I'm ba-a-ack!

I've returned from vacation, and will be in my office tomorrow. It's always hard to end a vacation, but it definitely helps if you enjoy the job you are returning to. This particular vacation was helpful in that I realized I don't take enough vacation, and that I need to set aside more healing time for myself in order to have more to give in return to clients.

Meanwhile, having checked my phone messages upon my return, I discover that the telephone voicemail is full. Among the calls I received were:

* Several phone calls from clients checking in on me and asking for call-backs when I get back to town

* Beth from Computer Geeks (again) telling me about their fabulous service based here in Watertown (I haven't yet called her, given that I have "Computer Rick" and don't need Beth, with or without her "geeks!" )

* Verizon Wireless DSL trying to persuade me to sign up for service. I had DSL before and it didn't feel that much faster than dial-up...leastways not enough to make up for the fee differential.

* A couple of clients who decided that they were ready to return to therapy and when could I fit them in?

* 6 calls from prospective clients who would like to come in for couples therapy. One person asked if I worked on Saturday. That stopped me in my tracks. I don't think I know of a single therapist who works on Saturdays. Then I remembered that I used to work on Saturdays many years ago - but there wasn't much call for it, so I stopped.

* Several phone calls from clients who wanted to change their appointment time.

* Sundry calls from other therapists and psychiatrists checking in on mutual clients.

Today was my first day back in town. Despite the fact that I wasn't officially working, I did return calls (in the order in which they were received).

I also spent 3 hours at the dentist's surgery while my granddaughter got veneers put on her two front teeth which had snapped in half during a bicycle accident while I was on vacation. Her teeth have now gone from large, buck toothed and crooked to perfectly straight and average sized. Ah, the wonders of modern dentistry! What was not pleasant was listening to her screaming from the other side of the building...apparently, she spotted "The Needle" despite having been told to keep her eyes closed. These loud and terrified screams came despite the fact that she had previously been giggling up a storm on laughing gas...I dread to think what would have happened if she hadn't been sniffing the gas.

Anyway, it's good to be back.

Time Passing Incrementally

For people who are finding this blog for the first time, I normally spend a fair amount of my time writing blogs about being a psychotherapist and my ideas about psychotherapy. For now, I'm on vacation, so the blogs have a strong non-psycotherapy tinge to them!

In the meantime, Dori got tagged by a friend, and I liked the "tag" a lot so I thought I'd copy the questions and answer them. I really love questionnaires, probably because asking questions is my stock in trade. It's fun to have the tables turned on me and be the person who gets to answer the questions for a change! The other thing that is fascinating about this list of questions is that, as a psychotherapist, I'm used to my days being parcelled out in 50 minute session chunks. To think in smaller and larger units of time is interesting, and makes me realize how compartmentalized my life is by these 50 minute units!

1. What were you doing one second ago?
My car broke down when Kathy and I were going to take it on a tour around the Berkshires the other day. Today, having called AAA to come and jump-start it, I drove the car to a Saab dealer in Pittsfield. This is a way of introducing the fact that one second ago I was talking to my "spousal unit" on the phone, who was inquiring how long it would take for Performance Automotive in Pittsfield, MA to repair my car. (My car won't be back until Thursday or Friday so no leisurely touring through the Berkshires with the convertible top down, singing loudly as we like to do!

2. What were you doing an hour ago?
One hour ago, I was sitting outside in Kathy's yard, with Ziggy and Jack playing chase in the long grass, watching Kathy's chickens peck at fruit and vegetable peelings in their covered pen. They are so fun to watch. She has several different kinds. Gigantic Delaware roosters, with white feathers on their body, black speckling on their heads, huge red coombs and wattles and a very proud bearing. She also has Bantams, little white darting things with feather trims on their legs and claws. There are also Red Sussex, a British chicken, with mottled feathers and glossy tail feathers.

3. What were you doing yesterday?
Yesterday, I was writing letters, and reading a book on Growing Local Communities. In the afternoon, I drove into Northampton, while Kathy took a nap and Dan, her husband worked in his home office. I had an amazing massage with a wonderful massage therapist, Valdene Etter. (Today I'm sore. My neck muscles were tight and knotted and she worked them into a pulp!)

4. What were you doing a month ago?
Okay, this is getting harder. How to answer this question? A month ago on this date? That would have been July 15th. This means that I was seeing clients in my office in the morning and early afternoon and evening until 8pm. In between seeing clients, I was probably having lunch at home and playing with Ziggy.

5. What were you doing 1 year ago?
One year ago on July 15th, I was probably doing the same thing as above!

6. What were you doing 5 years ago?
I was working at The Family Center, Inc. in Somerville, MA. Tuesdays were nearly always Parenting Journey days, so I would have been getting ready for an evening group, setting up the room and having a planning session with one of the other co-therapists.

7. What were you doing 10 years ago?
In 1996, I was running a lot of therapy groups, including body image groups for women. My daughter would have been 19 years old and my granddaughter was not even a twinkle in her eye. How strange to think of a time without my beloved granddaughter!

Online Therapy Developments

One of the things that I'm working on while I'm on vacation is the development of my online therapy site. I now have a super-duper web designer, Sheryl Heiser , who has been doing fabulous things with my website design. Most of the text for the pages has been written although, as you might imagine, a website is always a work in progress. I'm not usually a procrastinating prevaricator, but putting this website online has taken a phenomenal amount of time. This is in part because I want to make sure that I'm totally prepared to provide therapy online that is as professional as possible, and creates as comfortable an ambience (within the limits of any online experience that is) as I provide in my face-to-face office environment.

As I begin the task of working with my web designer, I find it fascinating to think about how I'm going to provide the kind of welcoming and safe space that I strive to achieve offline. In my office in Watertown, MA, I can achieve that with plants and soft cushions, with muted color schemes and a comfortable couch. Creating a website that evokes a similar feeling is difficult. Here's an example of the obstacle I'm facing. Sheryl sent me a couple of mock-ups of possibilities for the site design and although both were beautiful, only one of them came close to achieving the feeling of serenity and peace that I was looking for (no spoilers here, folks!). The one that I turned down, while beautiful in its own way, did not create a feeling of safety and stability. The photograph on the home page was a woman floating in the ocean with her back to the camera and in clear focus. The water is a beautiful, mediterranean blue and on first viewing, it looks almost like an advertisement for a Paradise vacation spot. However, looking over her shoulder, you can see the awe-inspiring sight she is staring at. In front of her is a huge wave, crashing first on the rocks, and then exploding in white foam.. The wave is in soft focus, but it's in direct contrast to the calm waters in which the woman is floating. The foaming water looks ominously like an approaching Tsunami, not exactly a reassuring image to somebody seeking therapy online, who may already feel like they are facing an emotional metaphoric Tsunami of their own in real life.

It's a tough challenge to create a website that evokes all the things that therapy online aims to provide. A safe place to talk to an experienced mental health professional, at a time that is convenient for you, in the comfort of your own home, trailer, airplane seat, back yard, sail boat or wherever you may wish to conduct therapy online. Once the site goes up, I will be excited to hear feedback from folks letting me know if my objective, under Sheryl's excellent and inspired design implementation, has been achieved.

Psychotherapy Questionnaire

I got tagged via email from a fellow psychotherapist. I'm supposed to answer these questions from the perspective of being a shrink. (I'll do this as well as I can, given that I only have 3 days to go before I'm on vacation for 8 days!)

1. I've never: given up on a client, unless I'm clear that I lack the skills and/or experience to truly help them.

2. If only: there were more hours in the day and I didn't need to sleep. I really and truly love being a therapist and wish it wasn't so darned exhausting. Sometimes I have to stop because I've run out of hours, but I haven't yet run out of a desire to listen. Oh, and another "if only" is "If only it were okay to call a former client up after a couple of years and say - So, how's life going? Are you okay?" Sometimes it's hard to have people leave and never know what happened to them.

3. Once, somebody told me that: the most important thing about being a therapist is to bring your authentic self to each session. Clients can see right through artificiality and NO good therapy will happen as a result.

4. It would suck if: I hurt a client as a result of bad therapy. I don't think it's happened yet that something I did caused actual, long-term emotional harm. I don't think I could sleep at night until I had made attempts to rectify that.

5. My feelings would get hurt if: I had a less cast-iron ego.

6. I kinda wish that: I had a magic wand. In therapy, I will often ask clients, "If you had a magic wand and could magically change this situation (substitute "this relationship, this child, this husband/wife") how would it look?" While it's a reach for some people to access magical thinking, most of us can imagine and feel the sense of relief that comes with the powerful sense of having a "super hero" tool, such as a wand.

7. The best thing that happened in a session: would be hard to pin down. There are so many times when I can see that a client's life has moved forward with a big leap or even a small stumble and all of these times need to be celebrated. Overall, I think the best thing that ever happens in a session is that a client has the guts and the bravery to show up. It's really tough work and kudos for anybody brave enough to turn up week after week to tear the scab off emotional wounds.

8. The best thing that could happen in session: is a realization on the part of the client that it was worth it to show up that day.

9. The Psychotherapy profession needs: more and longer clinical training, more clinical supervision, and a greater focus on therapists healing their own family of origin hurts.

10. The Psychotherapy profession could do without: inept therapists, untrained, and using hokey, unscientific, untested and invalid clinical/therapeutic concepts which waste a client's time and money.

Blogging About Books

I just got "tagged" by a sister blogger so, in answer to her tag, here goes:

One book that changed your life:
I can't think of one single book that has changed my life, but many books have affected me. Charlie Deutsch's book, "Broken Bottles, Broken Dreams" which is about how alcoholism affects families, particularly adult children with respect to birth order, made me see my life and my childhood in a different way and was responsible for changing the way I conducted my relationships with my siblings and my parents. Marge Piercy and Mary Oliver's poems have been transformative for me. But I think "Practicing Radical Honesty" by Dr. Brad Blanton has been one of the books that has most profoundly affected the way I relate to other people and the personal standards I set in my life around truth-telling and honesty.

One book you have read more than once:
I have read many, many books more than once. Yalom's book on Group Psychotherapy is a book I refer to constantly. Millon's book, "Disorders of Personality: DSMIV and Beyond" is one of the best psych books I've ever read and I find his classification of personality disorders more useful than any other book on the topic. I also love "Jane Eyre" by Charlotte Bronte and cry every time I read it. I've read Louisa May Alcott's "Little Women" and the subsequent books more times than I can remember. But J.M.Barrie's "Peter Pan" must top the list. I read this almost daily as a child and longed to be magically transported, via the magic of fairy dust, to Neverland.

One book you would want on a desert island:
I can hardly bear to imagine what life would be like without a neverending supply of books. The idea of being relegated to one solitary book is painful and almost makes me gasp to think about. I guess it would have to be Marge Piercy's book, "The Moon is Always Female." The poetry is uplifting, spiritual and she speaks with such a clear and powerful voice.

One book that made you laugh:
"Good In Bed," by Jennifer Weiner.

One book you wish had been written:
The #1 New York Times bestseller, "The Jassy Timberlake 100% Fool-Proof Way to Find True Love and Happiness and Create Intimate Lasting Relationships" available wherever great books are found!

One book you wish had never been written:
I can't think of one. I think that all books, even supposedly hate-mongering ones, serve a purpose. I'm anti-censorship and believe that people have the right to make their own minds up about their values and beliefs.

One book you are currently reading:
Wow, where do I start. I'm always reading more than one book at once. Here's the list, and it depends on the time of day and whether I'm tired or not....

1. "Sinners Welcome," by Mary Karr
2. "Children of the Self-Absorbed: A Grownup's Guide to Getting Over Narcissistic Parents" by Nina W. Brown, Ed.D.
3. "Dress Codes: Of Three Girlhoods - My Mother's, My Father's and Mine" by Noelle Howey
4. "Bastard Out Of Carolina," by Dorothy Allison
5. "One Nation Under Therapy: How the Helping Culture is Eroding Self-Reliance: by Christina Hoff Sommers and Sally Satel, M.D.
6. "Broken for You," by Stephanie Kallos
7. "Stumbling on Happiness" by Daniel Gilbert.

One book you have been meaning to read:
"Authentic Happiness: Using the New Positive Psychology to Realize Your Potential For Lasting Fulfillment" by Martin E.P. Seligman, Ph.D.

10 Questions

Here are ten questions I got sent via email. I LOVE getting questions in the mail, or on the comments section so keep 'em coming!

1. So, as a newbie psychotherapist early in your career, what did you do immediately after seeing your first ever client?
I sat at my desk and cried for half an hour. I was help? I talked about this with my supervisor who told me that nearly all therapists feel like this early in their careers. When you start to see people's lives shift and change and see them getting mastery over their circumstances, you feel better about messing around in their lives.

2. What do psychotherapists not like to admit to?
We don't like to admit that we spent a whole session with a client and had no idea what was going on. It doesn't happen often, but it does happen. We also don't like to admit that we make mistakes, screw up or otherwise create messes for our clients. We do it. We just don't like to admit to it. I try to be as honest as possible in sessions, even going so far as to say, "I'm really, really confused right now. Help me out and repeat everything you just said, would you?" Unfortunately, sometimes even the repeat doesn't help.

3. What is the most challenging aspect of working as a psychotherapist?
The amount of background work you could do thinking about a client is endless. I frequently read information on their religion, the part of the world they come from, (even if it's "just" the US), their social class background, etc. I find myself thinking about my clients frequently, and if I'm worried about them for some reason, I've had dreams about them too. I get concerned that I won't be able to get creative enough, fast enough, to help them through a really tough patch in their life. ("Lighten up, Jassy!")

4. Do you ever dread going into your office in the morning and have you ever cancelled an appointment because you were dreading going into work?
I've had days when getting up and going into work has been hard. This is usually more to do with what's been going on in my own life, and rarely to do with my clients. On the whole I don't tend to cancel appointments, and on the rare occasions when I've been forced to cancel sessions, it has been something really unavoidable that precipitated the closure, i.e. my car broke down, our basement flooded or I had something disgusting and gastrointestinal. I figure if I can't stand the thought of going into the office, I should not be working with a particular client.

5. Is there one especially unique challenge with just about any client?
I would have to say that the hardest thing to communicate to just about any client is the concept of differentiation. I could write a whole blogsite which just focused on issues of differentiation, so it's going to be hard to address briefly here. But, as simply as I can put it, differentiation is about the ability of an individual to tolerate feelings of stress, tension and anxiety in a relationship with another, without losing sight of one's core self, without blaming the other person for your feelings: to learn how to self-soothe strong feelings that arise in the relationship; to learn how to hang onto a sense of autonomy in relationships without feeling flooded with feelings or getting overwhelmed by the other person's needs, wants and desires. The ability to differentiate in a relationship has to do with an individual's ability to manage the complicated dance between closeness and intimacy on the one hand, and separateness and autonomy on the other. Few of us learn how to do this as children, and most of us will spend our lives trying to figure out how to do this passably well. More in a future blog!

6. What do you think is one of the biggest misunderstandings about therapy?
I think that people misconstrue the idea of therapy as advice-giving and are surprised when their therapist holds back from doing that. And leading on from this, I think that a "comorbid" misunderstanding is the idea that the therapist is able to fix or cure their clients, rather than the therapist acting as a mirror in which the client begins to be able to truly see themselves, understand themselves and select their future path.

7. Is it important that the therapist be perfect?
No, not at all. How awful would that be to try and struggle with one's personal challenges in the face of an all-perfect, all-knowing, super-persona who can do no wrong? Yucky. What is important is that the therapist be honest, be real, be truthful and be willing to take responsibility for places where they aren't perfect.

8. Do some clients become jealous of your other clients?
I think the fact that the relationship between client and therapist is more or less doomed to end at some point is a really difficult and painful idea for people to think about as they become more invested in their therapy. After all.....doesn't everybody want to feel special? One thing that I have noticed is that when people have a regular appointment, they frequently become inquisitive about the people who come in before and after their particular appointment. Some folks want to ask lots of questions, or create stories about the other clients. I'm quite sure that it's frustrating to be told, "I'm afraid I can't answer that question." But also reassuring. If I won't give out any information about somebody else, then it's likely that I won't pass on confidential information about them either.

9. Have you ever been scared of a client?
I conduct an intake over the telephone, during which time I ask a fair number of questions about the client and their presenting problem, so I have a pretty good sense of who a person is. It's not impossible to fake being a psycho, but I trust the ripple of hairs on the back of my neck as a predictor of craziness. I must admit that I'm more likely to be anxious about men coming for their first appointment (they don't call it "The Dangerous Profession" for nothing) so I tend to sandwich new male clients in between other clients, and schedule the appointments for the earlier part of the day when there are more people in my building and also when the folks next door at Watertown Community Housing are still in their office space. The only time I was really scared before a visit was when an angry ex-husband of a client insisted on meeting with me. It turned out fine and I think the visit really helped stabilize things in the family, but it was scary contemplating his arrival, given that he was an unknown quantity.

10. Do you feel relaxed when you're with a client?
Most of the time, I'm just grooving on hanging out with my "peeps." I want passionately for my clients to have the lives, loves and relationships that they truly want and I get a kick out of watching them work their way towards that. Even when a couple is having a really tough time in a session, I nearly always can reach for a place of relaxed bonhomie. I try to maintain my sense of humor, which helps when couples are trapped in difficult and painful places with each other. As I have been known to point out, I don't have to live with them and so can afford to be relaxed! As I've written elsewhere on this blog, self-care is very important for therapists. Everybody has stress in their life and therapists particularly carry a full load, mostly other people's, but it's still considerable. A therapist who lacks the ability to set down that load regularly isn't going to be a great deal of help to their clients in the long-term.