's easier to feel abandoned by your therapist, even though he or she has no contact over the vagaries of errant IP's. This means that sometimes time needs to be spent on explaining why the therapist wasn't at the chat room at the appointed time, or why the email didn't get through that you were depending on for solace and support. Online therapy is not covered by most Health Insurance plans, so unless you have credit cards or a regular income it can be prohibitively expensive.

About 18 months ago I joined the International Society for Mental Health Online (www.ISMHO.org) to get up to speed on all the current thinking and research being conducted into online mental health services. For those of you who are interested, it's worth checking out their website. You can also watch for my eTherapy site, coming soon to an internet near you, at www.JassyTimberlake.com.

A Therapist On Vacation

2005-08-14T06:41:00.000-07:00

Finally, I am on vacation. The last 10 days have been exhausting and busy, with new clients beginning therapy in my practice and the external stressors of pieces of my own life. I’m tired and ready for a break. I haven’t had the time or energy to write my blog for a while, and am looking forward to writing a great deal while on vacation.

The last time I had a real vacation was September 11, 2004 when my new spouse and I took a one week Honeymoon to Martha’s Vineyard, with my beloved mother in tow. She came over for the wedding and stayed for the honeymoon. It was definitely not a romantic, or even restful, trip, despite the beauty of Aquinnah (formerly known as Gay Head). My mother dislikes “moving air” and is therefore miserable in the convertible that is so perfect for touring around the island roadways. She, like many other Brits, considers a long car ride to be anything more than an hour. Remember. Britain is a country that isn’t much more than 850 miles from one end to the other so a Brit’s idea of a day trip is a one hour drive each way tops. Anything more than that is considered re-locating.

But this time I am spouse-less and driving towards Western Mass, where I will be spending ten days with my best friend, Kathy, at the foothills of the Berkshires, and on top of a mountain. I drove here on Friday morning, with a stop off to do a therapy home-visit with a couple who used to see me for therapy before they moved out to Western Massachusetts, and who wanted a therapeutic check-in on the state of their marriage. While discussing my vacation plans with Kathy (also a sex therapist) I told her of my planned visit and that I was very much looking forward to seeing the couple again, in part because they are so fun and spunky and work so hard at being good people. She said, “Tell them that. It’s an important part of therapy that a couple knows that they’re approved of, that they’re great together.” I hope that I adequately communicated my affection for them while I was there. Home visits are a wonderful way to get a bird’s eye view of a couple’s life together, and this was no exception. If getting to do couples therapy in my office is an honor, doing the same thing in a couple’s home is a supreme privilege. I think we did some good work together. I also think Kathy is right. We humans like somebody from the outside to say that we’re doing a great job. Being half of a couple can seem really hard and it occasionally feels like an impossible feat to do it well. Being told that you’re doing a good job from somebody whose opinion you respect goes a long way towards smoothing a small part of a bumpy ride. Self-validation is an important skill to develop, but occasionally a simple, “Way to go! You’re doing great!” is just what the doctor ordered.

Most of my day to day life consists of driving less than a mile between my home and my office. So this vacation is an opportunity to drive my red convertible fast on the highway with the rag top down. I have come to consider a convertible de rigueur on vacation. On this occasion, I’m accompanied by my 6 month old puppy, Ziggy. He is new to the delights of convertible driving and spends most of the trip sitting on his haunches, looking backwards over my shoulder as we zoom down the highway, his little 9lbs of doggy fluff leaning companionably against my right arm as his white fur is whipped around like so much frenzied candy floss. There is what I imagine to be a look of sheer joy on his doggy face as we zoom past fields of manure, the canine equivalent of antipasto, the smell of which must send his olfactory receptors a-dancin’ and a-twirlin’. His round black eyes, fringed with impossibly long black eyelashes, squint and tear up from the force of the air rushing past us. His smooth pink tongue peeks out from between his small, sharp puppy teeth. He is salivating, and makes frequent little lapping movements. All of a sudden, I realize. He is tasting the air.

Before you dismiss these descriptions as those of a dog-crazed fool, let me explain. I am not an animal person. I have always been people, people, people all the way. But I love my new puppy with a passion that has surprised me, and I feel that in the very short time we’ve had together, I’ve re-learned some of the things I had forgotten were important in the world. Like how wonderful it is to be greeted like you’re a long lost love each and every time you leave the house and come back through the front door. Everybody should have that experience at least once a day. Like remembering that stretching and yawning luxuriously and taking your sweet time about it is a sensual delight, and if you can be scratched under the armpit at the same time, then all the better! That running as fast as you can through long grass is nothing short of heaven, and that doing it with a pal is even better. Sniffing, licking and lapping are crucial to any dining experience and the louder you can do them the better you enjoy your food (and a post-culinary nap is a must!) Impromptu enthusiastic wrestling with people you love is a bonding experience and sleeping curled up with your head in somebody’s lap feels like the safest thing in the world, especially if they softly stroke your hair and murmur loving sentiments. That bad things happen from time to time, but you can get over them and move on with gusto, because you’re loved and accepted by the people you live with, who will reassure you of that whenever it’s needed.

When my clients talk about their desires and wants and how impossibly out of reach they feel, I sometimes tell them that if I had a magic wand I would wave it and grant them their wishes. These doggy learning lessons are things I would want each and every one of my clients to experience daily. I would happily relinquish my therapy practice if I could make this happen for them.

In addition to my dog, I am accompanied on my trip by a pile of books, but not as many as I usually bring because Kathy and her husband, Daniel, have more books than the local library and I can browse at leisure. I have brought Nancy Slonim Aronie’s book, “Writing From The Heart,” with me and my plan is to read each chapter and complete the writing exercises at the end of each. I’m now on chapter 4. Kathy, who also loves writing, is doing some of the exercises with me. One of the chapters is about seeing an old place through new eyes. Yesterday, we sat at her kitchen table with our laptops hooked up to her wireless server, and both wrote our pieces about aspects of Kathy’s home and when we had finished, we read our stories to each other and cried as we read our own, and cried as we listened to each other’s. Being with Kathy IS therapy for me: it’s the lived experience of being required to think differently about who you are in the world and how you can be more fully yourself, despite what people say, think or feel around you. Most of the days I spend with her, continuing to get to know her deeper and deeper, is a learning curve on the friendship road of life (how’s about that for a contrived cliché?) For reasons we don’t fully understand, we are not affronted by each other, we are not threatened by each other, we don’t judge or feel judged by each other and we are endlessly curious about each other. I laugh when she criticizes me. She is now able to cry in front of me and risks feeling the deep humiliation at her own tears. We encourage each other to be as big a human being as we possibly can. A visit with Kathy changes me profoundly on some small deep level, and it’s effortless, fun, hilarious and engrossing while it’s happening. It's one of the relationships I have in which I am as close to canine as I can get. If only all therapy could be like that.

Not the Trojans that Sex Therapists are usually concerned with!

2005-08-02T16:27:00.000-07:00

I've been online since 1996, and in all that time I've never had a virus on my computer. For the first 5 years I had a Mac Performa, a beloved computer that finally gave up the ghost and was "buried" with many tears on my part. But even since "going over to the dark side" and moving to a PC, I've been remarkably lucky and virus-free for somebody who spends a lot of time online unwilling, blogging, talking with friends and family in the UK via instant messaging or planning my website, etc.

Several months ago, I invested some considerable funds in a brand, spanking new lap-top for my clinical office. There it usually sits, my pride and joy, gleaming in silvery splendor on my office desk. Imagine then my horror when, despite the most up-to-date virus software available from McAffee, my computer became infested with Trojan worms, which eventually occupied 1.5 GB on my computer hard drive! Running the anti-virus program was to no avail - the little beasties remained stalwart and resistant to infiltration, spreading their noxious threads throughout the length and breadths of my computer's functioning. Icons sprang up on the desk-top, and not particularly pleasant ones. For example, a woman's burgeoning breasts in a push-up bra with the heading "Love" beneath the icon - something that you would be surprised to see on any professional's desktop, even that of a sex therapist. More frustrating still was the fact that I couldn't delete them. In response to attempts to delete, the worm would spew forward ever more of these inappropriate icons. The computer was becoming unusable. It would close down the Word program in the middle of typing a letter to a colleague, prevent me from running virus software, and was making my office life extremely difficult. I didn't dare email anybody from the computer for fear of transmitting the virus/worm around my address book.

A family member who works in Information Technology suggested that I try PlumChoice.com who have secure online computer support. Initially, I couldn't log on to the website for Plum Choice. The newest Trojan worms have code that prevents you from accessing virus software sites or online computer assistance. It took me several tries to get to the site, mostly as a result of running McAffee to "distract" the worm, while simultaneously signing on to the website. I don't know how or why but this seemed to work. (Can you tell I'm a therapist and not a computer expert?) Anyway, I am a PlumChoice.com convert! I signed up online to receive remote computer support, which consisted of logging on with a remote technician, who proceeded to fix most of the computer via remote control. Nothing is more amazing that sitting back, with hands in your lap, watching the cursor move around your desk top as the technicians clear up the mess on your computer. Remote control via the web allows them to see and interact with the computer while you watch. So, while this is not a psychotherapeutic topic for a blog, it is at least my attempt to spread the information to anybody struggling with these awful viruses that there is help at hand!

Should Therapists Be In Therapy?

2005-07-29T08:41:00.000-07:00

I belong to a listserv for therapists and this is one of the topics that people have been discussing recently. It’s frequently a theme that raises ire amongst therapists, so here are my blogged opinions on the subject.

I remember in the halcyon days of Graduate School being amazed at how few of my student peers had actually been in therapy themselves and wondering how they were going to be able to empathize with the experience of their clients unless they knew for themselves what it felt like to be a client. I believe that it would be unethical to mandate therapy before commencing a graduate program, but there is a case to be made for strongly recommending that future therapists experience therapy for themselves.

I believe that my experiences in therapy have helped me begin to understand how it feels for some of my clients when they sit opposite me in session. Having been a client myself, I can empathize with the discomfort and vulnerability of showing one’s self, of displaying emotions that few, if any, people in one’s life will see, of talking about distressing and painful topics that may be rarely discussed with lovers, friends and family, of laying bare the challenges one faces in the world, the difficult decisions, the complexities of close relationships and so on.

But there are some clients whose life experiences and challenges are so far removed from my own, that it would be impossible for me to fully know from the inside out what they have faced in their lives, what it has meant to be that client. Does this mean that I would not be effective as their therapist? Walking a mile in somebody else’s shoes would definitely be a learning experience. But does a therapist need to have experienced and recovered from substance abuse in order to work with folks who are in recovery? What about able-bodied therapists who work with people with disabilities? Therapists who work with schizophrenics? Therapists whose specialty is working with people with autism? The list is endless. I believe that one of the most important aspects of a therapist having been in therapy themselves is that they understand the power of the therapeutic relationship from both sides of the couch, and understand the process of therapy.

Therapists should be in therapy if they need to be, but I don’t believe that we all need to be in therapy all of the time, and that the same holds true for therapists. What would be the point in requiring therapists to be in therapy that they did not need? Such a requirement would be tantamount to an assumption that all therapists are broken down and in need of “fixing” – this would be a huge, and inaccurate, leap in logic. In point of fact, very few of the people I see as clients are “broken” (and luckily neither do I perceive therapy as a process to fix broken people).

For licensed psychotherapists, our ethical mandate is to ensure that we take steps to be as effective and competent as is humanly possible and that we “do no harm.” We aren’t required to be perfect, merely to take steps to make sure that we follow our professional mandate. This requires us to either obtain supervision or refer out clients with whom we are in over our heads. In some cases, this might also mean that we ourselves pursue therapy in order to “tidy up” places in our life that get in the way of our well-functioning as therapists.

As regular readers of my blog already know, I consider supervision a necessity in my practice as a therapist. I also, when needed, am in therapy when it is needed. My daughter and I are just wrapping up some sessions of family therapy that have dramatically altered our relationship for the better: places that felt too messy for us to wade through alone became magically illuminated by Bunny Duhl's excellent clinical flashlight. I have a wonderful individual therapist that I am seeing at the moment to help give me perspective on a variety of issues in life, including how to handle my parents' aging and future deaths. I have read books on aging parents, being an adult child of parents, relationships between mothers and adult daughters, etc. Reading gives me instruction, education, insight and perspective. But it is therapy that allows me to internalize and experientially navigate what it means to be a 51 year old woman whose mother is aging and to have somebody witness the sorrow and grief I feel about that unavoidable, imminent and painful loss.

As somebody on my listserv wrote today, “If I need to place a Band-Aid on my finger, I'm able, but I can't seem to get my own proctology exam done - there's room for both self-care AND more objective care/therapy with professional assistance.” Few would argue that developing a healthy regimen for self care is not a good thing. Eating well, exercising, a spiritual life however you define it, nurturing and loving relationships with partners, friends and family, reveling in the delights of music and honest self-examination where needed – these are just a few of components of a vigorous, healthy life. Therapy is one such component - but a "when needed" not a "should."

The Fifty Minute Hour and Closure

2005-07-26T11:17:00.000-07:00

I received some interesting questions via email about the practice of psychotherapy, and thought I'd respond to some of them.

How many clients do you have and how often do they come and see you?
The number of clients I have tends to fluctuate. At the moment I have 27 clients, and they include couples, families and individuals. This is about as many clients as I can see in any given week. If my practice is full and the potential client is not an emergency, I compile a wait list. If the length of time a client must wait is more than one month, I keep a referral list of other therapists that I recommend to potential clients. In the event of a client needing therapy immediately, I refer to other therapists as soon as I receive the call. Of this 27 clients about half are couples, with one or two families. The remainder are individuals. I generally work Tuesday through Friday. 25-30 hours of my work week is spent with clients face-to-face. I spend 5-10 hours per week attending professional meetings; I have peer supervision with colleagues and paid supervision with other experienced professionals; I conduct research into areas where my education is lacking; I talk with "collateral" agencies (this means other professionals who are involved in clients' lives, such as psychiatrists, other therapists, social workers, teachers, etc.); I market my clinical practice; I do my book-keeping and answer/return phone calls. When I started my private practice, I was determined not to burn myself out and decided that a four day work week was a more humane and reasonable approach to working. I pride myself on being a very conscientious therapist and spend a lot of time reading and researching on different issues that clients raise. This might mean educating myself about other cultures, religions or spiritual practices, learning about the stressors attached to various professions that clients have, consulting with other clinicians with a particular expertise, etc.

Most clients come to see me once each week for a therapy "hour" which is generally, but not always, 50 minutes long. For busy couples, especially those with children and the accompanying headache of finding regular babysitters, I usually suggest that they attend a 2 hour session every other week. Clients in crisis will often request extra sessions during the week, although unless the client is in an emotional crisis or is very depressed I usually suggest that they only come in once a week. While coming to therapy can be very helpful for people, and building a good relationship with your therapist enhances the quality of your therapy, becoming dependent on your therapist is not advisable. Encouraging clients to build supports into their lives in the form of friendships, communities, support groups and/or 12 step programs is a valuable adjunct to working in therapy. It doesn't take a whole village just to raise a child - adults need villages of caring support also.

Why do therapists have a 50 minute hour?
This is a fairly common question. The answer is that therapists, including myself, often need to have ten minutes before the next client. This allows time to jot down any notes that we need to remember, check messages and return any urgent calls and clear our heads before the next client comes in to the office. While a 50 minute hour works best for the therapist, in practical terms I will often allow more time if a client is dealing with a particularly challenging time in their life and would really benefit from an extra 10 minutes on the end of their “hour.”

How long do people stay in therapy?
There are as many reasons for people to attend therapy as there are people on the planet. Some people come and see me with a specific goal in mind: a parenting challenge; the death of a parent; a sexual problem; a miscarriage, etc. These people may spend 3-6 months in therapy and leave. Often they will come back in for a "refresher" later on, or they will return to therapy if another issue comes up that they think I could help them with.

Some people come in with bigger challenges: long-term depression; a marital crisis that has come about as a result of years and years of marital neglect and estrangement; families recovering from the effects of a family member's long-term alcoholism and new sobriety; people with a lifetime of struggle, who are just beginning to realize how much they have been affected by the family they grew up in and want to learn how to make different choices for themselves; men and women with histories of sexual abuse who want to learn different ways of being in the world. These issues are often more long term. I have some clients who have been meeting with me for 4+ years. Others stay for a year or more and then leave, possibly returning later if they feel it would help them.

Sometimes people come in to therapy and are not yet ready to do the work. I always leave the door open for these people to return. I know from personal experience that it can take time to pluck up the courage to sit and face your demons.

How do you know when you are done with therapy? Is it really necessary to have “closure” when finishing therapy?
In the best of all possible worlds, a client’s decision to terminate therapy would be because the problems or issues facing them at the outset of therapy are no longer present in their life. However, in reality a client’s decision to leave therapy may be simple or more complex: they may feel that the piece of work they came into therapy to focus on has been adequately examined and explored; they may not feel that they are benefiting from therapy; they may not feel that they are a “fit” with a particular therapist; they may have come face-to-face with some challenging feelings that they are scared to bring up with the therapist and see abrupt termination as a way out of that fearful place.

If it is the therapist who is driving the termination of therapy, they may suggest termination if the client is either unable or refuses to pay for therapy services; sometimes the therapist decides that the problems facing the client are outside of their particular expertise or competence; sometimes, despite a therapist’s best efforts, they can tell that a client is not benefiting from the treatment; sometimes the reverse is true and the client improves dramatically over time and is no longer in need of therapeutic services, leading the therapist to suggest termination; and there are times when a therapist is unable or unwilling to continue to provide clinical services, either due to illness, need for prolonged absence, or some other appropriate reason. Unless the client’s quality of life has improved to the point where they no longer need services and have decided, after discussion with their therapist, to terminate the therapy relationship, the therapist is at all times responsible for attempting to ensure that clients have access to other clinical referrals.

Therapists often disagree about the benefits of taking time to “close out” a therapy relationship. Some therapists prefer that several sessions be devoted to the termination of therapy. Others don’t see the necessity of a lengthy termination procedure, and still others, like myself, think that it really depends on the client, how long they were in therapy, what kinds of issues they were working on, and how invested they appeared to be in the process. If a client comes to therapy wishing only to work on a short-term goal, the issue of closure is less important. However, in the event of a long-term relationship between therapist and client, the issue of taking time to say goodbye to the relationship takes center stage in the final treatment sessions. Few of us have had the opportunity to say a proper goodbye to a relationship, and that opportunity is enshrined in the closure sessions between client and therapist. This is the chance to “do it right.”

The manner of terminating therapy is one of the most crucial aspects of therapy. All relationships should have a good ending and a good beginning and therapeutic relationships are no different in that respect. While licensed psychotherapists are bound by the ethical standards of their professions to follow appropriate termination procedures with their clients, clients are not bound by the same rules and ethics. I always hope that my clients will terminate therapy with me in an honest and straightforward fashion, but this is not always the case. Some people would rather drink drain cleaner than say goodbye! This shows in the way they terminate the relationships. For example, refusing to answer a therapist’s phone calls is not terminating therapy. That is hiding out from therapy and is not an honest approach to closure. Getting “too busy” in your personal life and not having time to attend therapy is also not closure. That is running off and is not the same as taking time to say goodbye. If a client is furious and/or upset with their therapist and is too scared to tell them, leaving therapy rather than dealing with their feelings that is not closure – that too is running.

On balance, the most effective way to terminate therapy is to talk about it. It is an opportunity to review where you are in your recovery path and to understand, with some perspective, where you have come from, where you stand and where you still might need to go in the coming years. Even a short term therapeutic relationship can benefit from one such session. It is a great opportunity to take stock of strengths and to pat yourself on the back for your hard work (both therapist and client!)

Before the Wedding

2005-07-23T04:41:00.000-07:00

I seem to be becoming the "expert" on Wedding Day jitters! I was just interviewed again for an article on Wedding Day Discord, for "Elegant Wedding" magazine. So, here are my thoughts on how to survive family discord at weddings. In fact just recently, a young couple has been coming to see me for pre-marital counseling. Among other issues they wanted to talk about was the anxiety and tension that was continually surfacing over mounting family discord (on both sides of the bridal couple) during the planning of the wedding, and how this was affecting the couple as their wedding day draws nigh. While therapy can be, and often is, a deeper examination of the origins of one person's complex inter- and intra-psychic issues, three weeks before the wedding is probably not the time to do critical or long term psychological digging. This is the time for understanding, solution-focused dialogue, clarity and clear-cut pragmatics.

Let's face it - weddings require huge amounts of preparation and planning around family and personalities, especially if the couple come from very different family backgrounds. Any time you bring together two groups of people with differing opinions on marriage, religion, culture and values, there's the potential for sparks to fly!

Problems? What problems?
For a start, in view of the divorce statistics, there is a high probability that the in-laws are separated, divorced or remarried which presents the problem of multiple combination of parental couples and dynamics, all with opinions and thoughts on how they would like their role in the wedding preparations and ceremony to play out. Here in Massachusetts where same-sex marriage is (happily) legal, homophobia will often rear its ugly head in the planning of the wedding and decisions over the presence of family members who will undermine the joy of the event creates a dilemma for couples.

There's a distinct chance that the couple, and therefore their families, represent different religious, ethnic/cultural backgrounds. Oftentimes, long simmering family feuds raise their ugly heads at weddings, with the specter of emotional clashes and uncomfortable disagreements arising on what the couple hopes will be their special day. Weddings also bring up social class issues and differing opinions and beliefs about money and how much or how little is available and how it should be spent. There are often disagreements, spoken and (often more dangerously) unspoken about how the wedding should be organized and how traditional or non-traditional it should be. In other words, weddings are potential powder kegs of family discord, and much of the anxiety created by bringing families together invariably ends up being carried by the couple.

What choices can a couple make and how can pre-marital therapy help?
The number one most crucial aspect of planning a wedding where there is a potential for family discord is communication between the couple. Marital therapists, trained in family systems and experts on family dynamics, are well placed to guide couples through the swirling vortex of pre-marital confusion. Marital therapists know that if the couple aren't on the same page, chances of smooth sailing become less likely. Now is the time to get to grips with the wedding day issues as a couple, being clear on the problems that each half of the couple has identified, being respectful of each person's fears and anxieties and being clear on the direction you are going to take together, and how you will communicate this resolve to family members. As an impartial observer, marital therapists can provide outside-the-box thinking on how to approach family challenges. One of the things that I usually suggest is that the couple create a "wedding support system" - one or more people from outside the couple's respective families, who are the designated "go to" folks for complaints and/or conflicts during the planning of the wedding. I typically suggest that this person or team is present at the couple's conflict-resolution planning sessions, either with me present, or in the planning the couple does outside therapy, so that everybody is clear on how the couple intends to approach potential or actual family conflict.

Weddings bring up people's romantic hopes and longings. For those relatives present whose marriages did not endure, weddings bring up feelings of sadness, of hopes, dashed, and bitter-sweet memories of their own weddings. Unless you are lucky enough to live in Massachusetts, USA, Canada or Spain, you are probably not living in a country or place that allows same-sex couples to marry, so if you are a gay or lesbian wedding attendee, weddings can be painful reminders of how you are denied access to such ceremonies due to civil rights issues. The wedding support team, as well as the couple themselves, can help smooth ruffled feathers by taking the time and being willing to listen to people's thoughts, hurt feelings and disappointments. But then calmly, but respectfully explaining their choices. Establishing a clear boundary that this is your wedding day and and that you retain the right to at all times reflect your choices and desires is important.

If the wedding is uniting two families of different religious or ethnic backgrounds, ask the families to submit a list of three religious symbols or ethnic/cultural customs that are important to them and then ask if they would be willing to have you pick the one that fits best with your wedding. This helps families feel that their beliefs and values are important and included.

Find an area of organization that family members can co-create, i.e. a table with a joint family album, or framed photographs from both sides of the family. The symbolism of having all these photographs on the same table or united in the same album will not go unnoticed as a statement by the couple and can be a strong symbol of unity that is effective in framing the wedding as a bridge to a new beginning.

I usually tell folks to get creative! If folks are fighting about who is going to walk down the aisle, have ALL parents walk! If you can't come up with a solution alone, consider taking representatives of each family for a family therapy appointment with a licensed marriage and family therapist. We are trained to handle a room full of disappointed and possibly irate people (and I have found that most people can agree to disagree if it's just for one afternoon!!) Bear in mind that for a formal wedding, seating arrangements can be made so that the paths of warring factions don't cross. I also usually remind the couple that the officiant at their wedding should be apprised of the situation if there are dissenting factions. Even if they don't have specific recommendations on how to handle the situation, they will at least be aware of the tensions and can better support the couple on their special day.

Is Therapy Private?

2005-07-13T19:47:00.000-07:00

When a prospective client first contacts me about therapy one of the first things I do is to send out a copy of my HIPPA (Health Insurance Portability and Accountability Act) Privacy Notice and a couple of pages (oh-so-poshly called my "Statement of Practice") that describe my clinical practice. The Privacy notice, as of April 2003, is a "must have" in any clinical practice and therapists are legally required to present one to their clients. I have one of the best written privacy notices EVER because my spouse was HIPAA Compliance officer at a major hospital a while ago, and made sure that I dotted my i's and crossed my t's! I know of many therapists who don't provide one for their clients, and are treading on a legal minefield as a result. Essentially what this notice says is (1) how information about you, the client, can be used and (2) how you, the client, can access your personal information. On my particular privacy notice there is a handy-dandy tear off sheet on the back. Most client dutifully tear off the sheet, sign it and return it to me where it is filed away for posterity, proof that I gave them the document. Only one client has ever had a conversation with me about privacy, thus proving that they actually read the privacy notice! As boring as it is, I wish more clients would take the time to read. It's frequently taken for granted and shouldn't be.

The very first session with a new client, I have a checklist of things I review with them. First one on the list is the limit to confidentiality. Here's where I inform my client that if they plan on beating up the wife, abusing their kid (or any other kid for that matter), wacking the next door neighbor, slow-poisoning an ex-boyfriend or killing themselves, I am duty bound to warn the appropriate authorities. This is the meaning of the phrase "mandated reporter," and there is no therapist in the USA who can circumvent this. The law is the law.

When all is said and done, most people, and by people I mean clients, can see the wisdom in this arrangement; after all most of us want to protect children, and most of us understand that people need to be protected from those few poor souls who want to hurt, maim or otherwise disrupt our lives in painful ways, even if this does mean revealing our confidential records. So, I typically explain that I would in most cases attempt to contact and talk with the client first, before making the call if I am about to break what I consider to be a sacred trust between therapist and client (their privacy) they deserve to hear it straight from the horse's mouth.

So, here's the irony for me in giving out this darned Privacy notice. Here I am, doing everything I can to provide a safe environment in which people can unload and unburden themselves of their deepest, darkest pain and yet I am required to hand out this blurb that essentially says that people have less rights than they think they have (if they were to think about it for more than 3 seconds that is!) In point of fact, clients who self-pay for therapy and don't rely on their insurance (and these clients account for 99.9% of my client base) have many more protections than clients who use their health insurance to cover their mental health costs. Health Insurance companies place great premium on being able to have access to mental health providers' files. In fact, they have the right to review ALL clinical files, even those of clients who are not members of their insurance plan, if they consider or suspect that the therapist is providing improved coverage and better standard of care to self-pay clients.

I was talking with my friend Kelly about privacy and confidentiality this week, and told her about this blog, and about the philosophical dilemma I am in each time I hand out the privacy notice. Kelly and I have spent endless hours discussing organizational psychology and the importance of a shared vision and mission in working with groups of people in collaborative efforts. Kelly works in a senior position at an urban multi-service center working with poor and homeless people and I used to be director of a large agency that covered five cities, and the mission of the agency (which also focused on poor and working poor people) was the central organizing principle for me with every facet of the work I did. This applied whether I was supervising staff, directing the various projects I implemented, or even down to the way I related to the people who delivered sandwiches to our agency site at lunch time. So, during this particular conversation Kelly told me the following:

"I was doing orientation this week with a new hire and told her what the mission statement of our agency is. Then I said that the mission statement for most people and organizations in the country is to make as much money as possible in the least amount of time. So if violating privacy makes money then that is what they do. I explained to her that mission statements are about what comes first over all else. At our agency the dignity of the guests comes first over everything else, including money, property, staff, etc. For you, your clients come first. Perhaps you could write your mission statement or a blog about what that would be... and how important it is to determine the mission of any person or organization that you deal with, so that you know where you stand with them, first or secondary to something else."

Hearing this from Kelly was like having a light bulb go on over my head. I have been short of a mission statement, a simple phrase that is my current organizing principle that comes first and foremost above all else! So here it is.

Jassy Timberlake's central organizing principle as a psychotherapist is to provide a safe, welcoming and supportive environment in which any information shared is regarded as sacred and private and not to be revealed unless severe physical or emotional harm to another human being would result.

Yep, that about sums it up.

Attachment Parenting (and Finding a Therapeutic "Niche"!)

2005-07-10T19:19:00.000-07:00

There are many kinds of specialties in psychotherapy: some therapists only work with individuals and focus on depression and anxiety; some work only with couples and focus almost entirely on marital/relationship issues, with little focus on sex and sexuality; some therapists work almost entirely with individuals and couples with sexual disorders and challenges; some therapists have a specialty of working with families, with a sub-specialty of doing play therapy with young children; others have a particular skill in working with adolescents and the list goes on.

The methods by which therapists come to develop “niches” in their clinical practices are many and varied. For example, some therapists feel drawn to working with people who have substance abuse histories, either because the therapist him or herself has substantial recovery from, and understanding of, substance abuse, or was raised in a family where there was alcoholism or drug use. In this case, the “niche” was chosen and made complete sense given the therapist’s own unique history. Still other therapists maybe interested in the larger issues around substance use and abuse, while having no particular experience of addiction to a substance, but discover that they are particularly skilled in working with this population of folks.

I happened into one of my therapeutic niches quite by accident.

One day I received a telephone call from a young couple who were looking for a couples’ therapist as they were having problems in their marriage. The couple, eschewing standard child-rearing practices, felt strongly about raising their child using attachment parenting practices, and had encountered problems locating a therapist who was supportive of, and wouldn’t pathologize, their parenting style. Parents’ decisions to practice attachment parenting have been “blamed” on various factors: they are told that they chose AP as a result of their own (theoretical) experience of feeling detached and disconnected from their own parents; they are told they are scared of intimacy with adult partners and use their children to avoid this; they are told that they are over-indulgent and don’t know how to set appropriate limits or “discipline” correctly, and the list goes on. As a result of these kinds of therapeutic catastrophes, a stream of parents subsequently contacted me, seeking couples’ therapy which would take into account their attachment parenting (AP) methods.

I raised my child under somewhat alternative circumstances, strongly influenced by reading John Bowlby’s books on parent/child attachment during my pregnancy. Committed to nursing (and despite many negative comments from friends and family), I breast-fed my daughter until she sadly weaned herself at the age of 16 months. Although my daughter only had brief periods of being home-schooled, I was supportive of home-schooling as a choice and felt strongly that children should be primarily parented and taken care of by their parents and close loved ones. I “wore” my daughter everywhere, carrying her in a sling until she began walking at the tender age of 10 months, and even then until she reached one year old. I still carried my daughter in the sling if we were out running errands.

For most of my daughter’s early life I was a single parent, reliant on child care and schools to “help” with the education and care of my child and I was therefore not, by strict definitions, an AP parent. I nonetheless supported the philosophical ideals and values of AP. My own experience with some of these practices meant I was more understanding of the challenges which AP parents face.

So, what is Attachment Parenting?

By way of an overly brief description, Attachment Parenting is a term coined by Dr. William Sears. He proposes a parenting style that focuses strongly on the quality of the relationship between infant and parent, and suggests the following tools to cement early attachment. (Please note that this is not an exhaustive list. For more information, please visit http://www.attachmentparenting.org/ or http://www.askdrsears.com/ .)

1. Create a solid early connection with your newborn infant.
2. Pay close attention to an infant’s cues, staying close at all times.
3. Breastfeeding (preferably until the child self-weans).
4. “Wearing” your baby, by using slings and carriers so that your infant is close to you at all times.
5. Sharing sleep (Some parents create a “family bed” with all family members sleeping in the same bed; others use bed extenders, etc.)
6. Maintain balance in family life

Sears encourages parents to recognize that their child’s dependence is a psychosocial, developmental need that needs to be factored into any and all parenting strategies. His belief is that if this need is successfully met it will provide a solid foundation for a child’s developing sense of self, and create a close, affectional bond between parents and their children. His emphasis on loving, respectful, thoughtful parenting is the hallmark of his ideology.

This sounds wonderful for children, but how does this labor and time-intensive method of child-rearing work for the couples who still need time to focus on their emotional and sexual intimacy?

Let me first of all stress that most of the issues facing AP couples are no different than for those confronting any other couple, but there are specific situations that do require creative solutions for AP parents. AP parents often come to my office reporting that while their children are flourishing in their AP household, the romantic/affectional side of the couple’s relationship often suffers. While maintaining balance in all aspects of family life is one of the ideas enshrined in the principles of attachment parenting, negotiating the complexities of an intimate couple relationship is hard to do given the intense hands-on aspect of AP.

Some of the challenges are:

* While they remain committed to sharing sleep with their children, the sleeping arrangements often create challenges to a couple’s attempts to initiate sexual intimacy, and there is frequently a down-turn in a couple’s ability to be sexual as much as they would otherwise choose.

* In practical terms, AP usually requires at least one parent to be present with their child or children throughout the day and night. This also requires that an infant has unlimited access to nursing, a role usually falling to the parent who can or is willing to breast-feed. Sometimes hurt feelings surface for the parent who spends less time with the child or children, as children tend to exhibit a preference for the parent who spends more time with them. This can lead to tension between the couple and arguments and bickering often ensue.

* Breast-feeding mothers often report that while they are committed to nursing their infants until their children self-wean, there is often a diminished identification with their bodies, and in particular their breasts, as erogenous zones. It is not uncommon for women who have given birth to temporarily lose interest in having sex. Also, ironically the very hormone, Prolactin, that stimulates milk production, is also the very same one that curbs testosterone and estrogen levels. Lower levels of Estrogen are also responsible for vaginal dryness which can make penetrative sex very uncomfortable and sometimes downright painful. Low levels of testosterone leads to low desire. Low-desire in one partner often leads to feelings of rejection, anger and sadness in the other.

* Given that there are relatively small numbers of people who are attachment parents, it makes life difficult in terms of creating real supports for your AP family. What this means is that unless you live near supportive family members and/or other AP friendly or practicing families, your AP family will have few places to turn for respite from non-stop parenting and the tasks and chores that accompany this. For most AP parents, this translates into having little or no “down time” or alone time without the children.

I’m not going to go into solutions for the above challenges, given that it would make for an even larger blog than this one. Suffice to say that addressing practicalities and coming up with strategic solutions is one aspect of the focus of many AP couples’ sessions. The biggest initial clinical challenge as a therapist working with attachment parents is finding time when I can meet with them without their children, which is exactly the problem facing AP parents as they try to find ways to focus time on their relationship. Parents who have nursing infants have an even greater challenge on their hands. I aim to be as flexible as possible with AP families, offering to come to their homes if they are in a position, financially and otherwise, to pay for my travel time, and being willing to have infants stay with them in my office if they have no other options. (I do not recommend this option if the couple is having serious problems, particularly when they are very angry with each other. Infants readily pick up on their parents’ anger and distress.)

One of the wonderful and exemplary aspects of attachment parenting is parents’ commitment to their children and to creating a family life that is loving and child-centered. Prioritizing your children’s growth and development is a noble and worthwhile philosophy, and the challenge for attachment parents is often the struggle to determine how to maintain responsiveness to a child, while at the same time honoring the individual adult’s needs and, even more challenging, the growth and development of the couple’s romantic and affectional relationship. This is, at the end of the day, the challenge facing most couples with children. In all the exhaustion and preoccupation with focusing on the parental relationship with the child, the adults’ romantic relationship all too easily gets lost in the shuffle. The relationship that they have with their spouse or partner will form the template that their child will use for creating and maintaining his or her own relationships in later life. I don’t remember the genius who said this, but there is a famous quote that says something to the effect of, “Marriages are like sharks. If they don’t keep moving forward, they die.” Continuing to develop your intimate “love map” with your partner is a central and crucial task for any couple; this intimacy and connected friendship is the life blood for any sexual relationship. Such a task is almost impossible to achieve unless you find creative ways to carve out time for yourself and your partner, despite the challenges.

Central to the clinical work I do with AP parents is the eliciting of their general philosophy of child rearing, and to define what they mean by being an “attachment parent.” I ask each parent to develop a list of adjectives that define the nature of the relationships they have with their children, the specific ways in which they relate to their children, the kind of human being they hope their child will grow up to be and what they see as their particular and individual strengths as a parent. Where do they see themselves as needing some help?

I then ask them to create a similar list, but this time using the concept of being “attachment lovers.” What is their general philosophy for being a couple? What would they mean by being an “attachment lover.” What adjectives would describe their preferred relationship? What words would describe their preferred way for relating to each other? What are their hopes for their “attachment lover” relationship and what do they aspire to have it grow into? What are their particular and individual strengths as a lover, as a friend and partner? Where do they see themselves as needing some help with their “attachment lover” self-concept?

In developing a relationship "compass" as we begin our work together, the most helpful part of my work with AP parents is the development of their own unique blueprint for both their parenting style and their intimate relationship.

Explosions in London

2005-07-09T09:30:00.000-07:00

I awoke on that eventful day this week to the news that Al Quaida had detonated bombs in several sites on the London Transit system. While bombings are nothing new to us Brits - we survived two world wars worth of bombings, and years of IRA attacks - I am stunned to recognize that national stoicism runs more deeply in my veins than I had thought. Here's why...

My family lives far enough away from London that I feel reasonably secure in the knowledge that they are all safe. Displaying my famous "glass is half full" personality, I put off calling home until lunch time EST, (5:00pm UK time) at which point I placed a call to my mother - she has always known where everything and everybody is, being the center of the known universe as I know it. Mum informs me that my sister went to London to see a play last night and has not returned home. She then proceeds to tell me that my sister Alison, who is joined at the hip to her "mobile" as they refer to them in the UK, is not picking up her phone and that my mother cannot reach her. I do not feel reassured. I have read online and heard on the news that cell phone lines are jammed in and out of London. In my vivid imagination, my sister is lying broken and bleeding somewhere in a London hospital or, worse, a London morgue, while her cell phone buzzes plaintively inside her copious (and ubiquitous) handbag.

I try to call my sister's home phone number before heading into the office to see clients and there is no answer.

Several clients ask me in concerned tones whether I have been impacted by the news from London. I find that I have to tell them that my sister appears to be missing. They look shocked and confused, and express concern and good wishes. I can't decide whether telling them is a lapse in clinical judgment on my part or not - but the truth is out. Interestingly, I get a very different response from friends and neighbors. They laugh and smile with embarrassment when I tell them my fears about Alison. Flustered, they apologize for smiling and explain that it's such serious news, they don't know how to process it. I understand their response, or leastways I have an explanation for it. Despite the out-of-the-ordinary sharing that I did with some of my clients about my sister being missing, the sharing was done in an environment that invites affect, emotion and feeling, even if there was a tables-are-turned quality to the sharing. Neighbors and friends are not expecting the information. Standing on our respective stoops with groceries and house-keys in hand, they are unprepared for the information, and not sure what response they should have and what is permissible in terms of displays of emotion.

Throughout the week, I notice that I am "spectatoring" my own responses, and pay attention to the feeling of tension that I notice in my body, the irregularity in my breathing and the tightness in my shoulders when I am think about Alison. I'm most definitely having physiological stress responses to my sister's "disappearance," it's just not surfacing into my consciousness. As I often instruct my clients to do, I tell myself that I can most definitely tolerate these feelings, as uncomfortable as they are, and I continue with my work week. I try to reach my mother several times throughout Thursday and Friday and have no luck. Finally, this morning I reach her. Alison is fine. My mother just didn't think to call me, as she assumed I'd realize that Alison would be okay (is this the therapist-as-mind-reader assumption at work again?). My mother's news is received by me with equanimity - actually, my mother was right. I did just know that my sister would be okay. I also find myself forced to identify to with a facet of British stereotyping that I've strenuously suppressed in myself for years - I am WAY more stoic than I like to think. Are optimism and stoicism the same thing? Hmm..I have some interesting things to think about. How will my optimism (or stoicism) affect my work with clients? I feel a blog coming on...

The Joy of (Psychotherapy) Blogging

2005-07-07T21:00:00.000-07:00

I do declare! I've had much fun writing this blog thus far. So, here are some general thoughts on my experience of blogging. To begin, I've received emails from folks in the UK, France, the Southern United States, Germany and Japan. While this presents problems in terms of maintaining more email relationships, it's fascinating to realize that by simply writing down a few thoughts, I am able to make connections with people, both therapists and non-therapists, in various parts of the globe. I have so much enjoyed hearing from everybody and hearing their opinions (although I also would LOVE it if people would post comments as well as writing emails to me). I love to write and this has satisfied my desires in that direction.

Some people have written to ask me if I find it hard to think up blogs to write about, but the business of thinking up blogs isn't that hard. I am constantly adding to my already long list of wiating-to-be-written blogging topics. A far larger problem is finding time to do this. By the time I get home from my day at the office, the last thing I want to do is sit in a chair and type, when the couch, my ever-growing pile of books, family members and my puppy, Ziggy, are all calling to me loudly. And then of course, there's the Monday through Thursday infusion of Jon Stewart's Daily Show - to my mind the most reliable news source! While purchasing an air conditioner has definitely increased the comfort level in my study, it is my time-management skills that could do with some focus.

My other continuing challenge, as mentioned elsewhere on this blog, is the problem of "audience." For example, an unexpected result of doing this blog is being told that I have current clients reading the blog relieved that they are not "revealed" on the site, and I've had clients reading the blog who tell me they are disappointed that they are not mentioned. (Waving "Hi" to those folks - you know who you are.) I have spent the last couple of weeks writing a blog (not yet published) on how therapists find their "niche" clients, and about a particular niche of mine, which has been working with Attachment Parenting folks. I've taken so much trouble over this blog, that I've tied myself up in knots, compiling huge amounts of text, but not achieving much. It feels a little like wading in molasses as I struggle through it. I hope it will be the next blog I post after this one and then all will be revealed. I realize that the issue of self-disclosure is omni-present. I want there to be enough so that I don't disappear behind a mountain of psycho-babble, and not too much to present clinical dilemmas. It is my hope that everything I reveal about myself is strategically positive.

There is a little of a "should" quality to perpetuating a blog, particularly once you develop regular readers which appears to have happened already judging by the emails I receive. I'm conscious when a few days go by that I haven't written anything new. The last gap of two weeks was a huge challenge - I became fixated on writing the Attachment Parenting blog, and forgot that I could write something a little more lighthearted.

Up until now, I have written nothing about sex. I am after all a sex therapist and a marriage and family therapist. I love writing about sex, reading about sex, and talking to people about sex. However not everybody wants to read a sex blog and I'm trying to be mindful of the dizzying array of blogging possibilities; I'll put my mind to coming up with an interesting sex therapy blog in the near future. What is sex therapy? Who comes to sex therapy? Any suggestions, folks?

After the Vows, the Reality!

2005-07-06T10:46:00.000-07:00

Yesterday I received a call from a writer called Rebecca Delany. She was working on an article for “Elegant Wedding” magazine, put out by the same folks who give us the illustrious “Boston Magazine.” Ms. Delany left a message asking if I would be willing to talk with her about the feelings of let-down and depression that brides feel after the excitement of their wedding day has passed. This was an interesting topic and it got me thinking. I suspect that it's not just brides who have this feeling, but is something that crosses gender.

Anyway, the fact is that usually by the time I see couples, the wedding day has long since passed and disillusionment and unhappiness have well and truly set in. While I have occasionally been called upon to do Pre-Marital counseling, by and large couples appear to wait until they are in crisis before pursuing the horrors of couples’ therapy. Oh, how much easier my job would be if they came in to see me before walking down the aisle, going through their commitment ceremonies, moving in together or having their first child!

The decision to join your life with that of another, regardless of one’s gender or sexual orientation, whether you seal your commitment with a wedding ceremony, a commitment ceremony or a civil union, heralds the beginning of a whole new challenge for a couple. Weddings and ceremonies are very exciting and usually drenched in romantic imagery and symbolic gestures. Physically exhausting to plan and carry out and emotionally exhausting to organize and participate in, for most people our expectation is that our happiness will come about as a result of our marriage, that there is something inherently magical in the wedding itself that will act as a talisman in protecting couples as they begin their marital or committed relationships.

While this is the myth of the power of the wedding, the reality is far removed from the myth. To start with, given that the divorce rate has climbed over the last 30 years, I can confidently make the assumption that more and more of the young adults currently walking down the aisle or having commitment ceremonies, are the product of divorced parents. A parental relationship full of conflict, unrealistic and unmet expectations is often the template that couples use when starting with their own marriages. We are unprepared for what a marriage really means, and unskilled in how to cope with the reality of sharing our life with another person. Our own parents created the blueprint and the backdrop for our expectations, both good and bad, for what could come our way as a result of joining our life with that of a romantic other. So, there’s marriage and then there’s long-term healthy marital relationships. In order to have the latter, you need to fully understand what marriage is about, develop some skills so that you can engage honestly in your relationship and be willing to put some work into the relationship.

So, the wedding is over. And you may have the blahs. Here’s a list of things I recommend that you think about or do as a couple:

1. Exhaustion is very common following a ceremony of such magnitude. The frenzy leading up to the ceremony itself means emotional and physical challenges, including arguments with family members over who will and will not be attending; differences of opinion over what the philosophy and theme of the wedding will be; arguments over clothing; competitiveness between family members for speeches, etc.; late nights and sleepless nights. So, once the wedding is over, take it easy. Get lots of sleep. Eat healthy, nutritious food, exercise enough to keep your blood pumping, do de-stressing kinds of activities (yoga, meditation, listening to music, strolling in the woods or park, reading quietly). Stress and exhaustion leads to depleted immune systems, so take steps now to look after yourselves so that you can recover adequately from the wedding before you catch the first virus that comes along!

2. One of the things that people often say after the wedding is over and the front door has closed, is that there is a feeling of “let down.” The rose-colored limelight shines brightly on a couple while they’re taking their vows. But once the cameras have stopped snapping, once the videos have been taken, it’s back to reality. Be kind to yourself during this period. Find ways to honestly talk with your partner about how you’re feeling – they probably feel something similar. Take time out to do things that make you feel good about yourself and to find ways to make your new partner feel good about themselves too.

3. If you haven’t already sought pre-marital therapy, look into post-marital therapy. Suggest to your partner that the two of you see a therapist in order to learn some skills that will help you over rough spots, before the rough spots have developed. If you are readers, ask for recommendations for good books (I recommend anything by John Gottman, Ph.D and David Schnarch as great places to start. Gottman gives a great series of questionnaires that provide couples with endless amounts of useful information that they need to know about each other, and the pitfalls in relationships that Gottman discusses can happen in any relationship.) Read the books out loud to each other and discuss the ideas that they contain. Don’t be lazy about this. Relationships take work. In fact ALL relationships take work, it’s just that marriages take even more work than any other relationship.

4. Take the time to develop your routine together. For couples who have gone from living alone to living with their partner, there is a huge upheaval in their lives. It takes time to iron out differences of opinion, to figure out who is responsible for what household tasks, to develop a family life that is a unique blend of where both partners came from. Don't expect this to happen over night It takes years to build a couple.

5. If you haven’t already had the conversation, start to talk about what it means to be a couple. It's surprising how different people's definitions can be. For example, do you expect to spend every minute together or do you value friendships and separate interests and activities, alongside your intimate relationship? If you aren’t a joined-at-the-hip couple, just how much time do you envisage spending together. Every night? Every other night? All weekend? Check in by phone once, twice three times daily? How much contact is too much? What does this mean to you? Is the idea of faithfulness central to your idea of coupledom? How will you decide what is private and what is shared between the two of you? Do you have a sense of shared and individual goals for you and your partner? What are they? Do they differ? What is your plan for incorporating any differences into this relationship? Are you planning on having children? Who will be the primary caretaker? What are your feelings about divorce? Who divorced in your family and why? What are your partner’s thoughts on keeping a marriage vibrant? How will you handle big differences in opinion? In what ways are you able to receive and show love in this relationship? (For some couples, physical gestures such as making morning coffee, cooking meals, etc communicate love. Others prefer romantic and affectional physical actions, such as hugging, kisses, sending cards, surprise notes, etc.) Make sure that you each know what these are.

6. Talk about sex for hours and make sure to eradicate secrecy over sex. Talk with your partner fully and honestly, disclosing everything about your sexual history. Be prepared to be clear about what you’ve done, who you did it with, what you liked and what you didn’t/don’t like. Don’t ever fake enjoying sex. If your partner sucks in the bedroom, gently tell him or her. I’ve known clients who would rather lie about their partner’s ability to satisfy them sexually and then leave the relationship, than be willing to talk about what is unsatisfactory and fix the problems with some honest communication.

7. Start right from the beginning with a conversation about money and work, as this is one place where couples tend to come unglued. What is your family’s history with money? What messages were you given about money as you were growing up? Did your parents fight over money? What is your personal relationship like with money? Does it run through your fingers like sand? Do you horde away every penny you make? Is long-term financial stability important to you or do you have a “live for the moment” attitude about your finances? In what way will your attitudes mesh and/or conflict with those of your partner? Is your career important to you? What do you value most about your work life? Do you plan to always work? Weddings and commitment ceremonies can cost a great deal of money, and many couples begin their committed lives together in debt. Make sure to take time to talk about how you as a couple will tackle this issue.

We like to think that love is enough. It’s not. Most of the couples who come to see me for therapy are in crisis. They aren’t in my office because they don’t love each other, but because they can’t figure out their way around the relationship dynamic that has become so problematic for them. If you are pro-active in working on your relationship, you may not have to reach this point.

Too Hot To Write

2005-06-14T10:07:00.000-07:00

People have been emailing me to ask why the gap in blogs during the last week. For those of you who don’t live on the Eastern Seaboard of the United States, let me tell you that we have been embroiled in a horrendous heat wave over the last week or so. While the bedroom in our house is air conditioned, the rest of the house has not been up until now. Writing a blog would have necessitated sweating my socks off in my un-air conditioned study. Having been raised in the United Kingdom where in my formative years 70 degrees Fahrenheit, without humidity, was considered a heat wave, for a delicate Northern European soul such as myself it is hard to breathe let alone form a coherent thought when the mercury rises to 90 degrees with humidity. Yes, I know that there are places in the world where you can fry an egg on the hood of a car and people still survive, (my brother, Mark, lives in the Sultanate of Oman which I understand has such a climate) but you’ll notice that I don’t live in one of those places! Regardless, I am happy to report that I am now fully air-conditioned and reporting for (blogging) duty.

While we’re on the subject of hot and cold weather, I must freely confess that I am one of those human beings who thrives in cold climates. There is a good reason why I live in Massachusetts…I love frigid weather! While I could happily do without icy roads and sidewalks, I love plunging temperatures and the bristling nose hair sensation that accompanies the aforementioned downward slide of the mercury. (Those of you who live in icy climates know exactly what I mean about nose hairs that feel like they will freeze up and drop off.)

In my therapy office, the air conditioning belts out frigid air throughout the summer (which is one of the reasons why I keep a blanket on the back of the couch for my poor shivering clients). In the winter, I am happy to wrap myself in a wool shawl (my constant office companion) and keep the heating down lower. Like most human beings on the planet, my mother’s words still ring in my head, yea these many years later. “If you’re cold, put on a jumper, dear!” (Jumper = Sweater in UK speak). So put on a jumper I do! Now that I’m thinking about it, it occurs to me that I like to wrap myself in a wool wrap no matter whether the temperature is artificially icy in my office due to the wonders of a/c or because it’s winter and frosty by natural means. My mother was a great believer in swaddling her infants (all four of us or so I am led to believe) so the therapist in me believes that this is where my passion for being “wrapped” comes from. It feels comfortable, cozy and safe for me to be swathed in fabric, even if I am now responsible for my own swaddling. (Witness the power of self-psychology, folks!)

This lengthy piece of therapist self-disclosure was to thank those people who have emailed me to ask why I wasn’t writing, and to explain the reasons for my brief absence. More later…

How Do You Prevent A Client From Giving Over Too Much Power To You As A Therapist?

2005-06-13T08:38:00.000-07:00

This is one of the questions that I was asked the other day and I thought it was an interesting and fascinating one. What does power really mean in the context of the therapy office, and what steps can (and should) the therapist take to make it knowable?

A client often arrives in my office feeling some combination of confused, embarrassed, depressed, bewildered, hopeless, isolated, anxious, shy and scared. They may or may not have some idea of the origins of their discomfort, but they are frequently in a state of extreme vulnerability.

Unfortunately, many therapists often have little awareness of just how much authority we have when we meet with the client who walks through our door in such a state of susceptibility. From the (oftentimes) big desks, to the psychology books on the shelves and the diplomas on the wall, all these things conspire to convey authority and power. That power has in turn often been sanctioned not just by educational institutions, but by State licensing bodies, institutions that the therapist is employed by or affiliated with and referring bodies and collateral agencies that a therapist is allied with.

But our real power lies not just with the physical accoutrements of our profession, but with our ability to define reality for a client. Given that clients arrive in a state of vulnerability, I am imbued with a huge amount of power to recognize the struggle facing an individual client, and to assist them in defining how they could navigate the complex world differently in order to re-emerge in better psychological shape. How powerful a skill-set is that in the face of a client’s fear that there is no way out of their predicament?

Whether it is our intention to convey this perspective or not, clients will often hears our words as, “I, the therapist, know better than you. Lean on me only. Trust me only.” Our job is to help a client understand that it is they who have the power to change, by changing their perceived relationship to the world/people/things they fear. Until that goal has been achieved, the therapist is seen as the conduit, as having the power to accompany the client through what they believe to be an impasse; it is part of our work to help our client to challenge their prevailing belief system. (“I am weak. I will always be at the mercy of my mother/husband/lover/friend/foe. I will always feel this way. I will never be free of self-defeating thoughts. I will never have a partner. I will never have what I want in life. I will never figure out how to identify and achieve what I want in life, etc.”)

So, in answer to the question, “How do we prevent a client from giving over too much power to us, as therapists?” I think the obvious answer is to talk about the nature of the perceived power in the room.

In practical ways, how this can translate is to:

* Have a conversation about the ways in which the client sees the therapist as powerful. How does this power translate for each client? In what ways does the client feel dis-empowered in the therapy room? In what ways do they feel that their power is being marginalized or minimized by you, the therapist? Does the client feel that this is the only place in their world that they are, and will ever be, successful? What changes can be made so that the power imbalance is made known and is constantly factored into the therapy?

* Foster an environment of relational equals. The therapist needs to be clear that there are limits to his or her power and knowledge, and that this needs to be communicated to a client. Beyond the level of that power and knowledge, lies a whole world of learning for each therapist – some of this learning happens in the context of therapy with that client. The client should understand that their job is to begin to rely increasingly on their ability to think independently and to trust their internal experience and rely on their internal judgments. The therapist’s opinions, view and ideas are no substitute for those of the client, who is the real expert on their life.

* Help a client understand how therapy is important, but it is only just one of several important supportive tools that can be used to grow the life that you truly desire. There are other supportive mechanisms that can be used: community groups, support groups, improving friendship networks, 12 step groups, interest groups, faith-based groups.

* Restrict the number of sessions a client tries to attend. For most purposes, attending therapy once a week is more than enough time for an individual client to make substantial changes in their life. Unless there are extenuating circumstances in a client’s life, entailing substantial emotional upheaval (i.e. severe depression, imminent loss of parent, divorce, miscarriage, etc.) I usually restrict the number of therapy sessions a client attends to one per week. Permitting more sessions than is needed sends a message that it is only through the therapist that the client can re-emerge into their life fully. This idea can and should be challenged by the therapist.

Lie Much?

2005-06-07T11:40:00.000-07:00

Okay, this blog might be controversial, particularly with other therapists, but here goes….

I believe that lying, to self and others, and being lied to is the fundamental reason why people end up in therapy.

Husbands have affairs and don’t tell wives the real reasons why. (“You gained weight.” “You won’t have sex with me often enough.” “You spend too much of my money.” “I’m too scared to talk about how I really feel and maybe this (affair) will make you throw me out so I don’t have to.”)

Wives have affairs and don’t tell husbands the real reasons why. (Ditto all the above)

People come to therapy ostensibly to work on their relationships with family members but aren’t willing to be honest, either with their therapist or ultimately their family members/parents, about their experience of growing up in their families and how this impacted them.

Women won’t tell men what they really like and don’t like about having sex

Men won’t risk telling women what really turns them on

Men and Women leave husbands and wives rather than hurt their feelings and tell them the truth about their diminished interest and hurt feelings about the state of their marriages.

Adolescents act out and lie to their parents to avoid the consequence of their actions.

Adult siblings who harbor long-time lies about events in their relationships would rather put up with diminished emotional connection and intimacy rather than ‘fess up to their deceptions.

People lie, cheat and steal their way through life and won’t authentically tolerate the release that comes from finally being real and getting honest.

Parents won’t be honest with their children about the mistakes they made.

Children won’t be honest to their parents about their mistakes.

People even (gasp!) lie to their therapists.

In fact, people even lie about lying. Here are some of the lies they tell:

“It was a white lie.”
“It was the partial truth.”
“It would kill him if I told him the truth and I’m hiding the truth to save his feelings.”
“I didn’t lie. I just didn’t say anything when asked.”
“I’m not an habitual liar. I just lie when I need to.”
“I don’t lie. I just withhold.”

Lying to yourself and lying to others causes:

**Stress (anxiety, elevated blood pressure, coronary problems, etc.)

**Depression and lethargy

**Exhaustion (due to the amount of tap-dancing you have to do to prevent the truth from being revealed!)

**Feelings of inauthenticity in yourself and in the people you’re lying to

**Distance and emotional disconnect in personal relationships

**An inability to really take the reins in your own life and assume responsibility for how you would truly like to live the rest of your life

**People to feel manipulated and deceived

Here’s my recommendation for folks who lie (that’s all of us by the way!):

**Read Dr. Brad Blanton’s book, “Radical Honesty: How to transform your life by telling the truth.”

**When you’ve done that, read, “Practicing Radical Honesty: How to Complete the Past, Live in the Present and Build the Future with a Little Help From Your Friends,” also by Dr. Brad Blanton. (www.RadicalHonesty.com)

**Start telling people in your life the truth and be willing to face the consequences and get real

**Tell your therapist the truth. This means all the places you hide, lie, deceive and manipulate the facts about your life in order to prevent your therapist from seeing the real you. He or she can’t help you if you hide yourself in a web of dishonesty and deception. Take a risk and find the truth.

Top Ten Pitfalls of Being a Psychotherapist

2005-06-05T05:40:00.000-07:00

Caution: Taking this seriously may be dangerous to your mental health!

1. You forget how to conduct small talk and can empty a room at a party in 30 seconds flat!

2. You’re constantly biting your tongue around friends and family (arm-chair therapizing of family is particularly de trop!)

3. ….and on the other end of the spectrum, running screaming from the room, after a 9 hour day in your therapy office, when your family wants to tell you about their marital challenges/office politics/boyfriend troubles/aches and pains/parenting dilemmas, etc.

4. Your hairdresser tells you all her problems. (Isn’t it usually the other way around?)

5. When you tell people you’re a therapist, they either (a) look scared and clam up or, (b) look grateful and unburden themselves or, (c) they ask if you can read minds and then test you, Verizon style, on your skill. (“Okay, can you read me now?”)

6. Your head is permanently tilted quizzically to one side.

7. You use the word “feel” so much it makes you want to slap yourself.

8. Having to hang out around other therapists.

9. Coming to the ghastly realization that your bottom is creeping out to the edges of your therapy office chair.

10. Comprehending with horrified astonishment that clients think you’re what passes for sane!

It's a Wonderful (Psychotherapist's) Life!!

2005-06-01T18:55:00.000-07:00

If I had been writing this some time ago, my “Wonderful Life” blog would read very differently. At one time, I worked full-time at The Family Center in Union Square Somerville as a family therapist (http://thefamilycenterinc.org/), and also had a small part-time private practice operating out of a shared office in Cambridge, MA. While the work at The Family Center was emotionally rewarding and the mission of the center entirely congruent with my personal and political philosophy, the hours were long, stress levels amongst clinicians were high, the paperwork overwhelming and the salary inadequate. My health suffered and my family life and friendships bore the brunt of the strain and stress I was carrying around with me. I was constantly tired and drained with little energy left over for anything outside of my work. I decided that despite my reluctance to leave The Family Center, my health demanded that I make a change and take better care of myself. So it was with much trepidation, I decided to move into an office of my own and grow my private practice from very part-time to full-time. The two concerns I had initially were financial and collegial. Firstly, I had heard horror stories of therapists not being able to build clinical practices that would pay the bills and secondly, I loved and respected my colleagues at The Family Center and was heartbroken at leaving the friendship and support that I both received and gave during my time there. In my darkest hours, (oh, how dramatic!) I feared being destitute and lonely, this despite knowing that I had, in another career incarnation, successfully run my own business. I have always had a tendency to leap into leadership vacuums and there is no better place to do this than in one’s own business ventures.

Despite the challenge of being self-employed, the change in my life has been dramatic, with most of the changes being for the better. Many therapists complain that their clinical studies ill-equip them for what is ahead in terms of running a business. With very few graduate programs offering business classes in marketing and management, therapists are left to their own devices when it comes to building their practices. My father was, in his later career incarnation, a Management Consultant and despite his tendency to drink all his profits (remembers that long and not-so-illustrious line of alcoholics I mentioned in my profile?) I learned a great deal from him, albeit inadvertently, about marketing and selling. This information and my inherent aptitude was one of the very few positive things that my father gave me, and I value it immensely, despite its origins. So, with relatively little financial outlay, I launched my practice.

Initially relying on print media for advertising and marketing, I soon gave up on this as having too narrow a geographic focus and too expensive given the very little returns, in terms of client intakes, that it brought. I turned instead to the internet and put my marketing dollars into that and networking. This was a great move, and killed two birds with one stone. Internet advertising did what I hoped and gave me a much wider location lens and my client base started to build almost immediately which took away some of my financial/income concerns. Secondly, because of the decision to also focus on networking, I have begun to create some collegial relationships which have added much to my life and detract from the largely solitary nature of my work as a psychotherapist. I joined the local chamber of commerce (http://www.wbcc.org ) which has enabled me to meet other self-employed folks in the area; I became a member of The Divorce Center (http://www.divorcenter.org) and have begun to forge some helpful professional relationships which support my work with couples; I joined a planning committee to identify professional development needs with one of my professional associations, the Massachusetts Association for Marriage and Family Therapy (http://www.mamft.org ) and I joined a Peer Supervision Group with 3 other psychotherapists.

As “Mistress of my domain” I set my own schedule, and rarely does this mean that I have to get up any earlier than 8-9am. My office is positioned in a professional building between a Starbucks and a Dunkin’ Donuts, so I usually drop by Starbucks and pick up a cup of tea or Decaf coffee on my way into my office. Not a day goes by that I don’t smile at my name on the window of my office and delight in the pansies blooming merrily in the window boxes beneath the periwinkle blue lettering. Being on hi-how-are-you terms with some of the people working in businesses that surround my office has greatly added to my sense of belonging in the neighborhood; I enjoy recognizing and having a day-to-day connection with the baristas in Starbucks; exchanging pleasantries with the lawyers and dentists whose offices are above mine; waving hi to Dori in the office next door. Alex in the sandwich store next door knows that I like my Turkey sandwich with mustard, no mayo. The folks in Starbucks knows that I like an extra shot in my non-fat latte.

My work week runs Tuesday through Friday with my first clients usually arriving at 10 am on Tuesday morning. I try to plan my day so that I either have a big chunk of time off in the middle of the day or don't start until mid afternoon. This allows time to run errands, occasionally fit in having lunch with a friend, or walking my puppy, Ziggy, and sometimes even taking a nap! On Tuesday through Thursday, I tend to see clients until 8pm and by the time I have finished with my paperwork for the day I usually arrive home around 9:00pm.

During the course of my day, the majority of the time is spent face-to-face with clients. If I have an hour off in between clients, I return calls, catch up on reading professional journals, research issues that clients are facing that I may be unfamiliar with (for example, a religion that I am inexperienced with or a profession that I know little about but still understand how much it impacts the client’s functioning and recognize that not to educate myself would impede my understanding of them and the progress of their therapy), attend my own therapy and in a similar vein, attend supervision. (More on supervision in a separate blog.)

One of the families I work with is involved with an agency in the Boston area, and I attend Case Management meetings once every three weeks or so with the team of professionals who work to support the family. In addition, the family’s Case Aid worker and I meet weekly, usually mid-week, to share ideas about the family, and to brainstorm ways of being even more effective in our work with them.

Furthermore, I spend time thinking about ways to market the Parenting Journey™ Group (a 12 week psycho-education group created by the talented folks at The Family Center for parents focusing on how our own experience of being children impacts the choices we now make as parents) that I, as a Certified Parenting Journey facilitator, am planning to co-lead in September with another therapist, Isa Mattei, LMHC. This involves emailing Isa, passing ideas backwards and forwards, and occasionally meeting face to face with her. I also belong to a Business Planning group and have regular meetings with John Badalament (buy his wonderful PBS video, “All Men Are Sons,” or bring him to your school or community to do the incredible work he does with Fathers and Sons and, at the very least, visit his website. www.AllMenAreSons.com ). John and I brainstorm ways to support the growth of our businesses, particularly as I begin to think of ways to creatively branch out into other ventures, such as public speaking, the creation of an eTherapy site, www.JassyTimberlake.com which is currently under construction and begin work on a radio program which will focus on a variety of sex therapy and mental health issues. And, just for the pure enjoyment, I have also been spending time with other mental health professionals seeking to start their own private practices by helping them figure out marketing strategies for their particular niche.

All licensed mental health professionals require the completion of CEU’s (continuing education units) in order to maintain our licenses and keep current with unfolding developments in the mental health field. As a clinical member of the American Association for Marriage and Family Therapy (http://www.aamft.org ) and a member of the American Association for Sex Educators, Counselors and Therapists (http://www.aasect.org ) I have a professional development training to attend on average once every 3 weeks. The topics for these are many and varied. In the last 6 months, for example, I have attended the following trainings:

8 day course in Radical Honesty (http://www.RadicalHonesty.com )
Sex and Addictions
Same Sex Couples: How do our values affect whom we treat?
Fad Diagnoses: The effects of a Bipolar Disorder diagnosis on children, adolescents and their families
Online Therapy Skills Training
Conversations about Marginalized Coupleships: Challenges and Opportunities Supporting Clients in their search for a mate: a cognitive behavioral approach Sexuality and Developmental Disabilities
Update on Reproductive Health: Focus on males and females
Sexual Development and Behavior ages 0-8 years

When I’m not in the office, I phone in and check my voicemail every 2-3 hours up until 11pm at night, so that I can be on the ball about returning calls, and getting back to clients who may be in crisis.

So, that in a nutshell is my wonderful life!