Seeing Signs: Is Pessimism So Bad?

Relationships evolve, with foreshadowing in the beginning, honeymoon stage, where upon reflection, we are usually not surprised when a dear friend, a loved one, lets us down. Heather and Claire are new girlfriends. They were off to a club, but Heather forgot to write the address so they never made it to their intended destination. Claire was angry and disappointed with Heather and they had a verbal altercation. Weeks later, Heather has “forgotten” the incident and feels that Claire is a deep and close friend, even though they have known each other for two months. “I think you should be thoughtful about Claire and understand her sensitivities,” I say, trying to help Heather have a clear view of the dynamics of this friendship. “Why are you so pessimistic?” Heather asks me, as if I had said that since Claire was intolerant of your mistake then the relationship is going to have problems. “It is interesting that you call me pessimistic, since I was not thinking in those terms, but I do think that seeing a sign that says ‘potholes ahead’ does not make one pessimistic.” Heather understood that, but she also expressed how much she wants to be close friends with Claire. “Wanting a friendship is not the same thing as having a friendship, so you will see how things deepen over time,” I say, trying to help Heather see that relationships are a journey which need to be monitored, but  can’t be controlled.  Heather knows this, but she also is yearning for the security of a loyal relationship. This yearning is both shameful and exciting for her. She is happy to have a new connection, but her neediness makes her feel bad about herself. A part of her wishes she did not need friends, and in this shame, she is hoping she can have a ‘fast friend’ so that her yearning does not scare anyone away. Heather’s  wish and  fear for  connection are fighting internally. Consciousness of this battle will help. Heather, reluctantly, would agree.

Why Would One Size Fit All?

 

http://www.latimes.com/news/opinion/commentary/la-oe-miller-drug-dosages-20130227,0,6503040.story

 

Dr. Miller talks about how, late in the game, dosages for Ambien are being modified for women. This seems so obvious. Anyone around alcohol knows that the average woman tolerates a lot less than the average man, of the same age. No one would go to a store and ask for a “shirt” without specifying the size. The individuality of drug response follows the individuality of our DNA. Personalized medicine is coming. Once we can take a closer look at the genome, then prescribing medication will be more specific, and hence more effective. In today’s world,  prescribing medication is like  shooting in the dark, hoping that for most people we are in the “range,” but we also know that we could be far afield. Like with smart phones, one day, we, physicians will say, can you believe that in the old days, we prescribed without knowing about the patient’s liver metabolism? I look forward to laughing at our current state of psychopharmacology.

Space Sharing: Herd Animals-Confirmed!

So, now we have technology which places an office in a pocket. The calendar, the phone, the email and the fax are all being filtered through a hand-held device. Now, I know I am late in the game, but I am coming to understand portability. I could be anywhere in the world and return phone calls, have a phone session, renew prescriptions and stay in touch with the day to day struggles in my local news. So, I think to myself, this brings a new-found freedom of not being tethered to an office. Duh, my readers are saying. Yes, I am slowly coming to understand that, but at the same time, I also understand that young creative types are searching out work spaces which they can share, and yet work independently. The water cooler returns. How do I understand the need for freedom, while there also seems to be a need to gather and work with the energy of other working folks. As with most things that I right about, this is another push/pull experience. There is both a need to break out of the mold and lie on a beach while getting work done, and at the same time, there seems to be a need to be around others, in order to work in parallel. I attribute the latter to the social nature of the human condition. We are the people we surround ourselves with. We compete, we strive, we grow, based on the bar that our friends set for themselves. We are comparative beings. We measure success against others whom we care about. Positive growth stems from surrounding yourself with others who are striving for what you want for yourself. Intuitively, those seeking out a shared work space know that. They will be more creative if they can find the right energy, the right environment, the right people to work alongside. New technology does not change human nature, although it might change some aspects of the human brain. The part of human nature that needs others for growth and development does not change with the smart phone. We are herd animals, after all.

Entitlement

Meghan, fifty-six, is bitter that she does not have her mother’s life. She is bewildered as to how she did not marry a wealthy man, stay home, raise a family and then enjoy a prosperous life. Instead, she feels she “has to work, which is not what I signed up for.” she says with the anger of someone whose contract is violated. Meghan is smart, and with motivation, could have scored a professional career, but since she assumed that was not her fate, she never pursued higher education. When her three husbands let her down through drug use, mental illness and financial recklessness, she realized that she had to make a living. She found a great job and she now makes good money, but she is mad. She is not mad at her marriages or their disappointment, she is mad that she did not replicate the life she came from. This attachment to her mom, her connection to a pre-conceived notion of how her life “should be” is her biggest hindrance to inner peace. I wonder if her mom gave her the message that her mom’s life is an ideal, and anything short of that, for a woman, would be “second best”. Meghan, I suspect, is carrying forward her mom’s insecurities, along with her mom’s belief that women who work are not as “lucky” as the women who don’t. Meghan cannot see how work is an opportunity for self-expression, for autonomy and self-esteem. Instead, she views work as a “dreadful” necessity of life. Freud would say that Meghan is fixated on her infantile objects (her mom), and as such, she cannot expand  her ego to contemplate the different ways in which people interface with their world. She can only see that because her mother could have a comfortable life with her dad, while not working outside the home, then she, as her mother’s daughter should have the same life. This very limited view of her life, one based on her childhood attachments, causes Meghan internal turmoil and stress. She cannot enjoy her job, or if she does, she quickly reminds herself that she “should” not have to be working. My job is to help expand Meghan’s world view, to help her see that life comes in so many flavors and her journey is necessarily different than her mom’s. I want to help her understand how this “should” came about; how is it that she feels entitled to her mom’s life. Further, what makes her think that she would be happy with her mom’s life. Maybe it suited her mom, but it would not suit her. Maybe she is fortunate with her work and so maybe her anger could rotate to gratitude. On the other hand, maybe she will stay angry, as her anger is how she stays attached to her mom. Maybe her mom unconsciously needs Meghan to envy her life. The depth of this attachment will, in part, determine how much I can help Meghan see her unconscious entitlement book. The journey, the psychotherapy, begins.

Who Is Paying For Content?

Geneva Overholser,  Professor and Director of the USC School of Journalism said that we, the consumers, have to pay for content we do not agree with. We have to stop reading what we know. So agreed, Kai Ryssdal, host and senior editor of Marketplace, public radio’s program on business and the economy. As far as I understand human nature, this is not likely to happen. Paying for content that goes against our grain seems so far from our basic motivation to agree with ourselves; our basic tendency to stay put, both physically and mentally. As someone who loves newspapers, I am saddened by this development, although I do appreciate the internet for so many things, this is not one of them. The loss of print journalism is going to change how much we expand our perspectives on the world. Professor Overholser, I respectfully disagree.

Telephone: The Literal Connection

Well, for those of you curious about my technological updates, here goes. My land line is going away, but my phone number (310-824-4912) remains. I will still be able to answer the phone, which is a part of my day which always surprises my callers. I am glad I can keep that. My leap forward is that now I will get messages in digital format, allowing me to have a written record of my calls, which I imagine will increase my efficiency, and yet, will not be a significant cost-saving. I also get more room on my desk, which I think means room for one more pile. What about the user interface, you ask? Well, that is interesting. Call me and you can hear the experience. You will hear my name, then hear music, and then hear my voice-mail  The music is new, and for those who feel like waiting an additional minute to get to my voice-mail is annoying, then there could be irritation. On the other hand, just ask me for my cell, or email me, and I will respond, so no need to fret about that minute. I am hopeful this is a win/win for all. Although I am known as responsive, I think this technological renovation will increase my turnaround time. My office, like our new world almost mandates, will be in my pocket. What’s next, you ask? E-calendaring and E-prescribing-now those steps are large! Stay tuned.

 

See also…https://shirahvollmermd.wordpress.com/2010/10/07/310-824-4912/

Focusing The Patient’s Attention

One of the goals of analytic work is to extend the province of the ego, and more specifically, to make the patient more aware of his distortions. With Lynda, from my previous post, with her unrelenting selflessness, I could say “you are determined to do for others and then resent your friends for not appreciating  you.” The words “you are determined” changes her from a victim to the author of her own experience. In this new narrative, she is now able to contemplate that this dynamic which she resents is of her own creation, and hence subject to change. These simple words, “you are determined” is the basis for therapeutic intervention which empowers the patient to take more control over his life. So, I am off to teach these concepts. This will be my last class for these ten engaged and enthusiastic students. I will miss them, as teaching is one way I express my agency, my desire to do what makes me happy.

“Understanding and Being Understood”

Does the patient want to be understood, or rather, to understand? So, Martha Stark MD poses the question. Helping the patient be curious about his internal world is the job of the therapist, yet, at the same time, there needs to be a sensitivity to the patient in so much internal crisis that understanding is too large in the moment. In those moments, being understood trumps understanding. Self-psychologists frame this issue as gratifying a need versus helping a patient understand the need. The classic example being the therapist leaving for vacation. The therapist has two choices. He can tell the patient where he is going, which is gratifying the patient’s curiosity, or he can explore why the patient cares where he is going on break,  as a way of stimulating the  patient’s understanding of his  need to stay connected with the therapist despite their physical separation from one another. Of course, this is a fake choice, as the therapist could say “I am going to tell you where I am going on vacation, but before I do that, I am wondering why that is important to you.” Such a two-part answer addresses both the requested gratification, the ‘being understood,’ as well as helping the patient with ‘understanding’ of his emotional interior. Hence the patient can be gratified and stimulated, at the same time.

Lynda, fifty-four, consistently puts her needs behind others. She is always helping her friends, her family and even people she meets once or twice. Inevitably, she is resentful of the “other” for not recognizing her sacrifice. “On the one hand, you want me to be sympathetic to your good nature in which you are a very giving person, and yet, on the other hand, you want me to help you be more protective of yourself and you want me to help you understand why it is hard for you to assert your own needs.” In this compound statement, I am both gratifying her need to be seen as a ‘nice person’ as well as understanding her unconscious plea to help her be a more ‘self-protective’ person. As with all of therapy, there is a constant duality. There is the duality of change versus stability and now we add on, by saying that one facet of this duality is the need to be  understood, which is part of maintaining stability, and the other part of duality, which is helping the patient understand himself,  the first step towards changing. It is this dance between support and challenge, which is the to and fro of psychotherapy. Nonlinear is the modern word for such a dance. The tension which ensues creates the dynamics of the experience. The wrong call, the wrong dance move, creates pain and suffering. The margins are narrow. The work is hard.

“The Price You Pay”

Martha Stark MD talks about helping patients understand the “price” of their conscious and unconscious choices in life. Megan, fifty-nine, constantly complains that she is always there for her friends, but her friends are never there for her. “You chose friends who are not as reliable or devoted as you are. That is very interesting.” I say, thinking about Dr. Stark’s point of view that  choosing relationships which lead to disappointments is the “price” paid for finding people who you otherwise find to be good reflections of your internal state. Megan, for example, seems to be pick friends that her mother, age eighty-six, would approve of. Megan thinks about re-creating her mother’s life which includes re-creating a friendship circle like her mother has. This desire to emulate her mom, comes with the “price” of picking folks who do not value loyalty or devotion in a friendship. Creating a consciousness about this “price” allows Megan, in this case, to see how she engineered her own unhappiness and she is not the victim of horrible people in the world who just “don’t care about anyone but themselves.” Every decision, every turn of events in life, is a constant weighing of pros and cons, a constant evaluation of “price”. Megan can see that she can compromise on her car, by buying a car which is not her ideal, but which fits her budget, and yet this concept, when it comes to relationships, is more elusive. Every relationship, in fact, does involve such a compromise. We never get all of what we want, and hence our job is to choose what is most important, to prioritize. Simple and complicated, at the same time, since so much of this “prioritization” is outside of our awareness. When a great deal of our decisions are based on keeping our parents happy, then we need to take a closer look. Again, that is obvious and not obvious. We will grow to resent our relationships if they were not what we wanted in the first place. Once again, the problem is almost always within and not without.

 

Scary Feelings

“How are you?” I ask, Whitney, fifty-seven. “I don’t know,” she responds, as she says each time I see her. “You need not to know your feelings,” I say, changing her words slightly to give her more of a sense of agency. It is not that she does not know her feelings, as she believes, as she takes a passive stance, but rather, it is more that she NEEDS not to know her feelings, since she is scared by them. Whitney’s husband of twenty-two years passed away two years ago. Her kids are grown and independent. She has a boyfriend. She works as a therapist. Yet, her feelings remain “not knowable” to her as she walks in my office. She then agrees. “Of course, I need not to know my feelings. I miss my husband terribly and so if I get too close to those feelings, I will hurt my boyfriend’s feelings, and my kids think I should be over that by now.” She says, defending her position of detaching from her feelings. “Yes, but you can feel them in here,” I say, pointing out the obvious, that my office, this play space, enables her to be free to talk about her feelings without fear of judgment or hurt feelings. “Yes, but then I have to leave, and my feelings do not just zip up as soon as I leave your office,” she reminds me that the transition out of my office can be quite challenging and she has to be mindful of that. “Yes, I understand that, but the price you pay for being detached from your feeling is also a large one.” I say, pointing out that there is a challenge in  both feeling and not feeling her inner world. “What do you mean about the price?” she asks, wondering about my choice of words. “The price of not experiencing the texture of life.” I say, even though I know she knows that. “I think it is worth the price,” she responds, keeping my choice of words. “Well that is where you are today, but you might not feel that way tomorrow.’ I say, pointing out that the ‘price’ might change for her with time and distance from her husband’s passing. Making her aware of the “price” is making her more conscious of her unconscious decision not to feel her feelings. The word price is carefully chosen to suggest that she is deciding how she interfaces with her world. Agency is established. Victim-hood recedes.