Charming Quote

 

Charm is the quality in others that makes us more satisfied with ourselves.
  – Henri-Frédéric Amiel

Moral Fiber

     Amy, seventy, divorced for thirty-five years, single,  was hurt by her forty-year old son, Jeff.  Jeff casually mentioned his upcoming vacation with his father, Evan, Amy’s ex-husband. Jeff knew after years of growing up with divorced parents that when he spent time with his dad, his mother was in agony. At the same time, Jeff loves his dad, and loves to take vacations with him. Jeff was in a bind. He had to tell his mother he was going away, but he knew that she would have strong negative feelings when she found out. Jeff handled this dilemma by telling Amy as he was walking out the door,  after a nice dinner at Amy’s house. Tearfully, Amy says “how could I have raised a kid like that? How come he could not just tell me during dinner? That kid has no moral fiber. He is a chicken shit.”

     Giving people bad news, especially people one cares about, is challenging. I say to Amy “but if  he told you during dinner, he might have been concerned that it would spoil the evening.” “Yes,” Amy says angrily, ” but he spoiled the evening by telling me as he was leaving.” Amy needs to accept that Jeff wants to spend time with Evan. She also needs to appreciate the bind that Jeff is in. Jeff, however, needs to find a way to talk to his mom in a way that is less hurtful. I wonder about Jeff and Amy going to therapy together to work this communication problem out. I do not know that Jeff lacks moral fiber, or if he is exhausted from navigating the sensitivities of his divorced parents. Amy calls him a “chicken shit,” since he did not stick around to see Amy’s reaction. Yet, it is not Jeff’s duty to patch his mom back together after hearing that her son wants to spend time with his dad.

     Some pain lasts a long time. Amy still cares about  Evan, as shown by Amy’s strong reaction to Jeff and Evan vacationing together. Jeff, although forty years old, still suffers from the agony of his parents’ tension. The meaning of this pain runs deep. Amy attacked Jeff in her mind by saying to me that he had no moral fiber. In so doing, Amy made it clear that her relationship with Evan is alive for her. Jeff is caught in the middle of the crossfire. More fiber is needed, but I am not sure if it is moral.

Scanning the Blogosphere: Found a Fan

 

Have a mental health, psychology or psychiatry blogger you miss who’s no longer blogging? Add your favorites below.

http://psychcentral.com/blog/archives/2010/07/14/mental-health-bloggers-we-miss-2010/

ForeverJung at 2:02 pm on July 21st, 2010

I miss Shirah Vollmer’s blog here — though she didn’t stop blogging, she was “asked to leave” psychcentral presumably because she was writing the stuff we all want to hear, but is too “dangerous” for this site.

She’s a fantastic psychiatrist with seering insights into psychotherapy — I continue to read her blog here:

https://shirahvollmermd.wordpress.com/

Ambivalent Relationships-II

    

Marla, https://shirahvollmermd.wordpress.com/2010/07/12/ambivalent-relationships/ called Monte on the anniversary of Monte’s mother passing. “Wait a minute, ” Monte says, “I thought we were ‘broken up’. ” https://shirahvollmermd.wordpress.com/2010/06/18/were-breaking-up/. “I don’t want an ongoing thing,” Marla states emphatically. “An ongoing thing?” Monte repeats. “Then why did you call me?” Monte asks. “Well, I was thinking about you and I thought it might be a hard day for you,” Marla says kindly. “Yes, but your call implies an ‘ongoing thing’. Further, we are colleagues, so we have an ‘ongoing thing’,” Monte responds with overwhelming anger. Marla goes silent. “Besides,” Monte continues, “the nature of our relationship is professional, although it did not start out that way.” Marla continues to be silent.

    The mixed message, the approach/avoidance behavior, that Marla exhibits is painful and understandable. Marla is deeply afraid of Monte’s anger and disappointment. As such, Marla attempts to ward off her vulnerability by saying that she does not want an ‘ongoing thing’. For Marla, this means that she does not want to feel that over and over again she does not give Monte what he needs. At the same time, Marla cares for Monte and she wants to let Monte know  that.

      Marla is a seasoned therapist, and as such, one hopes that she has worked out these ambivalent feelings such that she presents a clear message. The reality however is that for many patients Marla is helpful and clear, but when it comes to Monte, Marla is twisted and unsure of herself. Likewise, Monte is generally even keeled, but when he interacts with Marla, he is irritable and aggressive. As such, the interaction between Monte and Marla is heated with feelings which are unique for both. This uniqueness makes their relationship mutually interesting and scary; hence the ambivalence.

The Developmental Alibi

  “I would share, but I’m not there developmentally”

Loving Your Abuser

     Joshua, sixty-seven,  https://shirahvollmermd.wordpress.com/2010/07/08/the-oncoming-train/, never married, loves his brother Jeremy has been abusive to him his entire life; most recently  Jeremy is trying to steal money from him. Theresa, age fifty-one, never married, says that she feels closest to her mother, even though her mother both verbally and sexually abused her. Anxious attachment is the phrase that comes to mind. The connection creates dependency, yet at the same time, it produces overwhelming anxiety since the criticism from the one who used to be a caretaker persists.  The anxious dependency makes it hard to form other attachments since there is a feeling that other relationships would threaten this abusive relationship. Since the threat of losing this abusive relationship is frightening, even though both Joshua and Theresa are adults,  both Joshua and Theresa cannot form intimate adult relationships.  The tragedy is palpable. The intervention would be painful. Neither Joshua or Theresa are interested in letting go of their abuser. Therein lies the sorrow.

The Secret

   Howard, twenty-nine, morbidly obese, highly paid attorney, married for two years, states that he needs to see me because he  has something to “get off my chest.” Predictably, Howard is having a love affair with a married woman, Jocelyn,  that he met in law school. The secret.   https://shirahvollmermd.wordpress.com/2010/01/23/secret-science/ and https://shirahvollmermd.wordpress.com/2010/01/23/the-secret-garden/. I feel as though Howard is needing to confess his sins. Moreover, Howard is in deep agony wondering whether to leave his wife, Lucy, to break things up with Jocelyn, or to maintain the status quo of the secret. At first, I thought I was the only one who knew about Jocelyn, but in further exploration, Howard has told a number of friends about her. My hypothesis that he needed to share this “secret” was wrong. Howard did not just come to “confess,” he came because he felt like he was at a crossroads in his life. Howard loves Lucy; he also loves Jocelyn. He has enjoyable sexual activity with both. Living with Lucy though can be treacherous. He does not like her family. She isolates a lot, so she does not like to go out with friends. She can be hard to talk to. Jocelyn, however, is gregarious and more “fun,” but he has also never lived with Jocelyn so he does not know what that would be like. Howard’s obesity is not an issue for Howard, for Lucy or for Jocelyn. By Howard’s report both women love him and are sexually aroused by him.

    After months of weekly therapy, discussing Howard’s childhood, his current life situation, his fluctuating mood and anxiety, Howard decides that things as they are work well for now. He thanks me for my help. I am left to wonder. Did I help Howard? What about the morality? My job is to help Howard think and reflect on his life; on his choices. Yet, there is something unsettling by Howard’s decision to keep his dual life going. The deceit feels uncomfortable. I think about the power of the secret on the “privileged” ear.  This is the power to rattle. Howard did just that.

“I Can’t Talk About My Mom”

Zach https://shirahvollmermd.wordpress.com/2010/07/16/the-no-show/ and https://shirahvollmermd.wordpress.com/2010/07/15/i-dont-speak-to-my-mom-what-is-wrong-with-me/,  comes back after missing his last appointment.  He opens the session. “I can’t talk about my mom. I am meeting my aunt in an hour and I have to be in a good mental space. I just can’t talk about her.” “That’s fine,” I replied. “You don’t understand,” he continues, “I will be a mess if I start to think about her.” “I can understand that,” I say. “I am afraid that I will fall  in the sink hole,” Zach says. “That is interesting,” I reply. “It seems like you made your own sink hole after we talked about her the last time, since you burrowed under the ground and you did not come up for a while. I can see why you think about sink holes, since it seems that your coping style is such that internal conflict makes you fall away.” “Just like Alice in Wonderland,” he quickly responds. “Alice fell into a world which did not make sense, and that is exactly your experience when you begin to piece together your childhood memories,” I quickly respond in turn. “No,” Zach says strongly. “I can make sense of my childhood. My mom was a nut job.” “That is a broad stroke,” I say. “The details of the ‘nut job’ is where things get messy. However, I am aware that we are talking about the very thing you said we should not talk about.” “That’s OK,” he says. “I need to talk about it.” “Yes, but what about how you are going to feel when you meet your aunt?” I ask.  “Oh, I will be OK,” he says dismissively.

The approach/avoidance dance was clear and painful. Zach wanted to talk about his mom so that he could metabolize his feelings; so that his feelings would not cause him to fall like Alice in Wonderland. On the other hand, the process of falling was terrifying. Maybe his feelings about his mom should be left unsaid, he thought; at least today when he had to keep himself together so that he could keep up some social graces. We began to talk about his mom; he engaged intensely in the discussion. He was riveted to my commentary. His fear subsided to the point where he was dismissive of my reminder that he cautioned me about talking about this subject at the very beginning of the session. Wrestling with how his mother made him feel as a child, along with how his mother makes him feel now, felt to me  like he came in as a dry plant, but now he was  finally getting a drop of water. His body changed; his attention to my words, conveyed a deep need to hear my point of view of his childhood. It seemed as though he had kept his feelings buried for so long that he was relieved when his childhood impressions came to the light of day. His protestation not to talk about his mother, in retrospect, appeared to be a plea to talk about her. The scales of his approach/avoidance feelings were tipped. Approach we did.

Book Review; Psychoanalysis: The Impossible Profession

    This 1977 book captures the story of Monte and Marla https://shirahvollmermd.wordpress.com/2010/06/18/were-breaking-up/. The interplay between the professional and the personal makes for an “impossible profession”. Aaron Green, the pseudonym for the psychoanalyst, met with Janet Malcolm weekly, as Ms. Malcolm delved into the psychoanalytic world of New York City. Janet Malcolm reminds us that psychoanalysis created a major cultural shift in understanding the human mind; it also became a popular treatment for anxiety in the 1950’s. Yet, for the professional, psychoanalysis became a world of hierarchy, competition, and endless revitalization of  infantile wishes. The psychoanalytic institutes re-created family relationships where there were “favorite” children, and “unloveable” children. Unlike families of origin, the psychoanalyst, since he stays working in the profession, never has the opportunity to “grow up”.

     Dr. Green, like Monte, works as a middle-aged professional, yet when he walks into the psychoanalytic institute, feels like the child at the dinner table whom no one listens to. This asymmetry between Dr. Green’s public persona  and his internal life around his colleagues creates the stage for pulling up the curtain on the profession. It is not that psychoanalysis does not help people who seek relief from their internal demons; rather, it is that the field of  psychoanalysis has trouble helping the provider work through his infantile  fantasies.

      Psychoanalysis established the unconscious as an operative mode in the human psyche. The field also helped many people understand themselves in ways in which they can grow and open up new possibilities for ways to exist in their worlds. Mental health providers hit up against one limitation; it is hard to heal a wound, if the family never lets you leave the dinner table. A developmental principle is echoed; separation is the key to growth and psychological autonomy. Alas, the field of psychoanalysis needs to put into operation that principle. Hopefully, a new model of psychoanalytic training awaits; a model in which psychoanalysts do not associate professionally with their colleagues whom they have sought mental health treatment in the past. The field needs to grow up and go off to college; the providers need to find new colleagues when their training is done. Senior members, although it is hard for them to let go, must encourage this transition. The profession needs to become possible.

Listening

Marla could not listen to Monte’s disappointment with her, https://shirahvollmermd.wordpress.com/2010/06/18/were-breaking-up/ such that Marla had to take the drastic measure of  “breaking-up.” Similarly, Leslie, a thirty-five year old single, heterosexual, never married woman, was invited on a three-day  sailing trip with her lesbian friends, Roni and Susan. Roni wanted the three of them to have some fun together. Two weeks before they were about to leave, the three of them saw their mutual friend, Madeline. Roni told Madeline about the sailing trip, thinking aloud that the four of them might have fun as well, but she did not think that Madeline would be interested. After this, Leslie pursued Madeline with the hopes that she could join them. Madeline agreed to come, telling Roni that she was coming. The logistics were not clear. Roni thought that a lot of issues still had to be ironed out, but she also understood that Leslie might feel like a third wheel, and Madeline coming might help. On the other hand, Roni wanted time to think about this change of plans. Roni talked to Leslie. Leslie apologized for taking it upon herself to campaign for Madeline to come. . Roni was still uneasy. Roni wanted to talk to Leslie about her concerns. Leslie reluctantly listened. A few hours later, Roni realized that there were more things that were unsettling her about this upcoming trip. She called Leslie again. At this point, Leslie said “I can’t talk about this any more. I am not going.” Roni then called Madeline and told her that Leslie is not going, so Madeline also decided not to go.

Roni needed Leslie to listen. Leslie did listen, but she grew tired. In the end, everyone’s feelings were hurt. Leslie felt rejected. Roni felt pushed away. Madeline and Susan were disappointed about how the plans changed. Leslie felt she had apologized so there was nothing else to talk about. Roni appreciated the apology, but Roni wanted to ask  Leslie what she was feeling which made her campaign for Madeline to come. Roni felt there was a misunderstanding between a group trip, where a varied group of people get together, as opposed to an intimate three days with close friends. In an intimate trip, each person shapes the experience. In a group trip, like an organized tour, the people in the group learn to get along as they go. Managing expectations is the key to enjoying the experience. Roni knew that so she tried to talk to Leslie about Leslie’s thinking. By contrast, Leslie felt that talking about the trip was exhausting. She felt that going sailing should not be such a “big deal”. Leslie was confused about Roni’s persistence. Roni felt that if she did not try to talk about the upcoming trip, then tempers might flare once they set sail  and that would be worse. Leslie and Roni could no longer listen to one another, even though they did initially. The relationship suffered a blow. Roni felt like Monte. She wanted to say “you don’t have to agree with me, but could you please just listen to what I have to say?” Leslie was saturated. No, would be the answer.  Communication broke down. Leslie and Roni are “broken-up”, at least for now. Listening is hard. Not listening is hard too.