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?   

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