July 21, 2010

The Stories That We Tell Ourselves

Therapists hear stories. Tons of them.

Everyone has one.

But the stories that are most important are those that represent the essential narrative of a person’s life. You might have just one such story, one that tells you how you see yourself and your journey through life.

It may not even take the form of a specific tale or recollection, instead describing a view of how your life has progressed.

Perhaps you think you are lucky or, alternatively, unlucky. Maybe you see yourself as a “mover and a shaker.” Do you imagine a handsome and suave (or beautiful and charming) persona as you look in the mirror? Or someone who is lazy or hardworking or resilient or weak?

But even if there is no story attached to the qualities that you ascribe to yourself or to your life path, the character traits you claim still are central to how you see of yourself, something you refer back to repeatedly.

Nor does the story or characteristic even have to be true. It just has to be something that you believe is true.

An example. An old acquaintance thought of himself as a “lady’s man,” making such politically incorrect comments as this simile: “A woman is like a taxi cab — if you miss this one, there will be another one along in 10 minutes.” He was clever, energetic, interesting, and outgoing, but unremarkable in his level of success and appearance — not particularly tactful either. When a woman rejected him, he was usually undaunted.

This gentleman even had a theme-song, of sorts. It was the soaring horn call from the Richard Strauss orchestral tone poem “Don Juan,” representing the bold, dashing title character he believed himself to be. And so, ever on the look-out for attractive women, he did, in fact, have numerous love affairs. Many ended badly, and he was as often rejected as he was the person who terminated the relationship.

Another person, no less likeable or successful with the opposite sex, might have seen the identical romantic life as a disappointment. But, our “Don Juan” never showed regret, rarely was chagrined for long, and continued to pursue women with the vigor he had always demonstrated.

Well, you might say that our hero had little self-awareness and you might be right. But, the case can be made that he was more satisfied in living-out his romantic life through his chosen vision of himself — through the story he was telling himself about himself — than if he had defined his role in the story differently, or come up with an alternate narrative altogether, especially if it was that of the jilted, luckless lover.

Now, I am not recommending either this man’s approach to women or his less-than-fully realistic view of himself. Nor would I have been pleased if one of my daughters found someone like him appealing. But his view did enable him to have much romance and fun in his life. In other words, he would have told you that it worked for him.

Unlike our friend, I have seen people change their stories over a life-time. For example, from feeling unlucky to feeling lucky, or from being timid and unsure to becoming more bold, assertive, and capable.

It is worth asking ourselves what stories we tell ourselves about ourselves. Again, they might not stand up to external scrutiny, but they don’t necessarily have to in order to be useful. We frequently create self-fulfilling prophecies for ourselves, succeeding or failing because of what we believe will happen or who we believe we are. In large part the man in question had much romance because he believed in his “Don Juan” myth. Had he seen himself as an undiplomatic opportunist (something as fitting as his chosen vision), he would have had much less female companionship. Even worse, if he saw himself as a schlemiel.

Was his glass half-full or half-empty? That too is part of his story, and he certainly looked at life with a hopeful, optimistic gaze and focused on what was best in himself, not his weaknesses.

The person I’ve described had many, many friends and had much pleasure, not only with women. He led an interesting life. Even if it is not one you would personally choose, do not be too hasty to judge it (especially after I tell you that he was a loving father).

A great man?

No, but then, there aren’t too many of those.

But he was one who found a useful story.

Many of us do worse.

—

The above image is Don Juan and the Statue of the Commander by Alexandre-Evariste Fragonard, oil on canvas, circa 1830–1835; sourced from Wikimedia Commons.

March 4, 2010

The Upside of Depression and the Downside of Medication

Are there advantages to being depressed? Something good about something we think of as so bad? A recent New York Times Magazine article by Jonah Lehrer makes just that case: Depression’s Upside.

The essence of the argument is that some episodes of depression allow for and encourage a kind of analytic rumination that is productive. Put another way, the tendency in depression to focus on a problem, mulling it over to the exclusion of other thoughts, permits the sad person to find a solution to his difficulty and change his life in a positive way.

The counter-argument, however, is that the ruminative process is both painful and unproductive — that it often creates a kind of self-flagellating preoccupation with one’s trouble rather than a process that leads to something good; that unhappiness and focusing on pain and its concomitants simply feed on themselves to no helpful end.

In my clinical experience, therapy with people who are depressed over loss or injury often breaks down into two phases. The first of these is a grieving process, where the person expresses and processes (or sometimes purges) the feelings of anger, sadness, emptiness, desolation, and hopelessness that come with the loss of something of value — a love, a job, high social status, a capability, a fortune, etc.

The second phase involves learning from one’s painful experience about how to live differently, make different decisions, associate with different people, become more assertive, overcome fear; value things differently in life such as money, material things, status, accomplishment, friendship, and love.

Naturally, neither of these two phases is absolutely discrete — they blend into each other and overlap each other. As a practical example, someone who has had a series of bad relationships will typically need to grieve the unhappy end of the most recent one and, in the process, learn how he happened to choose a person or persons who made him so miserable; then changing whatever needs to be changed internally and externally so that different and more satisfying choices occur in the future.

People who are like the hypothetical individual just cited usually come into therapy in emotional pain and seek relief of that pain as promptly as possible. This desire is entirely reasonable — who wouldn’t want this? Some of them request medication, which is often the fastest way to “feel better.”

But many are leery of psychotropic drugs and see them as artificial, hoping that therapy will produce a more lasting fix without dependency upon a foreign substance. Indeed, while a good therapist will strongly encourage the use of medication for someone who is seriously depressed, i.e. suicidal, unable to work, sleeping away the day away (or almost unable to sleep); that same therapist will also know that medication sometimes serves to “de-motivate” the patient, giving him or her a relatively quick solution that allows that person to tolerate an intolerable situation. In the New York Times Magazine article mentioned above, Dr. Andy Thomson describes this problem eloquently:

I remember one patient who came in and said she needed to reduce her dosage. I asked her if the antidepressants were working, and she said something I’ll never forget. ‘Yes, they’re working great. I feel so much better. But I’m still married to the same alcoholic son of a bitch. It’s just now he’s tolerable.’

Clearly, this woman was aware that she needed to be in some amount of discomfort in her relationship with her husband in order to be motivated to get out of it. The drug made her feel better, but, it also reduced her incentive to change herself and her life. It was, in effect, a kind of band-aid, rather than a real cure. It anesthetized her and, in so doing, robbed her of something that was essential for new learning and behavior change to occur.

Unfortunately, most people who come to therapy are neither as courageous or insightful as the woman just described. Once they feel significantly better, whether due to therapy or medication, it is common for them to be less interested in continuing treatment. They have recovered from the event that precipitated their entry into therapy, but they might not yet have learned enough to avoid making the same mistakes that contributed to the problem in the first place.

Such a person can reason that the cost of therapy (both financially and in terms of time, effort, and the difficulty that comes with changing one self) is now greater than emotional pain from which they might still be suffering. Put another way, at this point, doing therapy “causes” more difficulty and pain than not doing therapy, just the reverse of what seemed true when they started the treatment process.

At this stage, those who continue in therapy have something that an old mentor of mine, Truman Esau, used to call “therapeutic integrity.” What he saw in some of his patients was an almost heroic desire to make themselves better regardless of how much the actual process of doing so was difficult, uncomfortable, or painful.

These patients didn’t shy away from problematic truths about themselves or others. They worked hard to stretch and challenge themselves, knowing that it was crucial to improve. They didn’t simply want a quick fix. Like the woman in Dr. Thomson’s example, they recognized that some pain was essential to being motivated. They knew that there was no such thing as “a free lunch,” and were willing to do whatever it took to repair and better their lives.

If you are in therapy now, it will be important for you to be sensitive to this shift from the often intense distress that brought you into therapy, to the point when the therapy itself might seem distressful. This can mean that the therapist is not skillful or that he is pushing you too much, but it just might also signal that some of the most difficult life changes you need to make are still ahead of you, even if the cost of making those changes seems greater than when you started treatment.

If you leave therapy because it is hard and unpleasant work, the problems you have won’t care. They will simply continue to reside in you, work on you, and trip you up. It is not enough to get over your last disappointment or unhappiness, but to change yourself enough to avoid future problems.

Few things that are worthwhile come to us for free.

—

The above image titled Depression is the work of Hendrike, sourced from Wikimedia Commons.

August 22, 2009

When Your Social Life is “Social Work”

The world is divided into “givers and takers,” or so we are told. Conventional wisdom advises that being a “giver” is the preferred choice, the moral high ground. Most of us don’t want to be thought of as selfish and non-reciprocal — only in it for ourselves. So being a giver tends to be the equivalent of being a “nice person.”

But can you be too nice? Can you be too giving? Giving to the point that it hurts, to the point of disadvantaging yourself and permitting others to “use” you routinely? Can too much giving be the equivalent of self effacement: showing deference and preference for others to go first, take what they need, and leave you at the end of the bread line?

If the answer is yes, how might you know whether you are giving too much?

Here are some signs your social life has become social work, caring for others to the point you are not taking good enough care of yourself:

Do you tend to be the person in your group who listens to others’ problems, the first person your acquaintances go to when they have something bothering them? By itself, this might simply indicate you are kind and empathic. But these types of relationships become problematic when they do not go both ways: when others don’t have time or understanding or compassion for your problems, but expect those qualities from you.
Do friends and acquaintances impose on you unreasonably? Do they regularly ask you to drop what you are doing to help them? Do they call late at night over small upsets without regard for your need to get up early the next morning?
Beyond words of thanks for your kindness, do your friends express gratitude in more substantial ways, like sending you a greeting card, flowers, candy, or picking up the check at dinner? If you do such things, do they reciprocate?
Do you find yourself disappointed too often when “friends” contact you only when they need something from you or someone to listen, but not for social invitations when they are feeling good?
Do you believe your only value to people is to be found in what you can do for them? Do you think if you failed to “give,” others would find little reason to spend time with you? Do you doubt your value beyond the ability to assist or console?
Do too many relationships begin with the other’s enormous gratitude for your kindness, but move to a point where your generosity is taken for granted, almost as if he is entitled to it?
Are you exhausted by the demands and requests of others?
Is it difficult to say “no” when something is requested from you, be it time, money, or a ready ear?
Do you fear being dropped by friends and acquaintances if you should become less available when they are in need?
Do you find yourself worrying a good deal about hurting others if you don’t do what they request?
Do you hesitate to express strong opinions to your buddies, opinions different from their’s? Are you afraid of rejection or criticism if you disagree?
Are too many of your friends “troubled souls?” Do you tend to associate yourself with people who have more than their share of problems, making it easy for you to take on the counselor, helper, or social work role?
Do you believe saying no is selfish? Were you told you were selfish growing up?
When you are not appreciated, do you think perhaps you haven’t yet done enough to please your friend?
Do you make excuses for the other when your efforts are unappreciated?

If you have answered “yes” to a number of these questions, you might have problems of self confidence and an inability to assert yourself. Another term often used in the types of relationships described here is the word dependency. Sometimes the word “co-dependent” is used instead. The dilemma is one of allowing yourself to be used, thinking too little of your own needs, and imagining you must do whatever it takes to keep certain people in your life. Standing up to others and setting collapses for fear of abandonment.

This style of relating to people doesn’t go away by itself. Rather, if you see yourself in the above narrative, consider going into psychotherapy. Life is much easier and more fulfilling when relationships work both ways. The sooner you address this problem, the more likely that your life will increase in satisfaction.

=========================

The world is divided into “givers and takers” or so we are told. Conventional wisdom advises that being a “giver” is the preferred choice, the moral high ground. Most of us don’t want to be thought of as selfish and non-reciprocal — only concerned with ourselves. Thus, being a giver tends to be the equivalent of being “good.”

Can you be too good? Can you be too giving — to the point that it hurts, to the point of disadvantaging yourself and permitting others to “use” you routinely? Can too much giving be the equivalent of erasing your needs? Might it become deference and preference for others to go first, take what they need, and leave you at the end of the bread line?

If the answer is yes, how might you know whether you are giving too much?

Here are some signs your social life amounts to social work without the salary social workers receive, caring for others to the point you are not taking good enough care of yourself:

Do you tend to be the one in your group who listens to problems, the first person your acquaintances go to when something bothers them? By itself, this might simply indicate you are kind and empathic. But these types of relationships become problematic when others don’t offer time or compassion for your problems, but expect those qualities from you.
Do friends and acquaintances impose on you unreasonably? Do they regularly ask you to drop what you are doing to help them? Do they call late at night over small upsets without regard for your need to get up early the next morning?
Beyond words of thanks, do your friends express gratitude in concrete ways, like sending you a greeting card, flowers, candy, or picking up the check at dinner?
Do you find yourself disappointed too often when “friends” contact you only in need of something from you or someone to listen, not for social invitations once they bounce back?
Do you believe your single value to people is to be found in what you can do for them? Do you think if you failed to “give,” others would find little reason to spend time with you? Do you doubt your value beyond the ability to assist or console?
Do too many relationships begin with the other’s enormous gratitude for your kindness, but move to a point where your generosity is taken for granted, almost as if he is entitled to it?
Are you exhausted by the demands and requests of others?
Can you say no when something is requested from you, be it time, money, or a ready ear?
Do you fear being dumped should you become less available when they are in need?
Do you find yourself worrying a good deal about hurting others if you don’t do what they request?
Do you hesitate to express strong opinions to your buddies? Are you afraid of rejection or criticism if you disagree?
Are too many of your friends “troubled souls?” Do you tend to associate yourself with people who have more than their share of problems, making it easy for you to take on the counselor, helper, or social work role?
Do you believe saying no is selfish? Were you told you were selfish growing up?
When you feel unappreciated, do you think perhaps you didn’t do enough to please your friend?
Do you make excuses for the other when your efforts are dismissed or taken for granted?

If you answer yes to a number of these questions, you might have problems of self confidence and an inability to assert yourself. Another term often used in the types of relationships described here is dependency. Sometimes the word “co-dependent” is used instead. In either case, the dilemma is one of allowing yourself to be used, thinking too little of your own needs, and imagining you must do whatever seems required to keep certain friends in your life. The thought of standing up to others and setting limits collapses for fear of abandonment.

July 23, 2009

How to Choose a Therapist

Most of us are not at our best under pressure. Similarly, when depressed, anxious, or otherwise stressed and in crisis, the patience and clarity of thinking needed choose a therapist might well be in short supply. So here are a few pointers, things to consider, when you decide to consult someone for psychological assistance:

1. Ask a friend if he or she is able to recommend a therapist with enthusiasm. Also be sure to request that your acquaintance explains “how” the therapist was helpful. Not all counselors are equally adept at treating every problem, so your friend’s recommendation should be carefully considered in light of whether your issues are different from your friend’s. You might also ask your physician for a recommendation. A good way to phrase the question is, “If you needed to get a therapist for someone you loved, who would you choose?”

2. Internet searches of various kinds can help find a good person. Various organizations list therapists who perform a certain type of therapy or work with certain types of problems. An example would be the Association For Behavioral and Cognitive Therapies: www. abct.org/ The National Register of Health Care Providers in Psychology is another such group: http://www.nationalregister.org

3. Some information about the therapist is usually available on web sites such as those mentioned above. If the therapist has a web site of his own, you will usually find out a good deal more.

4. What kind of therapist are you looking for? There are many choices. Clinical Psychologists are doctoral-level professionals (Ph.D. or Psy.D) who typically have completed four years of training beyond their college Bachelors degree and had additional instruction and supervision in the form of a year-long internship, often within hospitals or clinics. In most states psychologists cannot prescribe medication, but have received more graduate training in psychological evaluation (testing) and therapy than is typical of any of the other disciplines who perform therapy. Psychiatrists are physicians trained in medicine, who also receive specialized training during a psychiatric residency. They can and do prescribe medication and a number of them also do therapy. Clinical Social Workers generally have a Masters Degree obtained in the course of two years of post-college study, in addition to practical experience and a history of supervision. Marriage and Family Therapists usually also have a Masters Degree and may have a similar amount of training as do the social workers, although their education is not identical to that group. All of these disciplines encourage and sometimes require therapists to continue their study via post graduate course work, supervision, and reading.

4. What kind of therapy do you want? In part, that might depend on what kind of problem or problems you have. Psychodynamic psychotherapists will tend to pay much attention to early life issues including unresolved feelings toward one’s parents, and the potential impact of additional events that occur during the growing-up years in an attempt to free you from repetitive patterns of behavior that might have started at that time. Cognitive behavioral therapists use CBT to focus more on present day concerns, attempting to help you take steps to alter the automatic and self-defeating thoughts that influence your mood and fuel your depression and anxiety, as well as assisting you in changing your behavior. They spend much less time on early life events as a rule, and do not usually consider “insight” into the causes of your troubles to be crucial to assuaging your emotional pain. Marriage and family therapy aims to treat couples and family systems, usually meeting with the marital pair or family group rather than with one person at a time.

5. Try to determine how much experience your potential therapist has with a given kind of problem. Some therapists specialize, for example, in treating alcohol and drug abuse and are certified in this field (CADC or certified alcohol and drug counselor). If you have anxiety issues, on the other hand, ask your therapist how many people he has treated with this condition. Similar questions might be asked of someone who you wish to consult for the treatment of depression or schizophrenia. Don’t be afraid to ask. Any reasonable professional in the health care field will welcome your making an informed decision.

6. Other factors might be considered. How active do you want the therapist to be? Some tend to direct the therapy, while others are more comfortable listening to you and responding to just those issues that you believe are important. Some people choose therapists based on gender, believing that they will feel more comfortable with one or the other sex. Age of the therapist is important, since it tends to be correlated both with professional experience and life experience. If you believe that not everything in life is learned in a classroom, you will probably want to see someone who has a few gray hairs and who has been married with children.

7. Financial considerations often enter into the choice of a therapist. MDs are usually the most expensive people to see and Masters level professionals are the most economical. Ask your therapist about what he charges for his services and what portion, if any, of his fee is covered by insurance. Some communities have public mental health agencies that offer therapy at a heavily discounted price, although they often have long waiting-lists. A portion of therapists will discount their fees if you can make a good case for such a discount.

If you go through your insurance company, it is likely that they will steer you toward a practitioner who has a contract with them and has agreed to discount his fee to you. Understand, however, that the discount also typically benefits the insurance company, since they will have to pay less money in benefits if you choose a provider who is in their network. Therefore, their recommendation comes with a degree of self-interest.

Be aware that (as the old saying goes), sometimes “you get what you pay for.”

8. Some people choose not to use their medical insurance to pay for counseling. They make this decision because they have concerns about the impact of a mental health diagnosis on their future ability to get life or disability insurance, and the possibility that having a “pre-existing (mental health) condition” will complicate their medical coverage should they ever change jobs or go for a period without insurance and then attempt to obtain it again.

9. Remember that the most important element in obtaining a therapist is getting a person who is accomplished, talented, experienced, and a good fit for your therapeutic needs. You should also have a sense that he really cares and wants to help. While some of the other considerations mentioned previously might be important, if the therapist can’t help you, nothing else really matters. When you meet the therapist (see my blog post “What to Expect in Your First Therapy Session“) he should be able to convey expertise, compassion, and competence, as well as giving you a sense of hope. Don’t settle for less.

July 16, 2009

Infidelity and Its Treatment

The names don’t really matter. Today they are Tiger Woods; Mark Sanford, Governor of South Carolina; and John Ensign, U.S. Senator from Nevada. Tomorrow they will be someone else. Every day, there are other names, little known, but causing no less pain.

How does it happen? How does it happen that people who claim to live by well established moral norms, who have taken a public oath to remain faithful to their spouse, violate that promise? There are several reasons:

1. Power and celebrity = opportunity. People in positions of power and celebrity have more opportunity than most to be unfaithful. They are surrounded, sometimes literally, with admiring and attractive younger people. As Oscar Wilde said, “I can resist anything, except temptation!” The famous and powerful have plenty of that.

2. Contiguity. You might think that the separation of sexes in some religious fundamentalist societies is unfortunate or wrong, but it does keep opportunity at a minimum. In modern Western secular civilization, men and women work together, eat together, and travel together on business. Repeated contact with a sympathetic business associate, pulling together with that person as a team on a business project, creates not just the opportunity for sexual contact, but the chance to get to know and like one another. Perfectly moral and decent folk can find themselves stirred by the presence of a person to whom they are not married, even though they weren’t looking for anything outside of the marriage.

3. Disinhibition. Alcohol and drugs. If you are around sexually attractive people in a party atmosphere or when you are “under the influence,” your judgment and hesitation are more likely to be set aside.

4. The “Great Man” rationale. More than once, I’ve heard men justifying the concept of infidelity in the case of those who are accomplished and powerful. Often, the rationale includes reference to the role that “the great man” plays in benefiting society. According to this line of reasoning, the “heroic” figure is thought to have earned the right to live by a different set of rules than the common man, and should be given the chance to be compensated for his contribution to society by being allowed multiple sexual partners.

5. The “It won’t hurt anyone” rationale. The faithless sometimes persuade themselves that there is nothing wrong with their behavior so long as anyone who might be injured (spouse/children) never knows about it. This is akin to the old philosophical question, “If a tree falls in the forest, but no one is present to hear it, does it really make a sound?” What the argument ignores is that the transgressor is changed by his act of betrayal, that he must tell a continuing set of lies in order to maintain the fiction of his character, that he risks his partner’s physical health in the event that he has become a carrier of a sexually transmitted disease, and that it is impossible to guarantee that the secret will never be revealed.

6. Mid-life crisis. Poor humanity. Poor man. We age, we lose our youthful good looks, sometimes our hair, our virility, our energy, our strength, our stamina. The antidote? A youthful or new sexual partner who, for a time, can help us shut out the dreaded and self diminishing passage of time.

7. Solace. The ups and downs of life are inevitable, even in the luckiest of lives. The best marriages are not immune to the daily stress that takes a toll on a spouse’s ability to be compassionate, encouraging, and supportive. Financial worries, business reverses, family illness, house keeping, and child rearing soon diminish the “date night” and honeymoon atmosphere of the early days of the relationship. A fresh and sympathetic set of ears, all understanding and acceptance, often develops into something more, and something sexual.

8. “It’s not natural.” Some people, mostly men, justify infidelity with the notion that man was not meant to be a monogamous creature and the flowers of the field (i.e. the opposite sex) were meant to be enjoyed.

9. Longevity. At the turn of the last century in America, that is, about 1900, the average life expectancy was about 50 years. By that standard it was usual for marriages to be relatively short, 25 to 35 years at the most, many much shorter. No longer. Many now last 50 years and more. What happens in that time? People get older, their bodies change, and their personalities alter as well. When I do marital therapy, I usually ask couples what initially drew them together. The most frequent answer I get is something like, “He was hot and we had a lot of fun.” Thirty years on, it goes without saying, he isn’t so “hot” and they sure aren’t having fun.

In order for marriages to thrive into mid-life and beyond, the couple has to work very hard at the relationship, to keep the sexual spark alive despite physical changes and familiarity, and to see to it that personality alterations are compatible or synchronous. Too often one partner wants the marriage to be exactly as it was at the beginning and believes that both the personality and physical changes in the other person amount to a breach of contract. Meanwhile, the other might feel held to a contract that is no longer appropriate to the current state of the couple’s life together and to their age, personality, and experience. One or the other very well may see infidelity as tempting under such circumstances.

10. The scoundrel factor. Although an injured spouse sometimes believes that “evil” is the most likely explanation for her spouse’s betrayal, in most cases it really isn’t. Most people don’t set out to behave badly and many feel guilty when they do. That said, there are certainly more than a few cads among us, and they do with impunity what others only do with hesitation, a troubled conscience, or not at all.

11. Boredom. Boredom doesn’t cause anyone to stray, but it does set the stage for the temptation. Routine can kill even the things that we love. The pattern is well-known: wake up, go to work, come home, play with the kids, do the bills, and collapse from exhaustion. Or, the stay-at-home parent’s version: wake up, make food, shop, make food, take care of the kids, do the housekeeping, make food, clean, and collapse from exhaustion. Either way, the routine is deadening and there is little room for excitement.

12. A lack of sex. Again, this doesn’t cause infidelity, but can set the stage for it. A warning here: cease sexual contact at your own risk and at the risk of your marriage. But, this is not to suggest that you should have sex only because your partner wants to.

13. Cruelty, sarcasm, and a lack of appreciation. If the marriage has turned into a battle ground, with gratitude replaced by indifference or hostility, infidelity is more likely on either side.

—

When the infidelity is exposed, the result is devastating to the victimized spouse. Rage, sadness, a loss of self-regard, and feelings of inadequacy are common. What did I do? What didn’t I do? Why did he do that? If he felt that way, why didn’t he leave first before he took on another partner? The devastation occurs whether the infidelity is fresh, or the betrayed person discovers it years after it occurred. The emotional clock of devastation only begins to run from the point that one becomes aware of what happened.

If a couple comes to therapy in the wake of such news, several factors go into the therapist’s evaluation of the situation. First, is the infidelity over or is it still going on? If the marriage is to have any chance, the “other” relationship has to end. Moreover, it has to end because the spouse having the affair wants it to end and believes that the marriage is worth saving, not because his marital partner is threatening to leave or because of the fear of financial devastation in the course of a divorce.

The therapist will try to gauge what still binds the marital couple together, if anything. Do they still have positive memories of their courtship? Do they have children and are they concerned about the effects of a divorce on their offspring? Are they still in love? If there is no love on the part of even one partner, therapy is almost certain to fail to recreate it.

If the both parties want to save the marriage, have positive memories of the start of their relationship, and if loving feelings still exist between them, treatment often can help to repair things. One of the first items in need of attention will be allowing the injured spouse to grieve. This will require both tears and anger, but will need to be time limited. That is, however great the injury, the victimized spouse must understand that he cannot forever bring up the infidelity to be used as a weapon when he feels unhappy or aggrieved in the future. As the old farm expression goes, “Don’t burn down the barn to kill the rats.”

Of course, apology by the roving partner will be necessary and it will take time to rebuild trust. Once the immediate crisis is over, the couple needs to look at what contributed to their estrangement and what changes need to be made in their relationship. They have to reaffirm a set of values by which to live and goals for their relationship and for the family. Changes in patterns of communication will likely be necessary, as will time and attention to each other. Serious self-reflection and responsibility-taking will be particularly important for the unfaithful member of the relationship, but the partner too must be willing to look at the possibility that he contributed to his spouse’s feelings of disaffection.

Such situations aren’t easy, but they can come out well. Good will, sincere contrition on the part of the person who strayed, and emotional generosity on the part of the victim are all key. The betrayal is never forgotten, of course. But time does its work on the scar of infidelity, just as bodily scars tend to soften and fade over time, even if they never fully disappear. Happiness and love may yet flourish.

—

The image above is a cropped screenshot of Lana Turner from the film The Postman Always Rings Twice, sourced from Wikimedia Commons.

July 9, 2009

What to Expect in Your First Therapy Session

Going to therapy for the first time takes some courage. You are about to talk about some very personal things to someone who is a complete stranger. What can you expect?

1. First of all, expect to be at least a little bit nervous at the beginning. But even before you get inside the therapist’s office, you will have to fill out some paper work. You will also receive a written description of the therapist’s practice, including such details as whether the therapist accepts your medical insurance and how he handles that. Additionally, he will give you information about how your medical records are safe-guarded and the extent to which those records are confidential.

2. The therapist should greet you, bring you into his consulting room, and sit face-to-face with you. Therapists generally want to convey “openness.” It is therefore rare for a therapist sit behind a desk, with you on the other side.

3. After a few “ice breaking” words, the counselor will ask you why you have sought treatment. If you already told him some of this on the telephone, he will want you to fill in the details.

4. Don’t feel that there is a particular “correct” order in which to tell your story. Simply tell it. Initial sessions should generally allow enough time for you not to be rushed. The therapist has probably scheduled at least 75 to 90 minutes to spend with you.

5. If it makes you feel better, it is entirely appropriate to bring an outline of the topics about which you wish to talk, and to consult this outline or read directly from it whenever you need to.

6. The counselor is likely to have some questions for you. He should want to know about your background, not only about the concerns that exist in your life at the moment. Unless he knows about that background, he won’t be able to fully understand how you came to have the current difficulties and whether they represent a repetitive pattern in your life.

7. Among the topics you might be asked about are such things as a description of your parents and their approach to rearing you, relationships with siblings, the educational and social history of your school years, whether you changed residences with any frequency as a child, past and current health concerns for you and your family, the presence of any traumatic events in your life, your dating experience, the place of friends in your life, work background, alcohol or drug use, current medications, present family relationships (spouse/children), financial concerns, and past or current depression or anxiety issues.

Additionally, expect to be questioned regarding any evidence of mood fluctuations, sleep, digestive problems, headaches, caffeine use, suicidal or homicidal thoughts or actions, attentional problems, hyperactivity, hallucinations, delusions, hobbies, religion, how you feel about yourself, whether you are able to be assertive in your life (say “no” or ask for things), diet and eating/weight problems, obsessive thoughts, compulsive actions, and what you hope to get out of therapy.

Of course, there may not be time to touch on all these areas in the first session.

8. You should not feel that you must talk about topics that are too uncomfortable for you. A sensitive therapist will give you permission to cover only the ground you wish to, and a sense of control over the progress of the session, so that you don’t become overwhelmed.

9. The therapist might well ask you what challenges you’ve had in life and how you have managed to overcome them. This kind of question helps the therapist and you to know what strengths you have and to help you remember that you have surmounted past difficulties and therefore can rely on those strengths to help you surmount the current problems.

10. By the end of the session, the therapist should provide you with some feedback about what you have said. In part, this is to help you and the therapist know if he has heard and understood what you have been saying, and whether his initial impression of you seems appropriate.

11. The counselor, to the extent that he offers interpretations of the material you have presented, ought to let you know that this is a first impression and therefore not necessarily perfectly accurate. Any good therapist needs to hear your concerns about him personally, his ideas, the therapy approach he is recommending, and his effect on you. Such a person will not be offended by your concerns and actually wants to hear from you what feels right and what doesn’t feel right about the therapy process.

12. The counselor will normally allow a good deal of time to answer any questions that you have of him and his approach. It is not essential that you make another appointment at that time, although most people usually do. If you already believe that this therapist is not the right one for you, it is perfectly appropriate to say so and to ask him for a referral to another professional.

13. By the end of the session you ought to have a sense of direction and at least an initial treatment plan as articulated by the counselor. The therapist is likely to remind you of the importance of regular attendance and that your dedication to your own healing is essential to obtaining the results you want. Therapy, unlike medical intervention such as brain surgery, requires effort and activity on your part. It is also essential that you have the courage to look at yourself honestly, recognizing that in order for your life to be better you will have to be willing to change some things about yourself.

14. At the end of the first session you might feel exhausted, in part because talking about big emotions is hard work! You are likely to be less anxious than you were when you came into the session. You may feel some amount of relief at having talked about things that you have rarely if ever discussed before. If the therapist has done his job, you should have a sense of hope.

15. In the days following the first psychotherapy encounter, you might well find yourself still processing the material you discussed. This can be unsettling, but it is quite normal. Additionally, a person new to therapy can feel that he has said too much and made himself too vulnerable to the therapist, especially if he (the patient) is a private person. Some people will therefore not return to therapy after the first session. If you have this hesitation, however, remember that it is in your interest to persist despite your discomfort if you sincerely wish to change your life. Good luck!

—

The above image is the entry to Sigmund Freud’s office at Berggasse 19 in Vienna, Austria. It originally was posted to Flickr by James Grimmelmann and was sourced through Wikimedia Commons.

July 2, 2009

A Few Good Books

You won’t be looking at this unless you are a reader. So here are a few brief recommendations of books that have made a lasting impression on me. Most are not new and I suspect that some are out of print, but are likely to be obtainable by a search on the Internet. In no particular order:

1. Frauen by Allison Owings. Owings comes as close as anyone to answering the question, “How did the Holocaust Happen.” An American journalist who studied in Germany, she returned there to interview mostly gentile women who had lived through the period of the Third Reich. Owings summary does an extraordinary job of describing the psychology of the bystanding German population.

2. A Prayer for Owen Meany by John Irving. Irving gives away the plot of his novel early on: Owen Meany will die an unusual death. But rather than destroying the tension of the book, this puts the reader in Owen’s shoes as a man who knows that he will come to an untimely end, but doesn’t know exactly how. As the book progresses and that end comes closer, the terror is almost unbearable.

3. Agitato by Jerome Toobin. The story of Toscanini’s NBC Symphony Orchestra in the one decade that it attempted to survive after his retirement. If you enjoy anecdotes about famous musicians, this book is for you. The tale Toobin tells is both funny and sad, since the orchestra did not last. Jerome Toobin, by the way, is the father of Jeffrey Toobin, the legal scholar and public intellectual.

4. Regret: the Persistence of the Possible by Janet Landman. A book about the title emotion, viewed from literary, psychological, and other perspectives.

5. What is the Good Life? by Luc Ferry. A very good attempt to answer the biggest question of all: what is the meaning of life?

6. The Long Walk by Slavomir Ramicz. The author tells the true story of his escape from a Siberian prison camp. He and his compatriots, with almost no equipment, food, or appropriate clothing, attempted to walk to freedom and Western Civilization, which took them as far as India. As you can imagine, not all of them made it. That anyone at all did is astonishing.

7. Anna Karenina by Leo Tolstoy. This story of an unhappily married Russian woman touches on almost all that is important in life: love, friendship, obligation, children, religion, the value (or lack) of value to be found in work and education, death, and the meaning of life. None of that would matter much without the author’s gift of telling his story and allowing these issues to flow out of the human relationships and events he describes.

8. The Boys of Summer by Roger Kahn. Kahn’s classic tribute to the Brooklyn Dodgers baseball team of the 1950s, the team that had Jackie Robinson as its central figure and leader.

9. War Without Mercy by John Dower. Dower describes the racism that underpinned the Pacific theater of World War II. Unlike the war in Europe, each side viewed the other as less than human and treated the enemy with a brutality consistent with that view.

10. The Culture of Narcissism by Christopher Lasch. Although the book is now a few decades old, the writer’s message is still spot on. He looks at the empty pursuit of happiness in material things and acquisitions, driven by the increasingly disconnected nature of social relationships in this country, and the promise of the media that happiness lies, not in fulfilling human contact, but in the goods that come with “success.”

11. The Time Traveler’s Wife by Audrey Niffenegger. A fantastic and touching creation about a man unstuck in time, thrown forward and back, and the woman who loves him. Its being made into a movie, I’m told.

12. Patrimony by Philip Roth. Roth’s account of the illness and death of his father.

13. The Denial of Death by Ernest Becker . More than one person has told me that this is the finest nonfiction book they have ever read. It is a meditation on what it means to be mortal, and how the knowledge we all have of our inevitable demise influences how we live, in both conscious and unconscious ways. Becker’s book has lead to an entire area of psychological research called “Terror Management Theory.”

14. For Your Own Good by Alice Miller. Miller is a controversial Swiss psychiatrist who looks at the effect of harsh upbringing on the welfare of children. If you believe that children should be seen and not heard, this book might make you think twice.

15. A Tale of Two Cities by Charles Dickens. A story of self sacrifice and heroism set in the French Revolution. If you can read the last few pages without tears, you have a firmer grip on your emotions that I have on mine.

16. The Glory of Their Times by Lawrence Ritter. Ritter was a college professor when he began to travel around the country in the 1960s, tape recorder in tow, to obtain the first hand stories of the great baseball players of the first two decades of the 20th century, who were by then very old men. Probably as great an oral history as any of those written by Studs Terkel, and perhaps the greatest baseball book ever.

17. American Prometheus: the Triumph and Tragedy of J. Robert Oppenheimer by Kai Bird and Martin Sherwin. Oppenheimer is the man who brought the Manhattan Project to fruition, that is, helped create the bomb we used to end World War II in 1945. But more than that, this book is a wonderful biography of a complex, peculiar, and brilliant man, who was brought low by those who wished to discredit his opposition to nuclear proliferation in the period after the war.

18. The Mascot by Mark Kurzem. A story that is beyond belief, but turns out to be true. The central figure of the story, when he was a little boy, was adopted as a mascot by a Latvian SS troop after surviving the murder of his family. Why beyond belief? Because he was Jewish. The book reads like the most extraordinary mystery.

19. All Quiet on the Western Front by Erich Maria Remarque. The most famous anti-war novel ever written. The book is told from the standpoint of a young German infantryman during World War I.

Dr. Gerald Stein

Blogging About Psychotherapy from Chicago

marriage therapy psychology wisdom

The Stories That We Tell Ourselves

When Your Social Life is “Social Work”

Infidelity and Its Treatment

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this: