What if We’re Wrong?

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What if a person really could forget the horrors of the past?

Yes, I know; we therapists tell you it’s impossible to do without paying a price. We say that you have a lumber room of the mind, a hidden closet in which you stuff all the traumas and memories you wish you had no use for. We say, in time, the contents of this room start to smell. House guests, looking for the bathroom, will open the wrong door and let all your heartaches escape. The closet gets crammed with memories, so that if you try to put one more in, two more are dislodged and tumble out at your feet. All the horrors will find a way out, somehow, or they will make life difficult if they remain locked up. There’s no end to the neuroses, psychoses, character dysfunctions, family dysfunctions, and general malaise you are subject to if you try to put anything into that closet.

Therapists tell you it’s impossible to be effectively rid of the past and want you to take our word for it. You have to deal with the past, clean out the closet, pull out every item in turn, dust it off, and find a place on the coffee table to keep it. Face your demons or forever be running away from them. Deal with it, we say, as if you’re a lackadaisical croupier and we’re eager blackjack players. Become conscious of the unconscious, we urge. And we would be the very people to help you.

“I don’t see what this has to do with me,” you might say. “I don’t have any demons in the closet.”

Every therapist would then just smile. It’s no use trying to explain repression to someone who’s repressing. You’re never going to get it.

But, what if therapists are wrong, and it is possible to forget the horrors of the past? Continue reading “What if We’re Wrong?”

Mental Illness Happy Hour

shrinbks-links-photo1If you have ever thought you were the only person who thinks the thoughts that you do, in the way you do, I would recommend that you listen to the Mental Illness Happy Hour. There, you will hear yourself think.

The weekly, hour-long audio podcast of interviews with artists, friends and the occasional doctor is hosted by Comedian Paul Gilmartin.

Paul hopes that you hope, that the show and its website give you a place to connect and smile. So look at the website, listen to the show, fill out and read the anonymous surveys, and watch for hope returning on the horizon.

Click here to start.

Peeling the Onion

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When you meet someone for the first time, you’re generally on your best behavior. You’ll present the most polite, least objectionable version of yourself that you can come up with. This is called the public face, the mask, or the persona. Most of us cultivate this persona as carefully as we edit our Facebook page. Indeed, the Facebook page is another, virtual version of the persona. You probably possess several personas, some for work, others for family, and another for each circle of friends.

Continue reading “Peeling the Onion”

What’s the Best Form of Therapy?

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The easiest method of doing something is not always the most effective; but it is the easiest, so that’s saying something for it. Easy is more effective than the most effective if the most effective is impossible for you to do.

When it comes to treatment for mental illness, if I were to rank the forms of therapy in order of effectiveness, meaning how thoroughly and reliably they can solve your problems, I would put it like this:

  1. Group psychotherapy
  2. Individual psychotherapy
  3. Medication
  4. Reading self-help books

But, if I were to rank them the easiest to hardest, it would go like this:

  1. Reading self-help books
  2. Medication
  3. Individual psychotherapy
  4. Group psychotherapy

Continue reading “What’s the Best Form of Therapy?”

Project I am Not Ashamed

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If you have a mental illness, you know stigma. There’s stigma in the shame you feel if you say you have a mental illness. There’s stigma in the way people react if you say you have a mental illness. There’s stigma in the way mental health coverage is still something that needs to be fought for. There’s stigma in the way people blame you for your illness as no one would ever blame you for any other illness. When people with mental illness are blamed for every bad thing we can’t do anything about, you know there’s stigma.

We know a lot now about how to overcome stigma. We can see the way people who are gay, for instance, once stigmatized, are now more accepted. When I was a kid I thought homosexual people were strange and unnatural. I didn’t think I knew any. As I got older, and Gay people came out of the closet, I recognized homosexuality was really quite common. I knew dozens and, in knowing this about them, I discovered they weren’t strange or unnatural at all.

The same thing could happen with mental illness if mental illness came out of the closet, if the people who were mentally ill could be brave enough to say, this is a part of me. Then we could see how common mental illness is. We would see that people with mental illness are not raving lunatics, or scary gun-toting maniacs, but ordinary people with struggles. What person doesn’t have struggles? This is just a particular kind.

It is not my job to out anyone, nor is it to reassure you if you are afraid to out yourself. It’s a brave, brave thing to come out of the closet. It some circumstances, it may be dangerous and foolhardy. It may actually be crazy to say you’re crazy. But, for some people, it may be the right thing to do and the only way they can overcome their own shame and self-loathing.

That, apparently, is the case for Ross, a 38-year-old mental health advocate with Borderline Personality Disorder. Ross has come out of the closet to some extent (we, on the web, don’t know his last name). He has a plan to end stigma. Here’s his plan:

On Saturday, August 18th, 2018, we will go to the streets of our own community for 4 hours with a sign that simply reads “I have (your mental illness) and I am not ashamed. Break the Stigma #ProjectIAmNotAshamed.”

This is unquestionably the right thing to do for our society, but you’ll have to answer for yourself whether it’s the right thing to do for you. If you would lose your job, custody of your kids, or suffer any of a hundred other consequences of coming out of the closet, then please don’t do it. Other’s can blaze this trail. But, if the only thing that stopping you is fear or shame, then consider setting that fear and shame aside for a few hours on August 18th. It’ll be good for you.

If you don’t have a mental health diagnosis, but care about those who do, you can help, too. In the same way that family and friends helped to fight the stigma of homosexuality  by admitting they were connected, you too can come out of the closet. Just don’t violate the privacy of the person you’re trying to support.

As Ross says:

This event is not limited to those with mental illness. If you are not afflicted, your sign can read “I am a supporter of those with mental illness and I am not ashamed.”

For more information, go to Project I am Not Ashamed

 

Grounding

So, you’re anxious. It happens. There are basically two things to do with anxiety. You can face it or avoid it. Avoiding it is often the sensible thing to do if it’s a thing you are not likely to encounter very often; like snakes, for instance. I’m afraid of snakes. If I got a job as a snake charmer, I would have to do something about it; otherwise, I just avoid them.

Now, if I did become a snake charmer, I would have to face my anxiety. I wouldn’t just go and grab the first snake I found and say, go ahead bite me, I dare you. No, that freaks me out just to write about it. A better method would be face my fear systematically, little by little, in circumstances in which I was likely to be successful. And, and this is most important, I would keep myself grounded.

When you are grounded, you are most alert, yet calm and in control. You can get grounded before you step into a difficult situation and it will help you keep your wits about you. If you’re already in a difficult situation, you can ground then, too. If you just left the hard situation and your nerves are still jangled, ground and you will begin to settle down. You can ground anytime, anyplace, anywhere, and no one has to know. Grounding puts healthy distance between you and negative feelings.

No, grounding is not the same as relaxing, being cool, or mellowing out. It’s not a form of meditation. It’s getting a grip on the obvious, that’s all. The general idea is to get out of your head, at least the part of your head that’s like a broken record. It’s a little like breaking a spell.

If you know how to ground, you don’t need that stiff drink, or that pill, or that cigarette, reefer, or that bag of dope. If you know how to ground, you can go anywhere, do anything, and deal with anyone, within reason.

Here’s a few general tips on grounding:Continue reading “Grounding”

Love: The Prisoner’s Dilemma

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I can guess how this sounds, but love relationships remind me of the Prisoner’s Dilemma.

Two conspirators are arrested and brought into separate interview rooms. They are both given the opportunity to turn state’s witness against the other. The one that takes the deal goes free, and the other gets ten years. If both confess, each gets six years. If they both refuse, they both get six months.

If I was in this situation, my answer would depend on the nature of the alliance I had developed with my partner in crime. In every relationship there are multiple opportunities in which we choose to either cooperate with the other or go our own way. Most of these occasions don’t have the consequence of being sentenced to prison for ten years, but you get the sense of a person’s loyalty if they pick up the check at the diner when you plan the crime, bring their own burglary tools, and take off in the getaway car before you get in. You also get an idea of the cost of betrayal when you scarf up the tip he left, bend his best lock pick, and arrive late because you couldn’t decide on a color for a ski mask.

Every one of these tests is a miniature prisoner’s dilemma and every one of these tests is found almost continuously in every kind of relationship. Temptations abound, no matter where you are, especially in love. Do you steal the blanket? Put the seat down for her? Do you give her the first piece of toast in the morning? Do the dishes? Get up to answer the phone even when you know it’s for her? When she tells you about that dress she’s going to buy do you really pay attention, or just nod and smile? When she’s not listening do you talk about her with respect? Do you flirt when she’s not looking? Are you adult enough to admit there’s adultery afoot?

We form alliances because we get a better reward when we both cooperate, but it’s inevitable that every alliance is going to be violated in some way. It is impossible to go along with every little thing your partner wants. How are these inevitable violations handled? When you tug the blanket, does she tug back? Does she go all ape shit when you pee on the seat? When you put the seat down for her, does she put it up for you? Does she put the flirting in perspective, forgive the adultery? If she does, does it make her a patsy? If she doesn’t, is she just being a bitch?

Scientists have studied the prisoner’s dilemma by having players adopt certain strategies to see which win most often. Some will always cooperate, no matter how strong the temptation. Those players end up exploited. Their partners have no reason to play along since there is no penalty for failing. Others never work together with their partners, they give in to temptation every time. No one ends up trusting them. They say the winning strategy is called Tit-for-Tat: cooperate every time until your partner fails to, then punish him by withholding cooperation at the next opportunity. This will teach him a thing or two.

There’s one problem with that, though. We believe we are much better at detecting when we lose our partner’s engagement than we really are. The next time you are having a conversation with someone, watch her and you will see there are moments that she does not appear to pay attention, a minor violation in the alliance that could really piss you off. The thing is, she might actually be paying attention, or she might be the kind that can pay attention to two things at once. Ask her what you just said and you might be surprised that she can repeat it word for word.

There are times, though, that she can’t. You lost her; she tuned out, spaced out, went blank. It happens. If you taped it, hit the rewind, and play it back, you might discover something. You were boring. You went on and on and were inattentive to non-verbal cues that she wanted to participate in the conversation. Or you made your point in such a way that she couldn’t follow. Each of these errors is a violation of the alliance. You broke faith before she did.

We have built in, exquisite instruments that detect betrayal so sensitively calibrated that we are always chasing false alarms. What’s more, the instrument does not work on the operator. You don’t know when you are doing it. There’s a moral to the story. When you believe that your partner is violating your alliance, look to see if maybe you did so first.

 

 

Why I Don’t Specialize in Anything

As a therapist, I could’ve had a specialty. I did some post grad work in family therapy and some more in substance abuse. I sought for ways to address the desire my clients had to quit using tobacco back in the days when few others were doing so. I ran therapy groups for sex offenders. For almost twenty years I had a caseload full of victims of trauma, depression, bipolar disorder, and anxiety disorder. I sought clients with borderline personality disorder, when most thought they were untreatable. I could have specialized in any one of these conditions and turned away clients without them, but I’ve always resisted specializing in anything.

This is why.

When a person has a psychological problem, it takes a long time before they’ll get help for it. Sometimes it takes several fretful days, sometimes much, much longer. The average, I’m told, is seven years. They don’t get help at first because they think they should be able to handle things on their own or they’re ashamed to admit there’s a problem. At last, they seek help, not because they want to, but because they have to. The problem just overwhelms them. Friends and family can’t handle the problem either. So, they find a counselor and tell him their story. Whatever happens next is crucial.

The person with the problem might get lucky and bring his problem to just the right person with the right specialty, but it seldom works out that way. Often people can’t pinpoint what their problem is, or they’re mistaken, or there are multiple, overlapping problems. Sometimes the counselor has not advertised their specialty well enough, or there aren’t enough counselors. Most of the time, when counselors specialize, it’s hard to get the right match.

When I began in this field, there were a lot of suffering people who would go to the substance abuse programs and get told that their problem was their mental health. Then they’d go to a mental health practitioner and get told that they had to stop using drugs, they needed to be in a substance abuse program. Few stuck with the merry-go-round long enough to get help, most just went back to their problem. It was easier that way. The luckier ones got two therapists, one for substance use, one for mental health, as if they really needed two, as if the two issues could not be addressed together and the treatment goals combined.

This, I thought, was insane. The two conditions overlap almost two thirds of the time. That’s a lot of people getting the run around. There’s just no reason for it. There had to be a better way. I developed a program that integrated mental health and substance abuse treatment, one of the first in the country.

I vowed that when a client shares his problem with me I would not give it back or re-gift it to someone else. I consider it a sacred trust, not to take lightly. I would never tell her that her problem is too big or too difficult for us to handle together. I’ll encourage them to enlist additional supports and I might consult with experts myself, particularly if it’s a problem that is new to me, but I won’t just send them away.

Incidentally, this attitude towards problems is the reason why I’ve done so many things in the course of my career, the reason why few things are new to me. The counselor who, for instance, refers out all of the drug addicts she encounters, never learns a thing about drug addiction and is forced into an ever more narrow specialty. Almost everything I know I’ve learned from clients; they’ve taught me what works, what doesn’t and what it’s like when it doesn’t.

This is what they’ve told me works. When we sit with our problems, rather than deny them, run from them, or overreact. When we listen to what our problems are trying to tell us, not so they can be the boss, but so we can learn from them. When we tame our problems, rather than evict them or tie them up with duct tape and lock them in the cellar.

My job is not only to pass on this knowledge, but to embody it. I can’t espouse it if I contradict it by sending people away. They learn to sit with the problem by watching me sit the problem and learning all about it. That is why I don’t specialize in anything, so I can represent a willingness to accept life on life’s terms.

Because I don’t specialize in a single kind of client, I also can’t specialize in any one school of psychotherapy. I could have become a Rogerian, a Beckian, or gotten a longer couch and taken up psychoanalysis. I could have read everything ever written by Bowen, or Freud, or Jung, or Lacan and turned myself into a copy of those great psychotherapists. I’ve learned to do CBT, DBT, ACT, EFT, REBT, MET, and many other combinations of the letters of the alphabet, all ending in T. I’ve taken classes in them all, and then some. But I couldn’t specialize in any one approach because I never specialized in any one kind of person. When you throw your doors open to seeing whoever walks in and commit yourself to dealing with whatever they bring you, then you learn pretty quickly that no one approach works for everyone. You have to be flexible.

This is why I call myself eclectic. The only way that works is every which way. It’s always better to have choices, than to have none. So, I became like a mechanic with a whole chest of tools in my garage. The thing is, I have to know how to use all of them and what works best. That’s why I’m a reflective eclectic: because it’s necessary to think about what I’m doing.

Here’s another reason I don’t specialize: I can’t because I’m not just one thing. I’m not only a counselor, I’m also a lifelong learner, a tennis player, a small businessman, a writer, a philosopher, a gardener, an author, as well as a husband, father, son, patient, parishioner, customer, consumer, citizen, and all the rest. I’ve been a student, caddie, Fuller Brush salesman, dishwasher, football player, cook, hockey player, referee, homesteader, grape trimmer, school bus driver, sawmill worker, cow milker, egg packager, newspaper deliveryman, construction worker, bouncer, child care worker, boss, chairman of the board of a non-profit, and one of those guys at the public market, selling cider. I’ve driven truck, delivered milk, preached sermons, put out fires, put on roofs, and had a very important position at a dairy farm as the vice president in charge of manure. I have more stories than I can remember and have lived more lives than your average housecat. And I’m still hungry.

How can a person like that specialize?