Blogging Takes A Back Seat

I apologize for the gap in my blogs. We've been thrust into full time grand-parenting of our six year old granddaughter, Arya, after my daughter was admitted into hospital last week. She had been having a long-lasting, gastro-intestinal flue for a couple of weeks, and after a brief respite, some of the symptoms appeared to come back, only stronger. Finally, by Thursday of last week, her pains were so bad we took her into the Emergency Room. She had extremely low blood pressure, could barely stand up, high white blood cell count, and a high fever, along with pains that bent her double. After six hours in the ER, they rushed her into surgery for an appendectomy. Turns out that some stool had found their way into her appendix, which then further perforated and finally ruptured. The doctors then discovered a blockage in her gut, which they subsequently managed to unblock after suctioning out half a gallon (no, really!) of gastric juices, mucus and other sundry bodily fluids through her nose. She was very uncomfortable for a day or so with the tubes going down into her stomach, but after 18 hours of this, the tubes had done their job and they were removed during one of my recent visits.

Sunni is currently on three different kinds of IV antibiotics as they attempt to bring the infection under control, and she is additionally receiving IV pain killers. However, there is still widespread bacterial infection in her body so they won't release her until she's fever-free, able to get up by herself, and is without pain. She's likely to be in another 2-3 days at the current rate of progress.

Anyway, I'm relieved that after a very rough week in hospital, Sunni appears to have turned a corner. Walking is still difficult for her but she takes a few more steps each time. Her great excitement this morning was that she gets to have dry crackers!

Meanwhile, back at our house...we have been trading off dropping off and picking up Arya from school and after-school, chasing an active 6 year old around the house, fighting the fights that all parents have ("Yes, you do have to clean your teeth. No, you can't run your egg-covered fingers along Nana's painting. No, it's not possible that the cat let your hamster, Twinkle, out of the cage.") and falling into bed exhausted at the end of the day. In addition to working full time, I have been spending a lot of time at the hospital, and for the last two nights, we have had another puppy in the house, Ziggy's friend, Jack.

Once Sunni has been discharged from the hospital, she will stay with us until she's well enough to return home. I'll be on nursing duty for a while, but hope to be back to blogging soon.

The War In Iraq

Today I read a blog written by a woman who was, until recently, a nurse in Baghdad. I'm going to remember her vivid description of life as a war nurse each and every time I have a tough day as a therapist because very little can compare with what this woman endured in Iraq. No mortars explode 3 yards from my comfortable, leather office chair; nobody shows up minus their arms and legs; nobody spits at me, rapes me or tries to kill me; there are no enemies staring at me with hatred while I try to do my job; the smell of charred flesh does not linger in my nostrils and no babies die while I look on helplessly. No matter how challenging my day is, I leave my office with my body parts and senses intact.

Today was challenging, but it wasn't Baghdad.

I came face to face with a situation confronting a client that I've never had to think about before, and listened carefully to the client's confusion and upset as they struggled to make sense of the place they have come to in their life. I made a list of people to contact who might be willing to provide consultation, put the word out that I'm looking for a friendly Endocrynologist to talk to and have placed a call to a supervisor asking for help on how to create a meaningful intervention with my client.

I spent a lot of time reading books, articles and websites on Fibromyalgia and Chronic Myofascial Pain in order to better support and work with a client with invisible disabilities, and found my heart constricting with empathy, sadness and compassion as I read the descriptions of how people survive a life of pain, marginalized by the very community (medics) that should be supporting and working with them to improve their quality of life. (Read anything by Devin Starlanyl you can find if you want to know more.)

Today I've watched couples in pain fight with words and silence.

I've watched a brave woman take quantum leaps towards being the person she knows she can truly be, no matter what she risks feeling.

On a non therapeutic level, I ate bad Chinese food at lunchtime and took my puppy Ziggy to the vet (ear infections). He has allergies and is taking Benadryl. I'm definitely on a learning curve in the puppy department.

And now it's after 10 pm at night, and I'm trying to wind down by writing. Speaking of writing, next week I have my first meeting with a new writing group, and I'm excited to be tackling something that I've always wanted to do with a group of like-minded folks. Not only will I now (hopefully) belong to a community of writers, but I've already made a really wonderful new friend as a result of being turned down from another writing group. Will this be an end to the "run on" sentences in my blogs? You be the judge!

My puppy has stopped sniffling and scratching his ears for the time being. My spouse, S., is lying on the couch watching a new TV drama and I'm about to read a chapter on the Lymph System and the Immune Connection for the second time (I have a terrible time absorbing scientific information - I'm an experiential learner and find it hard to take in dry scientific "facts.")

(Just for the record, I am against the War in Iraq and comfortably to the left of democrat. )

Hollywood Therapists

Therapists have a lot of cultural stereotypes to live down. Most of us are not dazzling or even gallant as some Hollywood movies would have you believe (witness "Awakenings") and while some of us are quite possibly bullies like Dr. Phil, it's rare, or so I believe. (Please, don't even get me started on the horrors of Dr. Phil, peddling cheap shots at people in extreme pain for monetary gain and spectacle - NOT that I have strong feelings about him dragging down my profession by the weight of his coin purses, his heavy absence of true compassion, blindingly huge ego and unethical boundary violations, oh-dear-me-no!) In short, I believe that most of us therapists try hard to be, and are, decent human beings.

Let's take a look at what psychotherapists are up against.

First off, there's the image of the therapist as "Dr. Loony Toons" like Dr. Crane on TV's "Frasier" and Mel Brooks' tour de force in "High Anxiety." All neuroses, crazier-than-their-patients zany and over-the-top wacky. No help there, folks! They really put the word "psycho" in psychotherapist.

Or how about "Dr. Homicidal Maniac" a la Hannibal Lechter, evil to say the least, shady at best and mind-boggling in his ability to inspire fear (and putting a whole new spin on the idea of "having lunch together.")

Then we have the image of the therapist as "Dr. Fantastic" - brilliant in his or her deductive reasoning, able to pinpoint the ONE event in a patient's life that has stymied them throughout life, and to magically remove its power merely by naming it - oh, that I could have that power! (oh that this was clinically valid - and for those of you who doubt it, it's not!!)

And then there's "Dr. Stick Up Butt" as in the old meanie who tries to ruin a child's Christmas on "Miracle on 34th Street." Those therapists! Always getting in the way of folks trying to have a good time!

Barbra Streisand's portrayal of an unethical boundary-busting sexual libertine on "Prince of Tides" was not a great professional moment for us. I don't want to give the impression that I have my head in the sand about therapists violating boundaries, even sexual ones, with clients. Therapists do it more than we realize. It's just hard to have out there as an iconic representation of one's professional field.

To my mind, one of the most scary and stand-out portrayals of therapist as "Dr. Crazy" goes to Richard Dreyfus' portrait of a therapist driven even crazier than his initial presentation as an uptight, OCD, money-grubbing and self-serving Narcissist by the demands of a needy and relentless patient, played by Bill Murray. This therapist is unable to hang on to his own sanity in the face of his client's desperation and becomes unhinged, thus joining the ever-growing list of Hollywood's celluloid images of us therapists as even sicker than our clients. What hope is there for any of us with therapists like that out there?

I can't think of one single image in Hollywood that shows a therapist in anything other than a flawed manner. We're either morbidly curious, sexually predatory, unhinged sociopaths, moody and voyeuristic, power hungry and money-grubbing, or hapless and stupid. Yeah, yeah. I know that we're all flawed. But come on! Hannibal Lechter flawed??

Falling In Love

This blog was unwittingly inspired by an innocent comment made by a client last week. When talking about an interaction with a fellow bodywork professional, my client referred to their mutual understanding of what it feels like to “fall in love” with clients. I understood immediately that this was not meant in a sexual way, but referred to a clinician’s ability to fall in love with people’s vulnerable humanity. But it got me thinking, because I fall in love with nearly all my clients.

Many years ago I read that the need to love is as important for human beings as the need to be loved. I remember crying when I read those words, because it explained something important about the way in which I contribute to the world that was heretofore unexplained. I am a love machine – not in the way that the Motown group The Miracles meant it, but in a human miracle way. I get a kick out of liking and loving people and I’ve always been good at it. And while I’m definitely a caring person, I’m not exactly a caretaker. I don’t have too much difficulty with giving folks some straight talk if that’s what I think is required, even if it means they experience discomfort as a result. I don’t shy away from people’s feelings. I like people to feel good, but I’m not invested in that outcome if feeling bad for a while will get them to a more whole place in their lives. My friends tell me that I’m very loving, thoughtful and caring, good at expressing my affection and nurturing feelings towards them. My partner thinks that I’m the bees knees in the loving-and-caring department. In fact, I’m so programmed to like folks that I think of myself as somebody who can like and see good in just about anybody. As I have been known to point out to disbelievers, “Even Hitler loved his dogs.” In other words, even delusional crazy folks have at least one good quality, and I have rarely, if ever, failed in finding one.

I like thinking about liking people and interestingly, I’ve come to realize that it’s a lot harder to consistently and freely like and love partners, friends and family than it is to for me to like and love my clients? Why? Because relationships between lovers and family members are complicated. Even people who love you reciprocally will get tired of you complaining about the same old thing and tell you so. They won’t always be sweetness and light first thing in the morning or last thing at night. You have fights and struggles over the top left off the toothpaste and have to find ways to deal with the complicated minutiae of life, like who walks the dog most, and who forgot to pay the car insurance. And we take these fights very personally and they can get extremely messy.

Therapeutic relationships, like all relationships, have rules attached and the rules around caring and love are pretty clear. In therapy, the relationship exists to promote and benefit the client’s life, not that of the therapist. While the eroticisation of the therapeutic relationship is necessarily prohibited and contraindicated, verbal expressions of caring and liking are not. Just about everybody understands that seeing yourself reflected positively through a therapist’s eyes has a beneficial therapeutic impact. And, while there is a fragility inherent in most relationships, if you play your cards right you can return again and again to the relationship you forge with a therapist whose job is to see through your imperfections and personal challenges and reach for the true person inside.

There have been times when clients have made comments about the fact that I “have” to like them because they pay me and there are times when the issue of therapy fees can complicate therapeutic relationships between therapist and client unless you are completely willing to talk about the issue of money. However, while it’s true that therapy ceases for the most part when the fee is consistently not paid, it’s also true that the therapist remains willing to resume that relationship if and when the client returns. (I’m fascinated by the exchange of money in therapy and am working on a blog about this which I hope to post in the next few weeks.) This is not much different from other caring relationships where money exchanges hands. For example early childhood workers and teachers are paid to teach and encourage young children, and they invariably love and care for the children in their care, which is not a condition of their salaried position; the same goes for nurses and their long-term patients, and school teachers and their students.

Most clients are surprised by my willingness to talk of my affection and caring of them. They are surprised that I think of them outside of their sessions and frequently are moved to tears by observations and thoughts I have about them that surface in between our appointments. But as a client in my own therapy, I have had the experience of finding faith in my ability to tackle frightening challenges, buoyed only by my therapist’s caring and love for me. They don’t have to use the “L” word for me to know that I am loved – but sometimes the therapist’s empathy and nurturing have been the only things I have been able to rely on to propel me towards bravery. I use this personal experience of therapy in my own work as a therapist.

So, I see part of my job being to show love towards my clients and to encourage them to use this experience of my caring for them as a tool in other parts of their lives. Many people haven’t had the best experience of being loved in their early lives and without this experience it becomes difficult to love and treat oneself well. Therapy, with its one-way focus on a client is an opportunity to feel that acceptance and affection, the one-way focus on an individual’s life that many of us did not get to have as children. Therapists are, or should be, unfailingly polite and respectful, attentive and caring, concerned and thoughtful about their clients. It’s a gift to have this non-stop outpouring of thoughtful attention lavished on you for one hour a week with somebody who remembers the most seemingly inconsequential details about your life and can pull them together and tie up loose ends. And while being loved and cared for by your therapist isn’t THE whole story in psychotherapy, it sometimes forms the solid ground under the client’s feet that makes change possible.

Continuing Education For Therapists

I set great store in reading, researching and generally educating myself about all things psychotherapeutic. However, Continuing Education units (known as CE's) are one of the banes of my existence. CE's are a requirement for those therapists who hold licenses. Those of us who are licensed have to produce a certain number in a given period in order to renew our licenses with the state. Professional/clinical workshops and seminars that therapists attend generally lure you in with the promise of CE's in exchange for large sums of money and your attendance. Generally, shopping around for interesting workshops is challenging, despite the overwhelming number of workshops that are offered. Seminar titles may sound interesting, but presenters are frequently dull, turgid and uninspired in their delivery. On rare occasions, I have attended workshops whose titles sounded dreary and hum-drum, only to find that the presenter made the material come alive and I came away learning more than I had expected. It's a crap shoot. (I must remember to blog about the overwhelming number of gaming and sporting references that litter the American vernacular!)

Over the weekend I took the "4MAT Learning Type" inventory and discovered that my style is known as a "Diverger." As a result, I now understand why I get so bored in workshops in which there is so little experiential content (and this tends to be the case with most of the workshops I have attended) . My style is to "learn by listening and sharing ideas and to integrate experience with the Self." I need to be personally involved in the process of learning, not passively absorbing information.

Anyway, brochures advertising these CE seminars drop through my letter box daily. Most of them go straight into the waste basket, coming under the category of "I'd rather read the book." Let me give you some idea of the kinds of seminars that are offered:

* Assessing and Treating Reactive Attachment Disorder: Beyond Oppositional Defiant Disorder

* Is this abuse?: A conference on the intersections between abuser education and therapy.

* Forgiveness: How can I forgive you? A radical approach to healing intimate wounds

* Treating Couples: Clinical Perspectives on Men, Women and Couples Therapy

* Teaching Sexually Explicit, Comprehensive Courses: Reducing the Risk of Professional Liability

* The Perils of Trauma/The Diversity in Healing

* Child Sexual Abuse

Not only are these seminars a crap shoot in terms of interesting material, they are frequently expensive. For example, the Couples Therapy seminar is $260 (possibly because it's offered by Harvard Medical School.) The more credentials you have, the more complicated it becomes in terms of fulfilling CE requirements for that credential. The American Association of Sex Educators, Counselors and Therapists (AASECT) whose CE's I can apply towards my sex therapist credential with that organization, offer seminars infrequently on the Eastern seaboard of the United States, despite the fact that they are really the only show in town when it comes to credentialing as a sex therapist. On top of workshop fees, you then have to factor in travel/flight/hotel costs.

Forgive me, readers, if I take this opportunity to vent and whine about the overall quality of training for therapists. It's abysmal. When all is said and done, (and with few exceptions) the most useful clinical information I have received has come through one of three channels: talking with my clinical psychologist friend, Kathy, (see her blogs at www.humansexualitysextherapy.blogspot.com and also at www.kathymcmahon.blogspot.com ) my own research and reading or clinical supervision.

How to decide which seminars to attend
There are a few seminar presenters whose presentation style is stellar, and if I see their names on a workshop listing I will invariably attend. Failing that, selecting CE seminars/workshops usually involves deciding where the glitches in my knowledge base lie, and seeking out those seminars that appear to supply that training and information. For example, a workshop was offered through the Massachusetts School for Professional Psychology purporting to be a structured guide for therapists working with single clients who were seeking partners. The information focused on how to motivate clients and offer them resources. I believe the cost of that seminar was $95.00. I learned little that was new to me and I won't be attending any more of that presenter's seminars.

At the same location, I took a seminar on Sexuality and Aging. The presenter's style was dry and flat, but the bibliography was very helpful. Probably not $90.00 worth of helpful, particularly as I'm a great "googler" and book researcher, but it got me started in the right direction. And, of course, I came away with 3 CE's.

I typically will sign up for anything new and interesting in the Human Sexuality field that is available, including new theories about working with couples, anything that addresses working with same sex couples or folks who are transgendered, and seminars that address HIV/AIDS and sexual "dysfunction." This has frequently meant traveling to New Hampshire, Maine and Vermont for some of my day-time trainings. (For international readers, I must explain that this means I am often driving more than 300-400 miles in a day to attend a 6 hour training.) Some of the best of these trainings are offered by unlikely sources. For example, I have found that the Northern New England Planned Parenthood organization offers a variety of interesting seminars on many subjects to do with Adolescent sexuality and I have attended several of these, despite the long drive there and back. (Their workshops also tend to be more experiential which also would fit in with my learning style.)

Interestingly, the Boston Area Planned Parenthood organization does not offer as varied a listing of seminars as their out-of-state partners. (It would be much easier to drive 25 minutes into down-town Boston than to make the 6 hour pilgrimage to Northern Vermont and back!)

My profession has generally been slow to use the internet, but I've noticed that gradually there are more and more online CE's being offered and this feels much more do-able in terms of time, resources and the dispelling of tedium. These CE's have the added benefit of learning at your own pace, being able to take frequent breaks and not having to listen to an uninspired presenter. Oftentimes, I will attempt to drag Kathy along to a workshop with me, reasoning that we both need CE's and if the event ends up being a drag, we can at least have fun perusing the book displays and hanging out together!