Monday, December 30, 2013

Back from vacation

Sorry I haven't posted anything for the past couple of weeks; I took some time off of work (and responsibility).  I thought about posting on several occasions over the past two weeks but I couldn't seem to muster enough motivation.  This was the longest consecutive period of time I've had off of work since the end of 2008.  It was actually a bit disorienting.  I found myself forgetting to do little things that I typically incorporate into my daily routine.  Without the routine they simply slipped my mind.  There was no damage done; I eventually got around to doing everything I needed to do.  It just made me realize that work has become the structure for my life around which everything else is organized.  Without work, I sleep in every day.  The earliest I start to become productive is around 10:00 AM.  If I have the option to be lazy - even if it's for five minutes - I almost always seize the opportunity.  I waste hours and hours doing things with absolutely no productive value whatsoever.   Because my regular sleep cycle is thrown off my body is confused; I feel lethargic when I need energy and have energy when it's time to go to bed.  

I do a little better when I have things planned.  If I know I have to be somewhere at a certain time I can structure my day around it.  I know what I want to get done that day so I have to give myself enough time to do it before I have to be wherever it is I have obligated myself to be. 

I initially felt a bit guilty about how little I accomplished during my two week vacation.  Then I decided not to worry about it.  It was, after all, a vacation.  You're supposed to spend your time relaxing.  While I can live with a little chaos for a couple of weeks I could not live my life this way.  At first I thought it was about work.  I thought to myself, "I can never quit working.  I would be a complete mess!"  Later I realized it isn't about work at all; it's about structure.  I need structure in my life in order to thrive.  Without it I become lazy, disorganized, and unproductive.  I feel lost. 

This isn't really a novel realization; I long ago embraced the comfort of a good routine.  It's just that being without structure for a couple of weeks really reiterated this point for me.  I sometimes wish I could be the kind of person who "goes with the flow."  I'd love to be more fluid and flexible.  I know I'm too rigid - I'm just not sure how to be another way. 

Wednesday, December 11, 2013

"Baby Bust"

In case you haven't heard, the United States is currently in the midst of a "Baby Bust."  The birth rate in America has been declining for more than a decade.  According to Stewart Friedman, author of "Baby Bust: New Choices for Men and Women in Work and Family," the national birth rate in 2011 fell below "replacement" level.  This means Americans are not reproducing fast enough to maintain our current population level. 

People are concerned about this trend.  There are, of course, existential worries about the survival of our species.  However, with 6 billion people on our planet homo sapiens are probably in little danger of extinction, at least for the foreseeable future. 

Dr. Stuart Bramhall ( thinks interest in the so called "Baby Bust" is driven by something nearer and dearer to our hearts: money.  Capitalism, he explains, relies on growth.  Success in a capitalist society requires perpetual economic growth.  Economic growth is fueled by population growth.  If the population stops growing so does the economy. 

While Dr. Bramhall makes an interesting argument, I'm not convinced there's a vast capitalist conspiracy to keep American women having babies.  If that were the case, both the private and public sector would adopt policies and practices that make it easier for people to work while raising a family.  Instead, we have extremely expensive child care, schools that let out at 2 or 3 PM - in the middle of a typical nine to five workday - forcing parents to figure out what to do with their children for the two or three hourse after school lets out, and outrageously expensive health care (which is costly at the individual level and becomes financially burdensome at the family level).  Paid maternity or paternity leave is practically unheard of.   For these reasons and others it has become increasingly difficult to balance the demands of career and family.  If people think it impossible to have children and a successful career they feel forced to choose only one of these options.  Many choose career over children.  So while capitalism may need perpetual growth to sustain itself - as Dr. Bramhall points out - concern about population decline is not yet pressing enough to be a priority. 

And then there are those who simply don't want to have children.  This was unthinkable in past generations.  Not having children wasn't an option.  Today, people are far less constrained by cultural norms and societal prescriptions.  Having children is no longer a prerequisite for leading a meaningful and fulfilling life. 

By far the most interesting thing I read about the "Baby Bust" is an article by Joel Kotkin entitled "Why the Choice to be Childless is Bad for America" (  The "Baby Bust," Kotkin asserts, will have unintended consequences.  First, the population as a whole ages.  This is already happening as the baby boomers grow older and begin to retire.  According to Kotkin, retirees already receive $3 in government spending for every $1 spent on children under 18.  This trend will increase as our aging population retires, placing an increasing burden on younger workers (and ironically making them more likely to opt out of parenthood for economic reasons).

Beyond the economic impact, the Baby Bust could also have significant political implications.  Evangelical Christians, mormons, and similar conservative religious groups have much higher birthrates than other segments of the population.  If these children adopt their parents' politics the country as a whole will become drastically more conservative.  Whether or not this is a good thing depends on who you ask.

My husband and I have been considering having a child.  At one point, we'd decided to start trying in January with the hope of bringing a child into the world by the end of 2014 or the beginning of 2015.  My husband is extremely concerned about the financial impact of expanding our family.  This explains why I've taken an interest in why people choose to have or not to have children.  Just thought I'd share what's been on my mind lately...

Wednesday, December 4, 2013

Group therapy

The clinic I work in recently started a new two week therapy group for women who have had any kind of unwanted sexual experience.  Our medical director has talked about doing this for a while so I knew it was coming.  I was under the impression that we would start offering the group in January.  I was assigned two groups a few months back.  I was given discussion topics and encouraged to start thinking about content.  Apparently my boss decided at some point that the first two week session would begin December 2nd.  I somehow missed the memo.  (I appear to be the only one in the clinic who had no idea this was happening.  Logic suggests that we were all informed and I just wasn't paying attention).  Anyway, I had no idea until I got an email last week confirming the December 2nd start date.  I had given exactly zero thought as to the content of my assigned groups.  I printed out a few articles the day before Thanksgiving with the intention of coming up with something during the holiday.  Unfortunately, I went out of town and left the articles at home.

I spent a decent amount of time Monday coming up with a format for my group discussion.  Still, I was less than confident Tuesday morning when I introduced myself to the group members.  I was pleasantly surprised, then, when everything went smoothly.  I gave myself a pat on the back (okay, maybe two pats on the back) for a job well done.  It may be, however, that I just got lucky.  Sometimes you get a really good group of people who are extremely motivated and invested.  Everyone participates and members give each other feedback.  That makes my job easy.  I just throw out an idea, step back, and let the group do its own thing.

Tuesday's group was a good group.  Everybody contributed something and everyone was engaged.  So it could have been luck.  I guess time will tell...   

Monday, December 2, 2013

Feeling down

I usually start working on a new blog post at the beginning of the week.  This past Monday, though, I had a sinking feeling in the pit of my stomach.  I tried to start writing but I drew a blank.  I couldn't muster the motivation nor the focus to get started.  It was like this all day.  I lacked my usual easy way with my patients.  I had trouble making myself smile.  I usually laugh and joke but my sense of humor deserted me.  My voice was flat.  I could hear it but I couldn't change it.  It was strange.

Everyone has bad days so I didn't think much of it.  But Tuesday came and I felt the same.  And Wednesday too.  I've started to get nervous.  I know this feeling.  I'm surprised at how quickly I recognized it because it has been a while since I've felt it.  The giveaway for me is the sinking feeling in the pit of my stomach.  It weighs me down.  Something is wrong inside but it doesn't make sense because nothing is wrong outside.  Everything is fine.

But that's what depression is, if I remember correctly.  I work with depressed people all the time so I know what it looks like.  But it's been a long time since I've felt that way myself.  I guess seeing it and experiencing it yourself are different.

It hasn't settled in - the depression I mean - and it won't if I can help it.  It may just be that it's a certain time of month and all my hormones are conspiring against me.  In that case, I'll be myself again by Monday.   Let's hope for the best!

Thursday, November 21, 2013

How to cope when you get blamed for everything

How do you cope when your partner blames you for just about every problem that exists in your relationship?  This is something I've struggled with in my marriage, although my husband and I have made a lot of improvements in the way we interact.  I will start with an admission: I probably sometimes feel like my husband blames me for "everything" even when he doesn't.  I have become sensitive to him blaming me.  That means I am more likely to notice when he blames me for something and unlikely to notice the times he doesn't blame me or when he accepts responsibility himself.  Because I'm sensitive to him blaming me I almost immediately become defensive when it happens.  This has the unfortunate effect of making it harder for me to recognize when I am truly at fault.  This is, of course, something that only becomes apparent to me in hindsight; I rarely recognize it when my husband and I are in the middle of a heated disagreement. 

So I admit there are things I need to work on.  This doesn't obscure the fact that my husband has a very real habit of blaming me when problems arise in our marriage.  This makes it extremely difficult to resolve conflict in any meaningful or lasting way.  We therefore find oursleves confronted with the same problems again and again and we continue to respond to them in the same problematic manner.

Is there a right way to cope with this?  It's exceedingly frustrating.  It has at times made me feel hopeless about the possibility of ever solving problems in my marriage.  I will share how I've tried to deal with the situation in the hope that someone else with a similar problem might find it helpful.  I would also appreciate any suggestions or feedback for how to improve. 

It does not take long before constant blame begins to erode self confidence.  This is something I've been determined to prevent.  It took years for me to learn to love myself.  My self confidence was hard won; I will never allow anyone to take it away.  I protect my self esteem by refusing to accept blame for anything that isn't truly my fault.  I quite literally say to my husband, "I refuse to accept blame for this.  It isn't my fault."  The flip side is that I have to work really hard to accept responsibility when I am at fault, to apologize when I behave unkindly, and to admit when I've done something wrong (oh how I hate admitting I'm wrong).  I inevitably screw this up, at least initially.  Fortunately, I've discovered I can get more than one try.  If I behave terribly during an argument (I do this a lot more than I care to admit) I can go back an hour, two hours, or even a day later and say I'm sorry. 

Which brings me to my next point.  I have no objection to going to bed angry.  Arguing is only productive if it leads to resolving the conflict.  If an argument is going in circles, if it turns into a blame game, or if it simply becomes obvious that the problem is too complex to solve in one night then walk away.  Going to bed angry is better than fighting all night yet accomplishing nothing.  Get some rest.  You may still be angry in the morning but probably less angry than you were before.

The purpose of an argument, disagreement, or other conflict is as follows: clearly identify the problem (or the problem caused by a particular behavior, comment, etc.); accept responsibility and/or apologize as appropriate; solve the problem or resolve the conflict (this can sometimes take the form of identifying what can be done differently in the future to prevent the same thing from happening again).  When it seems like my husband is stuck on blaming me I point out that blaming each other damages our relationship and does nothing to fix the problem.  The first time I pointed this out my husband's response was to continue blaming me.  A day or two later we had a serious talk.  I pointed out to my husband that when conflicts arise in our marriage we have no effective way to resolve them.  We argue and point fingers but we never accomplish anything.  When we found ourselves arguing about the same issue a few weeks later I pointed out that this was the same argument we'd had a few weeks earlier but had been unable to resolve.  And when the same problem inevitably came up again a few weeks after that I pointed it out again.  And again.  And again.  Over and over again I told my husband how concerned I was about our marriage.  When he tried to blame me I lamented how focused he was on "winning" the argument or on being "right."  "If one of us wins that means one of us loses," I told him.  "If one of us loses the relationship loses.  I don't want to lose our marriage." 

I've also told my husband it really bothers me when I try to discuss a problem or concern and his immediate response is to say it's my fault.  Every time he does this I point it out.  "Stop blaming me," I tell him.  "I want us to talk about the problem."  If he continues to blame me I get up and leave the room.  That's my version of how it goes.  His version goes like this: "You get to say everything you want to say.  Then when I try to say something you won't listen.  You want to complain about me but then I can't complain about you."  It's true that I don't like to be criticized.  It's true that I sometimes walk away when he's saying things about me I don't like to hear.  Usually I take some time, think about it, and come back to talk about it later.  So he has a point.  My problem, however, is when I bring up something he's done that bothers me and he responds with a litany of things I do that bother him.  "If you have a concern you are free to bring it up later," I say.  "Right now, I want to talk about [the initial problem]."

So that is where we are.  Things have gotten better.  We're both starting to realize there are things about one another we are going to have to learn to accept.  For me, I am very slowly learning that it is sometimes better to go along with certain situations I don't like simply because it makes my husband happy.  I am trying to decide which of these situations I am willing to go along with.  There are some things I am unwilling to abide.  I am still figuring out where to draw the line.  It is hard to know when to put my foot down and when to give in.  The fact that my husband and I are both very strong willed makes it more difficult.  Neither of us are inclined to back down from something we believe in.  We are both bull-headed and hell bent on doing things our own way.  We both have a fierce desire to be right.  We both have difficulty admitting we're wrong. 

To a certain degree I suppose this is what marriage is about: two people finding a way to live together peacefully in a way that makes them both happy. 

Thursday, November 14, 2013

Listening well

I have been accused at times of not being a good listener.  This is ironic because probably 50 to 60% of what I do for a living requires good listening.  In college we called it active listening.  Active listening is basically listening in such a way that the speaker feels heard, validated, and understood.  This comes quite naturally to some people.  These are often the people we feel comfortable going to for advice or for comfort.  For other people, active listening is more difficult; it is a skill they have to develop with practice. 

I probably fall into the latter category.  Naturally, I'm not the best listener.  I don't think I realized this when I decided to become a therapist.  If I had, I might have chosen a different career path.  Anyway, at some point early in my career I began to notice that listening was a struggle for me.  Even now, after years of consciously honing my active listening skills, it still takes a significant amount of effort.  I constantly have to remind myself to pay attention, to make eye contact, and to refrain from interrupting.  I regularly forget to validate a person's perspective before suggesting another way to look at things.  I frequently have to quiet the running commentary in my mind so that I can fully attend to what a patient is saying.  All of this is in addition to reigning in my overwhelming impulse to blurt out every response the moment I think it.  (Self censorship is another skill that doesn't come naturally to me.  I've gotten a lot better at it over the years though).

Because listening demands so much of my focus and concentration it also requires a lot of energy.  Talking to people all day may not seem like it would be exhausting but it really can be, at least for me.  When my husband and I first got married he used to call me as soon as I got off of work.  He always wanted to talk about some problem he wanted to solve or to ask my opinion about some decision he needed to make.  It felt overwhelming to me and it led to a lot of stupid arguments.  Eventually I had to ask him to stop calling me right after work.  I simply didn't have the energy right then for the kind of conversations he wanted to have. 

Fortunately my husband was willing to do this so it wasn't a big deal.  What's been a bigger problem for me is that I never get re-invigorated after working all day.  By the time my husband and I get home in the evening I just want to read or watch something online.  Like most normal people, my husband wants to tell me about his day.  This is perfectly reasonable and yet it is such a struggle for me to listen.  This is especially true if he starts a conversation when I'm in the middle of looking at something else.  My inclination is to keep doing what I'm doing.  Normally, I'd set aside this inclination, stop what I'm doing, and have a conversation with my husband.  When I'm tired, however, I don't have the energy to overcome my natural tendencies.  It takes will power to overcome an urge and will power takes energy. 

Does anyone else have this kind of problem?  Do you have any suggestions for overcoming it?     

Thursday, November 7, 2013

Winter approaches...

They say it's going to be a cold winter this year.  I became a bit worried over the summer when I realized it just didn't get as hot as it usually does.  A mild summer usually means a cold winter.  I suppose a cold winter is a given in some places.  I, however, live in Virginia.  When it comes to weather, the only thing that's a given in Virginia is that July and August will be hot and humid.  Everything else is a toss up. 

In the summer, I manage to forget the toll winter takes on me.  I grow accustomed to feeling comfortably warm when I leave my house each morning.  I don't have to plan my wardrobe around the official weather report; short sleeves and open toed shoes are good every day of the week.  Yes, it gets hot outside - sometimes unbearably so - but I'm hardly ever forced to be outside against my will.  If it gets too hot I simply go inside.  It only takes a few minutes to cool down sitting in an air conditioned room.  And I adore the long days.  The sun begins to rise on my way to work and when I come home there are still hours of daylight remaining.

The first thing I notice as winter approaches is the days getting shorter.  It's gradual at first.  Then, Daylight Savings Time ends and suddenly the days aren't long enough.  Tonight when I leave the gym it will be dark outside for the first time in a long time.  That's when it seems official to me - summer is gone. 

Usually the temperature change creeps up on you too. In Virginia, it is not unusual to have 70 and 75 degree days through the middle of November.  We've even been known to have an occasional 80 degree day in December.  This year has been different though.  The colder temperatures raced in without warning, sweeping away the warm summer days in an instant.  This is yet another sign that this winter will be a cold one.

What is it about winter that affects me so?  At least I don't live somewhere like Norway or Alaska, where months pass without sunshine.  First, it's the cold.  My body betrays me when it's cold outside.  My skin becomes red and irritated.  Eventually, it starts to crack.  My poor hands ends up bleeding several times a day by the time it starts to get warmer.  I wear gloves when I go outside, but still my hands crack and bleed.  They itch and they hurt.  While I prefer warm weather to cold, I am no fan of being hot.  I sweat a lot when the temperature rises.  But cooling down when overheated is much easier than warming up when I get too cold.  Some cold water on my face and a few minutes in front of the fan cools me down pretty effectively.  Something about cold though...I've heard people say it gets into your bones.  I don't know if that's true but it certainly feels like it.  When I get cold, it takes forever to get warm again.  I can spend ten minutes in a hot bath shivering before I start to feel even a little bit warm.  I can bury myself beneath a mound of blankets - give me fifteen or twenty minutes and I'll start to warm up.  (But then I have to stay under the blankets to stay warm).  And in the car...I have a particular problem with that.  I blast the heat to stop shivering.  Unfortunately, the heat on my face (or even on my feet) is so pleasant I start to get drowsy.  I turn the heat off until I start to get cold again; I turn it back on and I start to get drowsy.  Off on, off on, warm cold, warm cold...I hate it.

So the cold is one thing.  The other is darkness.  I get excited after the winter solstice because the days start to get longer.  By January, I start checking the Weather Channel website to see what time the sun sets.  Each day it sets about a minute later than the day before.  I eagerly anticipate the long, warm summer days.

I will challenge myself to find things to embrace about the winter months this year.  It's better than sulking, anyway.

Thursday, October 31, 2013


Recently a close friend of mine mentioned that she'd started a new job and would only be working part time from now on.  In some ways I felt bad.  My friend and I met back in 2006.  We both worked at the same place.  It was my first job after college.  My friend graduated a year before me so she had a little more work experience than I did at the time.  In our profession, everyone has to "do their time" so to speak in a job that is less than desirable.  We are required to have two years of formal supervision by a licensed professional before we can apply for a license to practice independently.  Without the license, job opportunities are limited and income is low.

This was the situation both my friend and I were in when we met.  Neither of us liked our jobs very much and we were both struggling financially.  We'd expected the years immediately after graduation to be difficult but I don't think either of us expected it to be as bad as it was.  But we got through it.  Eventually she ended up moving back to her home town and completing her licensing requirements there. 

After sharing an employer for a few years our occupational paths diverged.  We both got licensed as independent practitioners and set out to find better jobs.  I found a job with my currently employer doing outpatient psychotherapy.  I've been at this job for five and a half years.  The time has pased quickly.  My friend wasn't able to find her "dream job" right away so she accepted a job she didn't like very much while she continued to search for better opportunities.  Except they never came, despite her best efforts.  She stayed where she was for about two years.  At that point, things were so unpleasant for her that she was willing to work just about anywhere else just to get away.  She took another job that was not really what she wanted but it was all that was available at the time.  She worked there for another couple of years but became increasingly unhappy with it.  In the meantime, she met a great guy and they got married.  Now they are getting ready to start a family.  With her husband's encouragement, my friend left her job and accepted a part time position with a different company. 

As I said before, part of me felt bad for my friend.  She's spent her whole career working at places she hates.  I know how miserable it is to hate your job.  Every morning is a struggle.  Sunday nights are filled with dread of the upcoming work week.  You want to quit but you can't; you have bills to pay.  You feel trapped. 

I also feel fortunate.  I work at a place where I am valued by my supervisors and coworkers.  The workload is managable.  I set my own schedule (with guidelines, of course) and the work hours are managable.  I don't ever have to be on call; when I leave work I leave work.  I have my own little office I can escape to.  My salary is set; I always know how much my paycheck will be.  My job isn't perfect, but I've got a pretty good deal.

So why do I also feel envious of my friend?  I felt kind of bad when my friend told me she was only working part time but I also felt jealous.  "Man, I'd love to only work part time," I said to myself.  I thought about all the things I could do with the extra hours I'd have every day.  "Better still," I thought.  "It would be nice not to have to work at all."  I'm sure I'm not the only one who has ever had this fantasy.  The majority of us spend most of our lives working hard so we can retire and spend our golden years in leisure.  So sure, we all dream about not having to work.  I just wonder if everyone dreams about it as much as I do...

I got my first "real" job when I was sixteen.  The rule was if I wanted to drive I had to pay for gas and for car insurance.  That meant I had to get a job. When you have no experience and few marketable skills you basically take whatever job you can get.  I took a job cleaning tables, sweeping floors, and washing dishes.  I hated it.  Immediately.  I can still recall the dread that bore down on me before each shift.  The days seemed endless.  I didn't last very long there.  Within two months I found another job and quit. 

The new job was at a grocery store, ringing up groceries.  This wasn't as bad as sweeping floors but I can't say that I liked it.  I worked there for about a year and then got a job waiting tables.  I'm clumsy and uncoordinated; I was not a very good waitress.  I lasted about nine months and then found a job at a big department store.  This was by far the best place I'd ever worked.  Still, I dreaded going to work and worked as few hours as I could get away with. 

Of course my job now is far better than anything I did before college.  I never dread going to work.  And yet, I never want to go to work.  I spend all week counting the days until the weekend.  Each month I check the calendar for holidays.  I look forward to things like Columbus Day, Presidents' Day, and Veterans' Day for weeks in advance.  I am always aware of the next day I have off.  Is this normal?

I wonder why I feel this way about work.  I sometimes think I must be lazy but I hate to think of myself that way.  What do you think?  What is your relationship to work?  How do you feel about it? 

Thursday, October 24, 2013


Memory is a funny thing and is not always as reliable as we tend to assume.  And yet we DO rely on our memory and become deeply unsettled if it seems to fail us too frequently.  This is an observation I've made again and again in my work with patients.

For example, a lot of my patients complain about not being able to remember things.  They forget to complete tasks at work, they forget about appointments and meetings, they do not recall being told important information and often have no recollection of the conversation in which this information was given.  They may forget to pay bills or to pick the kids up from school.  One patient made plans with his wife for the following day.  When they got up the next morning he turned to her and asked, "So what do you want to do today?"  She looked at him aghast.  "We talked about this for a while yesterday," she told him.  "We made plans, remember?"  But he did not remember.  The patient is undeerstandably distressed.  "I'm losing my mind," he tells me.

Another patient was disturbed after realizing that the memory of an event he'd been reliving in his mind for years was completely inaccurate.  This particular patient works in the medical profession.  For years he has been plagued by memories of a patient he treated while overseas.  He clearly recalls his patient speaking to him, begging him to end his suffering.  The memory is so vivid he can hear the patient's voice in his mind.  When he (somewhat reluctantly) shared this memory with his psychiatrist he came to the sudden realization that his patient had been on a ventilator the entire time he'd been at the hospital.  "He couldn't have said what I remember him saying," he said.  "He was on a ventilator the whole time.  He wouldn't have been able to speak at all," my patient told me.  He told me that, upon coming to this realization, he left the psychiatrist's office in a hurry.  "I couldn't even drive home afterwards," he said.  "I sat in the parking lot for an hour trying to calm myself down."  He'd concluded that his memory of something that never happened was a sure sign of insanity.  He was shaken.

Of course, trouble with memory CAN signal a deeper problem - the onset of dementia, a brain tumor, or some other terrifying medical condition.  What most people don't realize is that psychological trauma can also cause changes in memory.  Memories of a traumatic experience can intrude in a person's thoughts, sometimes several times a day.  If your mind is filled with memories of the past it becomes difficult to focus on what's going on around you in the present.

Sometimes a traumatic experience can disupt a person's sense of security such that the person no longer feels safe anywhere.  Thus, he is always alert.  When he leaves his house he is continously on guard.  He spends a significant amount of time looking over his shoulder or scanning his surroundings, seeking to identify any potential threat.  Looking for danger consumes most of his attention; he has little left over for everything else.  He thinks he forgets what people tell him but perhapss he doesn't pay enough attention in the first place.  The information is never encoded into his memory, which is why it isn't there when he tries to retrieve it later.

And sometimes memory plays tricks on us.  If a trauma is particularly horrendous, a person might supress his or her memory of it.  Some people are consumed by their own role in the event - how they reacted or the choices they made - that they completely lose sight of the context in which the event occurred.  A woman might, for example, be angry at herself for not fighting back when someone attacked her.  She is so focused on this that she completely forgets that the attacker had a gun and threatened to kill her.  Memory is affected by perception; what we remember depends on what we think happened in the first place.  A person's recollection of an event can even be influenced by things that happen after the event.  There have been a number of studies about the reliability of crime witnesses.  What they remember seeing can be influenced by something as small as how the investigating officer phrases his questions.

We rely on our memories; it is necessary if we are going function as successful members of society.  I simply ask that we keep in mind that memory is falliable...

Wednesday, October 16, 2013

What patients don't say

A few weeks ago I had a session with a patient I've been working with off and on for over a year.  He's the kind of patient therapists love; he's introspective and insightful, he listens to feedback, he thinks about things in between sessions, and he attempts to use every technique we discuss at least once to see how it works for him.  He was a bit guarded when we first started working together.  Over time, however, he became more comfortable and talked more openly about things that bothered him.  I was surprised when he revealed to me a few weeks ago that he has been intentionally holding things back during our sessions.  When I asked him why he replied, "To protect you."  He explained that some of the things he's been through were so horrific that he did not want to subject anyone else to them.  He's tormented by memories of these events but has not shared his recollections because he fears they might be damaging to others.

His consideration for my feelings was touching and I told him so.  On the other hand, I wanted him to feel free to talk to me about anything.  I assured him I am capable of hearing his stories.  I explained that it is my job as a therapist to take care of myself emotionally so that I am able to listen to people's stories without becoming overwhelmed.  I told him I am diligent about self care.  I said some other things I can't recall.  Basically, I tried to persuade him that I can handle anything he decides to tell me.  I don't know whether or not I convinced him.

As a result of this incident, I realized I'd been taking for granted that most of my patients feel comfortable telling me anything.  Of course I know there are those who hold back but often these patients are upfront about that fact.  I've had plenty of patients tell me they don't know me well enough to tell me certain things. 

The thing that struck me most was the reason my patient had for holding back: he was afraid of damaging me with his thoughts, feelings, and memories. This in one way reveals something about the patient's character; he is genuinely concerned for the well being of others.  (Ironically, he claims to not like people very much).  Maybe that's the only thing it reveals.  I wonder though, if there's something about me that led my patient to decide to hold things back.  Is there something I said or did that drew him to his conclusion? 

I've searched my memory but can think of nothing.  If there is something I'm doing then it is something I am not aware of.  I am, however, paying more attention now.  Last week a different patient talked about how hard it is to cope with the horrible memories she has of her time in Afghanistan.  She doesn't talk to anyone about her memories because, in her words, "nobody wants to hear about this stuff.  Even I don't want to think about it and they're my memories!"  She went on to explain that the memories are her burden to bear.  I replied that hearing her memories is my burden to bear.  "That's why I'm here," I said. 

I'm not sure if spelling it out for people makes any difference.  I guess I'll have to wait and see.

Wednesday, October 9, 2013

Making mistakes

Everyone makes mistakes.  It's part of the human condition.  Nobody's perfect.  Maybe it's not even unique to humans.  I bet if we observed animals long enough we'd see them make mistakes too.  Even our DNA makes mistakes (i.e., mutations).  Thus, we are falliable to our very core.

We spend a lot of time and energy thinking about mistakes - how to prevent them, how to fix them, how to learn from them, etc.  Some of this is time well spent.  If mistakes are inevitable we can at least try to learn from them.  Failure sucks but it sometimes teaches valuable lessons. 

It's not hard to put a positive spin on screwing things up.  Still, there are some very unfortunate truths about making mistakes that can be difficult for us to accept:

1. Once mistakes are made you can't undo them:  This is, of course, true for any course of action.  Once a thing is done it is done.  You cannot go back in time and change it.  Nothing is gained by continuing to dwell on past mistakes.  I've had patients who are still beating themselves up about things that happened years ago - perhaps even as children.  They all have their own reasons for doing this.  The result for all of them, however, is the same: they all feel terrible.  They carry the weight of guilt and shame with them everywhere they go.  Eventually, they begin to condemn themselves and then to hate themselves.  That's not to say we should not feel guilty when we do something wrong; we should.  There comes a point, though, when we need to forgive ourselves and move on.

2. It is possible to make the same mistake again and again without knowing why. People are creatures of habit.  We tend to have certain ways of behaving - certain patterns to our actions.  Some habits are good and some are not.  If we repeatedly find ourselves in similar aversive situations we are probably doing something to contribute to the problem.  Often we cannot see it ourselves; we may need to ask someone close to us for feedback in order to figure it out.  The goal is to try to identify any negative patterns of behavior you are engaging in.  Recognition is sufficient for change.  We might feel compelled to spend our time exploring why we engage in certain behaviors; we think if we know why something happens we will know how to fix it.  THIS IS NOT TRUE!  Knowing why we do something tells us nothing about how to stop doing it.  You can delve into your psyche looking for childhood wounds.  You are almost certain to find some - no one comes out of childhood with all of their emotional and psychological needs completely met.  (Remember, our parents are human too).  Once you discover these wounds, though, what will you do with them?  You'll still be left with the same problem behaviors and no closer to knowing what to do about it.  Focus on identifying the problem and initiating change first.  You can ask why later.

3. You cannot force someone to learn from your mistakes.  Most of us have had the experience of watching helplessly as someone we love makes bad decisions.  We can see they are traveling a dangerous path and we want to protect them.  The desire to safeguard those we love is natural.  Parents protect their children.  Older siblings look out for their younger siblings.  Mentors watch out for their mentees.  Those of us who have lived a bit longer have the benefit of experience.  We've made our mistakes and we've suffered the consequences.  We don't want our loved ones to suffer the same consequences.  We don't want them to make the same mistakes we made; we want better for them.  And so we teach them.  We impart to them the knowledge we've gained from our experience; we share with them the lessons we've learned.  Unfortunately, despite our best efforts we cannot always prevent someone we love from repeating our mistakes.  We can caution, cajole, alert, advise, insist, or imply.  Maybe our loved one will listen; maybe he won't.  In the end, we have to allow those we love to make their own decisions (we're talking about adults; children are, of course, different).  Sometimes people need to see things for themselves, to make their own mistakes.  Just try to avoid saying, "I told you so."

4. There is no shame in admitting you screwed up. Nobody enjoys messing up.  Neverthelesss, it is usually preferable to admit you made a mistake as opposed to trying to cover it up.  Acknowledging your mistake frees you up to change course without making excuses.  I for one have a lot more respect for someone who says, "Hey, I screwed up.  We're going to fix it and try something else" than for someone who stubbornly sticks to a course of action simply because to deviate would mean admitting they were wrong.

Just a few fundamental truths.  I'm sure there are many more.  Does anyone else have one to add?

Wednesday, October 2, 2013


Why do we procrastinate?  Everybody does it.  There is not a single person who has not, at one time or another, put off doing something that needed to be done.  It isn't a problem for most of us.  So we occasionally procrastinate.  We eventually get around to getting things done; that's what matters, right?

Then there are those of us for whom procrastination is the norm.  We do pretty much everything at the last minute.  Bills don't get paid until the day they are due, maybe even the day after.  We never start on projects until the deadline is looming before us.  (We actually prefer when deadlines are flexible or when extensions are freely granted).  We are the people who crowd the malls on Christmas Eve, sifting through whatever remains on the shelves, desperate to find gifts for everyone left on our list.  We never RSVP when invited to parties.  The "Snooze" buttons on our alarm clocks are worn from overuse; we get out of bed only when remaining there longer will make us late to work.

The vast majority of chronic procrastinators do not see it as a problem.  Many of them will tell you that, far from being a hinderance, procrastination in fact enhances their performance.  They will say that the presence of a looming deadline motivates them; they work better under pressure.  A sense of urgency spurs them to action.  It helps them focus.  It energizes them. 

They will tell you these things because they believe them; they are convinced that they work better when they procrastinate.  Unfortunately, the evidence does not support this.  Research on procrastination consistently shows that procrastinators tend to produce work of inferior quality to that of non-procrastinators. 

Think about it.  It's easy to make mistakes when you're in a hurry.  When something is done at the last possible moment, there isn't enough time to edit the finished product before turning it in.  Stepping away from something and coming back a day or two later often reveals mistakes that were previously overlooked.  Having someone else look over your work can sometimes yield suggestions for improvement.  People cut corners when their in a hurry.  An unforseen obstacle can derail the whole project if there is no time to identify and implement a solution.

It is not difficult to find suggestions for how to stop procrastinating.  Entire books have been written on the subject.  I see a sort of irony in this: a true procrastinator is not likely to buy a book about how to stop procrastinating.  If he did, he would probably put off reading it until he eventually misplaces it or somehow forgets that it exists.  As I said before, people who habitually procrastinate rarely see it as a problem.  It is most likely other people in a procrastinator's life who find his procrastination problematic.  And how do you convince someone to change something he doesn't have a problem with?  It can be done, but it's difficult.

There has to be motivation to change.  People don't think about changing a behavior until the behavior starts to cause problems.  When the consequences of a behavior begin to outweigh its perceived benefits then there is motivation.  Until that time...well, we can just put it off, right?   

Wednesday, September 25, 2013

Self anchoring

I wrote a few months ago about what it means to be selfish.  I shared my belief that we are all a little selfish because we naturally view things from our own perspectives; adopting the perspectives of others requires conscious and intentional effort.  It turns out that there is a name for this pehnomenon: it's called self anchoring.  Self anchoring refers to using your own beliefs and personal characteristics as a reference point for determining how other people think and feel.  When we try to estimate what another person thinks or feels about a given issue we begin by deciding if his or her point of view is similar to or different from our own.  If we have some sort of connection with the person we tend to assume that his or her beliefs are similar to ours. 

Everyone uses self anchoring to some degree.  In our efforts to understand others we start with what we know - ourselves.  We determine how others see the world by using ourselves as a starting point and making incremental adjustments. 

The problem is that we tend to underestimate the degree to which others' perspectives differ from our own.  Thus, we often make the mistake of assuming that people who are "like us" hold the same opinions, beliefs, feelings, and values that we do.  In other words, most of us are not very good at putting ourselves in someone else's shoes; we also tend to be clueless as to how bad we really are.

Unfortunately, the more power a person has the more likely he is to use self anchoring when making decision that affect a large group of people.  Thus you see heads of corporations, organizations, and other large entities enacting policies they claim are good for their members or employees but that actually create hardship for the rank and file.  "If they really want to make our lives easier why don't they ask us what we need?" we complain.  (And indeed, this would seem to make more sense).  The truth is this: they don't ask because they think they already know. 

I see examples of self anchoring on a much smaller scale, with my patients.  Sometimes patients assume that because we have a connection I share their beliefs and opinions.  I have, on many occasions, had to listen to impassioned political rants endorsing views that differ significantly from my own.  These rants are usually followed by an implied invitation for me to validate what has just been said.  It is probably easy for patients to assume I share their beliefs because I so often validate the thoughts and feelings they express, even if I later propose alternative ways of seeing things.  They expect me to affirm and validate because that's what I usually do. 

I believe the best way to avoid making inaccurate assumptions is to try to avoid making assumptions at all, whenever possible.  In reality, there is only one way to know what another person thinks or feels: ask him. 

Wednesday, September 18, 2013

Identity and attachment

Watching, listening to, or reading the news is often depressing.  Still, I want to have some idea of what's going on in the world so I try to keep abreast of current events.  This past week there has been a lot of talk about the flooding in Colorado.  Initially the rain was a welcome relief after a long drought.  But the rain kept coming...and coming and coming.  Several people have been killed and others are unaccounted for.  Thousands of people have been forced to evacuate their homes. 

I was listening to coverage of the flood on NPR the other day.  A correspondent interviewed a woman in her early 20s who'd sought refuge at one of the evacuation shelters.  The woman had fled her home with her mother and their two cats.  She described trudging through waist-high water, cat claws digging into her shoulder, trying not to be swept away by the current.  She concluded the interview thus: "They're saying we can't go back to our houses for two, maybe three months...or if the dam breaks, maybe never.  I'm just glad we're alive and safe."

Whenever I hear stories like this I try to imagine what it would be like to lose everything you own.  How would I feel if faced with such an obstacle?  I'd probably be numb from shock at first.  And then I think I'd feel...completely lost.  If I had to start over with nothing where would I even begin?

My logical side reminds me that possessions - a house and what's in it - are just thingsThings do not make life meaningful.  Things can be replaced.  In fact, there are people who willingly give up their possessions to live a life of contemplation or devotion.  There are people who never stay in one place for long and who carry everything they own in a backpack or duffel bag.  So why is it that I cannot imagine my life without things

I know the answer almost as soon as I ask the question: attachment.  I am attached to the things I've worked hard to afford.  In my mind, these things have become part of who I am.  I think of these things as part of a life I have built for myself: a part of my life and so a part of my self

I am not a Buddhist but I agree with a lot of what the Buddha taught, especially about suffering.  The Buddha spoke of four noble truths.  Among those truths is this: attachment causes suffering.  Everything changes.  Nothing is permanent.  When we become attached to something - or someone - we cling to it; we want it to stay exactly as it is.  This is, of course, impossible because everything changes; nothing is permanent.  And so, when whatever we cling to changes, we suffer.  Sometimes we cling tighter.  Sometimes we cling instead to the memory of what was, of what we had, of what we lost.  We tell ourselves it shouldn't be this way.  And we suffer.

These are things I know but have forgotten.  Going forward, I will try to remember to accept what is without clinging to it.   

Wednesday, September 11, 2013


I used to think of myself as ambitious.  After graduating high school I hit the ground running.  I had goals I wanted to achieve and I immediately set about working towards them.  My ambition was a source of pride, both for me and for my family.  My sisters and I were encouraged to aim high.  Ambition was a value in my family and it was one I readily embraced.

So I worked hard and achieved my goals.  I earned my master's degree in five years and became licensed as an independent practitioner of clinical social work two years later.  I bought a house and settled into a job I enjoyed.  I got married at 28 and was ready to enjoy a comfortable life with my husband.  I was content.

And so I've continued to enjoy the life I've made for myself.  I am actively pursuing two goals (in partnership with my husband): selling our house and buying a bigger one and having a baby within the next one to two years.  Perhaps these aren't as lofty as the goals I once had but I'm okay with that.

I am, for the most part, satisfied with my life.  Unfortunately, my husband is not.  He is firmly convinced that we need to make more money if we're going to live comfortably.  He devotes a significant amount of his free time to buying things, fixing them up, and selling them for a profit.  He has also taught himself photography and occasionally takes jobs photographing weddings, family portraits, private events, etc.

I don't have a problem with my husband's extracurricular endeavors and I only interfere when I notice that we're running out of room to store his current projects.  My husband believes, however, that I should devote as much time as he does to earning extra money.

This has brought me to the following realization: I am not as ambitious as I once beleived.  I have no desire to spend my free time trying to earn extra income.  I enjoy having time to relax, to wake up on the weekends and have no obligations.  To me, the luxury of not having to work all the time is one of the hallmarks of a comfortable life (and I'm living it already)!

As it turns out, ambition is not one of those things that tends to decrease over time.  In their 2012 article, Judge and Kammeyer-Mueller explain that ambition is a trait that remains stable throughout life; it does not disappear once a person has acheived a certain level of success.  From this I conclude the following: if I am not ambitious now then I probably never was. 

Judge and Kammeyer-Mueller define ambition as striving for "worldly success," things like status, rank, and material wealth.  Ambition is not, they are careful to stress, concerned with less tnagible achievements like wellbeing, sense of purpose, or happiness. 

So now I must admit to myself that I am not, nor have I ever been, particularly ambitious.  I strove for a certain level of attainment - a college degree, a career in mental health, a comfortable home, a sufficient income - and I achieved it.  I've never wanted to be "rich" (whatever that means these days).  Yes, I enjoy having a certain level of comfort but I don't need a bunch of expensive toys to be happy. 

Lately this has been a point of contention between my husband and I. In fact, we discussed it again last night.  "You have absolutely NO ambition!" he exclaimed in frustration.  And I guess he's probably right.     

Thursday, September 5, 2013

A distracted society

I went to a concert with a friend last week.  We could see the stage from where we were standing but from our distance the performers all looked about six inches tall.  Fortunately, there were two large video screens positioned above us on either side; we looked at these when we wanted to see close-ups.  Periodically, the screen also showed shots of the audience.  At one point, the screen showed a sea full of people with their smart phones held up to capture the moment on video.  My friend turned to me and laughed.  "All those people taking videos are actually missing the show," she said.  "I know," I replied, laughing.  "That's our entire society these days.  Nobody lives in the moment anymore."  We turned back to watch the performance.

In that brief exchange, my friend and I captured a profound truth about our world today: people are distracted.  I realize I'm not the first to make this observation but my experience at the concert really drove it home.  We - I guess I mean we as a society -- are missing out on life!  Sometimes we even miss out on life in order to share with other people what we're doing at the moment - to text a friend, to snap a photo, or to record a video to prove we were there.  Unfortunately, this comes at the expense of experiencing the moment, of being in it, of enjoying it for all it's worth.  Maybe that's why so many of us stay constantly on the move - each experience is really only half an experience.  Nothing we do leaves us feeling fulfilled.  Being half present means we have to do twice as much to get the same amount of enjoyment.

I'm not against the advancement of technology, not by any means.  I am grateful for the virtually immediate access to knowledge and information that technology makes possible.  I value how easy it is to stay in touch with the people I love.  I enjoy taking advantage of the ease with which I can identify and connect with other people all over the world who share my interests.  I even appreciate having instant access to mindless entertainment.  We are all fortunate to live in an age where these things are possible.

Technology should enhance our lives, not distract us from them.  It's not possible to have a conversation with the person next to you while simultaneously playing on your phone -- you can't fully engage.  I've seen people doing things on their phone while they're supposed to be listening to their children read.  People have been hit by cars because they're looking at their phones or Ipads instead of at their surroundings.  I've even seen children ask to play on their tablets instead of playing with other children sitting right next to them.

I really hope we start paying more attention... 

Wednesday, August 28, 2013

Does it take two for positive change in a relationship? Can one person do it alone?

From time to time I've had individual patients come to me requesting marriage counseling.  "Where's your spouse?" I ask them.  The reply: "He/she refuses to come."  My response has always been to explain that marriage counseling requires the participation of both partners; you simply cannot do marriage counseling alone.  But is this really true?

Change on the part of one person can certainly alter the dynamics of a relationship.  A dynamic is by definition an interactive system or process.  Change in one part of a system therefore changes the dynamics of that system.  An inter-action requires at least two individuals, each responding to the other.  Person A says or does something; person B says or does something in response.  Person A responds to what person B has just said or done; person B then responds to person A, and so on and so forth until the interaction is over.  Because humans are creatures of habit, two people in a relationship begin to develop "typical" ways of interacting with one another over time.  These sytles of interaction become increasingly automatic and are repeated across a variety of situations; they solidify into identifiable patterns.  If these patterns facilitate effective communication and serve to enhance the relationship the relationship will most likely thrive.  Sometimes the patterns of interaction between two people are dysfunctional: they interfere with effective communication and perpetuate conflict.  If the couple does not learn to interact in healthier ways their relationship becomes toxic and will probably not last. 

One person can disrupt unhealthy patterns of interaction in a relationship; it takes two to tango, so to speak.  To do this, one person in the relationship must choose to alter his or her reaction to the other person's behavior.  It only takes one person, for example, to walk away instead of engaging in conflict.  One person can choose to stop making demands of the other and learn to accept that their partner is not going to comply, give in, or otherwise do what they're being asked (or told) to do.  One person can decide not to become defensive when their partner makes a negative comment.  One partner can stop bringing up a topic that leads to arguments. 

There are a lot of things one person can do, particularly if the goal is to reduce overt conflict and/or confrontation.  And sometimes change in one partner can lead to change in the other.  The key word is sometimes

On the other hand, one person cannot "fix" a broken relationship.  One person cannot coerce another to acitvely participate in a relationship.  One person cannot force another to care about his or her wants and needs.  One person cannot convince another person to share his or her desires. 

If a person wants help in reducing conflict in his or her marriage then there are things I can do to help.  It is important, however, for the person to understand that this might mean accepting the behavior of his or her partner, even if the behavior in question is not really acceptable (e.g., cheating).   

Wednesday, August 21, 2013

Can a therapist with problems still be a good therapist?

I sometimes wonder why, in my personal life, I am not more competent interpersonally than I am.  In fact, for someone who spends a significant amount of time helping people learn to interact with one another I often find my own lack of skill in such matters embarassing.  I wonder if it is possible to be a good psychotherapist when I sometimes struggle with issues similar to those facing my patients.  Can I really help people learn to overcome problems I myself have not successfully mastered?  Can I teach others to do things I myself am not able to do?  And if not, does that mean I am not a good psychotherapist?  Am I doing my patients a disservice?  Do my personal limitations prevent me from providing adequate care?

Then again, I know I am not the only psychotherapist facing this problem.  I thinks about other therapists I know, colleagues both former and current.  Many of them have struggled in their personal lives.  Ironically, one of the best marriage therapists I've ever encountered has been married and divorced at least twice.  And yet, I refer my patients to him again and again, confidently touting his skill and expertise.  When I talk to patients who have seen him with their spouse for ocunseling, they always give positive feedback about the experience.  As good as he is at marriage therapy, however, he is apparently not that good at marriage. 

If a skilled marriage therapist can be terrible at marriage, it stands to reason that a competent psychotherapist can have unresolved personal problems.

Of course I decided to do some research.  In doing so, I stumbled upon an article written by an historic icon in the field of psychotherapy, Carl Rogers.  There was something in particular he said in the article that brought me peace of mind.  In the article, he proposes a theory in which he identifies the conditions necessarry for positive therapeutic change to occur.  One of six identified conditions is that the therapist be "a congruent, genuine, integrated person" within the context of his relationship with the patient.  He goes on to say that it is neither necessarry nor possible for the therapist to be "a paragon who exhibits this degree of integration, of wholeness, in every aspect of his life.  It is sufficient that he is accurately himself in this hour of this relationship..."

What a relief.  I don't have to have it all together all the time to be a good therapist.  I just need to bring my healthiest self each time I interact with a patient.

Wednesday, August 14, 2013


I realized quite some time ago that I don't handle stress very well.  This may seem strange coming from a psychotherapist.  Isn't a significant part of my job to teach people how to deal with stress?  Yes and no.

Learning to cope with stress effectively is certainly a goal for a lot of my patients.  But I think this means different things for different people.  For many people, effective coping involves limiting the amount of stress they expose themselves to (at least to whatever degree possible).  For example, if I am in the middle of a major life transition it is probably not a good time for me to take on a new project (unless I have to).

Here's another example.  Let's say I am someone who likes my home to be clean and tidy at all times.  Now suppose my spouse invites a large group of extended family members to spend the week with us.  Knowing this in advance, I might spend extra time cleaning up before they arrive and then give myself permission not to worry about trying to keep things tidy until after my guests leave.  (Because I can either spend my week trying to clean up after everyone and make myself miserable or I can spend quality time with people I love and enjoy myself). 

So because I know I have a low tolerance for stress I do my best to limit the amount of stress in my life at any given time.  Historically, this has been a pretty effective strategy.  Recently, however, there have been problems.  This is due, in part, to the fact that my husband believes I should be able to handle more stress than I do.  In making his case, he tells a story about how he used to worry about everything.  One day, he realized how miserable this made him.  He decided he no longer wanted to be miserable.  From that day forward, he resolved to stop letting things bother him.  He has been happy ever since.  The end.

It's a great story.  He makes a good point: excessive worrying does tend to make people miserable.  I know this.  And honestly, over the years I have learned to let a lot of things go.  What I think my husband fails to understand is that his experience of stress and my experience of stress are fundamentally different.  By nature, my husband is not easily exciteable.  His disposition is cheerful by default.  He likes to have fun and makes doing fun things a top priority.  When forced to choose between fulfilling some obligation (which can of course always be put off until later) and doing something fun, nine times out of ten he will choose to do something fun.

I, on the other hand, have apparently always been discontent.  My parents tell me I suffered from severe colic as an infant.  As a result, I cried a lot and was frequently inconsolable.  I can remember worrying about all sorts of random things as early as age four.  By the age of five, I had developed so many compulsive behaviors that my kindergarten teacher called my parents to express concern.  After a visit to a psychologist I was diagnosed with Obsessive Compulsive Disorder.  At the age of five.

So in my view, the cards were stacked against me from the start.  I have been dealing with anxiety for literally my entire life.  To me, the fact that I've been able to find peace in my life is remarkable.  And yet I do have peace.  Not all the time.  But I do have it, and I am grateful. 

On the other hand, maybe it would be good to push myself harder.  My husband says I need to spend more time outside of my comfort zone.  I'll admit that I've been a little resistant to this.  My comfort zone is where I have peace.  What if I stray too far and am unable to find my way back?  What if I upset the delicate balance I have worked so hard to achieve?

Then again, I believe we should never stop growing as individuals.  I have grown a lot over the years but that does not mean I am finished.  Who knows what I am missing out on while I stay here in my comfort zone? 

Wednesday, August 7, 2013


I think most of us are selfish, at least to a certain degree.  It's quite natural when you think about it.  We see things from our own perspectives and are influenced by our own thoughts and emotions.  This happens automatically, without effort.  We exist within our own bodies from the moment we are born.  And yet, no matter how much time we spend with ourselves there are always things we don't understand.  Why do I get upset over some particular thing?  Why do I have certain fears?  Why don't I have as much energy as other people?  Why do I worry so much?  Why can't I focus?  Why am I good at one thing but not at another? For every person, there is a part of himself that remains a bit of a mystery.

As difficult as it is to know ourselves, it is even more difficult to understand others.  In order to try to see things from someone else's perspective, we must first set aside our natural inclination to see things from our own perspective.  We must then imagine how that person sees the world.  This is easier to do in situations that are similar to those we've experienced ourselves; we can recall how we thought and felt.  Still, this strategy rests on the assumption that the person we are trying to understand reacts to the situation in question with the same thoughts and feelings we ourselves had.  This may or may not be the case.

It seems to me that the natural inclination is to see things from our own perspectives and to act accordingly; we are thus all inclined to be a bit selfish.  Empathizing with others requires intention and effort.  When we are under a lot of stress or when we are tired, sick, hungry, or distressed, we may lack the energy or the presence of mind to empathize with others.  These are the times when we are most likely to behave selfishly, often without even realizing it.

I've been thinking about this because someone recently accused me of being selfish.  My first reaction was to become defensive; I felt I was being judged, and unfairly at that.  It bothered me though.  I'm not selfish, am I?  I care about other people.  I constantly think about the people I love.  I call them.  I spend time with them.  I tell them I love them.

What does it mean to be selfish anyway?  Almost certainly it means different things to different people.  As I said before, I think everyone is a little bit selfish and I don't necessarally think it's a bad thing.  There are times when we need to put ourselves first.

Still, I've been thinking...Maybe I put myself first too often.  It is something to consider...     

Wednesday, July 31, 2013


The meaning of dissociation is found in the word itself: dis-association.  Dissociation occurs when a person’s mind dis-associates with his or her body.  This is not the technical definition of the term, but it’s where I start when I explain it to patients.  (The Diagnostic and Statistical Manual of Mental Disorders defines dissociation thus: A disruption in the usually integrated function of consciousness, memory, identity, or perception of the environment).  When a person dissociates, his body stays in one place while his mind sort of goes somewhere else. 
Dissociation is not necessarily pathological.  In fact, everyone dissociates.  Have you ever driven an oft-travelled route - perhaps heading to work or driving home – and arrived at your destination to find that you have no recollection of the actual journey (perhaps because you were daydreaming or otherwise absorbed in your thoughts)?  That’s dissociation.  Another example of dissociation is the experience of “flow:” we become totally absorbed in some task or activity such that we are completely unaware of our surroundings, to include the passage of time.  When we look at the clock, we are surprised to find that several hours have passed in what seemed like only minutes. 
So in certain forms, dissociation is a normal and quite common experience.  In extreme forms, however, dissociation can become disruptive and therefore problematic.  Probably the most severe manifestation of dissociation is in Dissociative Identity Disorder.  (Some of you might know it as Multiple Personality Disorder).  The identity or self of any given person is made up of various parts or components.  For example, there is a part of me who is compassionate and benevolent and another part of me who is petty and vindictive.  There is a part of me who is responsible and a part of me that is reckless.  I will think, feel, and even behave differently depending on which part of my “self” is activated at any given time.  Even though my identity consists of many different parts I am still only one person.  There is an overall cohesiveness among the different parts of myself.  There is some sort of “observing ego” that stands back from it all, that intimately knows each individual “part” of my identity, and that holds all the pieces together.  A person with Dissociative Identity Disorder (DID) does not have this “observing ego.”  The various parts of a person with DID are completely separate and unaware of one another.  They do not share memories and they do not share information.  One part has no awareness of what another part does, even though they all reside in the same physical body. 
Fortunately, Dissociative Identity Order is extremely rare.  In fact, there has historically been quite a bit of debate about whether it exists at all.  I have only ever worked with one person who was diagnosed with DID and I suspect the diagnosis was incorrect.
I have, however, worked with many patients who struggle with other forms of dissociation.  I’ve had several patients who recalled experiences in which they were outside of their bodies, seeing themselves but having no control over what they were doing.  One person saw herself go into a store, buy a bottle of pills, and take the entire bottle.  She said she was screaming at herself to stop but was powerless to prevent her own suicide attempt. Another person was involved in a serious industrial accident.  He described being outside of his body, watching himself curl up on the ground and scream with pain.  He told himself to get up but to no avail. 
Other patients have no recollection of what happened during dissociative episodes.  They simply report “losing time.”  One woman regained awareness to find herself in an unfamiliar city with no idea how she’d gotten there.  She’d somehow driven 75 miles without meaning to.  Another patient became anxious while driving and decided to pull off the road to calm himself down.  He remembers looking at the clock as he pulled off.  The next thing he remembers is looking at the clock again and seeing that over an hour has passed.  He has no idea what he did during that hour.
Dissociation fascinates me.  How can someone’s mind wander away from his body?  I imagine it is a scary thing to know that your body has been doing things without your knowledge (or consent).  I’ll talk about what causes dissociation and how to treat it in future posts.

Wednesday, July 24, 2013


I have narcolepsy.  It's not something I talk about a lot, especially not online.  Because I don't talk much about it, it seems like the people closest to me don't really consider how it affects me.  For example, my husband frequently becomes frustrated when I say I'm too tired to do something.  Take a recent Saturday for example.  At 7:00 AM, my stepdaughter and I met my sister, parents, and some extended family for a two mile charity walk.  Afterwards, my husband, stepdaugther, and I went to the beach and took the jet ski out.  The following morning my family met up at 9 AM for a Father's Day breakfast.  We all went to church afterwards.  As church let out, my sister mentioned that she and her husband were taking my nieces to the water park.  She invited us to meet them there.  My husband and stepdaughter went but I just couldn't do it.  I went home and napped for two hours.  When I got up, I finished doing laundry and went to the grocery store.  Later in the week, my husband commented on how active my sister is.  He said he wished I could be that way instead of only doing "one activity per weekend."  A couple of weeks later he told my stepdaughter that I'm boring because I never want to do anything.  He didn't understand when I told him his comment hurt my feelings.  "You don't like to do anything," he said, as if stating a fact.

It bothers me.  It's not that I don't want to do things.  It's just that I know myself.  I have a good idea of what would've happened if, for example, I had forced myself to go to the water park that day.  I would have been extremely irritable (because I was tired) and unpleasant to be around.  I probably would have wanted to go home well before everyone else was ready.  I would not have had the energy to do laundry and go to the grocery store when we got home, even though these things had to be done and no one else was going to do them.  And I would have been exhausted at work the following day and struggled to stay awake.  It's possible I might have fallen asleep at some inopportune moment, such as when driving to work on in the middle of a session with a patient.

I have no idea if everyone with narcolepsy has the same struggles.  I don't know anyone else with narcolepsy so I have no one to compare myself to.  (Incidentally, I have had two patients with narcolepsy over the years but I didn't think it was particularly appropriate to discuss my experiences with them).  I can't say whether or not my experiences are "normal" or "typical."  I do the best I can and I try not to dwell on my limitations.  Dealing with it is frustrating but I am grateful that things aren't worse - I know they could be.  I wonder, though, if there isn't some way to help the people closest to me understand without making it seem like I'm throwing myself a pity party. 

Tuesday, July 16, 2013

What makes a relationship last?

My husband and I have been married three years in November.  I wish I could say that I’ve learned a lot about what it takes to make a marriage work during the past three years.  I suppose I could say it, but it wouldn’t be entirely true and I’m not a huge fan of lying.  It’s not that I haven’t learned anything in the past three years.  It’s just that I haven’t been able to successfully apply the knowledge I’ve gained in any meaningful way. 
Here’s what I do know: Marriage is hard!  I realize this isn’t very insightful.  While I am usually a fairly introspective person, I find it very difficult to reflect on and understand my thoughts, feelings, motivations, and behaviors as they apply to my relationship with my husband.  And if it’s hard for me to make sense of myself, I often find it impossible to understand my husband. 
All this makes me wonder, what does it take for a marriage to work anyway?  So of course, I decided to do some research.  I discovered that there has been a lot of research done on this topic.  This research has led to the development of many different theories about what makes a successful marriage.  While each study generated a different list of variables associated with marital success, there were some common themes. 
*Communication: I wasn’t surprised to find good communication repeatedly identified as a factor associated with successful marriages.  Healthy communication allows a couple to understand one another; this enables partners to validate and empathize with each other.  Good communication facilitates allows day to day activities to run smoothly.  (Frequent miscommunication creates unnecessary crises.  For example, miscommunication about where to be and what time to be there can lead to confusion and disappointment.  Important tasks go uncompleted.  Problems arise.  Plans have to be changed, sometimes drastically.  More time is spent trying to fix problems caused by miscommunication, leaving less time for enjoyable activities that would strengthen the relationship).  Good communication also promotes successful conflict resolution.  It prevents disagreements from inevitably turning into arguments.
*Conflict management/resolution: This one didn’t surprise me either.  Couples who can resolve conflict have less conflict.  Successful conflict resolution prevents the same problems from arising again and again.  The ability to compromise leads to the development of solutions that leave both partners feeling loved and respected.  Time isn’t wasted arguing over who is right or who is to blame.  Both partners understand that if one person wins, the other one loses.  If one person loses, the whole relationship loses.  Thus, blaming always has a negative impact on the relationship.    
*Trust: I’ve always heard that you can’t have a relationship without trust – at least not a good one.  The presence or absence of trust impacts the level of security a person experiences in a relationship.  Security – a sense of safety – is one of the most fundamental of human needs.  An individual’s basic needs must be met before higher-level development can occur.  Thus, an absence of trust prevents a relationship from growing.  Distance emerges between two partners.  The relationship becomes dominated by feelings of doubt, fear, and hurt. 
There is a final factor that I believe deserves at least an honorable mention: commitment.  Commitment is the belief – held by both partners – that a relationship is permanent.  Commitment also describes a set of behaviors devoted to maintaining a relationship, even (and especially) when things are not going well.  When people are committed to a marriage, they are willing to do whatever it takes, again and again, to make the relationship work.  If one strategy does not work, they try something else.  Commitment is also characterized by the willingness of both partners to make personal sacrifices for the good of the relationship.

Sunday, July 7, 2013


To me there's always seemed to be a bit of irony inherent to the experience of loneliness.  One the one hand, loneliness is inextricably linked to the connections an individual has to other people.  People feel lonely when they spend too much time by themselves and not enough time with others.  On the other hand, there is a component of loneliness that seems to have no relationship at all to being alone versus being with other people.  Thus, a person can spend significant amounts of time by himself and not feel the slightest bit lonely.  A person can also be in a room overflowing with people and yet feel utterly and completely alone.  And so I've come to realize that loneliness is a phenomenon more complex than at first it seems.

Loneliness is a virtually universal experience; almost everyone experiences it at least once in a lifetime.  Almost all of us have an idea of what it means to be lonely, even if we can't exactly put it into words.  If I say to someone, "I feel lonely," he understands what I mean; I don't have to explain it.  Perhaps this is why the scientific community has only recently begun to develop a clear definition of loneliness.  For practical purposes, there is no need for a concrete definition of loneliness.  But in order to study a given phenomenon we must be clear about exactly what it is we are studying.  And so the need to define loneliness grew out of an increasing interest among social scientists in better understanding the phenomenon and its effects.

So what exactly is loneliness?  Researchers have identified three characteristics:

1. Loneliness stems from deficiencies in social relationships.

2. Loneliness is a subjective experience.  (In other words, what causes one person to feel lonely does not necessarily cause someone else to feel lonely).

3. Loneliness is both unpleasant and distressing for the person experiencing it.
'(Perlman & Peplau)

Because loneliness is a subjective problem, there are many different ways to go about trying to resolve it.  A person might simply lack good social skills and so find it difficult to make friends.  Others might fear intimacy or have "trust issues."  In such cases, loneliness is really a secondary problem that will most likely resolve itself once the primary concerns are addressed.

When's the last time you can remember feeling lonely?  What caused it?  Were you able to overcome it?  If so, how?

Sunday, June 30, 2013

More common human desires

One desire that seems to be common to almost everyone is the desire to be "normal."  I cannot tell you the relief many patients express  when I tell them their symptoms have a name and that other people share their experience.  Maybe this can be attributed to not wanting to feel alone.  People are comforted to hear that what they are feeling is "normal."  This is why support groups are often helpful.  Connecting with other people who have been through what you've been through or who have thoughts and feelings similar to your own creates a unique bond.  This is related to our need to be understood.  After all, who can understand you better than someone who has had a similar experience or whose suffering in some way mirrors your own?  When we connect with a group of people who have been through similar hardships we experience a sense of belonging. 

Another common need among people is the need for validation.  To validate another person is simply to say, "It is okay to feel what you feel.  It is okay to do what you're doing.  It is okay to be the way you are."  Validation both normalizes and communicates understanding.  It can also serve to remove shame.  People sometimes become convinced that they should not feel how they feel or that there is something wrong with the way they are.  This creates feelings of shame and guilt.  To hear from another person that the way you feel is okay or that there is nothing wrong with the way you are can provide an enormous sense of relief.  In some ways it gives a person permission to experience their feelings freely.

I am frequently struck by how many things seem to be common to all of us.  It reminds me again and again that no matter our differences, most of us want the same things.

Sunday, June 23, 2013

Things people want

As a psychotherapist, I have the unique privilege of witnessing all sorts of human behavior.  While every person is different and no single approach works for everyone I don't necessarally reinvent the wheel every time I encounter a new patient.  One of the reasons therapists tend to become better with experience is because when they meet a new patient they can eventually say to themselves, "I've had a patient with this type of problem before.  I remember what worked (and what didn't work) for him.  Maybe I'll try a similar strategy with this patient."  The longer you've been practicing the more likely you are to have seen even relatively rare variations of a given problem before.  (An unintended side effect: A lot of things seem "normal" to me that would probably seem strange to other people). 

Something else a therapist learns with experience is that even people who are completely different from one another posess common needs and desires.  For example, I've never met anyone, either personally or professionally, who did not have the desire to be understood.  This is something that probably evolved in concert with our capacity for speech and language.  On the most basic level, we want others to comprehend the meaning of what we communicate verbally.  After all, what good is the ability to speak if no one  understands what you're saying?  The significance of human language lies in its utility as a tool for creating common meaning among two or more distinct entities. 

We desire basic comprehension and yet this is not enough,.  We want others to understand us on a deeper level; we want them to really get what we're saying.  One of the most fundamental communication skills is something called reflection.  Reflection involves listening to another person and repeating his message back to him, either exactly as you heard it or in paraphrase or summary.  It sounds simple but it's more difficult than you might think.  So many of us have a habit of hearing a person's words without really listening to what they are saying.  I'll give you an example of a couple I once saw for marriage counseling.  I asked the wife to use an "I statement" to express her feelings to her husband.  The husband was asked to listen and repeat what he heard his wife say.  She started: "I feel frustrated and disappointed when you promise to do something and then do not do it."  Then it was his turn.  "I heard, "nag nag nag nag nag,'" he said.  My jaw dropped in surprise.  The wife started crying.

In sum, there is something profoundly affirming about being understood by another person.  Perhaps it helps us to feel less alone.

I'll share more observations about things people want later...

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