Other Side of the Couch

Leave John and Elizabeth Edwards Alone Already

2008-08-12T16:00:00.000-07:00

George Bush has decimated the country, dumped our economy into the toilet, started an illegal war based on duplicitous, purposefully trumped up allegations of WMD's, ordered American troops to bomb, shoot and blow up innocent citizens in Afghanistan and Iraq and we have done nothing. He has eroded our civil rights and trampled on much of what Americans have always held dear and yet still we do little. No impeachment. No taking to the streets in massive numbers. Few demonstrations of outraged indignation, least ways few that have been televised or reported on in the press.

But John Edwards does what countless other husbands have done before him (a conservative estimate by Shirley Glass, Ph.D., has extra-marital affairs running at 25% of wives and 44% of husbands) and the pundits on TV are salivating and creaming in their pants over the salaciousness of the situation. Upstanding, loving, good-hearted and otherwise honest and trustworthy people have affairs. Try as the press might to demonize the likes of Bill Clinton and men like John Edwards, an affair is not evidence of a lack of character. It's just evidence of boundaries that peeled away, leaving the person in a committed relationship open to the lure of an affair.

Focusing on John Edwards is a huge red herring for the American populace, as our cost of living sky rockets, our climate continues its wobbly descent into global warming via serious drought, melting icebergs, wildly fluctuating temperatures and general planetary instability. Our outrage over John Edwards cheating on his plump and dying wife, with a slim blond co-worker, Rielle Hunter, takes our attention off the crap that the neo-cons are pulling as they lurch into the dying months of their last few months in office. Meanwhile, John Edwards and his wife, Elizabeth have a lot of work to do in a short time as they have Elizabeth's incurable cancer to contend with. The task of rebuilding a marriage after an affair is an onerous one. I'm sure that task is not helped by the orgiastic delight with which news shows go over and over the details of the affair, pontificating for hours on end about whether Ms. Hunter's child is Edwards' "love child" and whether he should be allowed to stay in office due to this "serious error in judgment."

Our outrage also distracts us from what we should be doing to protect our own relationships, to have the kinds of discussions in our relationships that draw lines in the sand and define what fidelity means to us, whether we are in a monogamous or non-monogamous relationship. In my experience with couples who are dealing with the aftermath of an affair it feels to both partners like the world has tumbled off its axis. Partners need time, understanding, non-judgmentalism and compassion to heal from the impact an affair has on a relationship.

I hope the Edwards family has thrown out their television sets.

Inspiration For Being A Therapist

2008-05-26T07:46:00.000-07:00

I grew up in the United Kingdom. Although I was born in Swansea, South Wales, my family moved into England when I was still of elementary school age. One of my most vivid school memories was of a particularly loved teacher at Elmbridge Road Junior School in Elmbridge, Gloucester, UK. Mr. Rapson was my home room teacher when I was 10 or 11 years old. He was a very short, rotund gentleman with a short-back-and-sides hairdo, extremely baggy brown pinstripe suits, and a habit of twitching and blinking. In retrospect, I think he had Tourettes Syndrome, but back then it was just intriguing to watch him twitch and blink his way through our classes. English, and in particular story writing, was my favorite lesson time. Back then, we used ink pens that you had to continually dip into ink pots which teetered precariously in their roughly carved out holes in the rickety, creaky, wooden school desks - pens that left you with ink stained fingers and spots of Indigo Blue on your school uniform.

On one particular occasion, I had lovingly written, in ink and “joined up” writing, a vivid story, complete with my usual huge cast of characters, all busy relating, chatting and talking to and about themselves. Mr. Rapson bent over my desk and said to me, “All they do is sit and talk to each other, dear girl. Can’t you make them do something more interesting?” Shocked, I sat and pondered his question seriously. What, I thought, could be more exciting than sitting and listening to other people’s stories?

When my paternal grandparents died my father inherited all their books, which came housed in a huge, mahogany bookcase, with sliding glass doors. I believe it was my grandfather, Stanley, who was the avid reader and one of the book collections he had assembled over the years was a complete set of detective fiction by Erle Stanley Gardner, creator of the Perry Mason stories. I must have been about 9 or 10 years old when I picked up the first one and I was hooked. I slowly read my way through the entire collection, falling in love with the characters, fascinated by the complexity of the plots, and the development of the relationships between people. What 10 year old would not have been fascinated by books with titles like, “The Case of the Vagabond Virgin,” “The Case of the Cautious Coquette” and other fascinating and attention-getting headings? Thus began my love-affair with Mystery/Detective fiction. As I grew up, I moved onto Agatha Christie and Arthur Conan Doyle and later I read my way through the mysteries of Patricia Cornwall, Sue Grafton, John Grisham, The Kellermans, P.D.James, Martha Grimes, etc.

Can you see where this is going?

Being a therapist is a great deal like being a detective. Day after day, people come in and sit on the bright red psychotherapy couch in my office. Their job is to tell me stories about their lives and my job is to listen carefully. I hear about their parents, their siblings, their lost loves, their current loves, their fears and confusions. I hear about times in their lives when they have triumphed. I hear about times when they feel disappointed in themselves and feel that they have sadly failed. I hear about places where they feel strong and confident and places where they feel vulnerable and scared. They come in individually, looking for a place to make sense of the pieces they present to me over the weeks and months. They come in with partners, with friends and family members, each person with their unique spin on the same situation, with their own narrative to explain how their lives intersect. My job is to listen respectfully, and be able to pull all the seemingly disparate pieces together. (I have to confess that in this endeavor, I find it much more useful to think of myself as “channeling” Erle Stanley Gardner than Winnicott or Minuchin!)

So, if you’re good at Math in school, you’re told that you would make a great mathematician. If you’re a great athlete, you may be encouraged to think of yourself as an Olympic hopeful. But hardly anbody has words of encouragement or direction for small children who are just plain entranced by what human beings feel, experience, want and need to talk about.

So, yes, I was influenced to become a psychotherapist not just by my own crazy, wacky, dysfunctional family, but also by Mr. Rapson, Erle Stanley Gardner and the legions of mystery writers who came after him. (And there are those who say I look more like Miss Marples as each day passes!)

Health At Any Size

2008-03-27T14:26:00.000-07:00

I come from a long line of short, strong women ranging in size from voluptuous, to chubby-to-fat in girth, without exception sporting large breasts and wide hips. The women in my family live well into their late 80's and early 90's, with few health problems other than sore joints and seasonal colds. We have always eaten well and heartily. My own mother, nearly 79, still works out at the gym a few times a week, does numerous laps in the Olympic size pool there, still does her own home repairs, and likes to regularly go belly-dancing with my sister. For her 77th birthday, she went rappelling down the side of a 200 foot building and sent me the photos framed as a birthday present. She says she'd like to go hang gliding sometime in the next year or so. She shows no signs of slowing down yet. And she's for sure no light-weight.

If you've seen my photo, you'll know that I have not let the maternal side down. I'm most definitely fat. I tried not to be for years, but I am. That's just me. "Porky of bod," to quote an old friend (and I've come to love that expression) and it doesn't seem to change, no matter what I've managed to do to artificially shape-shift through dieting and (many, many years ago) a not-so-charming eating disorder. It never lasts and I'm miserable while I'm trying, so I've stopped. But I eat healthily and well for the most part, although I am planning to exercise more than I do. I'm in a sedentary occupation, with broken knees (a double knee replacement is in my future) and despite my occasional earlier incarnations as a gym-and-beach-bunny, in my nearly mid 50's I'm beginning to come to terms with the fact that this is just me - who I am - a fat (yes folks, it's just an adjective) therapist with above average intelligence, a big heart and a fairly healthy constitution.

I believe in "health at any size." I don't consider that being fat condemns people to a lifetime of diabetes and heart-disease, and I think that making healthy food choices is important because we only get one body and it's good to honor the one we get. Exercise is important for the same reason. (I'm not going to fight with folks about this - go look at Kate Harding's blog - she's written about this far better than I ever could.) I know that my perspective is an unpopular one, but I also think that time and adequate research will prove what most size-acceptance activists already know - it ain't that bad to be fat, if you are eating well and moving your bones regularly!

My granddaughter is 9 years old. A huge fan of Beyonce, Hilary Duff, Miley Cyrus and Fergie she sings along with her mother in the car, as the radio blares. Most of the words are beyond her understanding, but she's beginning to comprehend the idea that it's important to be "sexy" and that for some reason having the right kind of body is important. She's heard that being bootylicious is good, but fat is bad, although with a size-acceptance grandmother, she understands that laughing at fat people is not kosher and despite this, sadly, I have overheard her occasionally as she succumbs to the use of mockery, the chosen tool of most oppressors, when she sees fat people, young or old, on TV. For right now, she's a gymnast, muscular, slender, strong and lithe. And like many women who walk through my office door each day, she's confused. If bootylicious is good and "shaking your jelly" a la Beyonce is fine, where is the line between that and being overweight or fat?

"Are you bootylicious?" she asks my daughter the other day.
"Why yes, I suppose I am!" says my daughter, herself curvy with ample "toppage."
"Will I be bootylicious?" asks granddaughter, a furrow forming between her eyebrows.
My daughter, contemplating her own heritage, replies "Yes, sweetie, you will be bootylicious sometime in the near future."

Granddaughter is relieved, but I believe she's still confused. I think she's wondering how on earth you maintain bootyliciousness without sliding into fatness?

I can't think of one single female client I've had who hasn't, at some point, talked about the same confusion, and complained about the body they're in. Occasionally a man will talk half-heartedly about "getting in shape" but it's rare that they exhibit the same self-hatred as the women. Some women won't have sex for fear of their partner seeing their bodies. Some won't allow their photograph to be taken because they can't stand to see themselves. Some give up on big damn lives because of the body they have, the self-hatred they have and the flesh on their bones. Some won't go for walks, won't go swimming, don't go dancing even though they really want to, don't pursue relationship because they don't consider themselves desirable, lovable, sexy and attractive. Some of them count each calorie,and live lives of numeric and caloric turmoil as a result. Some of them have had weight-loss surgery, despite the health and morbidity risks attached. Few of them will make eye-contact with me as they talk about their hatred of their bodies. I try to reassure them that it's fine to talk about with me. However, if you're looking for diet support, I'm not a good person to come to. I encourage my clients to do what I try to do as best I can. Live as big a life as you can without being so concerned with the shell you're living it in. Eat healthily and heartily and stop when you've had enough and are full. Have sex. Get wet in a swim pool. Get mad when somebody tells you that you don't have a right to a life of joy, excitement, companionship, sexy times until you've changed your body size. This is your one shot at life in the body you have.

Settling In To Life As A Northampton Therapist

2008-03-20T15:05:00.000-07:00

Moving to Western Massachusetts has been a culture shock in many ways. There are sights, sounds, smells and personalities to familiarize myself with, and as somebody who lived most of my life in an urban setting, the learning curve is enjoyable, but steep.

The small town I live in is very rural, and other than a small log cabin near our home, there are no houses for half a mile and then another 2 miles before you come to the next building - the local (and only) grocery store. Despite the fact that our land is on a fairly major (for Western Mass) route, sometimes more than 15 minutes goes by without a car, truck or tractor driving past. During an ice-storm, few cars can get make it up the steep hill just past our house and when the ice and snow have carpeted the road surface with such a thick slick of slippery white, and we leave the lights on around our driveway to let people know that if they are stuck, they can call friends to be towed, and have a cup of tea while they thaw out and wait to be rescued. In between frequent snow and ice storms the road surfaces are visible and what was once a smooth road surface now ripples with frost heaves; parts of the road are almost split in half where the town didn't get around to crack sealing in time for the winter freeze.

One of the local farmers owns the corn field across from our driveway, and as spring approaches he tows cart-loads of manure and dumps it in the field, ready to spread it over the cornfield, readying it for the summer crop. Right now, the manure is frozen in dark clumps, forming piles which stand out starkly against the snowscape in the field. But as soon as the thaw comes, the manure will warm up and the smell will be unbearable to us city-slickers for a couple of days. I'm sure that we'll get used to it after a few years, but for the moment the smell is strong and unpleasant, as much as we appreciate the benefit it brings to the soil.

People are friendly and welcoming, but cautious and understandably so. I've been told by new friends that local people are wary of growing too close to those "flatlanders" who have newly arrived in the hill towns region of Western Mass. Apparently, as life can be harsh and hard here, sometimes people give up and return to their urban ways, leaving their rural friends behind. So there's a cautious "wait and see" approach to newbies in town. Your impact on a small town is much, much larger than the one you'd have in an urban town setting, and it's wise to be careful and even more respectful towards neighbors than you would normally. We clearly need each other more out here. Alienating neighbors is not a good idea.

I have always enjoyed spending time alone, and can wile away hour upon hour with books, writing letters, journaling and reading professional journals and magazines. Now a lot of my time seems to be taken in driving. Sometimes it takes me as much as three hours to get into Watertown where I spend two days a week seeing clients at my Watertown office. When I'm back at home, I have a 40 minute (19 mile) drive into Northampton to see clients one to two days a week. I plug in my Blue Tooth headset, and talk on my phone to friends and family on the long drives backwards and forwards down the Massachusetts Turnpike, and my CD box is overflowing with music that I listen to in between phone calls. I would still rather be sitting with my legs up on our over-stuffed leather couch, reading a book, but music and phone calls make the trips bearable.

My practice is still building in Northampton, but meanwhile my online therapy practice more than keeps me busy. I have developed a sub-specialty in working with transgender active duty military personnel (and sometimes their family members), and as my name gets passed around transgender chat rooms and transgender support sites online, this practice continues to build. (There is much to say about this, and my intent is to write a series of blogs on the issues facing people who are transgender and serving in the armed forces.) Meanwhile, sitting at my computer upstairs in my study wearing fluffy flannel pajamas, warm slippers and my favorite Pashmina around my shoulders (purchased by my mother as a present for me at a store in Heathrow Airport) conducting therapy online with a soldier stationed in Iraq is another wonderful way to pursue a life as a therapist, and adds greatly to the quality of my professional life that I can conduct some part of it in my PJ's!

Northampton is delightful. The town is fully of bijou restaurants, music venues and clothing stores, one-of-a-kind art stores, and so many bookstores that I feel as if I've died and gone to heaven. They don't call this area "Happy Valley" for nothing! Suffice to say that this is not a welcoming place to live for republicans. The town is very gay and lesbian friendly and while it's not as ethnically diverse as I would like, there's plenty of room for all sorts of people. People watching here is a delight. I described it to a friend as being "Harvard Square on steroids." I don't think I've ever seen as many white people with dreadlocks in my life!

Being one of only three sex therapists in the immediate area of Northampton and Amherst has also meant that I've been met with a very big and friendly welcome by local psychotherapists, eager for places to make referrals for clients struggling with sexual disorders. So, I've been invited to join online lists of local psychotherapists in private practice; I've received invitations to meet and socialize in local restaurants with like-minded clinicians; people have freely shared their resources whether it be suggestions for where to find office space, or how to locate a good billing person. I've been stunned at how fast I've made friends - what took years to accomplish in Boston, has happened in a matter of months in Northampton. So, my practice here has been growing nicely, and I love my new office space on King Street. In addition to being just a brisk walk into the hustle and bustle of the downtown area, there's also the benefit of being set back from the street, so my office is quiet and peaceful no matter what the time of day.

I feel quite blessed these days.

Are "Gay Divorcees" really feeling gay?

2008-01-23T13:55:00.000-08:00

Same-sex couples have been dealing with relationship break-ups in therapy for many years. A new wrinkle for some of these break-ups is the inclusion of legal marriage and legal divorce. While 50% of heterosexual marriages end in divorce, there are particular issues to same-sex divorce that psychotherapists and other divorce professionals must understand. These differences include same-sex couples’ lack of familiarity with the legalities of divorce, the homophobic culture that provides varying degrees of support for the marriage or understanding of the factors existing in same-sex divorce, along with added pressure from both outside and inside the LGBT community.

The Massachusetts high court ruling in November 2003, which allowed same-sex couples to marry beginning in May of 2004, was a landmark decision that took the GLBT community by surprise. Despite all their work fighting for civil rights, few GLBT activists expected the expansion of our civil rights to include legal marriage. The passage of the Defense of Marriage Act (DOMA) in 1996 had explicitly defined marriage as a union of one man and one woman for the purposes of federal law. At the time, the passage of that act felt for many in our community like large, rusty nails in the collective GLBT civil rights coffin.

The idea of having our relationships sanctioned by law was so unexpected, such a never-in-our-lifetime-feeling, that many people leapt to make their relationships legal, in order to take advantage of what they feared would be their only chance to protect their families. Some couples have reported feeling that, thrust into getting married to protect what limited benefits they were being offered, they didn’t really understand the long-term ramifications of being legally married. Some have even told of being audited because their taxes were not understood by the IRS. Other couples faced loss of their health benefits after passage of the bill, and felt they had no choice but to marry.

Same-sex couples aren’t the only ones unfamiliar with their new status. Many lawyers in Boston are refusing to take on same-sex divorce cases because the law is so untested and is even more problematic because same-sex marriages are not federally recognized. From a legal standpoint, this makes our divorces even messier than those of heterosexual couples. As Joyce Kaufmann, a Boston-area lawyer, has pointed out, divorce is one of the benefits of marriage. On top of the complex legalities of same-sex divorce, few of us have had time to catch up with the steep and complex emotional learning curve of such a benefit.

Divorcing same-sex clients often feel like they are walking on the crunching egg-shells of a legal system unprepared for same-sex marriage, let alone same-sex divorce. Kali Munro, an online therapist living in Canada says, “I find that heterosexual couples are more likely to have known other people who have divorced, what their rights were, how finances were handled, what to do, etc., whereas lesbian and gay couples are new to the legal and financial implications of marriage and don't always know their options. I've heard some lesbian couples say that they can't divorce, despite their great unhappiness, because their finances are shared and they don't see a way out of it. This adds even more strain to an already strained relationship.”

Making the decision to end a relationship is a difficult and painful one, a decision that few couples make lightly regardless of sexual orientation. Research has shown that most divorcing couples face a complex emotional salad of confusion, shame, embarrassment, uncertainty, sadness and a profound feeling of personal failure. Bear in mind that this research was carried out using divorcing heterosexual couples as the basis for the research, against the backdrop of a culture and society that promotes, supports and protects their marriages. The same situation does not pertain for same-sex couples whose relationships may have been vilified and discounted by homophobic opposition. Same-sex clients contemplating divorce, in turning to their therapists for emotional support and guidance, may find clinicians who are unaware of the particular complexities of same-sex divorce, including issues that may be concealed beneath layers of shame, humiliation, and internalized homophobia.

Same-sex relationships suffer from bad press and a host of inaccurate, homophobic myths. We have been told that our relationships aren’t “real”, that they don’t last, and have even been equated with bestiality (Thank you, Huckabee!) Joe Kort, psychotherapist and author, says that in his clinical practice he has found that same-sex clients who are in the process of divorcing “are afraid to tell family and friends for similar reasons that heterosexual couples have but, in addition, their divorce is like confirmation that heterosexism is correct and that gay relationships are doomed to fail.” None of us wants to provide fodder to anti-same-sex marriage individuals and right-wing organizations who will point to divorcing same-sex couples as evidence that we aren’t “real” couples. But, as Kali Munro points out, “How odd that anyone would even try to point to divorce in the lesbian and gay community as proof that those marriages were never 'real' when we all know about the divorce statistics in the heterosexual community!”

Same-sex couples with children choose to marry for some of the same reasons as heterosexual couples. Additionally, they want to give as much protection to their children and their own vulnerable relationship as possible by taking advantage of their ability to legally marry in Massachusetts. I spoke recently with a lesbian mother who is going through a divorce and agreed to talk with me on condition that she remains anonymous. She said that she and her partner had been together for many years before they married and her experience in her family of origin was, “You feel like an outsider when you're not married.” For this lesbian mother, having children legitimized her marriage, because her parents saw themselves as having a formal role, that of grandparents.

Regrettably, not all same-sex couples are so lucky. For some couples, some of the emotional issues that arise from dealing with a homophobic culture are further amplified by marriage and then heightened further by a subsequent divorce. A couple who saw me for therapy told me that both their families had consistently treated their fifteen-year relationship as completely unimportant and invalid, even after their legal marriage, and, now, with their impending divorce, as if that too was “invisible.” One of the partners commented that it was clear to her that her parents hadn’t recognized either her marriage or her divorce as important as they did that of one of her siblings, despite the fact that my client’s grief at the ending of her relationship was as profound as anyone experiencing the end of a marriage. While her sibling had been showered with financial and emotional support, she said her parents refused to bring up the subject of their divorce and had even changed the topic of conversation on several occasions. Some of the work we did in therapy involved validating for this couple that their deeply-felt feelings of sadness, loss, fear and humiliation were real, and nothing to gloss over, despite their families’ insistence on treating them disrespectfully and not hiding their disapproval and judgment of them and their relationship. It’s not easy work.

Many divorcing same-sex couples also report feeling pressure from within the GLBT community. The additional burden of feeling like a poster child for same-sex marriage creates an added and sometimes overwhelming feeling of pressure. These couples are struggling with feeling as if they let down their community. Joe Winn, LICSW, a psychotherapist in private practice in Arlington, Massachusetts, reports that among clients going through same-sex divorce he has noticed clients “who refuse to address the intensity of their divorce - minimizing their feelings, minimizing their loss and mourning - which I have been attributing to trying to avoid the shame and sense of failure that comes with loss.” Winn reports that he has seen in some of his clients a re-emergence of internalized homophobia and a developmental regression of their lesbian or gay identity. Other therapists report clients talking about their deep feelings of embarrassment and humiliation and, in some cases, confessing that they dread telling their heterosexual friends and relatives even more than same-sex friends. It’s not only the homophobic response from families of origin and society that same-sex couples fear. As Joe Kort remarks, “Others have been judged negatively by their friends who tell them they should not have gotten tangled up with a legal system to begin with, something that straight couples would not necessarily say to one another about marriage.”

Elizabeth Zelvin, psychotherapist and mystery author, points out that therapists need to be mindful not only of the ways in which same-sex couples are the same or different, but the fact that some same-sex clients may be less willing to reveal relationship issues in therapy. The same issues that are at play in larger society for divorcing same-sex couples may also play out in their relationship with their therapist. For example, if the therapist is heterosexual, the client may be concerned about misunderstanding or homophobia from the therapist. If the therapist is lesbian or gay, the same issue of “letting down our team” may surface for the client. Feelings of shame about divorce may make them less likely to talk about their relationship issues.

Therapists have been dealing with relationship break-ups forever. Now, they must deal with the ramifications of same-sex legal marriage and legal divorce. In order to provide useful support to their clients, psychotherapists and other divorce professionals must recognize the particular issues inherent in same-sex divorce, including lack of familiarity with the legalities of divorce, the homophobic culture that provides varying degrees of support for the marriage or support, and pressure from inside and outside the LGBT community. By being mindful of and addressing the complex interplay of these legal, emotional and social issues, psychotherapists and other divorce professionals will be able to assist same-sex couples who find themselves in this previously uncharted territory.

(With thanks to Joe Kort, Kali Munro, Elizabeth Zelvin and Joe Winn for their clinical input and ideas.)

Learning about Peak Oil and Your Emotional Response

2007-11-19T08:12:00.000-08:00

Readers:

This article appeared in the Washington Post today, November 19th, 2007. It contains some of the arguments, theories and controversies surrounding Peak Oil. You might ask what this has to do with you and your emotional life. Let's go one step further. "What does this have to do with therapy or psychotherapy?" you might ask. My answer is "a great deal." Our lives do not exist in a vacuum - they are dramatically affected by the world we live in and very definitely affected by economic and environmental forces. Your world and mine will be increasingly effected by declining fossil fuel production. One example? How much less money do you have in your bank account as a result of the recent hike in gasoline prices at your local gas station? This increase in oil prices will begin shortly to affect everything - the price of food in the supermarket, the cost of home goods and supplies, the cost of clothing....all these require transportation to ship them to stores, and transportation costs will be affected by increased oil prices. These are all passed along to consumers in the form of increased pricing in stores.

Along with this financial impact comes a corresponding emotional response. If you read it, how did you feel as you took in the information in the article? Does the information feel like it's nothing to do with you? Does it feel like somebody else's problem? Does the topic feel too overwhelming to think about? Do you find yourself reluctant to read it? Feel that you can't take the information in? Distracted? Bored? Upset? If you are able to think about the issues, how does thinking about Peak Oil change any of the future and possible life plans you had?

This is the best site for good descriptions of the emotional responses that are possible when starting to think about Peak Oil. I'll be interested to hear what YOUR responses are, and I will be shortly posting a blog on the challenges facing Peak Oil aware psychotherapists when working with clients who have not yet considered the impact that declining fossil fuel production will have on their lives.

(With thanks to my friend, Mary McClintock, for sending me this article)

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Oil Officials See Limit Looming On Production

By RUSSELL GOLD and ANN DAVIS
November 19, 2007; Page A1

A growing number of oil-industry chieftains are endorsing an idea long deemed fringe: The world is approaching a practical limit to the number of barrels of crude oil that can be pumped every day.

Some predict that, despite the world's fast-growing thirst for oil, producers could hit that ceiling as soon as 2012. This rough limit -- which two senior industry officials recently pegged at about 100 million barrels a day -- is well short of global demand projections over the next few decades. Current production is about 85 million barrels a day.

The world certainly won't run out of oil any time soon. And plenty of energy experts expect sky-high prices to hasten the development of alternative fuels and improve energy efficiency. But evidence is mounting that crude-oil production may plateau before those innovations arrive on a large scale. That could set the stage for a period marked by energy shortages, high prices and bare-knuckled competition for fuel.

The current debate represents a significant twist on an older, often-derided notion known as the peak-oil theory. Traditional peak-oil theorists, many of whom are industry outsiders or retired geologists, have argued that global oil production will soon peak and enter an irreversible decline because nearly half the available oil in the world has been pumped. They've been proved wrong so often that their theory has become debased.

The new adherents -- who range from senior Western oil-company executives to current and former officials of the major world exporting countries -- don't believe the global oil tank is at the half-empty point. But they share the belief that a global production ceiling is coming for other reasons: restricted access to oil fields, spiraling costs and increasingly complex oil-field geology. This will create a global production plateau, not a peak, they contend, with oil output remaining relatively constant rather than rising or falling.

The emergence of a production ceiling would mark a monumental shift in the energy world. Oil production has averaged a 2.3% annual growth rate since 1965, according to statistics compiled by British oil giant BP PLC. This expanding pool of oil, most of it priced cheaply by today's standards, fueled the post-World War II global economic expansion.

On Oct. 31, Christophe de Margerie, the chief executive of French oil company Total SA, jolted attendees at a London conference by openly labeling production forecasts of the International Energy Agency, the sober-minded energy watchdog for industrialized nations, as unrealistic. The IEA projects production will grow to between 102.3 million and 120 million barrels a day by 2030. Mr. de Margerie said production by 2030 of even 100 million barrels a day will be "difficult."

Speaking Clearly

This is "the view of those who like to speak clearly, honestly, and [are] not just trying to please people," he bluntly declared. The French executive said many existing oil fields are being depleted at rates that will damage their geologic structures, which will limit future output more than most people allow. What's more, some nations endowed with large untapped pools of oil are generating so much revenue from their current production that they feel they don't need to further develop their fields, thus putting another cap on output.

Earlier this month, James Mulva, the chief executive of ConocoPhillips, echoed those conclusions in a speech at a Wall Street conference: "I don't think we are going to see the supply going over 100 million barrels a day.... Where is all that going to come from?" He questioned whether the industry has enough support services and people to execute projects to add that much oil production.

Even some officials from member states of the Organization of Petroleum Exporting Countries, which has long insisted on its ability to supply the world with fuel for decades hence, are breaking ranks and forecasting limits. The chairman of Libya National Oil Corp. said at the same London conference the world will have difficulty producing more than 100 million barrels a day.

A former head of exploration and production at Saudi Arabia's national oil company, Sadad Ibrahim Al Husseini, has also gone public with doubts. He said in London last month that he didn't believe there were enough engineers or equipment to ramp up production fast enough to keep up with the thirsty global economy. What's more, he said, new discoveries are tending to be smaller and more complex to develop.

Many leaders of the industry still dismiss the idea that there is reason to worry. "I am no subscriber to the theory that oil supplies have already peaked," said BP's chief executive, Tony Hayward, earlier this month in a speech in Houston.

Exxon Mobil Corp. Chief Executive Rex Tillerson has said that if companies had better access to the world's oil reserves, production would increase and prices would go down. "Sufficient hydrocarbon resources exist to play their role in meeting this growing global demand, if industry is allowed to access them," he said in a speech this month. If access were granted, Exxon Mobil believes the industry would be able to raise fuel production to meet demand in 2030 of 116 million barrels a day.

The oil industry has long been beset by doom-and-gloom scenarios, which so far haven't panned out. "The entire oil industry in the late 1970s was convinced the price [of oil] would be $100 by 1990 and we would need huge oil shale mines" to exploit oil locked away tightly in rock, says Michael C. Lynch, president of Strategic Energy & Economic Research Inc. Of course, that didn't happen, as discoveries ushered in new eras of low-priced oil in the mid-1980s through the late 1990s.

U.S. government experts are optimistic -- to a point. The Energy Information Administration, the data arm of the Energy Department, forecasts world oil production will hit 118 million barrels a day by 2030. But the agency warns that its prediction might not pan out if resource-rich nations such as Venezuela and Iraq don't invest enough in their operations.

"We know that the world is not running out of energy resources, but nonetheless, above-ground risks like resource nationalism, limited access and infrastructure constraints may make it feel like peak oil just the same, by limiting production to something far less than what is required," said Clay Sell, deputy secretary of energy, in a speech in October. Resource nationalism refers to tightening state control of oil fields to achieve political aims, often by restricting outsiders' ability to develop the oil for world markets.

'Undulating Plateau'

Two or three years ago, it was far more common for oil analysts and officials to trumpet the potential of new technology to harvest more oil. In a report last year, Cambridge Energy Research Associates, a prominent adviser to energy companies, made the comforting prediction that oil production could reach 110 million barrels a day by 2015, and "more than meet any reasonable high growth rate demand scenario we can envisage" up to that date. Because of progress being made in extracting oil through new methods, CERA said it found "no evidence" there would be a peak in oil flows "any time soon." In a later report, CERA said world oil production won't peak before 2030 and that even when it does, production will resemble an "undulating plateau" for one or more decades before declining gradually.

Oil companies have seen several years of bull-market prices, and thus of trying to produce more. This has given their executives a better sense of what is and isn't possible.

One limit: Many people think most of the world's giant fields already have been discovered. By 1970, oil-industry explorers had discovered 10 giants that could each produce more than 600,000 barrels a day, according to Matt Simmons, chairman of energy investment banking firm Simmons & Co. International. Exploration in the next 20 years, to 1990, yielded only two. Since 1990, despite billions in new spending, the industry has found only one field with the potential to top 500,000 barrels a day, Kazakhstan's Kashagan field in the Caspian Sea. And Mr. Simmons notes it is proving expensive and difficult to extract.

Big strikes are still possible. This month, Petróleo Brasileiro SA announced a deep-water find off Brazil's Atlantic coast that appears to be the largest discovery since Kashagan.

But some of the most promising geological formations are in locations that are inhospitable, for reasons of geography or, especially, politics and strife. Output from Iraq's rich fields is unlikely to grow much until security improves and outside investment returns. The future of Iranian and Nigerian production is likewise clouded by geopolitical and local instability.

Labor and construction bottlenecks also are making it difficult to develop proven fields. One of the largest obstacles is the booming commodity markets themselves: The prices of raw materials used in oil-field platforms and equipment has escalated. And during the years of low or moderate oil prices in the 1980s and 1990s, companies didn't develop enough geologists and other skilled workers to supply today's needs. "Years of underinvestment in new talent have led to a limited and aging pool of skilled workers," noted Andrew Gould, the CEO of oil-service giant Schlumberger Ltd., last month.

High oil prices have also led to steep cost inflation for drilling rigs and other equipment. Costs have soared so much that the industry is falling behind in the investment needed to sate expected future demand. To meet demand forecasts of 90 million barrels of oil a day in 2010, the industry needed to have spent $350 billion on drilling and producing in 2005, argues Larry G. Chorn, chief economist of Platts, the energy and commodities-information division of McGraw-Hill Cos. But the International Energy Agency estimates that spending on oil-field production in 2005 came to only about $225 billion, he says.

A failure to spend enough in the past few years "may have already put the industry behind the spending curve," Mr. Chorn says. As a result, he predicts "temporary shortages over several years, causing debilitating price spikes."

Compounding the problem: Most of the world's biggest fields are aging, and production at them is declining rapidly. So, just to keep global production at current levels, the industry needs to add new production of at least four million daily barrels, every year. That need is roughly five times the daily production of Alaska, with its big Prudhoe Bay field -- and it doesn't assume any demand growth at all.

Rate of Decline

Mr. Simmons scoffs at estimates that production from proven fields will decline only 4.5% a year. He thinks a more realistic rate of decline is 8% to 10% a year, especially because modern technology actually succeeds in depleting fields faster.

If he's right, the industry needs to add new daily production of at least eight million barrels -- 10 times current Alaskan production -- just to stay even.

Mr. Simmons thinks the world needs to shift its energy focus from climate change to more immediate concerns. "Peak oil is likely already a crisis that we don't know about. At the furthest out, it will be a crisis in 2008 to 2012. Global warming, if real, will not be a problem for 50 to 100 years," he says.

Oil executives who believe a production ceiling is coming are making plans to stay relevant in a world where oil production is constrained.

Mr. de Margerie said at Total's annual meeting this spring that the company was "looking into" nuclear-industry investments and had hired nuclear experts to help make strategic decisions. ConocoPhillips recently said it was considering building a commercial-scale plant to turn plentiful U.S. coal into natural gas.

Soaring energy prices have breathed new life into projects targeting "nonconventional" oil, such as that trapped in sand or shale. But these sources can't be tapped nearly as quickly or inexpensively as the big oil finds of the past.

Vivid Example

Canada's massive oil-sands deposits, which hold the largest oil reserves after Saudi Arabia's, offer a vivid example. They contain an estimated 180 billion barrels of oil. But after years of intensive development and tens of billions of dollars of investments, the sands are producing only a little more than 1.1 million barrels of crude a day. That's projected to reach three million a day by 2015. The oil deposits are so heavy that companies must either mine them or slowly steam them underground to get the oil to flow out of the sand.

Randy Udall, co-founder of the U.S. chapter of the Association for the Study of Peak Oil and Gas, has written that these unconventional oil supplies are like having $100 million in the bank, but "being forbidden to withdraw more than $100,000 per year. You are rich, sort of."

As these uncertainties mount, there is growing hope that Saudi Arabia, which has about 20% of the world's oil reserves, would ride to the rescue if needed. Saudi Aramco, the national oil company, has embarked on an ambitious plan to increase its daily production by 30%, or three million barrels, early next decade, and thus reclaim the title of top producer from Russia. But Mr. Al Husseini, the former Saudi oil executive, now an independent consultant, said others aren't doing as much, leaving the world entirely dependent on Saudi Arabia to provide extra capacity.

"Everyone thinks that Saudi Arabia will pull us out of this mess. Saudi Arabia is doing all it can," he says in an interview. "But what it is doing, in the long run, won't be enough."

Write to Russell Gold at russell.gold@wsj.com and Ann Davis at ann.davis@wsj.com

How to Figure Out When Therapy Is Over

2007-11-02T11:28:00.000-07:00

This article was published in the New York Times this week. I'm posting it here because I found it funny, insightful and interesting and hope you do too.

How to figure out when Therapy is Over
By RICHARD A. FRIEDMAN, M.D.

Published: October 30, 2007

If you think it’s hard to end a relationship with a lover or spouse, try breaking up with your psychotherapist.

A writer friend of mine recently tried and found it surprisingly difficult. Several months after landing a book contract, she realized she was in trouble.

“I was completely paralyzed and couldn’t write,” she said, as I recall. “I had to do something right away, so I decided to get myself into psychotherapy.”

What began with a simple case of writer’s block turned into seven years of intensive therapy.

Over all, she found the therapy very helpful. She finished a second novel and felt that her relationship with her husband was stronger. When she broached the topic of ending treatment, her therapist strongly resisted, which upset the patient. “Why do I need therapy,” she wanted to know, “if I’m feeling good?”

Millions of Americans are in psychotherapy, and my friend’s experience brings up two related, perplexing questions. How do you know when you are healthy enough to say goodbye to your therapist? And how should a therapist handle it?

With rare exceptions, the ultimate aim of all good psychotherapists is, well, to make themselves obsolete. After all, whatever drove you to therapy in the first place — depression, anxiety, relationship problems, you name it — the common goal of treatment is to feel and function better independent of your therapist.

To put it bluntly, good therapy is supposed to come to an end.

But when? And how is the patient to know? Is the criterion for termination “cure” or is it just feeling well enough to be able to call it a day and live with the inevitable limitations and problems we all have?

The term “cure,” I think, is illusory — even undesirable — because there will always be problems to repair. Having no problems is an unrealistic goal. It’s more important for patients to be able to deal with their problems and to handle adversity when it inevitably arises.

Still, even when patients feel that they have accomplished something important in therapy and feel “good enough,” it is not always easy to say goodbye to a therapist.

Not long ago, I evaluated a successful lawyer who had been in psychotherapy for nine years. He had entered therapy, he told me, because he lacked a sense of direction and had no intimate relationships. But for six or seven years, he had felt that he and his therapist were just wasting their time. Therapy had become a routine, like going to the gym.

“It’s not that anything bad has happened,” he said. “It’s that nothing is happening.”

This was no longer psychotherapy, but an expensive form of chatting. So why did he stay with it? In part, I think, because therapy is essentially an unequal relationship. Patients tend to be dependent on their therapists. Even if the therapy is problematic or unsatisfying, that might be preferable to giving it up altogether or starting all over again with an unknown therapist.

Beyond that, patients often become stuck in therapy for the very reason that they started it. For example, a dependent patient cannot leave his therapist; a masochistic patient suffers silently in treatment with a withholding therapist; a narcissistic patient eager to be liked fears challenging his therapist, and so on.

Of course, you may ask why therapists in such cases do not call a timeout and question whether the treatment is stalled or isn’t working. I can think of several reasons.

To start with, therapists are generally an enthusiastic bunch who can always identify new issues for you to work on. Then, of course, there is an unspoken motive: therapists have an inherent financial interest in keeping their patients in treatment.

And therapists have unmet emotional needs just like everyone else, which certain patients satisfy. Therapists may find some patients so interesting, exciting or fun that they have a hard time letting go of them.

So the best way to answer the question, “Am I done with therapy?” is to confront it head on. Periodically take stock of your progress and ask your therapist for direct feedback.

How close are you to reaching your goals? How much better do you feel? Are your relationships and work more satisfying? You can even ask close friends or your partner whether they see any change.

If you think you are better and are contemplating ending treatment but the therapist disagrees, it is time for an independent consultation. Indeed, after a consultation, my writer friend terminated her therapy and has no regrets about it.

The lawyer finally mustered the courage to tell his therapist that although he enjoyed talking with her, he really felt that the time had come to stop. To his surprise, she agreed.

If, unlike those two, you still cannot decide to stay or leave, consider an experiment. Take a break from therapy for a few months and see what life is like without it.

That way, you’ll have a chance to gauge the effects of therapy without actually being in it (and paying for it). Remember, you can always go back.

Richard A. Friedman is a professor of psychiatry at Weill Cornell Medical College

The Last Twelve Months

2007-10-16T13:34:00.000-07:00

I have wanted to post here on many occasions over the last year, but life has come between me and my writing. I apologize. You have all been so patient. A lot has happened and I hardly know where to start.

My online therapy practice launched, and I now have a second clinical practice in Northampton, Massachusetts in addition to my Watertown office. Life is busy and rewarding. The website is still being fine tuned, with encrypted email coming soon. I would also like to add streaming video at some point. The photograph there was a "placeholder" until my web designer could post a new one. That still hasn't happened, hence posting my photo here as I'm a firm believer in truth in advertising.

My father died in June, after a long slow hospitalization in a hospital in Gloucester, England. I'm not going to go into details about that in this post, but I have had many insights into grief and loss since his death. My life has changed and the impact on my family has been monumental. To say that he was not a kind man would be a serious understatement. On the contrary, he was a cruel, mean-spirited, narcissistic tyrant who terrorized his wife and children. But to watch a person slowly disintegrate before your eyes, lose life force and die is a life-changing event. I will write more on this in the months ahead.

Probably the most profound event of the last twelve months was relocating my home. Seeking a lifestyle more in keeping with my politics, and philosophy of life, I moved to the countryside. Having spent my life living in claustrophobic urban environments, where my house was separated from the next door neighbor by a car's width, I'm now living on nearly 20 acres of beautiful farmland in an 18th century house with my spouse and our dog, Ziggy. With two and a half miles to the only general store in town, I pass 2 houses on my way to it and other than that, it's us and the sheep, and the Llamas used by local farmers to guard their herds from murderous coyotes.

I believe that our access to fossil fuels is about to take a dive and when that happens life as we have known it will change irrevocably, making access to food and all other life-sustaining needs, difficult if not in some circumstances impossible. I wanted my family to be in a position to live a simple and sustainable lifestyle. I carefully picked the area I moved to based on input from, and conversations with, a dear friend who was already living in the town. Check out her blog at Peak Oil Blues. The Peak Shrink has written about the impact of diminishing oil reserves on our physical and psychological lives far more eloquently than I ever could - why reinvent the wheel?

The town I moved to is small, friendly and supportive. And, most importantly, they are already working on ways to simplify life, including exploring renewable energy and a commitment to eating locally grown foods. In the last few months, we have been planting tree crops and vegetables, making our house as weather-tight as possible, looking into raising chickens and goats (coming next Spring) and tripling the size of the existing vegetable garden. This stuff does not come easily to me and neither do I enjoy it much. I'm great with houseplants, but mulch, manure and garden gloves are alien to me. I am somebody who likes my eggs to come pre-washed and neatly arranged in a rectangular cardboard carton. The idea of fishing around in hay for my breakfast egg was initially less than appealing. But I notice myself changing. Slowly and surely, I'm increasingly relishing the prospect of carrying eggs in from the chicken coop every morning.

As you can imagine, acclimatizing to a very rural life has not been without its challenges. For instance, we have to drive for 30 minutes before we reach a gas station, so our cars have to be gassed up at all times. The same is true of food and other supplies. No quick trips into town for us. Everything has to be carefully planned and shopped for ahead of time. Like every small town, gossip travels fast. One example of this is that my car was thumped by a pick-up truck in the gas station. As soon as I had finished exchanging information with the other driver, I called my mechanic a mile or so away. "Oh, I know why you're calling," he said before I had even begun to explain my predicament, "and I know that you're going to need an auto body shop!" It turns out that a customer of his on the way to the garage had seen the accident. I'm the only very old, red Saab convertible in town so the mechanic had put two and two together.

Then there's the wildlife. And the bugs. Bears steal the bird feeders off the windows, rummage through compost and have been known to help themselves to the content of the refrigerator. (A neighbor's, not ours, thankfully.) This year, we have had a literal plague of ladybugs. Not just 50 or 60 of them, but thousands of them - they throw themselves against the windows and doors, desperate to get in before the cold weather comes. We vacuumed solidly for two hours the other day to get rid of the ones that had actually made it into the house. Yes, I know it sounds harsh. But one or two lady bugs are sweet and pretty. Hundreds of them dive-bombing the table, crawling into your bed, landing on the coats hanging by the door so thickly you can barely tell what color the fabric is? That's definitely a plague.

On the other hand, when catastrophe strikes, the town hears of it quickly and people are quick to offer help, support and sympathy. There are no street lights and there's almost no cell phone coverage here. But at night, with almost no light pollution from towns and cities, the stars are brilliant and clear, appearing to hang low enough to touch. While there are few stores, there have been garden delights that more than make up for this. I've made apple sauce from our own apples, Portuguese Kale soup with vegetables from our garden and we ate blueberries, raspberries and blackberries daily until the season finally ended. The crime rate is almost non-existent and when you are sitting on your front step staring out at the fields, everybody who drives by waves hello.

There is so much to say about this change in lifestyle. It has affected everything about my life, which includes a change in the way I think about my role as a therapist. I'll be writing more on this in the coming months.

Online Therapy Site Goes Live!

2007-01-12T16:56:00.000-08:00

To all those loyal readers who have emailed me to ask why the long absence, I'd like to thank you for your patience. Buying a house, packing up boxes, moving and unpacking, maintaining a busy clinical practice of face-to-face clients, along with the usual craziness of the holidays, my sister visiting me from England and working hard to get my new online venture up and "live" .....all these things and more have consumed my attention in the last few months. To those stalwart folks who are still awaiting a response to their email, my apologies. I will be in touch with you all shortly.

Meanwhile, I'm very proud of the Jassy Timberlake Online Therapy website and I look forward to expanding my clinical practice into cyberspace. Plus, I'll be back to writing in my blog more regularly in the coming days. Stick around!

Bored in Bed in Baltimore

2006-10-24T15:50:00.000-07:00

Dear Jassy:

My husband and I have been married for 5 years. In the beginning, our sexual relationship was fine. We were very attracted to each other, and we had great sex together - leastways, it was okay sex. I enjoy sex a great deal and consider myself a very sexual person. I've had several sexual partners prior to my husband, and some of those relationships were very sexually inventive and hot, hot, hot!

My husband was hot-to-trot in the early months of our relationship, so for the first two years (we married a year after we met) we had sex 4-5 times a week. Sometimes he would initiate and more often I would. We have an active social life, inidividually and together, and decided early on that neither of us wanted to be parents, so we have a great deal of freedom to come and go, have weekends away frequently and take vacations together whenever we can.

In the last few years, I've grown really bored of our sexual relationship. I have tried hinting to him that I would like to try something different, but he just won't budge. He becomes very defensive, and irritable and says that he's still enjoying it and he can't understand what's the matter with me that I'm not enjoying it too. Our initiation schedule has changed around drastically - I never initiate sex now, and am really only having sex with him so as not to hurt his feelings. I've avoided having weekends away together in the last year or so, because he always expects to have sex and I'm just not interested. The problem is not that I'm not interested in having sex, but that I'm not interested in having sex with him. I'm in my early 30's and think I'm fairly attractive - I get hit on quite frequently when I'm out with friends, and I have to confess that sometimes I've been tempted to take up some of the men on their offers. I am not the cheating type, and I do love my husband very much. I just don't feel much sexual desire for him these days and don't know what to do about it.

I have enjoyed the common sense approach you have towards people and their problems, and would appreciate any insight you may have into my situation. Before you say anything, yes, I do understand that my husband and I would benefit from couples counseling. (Do you know any sex therapists in the Baltimore area?)

Thank you for any light you can shine on the problem my husband and I are having.

Signed: Ms. Bored in Bed in Baltimore

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Dear Ms. BBB:

Oh boy. Where do I start?

It's hard to be one half of a couple for all kinds of reasons. But interestingly, the first six months don't tend to be that challenging, right? The making out and the sex can be fabulous and, even if it isn't, it's so exciting being around that new person that the constant state of arousal you're in seems to make up for their lack of technique, their inability to talk about sex, possible shyness and reluctance, or numerous other ways in which your new person isn't perfect. But once the rot sets in, it seems to really set.

I can't tell you the number of folks who walk through my office door and confide in me that they don't enjoy having sex with their partners, and that they are only "going through the motions." When push comes to shove, they can come up with all kinds of reasons why they don't want to have sex - but the truth is that most of us want to have sex if it's the kind of sex we want to have. You are clear that you want to have sex, just not with your husband. Your problem is that if you don't start getting clearer with him about just how disgruntled you are feeling about your sexual life together, you are going to end up talking to lawyers. In the long run despite the discomfort you may feel, it's infinitely preferable to have honest conversations with our partners about our sexual lives than it is to dig deep into our savings accounts and credit cards to pay lawyers for costly divorce processes.

You don't go into the kinds of sex you do enjoy having, but I'm going to guess that you and your husband have different sexual styles. I'm also guessing that to some other woman, your husband's sexual style would be their idea of heaven on earth. It's just not rocking your world, right? So, it's worth figuring out what you do want (and it's surprising how many folks haven't given this much thought!). The idea of sexual styles was developed by a brilliant man called Charles Mosher. There are three main styles, and usually folks can see themselves either clearly in one style or else a combination of two. There's no "right" or "wrong" style - they are all just different and all valuable. The trick is finding a way to work with the style that you have if your partner's sexual style differs greatly from yours. Trancers tend to be easily distracted when having sex. They tend to like diffuse or no light, are easily put off by sounds outside the room and within, and aren't the greatest "talkers" in the boudoir. They are into the visceral experience of being sexual - body contact, the dreamy quality arousal gives them. On the whole, their sexual fantasies appear somewhat esoteric. "Well..when the sunlight hit that woman's hair...the way her hair gleamed ...I felt warmth in my body..."etc. Partner Engagers are the big time romancers in the crowd. They are the rose-petals-on-the-bed-folks; they will look into your eyes, murmur sweet (and not so sweet!) nothings in your ear; they are all about the relationship between themself and their partner; their sexual fantasies have themes of partnering, emotional intimacy and connection. They like candle-light, want to see and be seen. Role Enactors are what I like to call the "Mile High Folks." They are creative sexually, have numerous ideas of things they want to try, are sexually adventurous and will try anything once. They are the folks having sex in the elevator, in a crowded train, in the bathroom 1 mile up in the airplane! Their sexual fantasies are wild, creative and varied.

My suggestion is that you go back to your husband, armed with the information about sexual styles, and be willing to have the conversation about what really (and I mean REALLY) turns you on. What was the best sexual experience you ever had with your husband? What made it good? What do you not like about what he does? What do you particularly like? How do you like to be approached? Is there any way that the two of you can overlap styles so that it's more satisfying for both of you?

If you get stuck and need help with the conversation, look on the American Association for Sex Educators, Counselors and Therapists website and look for a sex therapist in your area.

One final word - I'm glad that you've resisted the urge to cheat on your husband. This would just make a complicated situation even harder. Talk with him now, before it gets any worse. You deserve to have the kind of sexual relationship that you both find satisfying.

Good luck!

Jassy

Gay (but not telling!)

2006-10-06T10:35:00.000-07:00

Dear Jassy:

I gather that, judging from all the various gay and lesbian sites your name and professional contact information turns up on, you are gay and lesbian friendly. So, I'm taking the risk of sending you an email about a problem that I have. I ask only that you not publish my name and/or email address.

I'm 29 years old, and good looking in a wholesome, preppy way, athletic and toned. I went to an Ivy League school, have an MBA and recently got engaged to a really nice girl. So far, so good, right? The problem is that I'm pretty sure that I'm gay. I've had what you could call "illict" (sic) affairs since I was an early teen - things that went beyond the usual "circle jerk" at summer camp. I've dated women alongside my activities with guys, mostly for a front. The main reasons for this is that my family is very homophobic. I am making a very good living, but also have a trust fund which provides me with an excellent cushion. I live in Manhattan, and own my very small condo outright. If my parents knew that I was gay I'm pretty sure that they would cut off my trust fund, so I don't intend to tell them. I don't tend to "date" men, preferring just to pick up guys at bars after-hours. I would never take them back to my place, because I wouldn't want to run the risk of bumping into my fiancee. I'm not seeing this as a major problem, because I'm not interested in settling down with another guy - it's out of the question. My fiancee is a good person. We have a so-so sex life (I don't think she's that into sex, actually) that seems to keep her happy, so I'm guessing that I'm not doing anything wrong by having guys on the side. (I always practice safe-sex). What do you think?

"Gay On The Side"

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Dear Mr. Gay on the Side:

Yes, I am most definitely gay, lesbian, bisexual, transgender and intersex (GLBTI) friendly. I also consider myself to be a "sex positive" psychotherapist, not judgmental or critical about sexual practice that doesn't harm, hurt or otherwise screw with people's emotional and/or physical well-being. So I have to admit that part of me thinks that this email has to be some sort of prank, because I can't really believe that you're serious. I've been sitting staring at the computer screen just dumbfounded, not knowing how to respond. How on earth to respond? I've started replying to your email on several occasions, but have been unsure how to approach your question. Do I present as non-judgmental, which is my normal way of being and feeling in the world ? Do I keep my opinions to myself and be empathic with your situation? So, my response to you is being written as a human being who happens to be a psychotherapist. This is my opinion based only on what you've told me, and it is most definitely not therapy.

What you describe is wrong on so many levels, I barely know where to start. So while I am GLBTI friendly and affirming, I don't find myself feeling very friendly towards you and here's why.

You are telling me that you are a closeted gay man, who likes his affluent lifestyle. As a way of maintaining this lifestyle, you have become engaged to an unfortunate young woman, against whom you commit numerous infidelities, in order to maintain a veneer of heterosexual respectability so that your parents don't financially disinherit you. You have sex with her periodically but obviously not very good sex given that she "isn't that into sex actually" (and people usually want to have sex if it's the kind of sex they want to have, buddy!) and it is your intent to continue with this lifestyle?

It seems to me that you are not the one with the problem.

Your fiancee is the one who has the problem. And that problem is you!

I implore you to consider breaking this relationship off now before you cause any great emotional damage to the young woman to whom you are engaged. She deserves better. If you are under any illusion as to the moral and ethical wrongness of what you describe, take your email (and my reply) to any other psychotherapist and see what they tell you. I also suggest that you look under the word "Sociopathy" in the dictionary and see what you come up with. Your complete lack of empathy or self-awareness would indicate you might have a problem.

Jassy

Note to readers of this blog: For any homophobes reading this, sociopathy is NOT any more prevalent in the GLBT population than in the heterosexual population. This man's behavior is not because he's gay. He appears to have a limited capacity for empathy and caring, that is nothing to do with his sexual orientation and smacks of a personality disorder.

Running Into My Old Therapist

2006-10-04T22:57:00.000-07:00

Hi there, Jassy:

I'm a big fan. I think I've read just about every post and have found it helpful to read about your life as a shrink, so thanks and keep writing. I like the new format where you answer people's emails, and thought you could maybe help me with a small dilemma.

My question is actually about ex therapists, not current ones.

I live in a small town in Northern California. I saw a therapist here for about a year. She was good and helped me sort out some problems I was having. I came to the end of the piece of work I was doing and the shrink and I agreed that the treatment was over. I was a bit embarrassed about being in therapy, mostly because I was having erectile problems - I didn't really tell anybody I was doing it, because I didn't want people to think I was a head case or nut job.

Since then, I've bumped into her in a couple of places. Once was in a social situation at a party and another time I was out for dinner (actually on a blind date!) and my old shrink was sitting at the next table. It felt a little awkward, and kinda cramped my style with this new date I was on. I didn't quite know how to address running into each other on either occasion. At the party somebody introduced us, and we just said hello and smiled. She looked nearly as embarrassed as I felt. At dinner, I just ignored her sitting at the next table. Is there a protocol for this kind of thing and if so, what is it?

Ex Therapy Client in NoCal

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Dear Ex Therapy Client:

This is a good question and one that often comes up for folks in therapy. My answer is largely dictated by you saying that you had kept your therapy private and had not shared your experience with people you know.

If I think that my path and that of my clients are likely to cross, I often have a conversation with them and ask them how they would like me to respond if we run into each other outside of the office. Some people say that they don't know how they would want me to respond, but if they say "Hi" to me, it's okay for me to respond. Some people tell me that they would like me to smile and say hello if they're alone, but ignore them if they are out with people. Some folks say, "Hell, I don't care - come on over and say hi!" and other people would just prefer that we not acknowledge each other. I guess my suggestion for you is to figure out what your preferences would be and then call your former therapist and explain the situation to her. You can tell her how you felt on the occasions when you ran into each other, and let her know if you have a preferred way of handling this. Therapists understand that this can be difficult to navigate, and I'm sure your former therapist will agree to anything that makes life more comfortable for you.

An important thing to remember is that your therapist is ethically bound to maintain your confidentiality no matter whether she or he is inside their office or outside of it. While it is a shock to run into our therapists when we are least expecting it, our expectation should always be that they would never "blow our cover. " When introduced by an unsuspecting guest at a party, therapists are NOT allowed to say, "Oh yes, I know Mr. Incognito! We see each other every Monday morning at 9am and talk about his erectile problems!" or anything that indicates they know you in the context of a therapeutic relationship.

On a couple of occasions, I have run into clients in place where I least expected to see anybody I knew and I think we probably have both looked at each other like deer caught in the headlights. But the next time we saw each other in session, we talked about the chance meeting and how my clients would prefer to handle such a situation in future. For any therapist, regardless of the feelings they themselves might have at accidentally running into a client, their priority is ensuring that the client (or former client) can rely on their confidentiality being protected.

I hope this was helpful and good luck talking to your therapist!

Jassy

Confused and Loving Dad

2006-10-02T10:29:00.000-07:00

Jassy:

I've been divorced from my ex for a little while now, and separated for even longer (3+ years). We have a 4.5 year old daughter together, and from the beginning of the separation, my ex has been dead set on having full physical custody of our daughter. I spent about a year fighting it, but after getting the same story of failure by a father to get custody in this state over and over again, I relented and agreed to a visitation schedule.

At first I felt like I needed to spend every opportunity that I could with my daughter, but as time has passed, I've remarried, and we're expecting a baby very soon. I love the time spent with my daughter, but that time is few and far between, and when she's at the house, all activities seem to focus on her. I feel guilty if I'm not paying 100% of my attention to her, but at the same time, I feel guilty that everything else in my life that needs to get done is not getting done. Now my ex has moved and she and my daughter live far away. Before, it was a 10 minute ride between houses (we moved specifically to be closer to my daughter), and now it's over an hour. My ex and I have been attempting to negotiate a new schedule, but she wants a schedule that has my daughter with me for most of the weekend. I have suggested that I have her every other weekend, and an overnight during the week. My ex is exasperated that I wouldn't want to spend the whole weekend with my daughter, but I have a life, that 6 days out of the week doesn't include my daughter, and I need to maintain that life. However, I'm made to feel guilty for not wanting to spend every free moment with my daughter. Also, my ex has moved in with her in-laws and lives about 3 miles away from her parents and brother. My wife and I have NOBODY who lives nearby and have a virtually non-existent support system, so when my daughter is with us...it's only us who can take care of her. We know for a fact that my ex's in-laws and parents do a lot of babysitting for my ex. I don't think it's unreasonable to suggest that my daughter spend one night a week overnight during the week and every other weekend, but there's a part of me that feels like I'm being a horrible father. My ex fought and fought to be sole custodian, and now it feels as if she might have regretted that, as she seems to want to spend weekends without her daughter. How do I stop feeling guilty and get my life back? This can't continue, especially after my new baby is born.I love my daughter very dearly and treasure every moment I spend with her, but I don't think my new family should suffer as a result. It doesn't make anyone happy.

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Dear Confused and Loving Dad:

You are on a serious treadmill here, dear man. “How do I stop feeling guilty and get my life back?” This is the question that at some point or other most parents ask themselves and almost nothing brings that question up faster than a divorce. Ideally, your daughter would never have had to go through a divorce along with her parents. But this is not an ideal world. The reality is that there has been a divorce and you’ve done the best you can to be available to her, even down to moving to be closer to her. And it is also clear to me that you love her down to the bone. Soon she will have a sibling who will love and idolize her too, along with her father and new wife. In addition, your ex-wife has done a wonderful job of surrounding your daughter with family who will love her, spend time with her and care deeply for her. She has no shortage of loving care-givers.

The treadmill that you are on is a non-stop road to self-recrimination. If you stay on it, you will never ever come to a place of serenity in which you make peace with the fact that you are less than perfect. The idealized/perfect parent has no needs of their own, no faults, no problems and no imperfections. We all hoped for this from our own parents and were, of course, seriously disappointed. Part of growing up (and how we manage this task has a lot to do with how our parents handled their own feelings of inadequacy) is to realize that our parents had shortcomings, and that we still somehow survived magnificently at best, and intact at worst. Work on forgiving yourself, Confused Dad. Just that, forgive yourself. Then it won't be okay or acceptable in any way if your daughter and your ex-wife are angry with you or disappointed in you. Continue always to express your honest love and affection for your daughter. Make the moments that you do have with her count, whether it’s every other weekend and one night or one weekend in three. Be always respectful towards your ex-wife, no matter what gets thrown your way. Don’t get tied into trying to make people change the story they have in their head about you, regardless of whether it’s your ex-wife or your dear daughter. Their stories do not have to be your stories.

When it’s appropriate, you will have the opportunity to freely admit to all the ways you failed your daughter and apologize. For her part, as she gets older she will need to forgive you for not being perfect, both then and now. All parents go through this (and in my mind’s eye, I imagine my own daughter reading this and thinking, “Oh boy, ain’t that the truth!”) and learning to forgive yourself will enable you to step off that treadmill.

I have one big suggestion for you and your new wife. You need to find yourself a support system of other parents or caring friends. Ask one of your friends to set up 3 weeks of potluck dinners for you and your wife when the baby arrives. Hire a cleaner for the first few months if finances permit. Advertise on Craigslist for a new parent’s support group or put a sign in your local library. Put some thought into how you will make connections with other people. Form a babysitting coop for a few months down the line. Take these things seriously. Couple burnout is high when a new baby arrives as you will probably remember from your daughter’s birth.

Remember. Forgive yourself. Nobody else can do that for you.

Warmly,
Jassy

Hard Hats and Lingerie in Chicago

2006-09-30T00:27:00.000-07:00

Dear Jassy:

Okay, so this is embarrassing and humiliating. But I don't know who else to write to or talk about this with.

I work on a big construction site in Chicago. With the exception of a few girls who got hired on, it's me and a few hundred guys all putting this huge thing up, girder by girder. It's tough work, and sometimes it's dangerous. We all, girls included, wear hard hats, jeans and T shirts in the summer, and then switch out and add in flannel shirts and thick vests in the winter. Unlike all the other guys, I am not wearing boxers or Y fronts under my jeans, but women's lingerie.

I live in fear that I will have an accident and have to be rushed to hospital in an ambulance as they cut off my jeans and find my thong underwear. I sometimes have premonitions as I'm crossing over the construction site that something's going to happen, and find myself flinching. But I can't stop dressing up for work. I'm sure nobody would ever guess, as I'm Mr. Super Macho Man, swaggering around belching and farting like all the rest of the guys. It's not really me.

I'm not gay, I'm really not. I went through a phase where I was scared that I was and looked at some gay male porno just to see. It just looked painful and funny to me. Don't get me wrong - I don't have anything against homosexual men (or women either). I like women, and get turned on by women. But I don't tend to stick in relationships for long, because it's hard to hide the fact that I "dress." I've done this since I was a kid - used to wait until my mother would leave the house and then go look through her cupboards and drawers. It's kind of like I feel all the pieces of the jigsaw fit together right when I'm dressed in women's clothes.

I guess I don't exactly know what my question is. I feel like a screw-up. I'm tired of living with this constant fear of being found out. Got any suggestions?

Signed: Hard hat and a thong in Chicago

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Dear Mr. Hard Hat:

First off, I have heard stories similar to yours from men working on construction sites, so it is not as unusual as you might think. Like many crossdressers, you have picked an extremely manly profession - one in which nobody would ever suspect you of being anything less than completely manly, a "man's man," a masculine man! Interestingly, researchers estimate that approximately 1% of men in the USA crossdress, so you're in very good company. Like you, they just don't talk about it. And therein lies part of your problem - you are very isolated and isolation can easily breed self-hatred and destructively avoidant behaviors.

So, Mr. Hard Hat, you need to educate yourself.

You're clearly comfortable online, so I suggest you get hold of a basket of books - you can order through Amazon if you don't want to walk into a bookstore or library . Peggy J. Rudd's book, "Crossdressing With Dignity: The Case for Transcending Gender Lines" might be a good place to start. You can also check out some of the online information and support sites for crossdressers. For example, take a look at the website of the Chicago Chapter of Tri-Ess which is a support group for cross-dressing men (and their girlfriends and wives if they have them.) In order to feel better about yourself you need to learn more about cross-dressing. You need to understand the myths about crossdressing and the realities.

In fact, let's start with some of those myths, shall we? First off, most crossdressers are not gay. The majority are red-blooded, heterosexual men who just happen to like wearing women's clothes from time to time. Crossdressing and gay drag queens are not synonymous.

Crossdressing frequently starts very young and it's extremely rare for men to begin dressing in their adult years, so you're like most other crossdressers in that you got interested in your mother's clothes when you were young.

The American Psychological Association does not believe crossdressing to be pathological behavior and current theory has it that crossdressing can't be cured. In fact, the failure rate for therapists trying to "cure" crossdressers is apparently abysmal so, to my mind, the primary goal of therapy is to help the client begin to come to terms with their crossdressing and make peace with themselves and their identity. Whether you find yourself less interested in crossdressing as a result, or clearer on the part you wish "dressing" to play in your life, my suggestion for you, Mr. Hard Hat, would be to do the same. Most crossdressers who come into therapy come because they are weary of hiding themselves, tired of feeling so at odds with the world and their identity. So therapy will not change your desire to crossdress, but if you find a good therapist it will help you to understand your desires more completely.

As for finding a girlfriend who will understand? Well, I suggest starting with understanding yourself first. There are plenty of women who will accept and love men who crossdress if you can be honest and upfront about who you are. But it starts there, Mr. Hard Hat. Like many crossdressers, threads of shame, humiliation, fear of discovery and compulsivity appear in your email. Life will be a lot more manageable if you aren't struggling with those heavy hitters! Plus, how can you expect somebody else to love and accept you if you are struggling with those very same issues yourself? Start there, Mr. Hard Hat. Like the L'Oreal commercials say, "You're worth it."

Best wishes,
Jassy

Lacking Confidence in Florida

2006-09-29T15:06:00.000-07:00

Dear Jassy:

I've been reading your blog for a while now, and have wanted to post but feel like my concerns are probably peanuts compared with the problems that some of your readers and patients are probably experiencing. What prompted me was the example you gave in your blog yesterday about the treatment plan for the person who couldn't stand up to their dad. That leapt right out of the page at me and I wanted to know if you had any suggestions for my situation.

I don't know what the clinical terminology is for what I have, but I guess you could say that I'm very shy and lack confidence. I'm 30 years old and I grew up in a small town in Florida with a family that isn't good at handling feelings. My dad is definitely the man of the house, and my mom is almost a stereotypical housewife - she works part-time, and has raised us kids (I'm the oldest of three, but the only girl). My dad's word is law and always has been and even when mom doesn't agree with him she'll stick up for him. She's always making excuses for the things he does and says. If my family were a schoolyard, he'd be the schoolyard bully, always puffing himself up and singling out the weakest one. I feel like I've spent my life avoiding him, trying to make myself small enough so that he won't pick on me. Don't get me wrong - he doesn't hit us, never has. But he doesn't need to. He has this way of looking at you that makes you shrivel and he is constantly angry, although it leaks out sideways and you never know when it will come in your direction.

I'm shy in groups, and am allow myself to be controlled by what I think people will think of me. I always assume the worst, and second-guess myself all the time. It stops me doing anything, because I'm convinced I'm going to fail, so what's the point. This would be easier to come to terms with if he had been outright mean, but it was more that he put us down, particularly me as the only girl (although he didn't always treat my Mom that well either.) I easily feel diminished and put down by people I hang out with - it makes having a boyfriend almost impossible. I'm just too scared I'd pick somebody just like my dad, so it's easier to stay single.

I've ended up in a job I don't really want to do, because I worry that my father will disapprove if I change career paths. I don't have friends, because I find it hard to trust people (and even harder to like them.) I bought a house I didn't really want to buy, but because it was close to my parents and my father said it was a "good deal." I live in a neighborhood I really don't like for the same reason. He's just too much of a bully to stand up to, so it's easier to adopt his dreams for me than to fight back against him and have my own. I just shut down around him as a way to deal with his non-stop telling me what I want to do, what I want to eat, where I want to live and how I should dress. He controls my mother this way too.

When I read back over this, I sound awful - like some kind of freak. On my good days, I can tell that I'm a good person. I'm very kind, thoughtful and caring. It's just that I can't always get in touch with remembering these things about myself.

I want to have a bigger life. A better life. One that I can feel happy in. Do you have any thoughts about my situation and how to change it?

Signed: Lacking Confidence in Florida

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Dear Ms. Confidence:

Your email requires a lot of detailed response, and if I were your therapist I would definitely want to explore all the ways in which being raised by your parents had impacted your ability to make decisions and feel good about yourself. However, for the purposes of this one email response, I don't want to jump in and give you advice or tell you what you should do, because I'm guessing you've been told what to think, what to feel, what to say and how to act most of your life and I suspect any attempt to do that would go over like a lead weight (and I was going to say "like a fart in church" but didn't want to offend any delicate sensibilities amongst my readers!).

If you are 30 years old then your father is probably somewhere between 48 and 60 years of age. He's lived more than half his life already, and hopefully at least some part of it has been the life he wanted. You, on the other hand, are living the life your father wanted for you, and it does not sound to me as if you are enjoying it very much at all. You have two choices. You can continue to live the life your father has chosen for you, and be unhappy. Or, you can start to make your own choices, deal with the fall-out from your father, but have a life that is more in line with your own values, wishes and desires. It really is up to you. If you pick option one, you pretty much know what to expect. However, option two will need some careful planning.

What I am going to suggest is that you carefully and slowly, taking your own sweet time, find a way to envision the kind of life that you would want to live - not the one that your father wants you to have, but the one that would make you truly content and happy. Remember - take this slowly, Ms. Confidence. It's going to take you quite a while, as you will need to get very particular in the details of your vision. To start with, close your eyes. Imagine you are sitting on a chair in the middle of a room. This room is in the house you live in, but not your current home. It's the home you don't yet live in, but will want to ultimately. As you slowly begin to see yourself sitting on the chair, start by describing the chair you are sitting on. Is it a hard wooden seat with a straightback? Is it a soft cushy armchair, with squishy cushions and pillowed armrests? Is it a Papasan chair, made from willow? Once you have the picture of the chair, go on to imagine the room you are sitting in. Which room is it? Kitchen, living room, bedroom or maybe you're sitting in a hallway? Imagine that you have opened your eyes and are looking around the room. Would it be small and cave like? Open and light? Just one large room with all your furniture and belongings around you? Do you imagine stairs leading to the second floor, or are you all on one level?

As you try to day-dream about this, you may find yourself resisting it and you may experience feelings of frustration. That is natural. You have not had free rein over your imagination for quite some time, so it will take a little while for you to feel comfortable and confident back in the driver's seat. Just keep breathing, and keep thinking about the feeling and ambience of the room you're in. Now imagine that you're standing up and walking around your house. Keep noticing the kind of house you're in and remember that you can create it to be exactly what you want it to be.

When you feel that you have a sense of the house, go to the front door and walk out. Take a deep breath, and with your eyes still closed, imagine what you see when you open your front door. Are you surrounded by trees, fields and countryside? Are you on a busy urban street? Are there people waving hello to you as you open your door or are they busy with their own lives not paying attention to you? Drink this in. Notice what feels happiest to you. Start to do this visioning with every part of your life - after all, how on earth can you change your life unless you know what you want it to look like? Think about how you would like to spend your evenings: do you want to go camping and hiking? Maybe dancing? Learn a new dance step? Or maybe a new language? Just keep writing down all the things that you'd like to try to learn, or have fun doing. Nobody is going to commit you to anything. You're just experiencing possibilities at the moment, mulling over potential interests, not committing yourself to a course of action.

If you are comfortable with writing make sure to write down all the things you figure out about the place you want to live, the people you want to live with or near, the kind of environment you want to live in and the kind of community you seek for yourself. Keep adding to it until you can practically taste it, until you can truly see it. Look for photographs in magazines that look like the kind of place you want to live, articles about things that matter to you, values you hold and keep them all in the same place with either your hand-written journal, or print outs from your computer the life you want and where you want to live it. Nobody, but nobody else will be able to do this for you.

Neither your father, nor I, nor your best and closest friends know what is best for you, or what kind of life you should have. You have the right to self-determination. You are entitled to make decisions that may not be the ones that I or your father, your mother, your friends etc., would choose. But you have the right to make them anyway. You even have the right to make no changes at all and to leave your life exactly the way it is. Just remember that it will be hard at first to come up with your own plan for your life - you are going to be stretching muscles that you haven't had to use in a while.

So, am I going to suggest that you cut the cord with your father? No. It would be pointless of me to advocate for that. Only you can know what's in your best interests. But I am going to encourage you to create a vision of the life you would really love so completely that you cannot bear not to be living it.

The next thing you could do, if you felt like it, is get hold of a copy of Brad Blanton's book, "Practicing Radical Honesty." There is a chapter in there on figuring out your "life purpose." It is one of the most useful exercises I've ever done. (If you don't have money for the book, email me your address and I'll photocopy the pages for you - Brad won't object, I'm sure.) Do that exercise as many times as you have to until you can really picture what your purpose is in the world.

At the point when you can see, taste and feel the kind of life you want for yourself, go see a therapist. When you start to put your life plan into action some pretty heavy duty feelings are going to come up, and you will need supports in place to help you deal with them.

First things first. You need to know your purpose AND the kind of life you want. When you've figured that out, you're onto the next place. So, Ms. Confidence, what do YOU want to do?

Best wishes to you,

Jassy

Frightened of Failing Therapy

2006-09-26T06:00:00.000-07:00

Jassy:

I value your opinion as someone who has journeyed through counseling & someone who has "studied" counseling. I need your advice & wisdom. Today in therapy, my therapist said that we need to "re-look at the treatment plan and re-evaluate: see which goals have been met and what new ones can be created". (I THINK she mentioned new ones.) We completed the original treatment plan in 7/04. It has really not been mentioned much. This freaks me out. Am I failing therapy? Am I not working hard enough? (Please don't say, "why don't you ask your therapist?"-that will piss me off.) I think i MIGHT bring it up, but that is 11 days away, but besides that, what do you think? Is she going to kick me out? Am I too dependent on her? Am I not needy enough? Why did she decide on this particular day to say we needed to re-evaluate? She told me I should journal about "why I am choosing to stay stuck; safe vs. unsafe." This was after I shared for the second time this entry I wrote around 8/15ish "Now if I don't want my life to continue as it has been, then obviously I need to make some changes..." and I listed 7 things. We briefly talked about the need to do something different, and about the quote "Mental Insanity equals doing the same thing over and over again, expecting the same results."

Spill it and preach it.

Frightened of Failing Therapy

PS: I am going to sleep on it tonight whether I should ask her for a copy of my original goals (I know I should have it but....), and whether I can see her earlier instead of waiting 2 weeks, because I am really freaking out. I know I need to create attainable goals. But I don't know...in therapy do you do SMART goals like in the business arena???? I am going to go through my therapy journals from the last 2 years. I am going to talk about what positive steps I have taken as a result of therapy, and what negative steps I have taken because of/maybe not because of therapy; and think about new goals I can work on.

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Dear Frightened:

Wow, you really do have yourself in a tizzy here, don't you? I apologize for taking time to respond to your email and yes, of course I am going to suggest that you show the email you wrote me to your therapist. I don't know you inside out like she does, and therefore can't possibly respond with as much insight about you as she would be able to. Go on! Take the bull by the horns and risk it.

However, for what it's worth I will respond to your "spill it and preach it" invitation.

First of all, you can never fail therapy. Your therapist can fail you, but you can never fail. Just by showing up week after week, you show your willingness to make changes.

Let's start by addressing the purpose of treatment plans in therapy. Some therapists, as part of the early work in your therapy, formulate a treatment plan with input and guidance from the client. When used correctly, a treatment plan is a kind of road map for the work that you will do with your therapist during your course of treatment. The therapist, and the client, will use it as the beacon that lights the way for it contains the goals, aims, objectives and ways in which you are planning for your recovery. The treatment plan will often inform all the work that you do with your therapist and is YOUR definition of the ways in which you want your life to change. This plan will include what you are choosing to work on ("I don't know how to stand up to my father. I want to learn how to do this"), what you will do to work on it ("I will identify in therapy the specific things that scare me about standing up to my father. I will identify various ways to practice standing up to my father and work on the feelings that come up as a result, using role play, talking to my therapist about my fears and reading books suggested by my therapist "), and how long you think it will take to do this ("I will use these techniques over the next 3 months and re-evaluate the changes in my relationship with him at the end of that time"). Sometimes they address specific tasks such as consulting with a psychopharmacologist about medication, sometimes they make suggestions about groups to join or meetings to attend. Treatment plans seem very hard and fast, but actually they most often are used flexibly as things get worked on and problems figured out, and also as new issues emerge. Some of the goals may be long-term and some short-term. But the point of the plan is to concretize the direction of the therapy and to make clear what you, the client, hope to get from all your hard work.

Okay, so onto your fears. If you are clear that you and your therapist worked on the original treatment plan together and as you say it has not been mentioned since, my guess is that you met all your goals. This is a good thing, not a bad thing. Give yourself a pat on the back for all your hard work, Ms. Frightened! As goals are identified, worked on and successfully treated, you will move onto the next goal. I suspect this is what your therapist is referring to when she talks about identifying which goals have been met. More than a performance review for you, it's more like a strategic planning session for you and your therapist. Actually, it sounds like you already have plans to do that for yourself, based on your statement that you are going to "go through my therapy journals from the last 2 years. I am going to talk about what positive steps I have taken as a result of therapy, and what negative steps I have taken because of/maybe not because of therapy; and think about new goals I can work on." You are clearly a pro-active kind of client , and this is wonderful - we therapists LOVE working with folks like you!

The insecurity that you display about your relationship with your therapist could probably benefit from attention. For example, unless you are (1) threatening your therapist with physical violence (2) not paying him/her or (3) repeatedly cancelling without notifying her, then it is highly unlikely that you are going to be "kicked out" of therapy. Tell your therapist about your fears. No doubt this isn't the only place in your life that you fear rejection, but it does give you a safe place to work on these feelings so that they have less power over you in your life.

I'll be rooting for you, Frightened!

Jassy

Girlfriend with Jealous Lover

2006-09-24T22:10:00.000-07:00

Dear Jassy:

I am a graduate student and, while doing an internet search, turned up your blog site. I know that you don't provide therapy in your blog, but you did say that you answer people's email questions and so I have a question for you. I'm a lesbian and have been involved with the same woman for the last 5 years. I'm 27 years old and she's 28 years old. We are very committed to each other and would like to spend the rest of our lives together. (Unfortunately, unlike Massachusetts, our state does not allow same-sex couples to get married.) My girlfriend is a wonderful partner. She's very loyal, devoted and we get along really well, despite having different interests. Where we are similar is that we want the same things out of life. Most of the time I'm really, really happy with her. We live together, with our dogs, contribute fairly equally to the household budget and see the same things as important in life - paying bills on time, having good food in the house, and spending time with our dogs and our human friends. From the outside, everything looks wonderful and we are, most of the time very happy together. The first year that we were together was just great. She said that it was the first time in her life that she had ever felt safe, and that she felt drawn to me because of this.

The problem is that after the first year, my girlfriend became more and more jealous. From having talked with friends, I think it goes beyond normal jealousy. Despite the fact that I have done nothing that deserves her jealous actions, she doesn't believe that I'm not going to cheat on her. She has a hard time with my close friendships. She has sneaked into my study and read my journal. She gives me a really hard time if I'm late home, and sometimes has shown up places when I tell her I have appointments. She frequently moves her schedule around so that she can be there when I come out of school in the evening, and is always showing up unannounced at the restaurant where I'm waitressing my way through graduate school. Sometimes she's opened my personal mail, and says that she was in a hurry and didn't pay attention. If I spend any time online, she's convinced that I have an internet romance and is constantly complaining about the time I spend doing internet research for school, or replying to my emails. I'm sure this jealousy has something to do with her own history. Her dad cheated on her mother and left them when she was quite young, and she's had other girlfriends cheat on her quite a few times before.

I would feel differently if I had something to hide. But I don't. I've never cheated on anybody. However, this behavior is crazy making. I'm beginning to feel crazy and dishonest even thought I haven't done anything to feel guilty about! I've noticed myself feeling more protective of my privacy, feeling resentful at her blaming me for things I haven't done and feeling like I don't want to share things with her because she doesn't trust me anyway!

I know that you're going to say I should speak to a shrink, but I don't have health insurance at the moment, and I can't afford to see a therapist until I finish school and have a job. In the meantime, have you got any suggestions for how to handle the situation with my girlfriend? I really love her and don't want this to come between us. I've tried talking to her until I'm blue in the face, and nothing seems to work. Every time I talk about it with her, she just says she loves me so much and she thinks I'm going to leave her for somebody else. Please, help!

Desperate Girlfriend of Jealous Lover

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Dear Desperate Girlfriend:

The first thing to be aware of is that love and jealousy are not synonymous. Your girlfriend is mistaken when she equates the two as equal. This is not to say that she doesn't love you - based on your descriptions, the connection that the two of you share and the life you have created together is clearly real for both of you. However, her attempts to desperately clutch at you have their origins in something other than the experience of love. Based on what you say, they are more based on her experience of loss of love. Unfortunately, if she keeps this up, her behavior may, eventually, have the effect of driving you away, and create exactly the thing that she may most fear. (Please note: You haven't mentioned domestic violence, so I'm hoping that her jealous behavior is not accompanied by violence or physical aggression. If domestic violence is present in your relationship, I recommend that you immediately contact your nearest domestic violence hotline and ask for a list of resources in your area. They usually offer free counseling which I would recommend you take advantage of. They will also help you make a safety plan. Everything else I'm about to write is based on there being NO physical violence in your relationship!)

Many people in committed relationships report the occasional feeling of jealousy, and some jealousy is normal and understandable in any relationship. Usually, these jealous feelings have their origins in our insecurities, after all very few of us feel 100% confident about our appearance, our intelligence, our sexiness, our loveability or our value. Most people can tell that their experience of mistrust is not rooted in anything rational, and are able to figure out ways to soothe themselves, and calm these feelings down. The difference between most people and your girlfriend, however, is that she is unable to tell that her behavior is irrational. For people this jealous, they truly believe that there is something to distrust and I'm guessing that no matter what you say you cannot convince her otherwise. This kind of jealousy borders on obsessional and normal ways of coping do not generally apply.

Locked inside the jealous lover's jealous feelings and behavior is the source of the jealousy and distrust. You wrote, "She said that it was the first time in her life that she had ever felt safe, and that she felt drawn to me because of this" and you also told me that her father had left her and her mother when she was a child You also wrote that she had experienced several infidelities in her lifetime. Now here you are. Finally, somebody she can trust! Unfortunately, the specters of the past come back to haunt us. The very thing she craves, the stability of constant, responsive and reliable love and companionship, is the very thing she is unable to trust. This kind of obsessional jealousy is destructive, for it does not respond to reason or reassurance. Added to this, it's hard to remain long-term in a relationship with somebody who is very jealous - people frequently describe it feeling as if they live with a third person in the relationship, and that third person is a tyrant.

First of all, there are several excellent books you can read on the topic. Although they describe a complex human topic, they are easy to read. The first is "Overcoming Jealousy and Possessiveness" by Paul A. Hauck. The second one is "Overcoming Jealousy" by Dr. Windy Dryden. If money is tight, ask your local library to order them for you. I strongly recommend that you do this, particularly as you don't have access to health insurance or a shrink at present. (If you email me with your location, I can see if I can drum up some resources for you in your town or city.)

Secondly, you say talking to your girlfriend hasn't worked. If you think talking to her won't work, consider writing her a letter. You can hand this to her and ask her to read aloud to you. Some people who won't respond to talking, will respond to visual information. Either write or tell her that you are very upset about the way she treats you as a result of the jealousy and possessiveness that she feels. Explain carefully, using "I" statements, what you feel when she accuses you of being untrustworthy, including that you love her and feel scared by her behavior. Tell her that you are educating yourself about jealousy, what it is, why people feel it and how to respond and that you are going to change how you respond to her in future. Your girlfriend clearly needs a great deal of reassurance, so please - tell her often throughout this conversation that you love her very much and you are not leaving. You need her to understand that you cannot continue like this and that this dynamic in your relationship needs to change. Explain that you are going to start taking responsibility for how you feel about her accusations and you hope that she does the same in order to create more stability, happiness and calm in your relationship.

Thirdly, ask your girlfriend for a short list of things that help her feel calmer. Does it calm her down if you call when you're going to be late? How about having an idea of your schedule so that she can feel more confident about your whereabouts? Are there things that she would like to hear from you that would reassure her? Once you have the list be honest with her about the things that you can and can't do. For example, if she says, "I want you to call me every half hour to tell me where you are, and who you are with" you have to decide whether that feels reasonable to you. (Hint: It's not.) If it's not reasonable, decide what IS. Be clear with her. "I won't do that, however I will call you in the morning and afternoon to check in with you and tell you about my day and see how you are doing." Be clear about what you are capable of. If you are going to promise to do something, you have to be absolutely certain of your ability to follow through.

Fourthly, tell her that from now on you are no longer going to respond to her accusations of infidelity and dishonesty. Tell her that despite what jealousy may whisper in her ear, you are a faithful, trustworthy and loving partner. Say, "Because I know that I am not the person you accuse me of being, if you accuse me of cheating or lying in the future, I'm going to either hang up or leave the room because I love you and myself too much to respond." Dr. Paul Hauck says that another way of explaining this is to say, "I love you enough to want to stop you from becoming the sort of person I can't tolerate." Then do it. If she starts to whine because you didn't answer your cell phone when she called you 10 times, smile and tell her you love her, and leave the room. If she clamors at you for "proof" of where you were today, smile and tell her that you love her, and leave the room. You are going to have to start "taking your sails out of her wind." Just because she's blowing, doesn't mean you have to go sailing! You mention that you have talked to friends about this. Tell them about your strategy, and ask them if you can call them if the going gets tough. It's stressful living with a jealous partner, so figure out ways to de-stress, whether this is spending time with friends, taking the dogs for a long walk, cleaning the bathroom or taking a bath. Find ways to de-stress and calm yourself down.

And yes, you're right...I am going to suggest that you try to figure out a way to meet with a therapist. Many towns and cities have free or low-price (but not low quality) mental health clinics. So, please be aware that this response to you is no substitute for a few sessions with a good psychotherapist. The suggestions I have made, along with the books, are not going to solve the whole problem. Your girlfriend has to buy into the idea that her behavior is a problem in the relationship in order for her to begin the process of changing it.

Good luck and keep me posted on your progress.

Jassy

Therapy Dog (in the fur!)

2006-09-10T00:20:00.000-07:00

It appears that "Therapy Dog" has a small fan club, or so it would seem judging by the number of emails I've received asking for a photograph. So I here present, for your viewing pleasure, a photograph of Ziggy Stardust Timberlake, aka "Therapy Dog."

Who could resist that underbite?

I'm ba-a-ack!

2006-08-22T12:41:00.000-07:00

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

2006-08-15T20:46:00.000-07:00

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

2006-08-14T22:14:00.000-07:00

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

2006-08-09T16:32:00.000-07:00

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

2006-08-07T00:09:00.000-07:00

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

2006-08-03T23:15:00.000-07:00

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.

Thinking About Your Therapist

2006-07-31T12:35:00.000-07:00

I received this email today, and asked permission to post it with my response. I agreed to leave the email address off to protect the blog reader's identity.

The Question:

"I've been in therapy for 2 years, so it's kind of interesting to hear from "the other side of the couch!" I have a question. If it is inappropriate or illegal to answer it, that's okay. I don't want anyone to get into trouble. I think about my therapist a lot. (at least 2x an hour) Not in a sexual way, meaning in a friendship way, wishing she was more a part of my regular life. I think this is because I have so much trust in her. I am always thinking, "What would G say in this situation?". What if G was watching me?" Is this normal? If not, what should I do so that I don't ruminate as much."

My Response:

The feelings you are describing are very normal and are experienced by many people who embark on therapy. However, explaining the therapy relationship is a difficult task. How do you explain a relationship in which one person gets to know your innermost thoughts and feelings more so than nearly anybody else in your life, and yet you know little or nothing about them? How do you explain the process of walking in through the door, and sitting down for an hour and talking with somebody about whom you know nothing, and yet feeling as if you could trust them with nearly anything? There are very few places in our life where the times we spend with a person are totally and completely focused on what is happening in our individual lives, with the express purpose of helping us to solve our problems and make our lives go smoother. Therapy is one of them. For those people who had less than stellar parental relationships, the relationship that grows with a therapist can also be seen as an opportunity to “re-do” that original nurturing relationship over again, to master what was out of our control back then.

In order for your therapist to be able to help you, sometimes you have to feel complex and often uncomfortable feelings. Withholding information from your therapist is not going to help you deal with this discomfort – sometimes the only way out is through. In other words, be willing to tell your therapist things that you would not ordinarily tell another person. In this particular case, I would suggest taking the bull by the horns and sharing either your email, or telling your therapist what you are feeling. I understand any possible reluctance about doing so. There are many reasons to avoid experiencing uncomfortable feelings like embarrassment, fear of rejection, fear of feeling humiliated, exposed, vulnerable and even possibly hurt. Any therapist worth their salt will recognize the value in talking over your feelings with you, and using the avenue of your feelings towards them as a way of exploring your hopes and fears about intimacy in relationships, past, present and future. One point of building a strong, working alliance with a therapist is to have the opportunity for what are known as “corrective experiences.” Talking about this with your therapist should enable you to feel un-judged, accepted, respected and cared for. There’s even a name for what you are experiencing. It’s called “transference” and it’s arguably one of the most important parts of therapy. Transference is a little like entering a time machine. Feelings from the past, along with hopes and fears from the past are magically transported into the present day and attach themselves with longing to the therapist. I suggest taking the risk of telling her what’s really going on with you, and be willing to examine, with your therapist, the feelings that come up.

I’m a good believer in “talking about talking.” In other words, maybe the first conversation you have with your therapist about your feelings starts like this:

“There’s something I want to tell you, but I’m scared of the
feelings that I might have when I explain what I’ve been
feeling. I’m scared that you might laugh at me, or get
embarrassed and that will make it harder for me to talk. So
can we talk about those feelings first before I tell you what
I’ve been thinking about?”

I think you'll find that talking about your "ruminating" with your therapist will help the feelings to find their rightful place in your life.

Many thanks and good luck to the person who emailed me this question,
and I hope that this post helps.