Ride the Ego Balloon

You may be amused, instructed, affirmed, chastened, enriched, or enlightened by my latest video.

The ego is a good tool if you understand its uses and limitations. The ego balloon can make you crazy, but it’s often a good crazy, a necessary madness, provided you can land the thing when it needs to come down.

Nouns

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Back when I worked at a large mental health clinic, the receptionist came into the lunchroom and said a vampire was asking to see a therapist. Who would like to work with a vampire? Everyone’s hands shot up because vampires are fascinating. The receptionist must have liked me best, because I got chosen. She would show the vampire to my office and I could meet with her when I was done with lunch. Continue reading

A Reconciliation Case Study

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Travis and Suzanne entered my office, sat down at opposite sides of the room, and immediately began to speak at once, competing for airtime. Travis was addicted to cocaine, Suzanne his long-suffering wife. The last time Travis used cocaine had been eight months ago; but at that point he had been repeatedly leading the family through a special kind of hell that included deception, lying, and unexplained withdrawals from the joint bank account. Since his last relapse, Travis had been to inpatient rehab and attended an intensive outpatient drug and alcohol program several times a week. By their account, he was doing well. Suzanne said he had been through treatment twice already, further stressing their bank account. This time he was also going to NA, had a sponsor, and was working the steps. To Suzanne, this meant he had lots of new friends, while her friends, including those at Al-Anon, all thought she was crazy to stay with him.

When I had a chance to interrupt, I asked, “Since you’re already with Al-Anon, NA, and the intensive treatment program, why did you set up this appointment?”

“She doesn’t believe in me,” said Travis. “She’s always on my case. I can’t do anything right, even when I’m doing everything right.”

She said, “All NA, his sponsor, and the program know is what he tells them, so they all think he’s doing great. I need someone working with him who listens to me.”

I was beginning to think I made a mistake advertising my private practice on my website by saying I had experience with substance use disorders and was willing to do couple’s therapy. I thought it was a good idea at the time since many providers, Travis’s program included, didn’t offer much to their patient’s spouses, citing problems with insurance coverage and HIPPA.

Travis added, “Every time I relapsed in the past, it was after a fight with my wife. I don’t want to use again, but she’s driving me to it.”

Suzanne answered, “If I let up the least little bit, Travis will start thinking he can use again. The only time he does well is when he’s in the dog house.”

Suzanne’s cynicism was easy for me to understand. The people closest to a person with a substance use disorder are always the last to believe they’re doing well. They’ve been burned before and have the most to lose.

I could also understand Travis, he was complaining about Suzanne’s Negative Sentiment Override, a corrosive tendency to assume the worst in a partner. No one can take a steady diet of negativity for long.

I knew what many in the recovering community and traditional treatment programs would say. They’d say that an addict is lying whenever his lips are moving. They’d say an addict’s best thinking got them into the mess; it’s not able to get them out. They believe addicts have to hit bottom, lose everything and become totally humiliated before they will ever change. These harsh views are like a two-by-four to the head for getting some people’s attention, but their effectiveness has diminishing returns. Most walk out of treatment when they’re told they can’t do anything right, as Travis may walk out on Suzanne.

I’m familiar with that approach from the many years that I worked in drug and alcohol programs before starting my private practice. Travis was a kind of dry drunk, a person who, while he is not currently using his drug of choice, was still under its influence. Despite all the help, he still didn’t accept responsibility for his drug use and was trying to blame his wife in advance for his next relapse.  Of course, he hadn’t been able to sustain abstinence, he hadn’t taken control of his life. That approach had not gotten through to him. There had to be another way.

I thought I had one.

Sometime before, I had gone for training in restorative justice. This had nothing to do with my work with addiction, but I was beginning to see how it could apply. Restorative justice is an attempt to repair the harm caused by crime. I became aware of this method when a teenager got caught spraying swastikas on the parking lot of the synagogue next to my office. The judge could have sent the kid to jail where he might have met some skinheads and been further radicalized; or he could have put him on probation, which would have been called a slap on the wrist. Instead, the judge sentenced him to work with a restorative justice counselor.

The counselor met with the teenager to check if he was ready to take responsibility for his actions and if he could imagine how spray painting a swastika on a synagogue parking lot might cause a stir. If the offender had no remorse, the counselor would send him back to the judge; but he did regret his actions. Next, the counselor met with representatives of the congregation to tell them about restorative justice and ask if they’d be willing to participate in a meeting with the offender. They were; so, they arranged a meeting.

The kid would have been prompted to speak first, to acknowledge the harm he’d done. The congregation would have replied, getting everything off their chests. If the apology was accepted, they’d move on to construct a plan to make amends. He’d scrub the parking lot, rake leaves, speak to the whole congregation, and listen to their stories about the Holocaust. A time limit is placed, and everyone shakes hands. If the offender follows through with his promise, then the judge dismisses the charges, the congregation forgives him, and everyone moves on. The skinheads look for other recruits. The world is a better place.

I wondered, could I do the same thing with Travis and Suzanne? There was clearly a break in their relationship, caused by both Travis’ drug use and Suzanne’s response to it. Could this break be mended? I believe it had to be for Travis to sustain his recovery and for Suzanne to stop being his jailer and go back to being his wife.

I knew the first thing I had to do was see them individually. Nothing could be done if they kept on talking over one another and, besides, I was getting a headache. The work I had in mind for both of them was the same, but they couldn’t do it together. Both were claiming to be the victim and expecting me to adjudicate. That’s not how it usually is in restorative justice work. There, someone already accepts the guilt and is ready to take their punishment. As long as Travis and Suzanne continued to make the case for the other being at fault, we would get nowhere. I had to get them past the blaming stage and be willing to clean up their own part of the mess.

Before we finished that day, I told them I wanted to work with them separately and confidentially for a few sessions before we met again together. I’m aware that some family therapists won’t do this, concerned that they would end up being complicit in keeping secrets from spouses. But that’s exactly what I hoped would happen; that is, I hoped that, by meeting with me individually, both parties would say things they never would with their spouse present. Later I might urge them to share with one another; but for now, I wanted to have a clear, safe space in which to work without interruption.

When I met with them individually, I said to both, “I hear you’re hurt by what your spouse has done or is doing to your relationship. What I want you to do is create a complete inventory of how you were hurt. Make a list. Don’t leave anything out. While you’re at it, put down the positives about your relationship, as well. That’s only fair. There must be a reason you’re still together.”

I have to first take their pain and resentment, as well as their continued commitment, seriously before they will ever let me look at their part of the problem. So, when Travis said he was hurt when Suzanne didn’t trust him to see friends on a Friday night, that was something he needed to say. He needed to say it and he needed me to receive it with congruity, empathy, and unconditional positive regard. When Suzanne shared her long list of his broken promises, lies, and betrayals, I had to receive it differently than her friends had done and not second guess her decision to stay with him. Any counselor schooled in Rogerian Person-Centered Therapy ought to be able to do these things, even when he wants to break out the violins or perform a good swift, pseudo-therapeutic kick in the butt.

I took a look at some things Travis and Suzanne wrote about. Some were major betrayals such as Travis smoking up the money they had saved for a down payment on a house. Others seemed petty. It’s important to ask a few questions about the apparently petty ones, like Suzanne not trusting him to see his friends. What I found was the petty injuries picked at open sores that have never had a chance to heal. The reason Suzanne’s monitoring was so galling to Travis was because his parents were domineering helicopters that he always resented. Cocaine embodied freedom that he craved and Suzanne’s action, which might have been fine in its own right, was the very thing he was the most allergic to. Travis was able to see this and acknowledge that the real beef he had was with his parents.

Next came the most delicate part of the operation. When a person feels safe after talking about their pain, almost inevitably they will show me their guilt and shame. I’ve learned to look for them. The guilt will become useful to energize the work that lies ahead; but the shame will get in the way. In common usage, guilt and shame are synonymous, but I like to make the distinction between the two. Guilt is when we feel bad for what we did; shame, when we feel bad for who we think we are. Guilt motivates empathy; shame just makes us want to strike back or hide.

At one point when I met with Suzanne, she called herself codependent. This is what I was looking for. Codependency is a very useful concept when it describes behavior, but Suzanne had turned it into a shame statement. The shame statement was not helping her change, it was convincing her that change was impossible. I had to do some quick work to clean off the shame and preserve the guilt that would motivate her to improve. I set about trying to ennoble codependency. I told her she was a hero.

“Heroes do things that are called impossible. Trying to prevent a cocaine addict from smoking cocaine when you are not the cocaine addict is an impossible thing. Your friends will try to warn you that trying to do the impossible is grinding you down. They say you’re codependent; but, I think this is what you do to have a meaningful life. Your friends want to see you happy; but you don’t want to be happy. You want to do something that matters. You do that by trying to do the impossible.”

Whenever I give a long speech in a session, I end up afraid I lost the client. I get carried away sometimes and when I come to, they’re looking at me funny. Suzanne was looking at me funny.

“I guess trying to do the impossible turned me into an impossible person.”

I had to laugh, half from relief that she understood the fine, tortured point I was trying to make. But she was still making shame statements. I had her break down how she was acting like an impossible person.

“Oh, just like he says. By getting on his case and not giving him a chance to prove himself again.”

It was much easier for Travis to talk with me in a shame-free way. Perhaps all the treatment helped. One thing rehab, group therapy, and NA do well is, by bringing together people who have made the same mistakes, they enable them to look at their guilt without shame encumbering. Without Suzanne around, he was able admit that, whenever he and his wife had a fight and he relapsed, the relapse was actually his choice. He didn’t have to do that. He even confessed to utilizing the threat of relapse as a means to defend himself from her. I explained that I was still concerned it might lead to relapse, for no threat is believable if you are not ready to use it.

He admitted several close calls. He still regularly indulged in the fantasy of use and had recently driven out of his way to go past his old spot. I asked if he had told anyone about this.

“Heck, no,” he said. “I told my sponsor, but not my program or my wife. That’s not what they want to hear.”

Once they were identified, I had them both write up a statement of responsibility for all the mistakes they thought they made and the impact they had on others. It’s important for a person to be able to tell his story, narrating the depth of dysfunction, all the way to his redemption. But, if they talk about it only in terms of their own suffering and leave out how it affected others, then they have a limited understanding of the costs of their choices.

I tried to be clear that this was a document Travis and Suzanne didn’t need to show each other. I explained, when it comes to marriage counseling, we never know how it’s going to turn out; it’s the type of counseling that has the lowest success rates, if you measure success in marriages saved. My main objective is for both parties to follow their true values. If that saves the marriage, and it often does, that’s great and the marriage is saved with both being true to themselves. But, even when it doesn’t, following your true values gives you a better chance of meaningful happiness in the future. To that end, I ask them to admit what they think they could have done better; not what their spouse would want them to say.

This is often harder to do than it sounds. Most people are thoroughly indoctrinated into believing that they want what others want. Here’s where all the emotions they’ve been feeling lately come in handy. Being a victim brings up lots of emotions; and emotions, I explain, tell you what your values are.

Fortunately for Travis and Suzanne’s marriage, it turned out they both highly valued honesty, as indicated by the depth of their emotions whenever they had to lie or hear a lie. Travis wanted to be able to say he missed his friends without Suzanne reacting so strongly, and Suzanne wanted Travis to tell her how he really felt. This lucky congruity made the next step easier because they would have to share their statements of responsibility with each other in a conjoint session. There are many times when partners write a personal statement of responsibility that contain elements they don’t think is wise to share with their partner. Often this is because they don’t want to take their medicine, but sometimes they have a legitimate concern that the truth will needlessly hurt their partner. When these thorny ethical dilemmas come up, I generally ask them how important openness is in their relationship. When it comes to marriage, most say it’s quite important.

During the reading of the statement of responsibility, often called an apology, I’m on alert for common errors. There are lots of ways to screw up an apology. They could be vague, apologize without confessing to anything, focus more on their pain than the victim’s, or fail to ask questions and listen. But the most frequent error is in thinking that once they make an apology, the whole matter should be done with. No forgiveness should ever, ever be extended immediately following an apology, or expected. Ever. Apology is the start of the process, not the end.

The next step is to decide how the offender can make amends. Remember, they were both offenders in their own way. Suzanne said, let me monitor your every action and I will believe in you when you get enough clean time. But that wasn’t going to work.  Getting overly involved in his recovery was the very thing Suzanne had to apologize for; and besides, there was no way she could monitor him effectively. The other problem was that, even though Travis’s use of cocaine was disastrous whenever he did it, he never did it very often. He could abstain from his drug for months or years and Suzanne would never know if he was going to relapse tomorrow. The best way to make amends was by some action that can be performed every day that would prevent them from repeating the harm they each caused to the other.

For Travis, this meant that he had to talk to Suzanne every day about how he felt regarding his recovery. We set it up in terms of a ten-point scale. Zero meant he had no desire to use and ten meant nothing could stop him. Suzanne would know that he was being honest because sometimes he would say things she didn’t want to hear. Travis had thought that by reassuring her that he wasn’t even thinking about using cocaine, he was helping her feel better and winning for himself some freedom from scrutiny; but she wasn’t believing any of it and his strategy was backfiring. She would feel far more secure in knowing the risk level than Travis being evasive about it.

For Suzanne’s part, she would receive these reports from Travis with more composure. We set up a ten-point scale for her, too; with zero indicating a lifeless response, and ten a total freak out. The scales made it easier to identify and talk about degrees. We expected that as she got better at accepting his reports, he would get better at making them, and vice versa.

It’s vitally important that, once all parties arrive at an understanding, they document it and set up a system to review progress at regular, frequent intervals. By regular and frequent, I mean every day or two at first. Far too many transformative plans whither away from simple inattention. I felt so strongly about this that I set up a system where they reported to me how they and their partner were doing, both in making amends and in giving positive reinforcement when their partner did so.

Travis and Suzanne were able to make these changes and did very well for a while. Travis eventually relapsed; but it was a far more contained and less destructive relapse than previously. We were able to go over the chain of events just prior to his use and see what had gone wrong. He had underestimated the influence one of his cocaine-using friends had on him. Travis was able to admit he was wrong about seeing this friend. Suzanne was able to accept this without saying all his friends had to go. They were better able to collaborate on future risk assessment because two heads working together were better than one.

Travis and Suzanne were, of course, a relatively uncomplicated example that I have used to illustrate how restorative justice can be a part of treatment. There are obvious applications in cases of infidelity as well as how an adult can resolve childhood abuse. Restorative justice can even play a part when mental or physical illness causes inadvertent harm to another.

I should note that no two people can work through their victimization and arrive ready to take responsibility at exactly the same time. More often, one is prepared before the other. Sometimes it’s unsafe and toxic to remain in the relationship, waiting. Authentic reconciliation is not possible as long as the partner is not ready, and some never are. The best anyone can do is to find safety and pursue personal peace by understanding the context of how they were harmed and doing whatever they can do to prevent it happening again with other partners.

I can only take a small part of the credit due for success. Travis and Suzanne did the hard work, as well as the treatment providers, and NA and Al-Anon groups before I ever came along. However, reconciliation with the people they’ve harmed is an essential but often overlooked part of recovery. It should not be left up to chance or delayed indefinitely. Therapists can easily play a part if they know how.

Snapshots

Photo by Ryan Magsino on Unsplash

If the inside of my own head is any indication, we all carry around a few snapshots of what our childhood was like. These snapshots are extremely powerful in determining our self-image, the choices we make, and the way we feel about everything.

One snapshot of my own childhood is that of me, sitting in a school bus. Every other seat is taken, but the seat next to me is empty. Continue reading

Freedom

Photo by Ryan Magsino on Unsplash

If you have ever been to a sawmill like the one I used to run, you have seen one of the most fearsome objects you are ever likely to meet: a sawblade at least three feet in diameter with teeth as big as a tiger’s whirring loudly just a couple feet from the operator. There were no safety guards on my sawmill. I’m not sure how there could be. I frequently had to reach close to the blade to remove boards and some debris.

One day while I was working, the thought entered my brain that I could just dive onto that sawblade and have it cut me in half. This thought frightened me so much I shut everything down, went home, put the covers over my head, and talked to no one. What was going on with me? I wasn’t suicidal. Until this happened, I was happy with my life. Was I going crazy? Continue reading

Defamiliarization

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One of the advantages of being a reflective eclectic is I can borrow techniques from other fields and apply them to psychotherapy. Some of these techniques come from surprising sources. Today I’d like to talk about something I learned from being a photographer: defamiliarization.

Photography can be a simple reproduction of the object photographed, or it can be art. When I get all artsy-fartsy with my pictures, I’m trying to enable the viewer to see something in an object that belongs to the object but she has never seen before. I‘m trying to cut through an overfamiliarity with the world that numbs us of delight and creativity.

The easiest way to do this in photography is often to shoot in black and white. When you look at a black and white photo of a familiar colored object, you can usually recognize the object, but it’s presented in a new way. This unforeseen appearance causes you to look closer and become more mindful of seeing. Suddenly new possibilities come to view. You might enjoy the play of shadows, the gradations of gray, and the stark contrasts that a black and white photo bring out. It’s funny how stripping things down to basics can enrich them.

Unfortunately, if you have seen a lot of black and white photos you can become immune to them. Black and white can become too familiar. Photographers have always got to come up with something new to stop people in their tracks. They crank up the saturation levels, adjust the tint, blow out the background, make something fuzzy or sharp, or find a new camera angle and frame things in a different way. However, they can’t make the new images so strange that the viewer cannot understand them. The art photographer has got to fit into a small window: familiar enough to be understood and strange enough to be intriguing.

It’s not hard to see defamiliarization at work in all the arts. The term itself comes from literature. The plot of a novel can be summed up in a few lines: boy meets girl, they fall in love, boy loses girl, they make up, and live happily ever after; so ordinary, you can see it happening every day. You’ll read a novel with that plot for 363 pages because the novelist has made it original. He’s added sparkling dialogue, unexpected twists, and quirky characters, all to keep you guessing. When you finish a good novel, you will have gained an understanding of the course of love as you have never understood it before.

Poetry and song do the same thing by putting in meter, verse, and startling vocabulary, thoughts you’ve had a million times before. This is why the same song is better in concert than it was when you heard it in your CD. The concert experience adds something new. For that matter, have you ever wondered why a singer or a musical instrumentalist doesn’t sing or play a well-known piece straight up, as it was originally written? He’s trying to make it fresh, so you can hear it as people first heard it when it just came out.

Have you ever wondered why some people, like me, prefer to live in a place like Rochester, New York, where the weather changes every day, from one extreme to another? There’s nothing like a new blanket of snow to make the world refreshed. Did you ever wonder why you’re sick of the same snow in February that you enjoyed in December? It’s gotten so familiar that you can no longer find the joy you once had in it.

Did you ever wonder why this person who you once fell in love with can do nothing but annoy you now? She’s gotten too familiar. Did you ever wonder why you get along so well when you’re on vacation? Just enough changes then that the relationship is renewed.

When you come to therapy and tell me something you’ve been thinking a million times before, you might think that going over it once more might not do you much good. Oh, but it does. Just hearing your voice say it, rather than your thoughts think it, may be just defamiliarizing enough to you that it enables you to look at the situation a whole new way. Then when I respond, you get another shot of defamiliarization. You see how that happens? The whole purpose is to wake you up.

To understand how defamiliarization works, you have to understand what’s happening when the opposite occurs. When you are familiarizing yourself with something, you’re taking it in and making it your own, making it part of the family. You’re fitting it in comfortably in your schema or world view. Once you have familiarized yourself, you no longer can do anything more with it. It’s become too close to you. You’ve lost objectivity. Defamiliarization gives you some distance, so you can see it more clearly and notice things you have not noticed before or have forgotten. When familiarization happens all over again, perhaps you fit it in a new place or have allowed it to change your schema. Generally, your world view becomes a little bigger then. You have more choices and more ways you can look at things.

There’s a saying in medicine: the thicker the chart, the worse the prognosis. That’s often true in therapy, too. The longer the person has been in therapy, the less likely a session will do him much good. Therapy also can get too familiar. That’s another reason I’m a reflective eclectic. I have a big bag of tricks, so that when one method starts to get old, I can try another.

In the interest of defamiliarization, let me conclude this post in a way I don’t usually. I’d like to quote from the master of making the familiar fresh, J.R.R. Tolkien, from his lecture titled: On Fairy-Stories. You probably know Tolkien as the author of the Lord of the Rings trilogy. In this lecture, he surprisingly talked about recovery.

Recovery (which includes return and renewal of health) is a re-gaining—regaining of a clear view… as things apart from ourselves. We need, in any case, to clean our windows; so that the things seen clearly may be freed from the drab blur of triteness or familiarity—from possessiveness…This triteness is really the penalty of “appropriation”: the things that are trite, or (in a bad sense) familiar, are the things that we have appropriated, legally or mentally. We say we know them. They have become like the things which once attracted us by their glitter, or their colour, or their shape, and we laid hands on them, and then locked them in our hoard, acquired them, and acquiring ceased to look at them.

Since Tolkien’s thing was building fantasy worlds, he puts in a plug for his way of writing as the best defamiliarizing agent since sliced bread.

Creative fantasy, because it is mainly trying to do something else (make something new), may open your hoard and let all the locked things fly away like cage-birds. The gems all turn into flowers or flames, and you will be warned that all you had (or knew) was dangerous and potent, not really effectively chained, free and wild; no more yours than they were you.

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